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Permit A A‘ CIT�( OF TIGARD MASTER PERMIT PERMIT #: MST2005 -00126 tilifl DEVELOPMENT SERVICES DATE ISSUED: 6/10/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA SR2_104 SITE ADDRESS: 12999 SW BLACK WALNUT ST ZONING: R -7 SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 104 JURISDICTION: TIG Project Description: New SF. BUILDING REISSUE: DM186 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 28 FIRST: 1,586 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,889 sf GARAGE: 638 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRD. sf RIGHT: 5 VALUE: 338,884.20 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,475 sf REAR: 15 • PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 5 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 < 100K: BOIUCMP < 3HP: VENT FANS: 5 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 FOR: PUMP /IRRIGATION: PER INSPECTION: EAADD'L 500SF: 7 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: 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: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes DON MORISSETTE COMMUNITIES DON MORISSETTE COMMUNITIES LL and all other applicable laws. All work will be done in 4230 GALEWOOD ST. STE 100 4230 GALEWOOD ST #100 accordance with approved plans. This permit will expire LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 if 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 Phone: 503_387_7538 Phone: 503 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 Reg #: LIC 162512 direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 10,851.05 1 - 800 - 332 - 2344. REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 Issued By : }t /L.-O £ c �% Permittee Signature : 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. Bui$ding'PermitmApplic ' , -- FOR OFFICE USE O -- - City of Tigard Received Date �-o yy (I,� Date/ By: . ll h_ 0 Permit No.: pe c) . o t„ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie eeY�ff!/ Phone: 503.639.4171 Fax: 503.5 60 arn /Nlip � ,rte Date/By: `G O ther Perini( K 0 8 2005 e 1 y: T s S '. ,li 00 5 — ovr aq Inspection Line: 503.639.4175 . li„ Date Ready /By: .s � / 1 �! kris. ® See Attached Checklist for Internet: www.ci.tigard.or.us Notified/MethodJ ,.L ps yc� Supplemental Information CITY OF TIG RD CY`•� / , �"es.s: �x,'73,G - •- ; ti,+:: :; is :;�^`�+ "it- `i4 13:t ° 2 % :w"k .. t*i5'k'xM Z�.i ;. Y €. _ *e �y ,:3 " °.ee :iTr;�Y` A "rig.- t,'.rfi:15�rix ;x..,.: - ^ .SS�':Li.- a ± tu�sa : . " vi.t ?; 4;i':q;.`- a...,_°. ` ::: �.V -?= «� :4 :. + y' .,a :, '.i•M . a:{f` - : 4 i ^a $ , 't .r f ll K f �4. ''h'. - `t. ' " , ' , i'° - , E' rig *VO494; ' .. ..; ., ' ;;a . & EQUII2 ' - . ' .a1- AND >ZrFAMILY /DW. K .:. =xc�•��., . ?.` ��i- �� h�%,• ���, �@ ��s4: ��� � ��r�� 3.`�b,�k �r::r�a r�,s;� �. X New construction ❑ Demolition 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 •x,. ,. _m :.•` 4z `t °'arrez°"a = �.';, , <tr;,t.gok ' r, xo;`t work indicated on this application. ;- -', ri,4 :: ,.,, ,- ,..,Vgy e ATE ORY�AOF CONSTR C ` '" ." . A Igtal Valuation: ❑ 1- and 2- family dwelling ❑ Commercial /industrial $ i I oa .6 ❑ Accessory building ❑ Multi - family Number of bedrooms: q ❑ Master builder El Number of bathrooms: ;. 'fit. - s- r e sf;Yc `, �+ ; " » r= sc.A:y :�-sr L ' n.. ° ..n >"r�, • .I. ' MT Total number of floors: n d' 7t_.,•.. , : OB m „E 'IlV OIiM ailt �. AN. D1! O iIO , ; Y � , X0 Job site address: \ { ` l�� •�1,C,k- ,,,.)„),,,,-,\_ - re i. f A. New dwelling area: � 3 square feet City /State /ZIP:'llt y ,iG i v ti Garage /carport area: L j square feet Suite/bldg. /apt. no.: ,,ff �_ Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet li �> 4:`. la��§ 6" �4r7 t': TS '"s `- 'f;i;','«; -• t; �'x°c�> fm;t°�� +s�„;°,°�X.*ti`{rtsH'£tR1.fi «tz REQ fira TfA:iCOA"4 1CI AL='US GHECIWI,SVIR 100 :�•F ,sast:m,,tfi� ? F.iA :.7, =:t, ;,W ;•n*.:.ib;r x ` 6 42,4 >z:: • 5txx° r a 4 Subdivision i 1 ‘k- 1C\gQ 1\W, Lot no.: 10t--t Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the R °; :> ,,, :t ;fit ,, , . ; ., v: s H su rsz , a rs , .< K i � . 1, s 17 ' >.., a Adc }w .«3 4 r,* 'fi t x ,..•. k �. yy ``�' �' ` u l "j' t ai DESC .OF_AW®RK � s s work indicated on this application. a .r. >[ ? �� , a£ , .5�; a�, .. -�:a_ �"t.,,.,.>a€;- >rn;�; mss* ,>,�= ,i�l�wr,��„ t �?'h�.+•. �,t�;�"n ., 'h`�1t� ���e� >,', r, Valuation: $ Existing building area: square feet New building area: square feet r••-.' • - au�us: ilt± : °c ;:'� ` " ("� t «� '�"�v. `ry , ± rv� , ; v -e,'x 7 k ,,; " '•�9r� `' aER RT ,' ®WN K- -i l 4 ' P �, i 'T "' ` x " v Number of stories: ` x '' � _ ,.; : a is .r,.:�`. , s S-�.Itt .,, :t. t t «. ,. 4'1,. `sY4��. :a=�..�,x� r, *mt�� -rte �:?1*;.<. °k�h.k�� � "�` t� �, .;.m ; �:i, Name: It( i S C / r co ' i-1 # n e Type of construction: Address: i t ta. v l a �l IX Occupancy groups: City /State/ZIP: Li (�� J q 7 3 5 Existing: Phone: ) 4 7 . ) - 7 y - 7551) Fax: ( ) 7 -- °2 Ce / 5 New: ;� �4; � �.it ` - `�c^i , z � �stti • .. k: � v ta i T�i�""e�y"4'f dye . :�l�k •�h�? , ,. ,, �y; , �a�e4�3,�:�,r>�:k;��` e: nC •. n�- ;s ,>,, ..-o:: ;g•-` , �4s t'� a r`k. 'tkw g - `: : 4 'L ` '?' c I s 'y . " ° � i " ° 4 9.. , : �. ��,`$"� � t ��,,, � ,�s� � °��-, . ® �QNT;ACT +PERSUN� ., � � �� t, a a �'�w` >� `�,�. �, ' ; ��. aq�,,,,•. o �« aa ," .._ _v�t, y ��� ( . � ti � E .ara�.� t s � frt user t', r :` "tt - -; e � IYDa�>ICE �s, : .azt.n...,,.ta��> l''\"\-1,e, � r���L�iI.I V t i:� l�''�.... �5.� ��,.� , sto-r`c � .�i.:,lt_vcr..; �S� °.F .;,a�.��,-�.::,,:' Business name: 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: y ': : ✓Y ;T.:1 .. ,^7; :e m:; 'zzs t � `.;.r.` a `:,,., t �. <r, n � � � .ra k= �� Y R as ,, k 7 r..i •� ,� 4,- ,t L CONTR?:CTOR, f fat , ,. � sin t. ,ti ;, s +w u�e �: ��' �;.," t�r��o`<. h ;�••:a�'.= :,r.ct``'m� ?r. . A�a<^ xsi; �'. astl. s ��a :�f -rtc 'a„ 'r'�M��`.. '"x`,'�a�x�.,_ Business name: •lam. Nave L c : �,r,r�;.a ',r;::.t:a- ° °-.,r..,,:.,.. , ..,,, �,-, r.... ,, „ ,,,,,t._ ,.;; +, BUILDING; PERIVIII „FEES Address: :i,: �.t�s.� - , :,:.:a,r�r�.�.�,:F,;, �.� ..., ,- a�,r =eE:.r3;� ,�: , �` "� :` ('�• Please refer to fee schedule. City /State /ZIP: Fees due upon application Phone: ( ) Fax: ( ) CCB lic.: 352 Amount received Date received: Authorized signature: \ j 17/ J j� This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: i { i i ) Date: — /510 * Fee methodology set by Tri- County Building Industry 11 Service Board. 1: \Building \Pei mils \Bt1P- PermitApp -dor. 12/03 440- 4613T( I I /02 /COM /WEB) Plumbing Permit , l'j lL 1<O•n � FOR OFFICE USE ONLY City of Tigard E ie 1312SW Hag Bl Tigard, OR 9722 PR 0 8 2005 D / Pernut No 7 -• o; J s w jjj Phone: 503.639.4171 Fax: 503.598.1960 4nn1 �t + Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639 4,1Z. •f 1 1 1 . C1 Y OF T1GA 4- Date Ready /By: dare 0 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method T � ^At Supplemental Information .5" � = ��r - 'i,n2' ."`;':' ,65; ;n x }.: ;, °ti's, ei,r. : ,, ,, v g„ � °' 5 T'. :7. ', } ., , c q tea' +,�^uizw, : a1.3. , 047:;, 3":t; ". €,,A. : ` , Si t4 nn `yt` S ,. , p t .4-14P r 4 ,��$.�G ; a"2 4 ' Y F 1 '�. ,W a *rY= C ^tgi W- '?v.' - •�: . - .! a T t - ',..T-4..,,,' ' . 3 a v ` , a f u ., : Z S A F z ? >.sT t N , ' . w�' �, i " 94, � .A S - t -, .. ,, 4, w . ?�, ..2�. .•.'F =kKS,a , k.....-: a. s:* ea` e�±:-: 4:: ais...:+. �. T. t,.. , *..€.,.4F.t�;.2.t.L�' n� '�''�. �1>ti°r�tr� _>.�z, ; `,�'�Y�. -.t a8 ' lei. , _ + � , ,"�i"�a�.m.as:Ca.�r, s;�at�zc..ve *rb .S€� - . y. �3.�t1t� t �,y, -�t f(New construction El Demolition For special information use checklist. 7 Description Qty. Ea. Total ❑ Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) • i ^" tl s ` -' iZ F O FD CONSTRUCT?ION , T _ ? - i " .a ..�" < 5 r#" r'. ' M. x �: ? r~r �a. �uwrv�i�ae �?�� ��: re. �: txc: �a. x. �. ra�z�, �% s, ��.:•.: ta� +f:�, "�.f' SFR(1) 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building El Multi-family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: _ Fire sprinkler ( sq. ft.) Page 2 +,r�,trs �.-4m�'a` °;�' +r>� ��:��,is:�ri4�raa;*>��s�y.;�r. - ::�� b;�+,�u yut< :;� ^_r+ in ° s; V t�•„ JOB } ' SITE INFORMt14= 4ND O.CATION , �. ::5' is a-, �.. ,p:`5la��e'i�-r*?iw^a:; �+?as,- :.v:;?!r'�m��rsxrnaa <:�.�a �s.-�e e�:a,�z;:a+�.�� -,r. ,:m, �i.� ".. �d Site utilities Job site address: .1-2_ a (p --'� "" Catch basin or area drain 16.60 City /State /ZIP: . - I IC j { ` n� Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: ` �J ' J� Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: _ "`a Q. 11,E Lot no.: 16 Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 - ,. F ' ' ., n Yom° Rd� Y ?ei : W"' ki�WY9i1�i :4';.',.¢.erth'�,Y&$e".:::�" fi.Z d`J5 . �..�Sa`&it?Ahx"2F'XL".: T° „�='�: !i ? :x F; 0 . r s`' a 4 Wiiii CRIPTION OF " eliti : E a? t Oat, „_z..'+ .,. ;rh.,,t: ,, tfkluil . m ,r, ..�e. �,r. . « *0y; x . t: �. 'Vi:. s :-a�� Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 rs +� ^s+^ *� � °`�' "�:�� °' =�se�:�' z' t ',x• a �^ix�°: ��;: � Drinking fountain 16.60 4 1 " ; €'= PnI O BERTI' ±® R ` . , t,. t ` nv a c 1< N,..S��; .. .`$;, ?YS`;x : d CflSY ' t" s.^ a.° uVT' i�. �k4k";+: �: ..' ' . „ ��b ?'xi.a,.:'���dki,.:a+.^w� :'ia t�i. • aeti;. *asMSYwtt::a%R*'. "',y::'..�.tsV .�S3i.�.....s�kR= '+b:ee ` `,.�^ Ejectors /sump 16.60 � Name: i- U \/ 1 C-'( In Expansion tank 16.60 Address:. ' W GI • SY , [CD Fixture /sewer cap . 16.60 City /State /ZIP: ' / Ch/Ve(-, , Floor drain /floor sink/hub 16.60 Phone: ') .9:) 7,__ ` � I tf Fax: (�')� -2-� (at Garbage disposal 16.60 xT.:KUr.ss x ^r. ^u; r # Hose bib 16.60 § s '�a x ai ilrk � WA4 -Igt- C rO, N t� � a ;a ® PERSONS & a - s ". �a " ' ` 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: ; r ,. ,,r�� <rrn :- v Urinal 16.60 -` ';'v, ; r,xro a 7 + "rat �'�xstw* p ,, '" aw rvii - : ... ='1 v C.®NTRACTOR : . r - +t: ` *2: g v . •�° . �:vn�. �^ �: �M: ����r: �:*. ���; �--,: �;. ��: �. �_ Y,':� ?A.�A�:3+i5"�2�����„Ivor_ �g Water closet 16.60 Business ` tr am,: . "ems \ ? f�i� \(-. Water heater 16.60 Address: 1' V ' t to `J 1 `"J1 Other: • City /State /ZIP: �`- rIY.A�'� p Subtotal ( Minimum permit fee: $72.50 Phone: a 3/ Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: 1 `"'' IV "lambing Lic. no.: 2 . 7 f /3 O Plan review (25% of permit fee) Authorized signature / State surcharge (8% of permit fee) TOTAL PERMIT FEE Print name: J Me-t.7 ` e Date: ( � / rJr/1� This permit application expires if a permit is not obtained within �J 1V 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Permits \PLM- PermitApp.doc 12/03 440- 4616T(10/02/COM /WEB) 0 i, Electrical Pe i OIl''' • FOR OFFICE USE ONLY Received J City. Of Tigard � 8 2005 DateBy: 1 / /9,5 Permit No.: i � a eM —00� , 13125 SW Hall Blvd., Tigard, J R o a2 Plan Review t Phone: 503.639.4171 Fax: 503.598.1960 - ° -11 1 1 ` 1 ' Date /By: Other Permit: Inspection Line: 503.63 ] Date Ready/By: y: Juris: See Page 2 for i Y OF TIGf�RD " = Internet: www.ci.tigard.o . Notified/Method: Supplemental Information r ire T' T % TT Q 1 ina . s T< � a_ -« t r� : : n . a ,,< ,i' t , ..,- t — :, QF,WORK. ,t3 ,, •,, a . t, , „,...,PLAN-- 1RE!'IE1 ” � - --. . _ -� ?•' _.,, .:,. r ...rv :�:..�,y -s _s� ;'�' ,.:;. % e? _. - " _s1.r,:�` taw ?p#' r. �..s.: '�'�"x -M - k�,._: C` x�." �.. ��; �: F--, h .�.t.:c..�- �.a,= a,�:a�,- .,•..<. ;�9 f ; ..,.c. .. c „ . ,'r N ew construction ❑ Addition /alteration /replacement Please check all that apply: //❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ❑Hazardous location e _; c; ,.u, ; . w Other: , C �k �:,, =:k= . :: • :.; - vice over 320 amps - rating ❑ Buildng over 10,000 sq. ft., Ser V'7 . . , r er . ~- '11 ®ONS —r w N `Y t .,-' and 2-family y dllis 4 or more new residential g ❑ 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure Multi Master builder ❑Building over three stories EFeeders, 400 amps or more 11:1 y ❑ ❑ Other: ❑Occupant load over 99 persons EManufactured structures or :'C`x;,;�� =`.E ' � '•'�;;iXa- ux.�e• +*r v�: ,- , w.^�. *_�T �; =. .�aa b-en3. ,�a�^'.°..� -. a* -..� .p' -�.um_ x t ° w • , .,.. rydOBc;SIT i INFO R1 fATa AND L®CA4I1I ' A a RV park _. ��'~; �Y,• a�: �±:.. w�~ ..�- ��"'�`�?�:.,��, =�s, i=,;a� ; �.: „a.s���.�; ;.::�,„ _,�:'� " �,ei +� �''^�"��t ❑Egress /l ightin g plan P • Job site address: MID Health -care facility Job no.: ['Other: ► -r✓1ir l�� J� , /1W - _ . ,1\ ` ubmit 2 sets of plans with any of the above. City/State/ZIP. . -- ti 0 c The above are not applicable to temporary construction service. Suite /bldg. /apt. no.: Project name: f ` IV' ,EE S;CAEDUL �: - , -, z41 -'" ' . Description Qty. I Fee. 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 Subdivision: l .. y Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 �" ”` ` l� � Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non- residential 75.00 2 ;, i T ' , :k' ;� _hDESCRPi'I OJ ©F,' W ill 'fir z tag �...�,b+�'��.....,... �,t� o,, ��t ,,..�,:�c "- ..._d�..�..��•n�m. -sue,, ..�-- :.�'r�.� „�?���,�.� *,�����,�t���.._����'.. a� ��s��, a tP 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 '�i ' t , , _ ,: k �.,. a r - t „ ,, ., i'w. ,. " 201 amps to 400 amps 106.85 2 ° , PROPERT1,440 ER ` ,, i 1 ' s ® TENA -, a P P .. e �.kl*., ���•- �, _ . �it v��� .� s _ :�� ` 401 amps to 600 amps 160 °60 2 Name: C Y \ V � -_ Q nAl.e, 601 amps to 1,000 amps 240.60 2 Address: Z v a + ..�I ( '� (J �7� Over 1,000 amps or volts 454.65 2 vv Reconnect only 66.85 2 City /State /ZIP: LOI„L p V, q '70 -ip Temporary services or feeders installation, alteration, and /or Phone: ) ����'- Fax:( - 2 — '7Ot S 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 `„� •,"- 3 . °tea; ••,as. r,a ,,..,. .,_- jy it.� :° .rvasn °aa �+,-�+.�.. a- «.•o;a�u�.zsvx: s 4 '`1; F '.sue - . , i” . APPL`IC .., ' .�.•. t � -; t i CON ACT EE A. Fee for branch circuits with ,,,,,_:..: - -4.0 =,.a .. -:,x t- -4,, ....:_,.,. .,..„ ��- : ,t'A,, -,.. r.. ` ; , _.. ?{r,_ ...2,? ..,,,,,, gON - :t service or feeder fee, each 6.65 2 Business name: branch circuit 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 53.401 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- 4n,� k -t: ', na r =mi .• A, ,k 10.M , gi p. CON'P.R IOTR,`r'° i' . z 'W"'-'l#,'. & 1t4r, r ( _ . -. � t. ..�,.,�,..,,',.:: <rl�s�s „�tx�d� �*•:'3'rtt�,.:�+s��,`;<t rr: �`r w energy panel, alteration, or �' — Business name: CA — extension. Describe: Page 2 2 Q , L Address: � � sV v V tr► 1 e . , �� Each additional inspection over allowable in any of the above �7 Per inspection 62.50 City /State /ZIP: '-" `� / q 290:3 Investigation per hour (1 hr min) 62.50 Phone: , b 24.Z -I )001 t Fax: ( ) Industrial plant per hour 73.75 t : x ,,� , "O RTR_ IGAI4 PERMIT.; FEES Sig en. tr-`- CCB Lic.: � r � Electrical Lic. j Suprv. Lic.: -,t95 Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) ,A State surcharge (8% of permit fee) Print name: � e — I Date: 1� ,h " l J 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 ** Number of inspections per permit allowed. i:\ Building \Permits \ELC- PermitApp.doc 12/03 440 -461 ST(10 /02 /COM /WEB Mechanical Fermi', t FOR OFFICE USE ONLY City of Tigard q _ Received rmit No.: / 13125 SW Hall Blvd., Tigard, OR 97223 DaDate/By: ` 6 h ' ra ('��� f 91:7 _ Plan Review Phone: 503.639.4171 Fax: 503.598. 08 2005 //nn�A� ; Date/B O Permit: Inspection Line: 503.639.4175 -l_ Date Read /B turfs: El See Page 2 for Internet: www.ci.tigard.or.us W. Notified/Method: Supplemental Information CITY OF TIGA.I i : 'F' _ :`�a ,� T w ' - L ,,, '"` tiR Y," ,,,,, r a;n -am'asas,.r:� »z^:• ., _:F . x• " 4�- r e . v rw «° ev ,n - z +.. g. 12a+.":at:`-1,._.2 . " ° a � c3• Z � � +' : ' 4 kM Y. V y 'f S S \ .Mz q . i x 4 .. ^f�•:..y 1.0,- 4 SEICHM °-' , , 4 ;0 . ,, . : , , 1 ,.. M ,. , T. , , , OF WORT{,, fx. Ilr.c' >.. u ; A ,, : COMMERCIAL S'EE * - s1USECHEC °a g 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. . g .., i ^r c ' +".'.. sn+'nxtw•x`:a,..�n ;,e=.:..x,orw:sary +uagsw : tia 5 '; - !!`;` ; ':' : !.:Mg' ='' n";:= I � ;: , , �,,,. , ', Value: a ,. e <1._ 3� CATEGORY {#OF .CQNSTRU,C'I§IO 1 ` `f .,vy -4 _ fix, . ,: . : : ,t a 1)16 ..._ _ �4�.� .- ..._s•�A. ==;,o,.,v ..:,,aa�s >Sas�,u�•, =. s:,, x+ =a�r: -,. ..'�. +� <, �.4a547 ....cs� 4 t sarrmx+ GG. a ...'�'r.�+: Fpm.�h-^n ia,.e�rras� ^.sa .; ::»•:L: a'�rsa;F w^ :���. v y sRESIDENITI ^AI FI Ii'1M Liek�S,YRj - M T Sa *- R " El I - and 2- family dwelling El Commercial /industrial ❑ Accessory building h ` °``'`" °° ° * - `' "" "' "'` °' ' For special information use checklist. ❑ Multi family ❑ Master builder ❑ Other: Description Qty. Ea. Total .�.. ,k .� :. ; .',';� �N+'.;�xw✓� :� _. r��.c+- ++.•- ,,.:xs,YS ra �f..w:��':,�h�� w t,aa�.� �p�•„ � ,yr',a,�n:�AC^5is^� =�.: r.»s•.as .,•�S''E¢'n"• ''• '; `:41` 'i 1. .J.OB B ITE IN FORM¢r1TeION,,.A i >O.C�AjTION. ? ;r t " Heating /cooling :s iu'cke 'S:' "ar= �'��..�Ys._zlr�N < ^- n33�:.sy.� ,h��urx...i� 3: sew- ',°��f=: §vescv;.T,� �. r„* i-,: �tEbsa.•'�s�rtr��°,f3��v'= - �f,�e ,+' !f Job site address: ,a l - l� \ u 1 * 1-er . Air conditioning or hegtp pump ) j��j (requires site Ian showing placement) 14.00 City /State/ZIP: _� . I `� I--- Furnace 100,000 BTU (duets /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 Urn / � ' � $ � Flue /vent for any of above 10.00 Subdivision: ` 1 1 0 ( Lot no.: t Other: 10.00 Tax map /parcel no.: Other fuel appliances % acof4�,z^ a V'^"!. ;w' r a "��ry t ... y m w. .a:�,�tsovrys..n.•zrw q r; er s�.:^;.a>•rr= - e. t&*. i *rot' ;s 7� 4 x 2 1 to 1DESCB OF- WORK "` 1 tlo Water heater 10.00 .n,. - s.',1�'. - za±;"zt�><'�,; ° . u tu�£as's =,� , �gs'.��a:r.�,•h..�:vzs = ?,i. :��"i � ,•.::,., � s �. - + 1011 1t; W 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 .V :'= „*h: g;,.iii �..;. n•.-,=4•:,a•«+s,_ n,•s*.., ,rrsr.aprs ?i" "ir"- '- "��•,,,.P,T4 ,.: ..«,. m ,w.�- .$ u 3i ?k;+ vf, "RSi .g.4 ;,, Chimney /liner /flue /vent 10.00 �P,ROEERTtY,,OWNER4� t) ,.._ ° •.:�:.. .��� _� �� .,gar x .bt ins °f'a"t._ i , .k ® �TE 1AN �a'���`��,��^�e other: 10.00 Name: \ A A. VOv ` � COY I \1VL/� t 1 3J Environmental exhaust and ventilation Address: (M ' I Range hood /other kitchen l equipment 10.00 City /State/ZIP: ' 1 co- 61'-)0-s Clothes dryer exhaust 10.00 Fax: r rr Single -duct exhaust (bathrooms, Phone: 7 ✓ 7S 7 ( � 7 2l J toilet compartments, utility rooms) 6.80 j { . : "'r rz..�,. °.0 „s ..ss. ;. �&- s r`u, ' 'q' .t ,^� "srss» :•u srw. } .:xisw '-u'' i 7.•nxx tw - ; . 7 Y ..IA A® gELICA IM i z t ± k N @ P �' Attic /crawlspace fans 10.00 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: ( ) I Fax: : ( ) Water heater E -mail: Fireplace Range .1 k"' :' . ' '� 1' - }.:Ft-:A�- ... �.,- ..�,.�,:. _3c k"'y Y" yy'3. ,.., r $" ?,I, `,,�. ` .t'` '` .:. .-. f : °,�„1�- .'. �� °'" _ ` �fr ..f'„$ ;:.. °� '.e fi ;^t : 1- :: - ' .. :. , , t Barbecue '.. . G wu _' °= :..'. -�irm : ���.:� �° � ; ° rCO1VaTRACTOR•. � �,� rn � , ,,� �.. � �. Business name: (1 / a Deo d` �f� Clothes dryer (gas) `� ' Other: Address: /'� L :,,.,4 fi 3>a: , v ' ,,,n_,Y.- rd .,,•..:r_ c= F= V �1L I 4 MECHuANI PERMIT * `' . . ' City/State /ZIP: \d - hi ( i f 2(.1 '5 Subtotal Phone: (�-)� ` 7� I Fax: ( ) Minimum permit fee ($72.50) Plan review (25 %•of permit fee) CCB lie.: l.) State surcharge (8% of permit fee) TOTAL PERMIT FEE Authorized signature: .*'��rl, �[ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: g0 a \ n al Date: JC /0 * Fee methodology set by Tri- County Building Industry Service Board \ is \Building \ Permits MEC- PermitApp.doc 12/03 ` 440 -4617T (1 I /02 /COM /WEB) N u AAAA .; ®AA A ®AAA . AAAAAAAAAA ,. AAAA � AAAAAAAAAAAAAAAAAAAAA , �_ AAAAAA y Pr 5i ® TREE E STREET R E CERTIFICATION el, A, 0- I, Lv� -(Le , 5 ®wner /Agent for 170 &to) sse {fie. (amn-,�c i //, es LL.6, (PLEASE RINT) (PERMIT HOLDER) 1 1 \ Ox- & t ® Do here `" " by«tc. =fly t�h�tt Afoll�o location �r y y},p' t 3 ot. meets y o and /Washi n on bounty ^ ....:ez�- ,- ...,f„,..rte. - aa�s. ..— a ® land use and development standards for street tree installation. All DI> ADDRESS: )2999 $ 6l.9.c. b+14--/.✓147 sit Dct- ® LOT: /0z/ SUBDIVISION: /-- X c 1 :. 4 ot- ®. BY: DATE: /o- 2 y -or 0 . a � %0 2 a E RECEIVED BY: � � - -�� �= -== � �--=-- -��� -� DATE: CITY OF TIGARD 0 BUILDING DIVISION PERMIT #: MST2{�05- 00120 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/10 /2005 Phone: (503) 639- 4171 Iii Inspection Requests (24 Hrs.): (503) 639 -4175 � INSPECTION WORKSHEET FOR DATE: 10/25/2005 TIME: 7:10AM PAGE: 50 SITE ADDRESS: 12999 SW BLACK WALNUT ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 104 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE NO. 2 DESCRIPTION: New SF. OWNER: DON MORISSETTE COMMUNITIES, PHONE #: 503- 387 -7538 CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503-387 -7538 Inspection Request Scheduled For: Date: 10/25/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 (9 inspection 019255 -01 503-209-4837 N • Corrections /Comments/ nstructions: CLelik- . Ce/S __M . (...-• ) k _\ i / Pi 'ASS H PARTIAL APPROVAL 7 CANCEL ❑ NO ACCESS 1 n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: Date: 1 / 2 7 e #: (503) 718- I Y CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 -0012E 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/10 /2005 Phone: (503) 639 -4171 41 lirl Inspection Requests (24 Hrs.): (503) 639 -4175 :.. INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7 :08AM PAGE: 9 SITE ADDRESS: 12999 SW BLACK WALNUT ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 104 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE NO. 2 DESCRIPTION: New SF. OWNER: DON MORISSETTE COMMUNITIES, PHONE #: 503 -387 -7538 CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503 -387 -7538 Inspection Request Scheduled For: Date: 10/21/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 N Electrical final 019031 -03 503-209-4837 N Corrections /Comments /Instructions: PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: �^I -����( `-�--'�� Date: d Phone #: (503) 718- r c� CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 -00126 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/10/2006 Phone: (503) 639-4171 Requests (24 Hrs.): (503) 639 -4175 ._.. INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7:08AM PAGE: 10 SITE ADDRESS: 12999 SW BLACK WALNUT ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 104 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE NO. 2 DESCRIPTION: New SF. OWNER: DON MORISSETTE COMMUNITIES, PHONE #: 503- 387 -7538 CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503 -387 -7538 Inspection Request Scheduled For: Date: 10/21/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 019031 -02 503- 209 -4837 N Corrections /Comments /Instructions: + -y' ( T ��f P I IL��t (0 vv-. co1-Jav, L�'a� -1 c,JI F'N( - -' ✓ op,0 I pc. o 9/ 1 - PASS I I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: *j - a \-w , w �,., Date: l 0 121 I V C' Phone #: (503) 718- CITY OF TIGARD MST2005-00126 BUILDING DIVISION PERMIT #: 6/10/2005 13125 SW Hall Blvd., Tigard, OR 97223 _ ISSUED: Phone: (503) 639- 4171 Ulq��� Inspection Requests (24 Hrs.): (503) 639 -4175 '' �.. 10/24/2005 7:02AM 32 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 12999 SW BLACK WALNUT ST SITE ADDRESS: SUMMIT RIDGE NO. 2 104 CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: TYPE OF USE: PROJECT NAME: New SF. DESCRIPTION: DON MORISSE.I I E COMMUNITIES, 503 - 387 -7538 OWNER: DON MORISSETTE COMMUNITIES LLC PHONE #: 503 - 387 -7538 CONTRACTOR: PHONE #: 10/24/2005 Inspection Request Scheduled For: Date: Pour Time: C 6 # InMsechairncai finajription � 1#i .0'916083 7 Me age Corrections /Comments / Instructions: N o ( . PASS n PARTIAL APPROVAL — CANCEL ❑ NO ACCESS FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED 1;6 Inspector: Date: Phone #: (503) 718