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Permit Alk CITY OF T I G A R D MASTER PERMIT PERMIT #: MST2004 -00183 t DEVELOPMENT SERVICES DAT ISSUED: 7/14/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 09317 SW HOME ST PARCEL: 2S111 DB -KE006 SUBDIVISION: KESSLER ESTATES ZONING: R - 4.5 BLOCK: LOT: 006 JURISDICTION: TIG REMARKS: New SF BUILDING REISSUE: BVH3465 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,455 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 2,010 sf GARAGE: 655 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 MR D: sf RIGHT: 5 VALUE: 337 OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,465 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 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: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5 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: 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: SIGNAUPANEL: 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: $ 7,908.64 This permit is subject to the regulations contained in the BUENA VISTA HOMES BUENA VISTA HOMES 6932 SW MACADAM #C 6932 SW MACADAM SUITE C Tigard other Code, State of All work w wil Specialty o ne i n PORTLAND, OR 97219 PORTLAND, OR 97219 and all ra cer applicable laws. s . This will done in accordance with approved plans. This permi t will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: 503 443 - 6033 Phone: 503 443 - 6033 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 152235 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins[ Rain drain Insp Electrical Final Sewer Inspection 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 lnsp Building Final Post/Beam Structural Mechanical lnsp Shear Wall Insp Insulation Insp Appr /Sdw Insp Issued By : P ermittee Signature : ' , .l � / Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the ne busin ss day r % Building Permit Application FOR OFFICE: USE O.I.Y Received (1) Building in , Date/By:0 Pr 0L4 0 Permit No.:l' I'1 O `� JUN 1 ) City of Tigard %� I ki Planning p pro al Other S �, , �; _ � 4 Date/By: N_ �\ 0 - /'7 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 CITY OF TIGP:' Ll.1 Date/By: MA U 7- 7 G Permit No.: Phone: 503 -639 -4171 Fax: 603= 5984960 �'"" "# ti!, (' ` Post - Review Land Use F ^ . . 1 I Date/By: Case No. Internet: www.ci.tigard.or.us Inspection Request: 503- 639 -4175 Contact 1uris. • Su See Page for 24 -hour Ins P 4 Name/Method: - I Gj Supplemental Information TYPE OF WORK N ew construction REQUIRED DATA: _ © ❑D emolition 1 & 2 FAMILY DWELLING _ ❑ Addition/alteration/replacement ❑ Other: CATEGORY OF CONSTRUCTION Note: Permit fees' are based on the total value of the work performed. Indicate © 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead and profit for the work indicated on this application. ❑ Accessory Building ❑ Multi- Family ❑ Master Builder ❑ Other: Valuation S JOB SITE INFORMATION and LOCATION No. of bedrooms / No. of baths:2'5 Total number of fl ors ..- Job site address: �J3 J '] L/ w St►' . New dwelling area (sq. ft.). ` (�. Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.)....L. Project Name: Covered porch area (sq. ft.) Cross street/Directions to job site: Deck area (sq. ft.) Other structure area (sq. ft.) REQUIRED DATA: r COMMERCIAL - USE CHECKLIST Subdivision: I F1' �5- 1 Lot #: Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor, NEW CONSTRUCTION — SINGLE FAMILY RES , overhead and profit for the work indicated on this application. DEATACHED RESIDENCE Valuation S Existing building area (sq. ft.) New building area (sq. ft.) Number of stories ® PROPERTY OWNER _ I ❑ TENANT Type of construction Name: Buena Vista Custom Homes Occupancy group(s): Existing: Address: 6932 SW Macadam Ave. Ste C New: City /State /Zip: Portland, OR 97219 Phone: 503-443-6033 Fax: 5 0 3- 4 4 3 - 2 4 4 3 NOTICE: All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under El APPLICANT Ea C ONTACT PERSON provisions of ORS 701 and may be required to be licensed in the Business Name: SAME AS ABOVE jurisdiction where work is being performed. If the applicant is exempt Contact Name: El iabeth Moore from licensing, the following reason applies: Address: City/State /Zip: Phone: Fax: E -mail: ' PERMIT FEES*. -. • CONTRACTOR Please refer schedule. Business Name: Buena Vista Custom Homes Fees due upon application S Address: 6932 SW Macadam Ave. Ste C City /State /Zip: Portland, OR 97219 Amount received S Phone: 503 - 443 -6033 Fax:503- 443 -2443 Date received: CCB Lic. #: 152235 Authorized - Signature: U � Date: Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. •Fee methodology set by Tri- County Building Industry Service Board. (Please print name) i:\Dsts\Permit Forms \BldgPermitApp.doc 01 /03 One- and Two - Family Dwelling Building Permit Application Checklist Reference no.: City of Tigard City Of Tigard Associated permits: ❑ Electrical O Plumbing O Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 O Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 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. 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 ❑ plan ❑ 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 if copyright violations exist. 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 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. 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. Jt RISDI( IIONA!. SPECIFICS 23 Five (5) site plans are required for Item I I above. Site plans must be 8 -1/2" x 11" or II" 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. "Mirrored" building plans will be not accepted. 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. 27 "Drawn to scale" indicates standard architect or engineer scale. 28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List. 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. 440-46 I 4 terootcoau .- 03/04/2004 16:26 5032537693 SUN GLOW INC PAGE 02 FU12(tEFI(k:1�1• t»tS Mechanical Permit pjpplicatiQn Received Mechanical Oateifa : Permit NO.: fr I I S " Od }g City of Tigard , GE�v G Nanning Appr�al net :: ~ 13125 SW Hall Blvd: ). A Flarr Review a Tigard, Oregon 97223 ` %� y Ida s . Phone: 503- 639 -4171 Fax: 503.598 -1960 Poet- Review Land Use y• 4 B Date/3 : Cast No,. lxtterttet: www.ci.tigard.or.u& 1Cik` Juns.: . =��4 -444, `aS � " � '� � 1 Conner 1,:e 24 -hour Inspection Request: SOt3 -" NamctMedsed: . i • .. ■ -, ; , :. .;.:1.,:4.:..:.•-'''.:.' ;';'•. "4t com i atcrAi'FEE gC iceoutE' iVsi icamcrosr II New construction • Demolition Mechanical permit fees* arc based on the total value of the work III Addition /alteration/replacement L Other: pCrformed. Indicate the value (rounded to the nearest dollar) of all ..CATEGOR: ° OF.CO1!ISTRtrCTf" 1;Y ": mechanical materials, equipment, labor, overhead and profit. L 1 & 2-Fax-nil dwellin: • Commercial/Industrial Value. S See Page 2 for Fee Schedule IF Access° Building ■ ' RESID>? MIIpMENTJ> iTIT34S:> SGFEEDULE Des er' •don 0 Fe ea- Tot L Master Builder Other: _ Heat.. Cootie: JAS SITE 1N1E'(?BMA"C[dlY and LOCATION' ' - '; . ' Fun • e .: rr .. :ercondtt1.•in• 14.00 Job site address: Gas heat • .• MI 14.00 INEEINIMMIIIMM ma, , /A.• t.#: Duct work 14.00 H dronic hot waters tem 14.00 Pro'ect Name: Residential boiler Cross meet/Directions to job site: for radiator or h ironic system 14-00 ' Unit heaters (fuel, not electric) (in wall, in -duct, suspended. etc.) 14.04 IIII Flue/vent for an of above 10.00 Subdivision: J Lot #: R .air units .. Fuel A. ,tin 12.15 Tax - -/ • arcel # Water heater inig 10.00 ' • DES or I' ION *F WORK 1 .., • - • Cm C fireplace 10.00 NEW CONSTRU TTON -ST GG7..,..• .• T • I Flue vent (water hea•:or / freplac:) -- 10.00 IIIIIIII Lo. li � ter : - • I 10.00 DETACHED RESIDENCE titr A ter .:- oye - 10 .00 NM Woad • • • lane/insert 111 10 Chitral- /liner /flue /vent iiiii 10.00 - PER'1'Y:0 • . . - RE TENANT , :t:-",:',:;;;: .. Other, V 10.00 � ' ' ' O • Envimamcnta existust & catfla ou Name: B _ = a V i s - .. 1- . 11 - 0 11 - Range hood/other kitchen equipment 10.00 Address: 6 • 2 SW Maca .'_ - ,t • v - S . - C Clothes dryer exhaust 10.00 Ci /State /Zi•: Portland OR 9721 9 Single duct exhaust Phone - • _ .. _ . , Fax: / _ • . _ , . (bathrooms, toilet cornpartrrcnts, I! " APFLICAN•I • MP Con SON trill rooms • 6.80 Attirlcrawl_spacc fans 10.00 Name: David Goloba Other; 1 to -00 Address: Fuel 'pith - R* .40 for first d, 51.00 each additional City/State/Zip: � � Phone: Fax Gas heat . am• OM '' E-mail: — wa<vsue•eodsd/unitheater IIMMUMMOMMEMOMN - CONTRACTOR • Water heater Business Name: . -.- G .w :. 0.1.iiri••• Address :2428 SE 105th Ave. BS• .. Ci /State/Zi•:Port:larld, OR 97216 Clothes. er as Phone: 503 -253 -7789 Fax:503 -25 - . da .; Other. Total: CCB Lic. #: 4 B 1 31 . - Authorized ' Subtotal: S Signature; Datc : Minimum Permit Fee $72.50 David Golob y Plan Review Fee (25% ofPermit Fee) State Surcher_c 8% of Permit Fee (Please print name) TOTAL PE - 1T FEE S Notice: This permit application expires 1f a permit is not obtained within . Fec p an doicp red set t o y Trt- CounI Building Iedastry Service Board. 180 dalre after it bits beea accepted as complete. i :\PSts\PCrmit ForinsWet:PecrnilAPP.doc 01.103 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: TOTAL VALUATION: PERMIT FEE: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $ 10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,001.00 and up $1,396.50 for the first $100,000.000 and $1.10 for each additional $100.00 or fraction thereof. All New Commercial Buildings require 2 sets of plans. I:\Building\Permit Forms\MecPermitAppPg2 09- 01- 03.doc .. 0,3/04/2004 18:21 FAX 5036284633 THE MULLEN COMPANY i BUENNA VISTA Z 002 /003 Fc)R clrrrc r. t.st cItiL Plumbing Permit Application Received Plornbins ry� Datr/By: Perini! No. :f/ 1J r - d4 • 001 g3 Planning Approval Sewer City of Tigard Defy Permit No.; 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 pate/Bv; Permit No.: Phone: 503- 639 -4171 Fax: S03 -59S -1960 Poft_Review Land Use h::5:.��,.,�;ih "�1 I 'I` Date/By, Case No.: Inttatttt: www.ci.tigard,or.us � -.� � Centact Juris - See Page 2 for 24•hour Inspection Request; 503.639.4175 - -- -- Namc /Method: Supplemental Info rmation_ � ,.,:.•. _, ,. ,,• :- - - �_ _, Tints - SC TILE. for infvlliiatlifir i ' 1' ra' New construction Demolition Descri • don Qty. Poo(a.) Total M i - Ti I�. Ih � . • I II' 1. Addition/alteration/replacement Cthtr, �' ° 't'`"` iii`:`;. &: ;- t'anatIt*felliugs' �',: :?:4 f ' ,;�:;. �o u e tat: E fat r iiiiiitin i»iiaeetion *.;` r" ' 0 , ' " ., '; 'c,CATEGoR AI tom SFR (1) bath 249.20. 1 & 2- Family dwelling El Commercial/Industrial SFR (2) bath 350.00 Accessory Building � .i Multi - Family SFR (3 b 399.00 J] Maste Buil Ot her: Each additional bath/kitchen 41.00 4OB SflE 4,FORN TION:iuid LOCATION Fire sprinkler - sq, ft.: _ _ Page 2 Job site address: ' .. • • . Stte.trtUittes :6:,,. ; ■..,,M1 .,,.Y'•, .. Suite #: Bldg. /Apt. #: Catch basin/arca 16.60 D cll/lea h line /tranch drain 16.60 Project Name: Footin: drain (ne. linear Et.) Irrriii Cross stTeetTDirectiorts to job Site: Manufactured home utilities 110.00 III Manholes 16.60 Rain drain connector 16.60 swill. sewer no. linear ft. Subdivision: Lot #: Storm sewer (no. linear ft.) Pale 2 Water service (no. linear R-) Pa:e 2 Tax map /parcel #: Fixture or Item . ' DESCRIPTION OF WORK Absorption valve 16,60 N .,CONSTRUCTION — SINGLE, FAMILY Raekflowprevcntcr _ Page2 FAMILY DETACHED RESIDENCE Backwater valve 16.60 Clothes washer 16 -60 - Dishwasher 16.60 Drinkin, fountain 16.60 ; :4 ''FE1 AdV'F . • .. E'ectors/eum- 16.60 Name: Buena Vista Custom Homes Expansion tank III 16.60 Address: 6932 SW p iaca r d,, A3z Fixturefeewer ca. 16.60 City /StatelZip: Port and, OR 9 7219 Floo drain/floor sink/hub II. 16.60 Garbage disposal 16.60• Phone: 503-- 443 -6033 i Fax: 503..443-2443 Hosc bib • NMI 16.60 AP • • , . • : ri CONTACT`1'ER$Q1s1 ' • ' tee maker 16,60 Name: Ray Mullen lnterce ' for /: ease Rap 16.60 Address: Medical : as • value; $ Pa • e 2 Primer 1111111 16.60 Cit /State /Zi : Roof drain (commercial) III 16.60 Phone: I Fax: sinklbasin/lavalo 16.60 E -mail: Tub /shower /shower .an NM 16.60 MOM CON)<RACTOR ,' • • - Urinal 16.6o Water closet 16.60 _ B i s i nessNarne: ED MU P lurr ng Water heater 16.60 Address: 24470 SW Rainbow Lane Other: City /State /Zip: Hill e ro . _I1$ A 71 2 Other: NM= Phone: 0 — 628-1 P ax: a — . tplu�titas>„1f cm ub _ Subtotal 5 CCB Lic. #: • ► , ; • Plumb. Lic. #: 34- L6 OPB '' Minimum Permit Fcc 572.50 $ Authorized / / Residenti Flacl:low Minimum Fee $36.25 Signature: A 4d L • EC: / Plan Review 25% or Permit Fee S Ray ul en State Surchar -e S% of Permit Fee $ — — (Please print name) TOTAL PERMIT FEE S - NoUcei Tills permit application expires If a permit is not obtained within All new aetnmeralal buildings require 2 sets of plans with isometric or ISO tfays after tt has been accepted u complete. riser diagram for plan review. .Fee methodology set by Tri - aunty Building Industry Service Board. i:\D5ts \Permit Fornv■P1rnPermliApa.doe 01/03 `03/04/2004 15:11 5036425815 ROSS ELECTRIC INC PAGE 02 Electrical Permit Application FOR 0141(1. 1 SF O \I.1 Received Electrical �,/ OateBy: Pcnr i .0 f 7 Zil —0 City of Tigard Planning Approval sign Date/8y: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/ Permit No.: 11 t ii i" c �. Phone: 503- 639 -4171 Fax .598.190 Post- Review • Land Use co 1 � 9 ` Cont Case No„ Internet: www,ci,tigard.or.uS ' Cont Jut is.: See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 ' Name/Method: SuLrplemerttal Information. 'TYPE -OF WORK ' • . • • MAN, REVIEW (Please the&iltthatiippb1 ' l •!: ' : ::::: '..*:::"..- cw construction Demolition ❑ Service over 225 amps- ❑ Health-care facility ❑ Addition/alteration / replacement Other, Coiiiiroial ID Hazardous location ❑ Service over 320 amps - rating of ❑ Building over 10.100 square feet, ' 'CATEGORYOF'CONS1 RECEION 1 & 2 family dwellings four or more residential units in Ei,t 1 & 2- Family dwelling El Cornrnercial/Indushlal ❑System over 600 volts nominal one structure Accessory $uildin� �] Multi - Family El Building over three stories ❑ Feeders, 400 amps or more ❑Occupant load over 99 persons ❑ Manufactured structures or RV park M aster Builder ❑ • Other: 0 Egress/lighting plan ❑ Other JORS1TE INFORMATION: UM LOCATION • ' Submit seta of plans with any of the above. Job site address: The above are not applicable to temporary construction service. Suite #: $ldg. /Apt. #: 'FEE* SCIIETK E:R.......:: ; :: ti:.[,: r:; ,: : Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total Cross street/Directions to job site; New residential shrglc or mold-family per 1 dwelling unit timbales attached garage. Service included: 1000 sq. ft. or Tess 145.15 4 - Each additional 500 sq. ft or portion thereof 33,40 1 Lot : Limited cn er , residential l�r 75.00 2 Subdivision: _ Limited cttergy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling DE L ON_OFWORK ' :: . `, ' service and/or feeder 90.90 2 0 -'-- /� O I S u V �/ i If 6 C l rn I / alttrgllo Scrvtoe or r • installation, c� fe n or re rel feeders location: - i - C1 OA e Lt � 7 r den �— 200 amps crr less 80.30 2 201 amps to 400 amps 106.85 2 � 401 amps to 600 amps 160.01 2 �•B'' ROEERTY OWNER : • :: C � 'UMW ' . !.: _ .,• 601 amps to 1000 amps 240,60 2 Name: al C/ a- Y i S �u,,F•JG C ./ � �1�} '1 a j 2 Over B eet amps or volts 454.65 2 Reconnect only 66.85 2 Address: (p c] '''._ ,,i/ l a Q cJ t 2 f Aye, Temporary services or feeders • installation. 1�f�'L alteration, or relocation: City /State /Zia: per 0 C — 72/9 200 amps or less 66.85 I Phon- . 5 • y 3- (a..) Fax' 1/5 201 amzs to 400 amps v 100.30 .. 2 * • NTACT PER$ON' 40 I to 600 amps 133.75 2 ` IA At' • IC . Name: S e v Q - ' SS � Branch circuits • e.., alteration. or /`O czteoslnn per paneel: Address: A. Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuit.. without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: Fax: Each additional branch circuit [ 6.65 2 E -mail: Misc.(Scrvice or feeder not included): ._, •::•. Each pump or irrigation circle 53.40 2 Each sin or outline l igh[ • ing _ 53.40 2 Job No: Signal circuit(s) or a limited energy panel. Business Name: J O E z- .-/-)6,. alteration, or extension Pale 2 2 Description: Address: x870 50 (2l si-v-e # Qe3 Ci /State /Zip: RI RS b41 - 6 , z o ft f -1 p 3 Each additional inspection over the allowable in any of the above: Per infection per hour (min. 1 hour) 62.50 Phone :503 Co Z 2.800 Fax: 503 .15 investigation fee: ' CCB Lic. #: 1$'`78q/ Lic. #: 3 .36G o ttsT , _ Supervising electrician // c7n I EtecMt�1 Pelc X suture required '7^ S Subtotal $ Plan Review (25 °,4, of Permit Fee) S i Print Name:.] - e.VC i ?OSS Lic. #: 9 2 ,3_i RS I State Surcharge (% of Per t Fee) S TOTAL PERMIT FEE S Authori zed Notice: This permit application expires If a permit is not obtained within Signature: Date: _ ISO days after it has been accepted as complete. •Fee methodology sit by Tri-County Building industry Service Board. (Please print name) i:\Dsts \Permit Frrrm\Elc Perm itApp.doc 01/03 /lsrazoo —_/ 83 ® kAAAAAAAAAAAAAAAAAAAAAAAAAAA AAA AAAAAAAAAAAAAAAAAA`AAAAAAAAAA Ir 1 1 Is- 1 1 Os- ® STREET TREE C 04- 1 ® 4 1 1 A I, ( �rs/Gs. , Own er /Agent for „u,� lA )'C (.,,�,(�/ ® (PLEASE PRINT) ( PERMIT HOLDER) 1 s ,� 1 Do hereby cer that* following location 1 meets City of Tigard /Washington County ■ 1 0. land use and development standards for street tree installation. t 1 1 1 ® ADDRESS: 53 {7 $ kins. fri A LOT: 6 SUBDIVISION: 6 .),..5 1 L S T A- g f 1 1 BY: r „ DATE: /6/ Z 4..7 7 1 1 0 , RECEIVED BY: DATE: f ( - °"--,-- - 0 i / O- A F VV7VVVV7VVVV`V7V I le ♦YYVVYYYYYYYYY CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST CU x-,00 /� INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested _ /c) ' AM PM ✓ BUP Location q 3 /7 Suite MEC Contact Person Ph ( ) � PLM Contractor Ph ( ) SWR p I1G Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Ina Sheath /Shear C) SA b S � , / F QA// . Framing � 1` ��[ Insulation --.� �,- r -� .�/ r Drywall Nailing l t` [- C� + Firewall A / Fire Sprinkler Fire Alarm Susp'd Ceiling Roof _ �� ilMb= Other: - PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final P PART FAIL E C H A CAL Post & Beam Rough -In Gas Line Smoke Dampers PAS PART FAIL EC CAL Service Rough -In UG /Slab Low Voltage Fi �larm final L I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SS PART FAIL SITE Please call for reinspection RE: I 1 Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date 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 MST .40/) ) 7 -6/ INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Requested / 1 AM PM BUP Location 3/ Suite MEC Contact Person Ph ( ) /0 r g'//c PLM Contractor 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 Firewall 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 Other: .1 .gS 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 Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ) �j� ADA Approach/Sidewalk Date ✓ _ - 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 ( MST o5 ) 69 INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested / / — 9 AM PM BUP Location 9 3 / 1 Suite MEC Contact Person Q 4L/)_c-n Ph ( ) -7-800 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear � � Int Framhn ath/Shear ` ) Cam ' 0 l / ' d C� -t '��5� Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof CAS6 '� . PART FAIL BING Post & Beam Under Slab my & 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 ampers PART FAIL RICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Reinspection fee of $ required before ne , .. spection. Pay at City Hall, 13125 SW Hall Blvd. PAS PART FAIL SITE Please call for reinspection RE: AS Unable to inspect — no access Fire Supply Line / ADA D 0 Inspector /Fr ��� Ext Approach/Sidewalk � Other: Final DO NOT REMOVE this Inspection recor om the job site. PASS PART FAIL