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ITIS DUE TO THE QUALITY OF THENo.36
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6775 SW Alfred St
CITYOF TIGARD _ MASTEPPERk11T
PERMIT#: MST2002-00400
DEVELOPMENT SERVICES DATE ISSUED: 1011102
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 06775 SW ALFRED ST PARCEL: 1 S125DA-04400
SUBDIVISION. ZONING:
BLOCK LOT: JURISDICTION:
REMARKS: 2 small additions for a total of 211 square feet. Path 1
BUILDING
REISSUE: �Y STORIES: 1 FLOOR AREAS REQUIRED SETBACKS — REQUIRED
CLASS OF WORK: ADD HEIGHT: 10 FIRST: 211 4f BASEMENT: at LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: of GARAGE: of "RONT: PARKING SPACES:
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENI: of RIGHT:
OCCUPANCY GRP: RJ JDRM: BATH: TOTAL: 211 of VALUE: 1049. 1 REAR:
_ PLUMBING
SINKS: WATER CLOSETS: WASHING MACH. LAUNDRY TRAYS. 1 RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS. ''1.0011 DRAINS, SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS
-
rUBISHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS,
MECHANICAL OTHER FIXTURES.
__FUEL TYPES FURN<100K: BOILIC'AP<9HP: VENT FANS: CLOTHES DRYER: 1
FURN>•100K: UNIT HEATERS HOODS: OTHER UNITS:
MAX INP: htu FLOOR FURNANCES. VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP GRVCIFEEDERS BRANCH CIRCUITS!_ MISCELLANEOUS ADD'I-INSPECTIONS_
1000 Sr OR LESS: 0 200 amp: 0 200 amp WISVC OR FDR: 1 PUMRIIRRIGATION, PER INSPECTION:
EA ADD'L 500SF: 201 400 amp: 201 - 400 amp: 191 WIO SVCIFDR. SIGNIOUT LIN LT PER HOUR.
1 IMITFD ENERGY: 401 600 amp: 401 - BOD amp: EA ADDL OR CIR. SIGNALIPANEL. IN PLANT-
MANU HM/SVC/FDR! 001 • 1000 amp: 601.ampa-1000r MINOR LABEL.
1000-amplvoll:
Reconnect only:
PLAN REVIEW SECTION
� --
>=4 RES UNITS: SVCIFDR>=225 A, >000 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL-RESI"RICTEDENERGY
A.SF RESIDENTIAL —� P..COMMERCIAL
AUDIO A STEREO: VACUU'I SY ITEM: AUDIO 6 STEREO FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNOSC LT:
BURGLAR ALARM OTH: BOILER: HVAC: LANDSCAPEARRIG. PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK, INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA✓TELE OOMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor TOTAL FEES: $ 668.67
This permit is subject to the regular ons contained in the
RICK JOHNSON JS NELMS CONSTRUCTION Tigard Municipal Code.Mate of OR Specialty Code. and
G6;'5 SW AI-FF.ED ST 8136 SE 282ND all other applicable laws All work will be done in
I IGARD,OR 97223 GRESHAM,OR 97080 accordance with approved plans This permit will expire 0
work is not started within 180 days of issuance,or if the
work is su.3penoed for more than 180 days ATTENTION.
Oregon law requires you to follow rules adopted by the
Phone: 503-663-3344 Phwio 503.663-33414 Oregon Ulil,ty Notification Center Those rules ale set
forth in OAR 952-001-001r)through 952-001-0080 You
Rog 0: f IC' 72110 may obtain copies of these rifles or direct questions to
,!NC by calling(503)246-1967
REQUIRED INSPECTIONS
Footing Insp F,)oting/Foundation Dr Electrical Rough In Mechanical Finai
Foundation Insp PLIA/Underfloor Framing Insp Plumb Final
Post/Beam Structural Mechanical Insp Insulation Insp Final inspection
Underfloor insulation Plumb Top Out Rain drain Insp
Crawl Drain'Backwater Electrical Sarvice Electrical Final
l c �
!ssur3d By ` ,;'� l 'G'�<_:_-__ Permittee Signature : ✓ /��G/C'� %D!1/
C:r,II (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Application
City of Tigard Date received: q /¢ D9.. Permit no.:
Address: 13125 SW hall Blvd,Tigard,OR 97223 Projecttappl.no.: nyj �
'
City of Tigard e:
Phone: (503) 639-4171 Date issued: Receipt no.:
Fax: (503) 5ets{I,S6 –
�(� (� Case file no.: Payment type. 1
9 /a _ I&.2 family:Simple \
Land use approve : ^_— Complex:__
-J
�Adtli2licaml
fly dwelling or acc^ssory U Commercial/industrial J Multi-family J New construction U Demolition L
n/alteration/replacement U Tenant improvement J Fire sprinkler/alarm U Other:
ess: 7 S S W 7 FR t O sr Bldg. no.: Suite no.:
Lot: P –
Z , Block: _ Subdivision: KIN 4 t; V I�'ty ---T'fax map/tax lot/account no.:
Project name:
Description and location of work on premises/special conditions: z Sri ft"t-k POO I TO UN S S f 4 1 SF
Name: V,iG{t JDNwsoo
Mailing address: "1 '+ SW /r t.fa-ro ST I & l family dwelling:
City: 11 V ttn.G State: 0 O I ZIP: of I t 13 Valuation of work ....zl.U/f................ $
Phone: Fax; I E-mail; No.of bedrooms/baths.................................. _
Owner's representative: rl4#rJNonl t=t_Nt S Total number of floors .................................. _
i
one:'o IrG 'Wi Fax:50 6626th E-mail: New dwelling area(sq. ft.).....:...................... ZI 1 SF
Garage/carport area(sq,ft.) ..........................
Name: a-'*A JNoat Nt�S Covered porch area(sq. ft.) .......................... –
Mailing address: em. $E 2182 n Deck area(sq. ft.).......................................... -----
City. G rgi m State: A ZIP: lop Other structure area(sq ft.)... ......................
Phone: r03 (,(v ''3y4 Fax:Sol 6 1F1i F-mail: CommerciaUindusirbillmulti-family:
Valuation of work ........................... ............ $
Existing bldg.area(sq. .)......... .................
Business name: �;, ��� Cc,aIST1rwLT tta.) New bldg.area(sq. ft ►,,....
Address 1 6 � 21'�Z N� . ......................
City: (p(��'t N State:OIL ZIP: 7
Number of stories.. ..................
C> Type of construction ... .
cne: co; 3 Faxa •I `� E-mail: Occupancy group(s)• Existing
CCB no.: . 119 \
Ci*�_�Ctm
rmetro lic.no.: Ids s New: _
Notice:All cont•dctors and subcontractors are required to be
licensed with the W-gon Construction Contractors Board under
Name: Ch(E Cc 140m(- Q L S1 tart provisions of ORS 701 and may he required to be licensed in the
Address: 12 "1 N r�✓Ur.U�,OE jurisdiction where work is being performed.If the applicant is
City: r,r< ,A State:G,rz- ZIP: 7o p exempt from licensing,the following reason applies:
Contact person: Dr—S Plan no.: --
Phone:of 665 1 b0 Fax: -
skin ILI 110
Name: Contact person: Fees due upon application.............................$
Address: Date re:eived: _
City: State: ZIP: Amount received...........................................$ —
Phone: Fax: I E-mail: Please refer to fee schedule.
11wreby certify I have read and examined this application and the Not all jurisdictions accept credit cards,please call juriwakiion for more infomution.
attached checklist.All provisions of laws and ordinances governing this U vire U Mastercard
work will be complied ith,whether s e ified het ein or not, Credit card number:
Expires
Authorized sl ture: 4
- r IF -- Name of cWho der a! shown on credit card _
Print name: - Cardholder signature T Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4404613(6OUCQM)
Plumbing Permit Application MEMO
Date received: 9/ Q9' Permit no.:}f fid • (�
City of Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.:
C1tyafTlgard Phone: (503) (39-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
U 1 &2 family dwelling or accessory ❑Commercial/industrial 0 Multi-family i]Tenant improvement
LI New const:vction Addition/alteration/replacement 0 Food service J Other:
4 U=9LMMzM= ,
Job address: 7 5 aV A-k 0i m uo C T / Drsc•ription Qh. Fee(eu.) I otal
Bldg. no.: _ Suite no. ew I-and 2-family duelling only:
fax map/lax lot/account n0.: (Includes loon.For each utility connection)
— - SFR(1)bath
Lot: Z°1 Block: Subdivision: ►LIN j - --- - - -
_� 4 _�/1 t'1✓J SFR(2)bath
Project name: --- - -
SFR(3)beth
Cit /county: -TI blttrtU ZIP: I IIL", Fach additional—bit—Ii/kitchen
Description qnd,location of work On premises: Site utilities{:
0 �-KVAID f 77LA'M Catch basin/area drain
Est.date of completion/inspection: Drywells/leach line/trench drain
twillILTMKIII Footing drain(no. lin.ft.)
G Manufactured home utilities
Business name: -� bING /N Manholes
Address' P10 60X- 3 _ Rain drain connector
City: GC/rGA�jfYyl 5 State 7.I P: 70 s Sanitary sewer(no.lin.fl.)
Phone:,fb)6559/(x/ Fax: 03 /jtL I E-mail: �,.-7 _y l Storm sewer(no,lin.ft.)
CCB no.: 5002. 91 Plumb.bus.reg.no: 3-/ /0(3 Water service(no,fin.ft.
City/metro tic.uo.: Z r Fixture or itetn:
Contractor's representative signature: C a�. Absorption valve
Back clow preoenter
Print name: #f
MAI YE ME U Date: -lir-02 Backwater vale
Basins/lavatory
Name: Clothes washer -
Address: — Dishwasher _ - --
Cit : — Drinking fountain(s)
_ State:_�ZWIP: Ejectors/sump
Phone: Fax: E-mail: Expansion tank
Fixture/sewer cap_
Name(print): Floor drains/floor sinks/hab
Mailing address: _—__._ Garbage disposal
------ Hose Bibb
Citv: State: ZIP:
__. Ice maker
Phone: Fax: E-mail: Interceptor/ ease 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 —
Tubs/shower/shower pan
Name: Urinal
-_
Address: - Water closet
Water heater —
City: -- State: ZIP: Other:
Phone: _ Fax: E-mail: _ oto
Not all jtuisdictiuns accept credit cards,please call jurisdiction for more infomution. Nonce: This permit applicationMinimum fee...............b
_
in
U Via ❑MasterCardMaat
ard o
expires if a permit is not obtained Platt review(at_ /o) $
Credit card number:_ _ _ a i_ L_ within 180 days after it has been State Surcharge(11%)....$ _
_ P
accented as complete.Name of cardholder as shown on cratat cab p e. TOTAL........................$
- _ S
Cardholder signature Amount 4404616(&0aCOM)
Mechanical Permit Application SOMM
"Dateceived; `l /J /d Permit no.: Oe
City of 'Tigard Project/appl.no.: Expire date:
city ofngard Address: 13125 SW Ilull Blvd,Tigard,OR c7223
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _ Building permit no.:
U 1 &2 family duelling or accessary UCommercial/industrial ❑Multi-family U Tenant improvernent
U New construction KAdditioti/alteration/replacement U Other:
Job address: �� 7 tVJ &EXt.ro .5r 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: '2„9 Block: Subdivision: It4l V/ *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fec
City/county: 17b&-Mo ZIP: IT-7 Z13
Description and logation of wok on premises:
e�(( 1 Ot .1 �ij T4 j _ Ree(ra.) Total
Est,date of completion/inspution: Description Qtv. Res.ooh Res.only
Tenant improvement or change of use:
Is existing space heated or ditioned? Yes U No
7Aihanlingunit—CFM�
_
Air conditioning(site pi"-,required) _
Is existing space insulated? Yes U No Alteration of existing HVAC system
Boiler/compressors
Business name: r0 A/ State boiler permit no.:
HP Tons BTU/H
Address: 0 QDI( _ Fire/smoke ampers/ tier gmo a detectors
City: �%�E$ _ State:oK I ZIP: ,j 30 Heat pump(site plan required)
Phone: (0 /8 611L I Fax:S01164S7E-mail: InsialtimpTace Gmrcelburner
CCB no.: 1/03,7 (,6', Including ductwork/vent liner U Yes U No
nsta rep ace-re ovate heaters-suspen
City/metro lic.no.: 4 a _ wall,or floor mounted
Name( lease print): Vf 2 is 7`/t- (ctAIWA of Vent for appliance other than furnace
Keffigertiltiona
Absorption units BTU/H
Name: Chillers _ . lip
Address: — Compressors _ ---- HP
nv ronmentA exhaust an ,endration:
City: estate: ZIP: Appliance vent
Phone: Fax: E-mail: Drier exhaust
Hoods,Type 171-1/res.
/II/res.kitche azmat
• 11'_,M. hood fire suppression system
Name: _ t VA i NS ad _ Exhaust fan with single duct(bath fans)
Mailing addresc�-h-l&77 _ 1►.� 1. !G� xhaust stem a art r or AC
ue piping an sf ton(up to outlets)
City: t' State:p ry,- ZIP: 017 1 Z I ype LPG NG Oil
Phone: ---T a I - n,i i l: tial i rn sac a none over outlets
Process piping(sc ematic require )
Name: Number of outlets
Addresses
Other step s pJ pliince or equ p- wnt:
_ Decorative fireplace
City: - _ State: ZIP: s Insert.type
Phone: — Fax: E-mail: o�,ve pe et stove _
T' Ot er.
Applicant's signature: Date: art
Name(print):
t all jurisdictions accent credit cards.please call jurisdiction far more infomution. Permit fee ..................... $
U Visa U MasterCard
Notice: This permit application Minimum fee................ $ _
Credit card number _L_L_ expires if a permit i3 not obtained Plan review(at_ %) $ —
expires within 180 days after it has beer. State surcharge(8"%).... $
Name of cardholder as shown on credit card accepted as complete. --
$ TO'T'AL..... ............. .... $ _
Cardholdersignawre _____—,Amount "04617i6Ixi('oM)
I
Electrical Permit Application
Date received: Permit no.:l l f%(r4
City of Tigard Project/appl.no.: Expire date:
01) o/'Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503)639-4171 Date issued: Hy: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
❑ I &2 family dwelling or accessory �4ddition/alteration/replacement
ommercial/industrial U Multi-family U Tenant improvement
U New construction U Other: U Partial
Job addres W /f CP►_ztp STTNNWRNI��
ldg. no.: Suite no.: 7 ,x map/tax lot/account no.:
Lot: 417 Subdivision: eIA14 C V/tjAj
Project name: — I D seription and location of work on premises: Z $'N1p-tt �4-Do M dNj
I'stimated date ol'completion/inspection: — —
smaiijklmajosiff
Job no:
I cr• %lar
Business name: ASt Tt: Description Qty- (ca.) total no.in.p
Address: 0:;At N 103 NewrcwldenHrl-tilnRkonnnhi-famllfper
dwellingunit Includesanachrilgorage.
City: A- , tate: Z ZIP; 7 Z Lp ScniceincFaded:
Phone: 9"3 25-2*110 Fax:503tS2SV'? E-mail: ^ . - laxi�ft.or less 4
CCB no.: 3 7 o) Elec.bus.lie.no: Zh- too G tach adJitional 500 sq,ft.orponion thereof
5.9f Limited ener , residential 2
Cit !mato IIC.n0.: Limned entily, non-residential
2
ra _ Each manufactured home or modular dwelling
urc_of supervising alae 'ciao (requi d) _ ate ,i, - Service and/or feeder 2
up elect,name(print). License no: Services or feeders-Installation,
■heratlon or relocatlonr
NMI 200 amps or less 2
Name(print): Uc �off-WfOnl 201 amps to 400 amps — 2
Mailing address: '7-15- s � � T— - 401 amps to 6W amps 2
Cit 601 amps to 1000 amps 2
Y State:04- ZIP: 7 a z Over 1000 am or volts _ 2
Phone: Fax: E-mail: Reconnect only I
Owner installation: The installation is being made on property I own Temporary servicesot feeders-
which is not intended for sale,lease,rent,or exchange according to installation,sherstion.orreloc■alon:
ORS 447,455,479,670,701, 2txr amps or less _ 2
ps to 400
Owner's SI nature: (late: 201 amimps 401 to 600 as -2
m2
Branch circuits-new,alteration,
Nr-ie: or extension per panel:
------ A. Fee for branch circuits with purchase at
Address: service or feeder fee,each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without puarh4.
Phone: Fax r-mail: of service or feeder fee,first branch_chcuit: 3 2
Each additional branch circuit:
ME U am MIse-(Service or—reed ernot Included)t
U Service over 225 amps-commenial J health-care facilih Each pump or irrigation circle 2
U Service over 320 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2
family dwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited encu[) panel
U System over(100 volts nominal more residential units in one structure alteration, or extension* 2
U Building over three stones U Feeders,400 strips or more . - — —--
U Occupant load over 99 persons U Manufactured structures or RV park Drscription
U Egress lighting Ian Each addl(lonal Inspection a•er the allowable In any of the abase:
Ilre g g P U Other: -- - Per inspection — -
Submit—sets of plans srlfh any of the above. Investi tion fee
The above ave not applicable to temporan construction.en ice. Other
Not all judidictioms r_cept credit cards•please call jurisdiction fix more infomotion, Notice: This permit application Permit fee ......................$
U Via U 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 ofca Ider as s own err c it card - """""""'•••••••••
_S_
Cuuholdtr sianeturc �— Amount
-- 440.4613(6/0NC'OM)
4
6
i
CITY OF TIGaARD 24-Hour
BUILDING Inspection Line: (503)639-4175 ` Gid �{O 0
INSPECTION DIVISION Business Line: (503)639-4171 MST --
IUP
Received — Date Requested _,� �� AM_- -_ PM SUP
Location
MEC
Cmilact Person Ph Z Y_ PLM `
— -- (_ ---) - -9 5
Contractor ---- - -- — _ Ph(---- ) ---------- SWR -- --
- ILDING Tenant/Owner
ELC- --
F!:undation ACGBSS. ELC
—-
Fig Drain
Crawl Drain _ , . � �_ ELR -- -- --- __ _
Slab Inspectiori Notes: `�1 _ SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shea --- --
Framing
Insulation
Drywall Naming
Firewall
Fire Sprinkler
Fire Alarm -- -- -
Susp'd Ceiling
Roof
Other
�Ih_ RT FAIL
F
Under Slab
Rough-In
Water Service
Sanitary Sewer -- -- _ --
Rain Drains ------- ---
Catch Basin/Manhole /
Storm Drain --
Shower Pan
O -- - - --
SS PART FAIL
ANICAL ___ Y
Post&-Beam - -
Rough-In ---- - -
Gas Line -
Smnke Dampers — ----
Final --
�59- FAIL --- -- - --
CrRICaI.-
- _
ervice -- - -- --.
Roug -n
UG/Slab - ------ -
low Voltage
larm
Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Had Blvd.
ASS PART FAIL
-- -
SI _ Ej Please call for reinspection RE: Un et
inspect -no access
Fire Supply Line -- -- —^_ ^� -
ADA Inspector R ' I
Approach/Sidewalk '!a Ins Ext
Other.
Final DO NOT RFMOVE this Inspoction record from thw lob aIte,
PASS PART FAIL.
CITYOF TIGARD PLUMBING PERMIT
PERMIT#: 8i4/0PLI02003-00384
DEVELOPMENT SERVICES
DATE ISSUED: 8i4/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 1 8125DA-04400
SITE ADDRESS: 067'75 SW ALFRED ST
SUBDIVISION: KINGS VIEW ZONING: R-4.5
BLOCK: LOT: 029 JURISDICTION FIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BAF KFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATE!l HEATERS, CATCH BASINS:
_ FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of backflow prevention device for irrigation system.
F _FEES
Owner: _ -- Description Date Amount
RICK JOHNSON II't.UM13I Pcrmit Fee 8/4/03 $36.25
6775 SW ALFRED S'f $2 90
I'r 1`i I �" titatr Tar 8/4/03
TIGARD, OR 97223
Total $39.15
Phone : 503-293-3053
Contractor:
STEVENSON& ASSOCIATES INC
PO BOX 1355
TUALATIN, OR 97062-1355 REQUIRED INSPECTIONS
R,''/Backflow Preventer
Phone : 503-692-66:6
Reg#: LIC 5650
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or it ,verk is suspended
for more than 180 days. ATTENTION: OrAgon law requires you to follow rules adopted by the Oregon
Iglu d B : permittee Signature
Y _
— - Call (503) -4175 by 7:00 P.M. for an inspection neaded a ne t business day
1
V
Building Fixtures
Plumhi>nil Permit Application Rcccivcd Plumbing
Date/B3 ePermit No.:
City of'Tigard Planning Apptoval Sewer
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Of !r
Tigard,Oregon 97223 Date/By: I'm 't No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review lend Ilse
Internet: www.ci.tigard.onus Date/By: Case No.:
4; k Contact Juris: See Page 2 for
1.4-hour Inspection Request: 503-639-4175 Namc/Method: I Supplemental Information.
TYPE OF WORK _ _ FEE"SCHEDULE(for special Information use check-
lis
t
Ncw construction Demolition Description _TQ ty. 1 Fce(ca.) 1
Addition/alteration/re.lacement - 2ther: New 1-&2-family dwellings
CATEGORY OF CONSTRUCTION _ (includes 100 ft.for each it Ility connection), _
I &2-Family dwelling Commercial/industrial SFR I 1: 249.20 _
SFR 2 bath 350.00
Accessory BuildingMulti-Tamil _ SFR 3 bath 399.00
Master Builder_ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler-sq.ft.: Pae 2
Job site address: S VV f Z1&t�20 Site Utilities
Suite#: Bldg./Apt.#: Catch basin/arca drain 16.60
i)�nvell/leach line/trench drain 16.60
Project Name: f 0�i/��i Footing drain(no.linear ft.) Pae 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no. linear ft.) Pae 2
Subdivision- Lot#: Storm sewer no. linear ft Pae 2
Tax map/parcel #: Wat^:r service no. linear ft. Pae 2
_ DESCPIPT'ION OF WORK Fixture or Item _
Absorption valve _ 16.60
�--�c K A L Backflow preventer Page 2
j(1 7 k1k Backwater valve _ 16.60
Clothes washer _ 16.60
- - Dishwasher 16.60
Drinking fountain __ 16.60
ROPERTY 0 W-N-Eft TOVENANT 4 Ejectors/sump 16.60
_ame: k l c V AJST\) _ Expansion tank 16.60
Address: S TL'f t f/Z CO Fixture/sewer cap 16.60
#' y� -- Floor drain/floor sink/hub 16.60
City/State/Zi L4�_ Garbage disosal 16.60
` Phone: `!J 3CS3 Fax:
Hose bib 16.60
APPLWANT CONTACT PERSON fee maker 16.60
Name: _ _ Interceptor/grease trap 16.60
Address: Medical gas-value: S Pae 2
�i Primer 16.60
C_�Sta10-ip- -
- Roof drain. commercial 16.60
Phone: _ Fax: _ _ Sink/basin/lavatory - 16.60
E-mail: Tub/shower/shower pan 16.60
Urinal 16.60
Liusiness Name: S Je ye r156r� �ri�55t`�H� Water heatcloser 16.60
�� r Water heater 16.60
_Address: other:
Cit /State/Zi : -r 4 L 1 A- Other: _
Phtme: Z Fax: PlumbinR Permit Fees*
CCBLic. #: ,� Plwnb. Lic.#: Subtotal S
_ Minimum Permit Fee 572.50 $
Authorized Residential Backflow Minimpim Fee$36.25
Signature: L /.SC� Dater Plan Review(25%of Permit Fee) S
r^ _ State Surcharge 8%of Permit Fee S
` (Please print name)` TOTAL PERMIT'FEE S U
Notice: This perms!application e:plres If a permit Is not obtained within All new commercial buildings require 2 sets of plans with isometric or
100 days after It has been sccepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\Dsts)Pennit Fomts)PlmPemutApp doc 01103
Plumbing Permit ygplication -City of Tigard
Page 2 - Supplemental Information
Fee Schedule: _ Residential hire Suppression Systems:
,filte Utilities Qty. Fee(es) Total i Square Footage: — Permit Fee:
Footing drain-I"100' - —S. 0 to 2,000 _ $115.00
6(YJ $160.00001 to 3,
Forting drain-er^.h additional 100' 46.40 2, —
3,601 to 7,100 _ $220.00
Sewer- Is!100' 55.0) -— 7,201 and greater $309.0_0 — —
Sewer-each additional 100' 4640
Water Service :st 100' _ 55.00 Medical Gas S stems•
Water Seivice-each additional 100' 46.40 Valuation: Permit Fee:
Storm&Rain Drain-Ist 100' 55.00 $100 to 55,000.00 Minimum fee$72.50 _
Storm&Rair,Drain-each additional I tNl' 46 4i1 $5,!X11.00 to$10,000.00 Si2.50 for the first$5,0011.00 and$1.52 for ead
t.dditional$100.00 or fraction thereof,to and
Fixture or Itern Qty. Fee(ea) Total including S10,000.00.
Commercial Back Flow lhevennon Ikvicc 4040 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and SLA for
Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to
minimum permit fee$36.25) _ 27.55 and includin $25,1)00.00.
Rain Drain,single family dwelling 65.25 $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
Inspection of existing plumbing or and includt�$50,000.00.
s ciall re nested ins ctihour_ 72 511
.—rteons-per — 550,001.00 and up $742.60 for the first$50,000.00 and S 1.20 for
Subtotal: each ndditional 5100.00 or fraction thereof.
Fixture Work:
Are you capping,moving or replacing existing fixtures? If
"ves",ulease indicate work performed by fixture. Failure to
accurately report fix(Lres could result in increased setter fcrs*.
--- Comments re orditi, fixture work:
— nantitV��xture Work Perfon_ved g P
Fixture Type: Replace
— Ne" M_eved Etlstln �C+piled ---- '------
Ba tWr ;Fon_-t -__--_
Bath -Tub/Shower
-Jacuzzi/Whirlpool
Car Wash -Each Stall _ — --- -
-Drive Thru _-
Cus idor/Water Aspirator_
Dishwasher -Commer-ial --
-Domestic — --� — -- - _
Drinking Fountain
_Eye Wash - -- -- —
Floor Drain/sink 2" —
Car Wash Drain -- — *Note: If the fixture work under this permit results in an
Garbage -Domestic
Disposal -('rmnrcreial --- � -- increase of,ewer EDUs,a sewer permit will be issued and
l ommeal fees assessed for the sewer increase must be paid before the
Ice Ivlach!Refri .Drains — plumbing prrmit can be issued.
Oil Separator Gas Station) —
Rec.Vehicle Dump Station _
Shower -Gang
-Stall
Sink -Bar/I.Avatory
-Bradley
-Commercial
-Service
Swimming,Pool Filter _—
W Rarer-Clothes _
Water Extractor
Water Closet-Toilet I _
Urinal
Other Fixtures
i:\Dsu\Permit Forns\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24-Hoar
BUILDING Inspectior Line: (503)639-4175
INSPECTION DIVISION Business Line; (503)639-4171 MST
BUP --__
Heceived __ Date Requestod--__.S_✓J -,- AM- '----- PM _- BLIP _
Location __—� ,�� �j_- ---Suite-__ ^ _-_. MEC _v
Contact Person _ -- -- ��(�I�c�1✓'�_�F'h( --) Q_:3_O-5 PLM _3
Contractor---- -_.__--_ �..---�-_-. Ph(- -) -- - - -- SNR --------
BUILDiNG ^---- Tenant/Owner _ -_–�-- — —_..-- ELC -_---_--��---
Footing
Foundationy--� ELC
Acco�s: --
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT —
Post 8 Beam
Shear Anchors -- -- --- -- - ---
Ext Sheath/Shear
Int Sheath/Shear -- - -
Framing — ,-
Insulation
Drywall Nailing -- --- -- -- --- --- ----- - -
Firewall
Fim Sprink!er - --- ---- -- _.. ---
Fire Alarm
Susp'd Ceiling - ---
Root
Other:- ----__------ ,.
Final
PASS PART FAIL — ---- -
PLUMBING -�—
Post&Beam - - -- —
Under Slab
Rough-In
WatNr Service -- --- --
Sanitary Sewer
Rain[)rains - --- ---------
Catch Basin/Manhole
Slorm Drain
Shower Pan
Ot er
PA PARI FAIL -v -- "- -
HANICAL
Post& Beam - - - —
Rough-In -__-- --
Gas Line
Smoke Dampers ----- ----- -- -�_.._ -- _ _--
Final
PASS PART _FAIL — - - -_- - — --
EL_EC_T_HICA_L .—
_
Servire -- - - -- - --
Rough-In
UG/Slab - - - - - —
Low Voltage
Fire Alarm Y
Final El Reinspection tee of$_ re uired before next Ins
PASS PART FAIL ----- Q pection. Pay at Ciry Hall, 13125 SW Hall Blvd.
SITE _ Please cell for reinspection RE: _-- L] Unable to inspect�-no access
Fire Supply LiPte
ADA
Approach/S%dewalk Datil /11Inspector ---
Other:
Final D NOT REMOVE this Inspection record from the Jot► site.
PASS PART FAIL
3/11A-L -�u
CITY OF TIGARD MASTER PERMIT
PERM17 #: MS12002-00042
DEVELOPMENT SERVICES DATE ISSUED: 2/13/2002
13125 SW Nall Blvd.,Tigard, OR 97223 (503)639-4171
SITE ADDRESS: 06775 SW ALFRED ST PARCEL: 1S125DA-04400
SUBDIVISIOV- KINGS VIEW GNING: R-4.5
BLOCK: LOT:029 JURISDICTION: TIG
REMARKS: Remodel,
BUILDING
REISSU..: STORIES: FLOOR AREAS REQUIRED SETBACKS_ REQUIRED
CLASS OF WORK: AL 1 HEIGHT: FIRST: of 8ASF-MENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: rf GARAGE. of FRONT PARKING SPACES
TYPE OF CONST: DWELLING UNITS: FINBSMENT: if PIG'IT:
OCCUPANCY GRP- P3 BDRM: BATH: TOTAL. n 00 of VALUE: T:'S nno nn
REAR.
._
PLUMBING
SINKS: I WATER CLOSETS: 2 WASHING MACH. LAUNDRY TRAYS: --_ RAIN DRAIN:
TRAPS:
LAVA.TORIER 2 DISHWASHERS: 1 FLOOR ORAINE. SEWER LINES: SF RAIN DRAINS: CATCH BASINS
TUB/BHOWFRS: I GARBAGE DISP: 1 WATER HEATERS: WATER LINES. BCKFLW PREVNTW CREASE TRAPS:
---. MECHANICAL OTHER FIX TURFS:
__FUEL TYPES FURN<100K: BOILICMP<3HP: VENT FANS: I CLOTHES DRYER:
FURN—100K: UNIT HEA TFRS: HOODS: OTHER UNITS
MAX INP: Mu FLOOR FURNANCES: V17NTS: WOODSTOVES: GAS OUTLETS
--- ELECTRICAL
2E8IOENTIAL UNIT SERVICE FEEDER__ TEN f'3RVCIFEEDERS ^BRANCH CIRCUITS MISCELLAI, 0US ALLYL INSPECTIONS
1000 SF OR I ESS: 0 - 200 arnp f. - 200 ampWISVC OR FOR PUMPIIRRIGATION PER INSPECTION:
EA ADD'L 500SF: 201 - 400 srnp: 201 - 400 snip: Irl WIO SVCIFDR: SIGNIOUT LIN LT
:R 4OUR:
LIMITED EMERGY. 4ul - 800 amp: 101 - 800 amp- EA ADOL OR CIRSIGNAL/PANEL IN PLANT:
MANU HM/SVCIFbR: 801 - 1000 amp: 601-ampa 1000r MINOR LABEI-:
1000♦amplvoll:
Reconnect only: PLAN REVIEW SECTION
—4 RES UNITS: SVCrFDR-225 A. >800 V NOMINAL: CL 9 AREA/SPC OCC:—_
-- ELECTRICAL RESTRICTED ENERGY
A.SF RESIDENTIAL - V�__ V B.CO'AMERCIAL
AUDIO f STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTEPCOM/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 M SYSTEMS
Z)wner: Contractor: TOTAL FEES: $ 769.61
LANDSCAPE EAST AND WEST OWNER This permit is subject to the regulations contained in the
P O BOX 30882 Tigard Municipal Code, State of OR Specialty Codes and
PORTLAND,OR 97294 all other applicable laws All work will be done in
accordance with approved plans This permit will expire if
work is not started w thin 180 days of issuance,or if the
work is suspended for more than 180 days ATTENTION
Phone 1032%-5302 Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center Those rules are set
Reg 4: forth in OAR 952-001-0010 through 952-001-0080 you
may obtain copies cf these rules or direct questions to
OUNC by callina(503)246-1987
REQU!RED INSPECTIONS
Mechanical Insp Electrical Final
Plumb Top Out Mechanical Final
Electrcal Rough In Plumb Final
Framing!nsp Final inspection
Insul Insp Building Final
Issued By : Permittee Signature
Call (503)639-4175 by 7:00 p.m. for an inspection nzeded the next business day
V Permit #:RECEI /-
yt Q '/ J' ) fEn _`r
FEB _ 4 2UU2
TYUF'I1(irARU Issi.iec hy: Date: /3�r
>BUILDI:�G
Statement: Infoa m3tion Notice to property owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permi,can be issued. 7his statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the approoriate blanks and initial boxes 1 and 2,and either box 3A or 313:
1. l own, reside in, or will reside in the completed structure.
2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
El3A. My general contractori; (Name) Contractor regis. #
I will instruct my general contractor that all subcoatractors whe work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately netifv the office issuing this building permit of the
name of the contractor.
hereby certify that the.rh� infornr<rtion i�cor cvt and that I have read and do understand the Information
Notice to Propert n -s aho t Con.slr ti Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Date)
(White ropy to issuing agency permit file,
pink copy to applicant)
I
Building Permit Application
11)0
ate received: Permitno.:
City of Tigardi / f'1
Address: 13125 SW Hall v 1V V f'toject/appl.no.: Expire date:
('ity„/l iAnrd bate issued: B ' Recei
Phone: (503) 639-4171 Y� t no.:P
Fax: (503) 598-1960 :�� _ 2�I�L Case file no.: —_ Payment type:
�.
Land use approval: CILY tff TiIiARV _ 1&2 family:Simple Complex:
U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition
W-4 ,/alteration/replacement U Tenant improvement U Fire sprinkler/alami U tither: —
INFORMATION
Job address: 075 _SW if e. F S n4g.-l� tS Z�_ Bldg.no.: SuirP no.:
Lot: I Block: Subdivision: _ Tax map/tax lot/account no.: C
Project name:
Description and location of work on preinises/special conditions: mor(C(_v �;
' '
Mailing address: 1 Q' 088 1 do 2 family dwelling:
City_ f�ae�// State:po ZIP: 7.2 9 Valuation of work........................................ $-I-amam m l
Phone ZS(o-531U—_j—Fax":1� 7 ail: No.of bedrooms/baths.................................
Owner's representative: Total number of floors.................................
Phone: pfix: >y' r! it1: New dwelling area(sq.ft.*) ..........................
Garage/carport area(sq.ft.)............. ...........
Name: Covered porch area(sq.ft.) .........................
Mailing address:
Deck area(sq.ft.)
City: State: ZIP: �^ Other structure area(sq.ft.).........................
Phone: Fax: E-mail: Commerciallindustrlal/multi-family:
Valuation of work........................................ $_
We.
h Existing bldg.area(sq.ft.) ..........................
Business name: (phd'STx
BPEp ,< S_ New bldg.area(sq.ft.) ................................
Address: py $a by"3 _
Citr4lnhel' State: c,F_ ZIP: r7� Number of stories........................................
City: Type of construction
Phone:5v 1,Zqf 53u4. Fax:561 !i}31761 E-mail: --
(kcupenc) group(s): Existing:
CCB no.: _
S 01 '_— - - r New:
City/metro lic.no.: Nouse:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may he required to be licensed in the
Address: — jurisdiction where work is being performed. If the applicant is
Cit Slur l .l i, exempt from licensing,the following reason applies:
Contact person: -
Phone: Fax: E-inaiI. —-
111,110 0
Name: _ Contact srson: Fees due upon application ........................... $
Address: _ _ bate received: ---
City:
City: State: ZIP: Amount received ............................. ........... $
Phone: Fax: d-mail_ Please refer to fee schedule\,..
I hereby certify I have read and examined thiF appy ation and the -Not all jurisdictions accept credit carte,pleser call jurisdiction for more information
attached checklist.All provisi of s a/dermin
anc•es governing'his I Ovi+a UMasterCard
work will be complied w' h er s c' or not. Cmdit s.rd numner: __ __L.L_
EeP6e
Authorized signalu bate: _ , Name of cardholder as shown on credit card
Print name:_ 'S��N J t ) ?L4 s
Crsrdholdet r�aatme Amount
Notice:"is permit application expires if a permit is not obtained within 180 days after it Mn accepted as con tete, 440461.1 JWWOMi
S.
� 1B � f15
One- and Two-Family Dwelling
RefereBuilding Permit Application (+heeklist Associate pe
— ------ Associated permits: '
City ofTignrd City of Tigard L]Electrical l]Plumhing i I Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Ll Other:
Phone: (503) 639-4171
Fax: (503) 598-1960
I Lana use actions completed.See jurisdiction criteria for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etr.
3 Verification of approved platilot. --
4 Fire district_ approval required. -
5 Septic system permit or authorization for remodel.Existing system capacity
6 Sewer permit.
7 Water district approval. _
Y Soils report.Must carry original applicable stamp anc signature on file or with application.
9 F"sion control L,plan U permit required.Include drainage-way protection,silt fence design and location of
,7-vlalch-basin protection,etc. _ —
10 Complete sets of legible plana.Must he drawn to scale,showing conformance to applicable local and state
building codes. Lateral desigdetails and connections must be incorporated into the plans or on a,eparate full-
nsize
sheet attached to the plans with cross r-ferences between plan location and details.Plan review cannot be completed
if copyright violations exist.
fT3ltt�pl9t lin drawn to ac Ltjbr_ anyrtust show lot and building setback dimensions;property corner elevations(if
prep:ismore ,nth�f'' t�-�e4�ivulion differential,plan must show contour lines at 24 intervals);location of easements and
driveway;footprint ol'stnicture(inchiding 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 holts,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,
I 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,
II 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,rool'slope,ceiling height,siding material,footings and foundation,stairs
fireplace construction, thermal insulation,etc. —
15 Elevation views.Provide elevations for.iew 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 addcndunis showing foundation,elevations with cross references are acceptable.
If, Wall bracing(Prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
m,n-ptescaptivee path analysis provide swrifrcations and calculations to engineering standards. _
17 Floorlroof framing.Provide plans for all f loo:.Jrool'assemblies,Indicating member sizing,spacing, and bearing
Jo alions.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections and derails 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 Iloorltoof 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,rcof truss)shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to he applicahlc to the proiect undo r review.
RM 111 IINL116
23 Five(5)site plans are required for Item 11 above. site plans must he H-1/2"x 11"or 11"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 COi'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. 44o4614(&tWOM)
Electrical Permit,kpplication
IDDatc received: Permit no.:
City of Tigard ProjecUappl.no.: Expire date:
City of-rig n,,d Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type.-
Land
ype:Land use approval:
U 1 &2 family dwelling or accessory U Commemial/industrial U Multi-farr.il
U New Y U Tenant improvement
AIsIsRnt/alteration/replacement U Other: J Partial
),,,construction
ss: 7 SW
i --1 Bldg,no.: Suite no.: Tax map/tax IoUaccount no
Lot: Block: Subdivision: -
Project name: --Tlkscription and location of work on remises:
---- - P
Estimated date ,ll rLICf Ch.
n
/ Job no: _
( Fee Max
Business mare: ( t' 5, E 4�rr� Ik-scriptlon Qty. (e■.) Iola! no.snap
Addross: y6 y LA 4 W $l�d New reridentia! d,gle ur rmdti-famlly per
City: LAIr.� (� p doellinRunit.lorlrais•sanach.,41garage.
S State: M ZIP:P. Seniceincluded:
Phone: 5'(6 wto S'S72 Fax: E-mail: 1000 sq.A.or leas
_ 4
CCB no.: 34 Elec.bus.tic.no' Z L4 tip Frrch additional 500 sq.ft.or portion thereof -- -
City/metro lic.no.: - Limited energy.residential 2
-- �C 0+ '' Limited energy,non-residential 2
Fac h manufactured home or mudulordwelling
91 acute of_supervising electrician(required) _ Date i Service and/or feeder
2
Sup,clec•r.name(print): La++y leen.,,,rm Senlces orfeeden-Installation,
alteration or relocation:
200 amps or less 2
Narne(print): ►1i/ 5� W es - 201 amps tc 400 amps 2
I`Aailing address: • wit 0 401 amps to 600 amps 2
\J o+�' (' State:vIL ZIP: qJ19y 601 amps to 1000 amps - 2 City: � - over 1000 amps or volts 2
Phone:.i tS1.53�L Fax:5o;133 31 E-mail: Reconncci onl
Owner installation:The install s being m n property I ownTem ra Po ryservicaorfeeders- !
which is not intended for sale ' se, nt,o ange according to rust"llallon•al6rnllar,urrelocaUnn:
ORS 447,455,479,67 2(x1 unips or less
Uwner's si natur . 3;_-�� 201 amps to 400 amps 2
\ Date: 401 to 6R)-amp, - —
Branch circuits-new,■Iteration,
Nettle: or extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee,eacF branch cirrutt
D. Fee for branch cir:uitswithout pur hale `—
Phone: I'a x' ti-muirl: of service or fee:er fee,first branch circuit: t
Each additional btar,rh circuit:fWn r
Misc.(Service or fet der not Included):
❑Service over 225 amps—nnnncrcn;rl U Her,ith-care facility Each pump or imgation circle 2
❑Service over 320 amps-rating of 1&2 U Hasardous location Each sign or outline lighting 2
family dwellings U Building over 10,000 square feet four or Signal circui(s)or a limited energy panel.
❑System over600 volts nominal more rr 'dential units to one structure alteration,orextension• `
U Buildingover three stories ?
U Feeders,400 amps or more "[cscri tion:
U Occupant load over 99 persons U Manufactured structures or RV
part—Each addillonai ingrertlrsn mer the allowable any of the above:
In
SubnsH,acts of plans with any or the above. — Per inspection __ J--T- __L__r--=
Investigation fee
The above are pot applicable to temporary construction service, other
Not all jurisdictions wcepr crrdh carts,please call jurisdiction For ram inrormatton. Notice:This permit application Permit fee.....................$
rJ
U Visa U MasterCard expires if a permit is not obtained flan review(at _ 96) $ .
Credit card number: within 180 days after it Inas been Slate surcharge(8%) ...$ t
_ 0xpnm' accepted as complete. TOTAL
Name cardfnaldrr as shown on credit c■r�— .......................$
-- — s —
Cardhdckr signa�ure _ Amount
440-4615(610aK'OM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
-- " — - TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: -
Rdatrictod Energy Fee...................................................... $75.06'
Number of Inspections per permit allowed (FOR ALL SYSTEMS,
Service included: Items Cost Total I Check Type of Work Involves::
Residential-per unit
1000 sq it or less $145 15 4 Audio and Stereo Systems'
Each additional 500 sq It or
portion thereof — $3340 __—_ 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Module Garage Door Opener'
Dwelling Service or Feeder $9090
Services or Feeders u Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less _ $80.30 2 Vacuum Systems'
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 _ 2
601 amps to 1000 amps $240.60 2 OtherOver 1000 amps or volts _ $45465 2
Reconnect only _ $66.85 —
--
ONLY
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL
Fee for each system.......................................................... $75.00
Installation.alteration,or relocation
200 amps or less $6685 2 (SEE OAR 918-260-260)
201 amps to 400 amps _ $100.30 _ 2
401 amps to 600 amps $133.75 Check'Type of Work Involved:
Over F00 amps to 1000 volts,
see 'b"above. Audio and Stereo Systems
Branch Circuits � Boiler Controls
New,alteration or extension per panel
a)The fee for brench circuits
with purchase of service or Clock Systems
feeder fee.
Ench branch circuit _ $6 55 Data Telecommunication Installation
b)Tt f fee for branch circuits
without purchase of service Fire Alarm installation
or feeder fee.
j First branch circuit _ $46 85 6 HVAC
Each additional branch circuit _ $665 0 Vt7_
Miscellaneous Instrumentation
(Sen,ice or feeder not included)
Each pump or irrigation circle $5340 _ Intercom and Paging Systems
Each sign or outline ligt ling — $53.40
Signal circult(s)or a limited energy ❑
panel,alteration or extension $7500
_ Landscape Irrigation Control'
Minor Labels(10) $12500
_--� F-1 Medical
Each additional Inspection over
the allowable In any of the above Nurse Calls
Per inspection $62.50
Per hooa $62.50 _
In Plant $73 75 Outdoor Landscape Lighting'
Fees: Protective Signaling
JJ �
Enter total of above fees $ F' n Other
64e State Surcharge $ �_ __Number of Systems
25%Plan Review Fee
sect on nn No licenses are required Licenses are required for all other.n tallations
See"Plan Review" $
front of application —
Fees:
Total Balance Due $
Enter total of above fees f_�__—
❑ Trust Account q __.--_ t / � 8'/.Slate Surcharge f --
Total Balance Due
All Now New Commercial Buildings require 2 sets of plans.
t d%ts\formsklc-fecs.dnc 013/30101
Plumbing Permit Application
Datereccived: Permitno.:nf, y
City of f 1l T lgaM Sewer permit no.: Building permit no.:
i' Address: 13125 SW Hall Blvd,Tigard,OR 97223
City of"Tigard phone: (503)639-4171 Projer:Ueppl.no.: Expire date:
Far,.' (503) 598-1960 Date issued By: Receipt no.:
Case file no.: Payment type:
Land use approval:
U I &2 family dwelling or accessory U Commercial/industrial ial/industrial U Multi-family U Tenant improvement
J New construction ¢(Addition/alteration/rcplacement U Food scrvi(c U Other:
MIR_111
Descri tion 7 (?ty. Fee(ea.) Tctnl
Job address: o?75'S SW' /� - � R' ew 1-and 2-family dwellings(inly:
Bldg.no.: Suite no.: (includes 100n.foreachutilityconnection)
Tax map/tax Iot/account no_ _ SFI�(1)bath
Lot:
--- Block: — Subdivision: _ SFR(2)bath
Project name: SFR(3)bath
City/county: ZIP: Each additional bath/kitchen
ises:
scription and location of work on prem �� n�4i Cx.sh _ 4itentilities:
III _ Latch basin/area drain —
Drywells/leach lineltrench drain
Est.date of comp:etion/inspection: Fwting drain(no.lin.ft.)
Manufactured home utilities
Business name l..0 f i rel /_J; Manholes
Address: Rain drain connector
City: State: ZIP: — Sanitary sewer
er(n
Fax: E-mail: Stomi sewo.lin.ft.)
Phone: Nater service(no.lin.ft.)
CCB no.: ` Plumb.bus,reg.nu: — Fixture or item:
City/metro lic.no.: --- Absorption valve
Contractor's representative signature: --_ Back,low p valve enter _
Print name: Date: Backwater val _
Basins/lavatory —_ —
Clothes washer
Nance: Dishwasher — D
Address: _ Drinkin fountain(s) —
City: State•_ i ZIP: Ejeccars/sump -
;'hone: FaE-
x: mail: Expansion tank
Fixturelsewer cap
_-
Floor
Floor drains/iloor sinks/hub _
Name(print): (,GIhC�Sfs; W } Garbage dis sal _
Mailing address: 3 Hose bibb —
City:?u. I „ ( State:pit ZIP: q7l H lce maker
Phone:5v'5 Leto 53uL Fax:s; 1153 1 E-mail: Interceptor/grease trap
Owner installation/residentia at an,,, I ie actual installation Primer(s) _will be made by me or the 1 era c•e al r r made by my regular Ruof drain(commercial) — �
employee on the prope w as hapter 447. Sink(s),basin(s),lays(s)
) �_ Sump
_ -
owner's signal Date:_ Tubs/shower/shower pan —
Urinal
Name: -----• Water closet----
Address: J-- - _ i✓utc-heater —_ --
City: State:_ Z1P: Other.
Phone: --rFax: E-mail: J Total
-- Minimum fee............. ..$
Na nt:),xisdirdau fccep, mat car&please aJ1)ai"dkti"°for 171O1e idmirati°a' Notice:'This permit application plan review tat — %) $
U Visa U Maxte(Card expires if a permit is not obtained State surcharge(8%) ....
/ __I within 180 days after it has been TOTAL .......................S
eaFire$
accepted as complete. 10,07-
Nsrtr of cardboldr uihov n xi ertdil nnl S (/( Cv�m)+
._ '-- _— ---Amami 4 -
C ardMdderilgnwre /7
v-
PLUMBING PERMITFEES:
PRICE TOTAL New 1 and 2•famlly dwellings only:
FIXTURES (Individual) _ _O_TY (ea) AMOUNT (Includes all plulnbiry fixtures in PRICE TOT..:
Sink 1G.6C i r ' - the dwelling and the fint100 ft. QTY .(ea) AMOUNT
Lavatory --� 166013&D for each utilit cox lection
one(1)bat, _ _ s�4s.zo
Tub or T ub/Shower Comb 16,60 Q Two 2 bath___3 $350.00
Shower Only 16.60 Three bath 0
339
9.0
Water Closet 16.60 -- _ _—�_—_ —
w _ ___ SUBTOTAL 4 _
Urinal 16.60 8%STATE SURCHARGE
Dishwasher ! 16.60 PLAN REVIEW 25%OF SUBTOTAL _
Garbage Disposal ! 16.60 — — TOTAL
Laundry Tray l— 16.60 t
Washing Machine 16.60 —
Floor Drain/Floor Sirk 2" — 16.60
3• 16.60- - PLEASE COMPLETE:
4" — — 1660
Water Heater O conversion O like kind 16.60 uanflty b ir Work Performed
Gas piping requires a separate mechanical — Fixture Type: New Moved Replaced Removed/
permit. 7V
Ca rd
MFG Hrme New Wat3r Service 46,40 Sink L
MFG Home New San/Storm Sewer 46.40
Tub of Tub/Shokver
Hose Bibs — 16.60 — Combination
Roof Drains 16.60 Shower Only _
Drinking Fountain 16.60 Water Closet — ——
Other Fixtures(Specify) —� — 16.60 Urinal`— Dishwasher 1 —
Garbaae Disposal /
Laundry Room Tray
— -,-- —
Washing Machine
-- Floor Drain/Sink: 2"
Sewer-1 st 100' 55.00 3"
Sewer..a oh additional 100' 4640 4" —
Water Service-1st 100' — 5500 Water Heater —
Water Service-each additional 200' 46,40 — other Fixtures
— (S ped --- --
Storm&Rain Drain- 1st 100' 55.00
Storm&fain Drain-each additional 100' 46.40 —
Commercial Back Flow Prevention Device 46.40 — — — —
Residantial Backflow Prevention Devine" 2 .55 — - --- — —_� —
CBasin
atch 16.60
Inspection of Er13ting Plumbing or Specially 62.50
R_egested Inspections perthr — COMMENTS REGARDING ABOVF:
Rain Drain,single family dwelling i 65.25
Grease Traps A --- 1660 --------� -------_--- _- -----.
QUANTITY TOTAL �- " --- -
Isometric or dser diagrrm i.required i/ — ---- --- -- -- — --`—�
Ouanlily rzrel is >8 ---
`SUBTOTAL --- ----- — -- --
8%STATE SURCHARGE -- ----------- -----
"PLAN REVIEW 25%OF SUBTOTAL -{
Required only It fixture qty.total is>9
TOTAI.
Minimum.permit fee is$72 50-9%state surcharge except Residential Backflow
Freventinn D+vice,which N$36 25-B%state surchar;n
"*All New Commercial Buildings require 2 sets of ai. Oth Isometric or riser
dlseram for plan review.
I:tdstslform.><ilm-fees.doc 12/26/01
1 Mechanical Permit Application
Da le received: Permit no.:n,e Uy/J
City of Tigard Project/appl.no.: Expire date:
('iryofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Date issued: By:
Phone: (503) 639-0171 Receiptno`_
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: building permit no.:
U 1 &2 family dwelling or accessory U Commercial/industrial U Mulli-family U Tenant improvement
U New c.msttuction ldit>fdWmn/alteration/repl icement U Other:
Um la 11 its Fn
I�
Job address: (p 7 75- SW TIZ(L — Indicate equipment quantities in boxes below. Indicate the doilai
Bldg.no.: Suite no.: value of all mechanical:Materials,equipment,labor,overhead,
Tax map/tax lot/accooni no.: profit. Value
Lot: Block: Subdivision_: *Fee checklist for imponant application information and
Project name: jun-,diction's fee schedule for residential permit fee.
City/county: ZIP: I'M am I 114 161111 lam 0
Description and location of work on premises:
Est.date of completion/inspection: DeKlipdOU Qty. Res.only Rm.only,
Tenant improvement or change of use:
Air handling unit CFM
Is existing space heated of conditioned?U Yes U No it conditioning(site pan required) _
Is existing space insulated?U Yes U No Alteration of existing HVAC system_
Boiler/compressors
State boiler permit no.:
Business name: _ NP Tons BTU/H
AddressFire/smoke atnpers/ uct smoke detectors
City: I State: IZI Heat pump(site plan required)
Phone: — Fax: E-mail: nsta I rep ace furnac umer.�
Including duetwoik/vent liner U Yes U No
CCB no.: nsta /rep ac re ovate heaters-suspended,
City/metro lie. no.: wall,or floor mounted
Name(please ptint): -Vent fora liance other than furnace
e gerrl on:
Absorption units-_— BTU/H
Name: Chiller. ___ __ _ HP - ----
---
CotMressors _ _ IIP
Address: Ellvironmental exhaust and rent AI on:
City: I State: ZIP: Appliance vent
Phone: Fax: E-mail: Dryerexhaust
Hoods,Type res.kitchenthazmat
` hood fire suppression system
l/1 Name: Lgvif� co �EpSl' L,/V Exhaust fan with single duct(bath fans)
Exhaust s st
Mailing adder s: �, em a tart from eanA ut AC
a st on(tito out cls)
Cit q. State: ZIP: V7 9 y
piping LI'(i NG P Oil
Y r+l d �— Type: -- ---
Phone:,%3 151►5y"- Fax:50 413 N0 E-mail: l-icl ti in each a tions over out ets
( roceaspiping(schematicrequired)
Number of outlets
Name: __ a or equipment:
Address: �__ DYcorativefireplace
City: -- I St ZIP: Insert-type -- -
o stogy pc et stove
Phune: X E-mail: ---
Applicant's signs
Nam!! (print): Ort Notice:This fx•rmil application Minimum-
Not cc
dl puivardom accept credit cml,,plow..III jaiatiction for mar infomutial. inim fee um feeee................$
................$ '
U isa U MasterCard expires if a pem it is not obtained
Credit crud namher –�--- -- Plan reVICW(al 9t7) $
� within I80 days Rer it hes Ixeit --��
Expires y' r: State surcharge(8%)....S
- - -- --- acce :ed as cons irtc
Name d catditvlder as shown on credit pard p � '
Cardholder sigannue ---- — Amount_ 440-4617(610(11010M)
I
F_
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEES Tab
� ( ori1A Price _Total
Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to 55000.00 Minimum fee$72.50 -- 1} FumTre to 100,000 B-i U
$5,001.00 to$10,000.UU $72.50 for the first$5,000.00 and including ducts&vents 14.00
$1.52 for each addition&$100.00 or 2) Furnace 100,000 BTU+
fraction thereof,to and including including duns&vents 17.40
_ _
$10,00000. - 3) Floor Furnace
$1.54 for each additional$100.00 or
$10,001.00 to$25,n00.00_ 3148.50 for the first$10,000 00 and indudin vent 1400 _
Suspended heater,wall heater
fraction thereof,to and including 4}
_$25,000.00. or floor mounted heater 14 00
__ _ -
525,001.00 to$50,000.00 $319.50 for the first$25,000.00 and 5) Vent not included in appliance permit
90
$1.45 for each additional$100.00 or --
fraction thereof,to and Including 6) Repair units 12 15
$50 000.00 -
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boller Heat Air
$1.20 for each additional$100.U0 or For Items 7.11,see or Pump Cond
fraction thereof. footnotes below. Comp '
_ 7)<3HP;absorb unit 14.00
Minimum Permit Fee$72.50 SUBTOTAL: $ to 100K BTU
6)3-15 HP;absorb 25.80
8%State Surcharge $ unit 100k to 500k BTU
9)15-30 HP;absorb 00
35.
25%Plan Review Fee(oi subtotal) $ unit.5 1 mil BTU --
Required for ALL commercial permits onl 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20
_ 11)>50HP;absorb 87.20
unit>1.75 mil BTU
-- 12)Air handling unit to 10,000 CFM 10.00
ASSUMED VALUATIONS PER APPLIANCE: _
Value Total 13)Air handling unit 10,000 CFM
Description: _ Q E( a) Amount 17.20
Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler
10.00
ducts&vents
Fumace_>1 BTU including 1,170 15)Vent fan connected to a single duct
8.80
ducts&vents _
Floor furnace including vent _ 955 16)Ventilat'nn system not ircluded in
Suspended heater,wall heater or 955 a liance ermit 10.00
floor mounted heater_ 17)Hood served by mechanical exhaust
Vent not included in applicanre 445 _ 10.00
permit __ 18}Domestic Incinerators
805
Repair units 17.40
<3 hp;absorb.unit, 955 19)Commerci l or industrial type Incinerator
69.95
to 100k BTU
3-15 hp;absorb.unit, 1,700 '1))Other units,including wood stovr s
101k to 500k BTU 10.00 _
15-30 hp;absorb.unit,501k to 1 2,310 -� 21)Gas piping one to four outlets
mil.BTU 5.40
33-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each)
1-1.75 mil.BTU 1.00
>50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL:
7Z,5
>1.75 mil.BTU 656 -- 8•/.State Surcharge $ A
Air handling unit to 10,000 cfm --
Air handling unit>10,000 cfm _ 1,170
Nan-portable evaporate cooler _ 656 - TOTAL RESIDENTIAL PERMIT FEE:
Vent fan connectao to a single duct - 446
Vent system not Included In 658 -
921 lance permit - Other Inspections and Fels:
Hood served by niedlanical exhaust 656 1 Inspections outside or normal business hours(minimum cherge-two hours)
Domestic indnerdtor _ 1,170 _ $62 50 per hour
Cema erclal or Industrial Incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge-half hour)
Other nit,including wood stoves, 656 $62 50 per hour
3. Additional plan review required by changes,additions or revisions to plans(mirimum
Inserts,.,te. _ _ - - charge-one-half hour)$62 50 per hour
Gas pljn _l 4 outlets 360 _
Each additlr.lel Outlet _ 89 -- •State Contractor Boller Certification required for units>200k 870.
"Residential AIC requires site plan showing placement of unit
TOTAL COW4ERCIAL $
VALUATION: _ - All New Commercial Buildings require 2 sets of plans.
i:\dst<s\forms\mech-fees.doc 12126/01
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Proposed Floor Plan
!u/r�/A0,'Q,r✓�kyt�rt�t[c 5ca I e: I/g„ _ �'—�
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Frcposed Lower Cvc.r oqe Plan
RECEIVEr)
MS�Or
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bedroom 9
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Dedroom 1
L—W]El
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Dot hroom � II UtillryRoom 1—i_J- _- .•r.•
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bedroom I -- I
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Geo I.1vinS Room 9.
Existing Flo 'r Pion
RECEIVED
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)
RECEIVED
Q1-Y t* I AjAAl,,
CITY OF TIGARD BUILDING ,"I ISPEC7 ION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639.4171 MST — —
�/ BLIP _
Date Requested_ AMPM _ _ BLD —
Locatiorl _--�?' �.; Suite —
MEC
Contact Verson Ph PLM _
Contractor _ kA- . Ph ��f `�i — SWR
BUILDING Tenant/Owner _ t' /}' ELC 00 CxD �(�
Retaining Wall ELR
Footing Access. -- -
Foundation FPS
I=tq Drain -
Ciawl Drain Inspection Notes: i / , - �t SGN _
Slab SIT
Post& Be•jm -
I Ext Sheath/Shear ( } ZJ
Int Sheath/Shear -- --
Framing
Insulation
Drywall Nai'ing I ----- -__-_---- - _-
Firewall
Fire Sprinkler
Fir( Alarm �- -1-�— —
Susp'd Ceiling - `'_sem- ��J�L-�-�c-- .�CC,- ilkl P �i
Roof --
Misc: -------- -_ -- ------ --- -
Final -- -
PAbS PART FAIL -_- _--- -- --_--
PLUMBING _
Post& Beam
Under
- -------
Under Slab
Top Out - -- ----- --- —---- - -
Water Service
Sanitary Sewer __--
Rain Drains
Final -- _-.
PASS PART FAIL
MECHANICAL -
."lost&Beam ---- -._.-----
iough In
Gas Line ---- ------ -------
Smure Dar,ipars - _-- ---- __—. -- _
Final ---- -- -- -- - - -- -- - ---------- ---
PASS PART FAIL
ELEICAL --_-- ------ -- - ..--- --- — ---------- ---
gLY1r.�
RoughIn ------ -- ---- ------ --- ------------- -------- - -_-----
UG/Slab
Low Voltage - ----- - --------- ----- -------
Fire Alarm
PASS PART FAII. ------- --- ------- --- - - -------- -- _
Rockfill/Grading _� - - ----- ------ -------- -- -----
+Sanitary Sewer
3torm Drain [ j Reinspection fee of$- required betore next inspection r'ay at City Hall, 13125 SW Hill Blvd
(Catch Basin --
Fire Supply 1_ine [ j Please call for reinspection RE. _ ( j Unable to inspect- no,ccess
ADA —
Approach/Sidewalk j )
Ocher — Date '—�� Inspector _Ext
Finel
PASS PART FAIL DO NOT REMOVE. this inspection record 7rom the joh .rite.
CITYO F T i G A R® MASTER PERMIT
DEVELOPMENT SERVICESDATPERMII M M 2001-00451
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 06775 SW ALFRED ST PARCEL: 1S125DA-04400
SUBDIVISION: KINGS VIEW ZONING: R-4.5
BLOCK: LOT:029 JURISDIC riON: TIG
REMARKS: Replace 1 e'of load bearir.g wall and install 10'x 11'of new subnoor in laundry room.
Electrical work was done under separate permit, ELC2001-00415.
BUILDING
REISSUE: ;TORIES: FLOOR AREAS REQUIRED SE70ACKS REQUIRED _
CLASS OF WORK: AIT HEIGHT: FIRST: of BASEMENT: of EF7: SMOKE DEI ECTORS:
TYPE.OF USE: SF FLOOR LOAD: SECOND: of GARAGE: sv FRONT: PARKING SPACES
TYPE OF CONST: SN DWELLING UNITS: FINBSMENT: of NIGHT:
/,
OCCUPANCY GRP: R3 BURM: BATH: tOTAL: ornVALUE: S 000 UUI sr REAR:
PL UMBING _
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAP4
LAVATORIES: DISHWASHERS: FLOGS.RAINS: SEWER L;NF!%. SF RAIN DRAINS CATCH BASINS
TUBISHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
MECHANICAL O r HER FIXTURES:
• _ __
'LEL TYPdS FURN<1100K: BOIL/CMP<JHP: VENT TANS: CLOTIIES DRYER:
FURN>•105Y: UNIT HEATERS: HOODS: OTHER UNITS:
44AX INF btu FLOOR FURNANCES: VENTS: WOODS�OVES: GAS OUTLETS.
ELECTRICAL _
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEr)ERS BRANCH CIRCUITS_ MISCELLANEOUS ADD'L INSPECTIONS
%oo sr OR LESS: 0 200 amp: 0 200 amp: W/SVC OR FDR: PUMPIIRRIGATION: PER INSPECTION
EA HUD'L 5005: 21.11 400 amp: 201 400 amp: lot WI0 SVCIFDR: SkiNIOUT LIN LT: PFR HOUR:
LIMITED ENFROY: 40. 608 amp: 401 600 amp: EA ADDL BR CIR: sIGNAL/PANFL: IN PLANT:
MANU HM.SVCIFDR Go L - 1000 amp: 601-amps-1000V: MINOR LABEL-:
10004 amptvolt
PLArI REVIEW SECTION
Reconnect only: - "'-----' ---
>•4 RES UNITS: SVC/FDR-225 A.: >600 V NOMINAL: C!S AREAISPC OCC,:
ELECTRICAL•RESTRICTED ENERGY _
A.SF RESIDENTIAL _ 9.COMMERCIIiL M ��
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO A STEREO: F'RF.ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT.
BURGLAR ALARM, OTH: BOILER: HVAC: LANOSCAPFARRIG: PROTECTIVE SIGNL
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR,
HVAC: r'ATArTELE COMM: NURSE CALLS: TOTAL 0 SYSI SMS'
Owner: Contractor: TOTAL FEES: $ 191.17
This permit is subject to the regulations contained in the
FITZER,CLARICE I. SUNRISE CONSTRUCTION&REMO[1 g-�Municipal Code, State of OR Spec:a,ty Codas and
6775 SW ALFRED ST STEVEN MEACHAM 311 Otnel ^Dlicable laws All work will be done in
TIr;ARD,OR 97223 7335 SW 28TH accordance with approved plans. This permit will expire N
PORTLAND,OR 97219 work is not started with in 180 days of:ssuancl,or if .1(-
work
ework is suspended for more than 180 days ATT EN i.ON
!'hone: Phone: Gregon law requires you to follow rules adopted by the
Oregoi.Utility Notification Center Those rules are set
Reg 0: I IC 48499 forth in OAR 952-001-0010 through 952-001-0080. Ycu
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
rooting Insp — —
Underfluor Insulation
Framing In3p
Final inspectlun
•uou By : f �a_� Permittee signature : f 1, -L
�S
Call (303)639-4175 by 7:00 p.m,for an Inspection needed the next business day
Building Permit Application
Date received: /'/ e/ Permit no.:
City of Tigard
F'rojccdappl.no.: Expire date:
'Cityef7lgard Address: 13125 SW Hall Blvd,Tigard,OR 97223 -- -
Phone: (503) 639-4171 �^ / /5- Date issued: By: Receipt no.:
t�
Fax: (503) 598-1960 C L el `DO/ Case file no: Payment type: c
Land use approval: - - -- - 1&2 family:Simple complcx:
--
.�tls
bo &2(artily dwelling or accessary U Commercial/industrial U Multi t;nndv U New construction U Demolition
XAddition/alteration/replacement U Tenant improvement 0 Fire slmnkIrt/alarm U Other:.
.1 0HS11 1. IN IVRMATiON
Job address: (�, l "� �� c� C r - Bldg.no.: Suite no.:
T— tax lot/account no.:
Lot: Block: Sdbdivisio.l: Tax ma M
Pm ect name:
work on premises/special conditiotis:
scription and location Y
1�
Name: Mme, N1 - t z er C t`h►SetV►'syZc ?
[Mailing address: a,-1 1' /� \ r c _� 1 &2 family duelling:
City: �ac:k-`fl IState: G ZIP: <"`«r �p Valuation of work........................................
Phone: ;Zo9 111-4 Fax: E-mail: No of bedrooms/baths................................. _---
Owner's representative: Total number of floors.................................
Phone: —� Fax: E-mail: New dwelling area(sq.ft.) .......................... ---
Garage/carp )rt area(sq.ft.)......................... -- -
Name: M\C-InAE V7 k 7Cevered porch area(sq.ft.) ......................... _ --
Mailing address: �_ G t c Deck area(sq. ft.)........................................ —
City- Qc l�'�pt\1 Stat e!C ZIP: Other structure i,ea(sq.ft.).........................
Phone: ;ej -1-7-; 9 Fix: E-mail: Commere;al/ind :stria)/multifamily:
Valuatior;)f work... .................................... S ----
_ Existing bldg.area(sq.ft.) ..........................
l Business name: �5 r Jell- I
_ New bldg.arra(sq.ft.)................................
Address: Number of stories
City: V 4 _ State:Q ZIP: Type of construction.................................... — -
Phone• ' ' 1'vt: F.-mail: — Occupancy group(s): Existing:
CCB nr.: Sb _ - New:
City/metro lie.no.: 3 7 Notice:All contractors and subcontractors are required to he
licensed with the Oregon Construction Contractors hoard under
• provisions of ORS 701 and may he required to he licensed in the
ie:
—-— --—- jurisdiction where work is being performed. If the applicant is
Address: exempt from licensing,the following reason applies.
Cit State: LIP:
<< tltact person: _ Plan no.: ---
Phone: --� F...x: E-mail:
<
,'Rimae: Contact person: Fees due upon application $
Address: -- ---� Date received:
e fty; State: ZIP: Amount received ......................................... -
Phone: — fax Email Please refer to fee schedule.
I hereby cs.t.t;I have mtid and examined this application and the Not all jurisdicdrns rapt credit cards.please u11 juriulictinn for more int.xntation.
:t•tached Lh,%1list. All pmvisions of laws and ordinances governing this io Visa U MasterCard
work will he complied witli,whether s ifled he in or not. cRait Lard r mix 0� `let
rapi,c<
Authorized signatur•Z!Y tA'114 Date: O cj ( No MAO ow CV0 card
M-_�" j_or t V $
Print name: P� t r- h�P \ F',-ii�� � _.� — Cardh _ upwtne — Amoant
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4404611 M011000M)
One-and Two-Family Dwelling
Building Permit Application Checklist '<etcrcncc°°.
Associated permits:
CiryafTigara ir•ty of Tigard., ,
U Electrical U Plumbing U Mechanical
Address: 13125 SW Mall Blvd,Tigard,OR 97223 U Other: _—
Phone: (503) 639-4171
Fax: (573)598-1960
1 Land upe actions completed.Sae jurisdiction criteria r concurrent reviews.
Zoning.Flooxl plain,solar balance points,seismic soiis designation,historic district,ctc. -
3 Verification of approved platllot.
4 Fire district _.approval required. _
5 Septic system permit or authorization for remodel. Existing syst,m capacity
6 Sewer permit.
7 Water district approval.
8 Solls report. Aust carry original applicable stamp and signature on file or with application.
9 Eroden control U plan U perm'required.Include drainage-way protection,silt fence design and location of
catch-hasin protection,etc. —
10 _3 Complete eels of 1^gihle plans.Must be drawn to scale,showing conformance to applicable local and state
building Bodes. Latew.l design details and connections must he incorporated into the plans or on a separate full-size
sheet attached to the pians with cross references het seen plan location and details. Plan review cannot be completed
if conyright violatic is exist.
I 1 She/;rlot plan drawn to scale.The plan must show lost and building setback dimensions;property comer elevations(if
there is more than a 4-11.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and
driveway;footprint of structure(including decks);locLtion of wells/septic systems:utility locations;dicction indicator,lot
area;building coverage area;percentage of coverage;in, �rvious area;existing structures on site;and sutfa,t 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 healer,
furnace.ventilation fans plumbing fixtures,balconies and decks 30 incl es above grade,etc.
i 14 Cross sectloa(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
detai:s of all wall and roof sheathing,toofing,roof slope,ceilin,height,siding material,footings and foundation,stairs,
fireplace constru tion, tiiermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remod^Is.
Exterior elevations must reflect the actual grade if the change in grade is greater that,four foot al huilding envelope.
Full-size sheet hddendums shoe ing foundation elevations with cross references are accep-hie.
16 Wall hr^ging(prescriptive path)and/or lateral analysis plans.Mt-st indicate details and locations;for
nor.-prescriptivpath analysis provide specifications and c:.lcuiations.o engineering standards.
17 Floor/roof framing.Provide plans for all noon/roof assemblies,indicating member sizing,spacing,and bearing
locations.Show attic ventilation. _
18 Basement and retaining wails.Provide eros, sections and details showing p!ecement of rebar.For engineered
systt,ms,see;tem 22,"Engineer's calculations."
19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists I •
over 10 feet long a_ndror any beam/joist carrying a non-linitorm load.
20 Manufactured floor/roof trues design details. ___ • • _ ��
21 Energy CoJe com lianre.Identify the prescriptive path or provide calculations.A gas-piping schemasu� e4•uired '
for four or more applianees. _ •• '
22 Engineer's calculations.When required or provided.Ox..shear wall,roof truss)shall he stamped by a•o rinser or
architect licensed in Oregon and shall be shown i,�Iw illph,able to the project under review. .•• ; .., I
23 Five(5)site plans are required for Item I I above. Site plans must he 8-1/2"x I I"or I I"x 17". _:f
24 Two(2)sets each aro,require!for Items 16, 19,20&22 above.
25 Building plans shall not cont-in rid lines or tape-ons.
26 No rolled,reversed or mirrored building plans will be accepted.
27
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans mdy he in blue or black ink
Red ink is reserved for department use only. nal-4614(6AXWO Mi
One-and Two-Family Dwelling
Building Permit Application Checklist Iteterenceno.:
ry of Tigard Associated permits:
C7
City of Tigard O Electrical U Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Q Other:
Phone: (503) 679-4171
Fax: (503) 598-1960
.I IIF 1.9110%VrNG ITFNIS ARV REt NRED FOR PLAN REVIEW I v% No NIA
I Land use sections completed.See iurisdiction criteria for a ncurnCnt [('views.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district.cit
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 -Fater district approval _
8 Soils report. Must carry original applicable stamp and signatute on file or with application. ,-
9 Erosion control U plan U permit required.Include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
10 _. 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 hetwecn plan location and details. Plan review cannot he completed
if co yright-iolations exist. _ __ _ _
1 I Site/plot e1'h
elan drawn to scale.' c plan must show lo,and huilding setback dimensions:property corner elevations(if —
there is more than a 4-ft.elevation differential,plan must show contour lines at 241.intervals):lvication of easements and
driveway;footprint of structure(including decks);location of wells/septic systems:utility locations;direction indicator:lot
_ arca:building coverage area;percenlage 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
si zc and location.
13 Floor plans.Show all dimensions,norm identification,window size,location of smoke detectors,water heater,
furnac• ,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,tool'construction. More than one cross section may be required to clearly portray constructicn.Show
details of all wall and roof sheathing,roofing.nx)f slope,coifing height,siding material,footings and foundati"n,stairs, j
nreplace construction, thermal insulation,etc.
15 Elevation views.Provide Elevations for new construction;mirimum of two elevations for addition! and remodels.
Exterior elevations mast 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(prescript(ve path)and/or lateral analyst's plans.Must indicate details and locations;for
non l,rescripove path analysts provide specifications and calculations to engineering standards. —
1' Floor/roof fnmiug. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections and details showing placement of rehar.For engineered
systems,see item 22."Engineer's calculations."
19 Beim 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-uniiorm load.
20 Manufactured fioorlroof truss design details._ • • _
21 Energy Code compliance.Identify the prescriptive path or provide calami ttions. A gas-piping schemata isaequired
for four or more appliances.
22 Ungineer's calculations.When required or pn,vided,(i.e.,shear wall,roof truss)shall be stamped by as-engin er or
architect licensed in Oregon and shall lx shown to be applicable to the project under review. j•_ i
23 Five(5)site plans are required for Item I I above. Site plans must be f(-112"x I I"or I I" x 17". _ f
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
L 28 --
Checklist must be comnletcd 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(64000rr(
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CITY OF F T i G�►R® ELECTRICAL PERMIT —
PERMIT#: ELC2001-00415
DEVELOPMENT SERVICES DATE ISSUED: 8/13/01
13125 S. ' Hall Blvd.,Tigard,OR 97223 (503) 639-4171 PARCEL: 1S125DA-04400
SITE ADDRESS: 05775 SW ALFRED Sl"
SUBDIVISION: KiNGS VIEW ZONING: R-4.5
BLOCK: LOT : u29 JURISDICTION: TIG
Proiect Description: Installation of service 200 amps or less.
RESIDENTIAL. UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 60fj amp: SIGNAL/PANEL:
MANF HM/SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
— SERVICEIFEEDER BRANCH CIRCUITS ADD'L INSPECTIONS _
0 - 2.00 amp: 1 W/SERVICE OR FEEDER: PER INSPECTrON:
201 - 400 arrip: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 arnp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 anim _ _ _ PLAN REVIEW SECTION —
L1000+amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only. _—_ SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor.
FITZER, CLARICE L DICKENSON'S ELECTRIC
6775 SW ALFRED ST 8449 SJV BARBUR BLVD.
TIGARD, OR 972.2.3 PORTLAND, OR 97210
Phone: Phone: 5(13-246-3550
Reg #: LIC 65534
ELE 26-140C
SUP 3100S
F-- FEES _ — Required Inspections
Type — By Date Amount Receipt Elect'I Service
PRNiT CTR 8/13/01 $80.30 2720010000( Elect'I Final
5PCT CTR 8/13/01 $6.42 2720010000(
Total $86.72
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laves
All work will be donr_in accordance with approved plans This permit will expire if work is not started within 180 days of issuance,or if work is
suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notificauon Center Those
rules are set Orth it OAR 952-001-0010 through 0�,R 952-001-0080 You may obtain copies of these rules ordirect questions to 0014C at(503)
246-6699 or 1-600-332-2344.
Issued By:
Perrilt Signature: J
OWNER INSTALLATION ONLY —
The installation is being made on property I own vhich is not intei -lei for sale, lease, or rent.
OWNER'? SIGNATURE: — DATE:-
CONTRACTOR INSTA-FL.LATION ONLY — —
SIGNATURE OF SUPR. ELEC'N: __i> ;- � �' 4� 6i �� _ DATE:.—
LICENSE NO: ---
Call 6394175 by T:00pm for an inspection the next business day
Electrical Pr�rniit application
rrDateeived: Petmitno&L(' k!1
City of Tigard `� ( G�r Project/appl.no.: Expire date: _
Lk
urA Address: 13125 S"e Hall Blvd,Tigard,O Date issued: By' I Receipt no.:
Phone: (Sup) 639-4171
Fax: (503)598-1960 Case file nn.: Payment type
Land use approval:
,
1 &2 family dwelling or accessary U Commercial/industrial U Multi-family U Tenant improvement
U New construction U Add'tion/altt,ralion/rcplaccme[it U Other: _ U Pania-
loll SI I 11
1
Job address:_ cJ - ldi . n,, ` ti1111n Tax map/tax lot/account no.:
Lot: Block. Subdivision: -
Project nar,e: Description and location of work on premises:
E6timatri dale of c,rtnplrfiom/inspt•t'il-III!
1.00' 11 CVI I ON 4, FEL SUIEDUE
ice 111:n �
Job no:
Description_ l)1`v• (ea.) Iblal no.insp
Business namt.: ( New residential-single or nu ld-fandiv per
Addres dwelling mil.includes attachetf enrage.
City: Stat [ZIP:27 2 Servicelncluded:
1000 sq.ft.or less 4
Phone: .1.(•f ,V Fax: ;?/? .y Y E-mail: Each additional 500 sq.ft.or pion thereof
CCB no.: S _ 7 r Elec.bus. ic.no: a^ V�- Limited energy,residential 2 _
City/metro lic.no.: Limitedenei6y,non-residential _ ?
/ Each manufactured home or modular dwelling
Si nature o rn bate C•' - Service and/or feeder
Services or feeders-installation,
Sup elect.name(print icense no: alteration or relocation:
21`10 amps or less — _ 2
211 amps to 400 amps 2
Nance(prim j: 461 amps to 600 amps 2
Mailing address: _ 601 amps to 1000 amps 2
City: _tate: ZIP: Over 1000 amps or volts 2
Phone: Fax: E-mail:
Reconnect only1
owner installation:The it,stalladon is being,.rade on property I own Temporary services or feeders-
inatttlldlon,alterallon,nrrelocaticn:
which isnot intended for salt.,lease,rent,or exchange according to 200 amps of less
ORS 447,455,479,670.'101. --
owner"; sign:Uur _-- -- _ Dale: 401 to 6W am�rs _ -
Branch circuits-new,alteration,
or extension per panel:
Narnc: _ _ A. Fee for branch circuits with purchase of
Address: - service or feeder fee,each branch circuit 2
City: _ - State: ZIP:
B. Fee for breach circuits without purchase
_ of senice or fader fee,first branch circuit: '-
Phone. _ Fa+' F inai1 Each additional branch circuit:
' ill Misc.(sierrice or feeder not included):
gj Each pum or irrigation circle Z ._
❑Servianva225amps-commetriat U Ileahh ca rla1111v Each sign or outline lighting _ _'--__-
O Service over
320 amps-rating 1&2 U Hazardous location Signal circait(s)or a limited energy panel ^
family dwellings U Building over 10,000 square feet four or B `
�3 System over 600 volts nominal more residential units in one structure allegation,orentetuion•
U Building mer three stories U Feeders,4M amps or more *Description: —
U Occupant load over 99 persons U Manufactured structures or RV park Fich additional Inspection over the allowable In any of the above:
U Egress/li,4htinr,pidn U Other: . ---_ Perinsraction
+ubmlt sets of plant with any of the altos. Invesugationfee
Fhe above are nol ahpFcable lu temporary construction service. Other _
Not ell Jurisdiction.eeetp credit cant, please call iurisdictinn for more information. Nonce:This permit appllCation
Permit fee.....................$
U Vise U MasterCard expires if a permit is no,obtained Plan review(at — %) $
Cmdit card numl+rr: —�—--- —�-�— within 190 days after it has been State surcharge(8%)....$
Expires accepted as complete. TOTAL .......................$
Name of c anr:��,s�ii end s
Amoun 00.4615(1 MICOM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
--"—�- ---""-� - -- I TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Fee Schedule Below: _ — _
Restricted Energy—Fee...................................................... $75.00
_ Number of InspectionsPer perniit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential-per unit ❑
1000 sq ft.or less _—_ $145.15 j Audio and Stereo Sys:erns•
Each additional 500 sq ft or
portion thereof _ $33.40 Burglar Alarm
Limiter)Energy $75.00
Each Manufd Home or Malular 2 ElGarageD,or Opener'
Dwelling Service cr Feeder _ $9090
Servl^an or Feeders ❑ Heatii 1,Ventilation and Air Conditioning System*
Ins_'latk o,alteration,or relocation p,,
200 amps or less S�nao� $�.30 2 (—I
201 amps to 400 amps $106.65 2 CLJ Vacuum Systems'
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or NroNr, $454.65_ 2
Reconnect only $86.85 � _ 2
Temporary Services ar Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation, Services
or relocation Fee for each system.......................................................... $75.00
200 amps or less $66.65 2 (SEE OAR 918260-260)
201 amps to 400 amps _ $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 ampu to 1000 volts.
sae"b"above. Cl Audio and Stereo Systems
Branch Circuits ❑ Boiler Controls
Now,alteration or extension per panel
a)The fee for oranch circuits ❑
with purchase of service or Clock Systems
feeder fee.
Each branch circuit _ _^ $6.65 ^,_� ❑ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of servk-? ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46 85 ---- --__- ❑ HVAC
Each additional branch circuit $c 65
i Miscellaneous ❑ Instrumentation
(ServlcA or feeder not included)
Each pump or irrigation circle $53.40 _ ❑ Intercom and Paging Systems
Each sign or outline lighting —_ $53 40
Signal cirradt(s)or a limited energy '
panel,alteration or extension — $75.00 Landscape irrigation Control❑
Minor Labels(10) $125.00 _
Each additional inspection over Medical
the allowable In any of the above Nurse Calls
Per inspeclion w _ $62.50_
Per hour J -- $62.50 --------- ❑
In Plant —_ $73.75 _ I Outdoor Landscape Lighting*
Fees: ❑ Protective Signaling
Eneer total of a,-vu't•es $ _ ❑ Other
8%,tette Surcharge $ ..—.__—_._.. _---_--Number of Systems
25%Plan Review Fee No licenses are required. Licenses are required for all other installations
.lee"Plan Review"section on $
f ont of application __..— _
Fees:
T,itat Balance Due $
Enter total of above fees
Trust Account# 8%State Surcharge s
Total Balance Due
i'%d3t5\foim5\-IC4f CS duc 06/07/01
CITY OF TIGARD 24-Hour
BUILDING
Inspection Line: (503)639-4175
INSPECTION DIVI ' ON Busin ss Line: (503)639-4171
13 U f
--Date Requested. -
A0 2--, -- -- PM 13UP -- ---
Received ____
Location - —�_ z-- •'— - e—/F c� MEC - -- --
;ontact Parson _.__._. ��—___ Ph
SWR -- -- - -
ILD,N ' TenanVOwner __.___--_ -- —..___ ELCELC
---
- --
Foundation
Access: =/W1_V1 y ��/kG.�S ��. �t�..--
Fig Drain %' R - -- - - -
Crawl Drain 1qK' /- --_-1--
Slab Ins action Notes: SIT
Post& Beam --
Shear Anchors
Ext Sheath/Shear �---
Int Sheath/Shear
Framing ---- --__�----------
Insulation
Drywall Nailing -- ------ -- - ---
-.- /
Firewall
Fite Sprinkler
Fire Alarm -- - ---- -- -___
Susp'd Coiling ----" -- --- 11�
Root - -- L - - --- --
rnal
T FAIL
LING _-- --- -- -- - - ------- ---
P m
Under
Rough In _ _
Water Service ----- —�._
Sanitary Sewer
Rain Drains -- — ---- ---
Catch Basin/Manhole
Storm Drain - --
Shower Pan —_ ------
incl - --- --
PARt- FAIL -- - -- -
earn
Rough-In - --- - - - --
Gas Line
S,mo e Dampers — -- -- -J- --- - —J'
in - -
A T FAIL ----- -_--- - --- --
CTRL -- -- --- - - --- -
Sery ce
Rough-In _--_-- __-_--- ----- - --
UG/Slab
Low Voltage - _ __------- ----- -- -
Fire Alarm
opf Ina�' r Reinspection fee of$-. _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
a PART FAIL L
-_-- - ---- . --- Unable to inspect - io access
I_7 Please call for reinspection RE:_.._ -_-_-_
Fire Suppry Lino �- ,�
ADA Dab `� /�__1�_(0J Inspector � �---- —__.Ext --
Approach/Sidewalk
Other:
-
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
....._._-
CITY OF TIGARD
Residential Certificate of occrzpancv
-C�b o 2.Address:
Permi t No.:/1ST o U 2___-._�
Owner/Contractor:
Date of Final Inspection: Inspector:
This structure has been found to be in substantial compliance with the provisions of the State of Oregon One& Two Family Dwelling
Specialty Code and is hereby approved for occupancy._ r