Permit CITY OF TIGARD MASTER PERMIT
Ali
PERMIT #: MST2003 -00118
�' DEVELOPMENT SERVICES DATE ISSUED: 4/15/03
,.� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13555 SW 124TH AVE PARCEL: 2S103CC - 05500
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 002 JURISDICTION: TIG
REMARKS: Const. new SF detached residence.
BUILDING
REISSUE: DM199 -2 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,680 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,850 sf GARAGE: 620 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 344,641.00
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,530 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 1 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 1 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 7 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL • RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,903.32
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 all other Municipal a w
la , State work k w Specialty Codes and
all other applicable laws. All work will be done i
STE 100 LAKE OSWEGO, OR 97035 t
accordance with approved plans. This permit will expire if
LAKE OSWEGO, OR 97035
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
Q 3 � g forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: t1 3873755533 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 84 Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insl Rain drain Insp Mechanical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Water Line lnsp Plumb Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line lnsp Water Service lnsp Building Final
Founda • Insp' PLM /Underfloor Framing Insp Gas Fireplace Appr /Sdwlk ' Insp
Issued By : 32 1 1F t-f� ✓L12 /1�1 �� %�C /" Permittee Signature : �C1 G )2
itt--flrq
Call (503) 39 -4175 by 7:00 p.m. for an inspection needed the next business day
Electrical Permit Application Received FOR OFFICE USE ONLY
R EC E I V Date/By: 4 3 3 Permit No.: � ,-� //g
Cit of Ti and Planning Approval Sign
y g Date/By: Permit No.:
13125 SW Hall Blvd. M A Y 2 Plan Review Other
Tigard, Oregon 97223 3 003 Date/By: Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -5 Post- Review Land Use
l I I r V F T /h � "��' i ° ",II? ' Date/By: Case No.:
w
Internet: ww.ci.tigard.or.us " , h,N _[_t t 4 . • I Contact Juris.: ® See Page 2 for
24 -hour Inspects R: Iciest: 503-63T-4 / Na e/Method: Supplemental Information.
j - C r -
YPE OF \; ORK ` ) PLAN REVIEW (Please check all that apply)
n. New construction ❑ emo1itlon ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition /alteration/replacement ❑Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
IE Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
_ JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
� � `�� The above are not applicable to temporary construction service.
Job site address: w , 2 y A L FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: 1-16k/5507'E"
-fill i3 Description Qty Fee (ea.) Total
New residential - single or multi - family per
Cross street/Directions to job site: • "n ,.�_ dwelling unit. Includes attached garage.
�, I Z l s ' r Service included:
GNG (4)41-041U 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: L Jh S T/ Ltd/)/ K Lot #: Limited energy, non residential �— 75.00 F 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK � ''
service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPER'X OWNER AHD 'ENANT 3 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: £ -5 - . Reconnect only 66.85 2 ,
Address: _ - - -- - • __ _ " &') _ �w Temporary services or feeders - installation,
City /State /Zip: %/irrkf c 5WLZ ag, /, 35 alteratp n rless ocation 66.85 1 200 to
400 103. 2
Phone: "St 3;7 Fax: - 3 -7 ' /G 20 40 1 1 a to ps to40 amps s 100.30 30 2
❑ °APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: 2:772.: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: fi �� L� : Description:
Address: /� 6 6 0C 59t%'
Each additional inspection over the allowable in any of the above:
City /State /Zi : A- 1-2407 Per inspection per hour (min. 1 hour) 62.50
Phone: 5 - 352,- 3 2 ( Fax: 563— 25 % 233/ Investigation fee:
CCB Lic. #: other
(;3 2 2 2 Lic. #: 3 t� ° Sfg3 Electrical Permit - Fees*
Supervising electrician ✓ Subtotal $
signature required: (7 r 0 Plan Review (25% of Permit Fee) $
Print Name: L,t,¢ie y Ye ; ; A , Lic. . ill (97 State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
El Audio and Stereo Systems
n Burglar Alarm
Garage Door Opener
D Heating, Ventilation and Air Conditioning System
El Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls
n Clock Systems
0 Data Telecommunication Installation
Fire Alarm Installation
n HVAC
n Instrumentation
Ell Intercom and Paging Systems
n Landscape Irrigation Control
Medical
Nurse Calls
LI Outdoor Landscape Lighting
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i: \Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
`o Il `j7-03 3 /coo
ding Permit Application
Date received,? - Permit no.: V ,v, ,w/ / r
Ai^ *� 1j City of Tigard
' - Project/appl. no.: Expire date:
City of Ti and Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment Y type:
Land use approval: 1&2 family: Simple Complex: 0
TYPE OF PERMIT d
❑ 1 & 2 family dwelling or accessory ❑ Cornmercial/industrial ❑ Multi- family ,'New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Ifk
Job address: I cc"? .-s-5 '( I. - , Bldg. no.: Suite no.:
Lot: tom` Block: Subdivision:a- , T1 L Tax map /tax lot/account no.:
Project name:
it
Description and location of work on premises/special conditions:
OWNER , '." - 1012. SPEC'Xt, lIftlFAIMATION, i SE CHECKLIST
Name: i► '_� a l (l loudplaill septic capacit%,solar,etc.)
Mailing address: j era ' icrai3o " MO 1 & 2 family dwelling:
City: Ettn'A ZIP: liiirA" Valuation of work $
Ar
Phone:. rt i , -mail: No. of bedrooms/baths Air
Owner's representative: s ' j i co- brj LYE Total number of floors (` r
Phone: Fax: E -mail: New dwelling area (sq. ft.) WO v
APPLICANT Garage/carport area (sq. ft.) 4 Ay or
Name: MUM „ gri gta � Covered porch area (sq. ft.)
Mailing address: , pele_„, III Deck area (sq. ft.)
City: 4 I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi - family:
CONTRACTOR Valuation of work $ �,
Existing bldg. area (sq. ft.) (lb
Business name: _ �� � ( /] � New bldg. area (sq. ft.)
Address: .A.vrtL W1.077■SiIIIIIIIIIIIMINI
City: State: ZIP: Number of stories
Phone: I Fax: I E -mail:
Type of construction
CCB no.: .j 5 b-.7-5 Occupancy group(s): Existing:
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: (-/et, (,� lt.l.Y ��� C • /TM, • provisions of ORS 701 and may be required to be licensed in the
Address: �>� OL,kri t� jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: 'State: ZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A r rovisions of 1 ws and o dinances governing this ❑ visa ❑ MasterCard
work will be compli - r wi ■I , whether ified kerei t. Credit cam number: / /
Expires
Authorized si _ atu • = q 1 (1 e: Name of cardholder as shown on credit card
$
Print name: •i _S t l _yy
F-- Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6r00/COM)
One- and Two - Family Dwelling
44Iht .,,, Building Permit Application Checklist Reference no.:
City of Tigard Cl of Tigard Associated permits:
J 0 Electrical ❑ Plumbing O Mechanic .
Address: 13125 SW Hall Blvd, Tigard, OR 97223 LI Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. V
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 4
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval. )(
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of ,/
catch -basin protection, etc. J�
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed t/
if copyright violations exist. J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2-ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot x
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. X
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable. J�
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
•
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation. !X\
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28 •
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440.4614 (6/00/COM)
Mechanical Permit Application
..�. Date received: Permit no.:
' City of Tigard ^: ty g 1'roject/appi. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: i Receipt no..
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial O Multi - family 0 Tenant improvement •
,Iew construction ❑ Addition/alteration/replacement ❑ Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 1 20c,-...---- 3 1,._.. `'.+l" 41 A . Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
$ l
Value aue
Tax map/tax lot/account no.: profit. '
Lot: c a- 'Block: (Subdivision: \AAA) , - t 'See checklist for important application information and
Project name: \A".� jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCI ®ULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: r handling
Is existing space heated or conditioned? Air conditioning 0 Yes O No A unit CFM P onditioning (site plan required)
Is existing space insulated? ❑ Yes O No Alteration of existing HVAC system
MECHAN CON.FRAC1OR Boiler /compressors
State boiler permit no.:
Business name: M � � C 4 ,,,I c _ . HP Tons BTU/H
Address: i Fire/smoke dampers/duct smoke detectors
City: \f t y\ State 7v al ZIP: 'R ! s Heatpump(siteplan required)
Phone:,,,A _ Fax: E -mail: Install/replacefurnace/burner BTU /H
Z y � Including ductwork/vent liner O Yes 0 No
CCB no.: '� 7r9' 3(' ) Install/replace/relocate heaters - suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): ' I P EL-c-- p ' (` . Vent for appliance other than furnace r--,
CONTACT PERSON Absorption Absorption units BTU/H
Name: IIP f "- C�` ELL- Chillers HP ,
Address: ,,, ,.� Compressors HP
v•"-e, GlA � _ _1 w C Environmental exhaust and ventilation:
City: [State: I ZIP: Appliance vent
Phone: Fax: E - mail: Dryer exhaust _
OWNER Hoods, Type U 11/res. kitchen/hazmat
hood fire suppression system
Name: 1 n �l Exhaust fan with single duct (bath fans)
Mailing address: Ir grap ill igiralgal rigWillisMillEIT. j,7 Exhaust system apart from heating or AC
City: . , State ' ZIPq 4 ) ?, 5 Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone:. t 7 - jI Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: Fax: E -mail: Woodstove/pelletstove
g .,,, gismrr� air
Other
Applicant's si na[u Date:
Name (print): 1.6 y f 1Y ;, e_ / f
Na all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Not Th permit application Minimum fee $
❑ Visa 0 MasterCard expires if a permit is not obtained
Credit card number: E
Expires w i t hin 180 days after it has been Plan review (at _ %) $
x •
p State surcharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440-4617 (61001COM)
,
Plumbing Permit Application
Date received: Permit no.:
{'lyi City of Tigard -
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City ofTigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ I & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
■: ew construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other.
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: i � 1N 19" • Description Qty. Fee (en.) Total
New 1- and 2- family dwellings only:
Bldg. no.: I Suite no.: (includes 100 ft. foreachutility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: [Block: I Subdivision: � �''�'� SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
PLU \IllI CONTRACl°R Manufactured home utilities
Business name: 191 Lu f" Manholes
Address: �� • Rain drain connector
Ci �' • • • State ZIP: Sanitary sewer (no. lin. ft.)
ty i� • —
Storm sewer (no. lin. ft)
Phone: y -- I Fax: E-mail: .� Water service (no. lin. ft.)
CCB no.: 1 L 7 +" LI —] — Plumb. bus. reg. no: - Fixture or item:
City/metro lie. no.: N/A Absorption valve
Contractor's representative signature � )(.> _ Back Clow preventer
Print name: 1n� • i - ' A , Backwater valve ` ,
CONTACT PERSON Basins/lavatory
Clothes washer —
Name: f\1/4--- 1 Dishwasher ,
Address: , ' , • • c Ni — Drinking fountain(s)
City: State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
0 12_4 _ 1 Floor drains/floor sinks/hub
(print): j Alt Garbage disposal
ome —
Mailing address: _ • " • �,► 11 • Hose bibb
City: ") , �>�g0125ENIZZAI Ice maker
Phone: :752)7 - I Fax: 7 , E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) _
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGIN Eli R Tubs/shower /shower pan ,
Urinal
Name: Water closet
Address: Water heater
City: State: I ZIP: Other.
Phone: Fax: E -mail: Total
Jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Not all
i P i N otice: This permit application Plan review (at %) $
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number. / 1 within 180 days after it has been State surcharge (8 %) .... $ �
Expires TOTAL $ —_____.--
accepted as complete.
Name of cardholder as shown on credit card
S
Cardholder signature Amount 44o -4616 (6 000M)
ElectricalPermit Application
Date received: Permit no.: •
r ,y; * ali i City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial Cl Multi- family 0 Tenant improvement
►' New construction ❑ Addition/alteration/replacement Cl Other. 0 Partial
JOB SITE INFORMATION •
Job address: i L A MA Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: ' , A '
- Project name: I Description and location of work on premises:
Estimated date of completion/inspection: .
CON I RAC"I OR . \PPI.ICATION FEE SCHEDULE
Job no: ' Fte Max
Business name: CA--) CV -\ _ Description Qty. (ea) Total no. Insp
_ New residential - single or multi- family per
Address: i `/ • . l t!t`ttt: • . � - dwelling unit. Includes attached garage.
City: T L P (� State: ° ZIP: ct "2 , Service included:
Phone:L44.3 - j Fax Fax: E -mail: 1000 sq. ft. or less 4
� � � G Each additional 500 sq. ft. or portion thereof
CCB no.: /-1 _ Elec. bus. lic. no: Limited energy, residential 2
— C: �� Limited energy, manufactured home or non-residential 2
Each manufactured home or modular dwelling
nature of supervising electrician (required) D ate Service and/or f ee d er 2
L ic ense no: Services or feeders- installation,
Sup. elect name (print): 1 �� alteration or relocation:
200 amps or less 2
201 amps to 400 amps 2
Name (print): A ID- • tltaltal .u/>• 401 amps to 600 amps 2
��Cji1:Ri k 4A
Mailing address: ` ; S 601 amps to 1000 amps 2
City: c 0 t State 1,0 ZIP: ?Q Over 1000 amps or volts 2
Phone:? ----; J Fax: ]— J�j(5E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: Ema Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
irrigation circle 2
i
i
Each pump or rrga
O Service over 225 amps-commercial 0 Health-care facility Eac 2
O Service over 320 amps rating of 1 &2 ❑ Hazardous location Each sign or outline lighting
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel.
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any oldie above:
O Egress/lightingplan 0 Other. Per inspection I I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for mote information. Notice: This permit application $
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at %)
Credit card number. / I within 180 days after it has been State surcharge (8%) .... $
, Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (600/COM)
I
I
A !
A ■
A •
• •
E TIFICATION
T R STREET EEC R
• •
• •
• I, /3LAt //A-r , Ow ner /Agent for D Mayzi ssc ,i t // on.� - 5 j
J (PLEASE PRINT) (PERMIT HOLDER) •
•
•
• •
• •
•
•
• •
• Do hereby certify that the following location ■
A meets City of Tigard /Washington County •
• •
A land use and development standards for street tree installation.
• ■
1 ■ •
■
• ADDRESS: J 3cc S S... / ? V � /4'' ■
• ■
• � "� ■
• LOT: Z SUBDIVISION: �/t/ lS7L S' C iJ -t /�- ■
• ■
• ■
• • BY: DATE: 7- Z Z -- ! ■
• i. - 1 �7 ( d 7 RECEIVED BY: DATE: 7 ' ►
A
/ VTVVVTVVTTTTTTVVVVVVTTTTVTTVVVVYVTTTTTTTTTTTTTTTTTTTTTTVV
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 -6-6 / / v
INSPECTION DIVISION Business Line: „(503) 639 -4171
• BUP
Received Date Requested 7 - a 3 AM PM BUP
Location - ) (ti-e-- Suite MEC
Contact Person Ph ( ) - X PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
S RT FAIL
P ING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains 4111K Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE [] Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA 2 ((� Ins P ector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
EUILDING Inspection Line: i v 6 -4175 1111 3 091
INSPECTION DIVISION Business Line: +- -4171 MST
BUP
Received Date Requested J2 � AM PM BUP
Location ( 35 SS 1 , Suite MEC
Contact Person V-(1.4 Ph ( ) — (a3-7 37 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear { )
L/I u S L1
Framing ��', / `? f�, / V V � r
Insulation l ,(CA' � � t�� /tit, /6 -
Drywall Nailing �l
Firewall (� w�-6�� �✓��` �� 40/0/63
3 U C
Fire Sprinkler
Fire Alarm 7 Nero G ��/ Susp'd Ceiling
Roof 3 , • —
Other:
•ASS PART
PLUMBING ^ Zd a 3- 0 0i y
Post & Beam
Under Slab �') C_.fw
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Si oke Dampers
ASS PART FAIL
EL CTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line \�w
ADA Approach/Sidewalk Date V 3 Inspector - `' ` Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 6 O 1 /J)
INSPECTION DIVISION Business Line: (503) 639 -4171
'] BUP
Received Date Requested c M PM BUP
Location 1 6 — eC /a JJ- Suite MEC
Contact Person Ph ( ) `1 v q £ 37 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall K6 --(_ . i
Fire Sprinkler �/
Fire Alarm 1- L
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
/Or' PART FAIL
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE EI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 -66 1 /9
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received / Date Requested ` ,� AM PM BUP
G
Location 3 55 g / A gam Suite MEC
Contact Person 6/04&_/ Ph ( ) 0 .16q - W 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: L SIT
Post & Beam / h/C1/ SEC v/2// / .
Shear Anchors / /
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof 404
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line Smoke Dampers c�`��� `� C � 1�1
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In 2' 1,<.,t7 y/d $/
u9/s
EL / O 3 -� 0 /4/6'
Volta
it -� rm
� '1 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
"SITk 0 Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA ��
Approach/Sidewalk Date ` 2 — ��� Inspector 4"- -- _ \ Ext
Other:
Final DO NOT REMOVE this inspection record from th ob site.
PASS PART FAIL