Permit � C ITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00070
'pox DEVELOPMENT SERVICES DATE ISSUED: 4/7/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA 07800
SITE ADDRESS: 14996 SW HAZELCREST TERR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 055 JURISDICTION: TIG
Project Description: New SF detached
BUILDING
REISSUE: DM170 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,570 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,620 sf GARAGE: 407 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5
VALUE: 308,364.50
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,190 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: 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 FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL /PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL #'SYSTEMS:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes
DON MORISSETTE HOMES DON MORISSETTE COMMUNITIES LL and all other applicable laws. All work will be done in
4230 GALEWOOD ST 4230 GALEWOOD ST #100 accordance with approved plans. This permit will expire
STE 100 LAKE OSWEGO, OR 97035 if work is not started within 180 days of issuance, or if the
LAKE OSWEGO, OR 97035 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: $ 10,564.40 1 - 800 - 332 - 2344.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Engineered soils
Issued By c_ ..i ; s _ 0-ems Permittee Signature :
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.
,.
Build l Permit Ap pli Received
atia w� x _ r FOR' OFFICE USE ONLY I �
City Of Tigard Date/By: y„, /,, 8 , 5 PermitNo.:mC p U 070
13125 SW Hall. Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 MAR 08 200g, /4 7 R410 0 1' p " �' ll+lt� Date/By: ( VIAL) • • C �' ,— C75. Other Permit: J����J� 001�.�-
Inspection Line: 503.639.4175 -:_ Date Ready /By: Juris: I3 See Attached Checklist for
Internet: www,ci.tigard.ocus CITY TIGA U Notified/Method: T / Cs Supplemental Information
BUILDING DIVISION
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11Q 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
�i:: r:le: W
s:�: „, �.r indicated on this application.
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Valuation: $ / " '
❑ I- and 2- family dwelling 1:] Commercial /industrial 3C'�t —1, c `—t (D . I O
❑ Accessory building ❑ Multi- family Number of bedrooms: f
111 Master builder ['Other: Number of bathrooms: 3. 5
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w.« a a`i:.;=e: •t.4 'as g° a :0 ; .,,, 4. h/ , r t: ,p+M,, Total number of floors:
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Job site address: l i...4 Il ' a0 4 \ 7e & c '\ 1 New dwelling area: sl c Q square feet
City /State /ZIP:.11 ,f _ Y � t V le_ Garage /carport area: H 61. square feet
Suite/bldg. /apt. no.: Project name: mm \ R 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: i)+ `Urn 1, ' c'\ 2 ' Lot no.: 5 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
»,,.,,,:., :., • : «,A:.W nt, m a and the p frt for the
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r
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.,•- + ,,,- �. a; , .t.l� ; „ „r.,t�:' - .,,s,.,�sv= 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: I - , l"' (-. M M tt N t1' ,s t l,i.,Q.) Type of construction:
Address: � f� Y
- It�"�1,.� �� ) �� Gj ( �, l.00 Occupancy groups:
City/State/ZIP: [6 g �� , o � q - 20 35 Existing:
Phone: ((�J yj� ° � � Fax: ( r p� - ~/ 7(.� /5 New:
:
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Business name: 5
.. ,� , ... .. _.: ... ,. ,,, �., ., a5 ..� „'
f > ., (KS t” CC�I-J 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:
isi¢>
`i:CONTRACtPO
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Business name: f
p :1� . 1,. 3''�; t"�' i :y
,,;, n,'r_t'i" ="s;i - rr�,:BUIliDING'PRIVIIT ::FEDS*, sir ^
Address:
, ±;; tts , ;,.,...: ' t ... '': `,.,.. ;1: ._..
Please refer to fee schedule.
City /State /ZIP:
Phone: ( ) Fax: Fees due upon application
( )
CCB lie.: _ Amount received
•
� � D ate received:
Authorized signature: i ^ v- This permit application expires if a permit is not obtained
1 within 180 days after it has been accepted as complete.
Print name: le .1,( IV_ K. k-4 Date: ( l (0G * Fee methodology set by Tri - County Building Industry
Service Board.
is \ Building \ Permits \BUP- PermitApp.doc 12/03 440- 4613T(1 l /02 /COM /WEB)
, Mechanical Permit App i tion
II�� roR OFFICE' +use ONLY
City of Tigard Date/By: ,.
`� y Permit No.: �'), "t� .-6190 /T
131 1J Blvd., Tigard, OR 97223 ;,� r '�/ fd��.�,5 V' !i(l
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 M/I p /lyo�s -X r I , +t� Date/By: Other Permit:
Inspection Line: 503.639.4175 //''1Uj 0 8 100 Ali,-111.„ Date Ready /By: Runs: PI See Page 2 for
Internet: www.ci.tigard.or.us 'T N otified/Method: , I�
Y OF TIr Supplemental Information
e
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N ew construction ❑ 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.
a , "
:k 3,;y1 >(: i : ".r, ., Value: $
RESIDENTIALTQUIPMENT / ;FEES ` 'i
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Qty E T t
Multi-family Master build a l o a
er O t er•
Description
'.b'� f�= �c'4 �, i.4 T- - . -.�`if `:: _
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} 4;�. _rx
;JO SIT N .. ORIVIAT 'ION'; >1:'�.. ,� „v_< �1''
..,_;. -� __ _;=a;�= • ...:,., - � ..::...:... ..:,r<:;__. ._ ,,,,,,,,.�:..>7 }.,._ -.,. ,;,:,,,�..._a,,._.. .:_, ..,.__,,, .,.....!_ _...,r�• Heat l i
Job site address: /' Air conditioning or heat pump
1 /' I��Q c )� l� c 2 (]re T---ex- C. (requires site plan showing placement) 14.00
•
City /State/ZIP: - WyCl6 , ! 0 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
Flue /vent for any of above 10.00
Subdivision: csi. )t`(1pn 1k. "Vi• \/,, y Lot no.: � - Other: 10.00
Tax map /parcel no.: `-0 � Other fuel appliances
.:.,,f c:,.,v E rx t�.,. Water heater
�;' "tiz . �.m � _ . � 10.00
�'� � DESC"'R�II'TI .: ,, � ,� W ®•., : ,k ��� r....
',.��> - .<. ,..k, , + te r
„_,_.. � .. .- .._ ,., „_ ,.MKS; w :.. ...... -}, ": a. �...- �.,., s-.. o-: o� .��r';�= otrh,,.�1 ?:'� T- i *��_.: �rsv^',N.,;t;.M.. �s «- i�z�. .,. � .,....
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
., me1 /flue /vent
- sl ., x dpi ,ii= :l €a';';s ! � 1 . .; f zs x : ; s,, ;. Chimne l' 10.00
�:t, P•ROP,ER� <Y >: ERA, , } >'''i ,,I.: , °i r.r.: ,,.:,,kw
T. =.OWN Y ❑,: TENAPIT< s€ ° >- . , , ,
'': '''': ,`� "' ". ^' „ °'`� a , Other: 10.00
gy - . ma r:'t. ,. � � � ,� Y ..:' SI>�?„ i <..,u�:,Y�+t +,
Name: ��- \ ►11 � k` � , 7 l ,) .y Environmental exhaust and .ventilation
Address: V 4J" , L Range hood /other kitchen
equipment 10.00
City /State /ZIP: . '' V f q _)Q Clothes dryer exhaust 10.00
Phone: ----2,i2 Fax: Single -duct exhaust (bathrooms,
( , toilet compartments, utility rooms) 6.80
�,�. �... - .,.�,`: ;. �:ratc -•',ia;: `,jt; » +'.,,u�� •,r ; ," � .- �,tN.^rr:cass :;;m , a�s�: ris;o,: -'�:yarts �...
;."fit %.:i':?�'4 r a• l^ , ;`t•x .,!:-, r. k7. �. a-, t ,•.'^;,1i�'t., }';F�j;:�,�,y'•w' :. ;r, .,4,Mh.`:r'
�;; - :-.:1 ; , . . _..,. 5 „ .LICANT ,,, w;;x„�� }�� , .: t : , , u , . .:CONT >� .,s, ''t ,, Attic/crawlspace fans 10.00
_ .,- _ _...,.a . _ ,._ .,.- �� a.-;. h 'Yx. . r.. ��= �e�.,.. �,s:_<, aa��T;�p�,;RSU1r5,u�R�,:;�x:,,� p
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
4 -
., ifr§ -
,., * ,- �- CONTRA�TgOR�;:� `.;�� �r�t t.:40 . :�`:.a `.:... Barbecue
Business name: (1 4
i1 - d ` /�( a,ry e
fit L r ` I L /M I ' �'L C �� Clothes' dryer (gas)
Other:
Address:
� V I r r ;"``;.1' 4:' `: F,r 1VIE „,,,, L"PER]VIIT, - - ` g t `
City /State /ZIP: V �L V� T Y ` �/ 1�` ` -21./11 ; :: .::.. ......_,c:a -... x =.,,_,. -F, ..r : ,5:;. . Subtotal 4 i .
Minimum permit fee ($72.50)
Phone: (5 g. ��• 5 'L'f Fax: ( ) Plan review (25% of permit fee)
CCB lie.: ' 5j j ! _ State surcharge (8% of permit fee)
C TOTAL PERMIT FEE
Authorized signature: • Vi ' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ' ! I . r ne I Date: / ( ) ( .. ) . r . 1 * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permils \ MEC- PermitApp.doc 12/03 \
440 -4617T (I I /02 /COM /WEB)
P1um,Ii .ng.Permit App '(tot- , FOR OFFICE USE ONLY ' . ' : .
City Of Z 1g8TCl • Received ,�,//�� n_
DateBy:L/� Z-7 1 Pemitt N��"JC7 : � .-6)00 0
io 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review I✓ 6
Phone: 503.639.4171 Fax: 503.598.196 AR 8 Z005 //htnpol b' 4\ DateB Other PernutNo.:
24- Hour Inspection Line: 503.639.4175,. `I Date Ready /By: ]uric: 51 See Page 2 for
Internet: www.ct.tigard.or.us ITY OF Tit, G ��� Supplemental
. _. ". _. ., ._LL,�,: .:; .a., ,., �... -: r .. .. a.. :u , >;.„ h.. f}Notified/Method: ",1a., 'a•t"r' a,• -
menta Information
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XNew construction ❑ Demolition For special information use checklist.
Description Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
as
Ii *
.rMe _ ;
_ , - tin.;,: : _z?
; ;s. +t ''iCAT'EGORY_=> F'? ONSTR
<�4 ;� O ,C, r UCTION�. ^i =,,�.;,f;:�: .:�`- i� % >.�.,�;_,, SFR (1) bath 249.20
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❑ I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
1=I Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath /kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
x. ��, , „£ JOB °S'1TE AND OCATION' i *F x =
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,. - . , - .. ,r..._ .... . ........... .... :vi9r,r, =•..,:..,." .crr.:�_. ,... , n „�.,.���r�.�.... �- ....',srr;.'� <., :,:._....t,.h,.,_,t., ,_ ",f/ �- ....,. Site utilities
Job site address: , C ltt) . l \gyp `cek- Teri Catch basin or area drain 16.60
City/State/ZIP: 4 1-d Q � Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: " / l Project name: Footing drain (no. linear ft.: ) Page 2
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� \t "?...la I Lot no.: 5 Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: nx ure or item
Fixture it
. kr-- ;,i`s:- �:r�;� - „�,,< _,,. == ;rh.s,. �,u,'. :,x4iH:` 'z / r ,,., , ,;- ".> Absorption valve 16.60
�,d,_} ; . .- i t iy F3 te, --4': mt � . -hret� s:,..ti3OW,.'✓: ` " .:Y∎ '0, r si ,,7,d'�.,<.,•..,,, .,.,
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g ` • t.; _: ,. , ,-,,�,..
_ .. ,,:._.��a - ,.,__;?:::.:,�- .,.. ,, ,�.rv.at�ex;� , ......- s,:, __.._• , .- t��_.. : 5,. �u�iira .,,�r Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
' Dishwasher 16.60
>,��;�:.::: •, `,I Zt-tr ; ! : rwa; _ r, . :; .., s; ,:z.: r +, Drinking fountain 16.60
,,,ii, �'ri *�: w ;S - ,3s,�;.�,, ..r '' .,Issr, "s:iG ..:..� -
k 1 .;: R`;= " " : m6 ;4 ..•�. ,,,._, as i _Mi -rNTt 4-' ;
_ ;' � ... ,,,..: ,e,n�a.�:^�;, <::�. <%i tea.. -- z�:0,�. , .a.3, ..� ..:,r��s�::isdd
m ; ..,_'. - -. F ,. - N ,,a .,.Ils,.,.,,. ,::3:;E.V 4a:u,.,....n ::... Ejectors /sump 16.60
Name: . 1 t' to t .� t c� �'Ln 3 �'(1 i .
it'1 ��)�- l Expansion tank 16.60
Address: t e' 1 * GI , G [ co Fixture /sewer cap 16.60
City/State /ZIP: el-Way) t Floor drain /floor sink/hub 16.60
Phone: F1') , %7 70 Fax: ()9y '��t f Garbage disposal 16.60
_, ,:., ;r .. }: <, - r.,a '; -:Y:- • : : xe, . Hose bib 0
:, ,,.. '. :APEIIC'ALVT ,',;;r�;_3;,,.• „ � •,.,,. t . ai ...d`�. ONT .
.,... __., _. __,. .,i:zsx?>` -r'w: ...r n,.. *;zt7,� ... 3 i. �2 =T3 , ..,:..:pn.,. , .,... Hsu ^),+oat•u ^o...; { ?:
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:
s;: e' „- Urinal 16.60
-" - _ lte .• th,,... - �i ;�' "p.ia��tr" ._7. . ,
: . < CON'TI3AGTOR .::z . 1,` ; ,r, ,_ :_ t : t .. •:: 6 ,
. . ., .. ,:.. ,'... ,.. = _..�;�': , _ � _ Water closet 16.60
�� _.�. .,: -�i��x ,u4�. .:? ,r,�� :,: .: :S.:e v. ,.. ter:: e.� .,. .M� .... ,. r. c.r .... ........�.i
Business name: Water heater 16.60
Address: O i✓� Other:
City /State /ZIP: .�� --f/ x. �, � 't � ( Subtotal
, "l.� r Minimum permit fee: $36.25
Phone: ( 59 6 ) ` Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: i O /`' b '1 W linnbing Lic. no.: 2 7--• '` ,ZP13 Plan review (25% of permit fee)
Authorized signature State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: ,. \ � � t 1 " Date: 3 i l ( oS This permit application expires if a permit is not obtained within
�J 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i \ Building \ Permits \P LM- PermitApp.doc 12/03 440- 4616T(IO/02/COM /WEE)
Electrical Permit A n. e tication w ;` ' l •<FOR- OFFICE;U SE ONLY
City of Tigard 1 ZULEIVEll Date/By: Permit No.: 11/GT Z "5°vUD7t
• 13125 SW Hall Blvd., Tigard, OR 97223'1 Plan Review
Phone: 503.639.4171 Fax: 503.598.1 q 0 2 2005 ��I A I Date/By: Other Permit:
Inspection Line: 503.639.4175 d`I -- Date Ready /By: Juris: E( See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
CITY OF TICARD
BUIteiNQFDARNEIN PLAN REVIEW
K New construction ❑ Addition/alteration/replacement Please check all that apply:
El Demolition El Other: ❑Service over 225 amps, comm'l ['Hazardous location
EService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
1 - and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi family El Master builder El Other:
❑Occupant load over 99 persons El structures or
JOB SITE INFORMATION AND LOCATION El Egress/lighting plan RV t park 19 Q - ) L .,— ❑Health -care facility I=I Other:
Job no.: 3 L� 5 a Job site address: 1 9 f _ 14, rut, E I CY /-i'', Submit 2 sets of plans with any of the above.
City /State /ZIP: 1 k g) o n ?0 22 5 The above are not applicable to temporary construction service,
�'���111
Suite/bldg. /apt. no.: Project name: /� FEE* SCHEDULE
I **
1 " � � U . �tC� Q/�/ P
V/ . Description Qty. Fee. Total
Cross street/directions to job site: 13 Q - � New residential single- or multi - family dwelling unit.
J/ Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 5 OrWit ` 1 ( + Lot no.: 55 Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK • Each manufactured or modular
l dwelling, service and /or feeder 90.90 2
/V -k) koi/S WI kiAf9 Services or feeders installation, alteration, and /or relocation
J • 200 amps or less 80.30 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: I i , • APiIII C .. I 601 amps to 1,000 amps 240.60 2
? Over 1,000 amps or volts 454.65 2
Address: 1123 6 6._A w6 0 � %R er - - S vi jQ() Reconnect only 66.85 2
City /State /ZIP: 1...„„,k � Lti �Q 1 / Q 3 Temporary services or feeders installation, alteration, and /or
/` relocation
Phone: (503) 38-2_ Fax: (57 3g 76 7I5-- 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 _ 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ 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, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax:: ( ) Pump or irrigation circle 53.40 2
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: 6 .4 / , ) 6 - Le --,. 72 _, c LL G .
Address: / #rte, Each additional inspection over allowable in any of the above
P. n Per inspection 62.50
City /State /ZIP: K 0 � 6 � d OP 0/ 7 75 Investigation per hour (1 hr min) 62.50
Phone: (53) 3 s 8- I Fax: (503) , qy -9 Ll/Li Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 22 Electrical Lie.: — 4 ,e3 Suprv. Lic1 Li -, Subtotal
Suprv. Electrician signature, required: h� AI Plan review (25% of permit fee)
Print name: L
J/ / r +� State surcharge (8% of permit fee)
L .1 ' �, ,� Da ng
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: Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PenmtApp.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:
Fl Audio and Stereo Systems*
I I Burglar Alarm
Garage Door Opener*
n 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:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
I HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
I Landscape Irrigation Control*
n Medical
I Nurse Calls
n Outdoor Landscape Lighting*
Protective Signaling
❑ Other •
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\Building\Permits\ELC- PermitApp.doc 04/03
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CITY OF TIGARD ' .
BUILDING DIVISION PERMIT #: MST2005 -00070
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2005
Phone: (503) 639 -4171 : Alli l� � 'i h,
Inspection Requests (24 Hrs.): (503) 639 -4175 ...- '__..
INSPECTION WORKSHEET FOR DATE: 9/7/2005 TIME: 7:08AM PAGE: gel
SITE ADDRESS: 14996 SW HAZELCREST TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 055 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF detached
OWNER: DON MORISSETTE HOMES, PHONE #: 503 - 3874638
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503.3874638
Inspection Request Scheduled For: Date: 9/7/2005 Pour Time:
1
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 015053-05 603 - 209.4837 N
Corrections /Comments /Instructions:
ig PASS 1 I PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
A 6?
Inspector: l Date: Phone #: (503) 718-
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CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MST200 00070
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/7/2005
Phone: (503) 639 -4171 AzwitIO
Inspection Requests (24 Hrs.): (503) 639 -4175 ''L
INSPECTION WORKSHEET FOR DATE: 9/8/2005 TIME: 7:09AM PAGE: 5
SITE ADDRESS: 14996 SW HAZELCREST TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 055 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF detached
OWNER: DON MORISSETTE HOMES, PHONE #: 503.387 -7538
CONTRACTOR: DON MORIS SE I I E COMMUNITIES LLC PHONE #: 503-3874538
Inspection Request Scheduled For: Date: 9/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 015194 -02 503 - 2094837 N
Corrections /Comments /Instructions:
ii .PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
CITY OF TIGARD . •
BUILDING DIVISION PERMIT #: MST2005 -00070
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/7/2005
Phone: (503) 639- 4171 +N4 fl��p�(1 " r
Inspection Requests (24 Hrs.): (503) 639 -4175 . - i L.
INSPECTION WORKSHEET FOR DATE: 9/8/2005 TIME: 7:09AM PAGE: 4
SITE ADDRESS: 14996 SW HAZELCREST TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 055 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF detached
OWNER: DON MORISSE ( I E HOMES, PHONE #: 503- 387 -7538
CONTRACTOR: DON MORISSE"I I E COMMUNITIES LLC PHONE #: 503- 387.7538
Inspection Request Scheduled For: Date: 9/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 015194 -03 503-209-4837 N
Corrections /Comments/ Instructions:
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I I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �< D ate: Q Phone #: (503) 718 -
1
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MST2005 00870
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/72005
Phone: (503) 639 -4171 A z a agp1111li l i
• Inspection Requests (24 Hrs.): (503) 639-4175 `:_..
INSPECTION WORKSHEET FOR DATE: 9/8/2005 TIME: 7:09AM PAGE: 6
SITE ADDRESS: 14996 SW HAZELCREST TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 055 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF detached
OWNER: DON MORISSETTE HOMES. PHONE #: 503 - 387 -7530
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503.397 ..7539
Inspection Request Scheduled For: Date: 9/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 015194 -01 503 -209 -4837 N
Corrections /Comments /Instructions:
VY\,,:ck.S-\— ma_.._. \ l 3 , °3 c
— gtc \ \ . `3 d
•
A S, PARTIAL APPROVAL n CANCEL n NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-