Permit CITY OF T I GA R D MASTER PERMIT
PERMIT #: MST2003 -00511
, A A, D EVELOPMENT SERVICES DATE ISSUED: 11/10/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13705 SW HATHAWAY TERR PARCEL: 2S103CC -07900
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 026 JURISDICTION: TIG
REMARKS: New SF detached
BUILDING
REISSUE: DM199 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,610 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,730 sf GARAGE: 630 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT: 5
VALUE: 326,232.40
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,340 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: BOIL/CMP < 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: 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 FD R: 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: EAADDL 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: $ 5,741.33
This permit
DON MORISSETTE HOMES DON MORISSETTE HOMES INC Mu is subject to the regulations contained C o i the
Ti
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 all Tigard other Municipal e law State work O Specialty Codes odes and
al
STE 100 LAKE OSWEGO, OR 97035 l other applicable laws. All work will be done i
accordance with approved plans. This permit will expire if
LAKE OSWEGO, OR 97035 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 adopted by the
Phone: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
5 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: BP 3 87 3 7 5 58 may obtain copies of these rules or direct questions to
1 - i OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Rain drain Insp Electrical Final
Issued By : ).��.:24. a/e- -X,5.is �.1/.-- Permittee Signature : Amid .
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
. - ,. Building T ) 1 1 - G -0 3 Ski' .a0 0037
Qa. ��/� � Application Y� ®� y'n^tfF� •'t:, C „; a ' "� 4". ^'.f ; 5:t.....' i S . 5 .:*X.i."L 1+-"sC e
iii Date received: 0 a 03 Permit no ' sra p vo 3-11
-, ;. " City of Tigard ��e
-`-'� =', -�!j Project/appl. no.: / Expire date:
Address: 13125 SW Hall Blvd, Tigard, OIL•2 �t
City of Tigard �
Phone: (503) 639 -4171 Op I d �® Date issued: By: Receiptno.:
Fax: (503) 598 -1960
7 Case file no.: Payment type:
Land use approval: a iT ) -- 1 '('0 1 &2 family: Simple Complex:
TYPE OF " PERMIT , ,; . .x ':
❑ 1 & 2 family dwelling or accessory ❑ Comercial/induS
m al ❑ Multi- family ,'New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other.
,A g , i - , _ SFJOB SI TE-INFORIIt'ATI - . `' `-' W i' `1 &
Job address: I f - A , 7 ‘ Bldg. no.: Suite no.:
Lot: 9-C/ Block: 'Subdivision: , ( c I Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions: 6 G -1 4-J D
i4"' w OWNER . --: ,, '7 FOR CIAL SPE INFORMAT1ON,rUSE CI•IECKLIST
` , . g.. . 0 xz X 1= 1 ;
Name: ' '( '- F a 4.., �l ,�` Flood Iam4rs ticea tacit s'"solar; ,,z-, .. k,:.
Mailing address: Ti W• . /,,(A) MIZZIE 1 & 2 family dwelling:
City: ; , , State ZIP: 1'x). , 2 Valuation of work $
Phone:. "7- 7 Fax: -mail: No. of bedrooms/baths - c= l /
'Owner's representative: L f- l' Gck {ILK:- Total number of floors r
Phone: Fax: E -mail: New dwelling area (sq. ft.) / ` P
k k .s'e t ,P'`° ; '', .. , `,' t =s-, ._. { Garage's .rpOr area (Sq. ft.)
- Name: � on L i �. .
, - J ,- ' ; ��
Covered porch area (sq. ft.)
-'�
Mailing address: ',r J a3 a. t., Deck area (sq. ft.)
City: I State: ZIP: Other structure area (sq. ft.) •
Phone: Fax: E -mail: Commercial/industrial /multi- family:
. ° Z 1,.,5 , 'CONTRACTOR , Valuation of work $
i Existing bldg. area (sq. ft.)
Business name:
�/ n I New bldg. area (sq. ft.)
Address: ia.. RAIL_
Number of stories
City: State: Type of construction •
Phone: I Fax: I E -mail:
CCB no.: :?j ` c �j Occupancy group(s): Existing:
New:
City /metro lic no.: Notice: All contractors and subcontractors are required to be
00 :'t a ` t,M ' TECT /D N NER iii, -, , � 5 licensed with the Oregon Construction Contractors Board under
(..
Name: (-lett .t.- , f . provisions of ORS 701 and may be required to be licensed in the
Address: �'� CL/ c- jurisdiction where work is being performed. If the applicant is
City: State: I ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
Name: Contact person: Fees due upon application $
Address: Date received:
City: 'State: IZ1P: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A .rovisions of 1a and o dinances governing this ❑ Visa 0 MasterCard
P`��
work will be comply wi.., whether Sb ciflesi liereInrttot. te /l" Credit card number: / /
�/� V11...---1 Expires
Authorized s!atu i..\ \ , i ® t7k,1 •t,. e Name of cardholder as shown on credit card $
Print Pair. __1 /7'', , ._ • +Zf ;t7 { 1 ..K, Cardholder signature Amount
Notice: This 'e mi"r. dciica ion expires if a ; a:. -.it is riot obuiiited will: 7 123 days after it has been accepted as complete. 440 -4613 (6ro0/COM)
One- and Two - Family Dwelling
1u g 4 ceding Permit Application Checklist Reference no.:
Associated permits:
City ofTigard Cl of Tigard J g ❑ Electrical 0 Plumbing D Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 D Other:
Phone: (503) 639 -4171 `
Fax: (503) 598 -1960
THE TOLLOWING iTEMS�-ARE� REQUIRED'',FOR PL'�AN V ` Yes No ,N /A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
4
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control D plan D permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed r/
if copyright violations exist. •
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property comer elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ff intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot /
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation. JX\
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
)<"
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. �(
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL'SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28 •
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614 (600 /COM)
Mechanical Permit Applica eived: Per ?' r .. " < F M b '
Date recmit no.: ;)C�, Y
r"` -' ' ` I City of Tigard �1,j: �•� � ty g ; - � D ProjecUappl. no.: Expire date:
City i Address: 13125 SW Hall Blv t �> /,ts.
rY f Tigard Date issued: By: Receipt no,:
Phone: (503) 639 -4171
•
Fax: (503) 598 -1960 OCT 21 2003 Case file no.: Payment type:
Land use approval: Building perm;[ no. •
TIME OF PERMIT- , ,
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement ,
, New construction 0 Addition/alteration /replacement 0 Other.
~ rtt °; V. ; { ' 'ry ; JOB;SITEINFORMATION° -1 .: 4 -: nr , c,OM1�iERCIAI: ,VAI:UATION iSCHEDULEw,t,1y ^*'-yx;,
s
. Job address: 7S 9f A / ff f ia= Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: 09 Block: 1 Subdivision: 1 ` `See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: 1 ' & FAMIL Y 1 DWVELLINGPERMIT� ,,FEE 1r
Description and location of work on remises: _ ` A1�1D{ CQ IVIMERICAi: 1i NUSTRIA L� EQIIII '�MESITSCIIEDULE
. Fee (ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
•
Is existing space heated or conditioned? 0 Yes 0 No Air handling unit CFM
space insulated? 0 Yes 0 No
Air conditioning (site plan required) •
Is existing p Alteration of existing HVAC system
'.-,10,1.e- *era, .. M - -:.: 'N,,, 4 l ' s CnN l RAC,TOR: l , r . t ,1 : Boiler /compressors ■
k 1
f txtx2�ar4 4 d .r rn.�t1 State boiler permit no.:
Business name: �� a�,.�► _ HP Tons BTU /H
Address: irdErstb Fire/smoke dampers/duct smoke detectors •
City : M t ra r a ZIP: eil,r a Heat pump (site plan required)
InstalUreplacefurnacelburner BTU /H
Phone:.�J . ' Fax: E -mail:
c � Including ductwork/vent liner 0 Yes 0 No
CCB no.: ?--),9L Install/replace/relocate heaters — suspended,
City/metro lic. no.: N/A wall, or floor mounted
( p print): R ^ , , j . Vent for appliance other than furnace
Name (please not = �L.: t�? 1 ���-� ---• ,
' CQNTr1C ('� I'LKSON , �' 1 ��
: , . Ab s r ption u nits BTU/H
ni ■
fi� >�s,.r � ;„',�,, �.,r,, .a�<...c.... +. �j. d Absorption u
Name: tw � . Chillers HP
Address: Compressors HP
a4_ 4 6 �t Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
I Phone: I Fax: E - mail: Dryer exhaust
I � .: - s, Type 1/11/res. kit tem
hen/h
azmat
Hood
,, ° hood fire suppression system
_�.ir► �B� � . Exhaust fan with single duct (bath fans) .
Mailin g address: w j� '���1 ri Exhaust system apart from heating or AC
°��"�"`�`" Fuel piping and d (up to 4 outlets)
City: State ZIPGl -- )/)s
Type: LPG NG Oil
Phone: . A E - mail: Fuel piping each additional over 4 outlets
a w k :. R Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: 1ZIP: Insert — type
Phone: Fax: E - mail: Woodstove/
� Other:
. 4E :���
Applicant's signatu "', ��- Date: 7 MOM Other.
Name (print): , .
. Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application Minimum fee $
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / / Plan review (at _ %) $ •
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
s TOTAL $
Cardholder signature Amount 440 -4617 (600/COM)
r t ' yM1 y
P lumbing Permit Application : r � : .: .$ s a A. M t 3 k .IA�t� , k � 4
b
Date received: Permit n011 „' _... < 5 0
z City of Tigard
Address: 13125 SW Hal BI V D Sewer pernvt no.: Building permit no.:
City o f Ti Phone: (503) 639 -4171 Projectiappl. no.: Expire date:
Fax: (503) 598 -1960 OCT 21 2003 Date issued: By: Receiptno.:
Land use approval: Case file no.: Payment type:
'' .
(..11 F TIGARD
r .
Cl, 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
' New construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOB SITEINEORMATION - . - FEE SCHEDULE (for special infarmation use checklist)
Job address: t
Description I Qty. I Fee(ea.) Total
, -- 7, 11\1 IL�V - L.'_ a� 1r " _4 '
New 1- and 2- family dwellings only:
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot_ i Block: Subdivision: llLgi / SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each addiuonal bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Esi date of completion/inspection: Drywells/leach line/trench drain I
_. - . Footing drain (no. lin. ft.)
. PLU IIIING -' CUNT1ZACTOR Manufactured home utilities
Business name: ` 7 ( L rr Manholes
Address: ��b11111`J._, Rain drain connector 111111
State ZIP: Sanitary sewer (no. lin. ft.) -S MI
-v� Storm sewer (no. tin. ft) --
• one:�� Fax: E-mail: .p Water service (no. lin. ft.)
CCB no.: [ �* - 7 l.. 1 Plumb. bus. reg. no: '�-
Fixture or item:
City/metro lic. no.: N/A / Absorption valve
II
• Contractors representative signature � Back tlow preventer
Prim Pri name I /
w Backwater valve __
is ° t (' O`1 AC 1 Pt RSC)N.- r� ,'._ E ,,t. . Basins/lavatory -
";" Clothes washer
Name: - .1 . ■ ' i ,_1E Dishwasher
Address: " 1a4k i 0 0 , ,N Drinking fountain(s)
City: I State: Ejectors/sump
Phone: Fax: Expansion tank
.. gyp 4 0WM It Fixture/sewer cap IIIII
Floor drains/floor sinks/hub IIII
Name (print): _ It < i )' ;, Garbage dispos =
Mailing address: 4 4;.?-2--r ) (-1 P rev • 1 • ' Hose bibb =
City: L,. l State la Ice maker _
I Phone: J , - , I Fax: lifflfgriglIE Interceptor /grease trap 111111
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property 1 own as per ORS Chapter 447. Sink(s), basin(s). lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City 1 State: I ZIP: Other.
Phone: I Fax: • I E -mail: 'Total
Minimum fee ................ $
Na all jurisdictions accept credit cards. please call jurisdiction for more information. Notice: This permit application $
C Visa titistc Card / expires if a permit is not obtained Plan review (at _ `fie) State surcharge (8 %) •••• $ �-
C.edit card numtxr. ( 1 within 130 days after it has b
Expires TOTAL S ----'
accepted as complete.
Name of cardholder as shown oa credit card
s
440- l6 (600.CO M)
■ Cardholder signature Amount
. • • • o §? k t ztk x`t Y *v _ q+ r a AQ� s Y h
Electrical Per Ap ,, esf tr � 3 ,. , �r� . =� tip,
Date received: Permit no.: _Ate — 665/
_„7, 'i , City of Tigard RECEIVE®
Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 OCT 21 2003
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: CITY QF TIGARD
,' r k ,{"_ „ S :..V.0 - • t - '$. ',. r' -1 1.4 ''' -. rte 'ik'Y eu %rl }
1 k
1 `�" ' ` ;TYPE OF'PERINTT „ _ . ,, , _,., - 1 .� r ; ; `
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
■• New construction ❑ / . AN Addition/alteration/replacement CI Other. 6 El Partial
1 4 .' ''',t4404' k rtil u ",�^'''- €c'L . ,..w y {J,+`Wx^, i ier lSN ORMTTIOY�' ' >1� '�i'r . + 2.+F •' 3 i+;,f ..A.rRr —'- f ],-ik ''„ _,�:.
�^{ � . y"'..'if4._ .K�t'��t .x''Fl £11'.{i4•`�:��� Yf�� F�f"�I°,:! .Yi- I-. - ,� __rk�1,.: ., Y�'?.5 : -. :
Job address: t ,A �/� L �, ► 1 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: .1 Block: Subdivision: W
Project name: Description and location of work on premises:
Estimated date of completion/inspection: �C� Cf7��T�T*
"k` { "-»� $ v a x i. } `� 3 > .,,+tt x 4 a1 . t , t*. .Y• .- °P, ,� tr irEL• ,.SCHEDU "� i +ir� .,� r ,;;
�,:,,,, , ��� , ���'1 "r.�' :�,�C()Ntf It�1C�tN;11ti`l�f 1•t'tC�rii�ICONt , � �•� „t , ��e; �+ ,.,.. � ' �.
Job no: «4 f Fee Max
IF
Business name: ....„ ./ Description Qty. (ea.) Total no. hasp
� -� 1 New residential -single or multi-family per
Address: ina fp �L /tt dwelling mit Includes attached garage.
Tip Service included:
Phone: ! - , 1 i j Fax: E -mail: 1000 sq. ft. or less
Each additional 500 sq. ft _
or portion thereof __—
CCB no.: Elec. bus. lic. no: or Limited energy, residential ___ 2
C Limited energy, non- residential ___ 2
Each manufactured home or modular dwelling ■■.
nature of supervising electrician (required) Date yr imam Service and/or feeder 2
�
, Services or feeders— installation,
t
Sup elect. name (print) - ti1 License no' ap 1 �' alteration or relocation:
`• e ' ' ; , PROPER "fY - 'Oi'§i k :- ''�',A- °' 200 amps or less 2
• 201 amps to 400 amps ME__ 2
Name (print): ��� A 401 amps to 600 amps ___ 2 • Mailing address: ill W. �� 601 amps to 1000 amps __ ' 2
City: . • , Vii'+ ZIP: IMO
�� Over 1000 amps or volts ___ 2
Phone: , le I ll rATRIM21 Reconnect 1
Owner installation: The installation is being made otgproperty [ s own Tempo n,alt services or , orrel - 1111111.11111111 _
2
which is not intended for sale, lease, rent, or exchange accordin g to tastallatiolterationorrelocation:
200 amps or less
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps _ 2
Owner's signature: Date: 401 to 600 amps MEM_ 2
ENGINEER , _} '• Branch circuits - new, alteration,
or extension per panel:
Name: A Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E - mail: Each additional branch circuit: •__—
94:' PLAN REVIEW (Please check all. that apply) • ` Misc. (Service or feeder not included): ■■
❑ Service over 225 amps- commercial ❑ Health-care facility Each pump or irrigation circle 2
n
❑ Service over 320 amps - rating of 18c2 ❑ Hazardous location Each sign or outline lighting a :: 2
2
family dwellings ❑Building Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension
❑ Building over three stories ❑ Feeders, 400 amps or more 'Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection __ _—
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
-
Cardholder signature Amount 440-4615 (6A0/COM)
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I 6 _ R >� _ - , Owner / Agent for D o Wi cr /. 'rri,�' ri?�S •
(PERMIT BOLDER) (PLEA S
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A Do hereby cei=ti[y that the following location d ■
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►
, meets City of 1- tgard /Washington County p ■
4 land use anicl development standards for street tree installation. ►
AD DRESS: / 7b S 7 Mt''`)/1 - k , i‘-g..Z, ■
® 2, to SUBDIVISION: W 5 oo 5 0/41/ C
LOT:
D ATE: 3 '/ D 0'7 ■
A BY:
® RECEIVED BY: DATE: __� —/ 0 - dj� ■
RE
CITY OF TIGARD _ 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 eV 3 _ Do
INSPECTION DIVISION Business Line: (503) 639 -4171
�/r � 3/7/64/ BUP
Received /7 l• 2�,0
`t" Date Requested AM PM BUP
Location 13 70 S Al Suite MEC
Contact Person Ph ( ) 02g ? 4 12737 ELM
Contractor OM Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
P PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service •
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA � �//
Approach/Sidewalk Dat - � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
• BUILDING Inspection Line: (503) 639 -4175 3 — 07) 61/
INSPECTION DIVISION Business Line: (503) 639 -4171
�� BUP
Received 3 /v `7 I ZID e Requested ) ,V11/1),./ AM PM BUP
Location / 3 7 ) _ ce74 _Gt,titf Suite MEC
Aof
Contact Person . 416 / Ph ( 0 ) (2 0 9 —46E3 7 PLM
Contractor 4 1 ". Ph ( ) SWR
BUILDING 72 Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear •
Int Sheath /Shear
Framing
Insulation '
L✓L as ` -6 5 ' It I l .
Drywall Nailing •
Firewall .
Fire Sprinkler
, Fire Alarm
Susp'd Ceiling
Roof
Ot
' inal
SS PART FAIL
P NG
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole •
Storm Drain .
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS P FAIL
ECT,, IC
Service
Rough -In
/ UG /Slab •
Low Voltage
Fire Alarm
PART FAIL
0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line r CT N c Q LE _
ADA
Approach/Sidewalk Date 3 1 t � ' f O L Inspector 2 , v Ext
Other: I
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL