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12805 SW BLUE HERON PLACE II a r IV 03 O CJ9 cn r � m O C1 n m I r I I 12805 SW Rlue Heron Placr: II1� CITYOF TIGAIRD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2004-00489 510 1312.5 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE I`SUED: 004 PARCEL: 2S10313C-09800 SITE ADF,RESS: 12805 SW BLUE HEPON PL SUBDIVISION: BLUE HERON PARK ?C'.,NG: R-4.5 BLOCK: LOT: 01-; JURISDICTION: T13 CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: _ BOILERS/COMPRESSORS_ HOODS: FI IEL TYPES 0 - 3 HP: 1� DOMES. INCIN: _ 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS'?: 30 - 50 HP: WOOD STOVES: PRESSURE- 50 + HP: CLO DRR ERS: FURN < 100K BTU: AIR HANDLING UNITS CR OTHER )NITS: FURN ­100K BTU: <= 10000 cfm: > GAS OUTLETS: 10000 cfm: Remarks: install A/C unit. owner: f__ ---_— - _FEES_ -- _ A SER SHERYL. Ivescription Date Amount W S _ '12805 SW BLUE HERON PL I�%I I CI I I Fcrmil I-cc 7/22/2002 _ $72.50 TIGARD, OR 97224 II1 1 X1 ►t Stutc Surchart 7/22/2001 $5.8_ II Phone: 503-793-2379 t` Total $78.30 Contractor: SPECIALTY HEATING &COOLIN'� 1501 SE RIVER RD HILLSBORO, OR 97123 REQUIRED INSPECTIONS_____ Phone: 503-WO-3607 Reg #: LIC 66578 This permit is issued subject to the regulations contained in the Tigard Municipal Code State of Ore. Specialty Codes and all other applicable laws. All work will ba done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, it if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 95:'-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-6699. Issued By: �� lPermittee Signature: Call (5031639-4175 by 7:00 P.M. for inspections needed the next b islness day Mekhatileal Permit ApplicatiouZ FOR OF E USE ONIN City of Tiiird Received g LiattaPermit No.y: _Fg� 13125 SIN Hall 8 vd..Tigard OR 97223 FlAn Review 124C. Phone: 50:1.639 4171 FA;:.: 503.399.1960 Dat&Sy: Other Perstut. Inspection Jne: :03-639.4175 Intemet: wv,-W,ci.igard.or.us now Date Ready/By; Jul go 2 for Notified/Method: .1 Information ."TOF of'Wook 'Cb'MMRC5i7�22* SCHEDULE - USE CIRMECkLIST _ENew canstrtction ❑Addihon/alteration/replacement Mechanical permit few are based on the value of the work performed.Indicate the value(rounded'o the nearest dollar)of of ❑Demo ition 0 Other: mechanical materials,equqpMent,labor,overhead,and protit, Value:S .4 V,17411iDENTIAL EQUI[PNIINT/SYSTEMS FEES- I-and Man I ly dwelling 0 Corritnetcial/industrial []Accessory building .For special mformation use cherklixt C1 lyfuld-farrul) 0 Master builder C]Other, — Descri I prion Qty I Ea. I Total .104 NITRI TOR Ok AZ46 t0t Hestia coelia 11 �, N ,MAIJ .-- I .1.1i Job site adAresg: 'r Air conditioning or heat pump re turas site ptati-showitilt ptacerneat) J— 14.00 City/State/ZIP: Furnace 100,000 BTU(ducts/voists) 14 10 Furnace 100,000+BTU(ducwvents) St,itelbldg./apt.n 1 Project nanic: 17.90 Gas hcat purnis 14.00 Cross street/directions to job site: Duct wirk 14.00 Hydronic not waters stem 14.00 Residential hailer(radiator or hydronic) 1400 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc 10.00 Flue vent Cur any of abo Lot no.: hOther. Tax map/p ircel n3.: Other fuel appil nets Watcy heater DMCRIPTION,OF 1000 1 Gas lire lace _L0 OU T_ue vent for water heater of gas -ftr-el-14–ce-— 1000 Lot lighter as 10.00 Wood,pellet stove 10.00 Wood tie eplace/insert10-00 PRI)kR�-Y 0 Chimn e�-A iner/flu-/vent 10.00 WNV Other 10.00 Name: Environmental exhaust and ventilation Range hood/ether kitchen Address. equipmentIn OO_City/State/MP. Clothes dryer exhaust 10,or) Single-duct exhaust(bathrooms, Fax: toilet compartments,unliDLtoorrs) 6110 V-0- UAttic/c raw Is pace fins-All W PE*01 Business name Other: 1 10.00 Pull piping Contact name: A,0 53.40 for first four;$1.00 for each additional Address: Furnace,etc, Gee heat Pu_TP City1St1te/*'!TP: ]it'll L Wall/suspencled/unit heater Phone:(I!S Liu Fax: SO f Water heater Fireplace E-mail: Range Barbecue Business name: Clothes dryer(Sas) Other Address: MkilAPftdAtPSWIT Ft%.9* Subtotal Ph.". Fax Minimurn permit fee(172 50) Plan review(?5%of Derma fee) CCTj lic.: State surcharge(87ii of permit feel TOTAL PERMIT FEE. Authorized ,:_tq L This permit applitedonexpirts its permit is not obtained within IRD sif'ruit Ire: days after It has been accepted so complete. Print Warne:_i__1 , t -1 t C Date: Fee methodology iol hv'r-.­'%jumy Building Industry Service Board 011uildingili"MW 1-mutAppiloo I Vol 440 461'T(I 110VC0NVWV.1I) 1'41, aH r­1 I e 1:3a6S fT1 t80 *,o 22 ,n r SITE PLAN i I i Oo PL i lo ' 7r _ ISI Sas S 1 ,ram STREET Specli<<I.ty Heating &: Coolinc, inc . 9528 SW Tigard Stree3 t Ti_ard , OR 9722 Phone 503 .620.5643 Fax 503 .598 .0718 Hill,boro Phone 503 -640-3)6f)'7Fax 503 .631 . 079"� d SILO RsFj cos 8ut���� A7T!�ordg tTis80 *0 aZ tnr i CITY OF TIGARD 24-Hour BUILDING iospection Line: (503) 639-1175 INSPECTION DIVISION Business Line: (503) 639-4171 MST --- B LIP Received _—�� __- Date Requested 7 f� , -_ ___ AM_ _ PM _._ BLIP Location �ago�__S .._- Suite MECb Contact Person .__ —_-_—__ Ph(—) 53-x' -7 a7a_. PL I!,. Contractor _ _—_ _ Ph(—) SWR __. __-- BUILDING _.BUILDING _ Tenant/Owner — ELC Footing Foundation ELC _ -- Access: Fig Drain ELR Crawl Drain --� - Slab Inspection Notes: SIT -- __ -- -___— Post A Beam -- �'✓�-.__ -- -- Shear Anchors -- Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing --- Firewall Fire Sprinkler - -- Fire Alarm Susp'd Ceiling ---- - — Roof Other: Final PASS PART FAIL PLUMBING IJ Post 8 Beam Under Slab — Rough-In Water Service --- _ -- Sanitary Sewer Rain Drains — -- - - - --- - - -- ---------- Catch Basin/Manhole Storm Drain ----- Shower Pan Other: ---- -- Final ---- -- PASS PART FAIL - -- - ---— - ------ --- - -- ----- -- Pos am— - -- �- Rjugh-In J ----- - - --- -- Gas Line �/ C SmokiLDampprs -------- F PASS PART FAIL — ----- ---- -- - - - - RICAL Service Rough-It. _ LIG/Slab Low Voltage _ Fire Alarm Final L Reinspection fee of$ squired before next Inspection. Pay at City Hail, 13125 SW Hall Blvd. _PASS PART FAIL SITE _ Please cell for reinspection RE:-- _ 'Jnable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Bono inspector fiElrt _ Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL I CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 , INSPECTION DIVISION Business Line: (50 ; 639-4179 BLIP __ ___ 7 Received - Daie a uested_ _' AM ____ BJP _ Location _Suite ____ MEC Contact Person K� Ph (C'�p� ) �'T� PLM Contractor ----.._—. ------ Ph ( _--) --- S-NR - -�'� BUILDING` Tenant/Owner _ _.--_— ELC 9'/ Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain SILb Inspection Notes: - SIT Post& Beam Shear Anchors --- Ext Sheath/Shear !nt Sheath/Shear Framing Insulation _. Drywall ailing --- - -- Firewall Fire Sprinkler - Fire Alarm 0 1 L Susp'd Ceiling - -- Roof Other: - -- - -- -_ - - Finel PASS_PART FAIL PL — UMBING__ Post&Beam - Under SlabRough-in Water _ ----- - -! Water Service -- -- --- Sanitary Sewer Rain Drains -- - ---- Catch Basin/Manhole Storm Drain — -- -- Shower Pan Other: -- Final PASS PART FAIL — - MECHA_NICAL_ Post&Beam - -Y ---_ '-- -- -- Rough-In -- --- - - ---- --- Gas Line Smoke Dampers - --- ----- — Finnl �P�ASS _RRTFAIL - --- -- — — LECTRIC" e e - Rough-In _ UG/Slab Low Voltage Fire rm �A Reinspection fed of$- __required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. AS PAR �� S Please call for reinspection RE: _ Gl Unable to inspe-t-no access Fire Supply Line ADA Approach/Sidewalk InspectorIExt Other: Final DO NOY REMOVE this Inspection record from the job site. PASS PART FAIL CITY O F T I GA R D _ ELECTRICAL PERMIT PERMIT#: ELC2004-00451 DEVELOPMENT SERVICES DATE ISSUED: 7/22/2004 13125 SW Hall Blvd., Tiqard. OR 97223 (503) 639-4171 PARCEL: 2S103BC-09800 SITE. ')DRESS: 12805 SW BLUE HERON PL ZONING: R-4.5 SUBDIVISION: BLUE HERON PARK BLOCK: LOT : 015 JURISDICTION: TIG Project Description: Install power for A/C equipment. RESIDENTIAL UNIT _ TEMP SRVCIFEEDERS _-- MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 40, - 600 amp: SIGNALWANEL: NIANF HMI SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER _ BRANCH CIRCUITS _ ADD'L.INSPECTIONS 0 - 200 amp: 1 W/SERVICE OR FEE::ER: 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+ amplvolt: >=4 RES UNITS: >600 VOLT NOMINAL: Reconnect only: SVCIFDR>=225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: WASSER,SH':RYL GREENWAY ELECTRIC COMPANY 12805 SW BLUE HERON PL 5460 SW TIGARD STE 104 TIGARD,OR 97224 TIGAPD,OR 97223 Phone: 503-793-2379 Phone: 503-620-6020 Reg #: I W 153421 _— I Ll 34-617(' _ _FEES; �I 11 5025S Description Date Amount Required Inspections — j FLI'RMTj EL('Permit 7/22 2un.1 $80.30 ITAxl Mie Stat:Surcharge 7/22.2o04 $6.42 Total $86.72 i hi¢Parmil is issued subject to the regulations contained in the Tigard Municipal Code,State of OR. Specialty Codes and all other applicably laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issudnoe, or if work is suspended for more than 180 days ATTENTION O egon!aw requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100 You may obtain copies of these rules or direct questions to OU14C at(503) 246.6699 or 1-000-332-23 Issued By- Permit Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: __ DATE:._ CONTRACTOR INSTALLATION ONLY SIGNA•rURE OF SUPR. ELEC'N: ____._.-._______ __ ___—__ —__--___-- DATE:__ LICENSE N O --- --— — ------------_ — ------—— - Call 639-4175 by 7:00pm for an inspection the next business day 07/22/:004 10:18 5036206124 GREENWAY ELECTRIC CO PAGE 01 Perinit Applica �j City of Tigard � �► oatel8 0y I PdmW I ltNo, 13125 SIV Holl Blvd„Tigard,OR 972 Q` O Pinn Review Phone: 5t 639.4171 Fax: :03,59t� `\� Detd : other Perms Inspection L:rc 503.639,41'!5 �� (� Dere Reody/13y: t-+',� ® See Pase 2 far Imemet: www,ei,tigard,or,us `y l7 � Noufled/Method: T suppkrttattollnWrmauoa ❑New construction ®AdttitionPolt nhci,l.c error Plonse eek all that apply: [JDemolition ❑Other, 08micc over 225 amps,comr.i'l [IHesardow location v ❑Service over 320 amps-ming ❑Buildng over 10,000 sq.ft., of I-and 2.Ihmily dwellings 4 or more new residential IXI I-and2-fur �d\ciG p, i ]''ommcr�inl'indu9trinl ©Ancr-ooryhuddinN ❑Sy'tcmover 600volts nominal units in onentructure I 1 Multi-family I� vtastet builder []gehcr ❑Building over thrix stories ❑Feeder,400 amps or more __ {`_ ..�_- 00ccupani load ova,99 persons ❑Manufactured aructums or ❑P_91-1/lighting plan RV pork r ❑Health-care facility DOther:_ Job no 30449-2 Job site addroge: 1280._ �W F31ue Heron PI. _ Submit 2 Bets of plans with any of tiro above. City/State/ZIP: Tigard,OR 97223 The above arc not applicable to temporary construction service, Suitc/bldg,/apt,no.. Project name:A/C Install -- Deserlilden 07. Pee. Teall I Of Crosn atreet/dircetions to job site: ew rnsldentbl ainglt.or multi-family dwelling trait. - Includes attathed garage. 1,000 aq•ft,or less 145.15 0.00 4 Subdivision: -+- Lot no,: Ea.add'1 500 sq,k or portion 33.40 ,00 1 Tax m / n: no.: - Limited energy,roaidontial 75,00 ,00 2 Limiter cn ,non-residcntial 15.00 0.00 2 {� 1 Each mbnufacturod or mo ar Install power for A/C Equipment dwelling,service and/or fxdcr 1 1 90,90 0.00 2 Servlcea or meden Installation,alters on,madlor relocation 200 amps or less 1 80,30 80.30 2 201 amps to 400 amps 106.85 0.00 2 401 amps to 600 amps 160.60 0.00 2 Name: Sherryl Wasser 601 amps to 1,000 amps 240,60 0.02 Os or 1,000 amps or volts 454,65 0.00 2 Address: 12805 SW Blue Heron PI. Reconncctonly 6P,85 0.00 2 City/9tate/ZIP:Tlgard, OR 97223 Temporary Services or Madan installation,alterstlon,and/or Phone:503-793-2379 Fax' relocation 200 amps or leen 66.85 0.00 1 Owner(nstalladont This intuallation is being made on property that I own which is not 201 amps to 400 amps 100.30 0.01.) 2 intended for sale,lasso,tent,or exchange,according to ORS 447,449,670,and 701, 401 amps to 600 ams 133,73 .00 2 (honer signature: Date: _ Brnaah circuits-now,alteration,or estanston per panel A.Fcc for branch circuits wfr s, fee Or Business name: b ch ircult roe,Doth 6,65 0.00 2 rue fur branch decal/ Contact name: wcrhour wrvice or fbodor Poe. Address c t branch circuit 46.115 0.00 2 Each add1 branch cirouit 6.65 ,00 2 City/State/ZIP: Miscellaneous service or Roder rat lacladed Pump or irrigantm circle33.40 0 2 Phone:( 1 Fax ( ) sign or outline lighting 53.40 10.00 1 2 fi•rneil Slignal circuit(S)or limltc4- energy wel,alteration,or extension Dgrrlbe: Page 22 Busincsa name:Greenway Electric Company 00 Addtcss: 9480 SW Tigard St.,Ste. 104 each additional Ins Setlon ever allowable In any of the above Per impaction 62.50 00 City/Stato/ZIP: Tigard,Oregon 97223 Investigation pr hour(I hr min) 62.50 0.00 Phone: (603)620-6020 Fax:1(503)620.8124 Industrial plant per hour 73.75 O.00 CCB Lie.;153421 Electrical Lic: 4.617C Suprv,Lie.: 5026S sub:ntat $80.30 Suprv.ElncMci in signature.required: ✓� Plan review(25X-of permit roc) Print name: Janata V. ne_ Dnte- 07/21/2004 store surcharge(11%of prnNt tion) $8.42 TOTAL PERMIT FEE $86.72 J-1 Authorized 9lgnsWre: Thlo periost applieefp- kmy p-e mn Is not"rood within 130 dart after It has bean accepted no trompiete Print name; Mork Short Date_07/21/2004 Fee me1hodo1op set rry Vri-r oumv Bu,ldirtlt Industry setvice Boal ••Number or in%,wmionp per parent allowed. I AA1ijdlaa\Pmn1anat.C4*rWlAppAm 1201 YOJai Ili lrWtrrgM/WtiD CITY OF TIGARD 24-Hour BUILDING Inspectior Line: (503) 639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 / I BU P ---- --- ----- Received - -_ _Date Requee teed__ Z - AM PM _ BUP Location A" Suite MEC Contact Person Ph( ) 7 Y-3275 PLM Cor Ph( ) SWR UILD Tenant/Owner -_- -- _ Et_C ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes SIT Post&Beam - - --- -- ---- ---- - Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing ---- ----- Insulation Drywall Nailing ---------- _----_-- -- Firewall Fire Sprinkler -- -------- — -- Fire Alarm Susp'd Ceiling - -- ---- Roof Other.--— -- F FAILPo Under Stab ----- -- - --- Rough-In Water Service -- Sanitary Sewer Rain brains -- - Catch Basin/Manhole Storm Drain - -— ----- --- - Shower Pan ot inti -- SS' PART FAIL — — — M ANICAL Post&Beam Rough-In ---- --------- — Gas Line Smoke Dampers -- — - -- r1r,a PAS T _FAIL - - ------ - CTR L Sery ce -- - — - - Rough-In UG/ !— ow Voltre _ — 4in a 1:mal- rm PART FALLReinspection fee of$ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd. > _ Please call for reinspection RE:.__ Ur able to inspect-no access Fire Supply Line ADA -- Approach/Sidewalk Date � Inspector � �-�r� 'Ext Other Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL MASTER PERMIT CITYOF TIGARD PERMIT#: MST2003-00034 DEVELOPMENT SERVICES DATE ISSUED: 2/18/03 13125 SW Hall Blvd.,7gard, OR 97223 (503) E,39-4171 SITE ADDRESS: 12805 SW BLUE HERON PI- PARCEL: 2S103BC-09800 SUBDIVISION: BLUE HERON PARK ZONING: R•4 5 BLOCK: LOT: 015 JURISDICTION: LIG REMARKS: Construction of new SFA BUILDING REISSUE: STORIES: FLOOR..REAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1.333 sf B 4SEMENT: of LEFT. 15 SMOKE DETECTORS: 'y TYPE OF USE: SFA FLOOR LC4D: 40 SECOND: 653 sf GARAGE: 290 of FRONT: 20 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING U 4ITS: i THRD. sf RIGHT: VALUE: 190,553.40 OCCUPANCY GRP: R3 BORM: 3 BATH: 3 TOTAL: 1.906 of REAR: 22 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 110 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: CATCH BASINS: iUSISHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: i WATER LINES: 100 BCKFLW PREVNTR: 1 GREA:E TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS: 2 CLOTHES DRYER: 1 GAS FURN>=100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 _ ELECTRICAI RESIDENTIAL UNIT SERVICE FEEDER _TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 D -200 amp: 0 200 amp: W/SVC OR FDR- PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 5COSF: 3 201 400 amp: 201 400 amp: tet WIO SVCIF OR: SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 - e00 amp: EAADDL Be CIR: SIGNAL/PANEL. IN PLANT: MANU HMISVCIFDR: 601 1000 amp: 6014amps•lo0ov: MINOR LABEL: 1000.A.1ulvalt PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC/FDR>•225 A.: >800 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL•RESTRICTED ENERGY _ q SF Pr.SIDENTIAL B.r:)MMERCIAL AUDIO 6 STEREO: x VACUUM SYST':M: X AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: X OTH: At L F 4COMP BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: X CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: X DATA/TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner Contractor: TOTAL FEES: $ 6,390.20 WINDWOOD CONSTRUCT'ON,INC. WINDWOOD S' E OTHER) This permit is subject to the regulations contained in the l Tigard Municipal Code,State of OR. Specially Codes and 12ti55 EW NORTH DAKOTA 12655 SW NORTH DAKOTA all other applicable laws. All work will be done in TIGARD,OR 97223 TIGARD,OR 97223 acoordance with approved plans. This permit will expire N work is not started within 180 days of issuance,or if the work is suspended for more than 180 days. A fTENTION: Oregon law requires you to follow rules acopted by the Phone: 50;-625-6526 Phone: 625-6526 Oregon Utility Notification Center. Those rules are set forth In OAR 952-001-0010 through 952-001-0080. You Rep N: LIC ;(1146 may obtain copies of these rules or direct questiors to OUNC by call,ig 1503)246-1987, REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Mechanics Mechanical Insp Shear Wall Insp Ga;�,lne Insp Rain drain In_p Sewer Inspection Underfloor insulation Plumb Top Out Shear Wall Insp Gas Fireplace Water Line Insp Footing Insp Crawl Draln/Backwater Electric al Service Shear Wall Insp Insulation Insp Water Service Insp Founditlon Inrp Footing/Foundation Dr; Electrical Rough In Exterior Sheathing Inst Gyp Board Insp Water Service Insp Post/Beam 11,ru(,wral PLM/Underfloor Framing Insp Low Voltage Firewall Insp Appr/Sdwlk Insp ISSU�d By : ' 'lr.! fr' _ Permittee Signature Call (503) 639-4175 by 7:00 p.m.for an inspection needed the next business day CITYOF TI GARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2003-000:3 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/18/03 SITE ADDRESS; 12805 SW BLUE HERON PL PARCEL: 2S10313C-09800 SUBDIVISION: BLUE HEROIN PARK ZONING: R-4.5 BLOCK: LOT: n I JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SFA NO. OF BUILDINGS: INSTALL TYPE: LTPSWR (� L IMPERV SURFACE: Remarks: S y.c�19�1, CIVVtI�.�-1 /II71 Owner: — - FEES WINDWOOD CONSTRUCTION Description Dale Amount 12655 SW NORTH DAKOTA TIGARD, OR 97223 1SWUSAJSwr Connecl 2/18/03 $2,300.00 ISWUSAJ Swr Connect 2/18/03 $0.0C Phone: 503-625-6526 [SWINSPI Swr Inspect 2/18/03 $35.00 [SWINSP]Swr Inspect 2/18/03 $0.00 Contractor: -- - -- Total $2,335.00 Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located,the installer shall purchase a"Tap and Side Sewer" Porm Issued by:,,�J�1� ���� �t Permittee Signatu Y -- Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Building Permit Appycloun F City of Tigard 'Datereceived: I J_p Permit no.: • CirynjTignrr/ AdPr.rject/appl.no.: Expire date: Address: 13125 SW Hall Blvd,Tigard,OR'97223 r' � Phone: (503) 639-4171 U� Date issued: By: Receipt no.: Fax: (503) 598-1960 LITY IIUARD Case file no.: Pavmenttype: Land use approval: _ C it�ISiQf� 1&2 family:Simple Complex: J;&?&2 family dwelling or accessory O Commercial/industrial O Multi-family O New construction O Demolition O Addition/alteration/replacement O Tenant improvement O Fire sprinkler/alarm O Other._ Job addre s: .01'sor 0 VA t l Bldg.no.: Suite no.: Lot: (5 1 Block: Subdivision: Lfl ITax map/tax lot/account no.. $/ 1- 3P Project name: Description and location of work on premises/special conditions: Name: 6LIM10 edAls '::_ Mailing address: U&�- w /l/ A i/z 1&2 family dwelling: City: r�t Stat ZIP: P7� Valuation of work........................................ $ (]J 3, 6 Phone: _ (� Fa y E-mail: No.of bedrooms/baths......•..•. ................ Owner's representative: ,t Total number of Floors..........al................... Phone:&U ax: E-mail: New dwelling area(sq.ft.) •. FI Garuge/carport area(sq.ft.) ..... ......... - Name: Q/12� Covvred porch area(sq.ft.) M4 Mailing address: Deck area(sq.ft.)...... City: State: ZIP: Othe..structure areas .ft.)....................:.... Phone: Fax Email: CommerclaUlndustrinUmultl-family: Valuation of work...................................... $ Business name: Existing bldg.area(sq.ft.) ................... ..... Add._ss: Al C —-- New bldg.area(sq.ft.) ................ ... ... .......... Number of stories State: ZIP: ,,, City: --- ...................... ..... ....... T -of construction _ Phone: Fax: E-mail: yp�. ............ ............... �.�_ CCB no.: Occupancy g•,oup(s): Existing: New: City/metro lic.no.: Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: Mot provisions of ORS 701 and may be required to be licensed in the Address: w t jurisdiction where work is being performed.If the applicant is City: 92 E or� Stated-,t ZIP: Q " exempt from licensing,the fnllowing reason applies: Contact rson: Q n I Plan no.: Phone:?.15~4/4 FaxjLj' E-mtr:l: Name: I Contact person: Fees due upor.application ...........................$ Address: Date received: City: PStat ZIP: Amount received .................I....................... S Phone: Fax: L E-mail: Please refer to fee schedule. 1 hereby certify I have read and examined this application and the Na W h.t.mcd=WCC mart ands•*W a,n JottA&Cdae rat more ldarmWaa attached checklist.All provisions of laws and ordinances governing this O Vis O Mastercard work will be complied with,whether s ecified herein or not. C,emt cad mmber Authorized signa"! Date: N. d d ao $ Print name: _�_ — — Amaw Notice:This permit application expires if a permit is not obtained within 180 days after it has ban accepted as complete. 4404613(rraOc'o►) I One-and Two-Family Dwelling MOM Imi Building Permit Application Checklist t.�ference Asscy:iated permits: City rTiaard City ,� Tigalyd O Electrical l]Plumbing L`Mechanical Address: 13115 SW Hall Blvd,Tigard,OR 97223 ❑Other. _ Phone: (503) 639-4171 Fax: (503)598-1960 1 lend use acdoms completed.See jurisdiction criteria for concurrent reviews. _ 1 _ 2 Zoning.Flood p_laii:,sola balance points,seismic soils designation,historic district,etc. 7_ 3 VPrlftcatlon o/approved plat/lot. 4 F i,<district approval required. 5 Septic system permit or authorization for remodel.Existing system capacity 6 Sewer re ermit. 7 Water district approval. _ 8 Soils report.Must ca.Ty original applicable stamp and signature on file or with application. 9 Erosion control ❑plan Ll permit required.Include drainage-way protection,silt fence design and location of catch-basin protection,etc. 10 J_ Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state building codes.Lateral design d-tails and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details.Plan review cannot be completed if copyright violations exist. I 1 Sitelplot plan drawn to scale.The plan must show lot and building setback dimensions;property comer olevations(if there is more than a 4-ft.elevation differential,plan must show contour lines at 24 Intervals);location of easements and driveway;footprint of structure(including decks);location of wellstseptic systents;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 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 heater, furnace,ventilation fans,plumbing fixhtres,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all f► ming-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, 8revlace construction, thei mal insulation,etc. 15 Elevation vlews:Provide elevations for new construction;minimum of two cravations 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 dddendums:ihowing foundation elevations with cross references are acceptable, 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for non mscnptive path anaILais provide specifications and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventihttion. 18 Basement and retaining wtdis.Provide cross sections and details showing placement of mbar.For engineered systems,see item 22,"En iaeer'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 floorlroof truss design detalls. 21 Energy Cade compliance.Identify the prescriptive path or provide calculations.A gas-piping schematic is required for four or more appliances. _ A-L-L 22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. --• .1 till ISDIC110NAL Silt('It-IUS 23 Five(5)site plans are required for Item 11 above. Site plans must be 8-1/2"x 1 I"or I V x 17". 24 Two(2)sets each are required for Items 16, 19,20 8t: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 8t:System Development Fees dux ument. 27 "Drawn t scale"indicates standard architect or engineer scale. 28 Site plan to include tree size,type&location per approved project street tree plan(if applicpble),and COT 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. 4404614(NOWOM) � Mechanical Permit Application Date received: Permit no.: -V City of Tigard Project/appl.no.: Expir,:date: City of Ti Address: 13125 SW Hall Blvd,Tigard,OR 97223 pate issued: By: Receipt no.: Phone: (503) 639-4171 — -- Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: _ _ Building permit no.: 1 U I &2 family dwelling or accessory U Commerciai/industrial U Multi-family U Tenant improvement U New crmstruction U Addition/alteration/rcplaccme.nt J Other: 1 1 Job address: O j kC /%,p2�A/4'te'- Indicate equipment quantities in boxes below. Indtcatc the Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overread, Tax map/tax lot/account no.: 5 tc3 9,oa profit. Value$ l.ot: -_ _ Blcxk: _ Subdivision: _� "'See checklist for important application information and Project name: kr ��, �,e/�,1A2 jurisdiction's fee schedule for residential permit fee. City/county: Was ! e •I_IP: i/2j�__—__ WINN Description and location f work on premises Fee(ca.) notal Est.date of completion/irspeclior: - Devcri ion (?1y. Res.onl Res.onl 'tenant improvement or change of use: ACS Is existing space heated or c nditioned"U Yes U No Air handling unit __.--CFM _— Air conditioning(site plan required) Is existing space insalaled?U Yes U No Iteration of existing A system_ I Is 111,121 Boiler/compressors Business pante: / State boiler permit no.: _ L C - _ HP --Tons—BTU/11- Address: Tons BTU/H Address: 3/7(, _ Fird"mok damper duct smoke electors City: G�S h am �Statc: IP: Q'�► 3 eat pump(site plan requirccT) Phone: �. Fax: Email: 1Isla h/rep ac —�furnacc 6mer_— Including ductwork/vent liner U Yes U No CCB no.: _ f L 9 LAInstal cplace/relocateheaters-suspended, City;metro lic.uo.: _ �15- woll,or floor mounted Name(please print): :/Ji 6p/t en for appliance other Irian furnace e era n: Absorption units-_ BTUfli _ Name: -50 1,A I!' - ^ Chillers HP Address: Compressors Hp Er Tironmental ex all and ventilation: City: _ Stale: ZIP: - Appliance vent _ Phone: Fax: E-mail: Dryer exhaust ocdF.Type res. itche azmat hood fire suppression system Name:—���G�Ca-jfJ ��t/� �'Y1` Y Exhaust fan with single duct(bath fans) Mailing address: �,. w pts � #-* j}� .xh_au_st systema apart mm eaun of A ' — '- �- ee piping 1 lea and distribution(up to out cls City: 7`I�f�2 6 "I�t State:Q� ZIP: 7, 3 Type: I.PG NG oil Phone: Fax- .6-357-1 E-mail: Fuelt ing eacc aTiiitiona of ver outlets Process ) Number of outlets Name: .-- - �ttorrlisted appliance or eq—UTP—Meet: Address: _ _ Deccrative fireplace-- F,t—)- ireplace _Cit): - State: ZIP: Insert-type Phone: Fax: E-mail: oc tove/pe etsti,ve ec Applicant's_signature: - Datc: j0ther. Name Not all)toiadktione mmvv creat cards,pletne can)uriubction rcr mire idarmtlim. Permit fee.....................$ _ U Visa U MacterCerd Notice:This permit application Minimum fee................$ / cxpirrs if a permit is not obtained Plan review(at — %) $ _ ^- credit crd number -.-.�___— Expires ___ within 190 days after it has been - e' State surcharge(A%) ....E ��-- Name of carrltroldrr a shown on credit cam accepted as complete. ----- Canthotda siputtm--- - ----- Amount 1/04617(6MICOM) CAL PERMIT FEES CIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE: VAL'UA IO E ITrFLE:'- :' x+.,�,t Prtoe _ Total r-0.01.00 Minimum fee$72.50 r a apical t'.ode Vii` Oty (Ea) Mit $ 00.00 :72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU Includingducts 8 vents 14.00 $1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+ (radion thereof,tr,and Including 17.40 $10,000.00. Including duds b vents ,000.00 $148.50 for the first sio,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or Including vent 14.00 fraction thereof,to and including 4) Suspended heater,wall heater $25.000-00. _ or floor mounted heater 14.00 625,001.00 to$SO,OChO. 00 $379.50 for the first 525,000.00 and 5) Vent not included in appliance permit 6.80 $1.45 fe each additional$100.00 or _- fraction thereof,to and Including 6) Repair units 12.15 $50,000.00. 650,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air $1.20 for each additional$100.OU or For Items 7-11,see Com Pump Co�d fraction thereof. footnotes below. - p ^ 7)<3HP;absorb unit Minimum Pe. ::Fee$72.50 SUBTOTAL Ii to 100K BTU 1400 8',.State Surcharge a 8)3-15 HP:absorb unit IOOk to 50Uk BTU 25.60 25%Plan Review Fee(of subtotal) a 9)15-30 HP;absorb unit.5-1 mil BTU 35.00 _ __Required for ALL commercial Permits only 10 0-50 HP;absorb TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20 11)>50HP;absorb ---- - - - - -- - unit>1.75 mil BTU 8720 /ASSUMED V_ALUATIONS PER APPLIANCE: 10.00"-' ' 12)Air handling unit to 10,�C,0,'M _ - Value Total 13)Air handling unit 10,000 CFM+ Description Ot _AEa Amount 17.20 umace to 100,000 BTU,Including 955 14)Non-portable evapora!e ct oler duds R vents _ _ _ -_ - 10.00 Furnace>100,000 BTU including 1,170 15)Vent tan connected to a single C ict duds 8 vents _ _ _- _ 6.80 Floor fumaTjncludin vent 955 16)Ventilation system not included in Suspended heater,wall heater or 955 appliance permit 10.00 floor mounted heater -___-_ 17)Hood served by mechanical exhaust Vent not included In applicance 445 10.00 805 18)Domestic incinerators 17.40 R(�ir units <3 hp;absorb.unit, 955 19)Commercial or industrial type incinerator 6995 to 1100k BTU _-- 3-15 hp;absorb.unit, 1,700 ?p) Other units,including wood stoves101k to 500k BTU _ 10.00 15-30 hp;absorb.unit,501k to 1 2.310 21)Gas piping one to four outlets mil. BTU _ _ _-___ 540 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) 1-1.75 mil.BTU _ 1.00 X50 hu;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: 'i" $ >1.75 mil.BTU __ _ Air handling unit to 10,000 dm 656 _ '�- 8%State Surcharge A; $ Air handling unit>10,000 crrh 1,170 _Non-portable evaporate 000ler 656 TOTAL RESIDENTIAL PERMIT FEE: , s Vent fan connected to a single duct 446 Vent system not Included In 656 -- - -- ~' applianceeerrmit -- --- Other Inspections and F294: Hood served by mechanical exhaust 656 h Inspections outside of normal business hours(minimum charge-two hours) Domestic incinerator 1.170 $62 50 per hour Commercial or industrial Incinerator 4,590 _ 2 Inspections for which no fee is specifically Indicated (minimum charge-half hour) Other unit,induding wood stoves, 656 6 per hour Inserts,etc. _ 3 Additi dltlonel plan review required by changes,additions or revisions to plans(minirnum charge-one-hall hour)$62.50 per hour Gas piping 14 outlets 360 Each additional outlet 63 'State Contractor Boller Certification required for units>200k BTU. TOTAL COMMERCIAL S --- "Residential A1C requires site plan ehowtnp placement of unit VALUATION: All New Commercial Buildings require 2 sets of plans. I\dst3Vorrnstmedh-fees.doc 12/26/01 Plumbing Permit Application Datereceived: Permit no.:(!') : it>> City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.: Cir,of Tigard phone: (503) 6394171 Projecivappl.no.. Expire date: Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: Case file no.. Payment type: all I RUN 11110111 If"I'll alt 2 family dwelling or accessory ❑Commercial/industrial 0 Multi-family Ll Tenant improvement Ll New construction 0 Addition/alteratiolt/replacement U Food service 0 Other: Job address: ��O� LN w ,OQ r Deacri Hoo . Fre ea. TOW _Bldg.no.: Suite no.: New I-and 2-family dwellings only: Tax map/tax IoUaccount no.: :x-51 V C / 3 FR( )l00R.foreachutiR¢ycnnnecriou) _�— — f�C SSFR(I)bath _ IAA: Brock: Subdivision: cP kroi SFR(2)bath _ — Project SFR(3)bath -- City/county: r., _ ZIP: 7Z Each additional bath/kitchen Description and Ia'Stion of work on prehulse.: Slteutllltlea: Catch basin/arca drain Est.date of completion/inspection: Drywells/leach line/trench drain v Footing drain(no. lin. ft.) Manufactured home utilities Business name: dt S _—_--_ Manholes Address: Err— / (p U Rair drain connector City: — I sunte;o sewer(no. lin. ft.) Y .-�Phone: Gly Fx —�-J()3 21 E-mail: Storm sewer(no. lin.ft.) •7 p Plumb. g. r/'�bf/ Water service(no. lin.ft.) CCB no.: Plumb.bus.m no: _ City/metro lic.no.: Fixture or hem: Contractor's representative signature: Absorption valve - - — Back flow prreventer _ Print name: Date: Backwater valve — Basins/lavatory_ -- Name: �`[/�l t Clothes washer -- - Dishwasher City: _ Address: Drinking fountain(s) City: State: ZIP Ejectors/sump _ Phone: Fax: E-mail: Expansion tank _ Fixture/sewer cap "�N�ame(pri /1c �t.JctiO C�t/5 t� L Flcxtr drains/floot sinks/hub —_ Mailing address: r'Y' s 4-,-i Al-- , Garbage bis sal �-3 'a � Hose bibb City:_—L�ix-d I S tatee 1C ZIP: u —Ice maker _ PhoneFax:(' E-mail: _ Interceptor/grease Imp _ Owner instal lation/residential maintenance only- The actual installation Primcr(s) will be made by me or the maintenance and repair made by my,egular Roof drain(comrnert ial) _ employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) Owner's si natu a e: _ Sum Xn 1113 Tubs/shower/shower pan - Name: Urincl - - — — Water closet _ Address: Water heater — --'� City: — tate: ZIP: — Other: Phone: Fax: m Tool Nor all luriadktiorar wcq%credit cads,pkw call jurisdiction ror more information Minimum fee.......... .....S Notice:This permipermt i application Plan rev'.ew(at -_ % $ ------- Credit _-__!._ _ ❑Visa ❑MuterCaxl ) expires If a Permit is not obtained Credit card twmter — —.__—_--.— -,.--_-- �_1— within 180 days apler h has been State surcharge(8%) .... liapim __ -- ---- accepted as complete. TOTAL ........ .... .........S Name of rmA holder ss shown on credit cared — ——� ---Cadholder dgmthee --Amount _ 440.4616(NOWOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FU(TU_RES (Individual) OTY lea AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink — 16.60 the dwelling and the first100 ft. QTY .(ea) AMOUNT Lavatory 16.60 for each utilityconnection —_ One 1 bath _ $249.20 Tub or Tub/Shower Comb. 16.60 Two _ $350.00 — Shower Only 1660 Three 3)bath --- —_— $399.00 _ Water Closet 16.60 - - SUBTOTAL Urinal 1660 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.60 — TOTAL _ Laundry Tray 16.60 Washing Machine 166 Floor Drain/Floor Sink 2" 1660 3" - --- 16.60 -- PLEASE COMPLETE: 4" 16.60 Water Healer O conversion O like kind 16,60 uantity b ir Work Performed Gas piping requires a separate,mechanical Fixture Type: New Moved Replaced Removed/ permit. ____LapLed MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory — Tub or Tub/Shower Hose Bibs 1660 Coi lbination Roof Drains 16.60 Shovi gr Only _ Drinking Foun'.airr, 16.60 Water Closet _ — Other Fixtures(Specify) 16 60 Urinal Dishwasher Garbage Disposal Laundry Room Tray _ -- --- Washing Machine _ — Floor Drain/Sink: 2" Sewer-1 st 100' 5500 3" — - Sewer-each additional 100' 4640 — — 4" Water Service- 1st 100' 55,00 Water Heater — -- Water Service-each additional 200' 4640 - Other Fixtures —.— (specify) _ Storm 8 Rain Drain-1st 100' 55.00 Storm 8 Rain Drain-each additional 100' 46.40 Commercial Back Flow Preven ion Device 4640 -- — Residential Backflow Prevention Device' 27,55 — — — -- Catch Basin 16.60 —�-- — Inspection of Existing plumbing or Spccially 62.50 Requested Inspections erRv COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 —_--- Grease Traps -- 16.60 QUANTITY TCTAL ------ --- — Isometric or riser diagram Is+equired if --- –`------- -- __— Quantity Total ism–r3 - _ -- - ----- — 'SUBTOTAL °Y — - --- — 8%STATE SURCHARGE — - -- — '"PLAN RFVIEV 1 25%OF SUBTOTAL – -- Reyulred cn1�if fixturety�total is>s TOTAL. 'Minimum permit fee is S7250-8%state surcharge,except Residential Backflow Prevention Device,which is$:19 25•8%state surcharge "All New commercial Buildings require 2 sets of plans wRh Isometric or riser diagram fu plan review. I:tdstsVorms\plm-fees.doc 12/26/01 Electrical Permit Application Received ElC:h;cal ')ate/Ry: Permit No.:46 7p�0 -G 70 9� City of Tigard I ing Approval Sign I)ate/By: Permit No.: 13125 SW liall Blvd. Plan Review Other Tigard,Oregon 97223 Date/ 3c. Permit No.. Phone: S03-639-4171 Fax: 503-598-1960 Post-Review Land Use Date/By: _ Case No.: Internet: www.ci.tigard.or.us Contact Juris.: Sec Page 2 for 24-hour Inspection Request: 503-639-4175 y Neme/Method: _ Su lemental Information. TYPE OF WORK _ PLAN REVIEW(Please check all that apply) ew construction _ Demolition Service over 225 amps- Hcalth-care facility -Ifcommercial ❑Hazardous location Addition/alteration/re 1p acenieilt ❑ Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet, _ CATEGORY OF CONSTRUCTION I&2 family dwellings four or more residential units in 1 &2-Familydwelling _Commercial/Industrial ❑System over 600 volts nominal one structure - -- Building over three stories ❑Feeders,400 ams or more ❑ B p Accessory Building_ [� Multi-Family ❑Occupant load over 99 persons ❑Manufactured structures or RV park Master Builder ❑ Other: ❑rgressnighting plan ❑Other: JOB SIT>a'INFORM�+TION;and LO ATION Submit sets of plans with any of the above. The above are nota IicsWe to tem1rorary construction service. Job site address: I kr FEE*SCHEDULE Suite#: Bld ./A t.#: Number of Ins ections per permit allowed Project Name: Desert rtion Qty Fee(ea.) Total New resldentlal-single or multi-fanilly per Cross strect/Dlrectlons to Job Site: dwelling unit.Includes attached garage. Service Included: 1000 sq.A.or less _ 145.15 4 Each additional 500 sq.ft.or portion thereof 33.40 1 Limited energy,residential 75.00 2 Subdivision: /I Lot#: l _ Limited energy,non residential 75.00 2 Tax ma / areal #: P.ach manufactured home or modular dwelling — service and/or feeder 90.90 2 - — BCRIPTION OF WORK _ Services or feeders-Installation, alteration or relocation: 200 amps or less 80.30 - -_-_ _---_-_ -------- ---- 201 amps to 400 ams 106.85 1 2 401 amps to 600 ams 160.60 2 rROPk,R'BV OWNER TENANT 601 to 1000r v 240.60 2 Overr 1 10(10 am or volts __ 454.65 2 Nanlc: C{[! /)I-'-_ _.�,.-. Reconnect only66.85 2 Address: �6 S` S�• 11J,0,r-T � �� __ Temporary services or feeders-installation, alteration,or relocation: City/State/Zip:—^2c+-� �U� 200 amps or less - 66.85 I Phone �� ry .moi,, I Fax: �j,�=/7 Sb 201 amps to 400 amps ---_—— 100.30 2 401 to 600 amps 133.75 2 -MA"LI_CANT , CONTACT>PERSON Branch circuits-new,alteration,or Name: — _ extension per panel: A.Fee for branch circuits with purchase of Address: _ service or feeder fee each branch circuit 6.65 2 CI /Slate/Zl 0.Fee for branch circuits without purchase of �- service or feeder fee,first branch circuit 46.85 2 Phone: `T Fax: Each additional branch circuit 6.65 2 E-mail: Misc.(Service or feede,not included): RACTOR Each um or irti ation circle 53.40 2 __-CONT � _- Each signor outline lighting 53.40 2 ,lob No: _ Signal circuit(s)or a limited energy panel, `---- alteration,or extension1'_"t e z _ 2 Business Na ne_ { �• c� -�� , Address: Description:ription: City/State/Zip: � Each additional inspection over the allowable In an of the above — Per inspection per hour(min. 1 hour) 62.50 Phone: I Fax: __ InvestiJption fee: CCB Lie.:H• J L.ic. #: — other: _ ittrh 11i lilt Feed Supervising electrician Subtotal S _signature required: _-� Plan Review 25%of Permit Fee S Print Name: Lic. #: State Surcharge 8%of Permit Fee S _ TOTAL PERMIT FEE. S Authorized Notl_ey. This permlt application expires If a permit Is not obtained within Signature: _ ____— Date:___ 180 days after It has been accepted as complete. •Eee methodology tet by Tri-County Building Industry Service Board. (Please print name) Ii:\Dsts\Permit Forms\ElcPemdLA pp.doc 01/03 r _ to o av 00 3� s �-o r yam, �� r O 1 FF o i � w 4 i f -1 T.) 5 w 64 1,1 titOoK-,� ALACI-A— 08;09%2003 11:19 FA'' 5035798056 2006 CITY OF TIGARD 13125 S.W.. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE GREENWAY ELECTRIC COMPANY 15145 SW GULL DR BEAVERTON, OR 97007 Electrical Signature Form Perms!# MSTk003-00034 Date Issuea. 2118!03 Parcei: .2.S103BC-09800 Site Address. 12805 SW BLUE HERON PL Subdivision: BLUE (HERON PARK Block: Lot: 015 .Jurisdiction, TIG Zoning: R-4.5 Remarks: Construction of new SFA Yc.,ir company has been indicated as the eledrical contractor for the permit indicated above. In order for the elecL-ica' r ;,-:'+o be valid, the signature of the supervisir g electrician is required_ Please have the appropriate individual from your company sign below and return this Liectrical Signature Form pnorto the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completrd form is received OWNER ELECTRICAL CONTRACTOR: WINDWOOD CONSTRUCTION, INC. GREENWAY ELECTRIC COMPANY 12655 !�W NORTH DAKOTA 15145 W G 4R 97007 ULL OR TIGARU, OR 97223 Phone #: 503-625 6526 hone: #: 603-F79-8064 (leg #. LIQ' 153421 F1 J- 34-617C SUP 50255 AN INK SIGNATURE iS REQUIRED ON THIS FORM x i ture Aft--r de �Visin6ctri cian ifyou have any questions, please call 503.718 2433. Pone Laga Dine ayni L du &LID 198cYZOcOq %vd FT:IT NOR M'60,'90 y O L2 G � o v � O y W ° V a G y c � I u a O a i