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11.320 SW AMBIANCE PLACE
CITY OF TIGARD BUII._DIrNG INSPECT ON DIVISION MST
24-Hour Inspection Line. 63�,-4175 Business Line: 639-4171 BLIP
Requested -- -- -AM
--- --PM ---� BLD ----
_ocation
1 �j " /��� t,,�t�C t'�-- Suite --.__ ;nnE� 9
Contact Person Ph -- PLM
Contractor - Ph — SWR -"_—_
BUILDING TenantlOwner _ Y ELC —_
Retaining Wall ELR -_-----
Footing P NOT REQUESTED FPS
Foundation
Fig Drain FOUND DURING RESEARCH SGN
Crawl Drain It NO INSPECTION(s) IN FILE
Slab _ SIT --- _-_--.--
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing --------- --_ -
Firewall
Fire Sprinkler — _
Fire Alarm
Susp'd Ceiling ----� -
Roof —
Misc __ - - --- " ---- —
Final
PASS PAPT_FAIL —- --- --- -- --
PLUMBING
Post R Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Fina
PX3 PART FAIL —
ECHANI AL
osf earn 10 - ---- - --- _
Rough In 11X —
Gas Line -
Smoke Dampers -
incl
PASS PART FAIL --
ELECTRICAL
Service -- -----
Rough In
UG/Slab -- --- - --
Low Voltage
Fire Alarm -- ----- ------ --
Final
PASS PART FAIL - —SITE --
Backfill/Grading
Sanitary Sewer
Storm Drain ( J Reinspection fee of$_ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ J Please call for reinspection RE _ [ ]Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
i
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hsl',Blvd.Tigard,Oregon 9-22308109 (503)839.4171
CITY OF TIGARD MECHANICAL PERMIT Receipt L� � (h.,r13
Permit 12
oeserir•ion
Table 3A Mechanical Code CITY PRICE A►AT
' .y of Tigard
13125 S.W. Hall Blvd. 1) Permit Fee -0- -0- 10.00
P.O. Box 23397
Tigard, OR 97223 2) Supplemental Permit 3.00
639-4175 Furnace to 100,000 BTU
1) incl.ducts&vents j 6.00 b o p
Furnace 100,000 BTU i
2) incl.ducts&vents 7.50
Name of Development Floor Furnace
03 zo SW b+K,f.io nC_� ��L 3) incl.vent 6.00
Job Address Susperded heater,wall heater
Address �� ; -A G -7��3 4) or floor mounted heater 8.00
Tax I nt Map No. Vent not incl.in
.00
Lot Block Subdivision appliance appliance permit 3
Name(or name of business) Repair of heating,refr ig.,
G �f—� � 8) cooling,absorption unit 8.00
Mailing Address Phorw L 3 -,77, Boiler or comp to 3 HP
Owner , 7) abs, unit to 100,000 BTtj 8.00
city/state Zip Boiler or comp to 3 HP-15 HP
I-%,C Y � 0 (r_ � -��P 3 8) absorp.linit to 500,000 BTU 11.00 _
Name 9) Boiler or comp 15-30 HP
ulrJ011tQ.�. absorp.unit'/z-1 million 15.00
� I�Ei��"IJ� tic s,
Mail"Address Phone Boiler or comp to 30-50 HP
1J t PO R �-:5 f -J'��5(u 10) absorp.unit 1-1.75 million 22.50
Contractor City/steleL / Zip Boiler or comp to 50 HP
�A,cTc�.x{e O 066 11) absorp.unit 1,750,000 BTU 31.50
State Registration No. city Bus.Tax No. Air handling unit t0
12) 10,000CFM 4.50
I hereby acknowledge that I have read this application that the information given Is 13) Air handling unit 7.50
correct.that I am the owner or authorized agent of the owner,that pians submitted are in 10,000 CFM +
oomptvrxe with State laws,that I am registered with the State Builders'Board,that the Non portable
nun•.;ier given is correct.(If exe'no from State registration pieaas give reason below). 14) _evaporate cooler 4.50
Vent fan c mectad
1°i)_to a single�dct 3.00
—' Ventilation system not
included in appliance permit 4.50
Hood served by
17'' mechanical exhaust 4.50
Signature(owner or agent) Date Domestic type
Describe work El addition ❑ alteration repair O18) incinerator 7.50
to be done residential ❑ non-residential ❑ Commercial or industrial
'- 19) 30.00
Existing use of type incinerator
building or properly ) 4.50
Other i.e.,woodstove,water 50
Proposed use of 20 heater,solar,clothes dryers,etc.
building or property. 21) Gas piping one to four outlets 3 2.00
Grp
Type of fuel- oil ❑ natural gas [?J LPG ❑ electric ❑
22) More than 4-per outlet
NOTICE
- U
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON-
SUB-TOTAL
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 S&10 16SURCHAP:�:� f'
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUB-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED. TOTAL w L
Special Conditions
Date issued L by '�Z1-�^ L� �-1 ► —
DEPARTMENT OF LAND I'Ic&TRANSPORTATION
1M
1V LAND DEVELOPMENT SERVICES DIVISION
WASHINGTON 0N ,._
YM S 155 NORTH FIRST,HILLSBORO,OR 97124
COUNW,
INSPECTION REQUESTS: 503/640-3561/693-4415
OREGON
NOTICE: This permit becomes null and void If the work or construcllon for which it Is Issued is not commenced within 180 days. Once construction has started.
the permit becomes null and void if construction Is Interrupted for a period of 180 days. I certify that the Information presented by the applicant and
his agent or agents In support of this permit Is true and correct to the best of our knowledge. I acknow ledge that the Building Department's reliance
upon false and misleading Information may Invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified on the plans or noted on the plane co,-rection sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use @segments. I further at knowledge that the use or occupancy of
the structure or building permitted depends upon my calling for Inspections at various limes during the process of construction and the building
Inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department is solely at the risk of the applicant and such use or occupancy Is revocable until all Inspection requirements are satisfied and
approval Is given by the Building Official. I further acknowledge that a Ilan may be placed on the title of the property upon which the permit Is issued
specifying that the use or occupancy of the building or structure is provisional and revocable until the satistaction of all inspection requirements.
APPLICANT'S SIGNATURE
i
WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
Electrical Inspection Section APPLICATION
155 North First Avenue,91350-12
Hillsboro, Oregon 97124
Information: 503 640-3470 Fax: 503 693-0412 project/Perml �_ / i `2
PLEASE • Number L�c� Date
Please complete
1. Location of install tion 4. Complete Fee Schedule below
.1(
3�-0 >L0 ��(u�C�. P Number of Inspections per permit allowed
Address
--- ,a Building Service included: Items Cost(ea.) Sum
City 7t-Y�.�v Suite No.
( � (�/.,,� �l,� A. Residential-per unit
11 "�" " I V- t Qoei ` �L 1000 sq.ft.or less $110.00 4
..�'�)
Each additional 500 sq.ft
Tax Lot Map No. --- or portion thereof $25.00
Limited Energy $25.00 1
Thomas Map Book: Page: Section: Each Manufd I•iome or Modular
Directions -- _--___--- Dwelling Service ojr feec'or $68.00 — 2
— — — B. Services or Feeders
Commercial ❑ Residential Installation,alterations or relocation
200 amps or less $60.00 — 2
201 amps to 400 ampf. $80.ij0 2
2a. Contractor Install t� on Jy: , • 401 amps to 600 amps —_ $120.00 2
L c 601 amps to 1000 amps $180.00 2
Electrical Conttaccttor — — Over 1000 amps or volts $340.00 2
IqMr
Addr@sS O — Reconnect only $50.00 2
Date�"z — Job N bar Property Owner �� �� C. Temporary Services fi:'Feeders
Contractor's License No. �j Installation,alteration or relocation
Contractor's Board Reg. No. — _— 200 amps or less $5ooo 2
201 amps to 400 amps $75.00 2
Signature of Su r. ec'n 401 amps to 600 amps $100.00 2
'
License No. a55 Phone o. V(a (o--Y . Over 600 amps to 1000 volts see'8'above
D. Branch Circuits
2b. For owner Installations: Now,alteration or extonsivo per panel
a) The fee for branch circuits with
PrintOwner's ame one o. purchoje of service or feeder lee.
Each branch circuit _-- $5.()o 2
RaBrfa§--- b) The fee for branch circuits without
purchase of service or feeder fee.
I — tate IP First branch circuit _ifme $35.00 —--- 2
— -- 2
The installation is being made on property Each edd'nl branch circuit $5.00 1 own E Miscellaneous (Service or Feeder not included)
which is not intended for sale, lease Or rent. Each pump or irrigation circle $40.00 2
Owner's Signature --
Each sign or outline lighting $40.00 — — 2
Signal circuit(s)or a limited
3. Plan Review section (if required) energy panel,alteration —
Please check appropriate hem and enter fee In section 5B. or extension $40.00 2
F. Each additional inspection over the allowable
_ 1 & 2 family dwellings over 320 amps s/c meter in any of the above
4 or more residential units in one structure Per inspection $35.00
Service over 225 amps; feeder 400 amps or more Per hourant $55.00
_ System over 600 volts nominal In
Building over 3 stories in height 5. Fees
Building over 10,000 sq. ft. 3-j•ccw
Occupant load over a9 persons A. Enter total of above fees $
— Manufactured Structures Park or Recreational 5'/o Surcharge (.05 X total fees) $ 7_S
-- Subtotal $ -
Vehicle Park: new, addition or alteration B. Enter 250 of line A for
Classified area or structure containing special Plan Review if required (Section 3) $
occupancy as described in N.E.C. Chapter 5 Subtotal $ ----
Submit 2 sets of plans with application where any of the Less Bulk Label Fee $ —
above apply. Not required for temporary construction Balance Due $ --
services.
For Inspections call This permit becomes null and void N the work suthorlxed by the permh Is not commenced
640-3561 or 693-4415 swithinuspended
180 days from date at any lime
ft each permit c a M the work aut�1�p days.
ewpended or abandoned N my lime aNer work le oommandd la•�
24-hour recorder,one working day tit advance of need EleNrksl permits are non-refundable and non-trensfenbfe. 5193