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Permit CITY OF T I G A R D MASTER PERMIT PERMIT #: MST2003 -00129 0 DEVELOPMENT SERVICES DATE ISSUED: 4/22/03 '41! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11422 SW LAUREL GLEN CT PARCEL: 2S110AC -01900 SUBDIVISION: LAUREL GLEN ZONING: R -4.5 BLOCK: LOT: 002 JURISDICTION: TIG REMARKS: Construction of new SF detached residence. BUILDING REISSUE: MAS2212G STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,200 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,339 sf GARAGE: 719 sf FRONT: 20 PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5 VALUE: 254,731.30 OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 2,539 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 0 TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 1 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 1 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1 GAS FURN > =100K: 1 UNIT HEATERS: HOODS: I OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 3 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: $ 7,757.85 This permit is subject to the regulations contained in the ALP ENGLOW HOMES ALP ENGLOW HOMES Tigard Municipal Code, State of OR. Specialty Codes and 5620 SW KELLY AVE. 5620 SW KELLY AVE. all other applicable laws. All work will be done in PORTLAND, OR 97201 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: 503 793 - 3866 Phone: 503 245 - 7720 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You Reg #: LIC 131932 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Erosion Control Insp 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins[ Rain drain Insp Mechanical Final Sewer Inspection Underfloor insulation Electrical Service Low Voltage Water Line Insp Plumb Final Footing lnsp Crawl Drain /Backwater Electrical Rough In Fireplace Insp Water Service Insp Building Final Foundation Insp PLM /Underfloor Framing Insp Gas Line Insp Appr /Sdwlk Insp Post/Beam Structural Mechanical Insp Shear Wall lnsp Insulation Insp Electrical Final Issued By : ���• - Permittee Signature : � � ��'L Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day 1, Building Permit Application FOR OFFICE USE ONLY "' l b` Received . , Building _ i , Date /By: '7` — 3 - 03 PermitNo.:V I a7O3 — OD4'Z9 City of Tigard V E n Planning Approval Other I� 1d Date /By: Permit No.: a 2�dD /Q3 � 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date /By: A 4\1 4 1' /1 PermitNo.: Phone: 503-639-4171 Fax: 5O3-19 1 ' ; .tlWd l ��N Post - Review Land Use id 2 , ,N� a �, r, I # Date Re Case No. Internet: www.ci.tigard.or.us c -.n g a — C Juris.: ® See Page 2 for 24 -hour Inspection Request: 503t6W�(4 Tl Name /Method: Supplemental Information BUILDING D \'Jl I' /C7 /a9-y% 5U a�a .. wad. TYPE.®F;WORK „ .`.s . ' : :.. .,..: 7 _ ,. ,x- .,�:,� �,� .�. .� � � �� �REQIJIREDrDATA � © New construction ❑ Demolition '„ '* N 1 & 2 T FAMIL E Y DWELLING : . lk ';:',121.,,,0;84 ❑ Addition/alteration/replacement ❑ Other: :- .. RY�OFCONST�RUCT�ION , ,; .;, ,r "J ., i Note: Permit fees* are based on the total value of the work performed. Indicate w r.r � '.�� �� °.,� �CATEGO LI 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 _ __ __._ .�� �.-T: - _._ N o f bedrooms: 5 No. of baths: �,�, ,, , �. , ; �JQB`SITEEINFO RMA TION and�LQ �CATION� �� ry "2- Job site address: I l 9 tz- 5w ( .ke.t.l 6-Ien CT • Total number of floors New dwelling area (sq. ft.) 2,-�� „�t��........ Suite #: Bldg. /Apt. #: Garage /carport area (sq. ft.) CS Project Name: Covered porch area (sq. ft.) 1La., Cross street/Directions to job site: Deck area (sq. ft.) r t1 (�• ,� _ 2 ,' t — o ., t ` U Other structure area (sq. ft ) f L.64_ o e Lamy I G”. - REQUIRED4DATA . V r ^ 3 „ COMMERCIAL USECHEC�KI , Subdivision: LA.Nre I G C 5 Lot #: '1-- Tax map /parcel #: I I C2 AC, .. o 'l Of 00 Note: Permit fees* are based on the total value of the work performed. Indicate 1 ,& M _ ;rtrgAttDESCRIPT,I,ON OF WORK : ; 2lr, l:"` . 0 , the value (rounded to the nearest dollar) of all equipment, materials, labor, all overhead and profit for the work indicated on this application. • lIew co et�7 ?/ • Valuation $ Existing building area (sq. ft.) New building area (sq. ft.) Number of stories ri' PROPERTY'OWNER ` :: ,Ii; TENANT4P „, l Type of construction Name: >�-1 5 1 p y ) Occupanc grou Existing: • ""`� New: Address: S'6 Z .0 5w ).e l l ,LL e City /State /Zip: e+ / �( Qv� 9 7 2- 3 1 • Phone 793- 3866 FaX Z [(s, 7 7 6 S NOTICE: All contractors and subcontractors are required to be _ . licensed with the Oregon Construction Contractors Board under il LS AP,PLICANT � � , .. : _I � � r-- .�CONTAG WA provisions of ORS 701 and may be required to be licensed in the Business Name: jurisdiction where work is being performed. If the applicant is exempt Contact Name: A ! 7 c_ ,,., from licensing, the following reason applies: ' Address: G5 City /State /Zip: Phone: 793-310c Fax: r I vIN , G F E ,P RMITs E S E-mail: e e < . 52. I f :i CON:T°RAGTOR 7'' . , ' � '.. P _� ° =.s . = a1 .,.,x 4' :� C ....'''.6'Z . :^'' lease ,e .,.. , ,. �__,.� , , . � _ � � ., . �z� � ^.� ,.. .,a ..� Business Name: , ti, t4 Fees due upon application $ Address: City /State /Zip: Amount received $ Phone: 74/3 - 3 4 3 Z F 2, - 776 s Date received: CCB Lic. #: Authorized �j/ Notice: This permit application expires if a permit is not obtained within Signature: */ Date: I 2 — °3 180 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 Commercial Plan Submittal -•�,L el Requirement Matrix City of Tigard TYPE O F UB S ITTA # of Plans Ate i $ E, (Includes New Additionsor Alte ations) NRe E Sutmi,ttal Site Work 4 (must include location of all accessible parking) Plumbing - Site Utilities 2 Building 1* Fire Protection System 3 ** Mechanical 2 Plumbing - Building Fixtures ;2. Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). *For over - the - counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or,NICET level "3" technicians. is \dsts \forms \COM- matrix.doc 9/24/01 Rpr 02 03 09:49a PLU.CON.INC. (503)658 -5232 p.1 Rpr 02 03,.06:29a Bob McCurdy 1503)245-7765 p.1 . ' Building Fixtures ...FOR OF EIC.E :l)SE ON Plumbing Permit Application r t«<i.ed Plnmbing Date/B . Permit N tSraaz3 - /2-1 City of 'Tiger Planning Approval Permi Sewer E v E' V Date/B Permit No.: 13125 SW Hal{ Rl Plan Review Other Tigard, Oregon 97 23 E D Date/B . _ Permit No.: Phone: 503- 639 -4171 Fax: 503,-59,14- Post - Review Land Use s � � (3 Gi,� t 111/11:, t t Date/B : _ Case No.: Internet: vvww.ci.tigard.o �sR '- , Contact Juris : IS3 See Page 2 for 24 -hour Inspection Request: 503- 639-4UZS - Name/Method: Supplemental Information. CITY OF } A� . B WING D VISION! . W 1'YPE 01' W ORIC FEE *.'SCHEDULE (for special information use checklist) New construction __E] Demolition Description ] Qty. Fee(ea.) Total Add U Other: New 1. & 2= rxtntly tl vellings CATEGORY OF CONSTRUCTION (iacttides 100 iL for each utility connec(ian) . M 1 & 2- Family dwelling D Commercial/Industrial SFR ti) bath 350 SFR (2) bath 350.00 [Accessory Building ❑ Multi- Family SFR (3) bath _ 399.00 Master Builder LJ Other: Each additional bath/kitchen 45.00 -. JOB SITE INFORMATION abd.LOCATION Fire sprinkler - sq. ft.: Page 2 Job site address: // q 2. l 3w Let u_'e. Crlw / t (1 Site Utilities Suite #: J Bldg. /Apt. #: Catch basin/area drain 16.60 Drywellfeach line /Wench drain 16.60 Project Name: Footing drain (no_ linear ft.) Pape 2 Cross street/Directions to job site: Manufactured home utilities 110.00 • 0 .4 MJ., TZ . , 1Z,�k 1) N Manholes 16.60 • Rain drain connector 16.60 ` 1. e1 0.4 Lq.u.ve 1 6-k .5 C4-. . Sanitary sewer (no. linear ft.) Page 2 Subdivision: cot ee.-e L tr /€ 1. 7 I Lot #: Z Storm sewer (no. linear ft.) Pagc 2 lax map/parcel #: Water service (no linear ft.) Page 2 - ...::Fiiitiire oi:Itetii:- -' - . DESCRIPTIONOFW,ORW Absorption valve 16.60 Backflow •rcvcnter Page 2 Backwater valve 16.60 Clothes - washer 16.60 Dishwasher (6.60 _ • Drinking fountain 16.60 ROPERTY:.OWNER A D.TENAN'F -°::i;. Ejectors/sump 16.60 Name: p} I 45 /a,., /101+1'S Expansion tank 16.60 • Address: c....) 8 /�( Fixture/sewer cap 16.60 7 Floor drain /floor sink/hub 16.60 City /Stale /Zl 10J � CA .. �?_3. 3 Garbage disposal 16.60 Phone: 1/3.- 3 $1,/, Fax: 245 - 77(,.5 Hose bib 16.60 • -- A`PPLICANT . . - • - , IB CONTACT PERSON - -.. Ice maker 16.60 • Name: lnterceplor/grease trap 16.60 _ Address: tom_ Medical gas - value. S Page 2 Primer 16 City /State /Zi�l: Roof dram (commercial) 16.60 • Phone: I Fax: Sink/basin/lavatory 16.60 E-mail: Tub/shower /shower pan 16.60 • CONTRACTOR . Urinal 16.60 , . Business Name: Water closet 16.60 • �� - -' Water healer 16 Address: /.D . ,t3pxt /06,d Other: City /State /Zip: C /otk O 7015 Other Phone :50,5 -&5g- 5;43, - Fax: Same PlumbingPerinit Subtotal $ CCB Lic. #: g,R ,Plumb_ Lic_ #: ,3- ,191p1,3 Minimum Permit Fee S72 -50 S Authorized .. - ✓' Residential Backflow Minimum Fee $36 -25 �- Z. D ate: ' 1''2"0.3 Sign uFC`: � "-�-`' � ` - Plan Review (25% of Permit Fcc) S 4,15 Oaa. mti.,J r7 State Surcharge (8% of Permit Fee) $ (Please print name) TOTAL PERMIT FEE • $ Notice: This permit application expires if a permit is PM obtained within As new commercial buildings require 2 sets of plans with isometric or ISO days atter It has been acceptant as complete. riser diagram for plan review. • Fee methodology set by Tri•Counly Building Industry Service Board. i:\ DstslPermitForma \PlmPermitApp.doc 01/03 • Mechanical Permit Application Received FOR OFFICE USE ical ONLY Date/By: Permit No.A 5 T;A.60 3--CSo 1 2--' Planning Approval Building City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date /By: Permit No.: Phone: 503- 639 -4171 Fax: 503- 598 -1960 Post - Review Land Use � ' I Date /By: Case No.: Internet: www.ci.tigard.or.us Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information. t . ; . ° °';- ..COMIVIErtorfi yFEE *,TSCHEDULEr sE CHECKLIST : , �.., �r ":� ,.. �.�.� � ��, - �TI'PE;OF.WORK z= .: .4 �` ' [l New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work ❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all 14'`i -: _ ' CATEGORY OF CONSTRUCTION " i . ' :' mechanical materials, equipment, labor, overhead and profit. 1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule Accessory Building 111 Multi Family F 7RESIDENTIAL4EQUIPMENT /SYSTMSIFEE*;SOHEDULE : Description Qty Fee(ea.) I Total ❑ Master Builder ❑ Other: , - Heating%Cooiing' ,, . _ . £ ' f ;'_JOB1SITE LNFORMATIQNIand,:LQCATION :.., X. -, Furnace - add -on air conditioning ** 14.00 Job site address: f 1 92 2- 5(-..) t* / 6A, C].- Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: Hydronic hot water system 14.00 Residential boiler Cross street/Directions to job site: (for radiator or hydronic system) 14.00 Unit heaters (fuel, not electric) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10.00 Subdivision: CLt r4re Lot #: " Z Repair units 12.15 1 6 r1 C , ,a. ;' 'Other Fucl'?AEpliancs • r, x 1 :_ Tax map /parcel #: Water heater 10.00 .x SAI": . I ESCRIPTION OF WORI{ - y`=3," Gas fireplace 10.00 Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 .ROPERTY OWNER,;..';, ( ,' _. , €; Other 1 00 Name: /I'L{wl H 0w*.C� , ' ,. t. ? Envrroiuriental `Ezliaustf&Ventilation;,' S? .:::;„2 . - _ lU S (_ ��a• Range hood/other kitchen equipment 10.00 Address: ,T2 t2 5t.J Ke I LI Clothes dryer exhaust 10.00 City /State /Zip: p4-0 bd.. et 17 2-3 Si d uct exhaust Phone: 793 - 366 Fax: 215- 776 3 . . (bathrooms, toilet compartments, <APPLICANTo..: IV. a r ®,CUNTACtMS®N ,,.. `; utility rooms) • Name: Attic /crawl space fans 10.00 Address: Other: 10.00 _ . f - ,Z:. ?.` ; �'' F P Fdel4Pipi'n ` Itk,=: .ate`• �. City /State /Zip: * *($5.40 for first 4, $1.00 each additional) Furnace, etc. ** Phone: Fax: ** Gas heat pump E-mail: . • Wall /suspended /unit heater ** _,; .Iiit 4 ? _ , a A CONTRACTiOR "':= IZZli L .s It° Water heater * * Business Name: g &- Wk. 1-1 c-" ') Fireplace ** Address: Ae O 6'x /11/ Range ** BBQ ** City /State /Zip: 130 ,'1" 04- T 7 0 al Clothes dryer (gas) ** Phone: S /S'- $763 Fax: 5D3 - S,- Jr - /LYS Other: ** CCB Lic. #: / 2.1.,/ 7 S Total: 7 Mec " apical}Permit ; Fees *' . Authorized t� —I Subtotal: $ Signature: �`'--� Date: / / Minimum Permit Fee $72.50 $ _ _ Plan Review Fee_(25 %0 of Permit Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. ' is \Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard • , . Page 2 - Supplemental Information Commercial Fee Schedule: $1.00 to $5,000.00 Minimum fee $72.50 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for each additional $100.00 or fraction thereof, to and including $25,000.00. $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Value Total Description: Qty (Ea) Amount Furnace to 100,000 BTU, including 955 ducts & vents Furnace > 100,000 BTU including ducts 1,170 & vents Floor furnace including vent 955 Suspended heater, wall heater or floor 955 mounted heater Vent not included in appliance permit 445 Repair units 805 <3 hp; absorb. unit, 955 to 100k BTU 3-15 hp; absorb. unit, 1,700 101k to 500k BTU 15-30 hp; absorb. unit, 501k to 1 mil. 2,310 BTU 30-50 hp; absorb. unit, 3,400 1-1.75 mil. BTU >50 hp; absorb. unit, 5,725 >1.75 mu. BTU Air handling unit to 10,000 cfm 656 Air handling unit >10,000 cfm 1,170 Non-portable evaporate cooler 656 Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 inserts, etc. Gas piping 1-4 outlets 360 Each additional outlet 63 TOTAL COMMERCIAL ' VALUATION: • i:\Dsts\Permit Forms \MecPermitAppPg2.doc 01/03 Apr 02 03 06:37a Matt Weber 503 620 6819 p.1 Wednesday, Apri1,02, 2003 6:33 AM Bob McCurdy (503)245 -7765 p. GUIi OFf[CT 151 O iI E Permit Application Rte eceire penamtr�l Date/By: No,./ % /�U � G?� /zy Planning Sign City Of Tigard 13ate1By: Permit No.: 13125 SW Hall 131vd. Plan Review Other Date/By: Permit No.: , Tigard, Oregon 97223 Post Land Use Phone: 503 - 639 -4171 Fax: 503-598-1960 ;;,,, • I r: r; Date/By: Case No,: Internet: www.ci.tigard.or -us -, ��II Contact lurle: See Page 2 for � 24 -hour Inspection Request: 503 -639 -4175 Name/Method: I Supplemental information .' .` :,PLANGSEYiEW;( Please cheelt4It hatiik49) ''. : :- :,� -:. : ,, La;:'". 1 -',.::,:!!- - ;::'. T�'1?E =Q'E e1�ORi�'- =_:�.;- :.•':." . . . .. . ..: . H raith�earcfacili _ a Demolition 0 Service over 225 amps- ❑ facility H New construction commercial 0 Hazardous location Addition /alteration/replacement I ❑ Other: 0 Service over 320 amps•rating of D Building over 10.000 square feet. :°;rye r :"r;' `:'• :: ; - cAiEGoZr(oP (' NSIY1.CEiOp -' 161 2 family dwellings four or more residential units in ❑ System over 600 volts nominal one structure ►� 1& 2 dwellin: (fix Commercial/Industrial 0 Building over three stories 0 Feeders, 400 amps or more I Accessory Building 12 Multi-Family 0 Occupant load over 99 persons 0 Manufaetuted structures or RV park ID tr'-�-� 0 Egress/lighting Plan 0 Other: Master Builder lJ Other: Submit _ jets of plans With any *Me above. Ai: : - $UB 5TH'E ^INFAR 1`141!Fatid'I � sIfITO ++ N' n ' The above are not aP� � icable to temporary construction service. . Job �j " LA t l G -(evt `�. r:•. . t.R.: ," �Y ' HI D., : i:-rt.;�.:... :Y � , :r:_.. . Job site address: wiz. Z - ""' . . _ Suite #: 1 BidgJApt #• Number of inspeettions per permit allewer: - Description Qty ' Per (ea.) Totai ..- Project Name: New residential- single or morn -family per ' Cross street/Directions to job site: dwelling unit. Includes attached garage. Service inciutkd: ta5.15 1000m. R or less • Each additional 500 sq, 0. or portion thereof 33.40 i Limited ener y,rcddential 75.00 - Subdivision: I o.v i e I G � lM E a I Lot #: 2 - Limited energy, non residential 75.00 - Tax map /parcel #: Each manufactured home or modular dwelling '/ - - q service and/or feeder 90-90 l ss >r : «" ' :�= %A TZOIY.OF. QRK ='r?t F + Services or feeders - installation, alteration or relocation: 80.30 200 amps or less 201 amps to 400 antes I0615 401 amps to 600 amps 160.60 - - rft !t, 601 amp to 1000 amps 240.60 T. 0$PiR' y °Vt;1Q1ER tw: ..`•:= tTel l 1!17 ::: ; ±kr "Z r O ver 1000 amps or volts 454.65 p }4.0.4i es R econnect oaly 66.85 , Nye' (i K ✓� Temporary services or feeders - installation, Address: slo Z O g. ,! Ie a ll l�`� ` alteration, or relocation: City!State/Zip: 9 t-1 rl e 4..- 4..- Ay 7 7 Z 3 q 200 amps or kss 66.85 100.30 • Fax: L yS --7765 201atspsto T 133.7s Phone: 74'3 -38106 401 to 600 amps � ,:;. l ;ppL"I�(',%CiV�i ?;�a: ' � ;'�s' ?' ': "t lJ�RC l4ER.�4N -< .. `� Braee3 cirenlu -new. alteration, or ' ' extension per panel: Name: / �ct y . A. Fee for branch circuiu with purchase of p /' . 4 service or feeder fee, each branch circuit 6.65 - • Addre Clsy /$tall JZIp: (tl of 04_ 9 7 77,3 - 9 3. S ss: (! 1 o S Sul 7/ � B. Fa for branch circuits without purchase of service or feeder fee, fest branch citron 46.85 Phone: /� ? 3 �(r6 '_ • I Fax: Z 54 - 774,5 Each additional branch circuit 6.65 , :_ _ 1 Misc.(Setvia or feeder net included): ): E Jon .., c G e Z . CO ✓1n Each pump Of Urination circle 53.40 .r.? .0 _. ; �, •'=V :L 1 •iK' G 1 .' :*il btu ^ .• "' { '-. :1 irk - Each sign or outline lighting 53.40 Job No: 'Signal chtuit(s) or a limited energy panel, Pate 2 _ / alteration, or extension Business lallle: f tT /h et TisC Description: y Address: AD 'Box Z 3 / l 5 Each a dditional in spection over the allowable in an of the above: City /State/Zip: Ti 9 aril Da 9 72 2 t 5 , Per inspection per hour (min - 1 hour) i 62.50 � .(, Investigation fee: t i Phonesp$ • G2a- / ?c,(0 Fax ww A (a`g ! CCB Lic. #: 4401 7 Lic 34 —'1 Ottler: i'. :aK ? �, ¢...j... �r..I ..r . #: �, : �f:, l"�IeitslCa�I'Rcl7atlt)ECet:'�` ;;: 4 �:ss. . ,t'z.: S electrician Subtotal S ..- signature required: , Plan Review (25% of Permit Fee) S L ic. #: 4 State Surcharge (8% of Permit Fee) S Print Name /� Itt<<6�/' - TOTAL PERMIT FETE $ Authorized — Notice: This permit appBcatson expires if a permit It not obtained within Date: 180 days after It has been accepted as complete. Signature; Date: methodology set.by 7Yl- County Building Industry Service Board. (Please print name) i:\Dsts\Pertrut FormslElcPermilApp.doc 01/03 ' .446-7-,2az)-cfer21 ' N. , -,„,..., ‘ --- -, , - • 1 5 5 , 10 i I>: A S Iv' , A t•-' 1 STREET TREE CERTIFICATION L it . A • A , , 110.- A OP. A 110- 11 1100. A I, '*2 I k on T/Y1 0 , rhymer A gen for 41,_p COAisT '- 1 (PLEASE PRI (PERMIT HOLDER) 4 4 A S. to. A A s A k fr \ , , :\*' --A1 1 Do hereb A444 t; i,,„i):- k 0 9 i I g location Oa. r. E 1 meets , 0 ..rd ' f A , 4 co 1 1 10' land use and development standards for street tree installation. I 1 /01' A ..„1 ADDRESS: - / i q0-(44' SLA/ L-At))2 i._ o LE c 7 - --. A A " ' lo. LOT 2 i SUBDIVISION: LAVPCL. G C.-7t2 ii■ ' ' ' A - I! BY: d,P)".-- 4 . 1i , DATE: 110. 1 ■ 1 Ika* 1 RECEIVED BY DATE: VO 1110- VVVYVVVITT7VVVYVVVVVVYVVVVYVVVVYVVVVVVVVVVVVVVVVVVVVVVVVVIFTV1 • CITY OF T*GARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 o 3 (� c� INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested AM -- PM BUP Location / ( 1 7 1 fa,z,Ze C�3aite MEC Contact Person Ph ( ) PLM AN Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: 7 C' 3 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: • •A PART FAIL //,‘ P BING, 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 Lirti Smoke r11,A .ers PART FAIL YI CTRICAL ervice Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA D ate > Inspector �/� Ext Approach /Sidewalk / P Other: Final DO NOT REMOVE this inspection record from the job site PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: 9 -4175 MS1e--OD 3 ---0U l Z INSPECTION DIVISION Business Line: 3 • ° -4171 / /0,210 _ BUP Received Date Requee ed 1 10 — OV AM PM / / BUP Location 7l `t Z Z 4,GLA pJ 44 Suite MEC Contact Person Ph ( ) 793- 3 s26'P PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Ft und n Access: ek � • ELC 9 ELR Crawl Drain Slab Inspection Notes: �1 SIT Post & Beam Shear Anchors Ext Sheath/Shear ' ` �, 1 c1 • 0 Int Sheath/Shear Framing Insulation •' Pe! Drywall Nailing Firewall ( Y Li G C ,s.� Fire Sprinkler ` v `—'� 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 Pare Other: final 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 Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please all 'for reinspection RE: n Unable to inspect — no access Fire Supply Line ADA C� Date t l Inspector , �1 ' (/ `� Ext Approach/Sidewalk ; 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 3 dd INSPECTION DIVISION Business Line: (503) 639 - 4171 BUP Received Date Reques AM PM BUP Location / I YI Z uite MEC Contact Person Ph ( ) 7 93 - 1e . ` 4' PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation ACCess: -7 Ftg Drain j / '73 ELR Crawl Drain G J 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: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low h Fire Alarm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. �E 111 Please call for reinspection RE: El Unable to inspect – no access Fire Supply Line - —/ - ADA Air L' Approach /Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection recor ' from the Job site. PASS PART FAIL