Permit A CITY OF TIGARD
DEVELOPMENT SERVICES MASTER PERMIT
PERMIT #: MST2005 -00005
. �i� DATE ISSUED: 2/15/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15089 SW GREENFIELD DR PARCEL: 2S109DA -SR046
SUBDIVISION: SUMMIT RIDGE ZONING: R -7
BLOCK: LOT: 046 JURISDICTION: TIG
REMARKS: New SF.
BUILDING
REISSUE: DM251 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 22 FIRST: 1,865 sf BASEMENT: 0 sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,507 sf GARAGE: 546 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: 0 sf RIGHT: 5
VALUE: 325,703.80
OCCUPANCY GRP: R3 BDRM: 6 BATH: 3 TOTAL: 3,372 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 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 < 100K: BOIUCMP < 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: 0 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: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EA ADDL 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: $ 8,812.70
DON MORISSETTE COMMUNITIES LLC DON MORISSETTE COMMUNITIES t T i g a permit is subject , the regulations contained C o ithe
4230 GALEWOOD ST # 100 4230 GALEWOOD ST #100 Tigard other Code, laws. Aof ll l o work will Specialty done in
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 and all ra cer applicable laws. s . This permit done in
accordance with approved plans. This permi t will expire
if work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days.
Phone: 503 387 - 7538 Phone: 503 387 - 7538 ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
Reg #: LIC 162512 952- 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -6699.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Iss e d By : : I /' if //� .!r Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
•
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Buildin.'Pe Ap p l ic ice FOR OF USE ONLY
!� h rr%%
Ci r, ) Tigard !9 E ® Received
�c�2 Date/By: /d -0. - Permit No.: ` 0,� f d uar
}' 13125'SW Hall Blvd:, Tigard, OR 97223 Plan Rem ` J '
liorie: 503.639.4171 Fax 503.598.1960 jA 0 `` I 200 //nv /Xl� �' , � (.� ' I +� Da te/ B ! �
Other it 3 I .
� • _ . ■ f�Jd'
,Inspection Line: 503.639.4175 f to -�7 " Date Ready /By: � O er erm
T� 0 See Attached Checklist for :
.' Internet: www.ci.tigard.or.us CITY OF TIGAH Notified/Method: - � 2b W) Supplemental Information
ti DING DIVISIO
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Y:
10- ,. ' TYPE. OF ..ORK�. •a . ; e 1RE • U EDs`D,, 1,1 ,ANI)2= FAIVIIL Y 'llW. : - ELI ING _,,;
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New construction ❑ Demolition Permit fees* are based on the value of the work performed.
x ,_.. Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
: r:a , ,., x; _rem.: :. .: :,, s. ':v >:
:., -r. ,x' � =:t =, work indicated on
._... ; ='�` rt -,,� .�—
: o this application.
., ': . T ORY,.OF°; CONSTRUCTION; r .., : ah•, :,-,;::_ ; ', •x':
rsfi�i' ���': ,,;,:i `i��e`- '�,-, .., sr �-z3it it:,:,:r.,:�: `fit ;.,,�_,_, .,._,..
.... .. ...:
.. ti , •mi'� r+°:?,�t:ei:fi +::.... AFB:.{_,•,,.. :.gX..:'s5r.rbi:;PXr.'', -f',.9 �..oh•.N �.�.. , ::�,
X 1- and 2- family dwelling Valuation: $
❑ Commercial /industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
•
❑ Master builder ❑ Other: Number of bathrooms: 2. 1/x
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k : , , , ` ,. ;:'" ., ; ,,,.w.: ?; ':;<,.: ag T otal number f
;:I, a =';` s` ' , :'a s . =- JOB SITE :INFORMATION? D• UOC'ATIOIV.. t`.•.r,:;<. = ; , +.. o floors: /
iii; f ! -- n ,. 4 ;;,; a .�� ...1, _ .� ` „ .,i,,, _„w -.. , i,;, t 5,4 AiirEa' ",ba _' R�
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Job site address: Igo g i C re, .ficIgi fir. New dwelling area: 3 A -12. square feet
City /State/ZIP: /t /0 ` Garage /carport area: square feet
J �
Suite/bldg. /apt. no.: Project name: Su plifittl i a a e Covered porch area: square feet
Cross street/directions to job site: � Deck area: square feet
' Other structure area: square feet
Y":r': 'rs;�,,4: -`-fit° ri"" r'!t R,,A -', ' mc , :n r - .o'z : ,' t3a :, �
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ADATA „iCO1VIMERC '` US�E1GHEC r
,a4,dr� 1=,•r- 40 ;! V,' , :!�:.;.au>at MT a::�. ,l:<:a::5Wq.i�, :,. _':t.raa.r; :;, n
Subdivision: Lot no.: 111 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
`si�- -' - .'.��. ..:- .,.,L„ >J•: ";'� ,
„�.;; work indicated
,_' �wE ,, RIPTI Ni°OF=:WO ,,, ::•:� +$fir . , Y. on this application
-. . ,,. a' "- .- .x•.`Yeu .�,.., .`'�' . . ....: .. .. ?rk * ♦: .,z._., ._.a,.A;>ts. .r .�;r,.
Valuation: $
1 Existing building area: square feet
New building area: square feet
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< - ';'PRO.PERT1' O, 4. . .mm ,'* .• 1.-- -' ,, ;, i�- ;: ,. TENAI,:, • .;: ri.:; i, Number of stories:
`it�'' - '.'.` ,y�1..;.u- ., ..�,Ya `'�T. s7 .�j.eyr �r:,�[:u.�.e' � " . -, �•�3 °e:�r },K�. �� �,i
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Name: -1\\ �-4c55 c rt.., YIYltltitl {� y L�C Type of construction:
Address: ��� �� t�� 1. Occupancy groups:
City /State /ZIP: L 1 - I Ok q '70 35 Existing:
Phone: (c.:1`5 � �j��� ) ' 5 Fax:() 7 -7/A5 New:
_Y .,£.�, . tl!; : 5';;•7�SJ; .SU '.r �r�; 3j ' :'2?; - _ .�t`3 :, l:a : <1;: _ .I {,`67":"'Fixl
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�, �, . ® • •:,,'w: .�. ®.CO ^ T PER ` 1V,- ., >`, >n pry,
r ; CANT=. ,;� ,�,< NTAC S,O z.,, -- t �.
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Business name: �� All contractors and subcontractors are r e quired 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 :;
ICON RA
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Business name: 4 :,:.
s:
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Address:
Please refer to fee schedule.
City /State/ZIP:
Phone: ( ) Fax: Fees due upon application
�''" ( ) - Amount received
CCB lie.: P,6il t , .
r 719a42(11. Date received:
Authorized signature: 'j f � Fi, /'� ` /e- -' This permit application expires if a permit is not obtained
�/l•��jC /l r A within 180 days after it has been accepted as complete.
Print name: De De I TZ. \ I , 1 .` ?4 Date: /21220y * Fee methodology set by Tri- County Building Industry
Service Board.
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i:\ Building \Permits \BUP- PermiiApp.doc 12/03 440- 4513T(i i /02 /COM /WEB) 1
, Plumbing Permit Application FOR OFFICE USE ONLY - -
City of Tigard Received Permit No. / S 2005 - 495
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: em / /
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Mit:06 , I l\ Date/By: Other Pemut No.:
24- Hour inspection Line: 503.639.4175 , `
� .� Date Ready/By: Juris: RI See Page 2 for
Internet: www.ci.tigat•d.or.us Notified/Method: Supplemental Information .
. f vi�... l�' ry {I - `S:'I�:: .ii9rr ' :.'f5' - qY i t.. _
";kit 1• 7 ° �' - '.%:ti' wn � -
... : -. , ,.• .. ,.6. .. a. ., -n... _ ,,,... t, - y?i. ?v i°'' . a+ r - `':�:.ii :•.Yip � S''L.
_ � - .:t � - :: >;?
- >,;;,...s.. ,.�..r.: _ .... ..: ...:...TYP OF.- .WORK:
• .r, ..__.,:r..� _v.. #...;,. >:. _ :�� ";FEE.
...._ .,_. ,.... 4_. ..,_.. __ ._.... ..,..•.. �... ;,.�� ,,.. EP:
3 meow .- .._..,...r.._. , r. �,.:
l New construction 111 Demolition For special information use checklist.
Description Qty. Ea. Total
❑ Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
st,
! CAT 'OCONSTRUCTION f. a: - +a�• " ;o,, , , , " <
I - and 2 -f
- �,::::. _ .�:..,>;,• SFR (])bath • 249.20
. . , ..,..
2-family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
1:1 Accessory building ❑ Multi - family
SFR (3) bath 399.00
❑ Master builder 111 Other: Each additional bath /kitchen 45.00
;.. F sprinkler ( sq. ft.) Page 2
- . "_ - - iii ": ,. y . r „ . :Li f.. � : �� °�iF. • -- Sf �*F. ": / .[:y •:I �" i %.F.
1 INFORMATION AND" L r i ; ? +la , 3 t - w ,Rfj Site utilities
Job site address: 15 7 S uv o 1. ®,. ttq e t t l iDp1 Catch basin or area drain 16.60
City /State /ZIP: TT, 4 01. 1 ny Drywell, leach line, or trench drain 16.60
.cvni Mb � R ;4cs� Footing drain (no. linear ft.: ) Page 2
Suite /bldg. /apt. no.: Project name:
V "" ��`"�� 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: 1 Lot no.: 4 b Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
:- :r..;, ,,;,,,,, ,,;,•' ,_: - :. =•:', ;, .. ;.f :: Absorption valve
,,,�._ �r,:k . �<': alt�c` ,�, ,;,�:`,,,:,,, ,�.rsF•k; :,;t=r� �.t,� Ab orpt' t 16 60
,,. yo-. e.' .rt ''`i'::' _ :ri = =;; >., c:: ,. r,.. e . s`"s� 'i:.,: ,
: :,s `;�i.:.:DES.CRIPTION OF .,*." =rfi : d: , ,.reu,,1,
%q'�,iY. +. -=3 - >4:r'fr4�'.- , :,P , .`s.�RK:. vi` %:�x e+.,; {,}.vr,iic; {:• .l�i`t�u ,E U' «;
. _, .>..,.. _._L:n,.,. <s,�,.•,,.:�,c�.,. -.. .r . -. fr;, ur- rrta���+: za- x• x .Y�.r.na�, +,_- ,,.u:�'t?Ir.a.._. s,,,w�..- _.,��ya_,.:3.., -,..• Backflow pt Paget
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
,,< •:E }- ,,; `: ti'- xr;rr .;' Drinking fountain 1 .
et „- .`i ='a 1/ ak i = = 4 , ':4iS - I:t u g 6 60
:4 %OPERT ,1, ;, � 1 ",-Yi «.- (.. & k : ; ENAN" ac «.
:ti #`, - � '�. V.VN -E ,, ,e: ''�,, �,::, t:�..:,vti •, ,: r -. .rs:ii,,.. 77 ��; .7 �t���.,,sl� ' S
:::':�3��`-.' (', .. `.; +:;;2x .. ;;r•jt::- ..i,i'ls.s_: ^',.., . }:0. ..r1 ..azkfo n .n,. c;?;;.,i;. .... ,sY x. ,
., ., ..,,,.:. _ .," ... u,,�(= �.�:,�; :�.;y . rt�s . Ejectors /sump 16.60
Name: • ` ,.+ 9
tU��_,�'�• ComCYLon (ties Expansion tank 16.60
Address: r- Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone:) . %7 -- 7 Fax: (m')2) ? • (a t S - Garbage disposal 16.60
,•y; :- , : VAi ;;a:. F•' ;.; +:,.:e,r� `- ` :v,k:.w..c„ -. . r, Hose bi
,, r : t'a., _ .,, ,
. „ o bib 16.60
fir. ':;, v,•
�ArrL "r � `
�0'_ C?1VTt.� .fi•= ;,C'.ONTA
'�ER "
, `i'%e
s`'.. ,. _. w , . . , ._.. _: ��:�s�.E:'K = �;: .,. . :,, < , .:z =, xc3 ..,. ����.::..h 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:
Urinal 16.60
O Ow
rGN TRAC �'T R"
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f, -
Business name V -•V-'_ t a rY `J ∎ ,� ( Water heater 16.60
Address: , J Other:
•
City /State /ZIP: V,� {' . Subtotal
C Minimum permit fee: $72.50
Phone: ( 5;) ?, )� - �[� r Fax: ( ) Residential backflow minimum permit fee: $36.25 -
CCB Lie.: ( 7 _-f II ^h Lic, no.: 2 7 -- 27``1/')70 Plan review (25% of permit fee)
Authorized signature w State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: ,,• ` i` - \ . � t V 1 \ Date: l� Z e This permit application expires if a permit is not obtained within
V 180 days after it has been accepted as complete.
• *Fee methodology set by Tri -County Building Industry Service Board.
is \BuiidingWcrmits \P LM- PermitApp.doc 12/03 440- 46I6T(10 /02 /COM /WEB)
Electrical Permit Application - FOR O USE O NLY
City of Tigar Received
0..
Date/By: Permit No,: frig3Z509- ' / �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4rafiliv 1) 1 Date /By: Other Permit:
inspection Line: 503.639.4175 Al A�'
� W . Date Ready /By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
, .i f , TYPE OF WORK w- . a. - -
New construction ❑ Addition /alteration /replacement Please check all that apply:
[j] Demolition ❑Other: EService over 225 amps, comm'l ❑Hazat•dous location
:._: c ' , ; . ,;...; . ,.:. ,: >:, -.,:: _.. ., ;. ,,,• ..::.... .:.......- ,:,:3:::.::::., -.:::. •.; .. ;• .:<< „, ,, _: : _,. ;, ::_, •. r: EService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
= CATEGORY: OF CONSTRUCTION ` s of 1- and 2- family dwellings 4 or more new residential
A 4 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ESystem over 600 volts nominal units in one structure
❑ Multi family III Master builder ❑Other: EBuilding over three stories EFeeders, 400 amps or more
::.,_;,. ..: ._, „., >:- :,,,.:,,:,, ,,::._;;:. persons structures o r
, ,,,,, ❑O ccupant l over 9 9 e Manufactured sb ucture
JOB_ SITE';'INFO ATIQN AND L OCATION A5,tr '; ` RV ark
.. .. - - .,. „�.. ., .._. •... � . ...... � .,...•t° - ' , -.. .: ❑E /li plan P
Job site address: 1./ �",�,�. ' ❑Health - care facility ❑Other:
Job no.:
14�' LS rV `�1 Submit 2 sets of plans with any of the above.
City /State /ZIP: — 11611,1 The above are not applicable to temporary construction service,
t ,,, f . � , l:y}:;.F 1 >p�r�ii1a�� " "1: ;'�'t�'` .'k. -..(. ::y.:!t:l�j•i;, - ,i'j �
"i ,��ar' ; x;i `FEE.- „..S�CHEDUI E �_,.,,..,:..usfz ``` s: _,:;
Suite /bldg, /apt. no.: Project name:
y� ;,, .:._ :......:
ASV tiN WL s'� lhilier. Description Qty. Fee. I Total I **
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: Lot no.: 4 b Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
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ry 5 ',. .ICA'
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SCR PTIO °OF� -
N` .ORKa
- ,:. . - ,:. .,..n._ _. - _,.,..,_ ,..:., �:.,,,- _,- „_�„e, »,• .�,da_._...::5.4,. -- ....'i_.,.._, ��:,�...WIT2A:, 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
,�.�: �t.„ i�7`:'sl. w�' =:'�r `,:',` sr4' *r, >_,��;• „•,a 201 amps s 106.85 2
�,`.*,: _ :;;i x�,'s, r -4- = s;=,. its .M.f ;
e: -- - ..v P P
PROP OW:1•R44 ;N.. , _r..:: =:rErTACNT• ;? 1.:, .4.,,..,..,,:t,
160.60 2
.�;•` « � -xxa ,v h.a„uz•: �::,.: r.. 4 � ; : ; .;«�° _ hv. c= r..> dglT'"`# t' �! is�r° j�SL ,T.rt;h ;;i':-�r§7��"> ; i a§ r
` � "' "' " ' ° ` `�� 401 amps to 600 amps
Name \ � ��� � • , C rn i l i .�
ni V h S 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
LOW � ��V� � • � � � - _ a - Reconnect only 66.85 2
City /State /ZIP: La, U1
Fax:,Pr' i (..20 r,. Temporary services or feeders installation, alteration, and /or
� , �. -� r^�.,) L - -76 relocation
Phone: ! l✓ 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.:= "`: A. Fee for branch circuits . ❑iaAPELICANT; „ ?.,, ,.., : °.z ° a; > 4t :` =•;,1; ®c CONTACT':P RS ON; . , , ..__. nits with
;f.
- - .� ,,: :.:.,.: 4 ...: E u N” service or feeder fee, each
Business name:
branch circuit 6.65 2
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or i Tigation circle 53.40 2
( ) Fax: ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
-
; :` {i� : :. ,
- energy ne panel, alteration, ton
`:CONTRACT � R'^ ''�t- , or
O gY P
1 extension. Describe: Page 2 2
Business name: � A. - \ Q,6_ t
Address: MOD SW LA.('- zs.) , . ` _ Each additional inspection over allowable in any of the above
Per inspection 62,50
City /State /ZIP: TI ( 4 . a / j „ C
� '7d9 - 3 Investigation per hour (t hr min) 62.50
Phone: 0 l j,L I V I t Fax: ( ) Industrial plant per hour 73.75
=/ ? ; '`' %i cii=s ELECTRICA VPERMIT` FEES *i':
CCB Lic.: �4-.1 r . Electrical Lic. l Suprv. Lie.: 3 el Subtotal
Suprv. Electrician signature, required: .. —
Print name: Plan review (25% of permit fee)
I �I , / State surcharge (8% of permit fee)
0,,,c,\( . 1� r ��J,� I Date: 12 � 0
TOTAL PERMIT FEE
Authorized signature. This permit application expires ifs 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 \BLC- PermilApp.doc 12/03 440- 4615T(10/02/COM /WEB
-Mechanical Permit Application FOR OFFICE U ONL •
City Of Tigard,. Date/By: Permit No.: 5 Tam 5 _ 5
,.. 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 A l I , irI\ Date/By: Other Permit:
Inspection Line: 503.639.4175� ��II y
Date Ready/By:
Internet: www.ci.tigard.or.us /Met h o d: Juris: S See Pen l Information
Noti
g fied/Meto Supplemental Information
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, New construction ❑ Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
JJJJJJ��� performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
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‘'GATEGORY OF' " G 'N TR � -TI � N,- .,•,�..:_ , ;
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" ' NTIAL, EQUIPMENT = %''SYSTEMS;FEES,;
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ Multi - family ❑ Master builder iii Other:
For special information use checklist.
Description Qty. Ea. I Total
JOB S IT E ` : I '`:,AND'�1OCAT °' , .=
... - ��;;. �:;': �^. � ,. : �;. �' :, " >c, #r.:: i '' Heating/
moll cooling
Job site address: 505/9 Si.) _�•w � Air conditioning or heat pump
5 �� -.
(requires site plan showing placement) 14.00
City /State /ZIP: i V Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg./apt. no.: Project name: S y MVO 1 e Gas heat pump 14.00
Cross street/directions to job site:
S J 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
Subdivision: Lot no.:
4 W Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
' i'e� ;�� �t. ,: - ., �,� . , Water heater 10.00
-_ :.,...':;a - , •:t.. _.,.. .4!�T,P m' ex.. y��ce-,<' a. r- �., p- ,n. Y'_; tzi¢° �,, ��. -t xr,.,' ��9. Ya:, �-.,'(. rv, _,- .x,' <`r;�c.Z�r� ^.�ytki��ls, ,,::a:1"x
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
a; x -< c = Chimne /liner /flue /vent 10.00
.... _..,:.. ,.: O RTIIh:`OWNER.
'c:.TENANT.. ry, "._ ,
. ,: ' ,�, . , „ „�rY \4?i?r
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...- ,,:. ,: ��;;;._r`;,,.,.:,,.... -.,» �z -,. - _:�;......,. _.'..,. , Other: 10.00
Name: \ � t ` ' Opal OW , I IeS Environmental exhaust and ventilation
Address: L Range hood /other kitchen
DA, �f fIC equipment 10.00
City /State /ZIP: L 9' . V f )O S Clothes dryer exhaust 10.00
r Single -duct exhaust (bathrooms,
Phone: , n - Fax: ( '°2 � � '- - 2 (? 1 toilet compartments, utility rooms) 6.80
: , -,;,,:l
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�,�.•' _ • S:• , Oc t n.1 t:`;4t3 :: \ *, 1'�' -'0 +i: :a_a:rt. �riiS.V „ ' f.eif
r,' „= ��?�:� .5�':i� ' „f� _ <.w � �, �.` - Attic/crawlspace fans 10.00
., :l,APEI ICANP, , ,, GON�I°AGT'>P, R,,,, „A 4, P
- k : -.' 1, �;1''' r;'i:;+ n';.1�.{:., ;. �.i.� � _ �! \.3.`y}l.`.FYI:r �`a;,S
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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: Fireplace
Range
CONTRACTORS Barbecue
Business name: r Clothes dryer (gas)
(��� �1 Other:
Address: /'� L 5° `
�1 � y ',,'a `',--s; 4 "1VIECHANICALrPER] :FEES *'� ` `'
y ` '�V \ V' 1 �.`^ /�/ � ) . . ...c- ,� .., .._•,t..,. _.rnv.. ., ,.. -1... ..,,,, .:.....:a`�.F:P4..;- „3 h1K ; A1�r: • = ��`� �'°t',':-. - `'
City /State /ZIP: V ` ( U I (I --/AA Subtotal
:: ,,, (� Fax: ( ) Minimum permit fee ($72.50)
Phone: r
� � I Plan review (25% of permit fee)
CCB lic.: . 5 State surcharge (8% of permit fee)
L TOTAL PERMIT FEE
Authorized signature: ,. f J' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Mnintir I tK. 1 Date: 2 M * Fee methodology set by Tri- County Building Industry Service Board
1: \nuilding \Permits \MEC- PermilApp.doc 12/03 440 -4617T (II /02 /COM/WEn)
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t rot,; ».: x, ,, !" ;e:: AS
® meets F t�. x :dt ' i�g ngton County
® l and use and development standards for street tree installation.
® ADDRESS: /608.9" Sui GkezA eid di _ .
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005 -00005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/15/2005
Phone: (503) 639 -4171 / /
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/26/2005 TIME: 7:27AM PAGE: 47
SITE ADDRESS: 15089 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 046 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503. 387 -7538
CONTRACTOR: DON MORISShI tE COMMUNITIES LLC PHONE #: 503-387-7538
Inspection Request Scheduled For: Date: 5/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message •
699 • Mechanical final 007821 -01 503.209 -4837 N
Corrections /Comments /Instructions:
P ASS PA'•TIAL ROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ' ALL F. • INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Dater 7r4 (OS
Phone #: (503) 718 -
CITY OF TIGARD - .
BUILDING DIVISION PERMIT #: MST200G -0000 �
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/15/2005 : #0
Phone: (503) 639 -4171 it
Inspection Requests (24 Hrs.): (503) 639 -4175 �. =W
INSPECTION WORKSHEET FOR DATE: U25/2005 TIME: 7 •12AM PAGE: 50
SITE ADDRESS: 16089 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 046 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF.
OWNER:
DON MORISSETTE COMMUNITIES LLC, PHONE #: 503
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503 387 - 7538
Inspection Request Scheduled For: Date: 5/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 007694-02 503 -209 -4837 N
Corrections /Comments / Instructions:
A
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[PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ C LL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: Date: �� Phone #: (503) 718-
CITY OF TIGARD - .
BUILDING DIVISION PERMIT #: !ASTMS-0000G !ASTMS-0000G 13125 SW Hall Blvd., Tigard, OR 97223 A. 4 J DATE ISSUED: 2/15/2005
Phone: (503) 639 -4171 �°�n��
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/25/2006 TIME: 7 :12AM PAGE: 51
SITE ADDRESS: 15089 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 046 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503- 387 -7538
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503.367 -7538
Inspection Request Scheduled For: Date: 5/25/20055 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 007694 -01 503 - 209 -4837 N
Corrections /Comments /Instructions:
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RECEIVED
MAY 2 9 2005
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BUILDING DIVISION
/KJ I .v\ Gk 4 Th Ilk--k 4 /4 4- C •
V PASS PARTIAL APPROVAL Ei CANCEL 0 NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 2 " S7 6 Phone #: (503) 718-
CITY ck I IGARD
BUILDING DIVISION PERMIT #: MST200& -00006
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/15/2005
Phone: (503) 639 -4171 / �a- ugMy�uyfl��l� �\
Inspection Requests (24 Hrs.): (503) 639 -4175 . ��� '__..
INSPECTION WORKSHEET FOR DATE: 6/26/2006 TIME: 7:27AM PAGE: 45
SITE ADDRESS: 15089 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 046 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503.387 -7638
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503-387-7538
Inspection Request Scheduled For: Date: 6/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 007821 -02 603-209-4837 N
Corrections /Comments /Instructions:
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MAT z 6 2005
CITY OFT;CnR
• BUILDING DIVISION
PASS • PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ILL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: — �i✓� /d
Date: 5 Phone #: (503) 718 -
b.