Permit e:.
C ITY OF TIG MASTER PERMIT
PERMIT #: MST2005 -00061
y,�l�, DEVELOPMENT SERVICES DATE ISSUED: 4/4/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA -04900
SITE ADDRESS: 15316 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 026 JURISDICTION: TIG
Project Description: New SF
BUILDING
REISSUE: DM186 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,600 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,903 sf GARAGE: 636 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT: 5
VALUE: 343,879.60
OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,503 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: 3 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS:,2 3
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: c .S � 6
ELECTRICAL ,/6e ,O -�� I 'Q-C-P
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 7 201 - 400 amp: 201 - 400 amp: 1st W/O SVCIFDR: 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:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes
DON MORISSETTE COMMUNITIES LL DON MORISSETTE COMMUNITIES LL and all other applicable laws. All work will be done in
4230 GALEWOOD ST # 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: $ 10,881.55 1 - 800 - 332 - 2344.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Engineered soils
I
Is . ued By : ► /� Permittee Signature : r �.,
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.
,
4 1 , - . - ^ ,
Building Permit Applic FOR orFlc ,us _ONLY- ,
City Received
13125 of Tigard - y Plan Re ' Remit No.
SW g P lan Re Hall Blvd., Tigard, OR 9R 8V E 6 ' P �� ;Z...5 S�..zQO�`'Ooo �j
Review yy +
N "Phone: 503,639,4171 Fax: 503,598,1960 /4210a 1�M1lI'�!'1# DateB qtj q— y - O Other Permit:,W065- 0O0b! • '' `
Inspection Line: 503.639.4175 Ready/By: kris: HI See Attached Checklist for
' • Internet: www.ci.tigard.or.us FEB 2 5 2005 Notified/Method: j I & Supplemental Information
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New construction 4 ❑ Demolition Permit fees* are based on the value of the work performed.
^ Indicate the value (rounded to the nearest dollar) of all
_, s ' -'• - _' ❑ Additidn /alteration/replacelnent ❑ Other: equipment, materials, labor, overhead, and the profit for the UA
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. -: -: ttry- : ° s °N r = + -:;a" ;':,° work indicated on this application.
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Valuation: ?
❑ I- and 2-family $ dwelling ❑Commercial /industrial J 1 13Q.
4
❑ Accessory building ❑ Multi - family
Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: �' / a
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Job site address: i `�� ( ree " e1_L �L �c New dwelling area:'�G�? square feet
City /State /ZIP: Garage/carport area: O "? Q square feet
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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
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Subdivision: >M ` - 2 Q , Lot no.: a p 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
equipment, materials, labor, overhead, and the profit for the
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° = 'tD OR .: , . •t „ : �. ,,, : = ":"-', work indicated on this application.
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Valuation: $ •
Existing building area: square feet
New building area: square feet
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Name: , ^ • A ,� CO f��MU cir t
1 t,, Q) Type of construction:
Address: . (A r lip VT c. [C.40 Occupancy groups:
City /State /ZIP: Li� t J,�r + q - 20 35 g:
Existin
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Phone: •
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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: ( ) I Fax::( )
E -mail:
- _.A-'• +Ff =i „ ' f'i., .i,i�'t �Fj %I•-. {��!� i,k+� n`1ti.
B usiness name: 5A-1,--1, J .. -, - „_ _ _.,. .. -., _ ... ?!� - - i; act :: ;:,, - _
k `i —h ; s ;fi � , , -.1: _
, BUILDING P,,, :H
,, 1;1f.:FEES
Address: .. - , . _ _„ :.,, _..,,
Please refer to fee schedule.
City /State /ZIP:
Phone: Fees due upon application
( ) Fax: ( )
C Amount received
CB lic.:
/(0':.).5 I •
/ D ate received:
Authorized signature: �j pf 1p, -� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
i �/ 1 Print name: 1 i i l � �)e ► � f . Date: l 15 / (5 * Fee methodology set by Tri -County Building Industry
' Service Board.
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; i \ Building \Pe,,mits \BUB- PermitApp.doc 12/03 440 -4G 13T( I IIO2ICOM /WEB)
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✓ ' Plumbing Permit Application - FOR OFFICE USE ONLY
Cit of Ti and Received
Y g Date/13y: Pemrit No.: 1 ZO )5 ,d (
/
/
13125 S W Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 //bpd /Ipr rilI Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 w. Page 2 for
Internet: www.ci.tigard.or.us W Notifie od: luris. Supplemental t mental Information
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I�New construction ❑ Demolition For special information use checklist.
7 _ Description Qy. Ea. Total ,
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
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(Y .
+CATEGORY` F1" •`ON TR -T.IO ,..
- .O G, S. UC, NY?� . ,,�.r .:,,: ,,43-
CI SFR 1 bath 249.20
❑ i - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
CI Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath /kitchen 45.00
❑ Master builder ❑ Other:
r - ,'.. ,.:r - st.: ;,,>:, { 3, r ::. F ire sprinkler ( sq. ft.) Page 2
`3L' %,i - �of �F: _ ; , fi..ty }':`h`;�
i;, JOB. SITE !IN'FORIV N O, ° D ='L : •:x ., ':.,>u;,- ',r-:r•...l
> . . -� ": r!id• .,I.,, . •<' a ..¢ . h. F i ' ia< FI .. l rs::
: .•. _:.- :. _, . �, :- :_.. .,..,. ...a. - ..r ^x£t•. , sr�;e + t,,. ,, �d�cFAaS = *'a :ei' ��:; ' ^. z.._.... -,., es... �. ., ,:....1._�.,,...�,<e Site utilities
Job site address: r� 4 _ r ; ' I I `' Catch basin or area drain 16.60
City /State /ZIP: )) 9C, O -� Drywell, leach line, or trench drain 16.60
t
Suite /bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 1 10.00
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: Lot no.: �� Water service (no. linear ft.: ) Page 2
' Tax map /parcel no.: J
Fixture or item
F' t r ite
.' 4: ,: •:;; , : ,:a - x,= ..r, , : r s j sk ., , Absorption valve 16.60
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:a ,,.,;t'. `lai I) 5'CRIP IONS,O: WFORK :t^ ;:A . :; ,-',.is ,r;.; <:1>:.
i . ,rt`r'uw'i�'7?YB., - - :, tA- ,.ii'1tr•„ yw. � ±•>tu?" _ '.' (h' .,F'" ,-ri: ?_. ,di,, ,e�'r..,;.
,:,.. ;.., . • __..,.,... ,.`xil, ,.. , ._:.0 :...>t_. �.�, .:..:rte ....,z <,r:��, W;,�,�,._. , <.�r..:u' -::, , � _�<,FN�,��..<,._,, ,,,�•._...,o..:.,.. Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
>,,,., c:s.',ts„ ,;, i; A .` ;,i- r .- , „ ° , Drinking fountain 1 , t ,:; .a.,i. AT ?t•.. >e,r ` k.,. "i< s` ?d; , g fain 16 60
:P,RUP,ERT" '04 > :5z.t r - Y� s =• '.,��Ki� , " <-T e �..,• _ ,Q .
.",, .)?V , 4 :4 �.:w.,,. 0 E ' 7• � 7 ANT ,r:',, r
r i;. . y :;7.i - em u+' =w , ';: i <' =:.? �rilae- us.::> �t'h, >•_, -. t,,; ss•..:sif � ".� .y._� <,.,r.�a ter., ,.v' (:.n {:a'r.:. - >.5.•I R:aa:t
`' i'' ,
" " `" Ejectors /sump 16.60
Name: " tpvc - 2, J 4C� c ril Mall r h9 (AP
q�� ( �] . 5?-4 � � l Expansion tank 16.60
Address: '�o .. (�j/ �,`e (,���,1. �� +..J a--- � � � t,..(..� Fixture /sewer cap 16.60
City/State/ZIP: `C , _ G ?) Floor drain /floor sink/hub 16.60
Phone: j)) . %7 •-+ 7 Fax: (a) ?� Garbage disposal 16.60
- _.,�: �, :..is. - _ 5 {i i:l .; �e ,�..., ',. :.'fry - - - � :�?n�:R:,i•,eCiF'd'�i';xe A4'r i,
i . , ;',�:�. f ;.T: >, ,, - t^'i „ V r, :, :__' . '; �.r I : i ' Hose btb 16.60
., - J'.'... i'.k�: "'.`�. a?:�� �� . i��;x,.r. ,. t' =•� ,<a �"', :s,ii:Yk `.i >�a� i� ' r � >e "Ctk: - i
., ,. � s v;. :rA$ IC AIVT •.t, .:+. ; ,,, . .GQNTAG -:: ,ER OBE} z .,��,>fit,
.,..,,r,...,.,_.•_ .., x.- i,�ss.a3 �.r =' ,,., ::rxxa,::,as.,>_,'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: ( ) I Fax:: ( ) Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
- - '_ '.i3!:. k'G)S': gal:. - nF•uri r.t.:;� ;.�k:� _ - °':i`4�'eP..s
t
'�• =. < _- t .�'"> -1�` tt-
, ,, , L. ,, ,-,,: - . , : - ::::: .._._,...... •. �- � , :,,: ,w� ... Water closet 16.60
Business name V . `, ' e ` '� � \O Y ...- "' ._.._.. Water heater 16.60
Address: '40 ' . Y . . Other:
City /State /ZIP: Subtotal
i , ( M i nimum permit fee: $72.50
' Phone: ) ) � 5/ Fax: ( ) Residential backflow minimum permit fee: $36.25
^rnmbin L ic. no.: Plan review (25% of permit fee)
CCB Lic.:
1006-74.1.--) ` ip g 7 -4 Authorized d signature State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: ,. N.--1 `� , � 1'v Date: c9 /f `G 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.
1:\ B01lding \Permit \
s PLM- PermitApp.doc 12/03 4 40-4 61 6T( 1 0/02/C0 M/ WEB)
.
Mechanical Permit Application - FOR OFFICE USE•ONLV .: f',- •-
City of;:Tigard Date/Bed Permit No.:
13`125 SW Hall Blvd., Tigard, OR 97223 y' �. >����� dDD d
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 kao„A•i e, Date/By: Other Permit:
Inspection Line: 503.639.4175 i 6'I1 1
Internet: www.ci.tigard.or.us Notifie od: lens: Supplemental Information
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❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work . r.
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New construction ion /replacem
✓ performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
„ si °i h' " Value:
i' '.�., lt 'C A GO OF . �iCONST ,RUCTION's " ;•.,, . .G , '.r
;Cr';RESIDENTPALEQUIPMENT' Y TEM ,F. E * rt'=
CI 1- and 2 - family dwelling ❑ Commercial /industrial 111 Accessory building '
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
: r x,,, •JOB:,SITE: >INEO ATIONiAND " '''
- >t.,. ,�•�: - > t, Heating/cooling
• Job site address: 2 I i �(� DC Air conditioning or heat pump
J �rPP,►� Q / l „ X (requires site plan showing placement) 14.00
City /State /ZIP: I� 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
Subdivision: `l� Lot no.: (,� Flue /vent for any of above 10.00
C`( t 1Cu w Other: 10.00
Tax map /parcel no.: J Other fuel appliances
nt` - ,. �¢:. -':..t.,, .n =':�(<xl'Y:= - ';9,t ..},;;;
iti - - '!'j':. ti' tTZl ` ".1':iY•. v;hq;.” :a:;
x:Y'!?' %f:' _ "a �ik. �'J...
, �:xf�. ���� ��= i �' a..z . �x;.:.. �.�.i Water heater
°;zip . '� G , �:._ r:(�:- �•x � =er 10.00
: = ?DDSCRI�PZtIO `.O . .WO r >, , ,-,•
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.. ;vSi_ - t'.rv rhrv. r.>1Yt c,.t. � > ,. .v. _ ? naEy�I..x :tip " ,. . -M .,
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
..,,'.:x ;: r >s , Chimne /liner /flue /vent 10.00
a4 t. = r
PRO PER '' , fit. - :: r:. ".;;g.` :. 'f: �, �. . ,.�,. _, :,..1=,u
.. TI'� y .- � °� x:.,s':��, >:.,:.❑ „TENANT ,F,,,,.;�• ,� , '�.,,,
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Name: A r �
`�i�`�!v►'ilE'., �. -� /C Environmental exhaust and ventilation
Address: barn, � -. ! /� . I. Range hood /other kitchen
( ��- equipment 10.00
City /State/ZIP: 7 ( I c J q ''-)C) Clothes dryer exhaust 10.00
e ( Single -duct exhaust (bathrooms,
Phone: `� � Fax: ( � ( toilet compartments, utility rooms) 6.80
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e:. : •..�,s ,; a .<, �scty :;:n;, �z ^;'a '4h'ds'i !` ^ -isdt” �i „.:,,s xx's-car, "a ,, . ts: a•- tx•: s ;v:;:•'..,;u��..rt-a: =a :- . <.�'
_:: ; _ "{ ®:i:APPI,,, „ ,•,r : i ii!V I _,; - w. sin ,; ",r, t P . Attic/crawlspace fans 10.00
..:. CANT . ��,., ,• °t,<< ,s,. '3isrsa,,�J . �❑r.GOLVII'ACT..P RSO ka' �.�� ;�f) 3a P
.,: - .���. ..,,a „:, .- -,:..� - _�.:,.��:^ ,t_hi. ":S.ta.' �G:,.._ . r.. ��= t � _.. >..�.a, ��A?x�`.<,��`. ,�,�va,,,4�� "rs.:. '?4
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
u 44 CONTRACT OR ' ' " i i 'i Barbecue
Business name: (lab a r- d ( p%� i° / 9 Clothes dryer (gas)
vt L ��f (�� Other:
Address: /"� ;:="» it fi{' : S :. ::A.': : * ft.` s .:.. _,
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City /State /ZIP: �� �/�� Subtotal
Y `
1 Minimum permit fee ($72.50)
Phone: 5 ' �'J Fax: ( ) Plan review (25% of permit fee)
CCB lie.: 5�� rr ') ) ' — State surcharge (8% of permit fee)
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: ' ! \ p ( ote.A. 6 Date: l i .F) 1 * Fee methodology set by Tri- County Building Industry Service Board
` 1: \Building \Permits \MEC- PennitApp.doc 12/03 440 -4617T (11 /02 /COM /WEB)
Electrical Permit A lica • V ' ,FOROFFICE USE ONLY 4 . � -
City of Tigard Received Permit \o. / /
Y g Date /By. \ 5 ' c� - �O a D I
13125 SW Hall Blvd , Tigard, OR 97223 I
Res,e..
Phone: 503.639.4171 Fax 503.598 1960 MAY 0 9 1ivii Oder Penmr
Inspection Line: 503.639.4175 � ! I� Date/By
Date Ready /By Juris El See Page 2 for
Internet www.ci.tigard.orus CITY OF '� �yotilied'\letltod• (' ' - 05 I 'r) f I Supplemental Inlornmtion
TYPE Miltra G DiVi804 PLAN REVIEW
'New construction ❑ Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ❑ Service over 225 amps, comm'I ❑ Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10.000 sq II .
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more nest iesidentiai
I I- and 2 family dwelling ❑ 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
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑ Egress /lighting plan RV park
3 Q ❑Health -care facthty ❑Other'.
Job no.: O Job site address: ``
M �w YHlD ft4stp bk Submit 2 sets of plans with any of the above
City /State /ZIP: J ,� � J 0 Q . q �1 �7' The above are not applicable to temporary construction service
1 vvvlll / I G FEE* SCHEDULE
Suite /bldg. /apt. no.: Project name: ., / i
f7N / t sil Crnr 1 Mlnill W3 Description Qty. Fee. Total
Cross street directions to job site: 6 _/1 �, ,„ 2 d e 'New residential single - or multi- family dwelling unit.
L7G�[1� Includes attached garage.
1,000 sq ft. or less 145.15 4
Subdivision: S • / • Lot no Ea. add'l 500 sq. ft. or portion 33.40 I
..i ` e - Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00
DESCRIPTION OF WORK Each manufactured or modular
/ dwelling, service and /or feeder 90.90 2
G 1 1,0 ✓SF. I'1J//Z //Illr Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30
PROPERTY OWNER 201 amps to 400 amps 106.85 I 2
iiir ❑ TENANT
401 amps to 600 amps 160.60 2 •
Name: 0 0 „ I J l/ 1 eri 5 5 601 amps to 1,000 amps 240 60 2
troV Address: !/ /V Y23 0 G 4 L�wao rri 5u, 146
Over 1,000 amps or volts 454.65 '-
Reconnect only 66.85
City /State /ZIP: L441 c (53e1) O R , 9 ", 03,s Temporary services or feeders installation, alteration, and /or
Phone: (503 ) 3 b,•7 _ ? Fax: (5 03) 7 & 1� relocation
200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I 0 30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133 75
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
Business name: I 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)
Pump or in circle 53.40 2
Phone: ( ) Fax: : ( ) -
Sign or outline lighting 53 40 '_
E - mail: Signal circuit(s) or limited -
CONTRACTOR . energy panel, alteration, or
- extension. Describe Page 2
Business name: it
Address: �. �� / 3
/ D Each additional inspection o ver allowable in any of the above
Jf t Per inspection 62 50 I 1
City /State /ZIP: k , ,�� ,- n./' 0e. 7 77 Investigation per hour It hr min) 62.50
Phone: ( 5z3) 3� _ e�`2- Fax: ( s�i / -�s �R.G fS ` Industrial plant per hour 73 75
v J ELECTRICAL PERMIT FEES*
CCB Lic.: 2 E lectrical Lic.: p Suprv. Lic.:
3 (,� 2 2. �— P3 � Su p X33 5 Subtotal
Suprv. Electrician signature, required: Plan review (25' %, of permit fee)
Print name: / State surcharge (S` %, ufpermit fee)
i
�A/ 4/ e Sti 60.4 Al Date: J r' s)' (��
TOTAL PERMIT FEE l
Authorized SIgn3[tfe' T his permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: Date: " Fee methodology set by Tri- Couniv Building Industry sers ace 13nard
"" Number of inspections per permit allowed
i A Building `. Permits \ELC- Permn.App doe 12:03 140.45 I OTi 10 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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener* •
n Heating, Ventilation and Air Conditioning,
System*
Vacuum Systems*
n Other: • • - •
COMMERCIAL WORK ONLY: •
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
I j Audio and Stereo Systems
n Boiler Controls .
n Clock Systems
❑ Data Telecommunication Installation
7 Fire Alarm Installation
❑ HVAC
7 Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
Ti •
-
Nurse Calls
Ti Outdoor Landscape Lighting*
Protective Signaling
7 Other •
Total number of commercial systems: . • ,
*No licenses are required. Licenses are required
for all other installations
\Building\Perrnits \ELC- PermuApp dot: 04 /03
/ 7 0-6-70,/ �,
AAA, < , AAA ,• .F, AAA 1 , A AAA A '
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STREET T'R
CERTIFICATION .. ..
t A a ,
I, ,g&A /GC ��' J fg-7C , / for /I N .v /.c re Co PLEASE P
(PLEAS PRINT ) / 3 t F (PERMIT HOLDER)
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� Do hereb �'' � _, ,� � F � t _ ;a. 5
y: c MA:3 r th t�� o f ol location
meets ty> ofµTgar
� _• -�w d %as�h��n ton County
land use and development standards for street tree installation. PA-
I
® AD DRESS: �S /� S� 62 �'� '�= 1�t.1> pg.,,
LOT: 0 SUBDIVISION: glt m hA.' Air p
BY: .r DATE: 7 —/B - 5
.. dir, l Fry
1 RECEIVED BY: DATE: P liti
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�
CITY OF TIGARC . ,
BUILDING DIVISION PERMIT #: MST2005 -00061
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/4/2006
Phone: (503) 639 - 4171 ° '��u/ Vl�I,
Inspection Requests (24 Hrs.): (503) 639 -4175 !�
• t INSPECTION WORKSHEET FOR DATE: 7/15/2005 TIME: 7 :11AM PAGE: 55
SITE ADDRESS: 15316 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 026 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF. 6/14/05, ADDING GAS FIREPLACE AND GAS PIPING.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503- 387 -7538
CONTRACTOR: DON MORISSEI I E COMMUNITIES LLC PHONE #: 503.387 -7538
r,
Inspection Request Scheduled For: Date: 7/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 011504 -04 503- 209.4837 N
Corrections /Comments / Instructions:
•
\K"i PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 . Date: ' Phone #: (503) 718-
1 •
I t
CflOF TIGARD
,
BUILDING DIVISION
,
PERMIT #: MST2005-00061
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/4/2006
/ Phone: (503) 639-4171 ',wit/14111 j
Inspection Requests (24 Hrs.): (503) 639-4175 ,A '11.
INSPECTION WORKSHEET FOR DATE: 7/15/2005 TIME: 7:11AM PAGE: 56
SITE ADDRESS: 15316 SW GREENFIELD DR • CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 026 TYPE OF USE:
PROJECT NAME SUMMIT RIDGE
DESCRIPTION: New SF. 6/14/05, ADDING GAS FIREPLACE AND GAS PIPING.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 603_3074636
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503-387-7638
Inspection Request Scheduled For: Date: 7/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 011504-03 503-209-4837 N
Corrections/Comments/Instructions:
•
I4 PASS El PARTIAL APPROVAL 0 CANCEL El NO ACCESS
l] FAIL 0 CALL FOR INSPECTION I11 ADDITIONAL FEES ASSESSED
Inspector: ---' k)(18(....- Date: 1 1 I 05 ---.. Phone #: (503) 718-1I-9ift
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005 -00061
• 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4f4J2005 "ai
Phone: (503) 639 -4171 ' i til ff
Inspection Requests (24 Hrs.): (503) 639 -4175 J.
INSPECTION WORKSHEET FOR DATE: 7/19/2005 TIME: 7:08AM PAGE: 74
SITE ADDRESS: 15316 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 026 TYPE OF USE: •
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF. 6/14/05, ADDING GAS FIREPLACE AND GAS PIPING.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503.387 -7538
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503 - 387 -7538
Inspection Request Scheduled For: Date: 7/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 011688-02 503-209-4837 N
Corrections /Comments /Instructions:
`Z- ( did )7 1, 6g‘) xSuc ‘
,_O �`' F, _C�"�Z_r
•
IV PASS pi - ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL /4 CA FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /v ° S Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST200500061
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/4/2005
Phone: (503) 639 -4171 �A /01011
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/19/2005 TIME: 7 :08AM PAGE: 73
SITE ADDRESS: 15316 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 026 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF. 6/14/05, ADDING GAS FIREPLACE AND GAS PIPING.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 50.387_7538
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 5Q3 -387 -7538
Inspection Request Scheduled For: Date: 7/19/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 011688 -03 603-209-4837 N
Corrections /Comments /Instruct sns: -
' �
. clr: .
1 PASS IV PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL y LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Aillitii0 Inspector: _ Date: 7 /'' Phone #: (503) 718-