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Permit CITY OF TI CARD MASTER PERMIT PERMIT #: MST2005 -00102 4 ;iiit. DEVELOPMENT SERVICES DATE ISSUED: 5/25/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA SR2_102 SITE ADDRESS: 12972 SW BLACK WALNUT ST ZONING: R - SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 102 JURISDICTION: TIG Project Description: New SF detached. BUILDING REISSUE: DM170 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1,570 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,620 sf GARAGE: 407 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5 VALUE: 310 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,190 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 0 RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < TOOK: BOIL/CMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1 GAS FURN > =TOOK: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5 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: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FCR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADOL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEWSECTION 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: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes DON MORISSETTE HOMES DON MORISSETTE COMMUNITIES LL and all other applicable laws. All work will be done in 4230 GALEWOOD ST 4230 GALEWOOD ST #100 accordance with approved plans. This permit will expire STE 100 LAKE OSWEGO, OR 97035 if work is not started within 180 days of issuance, or if the LAKE OSWEGO, OR 97035 work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules Phone: 503_387_753g Phone: 503 387 - 7538 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or TOTAL FEES: $ 10,625.67 Reg #: LIC 162512 direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 -332 -2344. REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 Engineered soils -�. (i� 2_ Issued By : ; ,. -) Permittee Si gnature Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application FOR OFFICE USE ONLY City of Tigard Fp:�� Date/By: 3 ' 0 A 6 Permit No.: 7 // 5 ;off / t) 1 - 13125 SW Hall Blvd., Tigard, OR 97223 p j IZ C E 0 • r F .. Plan Review Received Phone: 503.639.4171 Fax: 503.598.1960 l ` Ai , `t� Other Perm r. C . ' A l i � yP.'� I ( DateBy: .�W L -4)'005 _0o /05 Inspection Line: 503.639.4175 Date Ready /By: Jur' : l H See Attached Checklist for Internet: www.Ci.tigat'd.or.us I °' (�d a �i �R 2 20 Notified/Method: t � 1. t� i Supplemental Information s'Q a k-Q WV s) „ - -' {. i� : ^;:W "5,;:"x" v,K'�Y ti: %' „NFii:e `- ,' '�� :�sF'ira� �„ *.: fix.�;a "'..= , ;;5,, , -," �.U= •. #P __<.� -, ass . �;�k. r+r+k.++� - - , 4-k: "r`.;,. �.At. ' :v mss:, .s3, .e s� ttatt-r , ia�� '�i�'x -' `. .:;.:t ,'' " .sd, .:Y�r' ' rr,u' s,c�h. . Y ?i .''„ i nisi, «.;�t� ;1 - ., 4 , . , - r, , . -T0. P till `WO;Ri.� t• ,,. at' k �.. cdRE + U IItED�DATvi. 2 - F` \1VI .i a >� r °� � �"a, "' � .� ,��s �'r,§'z ' Q `r AND A IL DWELT;,�ING,�,, x � '� . �.., : x4�, ',s �: 3�S`' 4>;,: � BttfYtt � � ,_. �i��.a��.n `,+ m,° :�"m>c« �tU.;', K ?��a, : *s -t; =�;M l iras£ sd�"�,',;�:�"�#�i,��'�,°t'�r%`. ��R.w��k..:. ,� . �., .. � New construction V .� n ionnw Permit fees* are based on the value of the work performed. . Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the i,, - ..3` a.r,;t,;,N-S'*,tb':x' "t,,"'; �,-'1£ � to tt:'yg:Fcitt .'��r7,x.,:�"`'��4.iok. =sanjf ,,, ' ?(✓ §+ i work indicated =!- , �d A£ .6. ,CA OF kr TRUC , 's a f ,,,' 1 � i ated on this application. El 1 -and2- family dwelling ❑ Commercial /industrial Valuation: $ �JIJ`-1 t �(A�o ;C) ❑ Accessory building 111 Multi-family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: 0. s ..t,a ,',k ,a :,_� s y > ».vim: ;.s. ,.,, W. 3 ` „ -'t” -q n ' A rE �IN FORMAdTLON�' k L k " ' t ` i v Total number of floors: 0 ,, m x�aw�$`'���.n'�O 1� iw�.����tn�'�� .Z ,��^ _ `�� g Job site address: \ 1 a S1K\) r p- ) t t)\_ ' `ep' New dwelling area: `-"IC., O square feet City / State/ZIP:' ' TA 0 i (i � Garage /carport area: � square feet Suite/bldg. /apt. no.: _ {�"" Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet N 1,,') 0. tI _ IEE:# ; a =9' „,Si..,,.. „,_,„4,,v.„ „,. 'P ` to .,,, x fed . „4,t, .'ae�,; Fa * R EQUIRED l DDTA.” CONIMRCIALP;USE CHEGKLISTI :. , r a te. s woskvrw: ,xekwasemrN w sgm../f,s.. ,:sw.smo ,,,, - s ; Subdivision:0NN\t 1-1 CRAG Q _ Lot no.:, o q Permit fees* are based on the value of the work performed. Tax map /parcel no.: �/" Indicate the value (rounded to the nearest dollar) of all 0cz , •f. f 4, " ', pe , Z-,IA ,n y t , y„ Yu _ p vim{ _ x equipment, materials, labor, overhead, and the profit for the V* x `� 3 s cl it ia DECRIPrTIOl OF WOK 't '� � rc P ' '� `i work indicated on this application. _ vti:' 4h75 ✓�.t { `iS'±�.s+S.�` l ,,ar�,'*x u...,,<}i- +z� zti�..�.3uE•;� R �t�, „1 .,�a�:L�7�"��_� P Valuation: $ Existing building area: square feet New building area: square feet re;k. l �' -�,}. . �s, �:•.- '�? 34:Sv'�'$�U3s:€r,:c� - ;;4$k.'. �,ti�J + 3��n�x ,h u � :<{} �LZ yr:. `i^ti” -' N ' - .'X tgx"�2+= �;'�t; ., ° r {p� {?: Q? .�. t'i,imfrgaiite, ., i 'P.R®,, ,T. Y OWNE R.` t ., i ® ' rTEN�ANT� =° � , Number of stories: z Name: 11.,40r_t - , • I$' ES Type of construction: Address: 1 -0.w (14 oaD r' y �� �< (.( Occupancy groups: City /State /ZIP: L41 (J = J � . L7 q — 20 35 Existing: Phone: (a� -7:(?)--)- ✓ 5(.C✓ Fax: ( , 3) ..3 7 L i s h, •:. -' �:�;,,,,, :,x,;n;., - e,..:;;r:.�::,.tz n,_'. ,_; ,:.*' - New: Vix-r r, : .-•., .*q ' :Ytk r `� ria ';4, �„ ',kdk i za e E.< cx iis' .. .n,r, - y .rt ..,� y - � A APPLLGANT „`'� .;ar: ; ;. aF 'k:..,��:.���. �r�•>� ; �# ®� C®NT � T iP �, � - 5c. ' ,�: +� •�� �i�x �.: . ,. - - ..''1.4 :fir. ,,,,,, . t ". �fi ; , t,-:.0,'.!-,,,,41,,-.,, � . AC ERSO a re :.. .au'R.. ^+ � ' a�"e � � .T.3'"b �?3' t�', 4 . y ,�� � �* `ia t � � ~ " ..3" , � "+� �'Fz � j y � i�u� p " � ; :r ' i`k� .r,.an w �°Saru.ihN �E%x;xv, .. ' ",..6Y.Cfv�... . � i'' n,'. _ .. ,r ., „ : n az �x ;r:- N '.e . -- -- a ?s "tri i,,, >. f ' z,NO t �1 r t ' ;:;; ti?., i l , . t . Business name: d J' �/ e PKS f - 1a5Ve All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the. following reasons apply: Phone: ( ) Fax: : ( ) E-mail: ',:t. %z;-`4, ` P ,lZ l- lIi;'sfr"�:1_"n :ts.:i • Y: S'" {-a;� � ::. F. ti= E^'v;t�. I '° « a ' : n 0 ,. ` , ' , Halt , s1CONTRA � r y r, h'�la ° . - , . e : , v3, 4; r t ,,e t r ,,, ,Is „ ;a tX } aF'� ; t » ? 14- 13 Business name: & <eo /C .,.- ....., *„ �tti�r��CsQ; " =t"'cBiJILDIN PERIVLIT ` ,TEES *r' = ° ' `'4' Address: :,ti;kt,,,,,. , ,?�a"vw"'�rt��d?n ;44.mm W;; :,31,s ts`{ 4- -' ", .r `:-� ' : ..,t. Please refer to fee schedule. City /State /ZIP: Fees due upon application Phone: ( ) Fax: ( ) CCB lic.: 5 �- Amount received Date rece ived: Authorized signature: � _ f � / (,� V 171ga...4 Thi permit application expires if a permit is not obtained Print name: jJ Date: ct � within 180 days after it has been accepted as complete. 1 T2, K 1 ,D I O � * Fee methodology set by Tri -County Building Industry Service Board. is \Building \Permits \BUP- Permi(App.d 12/03 440- 4613T(11/02/COM /WEB) • \• u ECE V ED Plumbing Permit Application FOR OFFICE USE ONLY City of Tigard • MAN 4 ` 7005 Received y g Date/By: y: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 5�!3. 1.9RTIGARD � Date/By: Other Permit No.: 24- Hour Inspection Line: 503 1639.�IlI7G DIVISION r1'1 � ' .!J. Date Ready/By: y: Juris: .. Ei See Page 2 for Internet: www.ei.tigard.or.us Notified/Method: Supplemental Information ..�ur - " al' °t "4»s''srtaamc� F ;'�^:. ::,z:.' ras' - s• " z. - - a - : - z': y .`:>'.r� ..t� �" �; i .; '7 i•°» }: = • .t,',?�,.. :� , ±l?5 �`'�47 g:�' ` . s ' tS�.' v�:c - _ ,tx..rt., .."€.yap F � �';�-.���, €x�>o �evx.. a.�.ns ^�smiw..�.a," . �.ti�`��.r4r �;T':'is�, . r_ .s • ' w�;�; : .:'r , : t Fri, Y r : s :4.: T,YPE WO RKo., , gm b �:'r n �.,, . . `s� a , * a ''�' 1 ,. .M0_. ,.. , ' uw . '1,�• -= , :r=.- z1 , .m y kt ;- a s . °�,- `y .' "' _,FEE- SCHEDULE _.. v, s€ t `fit, t: - ,f. - ' - - -.... ,.��+7'`L, ..,$+. >i �...3. '?X e�4:= �x - ,a2 ,'..> � ' 41..- � �...�- �t " �� . - , , , rsa:�eu��r�+rwa�rs� rtsrn�; m + . ••f�`S : " �.�:� `�.t.� k. A I construction El Demolition For special information use checklist. 1 Description Qty. I Ea. I Total ❑ Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) .' , . � . g , : � .: .,�.�:�,s.sa�,�� :sa.v<c�ex�t�!ax�;�;e � � , a . :,:.,., ,';•. 4 :` " '' . .;i N:;'_AGntaiO lliCe ;ry ; al 5WIRTJCTIIO0 6 1 4 1N t ;°� #F ,>; t"` SFR a � -!''T; 'Y , ''" A ,1 ;:i , ?. t r :xM,.� : , .::;m,n,N,o,;,,.L. g o,,o pTJ:Jr ' « ,m _ g: :e ., , S (I) () bat 249.20 ❑ 1 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 1=1 Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: s:Y.r .., TM.,<, s =3 : s, a t. 3 mss, a x -. d., a, ;., •-; Fire sprinkler ( _ sq. ft.) Page 2 W:',i .: : 7 tee' , trC ° �„ {JOB -SITE INEORNI�ATIONNN ;AND J OCATiION'� ~ 4 > ," 5., . ''4.N - .....u, as -:,-A. ,.etaik :: 1;wv, . ,x: .4- s410,:,_..:a +rzt,: m- :r r_ti.,....w` ne 3 Site utilities Job site address: 1 '�d a '3 \,xc 1 \ ,„, T X ' ( Catch basin or area drain 16.60 City /State /ZIP: I 1 ; � r o 4 V Drywell, leach line, or trench drain 16.60 Suite /bldg. /apt. no.: U I Project name: Footing drain (no. linear ft.: ) Page 2 Cross street/directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision:IOW\ a Z,clq e- i Lot no.: 16a ' Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item e : >, r.. , �µ, a, ; K ,, .f :, w �,,. w , � i ry : ^e �t r Absorption valve 16.60 li e �x: NV = � . DES CRIP I igi * 61. 1 s` , . 4 4 . ,,, r.t ?:. Backflow preventer Page 2 Backwater valve 16.60 Clothes washer ' 16.60 Dishwasher 16.60 - a , ,,,, .•,,: , , 9 t s;: s,.a, w: , T, -: ,41r N . r , ,,,Np f, ;,_� a;; k t< •= Drinking fountain zr? l F x' g 16.60 to .;tf�.' ,VPROEERT.Y ,PEM i s i �T , T . It ANT , t . _s, € r smM'�,3w �r .., s e �,.. .icer x- Ejectors /sump 16.60 Name: ) 1 / Expansion tank 16.60 Address:•LL, ,. 'fjl :5\e--, I Fixture /sewer cap 16.60 • City /State /ZIP: -'4" (� -A , 04- T` Floor drain /floor sink/hub 16.60 Phone: j3) ?9 7 `7� - -- J Fax: (t)� .5�� (a( Garbage disposal 16.60 ..c!4, :» < .� , .. , :'' ( ; a ' .`dn' t:">I! r'4:a'.;s�i,:.as +. efo-{. ti. f.' a4: :2 +�"s�!"kLta't:4e4 u+" W° 7 "f' r � a • '= , t r '_ Hose bib 16.60 <K,� r� �APPL�CAIVT ���'� �l a �;. �`: � �' -. c -.;; 4`,,: I r a : =. "�P . ® @.ONT�ACT *.PERSON `i 441% ..... ." k ,at,,. ,ex3�a,tn 1- z;,. .<,.:.•,xa4: Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State/ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax: : ( ) Sink/basin /lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: -$ �? ; , f.: ,.$,' fz.X,:,�a a nkat .r q,.7e «,• a . Urinal 16.60 .. "'..- '..a S:. °�A� - y 1 'n �. CQIVtIt ... e .4.t.� -,A fr?a, ; >k ',,, +Ail,? ''�z , -- `�; ', RAC 'OR`.,, ., ,:..,' r.��.� ^�; _..,, >.r�;r,�: -.�... - �va�• =��M:�:�.�;7�` �sk:�:r:�'+�,,;�. ;x3`�_;�`'�;�� Water closet 16.60 _- Business name: ,, -w_,.. ? � � \ , b6( (,� Water heater 16.60 Address: 1 0 E! Lc `r `"J\ Other: City/State /ZIP:. --r/ x �, Subtotal / Minimum permit fee: $72.50 Phone: ;)2,) -- � [,1 3 Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: 1.0q3"7.4 .- 7 v�^s,tmbing Lic. no.: 27 f � Plan review (25% of permit fee) Authorized signature: t. State surcharge (8% of permit fee) TOTAL PERMIT FEE Print name: J pIW l I V e Date: 31,g11 Or: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. is \ Bu ilding \Permits \PLM -Pet mitApp.doe 12/03 440-461 6T( l 0 /02 /COM /WEB) Electrical Permit Ap :pl icatio'ri��� FOR OFFICE USE ONLY 4 u t�� . City of Tigard Received Date/By: Permit No.: 13125 SW Hall Blvd., Tigard, OR 9722344 2 ( 2�O5 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 t K4 , ,1, Date/By: Other Permit Inspection Line: 503.639.4175 �' Date Ready/By: Juris: E1 See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information r - , r ? "e'? (r ,'.Ari3:r 4 ;A,v -4'n : t' .u . �vt ole :;; �'; i ,:!? ^id 4. - r W-Mi -ill ,� � `tU m;� 4 4, - _ _ _ _ - - - • R « --t , ,, ' r , ,, I x ,._, s ' % : ; ' r . %.a ti`,' KL, re.;.� s H , cl, -, - :. a � ` � . ,. :;3 - ...� .TYP:E��OF .WORK . � ` . },_ ,� r,.�, � �.[�_ ;.� �� - -. �. ,..s.h:' ,s ._ _ . _ � , :•��? .s, c, t �" � . '� _,, ..�. °a��'x. � LA r' .. . � . . > k � ,e � .... , . _�, ��a�n �r "�:��.: �... , s ��..,,�..A,,. �„ ,...w �.F.t� r3 az 'A . - . `a a ' ax ', New construction LL � ❑ Addition /alteration /replacement Please check all that apply: TTT ❑Demolition 11 Other: EService over 225 amps, comm'l ['Hazardous location 7; s, ,Y _ $ts ,, „� O the r : a , r RU , �,. p , ,,,,, EService over 320 amps — rating ❑ Buildn over 10,000 sq. ft., ` ; F - .4 - :` iCA «TEG©RYWOFw cON TgC IONiN MF `� ` t �` .; � � ; , � Sl,k ��� � n�° �,_ of 1 -and 2- family dwellings 4 or more new residential El I- and 2- family dwelling [11 Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑ Other: ['Building over three stories ❑Feeders, 400 amps or more _ , , _, _ -, . ` pPIy Fy er: v} re t ❑Occupant load over 99 persons ❑Manufactured structures or ' : s ;a ,4 a JOB SITE „ INFORIyIAATION t ifiw 'PIO kvai . ? r ❑Egress /lighting plan RV park Job no.: Job site address: ` 1 \ ` 11 ,,1— u t ���� ❑Health -care facility ❑Other: 3 1 � 1 � � `-� �`w 1/ >nv Submit 2 sets of plans with any of the above. City /State /ZIP: ---t Ck_iii6 0 iP . The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project ATIMI E SCAEDUtiE ' r:< ; ct name: y; rb =c'::x, :;v Description Qty. Fee. I Total * Cross street /directions to job site: New residential single - or multi - family dwelling unit. includes attached garage. 1,000 sq. ft. or less 145.15 4 500 sq. Subdivision.���,,�� Lot no.: i '1 ft, or portion 33,40 1 S =��J \ V \ 1 12.‘.6 l d Ea, add � Limited energy, residential 75,00 2 Tax map /parcel no.: .', . r;s ;,,• k „tr:„ „fir.' ice =s;:x Limited energy, non- residential 75.00 2 /i i h litif ' ` 1 •...''`d DES '®�Fi,,.WORK r'� I T i ` , . • ..„ � „ .������ �;�, ,�.�r�,, - -„ Each manufactured or modular dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 ;"9 "' t,'v ��°°�= `�w' -�- - a ;�,�,�.�.�.,�r.,„, �"'? 3 ��. � �,;; �, E Z' "'"` ' 7 �' sn �i ^ e 201 amps to 400 amps 106.85 2 MAW d:. PROPERTtI'+t OW.NEiIt la KE ; W: ' TENANTS ) a s #t�r_y r s % r .. ,r . �; ��. 401 amps to 600 amps 160,60 2 Name: 111 ih' I ._4p 4�� 601 amps to 1,000 amps 240.60 2 « Over 1,000 am Address: ��.W •��� �, �� amps or volts 454.65 2 P Reconnect only 66,85 2 City /State /ZIP: L�, ,`� - U, q )0: Temporary services or feeders installation, alteration, and /or Phone: >7)) �� ' - Fax:S)3)? `7 — 7(01S relocation 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel u vy`y?':” ;11s " „� ^ ':.v1P.^� +.ZS:��., "3 �'.,£, . vet t$%1'�i.``= a£<�"k `x4'N ^sssY`Itaf. S?HV,:':A5.xr2 ;n(` y =ail t APPLICAiNT ' `' et a r `, , RSOrT l w A. Fee for branch circuits with Business name: branch circuit 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 Address: each branch circuit Each add'I branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2 E -mail: Sign or outline lighting 53.40 2 Signal circuit(s) or limited - _•F �; Asa �N s ,,Y t i$€ , kr C3ON'I::.*4,# R .,- a g • .. , tt •yt, en anel, alteration, or �� .�:: . fir*. t =.r'�,� � �� .� ,.tv,,.- ..- ..,E....��,,.,. �n��'��"•`.%�x -,.�:; ��� fir. �, gY P ti ” ��� extension. Describe: Page 2 2 Business name: (' Q,6 t Address: M60 SV A l/ !/ i f � t '---- .� 7 Each additional inspection over allowable in any of the above �{ LV 1 c Per inspection 62.50 City /State /ZIP: ' t] ` � 1 / � T?c 9 3 Investigation per hour (1 hr min) 62.50 Phone: (t5 L.14_1 I ' Fax: ( ) Industrial plant per hour 73.75 �L'' `` E')a; ° = . `^”" . '�'� EIiECTRICIAL gPER1VIIT F ; F''x : CCB Lie.: Ll Electrical Lic. � Suprv. Lie.: . .� Subtotal Suprv. Electrician signature, required: / Plan Plan review (25% of permit fee) Print name: �' hk(,C t/� // ,r•\ I Date: State surcharge (8% of permit fee) u � ' � TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board ** N o f in spections pe perm allowed i:\ Building \Permits \ELC- PermitApp.doc 12/03 440- 4615T(I0 /02 /COM/WEB Mechanical Permit A pR pli on FOR OFFICE USE ONLY • Cit y of Tigard MAR 2 4 2005 Received '' Date /By: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 an Review //N��tdlo� DateBy: Other Permit Inspection Line: 503.639.4175 CITY OF TIGARD a �, W Date Ready /By: Juris• ® See Page 2 for Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: Supplemental Information �,n,t ,�-; ;� man. _ ,.�:{� Y,s,. ,. _ a ,.�. va :xc �, i; �> ay.:- s,rc;a;.:•zma »•�ur����+t -�-... t� +s�:n:nzxer -�. ,-�..; ¢+?' %': -4- .qty, ;+4 :..�; 1 4 :1: � = , , , .' KeTBEb`°f`r. r . IE �, >w E., . - :a is r rrr,.,, „ : �,, «r. T P E OF WORK 7' s: `, ° �" . COMMERCIAL FEE , USE ' CH'EC I{L ' I , ,_ , -� _ 4 „ *� � :�,�'.'y. ,w . ,i''3r.4;' -.. rn.1k:u,rxLa s�runa:, ca�twn : +�`t�,�,��'t-�ia`a�'.2�r :c��s, ks'S_�.,,.re�_ et•�w�`s.;-.tias,nvrs , ae;:um:•_r�x=- r��E �uaui c s�n: 7n:. z��eaus ,::n,�...�. �a:.:a. �_ N ew construction ❑ Addition /alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. ;; " 4:,' , , '•tats> _4 tam. "3i rgiljrfr mac �- : """1;`lF Value: $ � a: '< .. .... . .., =: a u ', ' � 4_ �• 1iCAy T F ,GORY�OF,�?.GONSTRUCT�IONs`j�• �?�", p` t „a.� ..'+ +:•5- }. SY.- .i. .�qT.'� °GVa S`i�' }l' .., �i'�I' �i:�• ° 1? F` Y' �tt lu�i +°'T'.. i4.'F'•Pk: Cd. �i:i; yiV "Yi .. 3 •r a ❑ 1 - and 2- family dwelling ❑ Commercial /industrial RESIDENTI?ALVEQUIRMENTHSY9T =EMS FEES y ;" ❑Accessory building [11 Multi - family ❑ Master builder ❑ Other: For special information use checklist. Description Qty. Ea. I Total a yt '''''''4'r!' �* �,.. �, sx;:;.iu :v t, �. an »�ua«c.�.�,u,�«xr�,x ,�r'a..r�.::?..•nxx $ :.w $ s g rtcr�,:ar.:.z "fh's+.-3':''' r' ". "p`4`. 2 " "' : ; d JOB SITE' INFORIYIA ri fa L®CATI®Nr � ON t ati s ,',a." ,_:_" ' n} s2 -:_ E,.,- s,wiae, ..;,.,r,,: „. ,,?�?, e ..9ws,',I •:f':: .0d iR�rs ; Heating/cooling Job site address: kge.c.�Q >�c 1� , 1 o , ! c ., c l � � Air conditioning or heap pump ) J�x_M ' (requires site Ian showing placement) 14.00 City /State /ZIP: -��, / O Furnace 100,000 BTU (ducts /vents) 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Flue /vent for any of above 10.00 Subdivision: t i.-- T l Lot no.: 1�g JJ� Other: 10.00 Tax map /parcel no.: Other fuel appliances ::5!. '. 1 - y T'Ms ;,, :",Y+Y+'.c.', a! . f.' nv, ,ry„J .:; ( +tE + A { €q�•:AM1 y �iAY!� �. q ' + r'j1+ r`':% },v i r:s cr's r. a °a"`?£ °.f`m;"� Water heater i DES R, ,,, is , a, q ty 10.00 i, � �t��,.• v_ �a; axe,:�z,,�'��:�.:s�a;t:, C__ ^ ON. OF''WORK� � „it�ss� �"- p ' " t Gas fireplace 10.00 • Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood /pellet stove 10.00 Wood fireplace /insert 10.00 ' r' : g>'' ;. �, f' , . . . ,, * *,*..« ,- * *,,,- wa, 6.24 } r; :, .�; *wr, v Chimney /liner /flue /vent 10.00 DR- ER � l g:.x )tit - TENANT t 10.00 A, B . T _a�3: .�. �c X.v &5m+5 a ..rcwst.:..i .v�.a,'`5�i.^' a�..h�+'3i ()th Name: I i 11/\ O Environmental exhaust and ventilation Address: ✓l 'r Range hood /other kitchen Oa �/ � ap equipment 10.00 City /State/ZIP: '' 1 q )O - S Clothes dryer exhaust 10.00 . t Single -duct exhaust (bathrooms, Phone: -E'lJ� ' r � t Fax: ( 7 • - - 7 tot toilet compartments, utility rooms) 6.80 i s C, $:� ' s #. �.A..>��? .his' °.tmue ^'. : , ..a'y:i� • ?i #A l`i: ;f3a„, ,, f rr+ g r ;y' t`' 'e�m. ::s :.• ', "mot "t ararab: �;r�+ ' ,, , ;.- ®AP -,-.. T w ,• _ ', ; t' i Attic/crawlspace fans 10.00 �:,a +F:. ,. k . , s;;.,' . �,,< M�..�w�.��,� �,..� > ®:;CQN,�'TA T;PERS�ON����� P s Business name: Other: 10.00 Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State/ZIP: • Wall /suspended /unit heater Phone: ( ) Fax: : ( ) Water heater E-mail: Range ,,,; � . ,. - 's ' - ,CQNTRACTIOR, I, - . a: . 'a , . �_ ...;. °:: � ,. �, � : , ;: . zr. �: c w�: �;* � x�' E�j i<: �3; �ta�,+ ��' ��' �"T.- r' r � , `�,«. ' ,�C'. s;�4.: &3�'�,' Barbecue Business name: �7 r Clothes dryer (gas) / �� [ Jl r �i + Othef: Address: � L( .. ``k'Al Ii A1VIkAL PERiiifii EES "•ys" J ' .�` -� g w. ��(„, `�� ` :re.0,, k: 3;ec.4+ , ±tm-:.,,, .,,,. <' 44. ux„s."cr;..�:�. -- *s'4 : • '. ' `,,,C �-. +`:. C ity /State /Z IP: V e&- Y `V ` ` "t 70,5 Subtotal 3-,c,..:>.] Minimum permit fee ($72.50) Phone: `a. Fax: ( ) Platt review (25% of permit fee) CCB lie.: -) State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: +4 I ,aNce This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. PI'int ttan I Date:` ji U � * Fee methodology set by Tri- County Building Industry Service Board is \Building \Permits \MEC- PennilApp.doc I2/03 440 -4617T (11 /02 /COM /WEB) AA AA ' b AAAAAz AAAAAAAAAA A® AAAAA ,a.: AAAAAA ,1 AAAA A® AA , _ AAA® Iv . A A STREET EE CERTIFICATION ®• e L ig Lke._ , O wner /Agent for ,/,„,e.:-„,71,1, afr.„ s L ® (PLEAS P NT) (PERMIT HOLDER) ®: �I k y:. A / ,: ,,-., ,i.\ Do hereb ce fy haFt ta owing location A A401 -'115 � 'a•ti°;3: meets ArOaigli /W a� ount sz: �rsi.Fan3'me;; �r;,rt�': -:'za' ,�:'.w'er,•�a 0 . land use and development standards for street tree installation. , h;- ® • ADDRESS: 1 7 Z 54 ---/ -e1 - c�� ® LOT: /07_,■- SUBDIVISION: 54-, , / I ,.�.,c/ ,7'-- 0. 0. 0. ® BY: Gj DATE: v/ 5' - � _5 A 1 RECEIVED BY: DATE: 7 2/ • & S'�' A VYYYYVVvvv h Yv®Y .. YVY VY Y Y - y ° ' a CITY OF TIGARD . , BUILDING DIVISION PERMIT #: MST2005.00102 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/25/2005 Phone: (503) 639 -4171 . ��"a4m��ii �� Inspection Requests (24 Hrs.): (503) 639 -4175 = � � INSPECTION WORKSHEET FOR DATE: 99/71!2005 TIME: 7 :03AM PAGE: 30 SITE ADDRESS: 12972 SW BLACK WALNUT ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 102 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE NO. 2 DESCRIPTION: New SF detached. OWNER: DON MORISSETTE HOMES, PHONE #: 503. 3874538 CONTRACTOR: DON MORISSEI IE COMMUNITIES LW PHONE #: 503 - 387 -7538 Inspection Request Scheduled For: Date: 9/21/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 016255 -02 503 - 209.4837 N Corrections /Comments/ Instructions: 6 �� 0 Gn2P.-l7E- ° TMo n! S Vb PASS ITPARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS 1 I FAIL ' :LL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector ■_ Date: ,'"Z/OS e''- Phone #: (503) 718- lb CITY OF TIGARD - BUILDING DIVISION PERMIT #: MST200 &00102 13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 5/25/2005 Phone: (503) 639 -4171 aatlPli,lij Inspection Requests (24 Hrs.): (503) 639 -4175 111. INSPECTION WORKSHEET FOR DATE: 9/1612005 TIME: 7 PAGE: 4 SITE ADDRESS: 12972 SW BLACK WALNUT ST . CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 102 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE NO. 2 DESCRIPTION: New SF detached. OWNER: DON MORI SSETTE HOMES, PHONE #: 503...387.7538 CONTRACTOR: DON MORISSE, I E COMMUNITIES LLC PHONE #: 503..387 -7538 Inspection Request Scheduled For: Date: 9/16/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 015935 -01 503 - 209 -4837 N Corrections /Comments/ Instructions: I PASS n PARTIAL APPROVAL n CANCEL n NO ACCESS n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: VW V J Date: I J D Phone #: (503) 718- C OF TIGARD BUILDING DIVISION 0 00 PERMIT #: MST2005.00102 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/25/2005 Phone: (503) 639 -4171 ' �� 4 ju��iigl� iii Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/14/2005 TIME: 7 :11AM PAGE: 17 SITE ADDRESS: 12972 SW BLACK WALNUT ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 102 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE NO. 2 DESCRIPTION: New SF detached. OWNER: DON MORISSETTE HOMES, PHONE #: 603 -307 -7530 CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503 -387 -7538 Inspection Request Scheduled For: Date: 7/14 /2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage 011418 -16 503 - 519 -6462 N Corrections /Comments /Instructions: $PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL r CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED / Inspector: • ice' '' Date: / 6 Phone #: (503) 718 - 2-9IL r tit Y OF TIGARD 1NCa ®IVISION Mr PERMIT #: MST2005"00102 13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 5/25/2005 Phone: (503) 639 -4171 hze wtill Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9/19/7005 TIME: 7:06AM PAGE: 3 ---\ SITE ADDRESS: 12972 SW BLACK WALNUT ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDG NO 2 LOT #: 102 TYPE OF USE: ROJECT NAME: SUMMIT RIDGE NO. 2 ' ESCRIPTION: New SF detached. OWNER: DON MORISSETFE HOMES. PHONE #: 503 - 387 -7538 CONTRACTOR: DON MORISSE, IE CO'MMUNITIES LLC PHONE #: 503-387.7538 Inspection Request Scheduled For:v Date: 9/19/2005 Pour Time: Code'# Inspection Description Confirm # Contact # Message 199 Electrical final 016047 -01 503-209-4837 N Corrections /Comments/ Instructions: y PASS n PARTIAL APPROVAL n CANCEL NO ACCESS 1 I FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED i 9-' Q Inspector: 4, �_ �� _, .ri. - Date: —J ? 5 Phone #: (503) 718-