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Permit `A ., A CITY OF TIGARD MASTER PERMIT PERMIT #: MST2005 -00025 . giP DEVELOPMENT SERVICES DATE ISSUED: 3/4/2005 „ °•j �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2 S 109 DA -S R082 SITE ADDRESS: 12928 SW SUMMIT RIDGE ST ZONING: R -7 SUBDIVISION: SUMMIT RIDGE LOT: 082 JURISDICTION: TIG REMARKS: New SF. BUILDING REISSUE: DM308 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,910 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,590 sf GARAGE: 400 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 Twttt sf RIGHT: 5 VALUE: 334,780.00 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,500 sf REAR: 15 PLUMBING SINKS: 2 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: 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: 2 CLOTHES DRYER: 1 GAS FURN > =10OK: 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/FOR: 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 +amp6- 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: INTERCOWPAGING: 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: This permit is subject to the regulations contained in the DON MORISSETTE COMMUNITIES LL DON MORISSETTE COMMUNITIES LL Tigard Municipal Code, State of OR. Specialty Codes 4230 GALEWOOD ST 4230 GALEWOOD ST #100 and 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 Phone: 503 387 - 7538 Phone: 503 387 - 7538 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through Reg #: LIC 162512 952- 001 -0080. You may obtain copies of these rules or FOTAL FEES: $ 8,865.29 direct questions to OUNC by calling (503) 246 -6699. REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 Engineered soils Issue By : � � . / /i ' 1 Permittee Signature Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next 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. tuildin Permit A '��® 4 FOR OFFICE USE ONLY City of Tigard 97223 Date/By:/ e9 (X to j ) Pe No. 5�A�� d opt j 13125 SW Hall Blvd., Tigard, OR �� pp �` Plan Review �}�( � jyl` Phone: 503.639.4171 Fax: 503.598.196JAN 2 8 Z005 �iem Mr^It � t -e �� " OtherPerrnit:e' �JJ addag Y r Date/By: 3 - , ) Inspection Line: 503.639.4175 Date Ready/By: 3uris: ® See Attached Checklist for Internet: www.ci.tigard.or.us Notified/Method: 'r`( Supplemental Information CITY OF TIGARD • . i - 4 i t .' q • � .' . t •. r '•' Yr; .r ,l ' : . ,•. %t :•, C ,. - '' ' 1 • - fTYEE. OF � ..- . s _ , �;,,;. -. `' � • , r . >e ;RE.' UII D'ATAi';1' "t . )2 � • D I �. .: •. i� DWELLING' - ..,1 ^...'.._ t•: '.x(-. .. ". ...�. .. t. . i. .. , . ... .r.H "' , ..•'�::r..ir.;•. � /•.. .. x New construction ❑ Demolition P erm i t fe es* are based on the value of the work performed. Indicate the value ( to t he nearest dollar) of all ❑ Addition/alteration/replacement El Other: equipment, materials, labor, overhead, and th profit for the ' - E y ... '•t t ,' 'r �� • � work indicated on this application. . C, �imEG ©R�'i;�UF�.GOI�ST,I�UCGC01�,' • ':. , •v.. �'' � 1 Valuation: $ ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: of fl b l 1.. . i;e:\ ," :N:;� 1.,, r,, ';:r. ir',:t =v; : :1: y:;, ,;.�'r�6: ,;,;'' Total number 000rs: /J )• '; z JOB Tttf 'IIy QRNtATIQI,(, ,i -. QCATIOIy N r '' t } C/ I2 e s 'r `` _ - .. ,t _ r c,,. t. , r -.. � ,�.. ,. �. ,-4:.!: _ . i r S. F i '; •t'' Job site address: \j �V 4 - �� t New dwelling area: b square feet City /State/ZIP: • y V l � o Gara area: J 4/) square feet ��/ ( "It.�tl Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet 10:51 EDLDck. r � day( , E , I�CI I� -> S i0,4,CKLIS!i yp , 1 ra.,.,7s. , rr �: �; �. o4�' N 1•:,:- Lu� „ gin :, Subdivision: A� 1 /��� �(. Lot no.: e-d— Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the "' . `'''- ,,$,. DE CRIPTI + Nlr F ©RIC: •' � 1 ';!?`r work indicated on this application. = ., ' ..i• Q, mt.:''.?:, b , a,'.n` {ii ,tt 4 i , p'.�� t PP s. Valuation: $ Existing building area: square feet New building area: square feet 1. ? , I :PROP, * U�yrND R ; `. , ' ' y :.,a: ,4 • :i' I.' - .T.E NANIF ' : Number of stories: } c.- � �� , ” { r• Ira '4..4A t 4•h;, ?I' .1 � ' -•I .:v"!. 1.1 w ",r'. ��.'. �• :i A .Irl ■ .,. i { r : Yi �'' fie- 4r. ,,,' , ' >,.� °� 5 — '': ' 1 • a�, . � � - := '1'Y, , fit ;3,'. >"rJ.;I i .;r; � r ! i "I Name: / K--i W �a m It J f (E ` "- 1 j -`l Type of construction: Address: 'L ( ) G) . c( ,.. L p Occupancy groups: City/State/ZIP: L :747.>-? - ( �C) 1 —7 q / 0 3 5' Existing: Phone: (. ✓/ ' 5?) Fax: ( ./5) 3 / • 7 (.o [ S New: ,:' :tr y .c' - .tw• - ,n'a { ; ;' :! �..ii ,.:;', r •t; _ :,I i 3 :.!'ta,..,..\,.; ";;,.::'':.1 ''ti' r . ®':APRt, GA , ' ' q ' 'n;� . �� :'.•\ ,1 70 N TAG� . A13RS0 , , '.5 , . , q , °,F ei °,;; ,:A;; _. ., ..o ... nr Y.. 4: , +'t , n$ .. h : : �N' :r, .WI .1. 1 ? ;;' 15 nt. .1 ! Y .,, :,, . Business name: � : 1... V r 1J �/V_ All co . i�: l : , ' contractors ' , t 9 y ' o rs ;, y .. :, �q � ntrtrs 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: ( ) Fax: : ( ) E -mail: .;1 ,, . : •lll /� TI . t/ , w �� •li . .„ 1 1,,1 :'r,�,-, : � .' ,VQ '�I2:4CI?Ul�t;�c "`.. : r to ' r; : %I ! '. Business name: 5 t� , k`k Sri ,: ' ..r. ' B ; F.EDS * ' Address: Please refer to fee schedule. City /State/ZIP: Fees due upon application Phone: ( ) Fax: ( ) ( _ Amount received CCB lie.: `�' �5 ` Date received i Authorized signature: pe rmit a / � ' Tltis pplication expires if a permit is not obtained I within 180 days after it has been accepted as complete. Print name: De I . . 1 C �� Date: B j kp * Fee methodology set by Tri -County Building Industry Service Board. i:\ Building \Permits \BUP- PermitApp.doc 12/03 440- 46I3T(I I /02/COM /WEB) Mechanical Permit Application, FOR OFFICE USE ONLY City of Tigard Q ECElD Received � i" Date/By: Pemut No.:�., 31: gu ©� 13125 SW Hall Blvd., Tigard, OR 9722, a, Plan Review Phone: 503.639.4171 Fax: 503.598.1960 SAN 2 8 X00 Din ■ .;p rl , � l ).1 A Date/By: Other Permit: Inspection Line: 503.639.4175 ■ � r.� Date Read B Juris: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: • Supplemental Information CITY OF TIGARD . R , *: ,.,. '• <: ,`'I� :,,, ,�,•.� _., ;• '� ,. <'t�4',: `. *'` ' ;COMMERChAL•,FDE - S CHEDULE- :lJ CH (New 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. i"CATEGORY,'±OFICONS� RUCTI© .., r .. ; Value: $ Y dwelling ❑ ..,, _, ❑ 1 -and 2 -famil dwellin Commercial /industrial ❑ Accessory !., ESI .. ccessory building .' � • .;RESIDENTIAL EQUIPMENT %;SYSTEMS'F.EES * ' For special information use checklist. ❑ Multi family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total :JOB SITE INFORMATION4.;ANDM.LOCAT1:OIN; :;I`•';, „„ ^` I .i ; ; i Heating/cooling Job site address:, Air conditioning or heat pump I (requires site plan showing placement) 14.00 • City /State/ZIP: f D- Furnace 100,000 BTU (ductslvettls 14.00 Furnace 100,000+ BTU (d 17.90 Suite/bldg. /apt. no.: I 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 W C Subdivision:bAN I Lot no.: fg Other: 10.00 Tax map /parcel no.: Other fuel appliances -a: ',r,y. .,. .,,. ta,� -. ; ',..- .�;.: = s; '. •' +'- .s., , TIION >' :OF'. .::e 1: \• ;' ' , .w. ' ' Water heater 10.00 ' .1! t , 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 .. ,'Ye M, Chimney/liner /flue/vent 10.00 • PROPER OWNER; . ; ,'•. ., : - "`i; - `` ;i ®': TENAN '' • .. �;� ,...: , % I r. ��� P� �.. - � ■ Other: 10.00 • Name: \ ,... Range hood /other kitchen V- � / . TN A�kkel. Ui )/ Environmental exhaust and ventilation Address: VIJ"'�" J�� -. C e, t� ` (/ "'' �l� -��/J/ equipment 10.00 City/ State/ZIP: q )0-s Clothes dryer exhaust 10.00 i Single -duct exhaust (bathrooms, Phone: - - 7s- - ) Fax: (f'.0 7 — 2 01 toilet compartments, utility rooms) 6.80 ;:� , 'i f i ��' �.5' ;;, • k • .,'�•., :,. Attic/crawls ` i' •;,:- ®;.APpLrCei7YTt• 'i ° "? r : , .' x �iiCON1 , :P R3U r 1 ;a ace fans 10.00 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: ( ) I Fax: : ( ) Water heater E -mail: Fireplace Range CONT 'CTOR ... ,;.; , ;; .;.; , ' `,. Barbecue name: � ,`( Address: poi Clothes dryer (gas) Other: p , �� , t ] L'I (t-201,5 • 1i ,,,: MECHANICALTERMIT'Fi';ES *. . City /State/ZIP: `� ", � u�_ Ole- Subtotal Phone: ea) 3 _ 3,72,;),,. Minimum permit fee ($72.50) I Fax: ( ) Plan review (25% of permit fee) CCB lic.: .• /)')) State surcharge (8% of permit fee) C TOTAL PERMIT FEE Authorized signature: , f/� 'r� This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: 2--Q ►' � 1 /,� Date: l � l * Fee methodology set by Tri- County Building Industry Service Board \ B i:uilding \Permits \ MEC- PermiiApp.doc 12/03 * 440-4617T(11/02/C0M/WaB) Electrical Permit Application FOR OFFICE USE ONLY • • City of Tigard Received • Date/By: Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 y' /1351:;(20 .5 °Q Phone: 503.639.4171 Fax: 503.598.1960 / , Plan Review Inspection Line: 503.639.4175 61 'III Date/By: Other Permit: 6 Date ReadyBy: Juris: I H See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW New construction . ❑ Addition/alteration /replacement Please check all that apply: ❑Service over 225 amps, comm'l ❑Hazardous location ❑ Demolition ❑Other: CATEGORY OF CONSTRUCTION ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft, of 1- and 2- family dwellings 4 or more new residential ►:t 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure ❑Building over three stories ❑Feeders, 400 amps or more ❑ Multi - family ❑ Master builder ❑ Other: JOB SITE INFORMATION AN e N ['Occupant load over 99 persons ❑Manufactured structures or �, T < ❑Egress c a re ingplon RV park Job no.: 35— / Job site address:.._ ._ :. i. ❑Health - c a re facility ['Other: � << - Submit 2 sets of plans with any of the above. City/State/ZIP: / - Off .. 17223 The above are not applicable to temporary construction service. — Suite/bldg./apt. no.: ✓ ' I Project name: / FEE* SCHEDULE DQal �r/a� G,,„ • Description p I Qty. I Fee. I Total I ++ Cross street/directions to job site: B OVF - sCA/ Q6 New residential single - or multi - family dwelling unit. Includes attached garage. 1,000 d'! ft. or less 145.15 4 Subdivision: �� Ea . add'1500 sq. ft. or onion 33.40 t1 Al I Lot no.: 8 q• p 1 Tax map /parcel no.: Limited energy, residential 75.00 2 • DESCRIPTION OF WORK Limited energy, non - residential 75.00 2 • Each manufactured or modular ,,,_ / Moll LS � �� dwelling, service and /or feeder 90.90 2 ��' ���/// O �✓ /7 f` �n1 Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 JAI PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: / it/C/1 amps to 600 amps 160.60 2 Q�/ / — /O/7 SS Csy AA € y 1 I L _ 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: /, �t e � Reconnect only 66.85 2 LA /C. +� V S/,4/ Go ve CT 7 Q, � Temporary services or feeders installation, alteration, and/or Phone: (53) _ 38 - 7 , 7 �. 3 t Fax: (5-73) 7 3) 3x-7-76 2 200 amps 000 amps or less 66.85 Owner installation: This installation is being made on property that I own which is not to 40 0 amps 100.30 2 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670; and 701. amps to 400 401 amps to.600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, panel ❑ APPLICANT 0 CONTACT PERSON A. Fee for branch circuits with Business name: service or feeder fee, each branch circuit 6.65 2 Contact name: B. Fee for branch circuits without service or feeder fee, Address: each branch circuit 46.85 2 Each add'! branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) I Fax:: ( ) Pump or irrigation circle 53.40 2 E -mail: Sign or outline lighting 53.40 2 Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or Business name: !3 r' ) FL gap , - extension. Describe: Page 2 2 • Address: A 0 �GX %33O JJ� Each additional inspection over allowable in any of the above n Per inspection 62.50 City/State /ZIP: D � M 6J O �/ R ?7 , 1 Investigation per hour (1 hr min) 62.50 Phone: (� 3) 35 - 6 _, l 8 2" I Fax: 3) , C ` L� g- Industrial plant per hour 73.75 A I ELECTRICAL PERMIT FEES* CCB Lic.: / 2 J 222 L Electrical Lic.:311_ y cI Suprv. Lic.: 4./L t 67 Subtotal Suprv. Electrician signature, required: �6 - Plan review (25% of permit fee) _ � �.� Print name: / ,,,t 0 vN I • a �? 7 6.5-- State surcharge (8% of permit fee) — Authorized signature , TOTAL PERMIT FEE h is permit application expires if a 0 ermit is not obtained within I P 8 Print name: days after it has been accepted as complete I' e: • Fee methodology set by Tri -County Building Industry Service Board ** Number of inspections per permit allowed. 1 :\ Building \Pennits\ELC- PermitApp.doc 12/03 440-4615T(10/02/C0M/WEB Plumbing Permit Ap I • FOR OFFICE USE ONLY City of Tigard Re ceived Permit No. 1 3125 SW Hall Blvd., Tigard, OR 97223 pp apy, DatDate/By: . � d�O Pl Phone: 503.639.4171 Fax: 503.598.196OJAN 2 8 p 2 005 an Review ��*- rtS1✓ /- ' �� DateBy: Other Permit No.: 24 Hour Inspection Line: 503.639.4175 ! '� C� 4 1� � r r l I orris: Internet: www.ci.tigard.or.us Date Ready /By: El See Page 2 for g CITY T J Notified/Method: Supplemental Information ,. . -'y s: .,'r BGA� ..,.,•: , . .�J;r'- e " �. • . . - Tl�;�y. ' Iii . .. '` " ",.: fi; 1 �d:'!'1 V:":•!1:.•.,,,,,, - , r` • ' • . 'E E4 ;SCIiEDULE IfN construction ❑ Demolition For special information use checklist Description Qty. Ea. Total ❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) :CATEGORY OFi' Vo.;(2 " :;. 1 r •;, i { :: . ";, .._ ,. .:,, •,. , CONSiI?RUCTION;�;- ~,•:,. -t .,,• . ;.,,�. " SFR (1) bath 24920 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath . 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 r 1 . -, " =JOB, SITE: " FORiVIATION'• LOCAiIlIONh' .: ,, - , .1.: •+'• ' e_Mi r .1 Site utilities Job site address: 12.2i � _� 1 '� / g t Catch basin or area drain 16.60 City / State/ZIP: I Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I 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:5 1 �' �/�� J Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item 1 ., ;0.,,--0 , f ..: : :,,: ,,,;..,,<.-• _ N :Y,. Absorption valve 16.60 ■ ,r C `• ,, , ; Y - ' ' ` �r"4.f'. IO � , }O Fi:�` ,O RI :',5- -' ; ; ; S,S.. � _�% /� _ ;j; .. i, -, j .., ... + .. .,. . , n , . . � '�' , .- .. T . +T; .:T�'" .:rt •�f /•. •1 .. , .* Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 '` \z Drinking ountain 16.60 -'�` .'; "PRP, Y'OW_ !T.LizI .. .: ?:, v ®!..TENANfi` ,, .. , : •' ''".i� ,iy g ' 0: :._ I <. _. ,... ; 'r .... ... :: .... Ejectors /sump 16.60 Name l M Vt `77t Corn m a r t 's' ') I , �,�.ti Expansion tank 16.60 Address: '' , � ` G\ ,, 5 -, 1 c o Fixture/sewer cap 16.60 City/ State/ZIP: C./IQ . q---2) Floor drain /floor sink/hub 16.60 GyC2) . 3 • 7 (yt� %)'.2--" _ Garbage disposal 16.60 Phone: - v Fax: �,.t/ / ' .. . "F ° . A II .•. Hose bib 16.60 ® °:ARRLIC T� i „- - ;. • -: -..: :"r..: : Wezy ® ",^ , G P'. Oaarr,..+=.., ` • 3,'i1 ., u ., n.. A l ?, �. " r , ,1,r "�:'_ . .. �. , . - �.._a• • .r t," . /.... r .. ' � •j Ice maker 16.60 Business name: Interceptor /grease trap • 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 Cily /State/ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax: : ( ) Sink/basin /lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 �,GOfVTRACTOR1 a' . !. .``. I Water closet 16.60 Business name: V ? k da f ,^ ` Water heater 16.60 Address: `✓ Other: City /State/ZIP: �� p / Subtotal / a) _ ✓ r ( minimum permit fee: $36.25 Phone: ) .5) " 7 � ( ) Fax: Residential backflow minimum permit fee: $36.25 CCB Lic.: O 7 -f ' 1p hunbing Lic. no.: %3 � Plan review (25% of permit fee) Authorized signature . State surcharge (8% of permit fee) TOTAL PERMIT FEE Print name: J - ' - 1 I v I Date:' v 1 c7 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. 1:\ Building \ Permits \PLM- Pem,itApp.doc 12/03 440.4616T(10 /02/COM/WEB) A4 5 7 5 -''a 5 . AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAA® ® ® ® ®® 1 V 1 T EET TREE CERTIFICATION S R ,. / \ ft> A I, j lc1- A-Th , ) 5wner /)gent or ® (PLEASE PRINT) \ (PERMIT HOLDER) 1 r ® fir, . ,.a CJ ,, ,� g location ® Do hereby certi £hat th f owm A ! �1 L. ;' t lfio i A meets og�igard %Washi ® land use and development standards for street tree installation. ® ADDRESS: /0 5i- ,C w r,.r, .4t9A. crz. 6 i Pit ® LOT: t Z SUBDIVISION: cam '► / 1. e_, te- 1 11 kt. ® BY: DATE: 9 - O,- 0. 1 0. 1 ; ' ® RECEIVED BY: DATE: te�/O> O. A V VVV V V VV VVV V VVVV Tit VVVV V ' YYV VVY YYYV VY®® ® ®®®® ®®® ®V VVYV V V® 1 CITY OF TIGARD BUILDING DIVISION . PERMIT #: MST2005-00025 13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 3/4/2005 Phone: (503) 639 -4171 A y Inspection Requests (24 Hrs.): (503) 639 -4175 4- F 'I I. INSPECTION WORKSHEET FOR DATE: 6/30/2005 TIME: 7:06AM PAGE: 74 SITE ADDRESS: 12928 SW SUMMIT RIDGE ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE LOT #: 082 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE DESCRIPTION: New SF. OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503- 387 -7538 CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503 -387- -7538 Inspection Request Scheduled For: Date: 6/30/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 010524 -05 503 - 209.4837 N Corrections /Comments /Instructions: V6(2 Ii Z 0C Q�2 ' l- SS've_S Q ...... A A ___ .e k ......5. 0 , 4 !D PASS El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED VZ c Z Inspector: Date: 6 /one #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005.00025 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/4/2005 Phone: (503) 639 -4171 6 1 1 ,' �' Inspection Requests (24 Hrs.): (503) 639 -4175 "I INSPECTION WORKSHEET FOR DATE: 6/30/2005 E: 7:06AM PAGE: 76 SITE ADDRESS: 12928 SW SUMMIT RIDGE ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE LOT #: 082 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE DESCRIPTION: New SF. OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503 - 387 -7538 CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503-387-7538 Inspection Request Scheduled For: Date: 6/30/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 010524 -03 503 - 2094837 N C. rections/Comments/lnstructions: ... l • f Id . 44 6 < V2A3) - ‘. .55 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: u / 67bphone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200500026 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/4 /2005 Phone: (503) 639 -4171 � � ,, - t � i l\ Inspection Requests (24 Hrs.): (503) 639- 4175 INSPECTION WORKSHEET FOR DATE: 6/30/2005 TIME: 7:06AM PAGE: 75 SITE ADDRESS: 12928 SW SUMMIT RIDGE ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE LOT #: 082 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE DESCRIPTION: New SF. OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503- 387 -7538 CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503 387 - 7538 Inspection Request Scheduled For: Date: 6/30/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 010524 -04 503 - 209 -4837 N Corrections /Comments /Instructions: • iA - 1Q /2 5 6 C (v24) — `s5 v-Q-S 0 Af\A1U-jt k PASS ❑ PARTIAL APPROVAL El CANCEL El NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 1 ' 3 6 6 Phone #: (503) 718 CITY OF TIGARD 1 BUILDING DIVISION PERMIT #: MST2005.00025 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/4/2005 Phone: (503) 639 -4171 A s s Y,l ll l Inspection Requests (24 Hrs.): (503) 639 -4175 _..' `'_- INSPECTION WORKSHEET FOR DATE: 6/29 /2005 TIME: 7:08AM PAGE: 65 SITE ADDRESS: 12928 SW SUMMIT RIDGE ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE LOT #: 082 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE' AAp/ 03 Vt- b' DESCRIPTION: New SF. 'B143-e aim • 209. t3') OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503.387 -7538 CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503 - 387 - 7538 Inspection Request Scheduled For: Date: 6/29/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 010424 -04 503 - 209.4837 N Corrections /Comments/ Instructions: C \At 0 VOA- Pt XT V (tcS vAI. E t Z- W■ ► N 61- C. - ‘0 1 g 0A, I PASS 111 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G --- Nat- N GS Date: ( f 2 9 ( Phone #: (503) 718-