Permit CITY O F T I A R D MASTER PERMIT
AA
PERMIT #: MST2005 -00003
X11 I DEVELOPMENT SERVICES DATE ISSUED: 3/8/2005
e_ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 109 DA -S R036
SITE ADDRESS: 15124 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 036 JURISDICTION: TIG
REMARKS: New SF.
BUILDING
REISSUE: DM181 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,605 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,709 sf GARAGE: 640 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5
VALUE: 330
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,314 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 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: BOIL /CMP < 3HP: VENT FANS: 4 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:
EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FOR: 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 REVI E W S ECTION
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: This permit is subject to the regulations contained in the
DON MORISSETTE COMMUNITIES LL DON MORISSETTE HOMES INC Tigard Municipal Code, State of OR. Specialty Codes
4230 GALEWOOD ST # 100 4230 GALEWOOD ST, STE 100 and all other applicable laws. All work will be done in
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 accordance with approved plans. This permit will expire
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: 503 387 - 7538 adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
Re g #: 952- 001 -0080. You may obtain copies of these rules or
TOTAL FEES: $ 8,889.42 LIC 35533 direct questions to OUNC by calling (503) 246 -6699.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Engineered soils
Iss ed By : _ ■ . . . 4. 4 i!1 `, e - Permittee Signature : V
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next 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.
•
is, , : , .
r 'Tunin `Permit Application FOR OFFICE USE ONLY
City of Tigard c g CEVED A S� Received � � �✓ e PermtNo.: m Date /By: } 7a— W J
13125 SW Hall Blvd., Tigard, OR 2 Plan Review
/Amp Other Per m it :"
Phone: 503.639.4171 Fax: 503.598.1960 1p� D a t e /B y: MT . 2 - �. � - � - � ���� 4d00
Inspection Line: 503.639.4175 AN 0 2005 L Date Ready /By: Juri : El See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: J1 Cr Supplemental information
. C ITY OF TIGAIRpD���
xs,'4 +4 ; �i�3,r'3,�'` .3 •sA�. ",gas �s . -.i y 7.��i#�1 =.- '.roe�'^ �: ^` .' _'t :.�; ,c, +.�.nt r,:.,a � s,MV �:rd'T,^ ,� tia -r ,_ i
*' ,. ',A, , _ • 21 , :, , . s�� Ra: � ; ., ;. I- ,k , IRED DATA: I AIVD 2-Fn DWEL '
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New construction ❑ Demolition Permit fees* are based on the value of the work performed.
V \ Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
:• ': ? ,t'; _, �. ar m gg,' . .* . u "` work indicated on this application.
- °* n yid y - , gCA >T=EGORY1,,a. C . '' �� + " ° ,r� pp
` "s_, 1 ti� <� '1;4:. 4 `: X:: 'A � _,e x k:t ; . .r 'Z1`1 ° :t ':, `Vd`- .A, • � zl } t4 ,
V 1 - and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms: Lf
Number of bathrooms: °
❑ Master builder ❑ Other: a,
2.
.. .*, _ >, � >, . t .r te �, r 1 Total number of floors
1' JOB ;SIrEIIIVFORMATaION #r`t1NDtrLOC rilii
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lk = - ta • :' .:4k- tier,g L ? � •: .
Job site address: I 1 ` ,.13,1-i CV— () C .ev,� fie 1.0 Dr, New dwelling area: 3 / ) square feet
City /State /ZIP: 'IA t t , i C Garage /carport area: square feet
Suite/bldg. /apt. no.: t Project name: Cum \t W Covered porch area: square feet
Cross street/directions to job site: v ` Deck area: square feet
Other structure area: square feet
y :,,,, b m �'„ ili ,Aii xzrivir� i -gut e , ,:a ;ae a :.,.
RUIRED EQ ° DATA :OMMERCIL
g S .CHECKLIST
,. S441s sa
r,, R.p,le, 444. 'u::°',i4.7 44t44hr,�46. -. ,4,4 o°c.,,`34`. TM °41 SE ,,444 :.44 ?4,44Rt ','. ,-, "J., 41
Subdivision: Lot no.: 3 (._, 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
y _ ^ _ a y ix P% ^A r r „tr y equipment, materials, labor, overhead, and the profit for the
'_ . j < �a,k t a ry . ^ r � z „4 , i i g , �CRIPTIOIV 4 OTit WOR„ tr rl ,„ r _ r� work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
, . ' � A - ,I�au < ':, t= ? t t r xt, ''3e e l t�, ,xx „ . zr�,s� . :a te, y� , -t.. AM
; � P, ROl'ERTY OWNER ,' `, ” 'fie 1 TtEN €ANTS ,,' ;� Number of stories:
Name: — _ N EEO -t .-. Co f.�u� 1 ri s ` u ... c__ Type of construction:
Address: ��. � � �- � �� !C;� Occupancy groups:
City /State /ZIP: Li e � J _� �� � � -- ) 3 � Existing:
Phone: (5);5) ( / ' ?) Fax: 1.3) a / `_ „-7 Lc, I5 New:
1zr isKiaf. ,,-ti .,' °s;> "e;z7 , _,0 ': . itrpi;t'V ∎,4,,'a'rem i g. - - ., `14.33: -; 3 r ` . , n
. ? +_ t: ;, '® APPLICANT "=` v, «;;.; C , 4 $k CONTACT°'.'PERSON mow' �., -Y_ ^ I ° .a,' ",i -sr. a 're ",-A"' �xt'* •. - ,19. "pY /''',;'=',w4''',
,4 .
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Business name: �,/I, G All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be in the
Address: jurisdiction in which work is being performed. if the
City /State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
,, : :�2' r 3: ',', *'; :• ; ser . ; :; , ;v;�°�t: &.t� ?irn� x`a .- ye ,`° x . "ki "rt��" I: �'e �5, �,.rq ...R�.t;'4 �`". '.�,@ f '+a,o. Y�,
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,..._ C " .se *a a.�lu .a :L'= �*ist.�4+6?m Ws -n �,£?c3•`w��i'.�t.Ei.'ftP'�W;�tL r`r- 1,:=
Business name: • , . �.
_ �� � 1 %?�l✓ v �i a �'^�``'�'i: aw =.. �na � i•s °-,s � s° t, * ,F :�,
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Address: t , sBUILDING PERM_1T F'EES'.,. ` `- _ a . 4
`r3�W.'.`•`5£e�'>s. w�Y' w$• �I.'. .'.N.sti.f:;��1:1�.z;is:'#,.V+u� s: `t'.�.'�,`'- ,.''`')L:s .x:1..'6
Please refer to fee schedule.
City /State /ZIP:
Phone: ( ) Fax: Fees due upon application
( ) _
CCB lic.: Amount received
= Date received:
Authorized signature: This permit application expires if a permit is not obtained ,pthe,„ , i within 180 days after it has been accepted as complete.
Print name: De N f . . , i a, � Date: 1Z/77/ 0y * Fee methodology set by Tri -County Building Industry
Service Board.
is \ Building \ Permits \BUP- PermitApp.doc 12/03 440- 4613T( I I /02 /COM /WEB)
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•
1f luinbirig Permit Application ' FOR OFFICE USE ONLY
City of Tigard \ Received
y Date/By: Permit No.�Sr 5 ° o '' '
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review r��
Phone: 503.639.4171 Fax: 503.598.1960 /�alol; + 'Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 I,.. Date Ready /By: Juris ®See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
'Y: ,. nun- s�•3:� ^ S'. : r z 4 . ,xa a , :.w '::�H';rf °r:�:: <:ac�: a.,-te 3.� ha ,'n - rr vx. au e�n,, r,= .�i.t�:;r- ,_saaa:�= �r *co.,t.�v.
t �' } - 5 l TY PE S F e > ' `r' ll -s ., w - `4 r f t , <.,s ` :, ;,- ,
; ,,4,5.. =n, :, e .,,,° ;; 5~ , ;;A fg - ,,�: O WORK n , ;,,t<.,r ':Ac:� , ?t SCHEDULE, �. � �'
x
='� "€ P. rise. _� �....x.� •s�s�; ° =�: :�..��w�� � ..'. a'ds. c_,"U# Via: ^= aM�..,.. a .�a. � azxr.:.z.a7�m:v ate, �,ue,_ k ��a•:,�+.�?c��- _.. A: S '�.".'te" �[
I New construction ❑Demolition For special information use checklist.
Description I Qty. 1 Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
N t3 "'� r`±5s 4` i{"':#. i5'k?stP.t:' as Pe:*` li¢3 ,aY�;.l;'574 .w'iR:�,'�.t!'y�'^ '
v '° *• 5, d -. �;, iL�' -,. , it . .
�a ^; ' , ,, .I -. e (C ATEGORY.OF; CONSTRUCTION ., . " a SFR (1) bath • 249.20
.., -.. �z'��`<:�.+°.±;.1��..n��_ �''� e`.�L�fi4'» wur; :�:-: :...a:�: �.;. nsa.;�; ,.r r.�a? art 'sw.-��ss= »�;Fnau..'�:`,a:i�s' m°L. � _
7 11- v and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ID Multi-family SFR (3) bath 399.00
111 Master builder Each additional bath /kitchen 45.00
❑ Other:
" � z'" '4'1 .t: r3a: .a�;t• xr i tif i Pt , r aeee. ;r,a�xs fkaAW' 74-"-vi., a r
Fire sprinkler ( sq. ft.) Page 2
'erg ., , JOB'S I iA LOCATI , 1
-K -�t. �...�/:.�, =w�, �'rs�°�a'z.�.as�.,�r.ree�a u+c�4s,�;� �%..iee. ��3 "a�., Site utilities
Job site address: 1 C 1 gw cytvi[,Q,, Di Catch basin or area drain 16.60
Ti�jc��
City/State/ZIP: OR q f Dr y
well, leach line, or trench drain 16.60
.w Footing drain (no. linear ft.: ) Page 2
`
Suite/bldg. /apt. no.: Project name: t, rnol t gF I P
`` f' 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: I Lot no.: 3 (ie Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
vx,,,��. .,., aa, ,� a I Absorption valve 16.60
?� i ' r 4b E SCRIPTION alt#Ii K i 1x
> � z�, �.� . ,N� - � � 1.�;. a , it „: m s _,,,,,,,,K .,, Ba preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
W.,1 v ,.n . {,� .r:. V „,m a. ,;:s f . ", w, .mr_,m °,s v v„ Drinking fountain 16.60
�r � - ® sP • 2q , TENA NFTE i
. w; 34,; ,u tut+x rom..w, -,_x. 4*, .',Ao,,u .,,:,,,ar.t �i _M ara = atk.rrt - P A • Ejectors /sump 16.60
Name: V \q, _ CO�ta +A. l ua) Cr t VS ! L-L--L Expansion tank 16.60
Address:.44 , ' J/ s �,. ; I y � Fixture /sewer cap 16.60
City /State /ZIP: . , ' Nif Floor drain /floor sink/hub 16.60
Phone: Fax: Garbag dispos 16.60
, ..CP ; / x t' , . "'+'�'i ” u W .,, g r
q Hose bib 16.60
, ,. - ar APPLICANTa , ' A Y ��C®NTACT -aP,. , ,,
':��e..�•,<:'.�zw,�.,,., I�ta�x�x��,a�- -„aw :'mar:; ` , � At 4v�d�' " ^..w..�+�, -.�.� a ^�e:- ERS.ON ��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: ( ) Pax:: ( ) Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
sF:%K,: _ y.., a n^ rra.. •xa ,tea y s 5 , sx Urinal 16.60
4, :1 ,1.81 . CONTRACTOR •� . uI ... ,
� : �.:.�a�; �tw .:� °�. ; .s:z:;�ai .a;��,,,t�s����, .�:������?���^��±.`�,��:tini� Water closet 16.60
Business name: v C L ? � AtrYL ,^ ; ,n(5 Water heater 16.60
Address: k 0 ': Other:
City /State /ZIP: .1/40 ,. ," Subtotal
- � ` Minimum permit fee: $72.50
Phone: 5,,)z) `(1A,, - �(.1 3l!/ Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: f O .Y 7 -P. 7 'iprinmbing Lic. no.: ?� • .3L �v t 6 Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature
TOTAL PERMIT FEE
Print name: ,� pl -' 1 V � � :t2 Date Z7/ 1
jaL, This permit application expires if a permit is not obtained within
�J L 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(I0 /02 /COM/WEB)
Mechanical Permit Application FOR OFFICE USE ONLY
y Cl ' OhtTigard Reced
Date/By: Pit No.:
6 O -�3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / / A Received
oo 3\ Date/By: Other Permit:
Inspection Line: 503.639.4175 ryp' y
Internet: www.ci.tigard.or.us c � ., Note Ready/By: Juris: See Page 2
g Notified/Me o: Me[Itod: Supplemental for
upplemental Innformation
' F `�4 �n�_. .tx fT -' _'- t^�,.` "t -- a T+�+!' : .�r i Mfl••�;5tit �k. .i'&:F 3• a *.x,'3tEa'k2 � }- y �9Y � ° °. 'Y^' �.� � .".Y' T .y.. :Yl YaNa + 9S S' "' =� .4 = s::4.* `Yx`: &t4""vY._' ES.xrZ ° 1.t:'an ,s'nl:t8_ -
^.t ' : r .,^ - ; _ "` K -°' :IMP ¢ e - a 'mod,- ;x^ki.., i, ' ; '. { SttF t tI ' .�. l �a ''i � 3 ' " `' 3 i .s Mt -,F :"�,.. `. ! -at:,£..„t..
, „. r ,„ E ,,„ WORK ,; � , ,, ,� COM FEE SC USECHECKLIST'
� '_, ...t, . �cc�k�3s; - :� �- �ravf� ���k�k;� > a�t;ty '�� +,��?� �.. n _ ;�tt �';.. -- - .�;�.�an� �,a:��., .ter �• „iV .',�.�- ., - � -s •r>v
New construction 0 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.
�. n, .+a� s . k ,.� .r;, :�vuarc�'r �. °�;r�: ;. ,:.s.=...unxr,;..:Fw�! - �waa:.c+�; - ' ? ::eg.. a�,s�� -:,� c:v. $
.y `;'* 3t.'.�'s's. a I .,: x a a a ")- s. a .,i- , h' Value:
`,t „.� _ _� '�GAti'rEGOR�Yi =OF, ,CQNSTaRUGTaION � �.�- ���'',- ,,���;.i�
^4`sh* ... _ .1 x 2`�4,s1 -i'.at � -w =. -. _ §„�� xa ;- , _. rwa. r. �r. �v�xa.. �e:::. ���c, a. sz, �,. iw�3 ,4�..�1..-.��?�t.A=ut�..t=.,.� � }. ,�r.s ,a,:,,,u.dw�: "w � ..
."'"e4. 1- and 2- family dwelling ❑ Commercial/industrial ❑ ' RESIDENTIA'" -' -- IPMENT /,SYSTiEMS,EEES *tip "'
al Accessory building A: a. ,_ F.,. v.:. ri, � . . _ .M�.... _ -,-. ,� .;
For special information use checkl
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
K._iiiin �:��,.��. �_, rz,e` �. - ��M.rr�iv: vas. t+='-. e., rr,. °u�;<">Ar..re- .aen�p.axaet3;. ^, s�rw� s�eeter�r vn,.z >��.., xi�,.r� .,7
JOB ( SITE INFORMATIONI AND_.WLOCATION,� r Heating/cooling
Job site address: f 'e J D Air conditioning or heat pump
v 1 Cr 7 (requires site plan showing placement) 14.00
City /State /ZIP: 1 1ff I ,,� r ` - Furnace 100,000 BTU (ducts /vents) 14.00
Fur
Suite/bldg. /apt. no.: Project name: S l 1, PJ 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: Lot no.: L n
Other: 10.00
Tax map /parcel no.: Other fuel appliances
k � " ¢ } * ` � ' �` DESCR r OF WORK " ' ; 1 4 '- �' ' &` Water heater 10.00
VA. - a=,�K ,;=" eh t f, .� '''' *z' S ava. ti ,,a:.a.F.: ti4-y,,,... scry :14 ,„„„, e .. , .,,,,w, ,* E R.a. -. ,,,
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
�..,-:.. �.,.. ;. �.-` ��:..;,. ;�,.mt�, .,.,�� �•� ,� „ ,: ,�, � :.w , � �' >, , �.� Chimney/liner/flue/vent 10.00
N r , -PRO P E R T Y®WNER i INERO ® T ¢u y
`•`' Other: 10.00
Name: • CCryt.wcl+ - i Y it. C_ S LL Environmental exhaust and ventilation
Address: �'1J /�
Range hood /other kitchen
�' f l�l+/ equipment 10.00
City /State/ZIP: i 1 £ '')°-S Clothes dryer exhaust 10.00
♦� E Single -duct exhaust (bathrooms,
Phone: e , ' - 7 q2 Fax: ( 2 ) 2 •- 7 �o 1 J toilet compartments, utility rooms) 6.80
R s �+F,a a:i"' s ; "j.ai figia:, N •'1 1 er:... ,, ,..y,,,;,. ,r,,; # '
;71 : , i =.;n ut=�=._ ,itir,:a`vna ^SO`=.5 as4. - .
t. 3_ x. ®APP,LICANT i• -; Xd-I� ;CONTACT PiERSON Attic /crawlspace fans 10.00
w ". v:,r,�_. , -. _,�:,...t ' ..; ^nz�taI,1.a' " z�: s rte s�l::ac�ronam.ua �+ecw'a��'�1'n'��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: Fireplace
Range
._, . _ ,` , w g xi z N
x C OTRACTO. `T. r v t Barbecue
l �' � •�', �'i' �'e .�., , tr. �,:�,..,... �:;°,.r .,��� �'�.� ,. ��1== �;,, k.. c >.'l�r`:�_r:..�+,f��,� -`a
Business name? f r' i� Clothes dryer (gas)
r, l� (JlT t r ` I./� " " "" Other:
Address: //''�� 1 Li 1 1 ;it- "t"�z, *+nu..A.w- :zcrnK,'<4 } 's.- aur,'� . .,a�s,'s -k- �.,,
(,� ^ p l � f^ /� /� /) �q x MECHA =,-16t f ,•
Vim- Uc `V ` �✓I� ` t 7Ct 2'e § sa y .,„ :,w...° .�_: _ - o ta l s,s _." ':
City /State /ZIP: Subto
t Minimum permit fee ($72.50)
Phone: 6 � ` Fax: ( ) Plan review (25% of permit fee)
CCB lie.: - D State surcharge (8% of permit fee)
� -C/ TOTAL PERMIT FEE
Authorized signature: +.4� ' ir This permit application expires if a permit is not obtained within 180
a/'�` l L , / days after it has been accepted as complete.
Print name: F / ). k 4 Ir 6 I Date: 1 � � * Fee methodology set by Tri- County Building Industry Service Board
is \Building \Permits \ MEC- PermitApp doe 12/03 440 -4617T (1 I /02 /COM/WEB)
Electrical Permit Application . ` - ` FOR OFFICE VSE'ONiv
City of Tigard RECEIVED Received 0 ,--- a Permit No. M s? 2 3 --- 4504 03
Tigard, OR
g
13125 SW Hall Blvd., Ti y
Plan Review
Phone: 503.639.4171 Fax: 503 598.1960 / N ° ) Date /By: Other Permit:
Inspection Line: 503.639.4175 APR 1 2005 ti! I ( Date Ready/By: Suris: 2 See Page 2 for
Internet: www.ci.tigard.or.us ard.or.us Notified/Method: Supplemental Information
C4yWEGO TvidokiiD PLAN REVIEW
New construction MilkiiMNatDIVISI9Atement Please check all that apply:
El Demolition III Other: ❑Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
11 1 - and 2 -famil y dwellin g ❑ C ❑Accessory building ❑ System over 600 volts nominal units in one structure
El Multi family ❑Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more
El Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: 3 Job site address: 5 w &h gerw ❑Health -care facility ❑Other:
/
7 1 cS v /y Ql Submit 2 sets of plans with any of the above.
City /State /ZIP: oe d Q 2 97273 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: D�
Q ��'1 SKI G FEE* SCHEDULE **
c� Ai , Description Qty. Fee. Total
Cross street/directions to job site: Q om , F � New residential single - or multi - family dwelling unit.
// Includes attached garage.
1,000 sq. ft. or less 145.15 4
Q Ea. add'l 500 sq. ft. or portion 33.40 1
Subdivision: S um .4 it 1L q� Lot n o. : 3 / _
/ lD Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Al moose- LQ ose w „ f' ,_ dwelling, service and /or feeder 90.90 2
�i�1/(� Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: s 240.60 2 6 01 amps to 1,000 amps PLrYI,,$,r 677E Ca .n (Ill 1 m 83 LIfv. P P
Address: (12 3 Q 6- -LE-AvQa S7rex- Svc /d C) Over 1,000 amps or volts 454.65 2
J Reconnect only 66.85 2
City/State /ZIP: L iir. u S k!_ e34 77.03(5— Temporary services or feeders installation, alteration, and /or
Phone: ( ) 367 75 Fax: (5'0) 387 — 76,45----- 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 snips to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON . A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53.40 2
E -mail: Signal-circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 5 y hT.i 6.2,e0V/ C C..�..0 .
Address: O. Each additional inspection over allowable in any of the above
V �I 2 a Per inspection 62.50
/� ^
City/State /ZIP: D M- d � O q 7 7 G Investigation per hour (1 hr min) 62.50
Phone: Fax: Industrial plant per hour 73.75
( 8 G 2 � G � 73 , y Y ELECTRICAL PERMIT FEES*
CCB Lic.: /32 Electrical Lic.:34/ /183 4 Suprv. Lic.: L/GG 7 S Subtotal
Suprv. Electrician signature, required: - _ Plan review (25% of permit fee)
Print name: L YO(/ O D � 9 a State surcharge (8% of permit fee)
/ TOTAL PERMIT FEE
Authorized signature` his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: • ate: * 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- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
Burglar Alarm
Garage Door Opener*
Heating, Ventilation and Air Conditioning
System*
Vacuum Systems*
Other: •
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls •
Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
I I HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
I I Nurse Calls •
I I Outdoor Landscape Lighting*
I I Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pecmits\ELC- PeanitApp.doc 04/03
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005 -00003
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/8/2005
Phone: (503) 639 -4171 : �NPn�iaj�l'I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/21 /2005 TIME: 7:11AM PAGE: 93
SITE ADDRESS: 15124 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 036 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF.
OWNER: DON MORISSETTE COMMUNITIES.LLC, PHONE #: 503.387 -7538
CONTRACTOR: DON MORISSETTE HOMES INC PHONE #: 503- 387 -7538
•
Inspection Request Scheduled For: Date: 6/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 009756 -02 5503 - 209.4837 N
Corrections /Comments /Instructions: •
O L10 r (_ r ts) 5 aS �- — • D/"
' - 1 \ k 9.4
IN PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: " V' Date: (19 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005-00003
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/8/2005
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/21/2005 TIME: 7:11AM PAGE: 94
SITE ADDRESS: 15124 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 036 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF.
•
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503- 387 -7538
CONTRACTOR: DON MORISSEI IE HOMES INC PHONE #: 603 -387 -7538
•
Inspection Request Scheduled For: Date: 6/21/2005 Pour Time:
Code # Inspection Description / Confirm # Contact # Message
199 Electrical final 00975601 503 - 209.4837 N
Corrections /Comments /Instructions: •
•
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ��� Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005.00003
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/8/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 =_
INSPECTION WORKSHEET FOR DATE: 6/22/2005 TIME: 7 :28AM PAGE: 73
•
SITE ADDRESS: 16124 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 036 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF.
OWNER: DON MORISSEI I E COMMUNITIES LLC, PHONE #: 503- 387 -7538
CONTRACTOR: DON MORISSETTE HOMES INC PHONE #: 503 -387 -7538
Inspection Request Scheduled For: Date: 6/22/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 009869 -02 503-209 -4837 N
Corrections/Comments/Instructions:
•
PASS ❑ PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
j'A
Inspector: Date: 4 -- —D S Phone #: (503) 718-
CITY OF TIGARD • • •• i 1.
BUILDING DIVISION PERMIT #: MST2005 00003
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/8/2005
Phone: (503) 639 -4171 ' ��'mlWnyp�pl�l "
Inspection Requests (24 Hrs.): (503) 639 -4175 -..' 9 `'J..
INSPECTION WORKSHEET FOR DATE: 6/22/2005 TIME: 7:28AM PAGE: 74
SITE ADDRESS: 15124 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 036 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF. -
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503 - 387 -7538
CONTRACTOR: DON MORISSETTE HOMES INC PHONE #: 503 -387 -7538
Inspection Request Scheduled For: Date: 6/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 009869 -01 503 - 209.4837 N
1
Corrections /Comments /Instructions: •
P ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: . Date: 6 —2- 2. %'- Phone #: (503) 718-