Permit CITY OF T I G A R D
DEVELOPMENT SERVICES MASTER PERMIT
PERMIT #: MST2003 -00455
� i� DATE ISSUED: 9/30/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12345 SW THORNWOOD DR PARCEL: 2S110BC - 04900
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 020 JURISDICTION: TIG
REMARKS: Const. new SF detached residence.
BUILDING
REISSUE: DM2897 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 33 FIRST: 1,600 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,700 sf GARAGE: 665 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 322
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,300 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: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 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 FD R: PUMP /IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F DR: 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 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,989.74
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 Tigard other r applicable Municipal Code, State work will Specialty e Codes and
al
STE 100 LAKE OSWEGO, OR 97035 all thr applicable law All wok will by done i
LAKE OSWEGO, OR 97035 accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
5p
Reg #: LI 38737 $ may obtain copies of these rules or direct questions to
s OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control lnsp & Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service lnsp
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins l Gyp Board Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line lnsp Storm drain Insp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Building Final
- ) ......\\. 2___ ,,
Issued By : AO _ 4110 _ - Permittee Signature :
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
• - 1— '3e) - er"?' l ewl
B+ u7�'�i�Q -1.!, " _ ' '_I _A i .. � lication �.,.. -.. t ......�
• / Doi ii/
�r
�'' ., � `' Cl of 1 al' Daterecerved: 9-3-46 Permit no.:/y�T�n3 -O0 y .
�� I g Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW HabBLvd)Ti OR 97223
Phone: (503) 639 -4 Date issued: Bye/ I Receipt no.:
Fax: (503) 598 -1Wry OF TIGAI D v Case file no.: Payment
BU1 DING DIVISION -7- /�
y type:
Land use approva�: / 1 &2 family: Simple Complex:
TYPE OF PERMIT , , ,
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family y 'New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other.
' NFO N
JOB SITE I INFORMATION -�.
Job address: 1 ✓ � 1/\) wi Q r Bldg. no.: Suite no.:
Lot: Block: (Subdivision: 1 A. / 11 I Tax map /tax lot/account no.: ,S/ /t2& - 0.9%240
Project name: i✓-°y
Description and location of work on premises/special conditions: ,
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: , r,V\ it \I t‘ / ' (Floodplain,septic ' , solar, etc.)
Mailing address: -2 11_ � A f 1& 2 family dwelling:
City: I 4 ZIP: Valuation of work $
Phone: . r eJ -mail: No. of bedrooms/baths
Owner's representative: , V .""� j• If ( (1 t.4, Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.) ' 51 •
APPLICANT Garage/carport area (sq. ft.) _
Name: MEM �,� , A ', g & _ _ Covered porch area (sq. ft.)
Mailing address: r � a cc, "C___, Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
Business name: _ llla= r I MLA"
"
� �` New bldg. area (sq. ft.)
Address: _
City: State: ZIP:
Number of stories
Phone: I Fax: I E -mail: Type of construction
CCB no.: 2j 5 G �j'b Occupancy group(s). Existing:
4- -� ..-. New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: - 10,.i,� provisions of ORS 701 and may be required to be licensed in the
Address: ,l;lP a $' jurisdiction where work is being performed. If the applicant is
City: State: I ZIP:
exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER .
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: (ZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A . rovisions of I ws and o dinances governing this O Visa ❑ MasterCard
work will be compl - • wi • , , whether cified klereir . Credit card number: / /
�j �
Authorized Si a a . , / i A � 1k t �� Name of cardholder as shown on credit card Expires
Print name: ••!� _ $
��r f Zpet. I ( - r-- C ar dh o ld er signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4404613 (6/00/COM)
One- and Two - lFamily I➢welhng
',..., ' , Building Permit Application Cheekhst . .. Reference no.:
r , . I .. g PP
C J tl J
Associated permits:
City of Tigard City of Tigard • U Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other:
Phone: (503) 639 -4171 '' , ' • , ,
Fax: (503) 598 -1960 •
;;; }1.* ,' ' TILE FOLLOWING ITEMS ARE REQUIRED. FOR. PLAN REVIEW . Yes No N /A,
I Land use actions completed. See jurisdiction criteria for concurrent reviews. V
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 0
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. - X(
8 Soils report. Must carry original applicable stamp and signature on file or with application. )(
9 Erosion control 0 plan 0 permit required. Inc_ lude 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 r/
if copyright violations exist. - , J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft_ intervals); location of easements and
driveway; footprint of structure' (including decks); location of wells/septic systems; utility locations; direction indicator, lot x
- area; building coverage area; percentage of coverage; impervious area existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location. . ic
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. x
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. J�
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 •
i 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 V
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. .
,: JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". X
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons. -
26 No rolled, reversed or mirrored building plans will be accepted.
•
27
28 .
•
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614 (6r00/COM)
!,
Mechanical Permit Application ` , r ,s. a � : , * , ?.{_ „ :Q
Date received: Permit no.: %r ,, , t0YJ~
- �r > ECE IVE®
.4..d I City of Tiga Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 SEP 0 2 2003 Date issued: By: Receipt no.:
• . Fax: (503) 598 -1960' Case file no.: Payment type:
CITY OF TIGARD Building permit no.:
Land use approval : DING VIsI�1.nl .
• •:TYPE OF PERMIT ' .
❑ 1• & 2 family dwelling or accessory . . Cl Commercial industrial ❑ Multi - family ❑ Tenant improvement •
,Iew construction ❑ Addition /alteration/replacement ❑ Other. • •
• =t.. ^;JOB-SITE - . - .,:•,-: , •s - , .COMMERCIALNALUATION SCHEDULE
Job address: [.,,,, Atttt� �dik Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: - • value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ -
Lot: Block: Subdivision: II 0 r�' _ *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential.perrnit fee.
City/county: ZIP: .. &: FAMILY DWELLING PERMIT FEE SCHEDULE.,?
Description and location of work on premises: AND COIVLMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
. . Fee(ea.) Total
Est. date of completion/inspection: , Description • Qty. Res. only Res. only
•
Tenant improvement or change of use: • . HVAC: •
Is existing space heated or conditioned? ❑ Yes ❑ No Aircondit unit CFM
S P Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
' • MECHANICAL CONTRACTOR Boiler /compressors •
e ��}� L State boiler permit no.:
i"4 AJ M _ HP Tons BTU/H
Address: t�rMilirb_ Fire/smoke dampers/duct smoke detectors I.
j t AAI I�Ma ZIP Weal Heat pump (site plan required) IIM
Phone: Fax E -mail: Install/replace furnace/burner BTU /H
�/� ' ' Including ductwork/vent liner ❑ Yes ❑ No II
CCB no.: — • - Install/replace/relocate heaters -suspended,
City/metro lic. no.: N/A • . wall, or floor mounted , ■
Name (please print): j fp 2 - 1 v (1E 2.__ Vent for appliance other than furnace
Refrigeration: II
CONTACT I'L:RtiON Absorpijonunits BTU/H
Name: Chillers HP
Address: Compressors HP E
�. ♦� Environmental exhaust and ventilation: .
City: State: ZIP: Appliance vent
I Phone: Fax: E -mail: Dryer exhaust
O t1' N F R Hoods, Type 1/ hires. kitchen/hazmat
• hood fire suppression system
D ill M , ei . Exhaust fan with single duct (bath fans)
Mailing address: girr / %�_� ;ii1al Exhaust system apart from heating or AC Ns
.i ZIP x)S Fuel piping and distribution (up to 4 outlets) II
Type: LPG NG Oil
Phone: • 1 7 ` State . J/A Fax: E -mail: Fuel piping each additional over 4 outlets ■
ENGINEER Process piping (schematic required)
Number of outlets
Name: - Other listed appliance or equipment:
II
Address: Decorative fireplace
City: State: ZIP: Insert - type •
Phone: Fax: E -mail: Woodstove/pellet � ��
PP g 1I//i��.►��`I�� r:r/ , Other: _
Applicant's s sf natu Date: Other.
Name (print): r ., ► , / .
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application Minimum fee $
❑ Visa ❑.MasterCard exp if a permit is not obtained
Credit card number: / . / Plan review (at _ %) $ •
. Expires within I80 days after i t has been State surcharge (8 %) . $
Name of cardholder as shown on credit card as complete.
s TOTAL $
Cardholder signature ••• Amount 440 -4617 (6t00/COM)
Plumbing Permit App .. _ .. . • . ,
. .
Date received: Permit no.: u... Ao .�
° - `e�1 City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW ' 1 ` V j pE
City ofTigard Project/appt. no.: �P date:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: SEP U 2 2003 Case file no.: Payment type:
CITY• -
7 iYPE OF PERMIT
• 1 •
O 1 & 2 family dwelling or accessory 0 Commerci. industrial 0 Multi- family 0 Tenant improvement
►: ew construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: 1,4% j ,c-5\N lriv M ')V Description Qty. Fee(ea.) Total
New 1- and 2- family dwellings only
Bldg. no.: Suite no.: (indudes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: 00 Block: Subdivision: A' ^ SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Drywells/leach line/trench drain
Est date of completion/inspection: Footing drain (no. lin. ft.)
Manufactured home utilities
Business name, IN, gv 1 NF L1) H,13 11�1b I Manholes
P l I �� Rain drain connector
Address: fi �1. Sant sewer (no. lin. ft.)
City: ` • ag ■ State ZIP: '
E -mail: Storm sewer (no. lin. ft.)
Phone:() �j>� Fax: _�� Water service (no lin ft
C no.: CB 3 (jC '� t.( __ Plumb. bus. reg. no: - Fixture or item:
City/metro lic. no.: NIA � ,� ' Absorption valve
Contractor's representative signature �✓t Back flow preventer
Print name: , V` , t. U- �' affil n► Backwater valve I
• (INTACT PERSON Basins/lavatory
1 1 , sP�� Clothes washer
Name: I E Dishwasher
Address: G _'ry.e , Ci„„is Q-,tr2()\e _ Drinking fountains)
City: State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains /floor sinks/hub
Name (print): j Ail Garbage disposal 'il rail Mailing address: _ • ' • �► • 1 . r Hose bibb
City: -D . EENEV IESIL Ice maker
. Phone: •7 -" 1 Fax:5?7-70 E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s). lays(s)
Owner's signature: Date: Sump ,
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other.
Phone: I Fax: I E -mail: I Total IM
(vtinimum fee ................ $
' Ntx all iunsdicuotss acceq credit cards, please call jurisdiction for more infMiuuon` Notice: This permit application % $
Plan review (at )
0 'Visa ❑MasterCard / / State surcharge (8 expires if a permit is not obtained m
) •... $
C.edit card number. w ithin I80 d ays after it has been .o �-
Expires TOTAL $ __.---
accepted as complete.
Name of cardholder as shown on cretin card
S
Cardholder signature Amount � 44046I6 (6r00rcOM)
- Application t �- '1
,' ,A
Electrical Permit App ,
Datereceived: Permitno.fyt5f,a)5_ ✓9 7�
�=t i i R E C E 11/ E D
j, .� I City of Tigard ProjecVappl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 Sr,. 0 c i` 2003
Fax: (503) 598 -1960 - Case file no.: Payment type:
CITY Y OF TIGARD
Land use approval: UILD!NG DIVISION
TYPE OF PERMIT •
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi family ❑ Tenant improvement
►' New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
. JOB SITE INFORMATION .: . -. ''— ' - ' .
Job address: . A er .ALART MPA Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: a Block: Subdivision:' y I' r
Project name: I Description and location of work on premises:
Estimated date of completion/inspection: .
CONTRACTOR APPLICATION FEE SCHEDULE - --
Job no: 9) � Fee Max
Description Qty. (ea.) Total no. Insp
Business name: 1
_ Q � `/ �� �--- New residential -single or multi-family per
Address: C • �` �` • � , S� • - dwelling tmitIncludes attactredgarage.
City: t �t 1 ZIP: • Service included:
Phone:`. r, I l . Fax: E -mail: 1000 sq. ft. or less 4
T� Each additional 500 sq. ft. or portion thereof
CCB no.: f Elec. bus. lic. no:�(�� C..., Omi� energy, residential 2
Limited energy, non- residential 2
Each manufactured home or modular dwelling
nature of supervising electrician (required) Date / ry
Seice and/or feeder 2
License no: '9
Services or feeders— installation,
Sup. elect. name (print): 1 alteration or relocation:
200 amps or less 2
Name ri : 201 snips to 400 amps 2
(P nt ) . . � '��� 401 amps to 600 amps 2
Mailing address: ii .�... gBi ),� C5 1 601 amps to 1000 amps 2
City: L State 17 ZIP: 76 Cj Over 1000 amps or volts 2
Phone:)? 7J Fax: - -76152E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary servicesorfeeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelonaon:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
- ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
Cit 'State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
i
Each pump or irrigation circle 2
O Service over 225 amps-commercial 0 Health-care facility 2
O Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel.
O System over 600 volts nominal more residential units in one structure alteration, or extension' 2
O Building over three stories 0 Feeders. 400 amps or more 'Description:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan 0 Other. Per inspection I 1 I I
Submit sets of plans with any of the above. Investigation fee .
The above are not applicable to temporary construction service. Other
Permit fee $
Na all jurisdictions accept credit cards, please can jurisdiction for more information. Notice: This permit application
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number. / / within 180 days after it has been State surcharge (8%) .... $
, Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440-4615 (600/COM)
Electrical Permit Application FOR OFFICE USE ONLY
Received :
RECEIVED DateB 1 v c3 r Sign No it .rO3 —ba AI
City City of Tigard PlanningAp.rov Sign
b DateB : Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 NOV 7 2003 Date/B Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Internet: www.ci.tigard.oiQfTY OF TIGARD L_�1 I DateB : Case No.:
■ ` Contact Juris.: ® See Page 2 for
24 -hour Inspection Regtl�§lIL6l0 &ZIVI�RON -" Name/Method: Sul • lemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
N 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The ab are not ap plicable to temporary construction service.
Job site address: 17.3 IN / �/ bQ� �,{�� J� p� FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: ow A oe E -77-E - R�, i lk • Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per j
60 Ll F „4, �yy, R dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: � J� WOO Lot #: aQ Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Qo, Mar/;S5L " Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City /State /Zip:
alteration, or relocation:
200 00 amps or less 66.85 I
Phone: gar - 367- 71'38' Fax: 503 -38-7 —7Li ( 201 amps to 400 amps 100.30 2
401
❑ APPLICANT ❑ CONTACT PERSON Branch 600
ch amps 133.75 2
circuits circuits -new, alteration, or
Name: extension per panel:
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 circuits 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.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: a c7 Signal circuit(s) or a limited energy panel,
Business Name: I3/14 p a ., C ., Description: or extension Page 2 2
��!! Descri
Address: 0, 661 5' Gtf
Cit City/State/Zip: I q �6 Each additional inspection over the allowable in any of the above:
Y P Jc L,t � a P • 17 7 Per inspection per hour (min. 1 hour) 62.50
Phone: 533 -356.. -862 $ Fax: 4 33 .- f, I3 --9 iiv,s Investigation fee:
CCB Lic. #: 13222-L Lic. #: 31/ - i ij; c Other:
Electrical Permit Fees*
Supervising electrician Subtotal $
signature required: / Plan Review (25% of Permit Fee) $
Print Name: L,, a, ji-r-ic : -enV i g62 5 State Surcharge (8% of Permit Fee) $
/ ✓ TOTAL PERMIT FEE _ $
Authorized l Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: •
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
El Burglar Alarm
El Garage Door Opener
Heating, Ventilation and Air Conditioning System
Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system ... $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
•
E Audio and Stereo Systems
E Boiler Controls
El Clock Systems
El Data Telecommunication Installation
n Fire Alarm Installation
HVAC
❑ Instrumentation
• Intercom and Paging Systems
Landscape Irrigation Control
n Medical
E Nurse Calls
Outdoor Landscape Lighting
E Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
is \Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
1 . /4 S - r -- .0 - 1D 3 - °�'y 5 5 -- - _
A ■
T ION ►
• TREE TIFICA ► •
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I , A J� , Owner /Agent f or 001-/ M / s " s -e-1 ' .. jh�'^^� i ■
L�1-� � /4- 7 ` (PERMIT HOLDER
I (PLE PRINT) (PE )
1 ►
I • ►
•
• . Do hereb :cer that the following location - •
• •
• meets City of Tigard /Washington County ►
• land use and development standards for street tree installation. • •
• • •
• ■
S: ) 2 3 y � S w %1 N �- o 0 �1 )�-,�- ■
• � ADDRES ■
1 LOT: Zv . SUBDIVISION: /L• .- .:,) 0 U r )
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a DATE: / - Z i —v -- 3 ■
BY: ►
•
•
. RECEIVED BY: I• DATE: ■
• A
®vvevTVITTY®ovVVVYYV®vvy. vYTY VVV®yVVVVVVVVVVVVVVYVVVVVVVYTy®
CITY larm OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 �3 _{Vel55
INSPECTION DIVISION Business Line: (503) 639 -4171
� eate BUP
Received / G1 AI f(79 Request� /"--- d 22 0 �AM PM BUP
Location /a ?) q / &-O'tf .(/7J7Y�. Suite • MEC
Contact Person 7.(ct` i ' / Ph ( ) , o 4 -1f3 2 PLM
Contra • '� A� Ph ( ) SWR
BJLDIN � Tenant/Owner ELC
- ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
IJ_• •ART FAIL
• • • : Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Oth �
•/a PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
P T FAIL
LECTRICA
Serv e
-n
UG/Slab
Low Voltage
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
rTh
SITE 111 Please call for reinspection RE: Unable to inspect — no access
Approach /Sidewalk Inspector upply ne T FAIL
A
Fi
A Li R
Date /' Z Z ` � ector l ( C ) - 7 Ext
P /
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL