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10290 SW BROOKSIDE COURT
MASTER PERMIJ
CITYOFTIGARD PERMIT 4. . . . . . . : MS 1.91.-01 6b
CIlYOFT ARD
COMMUNITY DEVELOPMENT DEPARTMENT tmaow
13125 SW FW I Blvd. P.O.Box 23347,Tip M.Unpon 97223")639,-4175 DATE i S S U E D: 12/31/91
" I TL HLURf aS. . . : 1 Q1C- :7W L+kQUK.J i UL (-T PARCEL:
SUBDIVISION. . . . : WALNUT ACRES ZONING: R-4. 5
BL.00K. . . . . . . . . . . LOT. . . . . . . . . . . . :5
AUILDI;VG ---------------------------------------
REISSUE:
--•----------------------._-_-__--__-_FSEISSUE: DWELLING UNITS: 1 BASE=ME=NT. . . . . . . . :0 s f
CLASS OF' WORK. -ADD BEDRMS:O BATHS: 1 GARAGE. . . . . . . . . . :0 sf
TYPES OF USE. . . :5F FLOOR AREAS_._..________-- REQUIRED SETLAACKS------•---.----.
TYPE. OF CONST. :5N FIRST. . . . :437 sf LEFT. . :0 ft RIGHT. :13 ft
OCCUPANT.*Y GRP. :R3 SECOND. . . .0 s f FRONT. .0 f t REAR. . :0 ft
STORIES. . . . . . . : 1 THIRD. . . . :O sf
HE I GHT. . . . . . . . . 12 ft TOTAL ------:437 s f SMOKE DFTECTOR S. :Y
FLOUR LOA'). . . . :Ajo Q S f VALUE:. . . . . $ : C."50171 PAPK I NG SPACES. . 10
Femarks : addition converting dot-rble garage into living area
PLUMBINEa
S?IVEiS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :0
LAVHiORIES. . . . . : 1 WATER HEATEcRS. . . : 1 TRAPS. . . . . . . . . . . .0
TUB/SHOWERS. . . . : 1 LAUNDRY TRAYS. . . :e1 I;ATC,H BASINS. . . . . . . :0
WH Ck.R CLOSETS. . : 1 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . :0 WATER LINE: (ft ) . :0 OTHER FIXTURES. . . . . :V,
GARBAGE: D I SP. . . :0 RAIN DRAIN (f•t ) . :0
WASHING MACH. . . :0 SF RAIN DRAINS. . :0
________----___-•-- MECHANICAL. __.___.______ FEES
FUEL TYPES -- __..___.__ UNIT HTR,. . : 1 t% pe amoi-int by date recpt
/GAS/ / / VENTS . . . . . :111 BPRT f 38. 50 JLH 12/31/91 -
MAX INE'IJT:i BTU VENT FANS. . : 1 BPLC t x.5. 03 JL.H 11/2.6/91
TURN ( 100K . . :0 HOODS. . . . . . :0 B5PC $ 1. 93 JL.H 12/31/91 -
F•UPN ) =100K . . :0 WOODSTOVES. :0 MPRT * 25. 50 J1-H12131 /91 -
FLOOR FURN. . . . :0 CLO DRYE=RS. : 0 MPLC $ 6. 38 JLH 121,31/91
BOIL/CMP ( 3HP:0 OTHER UNIT5: 1 14115F'C $ 1 . ;218 JL.H 12/31/91 -
GAS [lUTLETS: .L PPRT $ 37. 50 JLH 12/31/91 -
Ownar; - _ --.._. ___-__----------.-- .._____ __-_-_____ __.__-- P.9PC $ 1 . 88 JL_.I-1 12/31 /91 -
HI._F IIL.0 U 1.L. ,,MNN ,.I k.
Phone #:
f-f)1,,TRACT0R NOT ON FILE
Phone #:
Req
t 136. 00 TOTAL
This perait is issued subtect to the regulations contained in the -------•- REQUIRED IN,3PEC'rIONE, --------
Tigard Municipal Code, State of Eyre. Soecialty Codes and ail other Post/Seam Str-r.ict 97111.1mb Final
applicable laws, All work will be done :n h approved PL_M/Underfloor Building FinAl
plans. This pereit will expire if w is not started wi hin 180 Mer_hanicall Insp Erosion Control
days of issuance, or if work is su enaed or not, 0 days p .l Limb Top Clut
r,aminq Insp
Pp*•mittee E,ignati.ir•e . i, Insp-tIAtion Ins
Byp Board Insp
lssi.ied By : ilecharlical Final
Call for inspection - 639-4175
CITY Or TI GARD 1311.5 sw 11au[;Na. {'LNCK/REC� #
PO[lox 23397 P E RM I T # 025Z
"01 1 Al UN ITY 1)l;V EL01'M EN'I'I)EI'AR'I'M I;N'I' Tigard,Oregon 97223 G�.►cz--- ----
(503)639-4171 DAI E ISSUED
JOB ADDRESS; /�J,yG'��Jd��e� C.�' TAX MAP/LOT 1�?I3G+JL�6
SUB: lc�:`.�x. :t, LOT _ LAND UFE: __ "1���21f► 11
VALUATION:
/OWNER SPECIAL NOTES
/-NAME: �L�r�v�J L ��(�.rsd� fir' _ REISSUE OF: —_-
ADDRESS: l'T" _ LAST REISSUE:
I
__z:(> �j Fl_OOD PLAIN/
PHONE: &SZ) __ SENSITIVE LAND:
GUT
CONTRACTOR APPROVALS REQUIRE
)(NAME: � E��Jt;,fsitJ � PLANNING: OK use AS ,kO194rt Necc -
� �,1 ff,c Noir oRRccW;ZWN A�1"Itt"UT
ADDRLSS: tief�/��= `� L _ ENGINEERING: cr�t�'rrc�u►c.. r Rov
FIRE DEPT:
PHONE: OTHER: . U
CONTR. BOARD #: —_ EXP DATE:
� ITEMS RLUOR'"
SUBCONTRACTORS: PLUMB: k -- LIST/SUBCONTRACTORS: _
MECH: _11LI !flf _ BUS TAX:
ARCH ENGINEER CALCULATIONS:.
NAME: _ TRUSS DETAILS:
ADDRESS: __. _ OTHER:
PHONE:
PROPOSED BLDG. USE:
COMMENTS:
APPLICANT SIGNATURE _
Received By: _ ^_ Date Received: _._ 2444r
PERMIT # ACCT # OFSCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees 39.s"a Lfs
lo-
10-431 00 Plumbing Permit Fees 3 7.S° _ 7.5'�'
10-431 01 Mechanical Permit Fees J,:.5,d 2j-y
10-230 01 State Building Tax (5%) S,6 9
Building A y j
PIumbinq /,6"N `
Mechanical /• Z�,
03
10-433 00 Plans Check Fee d ,;��
Building !„S',0 3
Plumbing _
Mechanical
10--230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection ,-
25-448--02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
2.5-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-450 00 Storm Drainage Syst Dev Chrg
(SSDC) _ -----
24-445-01 Water quality (Fee in lieu of)
2.4-445 02 Water quantity (Fee in lieu of) _
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RD CITY OF TIGA � PLAN CHECK APPLICATION
WARD C1IYOFIPLAN CRELT, { _
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT
13125 SW Ni S1nd PA_Bar ZX W,Tlpr�OMOM WW
DATE ISSUED
TAX MAP/LAT .2�/ - f�c o ' �b
LOB ADTM+Fss: /Da9Q �.—. _ -
SUB: _l;,t( �- ±.OT: yy LAND USE:
VALUATION: ' U J _ SETBACKS: FRONT: REAR: LEFT: RIGHT:
YORK ('LASS: a HEIGHT: TOTAL AREA:
USE TYPE: FLOOR MAD: 1ST:
CONSTB TYPE: HEAT TYPE: 2ND: __--
OCCUP GROUP: DWELI./UNITS: ' 3RD: _--
OCCUP LOAD: _ NO BEDROOMS: _ BASEXENT:
NO STORIES: i NO BATHS: / GARAGE:
D(P SURFACE: -
ES ITEMS R
SPECIAL. NOTUIREI
APPROVALS REQ'D _ �-...
PLANK m: REISSUE OF: LIS SUBCONTRACTORS:_
ENGIRSEB.ING: LAST REISSUE: _ BUS TAX: -
FIRE DEPT.: FLOOD PLAIN/ CALCULATIONS: _
OTRER: SEN LND.: TRUSS DETAILS:
�- PARKING PLAN:
LANDSCAPE PLAN:
PIAN CHECK BY: OTUIM: _-M-
COMMENTS:&-&- --
PERMrT 1 AOCT N DF_SCRIPTION AMOUtdT (tJOL?NT P0. BAL. DUE
r � 14-432 00 Building Permit Fees ^2��9,s� 38 Su
10--431 00 Plumbing Permit Fees
10-431 Ol. Mechanical Permit Fees
10-230 01 State Building Tax (5%) -
Building
Plumbing (. j�' ,
Mech
10-433 00 Plans Check Fee 31 •�1 -� ie3 �'��
Building
Plumbing
Mech
30-202 00 Sewer Connection _ - --
30-444 00 Sewer Inspection ---
51-448 00 Street System Dev Charge (SOC:) -
52-449 00 Parks System Dev Charge (POC) - -- -
31-450 00 Sturm Drainage Syst Dev Chrg (SSOC) ---
10-230 09 TRFO -- --
10-230 06 Washington County Fire N1 (95X)
10-2.20 00 Amart/Wedgewood - --
10-1-A13 112,
REC N _ ---
l( Wool ',I1;NATURE-
feeceived Hy ------- ------- - -- --- -- Date Rout,ived: - -------- __
cn/3587P/1811
77/7��, JC �L-
WASHINGTON COUNTY ELECTRICAL PERMIT
of Land Use & Transportation
'�--• Electrical Inspection Section APPLICATION
155 North First Avenue, k350-12
Hillsboro, Oregon 97124
Information: (503) 640.3470 Fax: (503) 693-4412
Permit
PLEASE PRINT Number r 1 L. 9-5- 0Q(-..q Date
complete4. Complete Fee Schedule below
Number of Inspections per permit allowed
1. Location of installation -- --- -- --
Address r,L0 ko d kC7 Service included: Items Cost(ea) Sum
Building A. Residential -per unit �^
City Tire Suite No.
1000 sq.ft.or leas ��. $110 v0 4
Tenant Name Each additional 500 sq.ft -�
(if commercial) — or portion thereof $25.00 _
Limited Energy $25.00 1
Map No. Tax Lot _ — — -- Each Manuf'd Home or Modular
Dwelling Service or Feeder $6800 _ 2
Thomas Map Book; Page: ___ Section:----
Directions- B. Services or Feeders
- ---- Installation,alterations or relocation
200 amps or less $60.00 _ 2
Commercial❑ Residential 201 amps to 400 amps $80.00 2
401 amps to 600 amps $120.00 _r_ 2
601 amps to 1000 amps $160.00 - 2
2a. Contractor installation only: Over 1000 amps or volts $340.00 __ 2
Electrical Contractor / _ej y,1 1211 r 1-4 P e.',l„3 5 7- Reconnect only —_ $50.00 2
Address /5 L 7 v S. -Ac'r K=. '
City t State ZIP ; C. Temporary Services or Feeders
Date . Job Number installation, -iteration or relocation
Property Own `— 200 amps or less $50.00 _ ^_ 2
Contractor's License No. 201 amps to 400 amps _- $7500 2
Contractor's Buard Reg. No. t3 rte_ 401 amFs to 600 amps v_ $100.00 2
Over 600 amps to 1000 volts see'0'above
Signature of Supr. Elec'n D. Branch Circuits
License No.0 5 E? �:', Phone No. 2 C., iJ New,alteration or extension per panel
a) The fee for branch circuits with
2b. For owner installations: purchase of service or leader lee.
1 Each branch circuit $5.00
b1 rho fee fur branch circuits without
Print Owner's ems one o, purchase of service or feeder fee.
Address -- F.rst branch circuit _ $35.00 2
Each add'nl branch circuit $5.00 2
ry State Zip _– E. Miscellaneous (Service or Feeder not Included)
Each pump or irrigation circle__ $40.00 2
The installation is being made on property 1 own Each sign or outline lighting $40.00 — 2
which is not intended for sale, lease or rent. Signal circuit(s)or a limited
energy panel,alteration
Owner's Signature or extension $40.00
F. Each additional inspection over the allowable
in my of the above
3. Plan Review section (if required) Per Inspection
Per hour $55.00
Please check appropriate Item and enter fee In section 5B. In Plant $55.00 _
4 or more residential units in one structure
Service and feeder, 800 amps or more 5• Fees
__System over 600 volts nominal A. Enter total of above fees $ - —
Classified area or structure containing special 5% Surcharge (.05 X total fees) $
occupancy as described in N.E.C. chapter 5
Subtotal $
B. Enter 25% of line A for
Submit 2 seta of plans with application where any of the Plan Review if required (Section 3) $ --
above apply. Not required for temporary construction Subtotal $
services. Trust Account $
Balance Due $
For inspection& r'all This permit becomes null and void Hthe work authorized by the permit le not commenced
640-3561 or 693-4415 within tae days from dAte of Issuance of such permit at it the work•uthorired is
suspended or abandoned at any time after work Is commenced for a period of te0 days.
24-hour recorder, one working day in advance of need Ele iricai Permits are non-refundable and oon•transferabte.
8'94
I
CITY OF TIGAR BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Phone: 6394171
Date Requested: A.M. _ P.M. MST:
� I
Location: �Q j� ��` __
BIJP:
Tenant: _ _ _ Suite: Bldg: ►vt);C:
— j,� /
Contractor._01_,1_:i7( Phone:X_1'(�_ PLM: _
Phone: _ LLC:
Sri*:
BUILDING conUM
t) PLBING MECHANICAL, ELECTRICAL _SITE
Site earn Post/Beam Post/Beam Cover/Service SeweilSte;m
Footing Roof Undrl/Slab Rough-in Ceiling Water Line
Slab Framing 'fop Out Gas Line Rough-in UG Sprinkler
Foundation Insulation Sewer flood/Duct Reconnect Vault
B.smt Damp Drywall Storm Furnace Temp Semice MISC.
Masonry Ceiling Rain Drain AIC UG Slab
Shear/Sheath Fire S /Alm CrawUPound Dr Beat Pump Low Volt
prov Approved Approved Approved Approved
Appr/Sdwlk roved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL
C]Call for reinspection ❑Reinspection fee of Sr uireu before next inspection 0 Unable to inspect
In tor: Z Page of
— _ ------- — Date:__.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
2.,"-Hour Inspection Line: 639-4175 Business Line: 639-4171 �-
BUP
_Date Requested S - 7 A.M ___I'M --` BLD
Location1102- Suite MEG _M
Contact Person _ PhG Z T G 3 / PLM
Contractor Ph SWR
ELC Z��-- a� Z3Z.
BUILDING Tenant/Owner --------
Retaining Wall — ELR
Footing Access.
Foundation FPS —
Fig Drain -_- -- - SGN
Crawl Drain Inspection Notes: _ —
Slab -_-_____ SIT
Port& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall ���; ( / i , _ l -Oak --
Fire Sprinkler _ �5- r'S .�._1��'--lr�!-r.��.1--�•..,.�..�'—�°�►+►'�''�31 ___ _
Fire Alarm
Susp'd Ceiling _—
Roof
Misc:
Final
PASS PART FAIL ------
PLUMBING
--- - ----PLUMBING
Post& Beam -
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL UOOOor
MECHANICAL
Post a Cream ---
Rough In
Gas line ----
Smoke Dampers
Final _f--
PASS PART FAIL
ough In
UG/Slab
Low Voltage
Fire Alarm
m
PASS )PAR1 FAIL
iRr
Backfill/Grading -�
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( ]Please call for reinspection RE._ ( J Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Date T- t 7- L% Inspector Ext
Final
PASS PART FAIL DO N 3T REMOVE this inspection record from the job site.
CELECTRICAL PERMIT
CITY O F TIGARD A R D
PERMIT M. ELCO232
DEVELOPMENT SERVICES DATE ISSUED: 05!04/20014/2001
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 2S102BC-00106
SITE ADDRESS: 10290 SW BROOKSIDE CT
SUBDIVISION: WALNUT ACRES ZONING: R-4.5
BLOCK: LOT : 005 JURISDICTION: TIG
Proiect Description: Installation of 200 amp service. Job#11193
_(
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS_ 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNALWANEL:
MANF HM/SVC/ FDR: 601+amus -1000 volts: MINOR LABEL (10):
SERVICEIFEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amp/volt: �J >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC/FDR 225 AMPS: _ CLASS AREAISPEC OCC:
Owner: Contractor:
DICKMAN, ALFRED E + CLAUDIA H WILLAMETTE ELECTRIC INC
102.90 SW BROOKSIDE CT PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 624-3631
Reg#: LIC 75059
SUP 19655
ELE 34-2830
FEES Required Inspections `_—
II Type By Date Amount Rezeipt Elect'I Service
APRMT CTR 05/04/2001 $80.30 2720010000( Elect'I Final
5PCT GTR 05104/2001 $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 laws.
All work will be done in accordance with approved plans This permit will expire if work is no!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 Notification Center Those
rules are set forth in OAP 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules or direct questions to OUNC at(503)
246-6699 or 1 800-332-2344
Permit Signature: Issued By: 4l1 ld,L'
OWNER INSTALL-ATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURP: _y_ —__. ., DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. tLEC'N: &)I lrA►f/ �1� = � ,. _� _ DATE:------
LICENSE
ATE:_-_ --LICENSE NO: —,- __--
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Dalereceived: f7 Permit no. � �• 1
City of Figard Project/appLno.: Expiredate:
Its � gard,OR 972"23
Crry of Tigard Address: 13125 SW bate issued: qy: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 MAY 0 4 NO Case file no.: Payment type:
Land use approval:
14 1 &2 family dwelling or accessory U Cornmercial/industrial U Multi-family Ll Tenant improvement
U New constnrction U A(itlition/alteration/replacement U Odiet: U Partial
JOBSITIE INFORMATION
Job address: /c,1 & 54v ✓3,,��.t' r / I Bldg.no.: Suite no.: ITax map/tax lot/account no.:
Lot: I Block: Subdivision:
Project name: R 1 A e,j 'e k r«c, . Desciiption and location of work on premises: 57t-rt u,e C 1,r, T e
Intimated date of contlrlclion/inslxclion:
UONTRAVI`011 APPLICATION FEE SCHEDULE
lob no: / `'I j FrY ONE Max
BUSIOCSS name: Ad Description Qly. (ea.) 'rural no.Ins
New residential-single or nadir-family per
Address: 3 o S dwelling unit.Inclurksaltncledgarage.
City: f1i 4 kos s V1 SletC' ZIP: �!>'7L Serviceircluded:
Phone! - Fax: Z -z c, E-mail: 1000 sg n.or lets __ — - -4 -
F:sch additional 5W a .ft.or portion thereof
CCD no.: s�, c t FICC.bus.tic.no: ?y •Z '3 t Limited energy,residential 2
City/metro lic.no.: %' y j Limited energy,non-residential 2
S ' U/ Each manufactured home or modular dwelling
Signature of suromiling electrician(requited) Pate Service andlor feeder 2
Serviceaorfeeders-Installation,
Sup.elect none(pnn): J I,ff License no: />G S S. alteration or relocation:
2(x)amps or less % (� 2
Name(print): 201 amps to 400 amps 2
0
41 amps to 600 amps 2
Mailing address: _ 601 snips to IOW amps 2
City: State: ZIP: Over IWOamps orvohs 2
Phone: Fax: I E-mail: Reconceclonly I
Owner instnilation:'Ilse installation is tieing made on pn,pcliy I own Temporary ornlets or feeders-
which is not intended for sale,lease,rent,or exchange according to hionIlotion,alteralion,orrelocation:
or Itss
ORS 447,455,479,070,701. 21x18111p—to 44-W 2
201 anyu (10 a�nps 2
Owner's signature: _- bate: 401 to 60x1 amps — _ -- - 2
®ranch circuits-new,alteration,
or exlenslon per panel:
Name.: A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit _ 2
City: Slate: 'ZIP: Il. Fee for branch circuits without purchase
--- -- - -- -- --
Photic: E-mail: of service or feeder fee,first branch circuit: 2
I ax -- -
Each addilional hrnnch circuit:
'PLAN REVIEW(Plense Check all that apply) Misc.(Service or feeder not Included):
O Service over 225 amps-comnelcial U I leap,,-care facility Each pump or irrigation circle 2
U Service over 320 amps.rating of 1&2 U Ilarardouslocation Eachsignoroutline lighting 2
romilydwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel,
O System over W volts nominal nano residential units in one structure alteration,or extension• 2
U Ouilding over three stories U Featem 400 amps or more *Desai tion:
U Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over the allowable In any of the alcove:
U Egress/hghangplan U Other Per inspection
Submit_sets of plans with any of the above. Investigation frc_
The above are not applicable to temporary construction service. ogler Perrilit fee
Not all judsdictlons accepts credit cards,please call jurisdiction for more information. Notice:This permit application -- — -�"
Plan review(al r 96) $
Uvna U MasterCardpermit is expires if a peris not obtained
Credit card numb" _______ / within 180 days after it has been Stale surcharge(8%)
p.xpites accepted as complete.
TOTAL .......................$
Name d cardholder uu shown on ern N e
_ S _
Cardholder signature Amount 440-461s 16MCOM)
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee...................................................... 515.00
Number of inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved'.
Residential-per unit
1000 sq fl or less $145.15 4 Audio and Stereo Systems
Cacti additional 500 sq It or
portion thereof _ $33.40 1 Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Garage Door Opener'
Dwelling Service or Feeder — $90 90 2
Services or Feeders Healing,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 Vacuum Systems'
201 amps to 400 amps $106.65 _ 2
401 amps to 600 amps $160.60 _ 2 Other
Go amps to 1000 amps $240.60 2
Over 1000 amps or volls _ $454.65 _ 2 -------—
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCi AL ONLY
Installation,alteration,or relocalion $75.00
200 amps or less $66.85 2 Fee for each system.....................................................
201 amps to 400 amps _ $100.30 2 (SEE OAR 918-260-260)
401 amps to 600 amps — $133 75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see"b"above. ❑
Audio and Stereo Systems
Branch Circuits
New,alteration or extension per panel Boiler Controls
a)The tee for branch circuits
will;purchase of service or
feeder lee. LJ Clock Systems
Each branch circuit $665 _ 1
b)The lee for branch circuits Data Telecommunication Installation
without purchase of service
or feeder fee. l] Fire Alarm Installation
First branch circuit $46.85
Each additional branch circuit $6.65 Ej HVAC
Miscellaneous r--�J
(Service or feeder not inrluded) LInstrumentation
Each pump or Irrigation circle $5340
Each sign or outline lighting $53.40 _ _ intercom and Paging Systems
Signal circuits)or a limited energy
nanel,alteration or extension $7500 r—'
Minor labels(10) $12500 u Landscape Irrigation Control*
Each additional Inspection over Medical
the allowable In any of the above
Per inspection $6250 _
Per hour $6250
Nurse Galls
In Plant $73 75 --- ❑
Outdoor Landscape Lighting'
Fees:
Protective Signaling
Enter total of above fees $
Other_�_____—_----- -----.__--_-- -- --
8%State Surcharge $
_ ___Number of Systems
25%Plan Review Fee
See"Plan Review"section on $
No licenses aro required Licenses are required for all olhr installations
front of application —
Total Balance Due Fees:
Trust Account Enter total of above Ices
q� --- – — -----�_... --- —�
1 8•h State Surcharge $_ _
Total Balance Dur.
41s1s\fnnns'elr-lcr>(Im to oil(x)
CITYOF TIGARD, PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00374
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 8/9/01
PARCEL: 2S102BC-00106
SITE ADDRESS: 10290 SW BROOKSIDE CT
SUBDIVISION: WALNUT ACRES ZONING: R-4.5
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
1'UB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 200 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of hose bibbs, water service. Other fixture is (1) hose bibb. _
FEES
Owner:
Type By Date Amount Receipt
DICKMAN, ALFRED E + CLAUDIA H PRMT CTR 8/9/01 $118.00 27200100000
102.90 SW BROOKSIDE CT 5PCT CTR 8/9/01 $9.44 27200100000
TIGARD, OR 97223 ---
Total $127.44
Phone 1:
Contractor__
TOWN * COUNTRY PLUMBING
ISOM, GARY L.
PO BOX 230472 REQUIRED INSPECTIONS
TIGARD, OR 97223 — —
Phone 1: 590-8717 Water Line Insp
Reg #: LIC 132817 Rough-in Insp
PLM 34-337PB Final Inspection
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 if work is suspended for more
than 180 days ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. 1i;nr,e rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: if /<L-���i` Permittee Signature;<-
Call (503)639-41T5 by T:00 P.M. for an inspection needed 01 business day
s,/
Plumbing Permit Appheati
Date received: Permit no.: •DO 3�
City Of Tigard
)tg'al�l� / / Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, 11g, OR y
Cifyq/Tigard phone: (503) 639-4171 Projccdappl.no.: Expire date:
Fax: (503) 598-1960 Date issued: H Receipt no:
Land use approval: _` Case file no.: Payment type:
1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U'Tenant improvement
U New construction U Addition/alteration/replacement U Food service U Other:
JOB SITE.INFORMATION FEE SCIIIIED11 1.1-.(14)r%peciiiiiiif()ritiall(iiiti%eclieckli,41)
Job address: ) '' , Description Ot . Fee(ea.) Total
Bldg.no.: Suite no.: New 1-and 2-family dwellings only:
(includes 10011.foreach utility connection)
Tax map/tax lot/account no.: SFR(1)bath _
Lot: Block: Subdivision: SFR(2)bath
Project name: _ SFR(3)bath _
City/county: ZIP:if Each additional bath/kitchen
Description and location of work on premises: Siteutilities.
QQI_Igi0-4.e pyo Catch basin/arca drain
Est.date of completion/inspection: Drywells/leach line/trench drain
Footing drain(no, lin. ft.)
Manufactured home utilities
Business name: 7� • Ir
T��,J__���- p�' _ � Manholes
Address: Rain drain connector
_City:� p� State: ZIP: Sanitary sewer(no.lin.ft.)
Phone: _ Fax: E-mail: Storrs sewer(no.lin.ft.) —
CCB no.: Plumb.bus.reg.no:3 .$ '7 Water service(no, lin. ft.)
City/metro lic.no.: Fixture or item:
Contractor's representative signature: %,. Absorption valve
Back flow preventer
Print name: -� G _
_jApfI)a1t. -S -0 Backwater valve _
Basins/t avavatory _
Name: Clothes washer
Dishwasher _
Address: Drinking fountain(s) _
City: 1,,uuc: ZIP: Ejectors/sum
Phone: Fax: I Expansion tank —
MINE a I= Fixture/sewer cap
Name(print):
Floor dmins/tloor sinks/hub
Garbage disposal --
Mailing address: —
Hose bibb _
City: State: ZIP: Ice maker
Phone: Fax: I E-mail: —Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primers) _
will be made by the or the maintenance trod repair made by my regular Roof drain(commer ) _
employee on the.property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s) _
Owner's signature: Date: Sump ,
Tubs/shower/shower pan
Name: Urinal
Water closet _
Address: Water heater
City: Stale: LIP: Other:
Phone: Fax: _ E-mail: Total
Not all jurisdictions wcept credit curls•please call jurisdiction for more information. Notice:This permit application Minimum fee................$ 00 .
Plan review(at 91�) $
O _Visa U MasterCnrd expires if a permit is not obtained —��
credit cud number. -___ �__ L_�— within 180 da s atter it ha,been State surcharge(8%)....$
[:spires y TOTAL . $
---Nene of catdlnolcke u shown on credit cud
accepted as complete. """ """""""'
_ S
- Cardholdet signature Amount 44OA0161MxMCOMf
PLUMBING PERMIT FEES: ,
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (individualL! QTY ea AMOUNT j:racludes all plumt ing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and Ina flrst100 ft. QTY (ea) AMOUNT
16.60 for each utility ct nnection
Lavatory — One 1 bath $249.20
Tub or Tub/Shower Comb. 16.60 Two 2 bath $350.00
_ j 1-—__
Shower Only 16.60 Three(3)bath _ _ $399"00
Water Closet — 1660 - _SUBTOTAL
Urir,el 16.60 A%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
TOTAL
Garbage Disposal 16,60 --- - ---
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor—Sink
rain/FloorSink - 2" -- 16,60 PLEASE COMPLETE:
3-—� 1660
4" 16.60
Water Heater O conversion O like kind 1660 �Quantit b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
_permit — - -- Capped
MFG Home New Water Service 4640 Sink
MFG Home New San/Storm Sewer 4640 LaTubalo _
b or Tub/Shower
Hose Bibs I 1660 Combination _
Roof Drains 16.60 Shower Only _
Drinking Fountain 1660 Water Closet -
16 660 Urinal
Other Fixtures(Specify) Dishwasher _
Garbage Disposal _
- — Laundry Room Tray_
-- — --
Washing Machine
_ Floor Drain%Sink:2"-
Sewer-1 st 100' 55.00 3" -
Sewer-each additional'100' 46.40 4" —
Water Service-1st 100' 5500 r' Water Heater
Other Fixtures
Water Service-each additional 200' 46.40 �.�
_ � Specify)
Storm&Rain Drain-1st 100 55.00
Storm—&Pa n Drain-each additional 100' 46.40 —
Commr-Irccal Lack Flow Prevention Device 46.40
Residential Backhu.x Prevention Device' 2.7.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specialty 72.50
Requested Ins tions erlhr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps -- -- 16.60 --- -- ---
QUANTITY TOTAL —
Isontetric or riser diagram is required If
--
*SUBTOTAL --
8%STATE SURCHARGE �',/ ---- --- - —="— —
•'PLAN REVIEW 25%OF SUBTOTAL — 7
Required only if fixture qty total ismer
TOTAL E •,-
Minimum permit reg is$72 50•8%state surcharge,except Residential Backflow
Prevention Device,which is$36 25+F1 state surcharge
*"ATI New Commercial Buildings req lire plans with Isometric or riser diagram and
plan review
i\dsts\forms\plm-fees.doc 10/10/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 - --
BUP _
_Date Requested 1 �L' AM_ _PM __ BLD
LocationG' Z-cjCJ ��.Jt '�,c.eCo Suite — MEC
Contact Person -c� ��v� Ph 4 `( ? PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS _
Ftg Drain SGN _
Crawl Drain Inspection Notes: - --
Slab SIT
Post&Beam --—
Ext Sheath/Shear
Int Sheath/Shear
Framing - -- -- — -- -- -- - - --- ----- --
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm _ —
Susp'd Ceiling
Roof
s :
Final ----- ---- _--_-------
PASS PART FAIL -- - _
PLUMBING
Post& Beard
Under Slab
To
ater Service'
Sanitary Sewer - - -
8ins
ART FAIL
IWMHANICAL
ost&Beam -- --- - ----- -- - —
Rough In
Gas Line ----.. _— - -- -- -
Smoke Dampers
Final ----- ----- --
PASS PART FAIL_
ELECTRICAL --- - -- -
`(11Viee
Rough In -— - -- --
UG/Slab
Low Voltage -
Fire Alarm
Final
PASS PART FAILSITE
Backfill/Grading --- -- - —
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( )Please call for reinspection RE: _— - ( J Unable to inspect no access
Fire Supply Line -
ADA
ApproOther
_ Date O/ lnspector' ( �C Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -- -`
ry BUP
_ Date Requested D J _AM PM _ BLD
Location f i -� `1 i�� � 66tnte MEC
Contact Person � --� `�,r\ a �- Ph PLM ��,�
Contractor 1� Ph SWR __-
BINLDING�J Tenant/Q� D ELC
Retaining Wall ELR
Footing Access: �h FPS
Foundation
Ftg Drain r 1 RNs SGN
Crawl Drain Inspection Notes: --
Slab — -- - _ - --------- SIT --
Post&Beam
Ext Sheath/Shear I -- ----
Int Sheath/Shear ! C'/Framing 1n 0_1.11 G� p� <<._—�� �tS�- �----
Insulation
Drywall Nailing —
Firewall
Fire Sprinkler � — ------- --- --- ---�--- -_--
Fire Alarm
Susp'd Ceiling ---- ------- -- ---- _ —_`--__�
Roof
Misc: __ ---- --.._.._------ -------- - -- -- -
Final
PASS PART FAIL --- -_____..._ -- - --- - -------- ------
PLUMBING
Post&Beam
Under I b
o Ou
a er r1po
Sanitary Sewer
Rain Drains --------
Final
PASS PART FAIL -----
MECHANICAL _
Post&Beam --_ ------ - _---- - ---------- --------------_---- _—_—_�-_ -
Rough In
GasLine ----- - ---------------__ -- -- -----..._ ------- — --_--
Smoke Dampers
Final _ -�____-_---------------- __ ----._.._.- -----
PASS PART FAIL
ELECTRICAL - -- -. ------ -------- - _____ -----�,�_�—_ _
Service - - - ----- - -- ----- --- -- --
Rough to
UG/Slab --
Low Voltage
Fire Alarm --- —
Final
PASS PART FAIL ------------ _.__�_.___ -- - __- __.---- --_----- -
SITE _
I;ackfitl/Grading -
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ - required before next inspection. Pa;,at City Hall, 13125 SW Hall Blvd
Catch Basin Unable to Inspect-no access
Fire Supply Line [ ]Please call for reinspection RE _ - -__ ( ] P
ADA
A roach/Sidewrik �p q �,
PP Date Q��y � Inspector. � � � � - _Ext
Other 5�-- -_ ' - - - ------------
Final
PASS PART FAIL DO NOT REMOVE this inspection record from. the job site.