Permit CITY OF TIGARD MASTER PERMIT
1 PERMIT #: MST2003 -00358
I DEVELOPMENT SERVICES DATE ISSUED: 8/7/03
'� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13625 SW HATHAWAY TERR PARCEL: 2S103CC -07500
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 022 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: DM139 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1,777 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: V
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,173 sf GARAGE: 465 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 283
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,950 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 0 RAIN DRAIN: ,001 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 4 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 FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 5 201 - 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: $ 5,386.63
This permit is subject to the regulations contained in the
DON MORISSETTE HOMES INC DON MORISSETTE HOMES INC Tigard Municipal Code, State of OR. Specialty Codes and
4230 GALEWOOD STE #100 4230 GALEWOOD ST, STE 100 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 adopted by the
Phone: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 -001 -0010 through 952 - 001 -0080. You
Reg #: i may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 84 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins F Gyp Board Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final
/ // i Permittee Signature ISI,jpi
Issued By : ��/.�4_ �.11� ilF
� _ 9
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
■
Pr - 7 - - & 3 To Y - M
i ll
1 . 4 . ) i 2 2003 — 00 28 ?
Building Permit Application . -
Date received: '7 ® p.3 Permit no.
, 4“ . :4 1 ' City of Tigard 1
._ � rf� � rte ® Project/appl. no.: Exp re date:
City of Tigard Address: 13125 SW Hall a ral �, . 1 f :
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 5984960 L.'. Uui• Case file no.: Payment e
IlAilj L 1 At iiiir ' y :
Land use approval: ., " __� ►rte,[...,,; 1 &2 family: Simple Complex: ��
. , r;,- ,4 er :, #.„h :�`tr :: `` ., .;- .,. l. F. ,' ,' i'k' ,r -OL 1'_EIU I {''.; A � � ,., ` , . : ,'`: ' . 5+ ; ik ., :
El 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family j 'New construction 0 Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement 0 Fire sprinkler /alarm ❑ Other. .
JO 'N;� -.� .a IATIOs r:_• ` ids.".. ..°Y` °";i'
Job address: A ,, 'r A M A / k „ ..4. ' Bldg. no.: Suite no.:
Lot: iym Block: Subdivision: " Wag Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions: ji
f . . OWVN111 I Olt SPECIAL INFORMATION, USE .CHECKLISI' .
g " , '' �- i -, 5 .; - , (Tloodplaii , septic capacity, solar, etc.) .' ' '
Mailing address: j e laT M�,. i 1 & 2 family dwelling: ..,93 67/. Si'
IIEFAINIER N ZIP: - 'x)- Val Valuation of work $ _ Pil
Phone:. it �J OISM No. of bedrooms/baths
Owner's' representative: , . its Mr ( _ Total number of floors ,��.,
Phone: Fax: E -mail: New dwelling area (sq. ft.) ili
, . 4 � APPLICANT.. ;. , : .,,..6... , . Garage/carport area (sq. ft.)
N MJl��i� Covered porch area (sq. ft.)
Mailing address: A �, a _ Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: q' 6;.— Fax: E -mail: Commercial /industriaUmulti- family:
_• "CONTRACTOR 1 x : `., . Valuation of work $
IMMETIR /_'' rlfillil_: ;► IN Existing bldg. area (sq. ft.)-
Address: ,�v`i i New bldg. area (sq. ft.)
C
Number of stories
City: State: ZIP:
Phone: I Fax: I E -mail: Type of construction
CCB no.: 5 Occupancy group( Existing:
New:
ii
t, /metro lic. no.: Notice: All contractors and subcontractors are required to be
°, 'ARCIIC /DESIGNER . " "
,..`.���� , � . T,,� ,,.. ' . licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
Address: _ ,L i C 4 r �� ' jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
'-'41.. Address: Date received:
City: (State: IZIP: 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 l ws and o dinances governing this ❑ Visa ❑ MasterCard
"'ork will be complied wt.', whether cified iIereii r tot. I i Credit card number: / /
Expires
Authorized si: atu , ' / /� �- ' ! i it 6: Name of cardholder as shown on credit card
Print name: Sri i ' - • 'f " Z ,- I ( -K.-- Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 44O -4613 (6/00/COM)
One- and Two - Family Dwelling
, Building Permit Application Checklist Reference no.:
•
City of Tigard City Tigard N 4�' z t
Associated permits:
`J b ' 0 Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, 04 97223 0 Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 •
: THE ,POLLOWING ITEMS ARE''REQUIRED FOR PLAN REVIEW
1 Land use actions completed. See jurisdiction criteria for cod'current reviews. _ • v .L
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
4 Fire district approval required. X
5 Septic system permit or authorization for remodel. Existing system capacity }t
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 0 plan 0 permit required. Include drainage -way protection, silt fence design and location of ``
catch -basin protection, etc. J�
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. J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot x
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.
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. x
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 ". X..
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 (6ro0/COM)
•
Mechanical Permit Application , ,,; ' y,; ;, • • ` r , . f : • • Date received: Permit no.: , 1 03_00
' ' I'I� Ci of Ti and
: ty g CEIVE® Dat e receiv .no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 - •
Phone: (503) 639 -4171 f UL 1 100 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 CITY L Case file no.: Payment type:
TIGARD
Land use approval: BUl1DINQ OF D VIStQ Building permit no.:
:: TYPE OF�'PERMIT , w . ,
r. R.A•kw�n t 4Cq� 4 i n R , ? .‘1 , -.... F .1,.--,!'s : -. 5 !.. r 4.
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement -
,New construction ❑ Addition/alteration/replacement ❑ Other.
- f `" '' 'JOB'SITEINFORMATION . " "' - '''' - • ' 9 ' COMMERCIAL ' VALUATION SCHEDULE" ''''
. Job address: 4 , 0 771 W 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: m Block: Subdivision: c ram *See checklist for important application information and
Project name: A/A 1, jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: 1 & 2 FAMILY DWELLING PERMIT 'FEE SCHEDULE;'
Description and location of work on premises: AND COt 1II1' IERICALIINDUSTRIAL EQUIP.MENTSCIEIEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: III •
-
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
g P Air conditioning (site plan required) _
Is existing space insulated? ❑ Yes ❑ No m{ Alteration of existing HVAC system _
150,1.15, ,, Ef >'t� 9: ..a E s C '^ a . ';' 'tic = ) A Cs'SYssr . '+ ,i i')s` S^. Boiler/compressors II
,r:n r MECFIANIG1L'• '•CnN'fRCTOR , ;.-.1.,...;0..8 p
State boiler permit no.:
s//fti ‘.y - HP Tons BTU/H
Address: �
: r n -
Fire/smoke dampers/duct smoke detectors
P4
� ;��ijlffi� Heat pump (site plan required) :�
Phone:/ - 'Far: E -mail: Install/replacefurnace/burner BTU /H
Including ductwork/vent liner ❑ Yes 0 No
CCB no.: , — ..e InstalUreplace/relocate - suspended, ■--
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): grarfp G� Vent for appliance other than furnace _
Refrigeration: ■--
CONTA PERSON. - • Absorption units BTU/H
tI ` Chillers _ HP MI
Address: Compressors HP
ti`_ ♦ �t Environmental exhaust and ventilation: ■--
City: State: ZIP: Appliance vent
Phone: Fax: E-mail: Dryer exhaust 1.1—
N Syr ; o ,,'y "�>" i } , };. ,, Hoods, Type U lures. kitchen/hazmat
■__
w ;`" • r Oil' 1� E R 7• ._l >. hood fire suppression system
Mffi� �L � Exhaust fan with single duct (bath fans) - .
.
Mailing address: so / �m_ai�7,d Exhaust system apart from heating or AC _
��
���� Fuel pip and d (up to 4 outlets) ■--
� Type: LPG NG Oil
Phone:. I� Fax: E -mail: Fuel piping each additional over 4 outlets MO
ENGINEER Process piping (schematic required) = ME
Name: Number of outlets
Other listed appliance or equipment:
III
Address: Decorative fireplace
City: State: ZIP: Insert- type
Phone: MEIMMINI E -mail: • Woodstove/pelletstove _
Other:
ME
Applicant's signatu ',fi��- Date: Other.
• -
Name (print): r, - 1 , ' I MI
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: E
Expires w ithin 180 d after it has been Plan review (at %) $
z
p State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440-4617 (6A0/COM)
Plumbing Perm Application "0R ry. -, . F ..:^ ; E s:
Date received: Permit no.: j 5 _ `/ 3 i
�, t City of Tigard cE LV D p�
x ,1 4 , ` � Sewer permit no.: Building permit no.:
City Projec
Address: 13125 SW Hall Blv ire date:
City of Phone: (503) 6394171 dappl.no.: Expire
Fax: (503) 598 -1960 JUL 1 c 2003 Date issued: By: Receiptno.:
C ITY O F TICS Case file no.: Payment type:
Land use approval: _ �A.E3D• --
•
' rh -rm ' S? ?"..VA O "d""'"t S41. "" . ri : s K r. i4.. l� PERMIT' 4 '.:' '' . . ;cK :. a�`a .-:
0 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family 0 Tenant improvement
•: New construction 0 Addition/alteration/replacement ❑ Food service 0 Other.
° .. rf JOB SITEINFORMATION ' " 4 . FEE `SCHEDULE (fo , special mfa
r iiiattai ise checklist)°
Job address: / ;,t� / TL�� - Description Qty. Fee(ea.) Total
— �� 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 �At Block: Subdivision: A .AILLAIIP SFR (2) bath
Project name: �,/ r SFR (3) bath
City/county: I ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Est date of completion/inspection: Drywetls/leach line/trench drain
Footing drain (no. lin. ft.) •
PLIJMUING, 'CONTRACTOR Manufactured home utilities 1111 Business name: P,(��l L . Manholes
Address: Tittb_ t 20111111111111111111111111111111111 Rain drain connector NM
� ZIP: Sanitary sewer (no. lin. ft.)
City: � — V� /al IIMI
Phone: Storm sewer (no. lin, ft)
Fax:
.� E -mail: `ti Water service (no. lin. ft.)
CCB no.: [ `s •7 L- i Plumb. bus. reg. no: - — ;his Facture or item:
• City/metro lac. no.: NiA / '/ Absorption valve
• Contractor's representative signature �.�/ C. ' Back Clow pre':enter
Print name: , 1 ■ ` — M/7�j> Backwater valve
- C'i)N'1 AC f PI RSON ; Basins/lavatory
t • p, e_D Clothes washer
Name: `— I N E Dishwasher
Address: AA / 0 b A ,V — Drinking fountain(s)
City: State: ZIP: Ejectors/sump IIIIII
Phone: Fax: E - mail: Expansion tank
7.t 4 -: rs >. =:.; :;i: ,. OW \ F. R " Fixture/sewer cap III-
�. y� Floor drains/floor sinks/hub
Name (print): :��< < � Garbage disposal _
Mailing address: .1..). 2_i C-1 P _�V 7 ') .- Hose bibb NM=
City: L.. State .. �ZIP:c7C. Ice maker
Phone: j , — r Fax: ',E Interceptor /grease trap _
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 I 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: State: ZIP: Other: - -_
Phone: Fax: E -mail: Total
Minimum fee $
Na all jurisdictions accept credit cards, please call lunsdictiun for m
more in(ouaon:\ Notice: This permi application
Plan review (at %)
C Pisa O MasterCard ! ! expires if a permit is not obtained State surcharge (8 %) •••
C.edit card number. w ithin 180 d ays after it has be en $
Expires TOTAL ----
accepted as complete.
Name of cardholder ss shown on credit card
S
s. Cardholder signature Amount 440 —i616 (606COM)
•
. .
Electrical Permit Application }
, A • Date received: Permit no.: y 1. 0,3_ cJ 3C
�tr4 1
_, , City of Tigard Project/appl. no.: Expire date:
Address: g 2 Date issued: By: Receipt CiryofTigard Add 13125 SW Hall Blvd ( � ED Y• tno.:
P
Phone: (503) 639 -4171 "" �, �/
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: JUL 1 4 �003
;,: r TYPE OF PERMIT , 1.1....S.:$'1;- ,
CI 1 & 2 family dwelling or accessory ❑ ` Commerci 1 � 1 M Cl Multi - family O Tenant improvement
r. New construction 0 Addition/alteration/replacement O Other. ❑ Partial
:..JOB SITE INFORMATION •
Job address: I , � n PM i f, 0 I Bldg. no.: Suite no.: Tax map /tax lot/account no.: .
Lot: C7a 'Block: Subdivision: - 1A141.1,
Project name: I Description and location of work on premises:
Estimated date of completion/inspection: •
CONTIZAC`'I'OR Al'PI:lCA FEE SCHEDULE .
Job no: Fee • Max
` c �, c, Description Qty. (ea.) Total no. Imp Business na me: l�l
- New residential - single or multi-family per
Address: - gip _ 1p L'.... 1'1'1'2, E - " dwelling unit. Includes attached garage.
= . N ZIP: # .--..- Service included:
Phone: ..-3 j aj Fax: E - mail: 1000 sq. ft or less • 4
i Each additional 500 sq. f . or portion thereof ,
CCB no.: Elec. bus. lic. no: - (� Li m i ted energy, residenual 2 iiir
C Limited energy, non - residential 2
Each manufactured home or modular dwelling
nature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): 1 �� �j License no: 9 a Services or feeders- installation,
AIL alteration or relocation:
' PROPERTY OWNER 200ampsorless 2
Name (print): A__ / r,. —) T t 201 amps to 400 amps 2
LPL_)( % ) l t 1 l� G� n 4 0l amps to 600 amps
Mailing addres �! �• �1 C.� 601 amps to 1000 amps , 2
City: Ls , I State(ZIP: � 7(J , Over 1000 amps or volts 2
Phone: 7--7 Fax: -7 &(5E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary servicesorfeeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation: 2
200 amps or less
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
�`c�� a l rftiraa^ri' "'� 'w`r aik s .iglu ` ' "I Br anch circuits - new, alteration,
� �` �'�ENGINEER�,:z.� r , t .., •
or extension per panel:
• Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E Each additional branch circuit: -
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps-commercial Cl Health-care facility Each pump or irrigation circle _ 2
O Service over 320 amps- rating of I &2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension' 2
O Building over three stories 0 Feeders, 400 amps or more *Description: ,
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 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
Plan review (at _ %) $
Cl Visa O MasterCard expires if a permit is not obtained
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
S
•
Cardholder signature Amount 440 -4615 (6iVOCOM)
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1 STREET TREE CERTIFICATION .
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(PLEASE PRINT) , (PERMIT HOLDER)
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 Clip 3 - Do3se
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received 0,7 4/. 3 3 // Requested `f X 94 3 AM PM BUP
Location / � J LP a- J grA.+n 6t- CA) Cl M-4/17—Suite MEC
Contact Person Gtk2. Ph ( 01-01 —4/P3 7 PLM
Contractor 1.). rn - 4-wt.5 . Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Final
ASS PART FAIL
Post & Beam
Under Slab
Rough -In
Water Service -
Sanitary Sewer - _
Rain Drains -- - __
Catch Basin / Manhole
Storm Drain
Shower Pan
O er�
Fi nal
SS PART FAIL
NICAL •
Post & Beam
Rough -In
Gas Line
final Dampers
Final
• i 3 'ART FAIL
?*� .L
ervice
Rough -In
UG /Slab
Low Voltage
F' larm
ina E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS ART FAIL
Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA Date /7A9/1 Inspector Ext
Approach /Sidewalk p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL