10290-10330 SW GREENLEAF TERRACE N
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10290 THRU 10330 SW GREENLEAF TER
C� _BUILDING PERMIT _
!TY ��F TIGARD PERMIT#: BUP2004-001 19
DEVELOPMENT SERVICES DNTE ISSUED: - 2/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-417' PARCEL: 11CC-19600
SITE ADDRESS: 10295 SW GREENLEAF TERR
SUBDIVISION- SUMMERFIELD NO 5 ZONCIG- R-12
BLOCK: LOT: 255 JtJR-ISDICTICN: TIG
REISSUE: FLOOR AREAS_ EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ()Tft FIRST: - sf N: S: E W:
TYPE OF USE: SFA SECOND: sf _ PROJECT OPENINGS?
TYPE OF CONST: sf N: S: E: W:
OCwUPAN( TC''r'AL AREA: U sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: PASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GAPAGE: sf OCCU SEP. RATED:
PSN1T?: MEZZ., . REQ0 SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS.- IMP SURFACE: PRO CORR: PARKING:
VALUE: 25,957.60
Remark;,. rroot e,ildir'j .f8, 10295, 10305, 10315, 10325, 10335, 10345 —
/035
Owner: Contractor:
i 011R, EDWARD S + OLIVE M JBC ROOFING
10295 SW GREENLEAF TERR 12155 SW GRANT AVE STE C
TIGARD, OR 97224 TIGARD, OR 97223
Phone.
Phone: 503-968-123.5
Reg #: LIC 98255
FEES REQUIRED INSPECTIONS
Description _ Date Amount Final Inspection
N0 11 DI I'rrnut FCC 3122/04 $13930
I A\I ti ~talc surcharl 3/22/04 $11.14
Total $150.44
This permit is issued subject to the regulations cont-wined in the Tigard Municipal Code, State of OR Specialty Code;
and all other applicable law 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 lav,
requires you to follow the 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 a copy of these rules or direct qu—tions to OUNC by
calling (503) 246-6699 or 1-800-332-"344
Issued By: ---
Permit`.ee `
Signature:
Call 639-4175 by 7 p.m. for an inspection the next business day
IL
Re-hoof
Ouildin, 1'L;-mit Application %FOR OFFICE USE ON[.11
`, � Rect,ived
c�ly of"!'igard :�; li�/�..J oecte#fB! r11.� N . d18 -JU /I
13125 SW Wall Blvu„Tigard,O �- Plan Review
Phone' 503.639.4171 Fax: 503.598.1960 tlate/Ny: Other Pennia
Inspection Line: 503.639.4175 MAR iii 204 Date Reedy/By: -- Luria — ® See Pane 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
Gip QESICIARD
Bulawc arm" _ REQUIRED DATA:I-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees'are based on the value of the wurk performed.
Indicate the value(rounded to the nearest dollar)of all
Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
C/.TEGORV OF CONSTRUCTION work indicated on this application.
r] 1-and 2-family dwelling ❑Commercial/industrial Valuation: S
❑
Number of bedrooms:
Accessory building ❑multi-family
❑
Other: WAW H0 s Nwnber of hathrocros:Master builder .� � U S�
JOB SITE INFORMATION AND LOCATION Total number cl'tlours:
Job site address:/p'; f14 --/y�S G(T � �I1�4 �f{ New dwelling area: sauarc feet
City/State/ZIP: �—,( 7 y G _ Garage/carport area: square feet
Suite/bldg./apt.no.: Irroject name: /Vf N(��tP� /s L Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
_ REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdiv Bion: Lot no.: Permit fees*are based on the value of the work performed,
Tar,map'parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the f-ofit for the
DESCRIPTION OF WORK work indicated on this application.
R J SW/AJOL L F_•�%�L-_'�� valuation:- S
Flyl B U r.= � Pq
� -'yfr _ ''
Hee EIAC) (� /�'!�L-t- '�� 'Y" �p Existing building area: _ square feet
Yoe, A/ a•R<.A4C-t/"tr, 3rAf! C CC-.5 New building area: square feet
,&PROPERTY OWNER — ❑ TENANT -�-_ Number of stories:
Name: 4!41 H R SM/-r 4 trF"Lt�S 734,14�Ae 4&af_:IU Acrv$ construction:
'i'3— aOccupancy groups:%�yr / o3
City/State/71P: �d Existing:
Phone:( ) Fax:( ) � New:
❑ APPLICANT CONTACT PERSON NOTICE
Business name: --___ All contrartors and subcontractors are required to be
Contact name: Me L$p AJ-- licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in whish work is being performed.If the
City/State,/ZIP: applicant is exempt from licensing,the following reasons
apph: -
Phone:_03_-tl; Q_ CIFC) 17 Fax: :( )
E-mail:
CONTRACTOR
Business namo: J 1 D lZ/M r 4�, 521
BUILDING PERMIT FEES*
Address: L�eQsw' / Please refer to fee schedule.
City/State/ZIP: �"`��- �-R�►j C•}r
- -- Fees due upon application
Phone:(�%�l _9 Fax:( ) ---
Amount received
L13 tic: � --
--r Date received:
Authorized signs t (;e.: 4%4w"'
z Thfs permit application expires If a permit Is not obtained
V titin 180 days after!t has been accepted as complete.
Print name. — �Dater C "Itis dtethudology set byTri-County Building Industry
Service Board.
i$uitdinitWetmiu\ROOF•PeindtAppdoc 12101 110-4613T(IIWCOMWEa)
RE-ROOFING PERMIT CHECK LIS1
RESIDENTIAL(One-&Two-Family Dwelling)
[� REPAIR (major)plan review required by plans examiner _
Building permit is required when structural changes are nadc or the space sheathing
is removed or replaced.
SUBMIT TWO (2) SETS OF PLANS SPECIFYING:
A. Roof area and nearest street.
13. Attic vents: Provide 1 sq. ft. for each 150 sq, ft. of attic space. Vents shall be
located in the upper 1/3 of the roof. Provide I sq. ft. for each 300 sq. ft. when
cave and attic venting is provided.
N-,0e: No permit is required fo- residential re-roof if not more than two (2) lay--rs of
roofing will exist upon completion cl the re-roofing.
COMMERCIAL(includes multi-&_trdly and condominiums;
RI -ROOF: Pre-inspection is required for all roafs sloped 2::2 and less. Please
_make an appointment bcalli�e inspection I:ne at (503) 639-4175_
PLAN REVIEW:
Note: Depending on the conditions noted at the pre-inspection, plans may be
required to address any non-conforming items.
VALUATION OF PROJECT: $
ft. of roof area — –
Permit Fee based on valuatioc: $
----_ _�_ (seeFiume Pern-it Fees char)_ _.---.---------------
8% State Surcharge:
65% Plan Review Fee: $
(Required for major repairs of residential and
al w*cts.)o
special purpose roofing of commercial_ TOTAL: $
i''�RuildingTonns\Re.RooR'hecklist.doc 12/24/03
'.:-ITY OF TIGARD 24-Hour
BUILDING Inspection Line: (5021639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST _
Received �L Date Requested_ �Cw AM PM BUP
Location 1011 �,f�L;':�; l��
3L Z� lG� 2. 5 Suite MEC _
Contact Person ;fc'6 ir _G L c:�Ph t ) ____ PLM
Contractor._44a ::k �^ d611. n - - SWR
BUILDING Tenant/Owner �1(_c��L1 �l.�.C�.�a [ DS� ELC
Foundation ELC
AS.CesB
Fig Drain . ELR
Crawl Drain
Slab I I ii.spection Notes. SIT
post& Beam 1
, I _
Shear Anrho.s
Ext Sheath,Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing - -
Firewall
Fire Spi;nkler - --- - -
Fire Alarn
..SusRd Ceiling ------ - - --
Roof
Other �.
Fin - ------_
AS PART-FAIL
PLUMBING
Post& Beam � --- ----- - -- -
Under Slab _Rough-In
Water Service - -- - -----
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain -- -
Shower Pan
Other
Final _ T_
PASS PART _FAIL
CH_
MEANICAL
Post& Beam
Rough-In ----
Gas Line
Smoke Dampers — -
Final
PASS PART __FAIL ---- --_ -_. ---- - --------- ...__--
ELECTRICAL
-
Service
Rough-In _
IJG/Slab
Love Voltage -- - - -- -- -- -- ---- --- -
Fire Alarm
Final I I Reinspection fee of$ - required before nex�inspection. Pay at City Hall, 13125 SW Hall Bivd.
PASS PART FAIL
SITE Please call to, reinspection RE: Unable to irspect-no access
-
Fire Supply Line
ADA 1,
Approach/Sidewalk bate ✓ _ Inspector Ext
Ext
Other
Final DO NOt REMOVE this Inspection record rom the Job site.
PASS PART FAIL
J CITY OF TIGARD --- BUILDING PERMIT
PERMIT#: BUP2004-00115
DEVELOPMENT SERVICES DATE ISSUED: 3/22/04
13125 SW Hall Blvd., Ticiard, OR 97223 (503) 639-4171 PARCEL: 2S111CC-2.1600
SITE ADDRESS: 102'.,0 SW GREENLEAF TERR
SUBDIVISION: SUNIMERFIELD NO..5 ZONING: R-12
BLOCK: LOT: 274 JURISDICTION: TIG
REISSUE: _ FLOOR AREAS _ _ _ EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S:— E: -- W. --
TYPE OF USE: SFA. SECOND: sf _ PROJECT OPENINGS?
TYPE OF CONST: sf N: VY S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANC ( LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OC CU SEP. RATED:
BSM'T?: ME7?": _ REQD SETBACKS _ _ REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL SMOK DET:
DWELLING UNITS: FRNT: ft REAL-;: ft FIR ALRM : HNDICP ACC:
BEDR.MS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 25,957.00
Remarks: Reroof Building#4, 10280, 029 . 10300. 10310, 1p31b,�033fr
1333 C)
Owner: Contractor:
WALLER, MILDRED Z TRUSTEE JBC ROOFING
WATKINS, VIONA J TRUSTEE 12155 SW GRANT AVE STE C
10280 r''.^.' rnF-FNJ r^F TERRACE TIGARD, OR 97223
TIGARD, OR 97223
Phone:
Phone: 503-960-1235
Reg #: LIC 9825.5
FEES REQUIRED INSPECTIONS
Description "Date Amount Final Inspection
[BUILD] Pemiit Fee 3122104 �^^ $139.30
[TAX]S%State Surcharl 312.2104 $11.14
Total $150.44
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans This permit will expire if work is
riot started within 180 days of issuance, or if work is suspended for more than 180 days ATTENTION: Oregon law
requires you to follow the 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 a copy of these rules or direct questions to OUNC by
calling (503) 246-6699 or 1-800-332-2344
Issued By:
Permittee /l
Signature: CZ't.t -Call 6V9_4175 6 9-4175 by 7 p.m. for an inspection the next business day
_ BUIL-DING PERMIT
CITY OF T I G A R D PERMIT#: 13UP1999-00294
DEVELOPMENT SERVICES DATE ISSUED: 7/14/99
13125 SW Hall Blvd..Ticiard, OR 97223 (503) 639-4171 PARCEL: 2S111CC-19300
SITE ADDRESS: 10325 SW GREENLEAF TERZ
SUBDIVISION: SUMMERFIELD NO.5 ZONING: R-12
BLOCK: LOT: 252 JURISDICTICA: TIG
REISSUE: — '— FLOOR AREAS EXTERIOR WALL CONSTRUCTION _
CLASS OF WORK: REP FIRST: sf N: � S: E: W:
TYPE OF USE: MF SECOND: sf PROJECT OPENINGS?
-f YPE OF CONST: 5N sf NI: S: E: W:
OCCUPANCY GRP: R1 TOTAL AREA: sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: REQD SETBACKS _ REQUIRED
FLOOR LOAD: psf LEFT: ft RGHTY— ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
REDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 1,000.00
Remarks: Exterior structural repairs - Permit fees cover (2) two individual inspections. Additional inpsections subject to
re-inspection fee of$50.00 each. No C of O required
Owner: Contractor:
BLAIR, THOMAS P JR K CONSTRUCTION INC
ERNA J PO BOX 34
10325 C\A/ 15REE-NLEAF TERR NEWPORT, OR 97365
TIRARDOR 97223
one, Phone: 541-764-3858
Reg #: uc 97820
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Misc, Inspection
INSP DEB 7/1-";99 $100.00 99-316783 Final Inspection
Inspection
- ----—Total _ $100.00
Final
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable law. All work will be dine in accordance with approved plans.
This permit will expire if N/vork is not started within 180 days of iSgUance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-1987.
Pe rm itee
Signature: _
;ssued Bir,
Call 639-4175 by 7 p.m. for an inspection the next business day
CITY OF TIGARD C nmercial Building Permit Application Rev'd By--�-
13125 SW HALL BLVD. New Construction and Ad+ditt'ons Date Rei d--1, ,tel'-i
TIG ARD, OR 97223 Date to F.E. _
(503) 639-4171 Dale to DST
Permit 6.P i 9 9 q-00;i9
Print or Type Related SWR•_
Incomplete or illegible applications will not be accepted Called
Name of Development/Prop-cl
Job
Address street ndtress �{C�A �t,�,T suite
— Existing Bui!di7g NJ New Building E]
.. Ttx<C I Building
Bldq ft City/State Zip Data _
_ T4Aff" exf 9 7.2 Existing Use of Building or Property.
Name
Property U J 5
Owner Mailinq Address 4; Suite Proposed Use of Building or Prooeity y1
le""r 2 5 T tX,oO- _
City/State ZIP Phone (
_ _
—11 / !p mQ No. Of Stories:
z23
Occu�pant Name
_ Sq. Ft. Of Project:
Name —' Occupancy Class(es)
Contractor K
Prior to permit Mailing Address sung Types) of Const.uctitan _
nuance,a copy f7 U 3 ,/ � ,i
of all licenses e' XX
are required if City/Slate ZIP Phone L Will this project have a Fire Suppression System? - --
expired in C O'r
database /✓�wPm Oeg7';(.S _?E y. 3� 7� Yes ❑ No ---
Oregon const.cont.Board Llc.t Exp Date Arnericans with Disabilities Act(ADA)
2 7 S Ze /, ' /� Valuation X.25% = $- Participation
Cr,rnplete_Accessibilih Form
Name ProjectY $ --- ��---
Architect Maili ____ _ _ _ Valuation
ng Address Suite P C O
Plans Required See %,#-:;;for number of sets to submit
City/Stale Zip Phone ���, on back
Engir-er Name — I hereby acknowledge that I have read this applicahr i.-that the information
given is correct,that I am the owner or authorized ar ent of the owner,and
Mailing Address Shite _ that plans submitted are in compliance with Oregor State Laws
Z"
Slgna� f Ovynej/AQb Date
City/State Zip Phone --- �` r L /�
TTT
_ Contact Person Name Phone
Indicate type of work: New O Addition O Demolition O ll���tr�� r_`' r' /' l / i r/ -
- L _� --�
Accessory Structure O Foundation Only O Alteration O
Repair 0 Other o FOR OFFICE USE ONLY
C, crlption of work: Map/TL# Land Use 1
S4�f' T U
Narks: Estimated!of Employses — TIF' -- '—�-
If the above figure Is not supplied at the time of application,the city will
calculate the fee based upon the number of parkins aces.
Note: Site Work Permit Application must precede or accompany Bcllding
Permit Applfcatlon
I\COMNEW DOC (DST) 5198
y
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependent upon submittal of BOTH plans AND a COMPLETED
application. For an electrical submittal, the application must contnin the
signature of the supervising electrician before plan review will be conducted.
Atter plan review approval, Plans Examiner will contact the applicant to request
additional plan sets for distribution purposes. (Copy for Contractor, City, .4
Washington County, Tualatin Valley Fire & Rescue)
Tvta! # of
TYPE OF SUBMITTAL. Plans KEY:
Submitted
S (Private) _ 1^ S = Site Work
B
New or Add) 1 B = Building
F (New or Add or Alt) 3 F = Fire Protection Sys,-rr,
M (New or Add or Alt) _ 1 M = Mechanical
B & M (New or Addy P = Plumbing
P (New, Add, or Alt) _ — 2 F_ = Electrical
B & M & P (New or Add) 2 New = New Building
E (New, Add, or Alt) 2 Add = Addit'-)n
B & F & M & P & E 3 Alt - Alternation to Existina
01111ew , Add) _ Building
`R ar B & M (Alt) 1
*B & b1 & P (Alt) 3 �'
*B & M & P & E(Alt) 3
*8 & M & P & E & F(Altjv 3
NOTES'
'Shaded meas designate ALT submittals only.
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CITY OF f I GA R D - BUILDING PERMIT
PERMIT M BUP1999-00337
DEVELOPMENT SERVICES DATE ISSUED: 8/2/99
13125 SW Hall Blvd.,'Tigard, OR 97223 (503) PARCEL: 2S111 CC-21700
SITE ADDRESS: 10290 SW Gku-cNL.EAF TERR ORIGINAL
SUBDIVI',ION: SUMMERFIELD NO.5 ZONING: R-12
BLOCK: LOT: 275 JURISDICTION: TIG
REISSUE: FLOOR AREAS _ EXTERIOR WAL L CONSTRUCTION
CLASS OF WORK: REP FIRST: sf N: S: E: W:
TYPE OF USE: MF SECOND: sf PROJECT OPENINGS? _^
TYPE OF CONST, 5N sf N- S: E: W:
OCCUPANCY GRP: R1 TOTAL AREA: sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT. ft GARAGE: sf OCCU SEP. RATED:
E3Sl41T?: MEZZ?: REQD SETBACKS _ REQUIRED
FLOOR LOAD: psf LEFT: ^ ft RGHT: �ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE:
Remarks: Exterior structr-ral repairs Permit fees cover (2) iwo individual inspections. Additional inspections subject to
m-inspection fee of$50.00 each. No C of O required.
Owner: Contractor:
FIRST INTERSTATE BANK OF OREGO K CONSTRUCTION INC
FOR ANDERSON, HELEN MAE PO BOX 34
10290 SW GREENLEAF TERR NEWPORT, OR 97365
TI one, OR 97224 Phone: 541-764-3858
Reg#: uc 97820
_ FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt _ Mibc. Inspection
INSP DEB 8/2/99 $100.00 99 317345 Misc. Inspection
Final Inspection
Total $100.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approves' pans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than i 90 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 -0010 through OAR 952-001-1987. You ma;,obtain a copy of these rules or d1fcc1 questions to OUNC by
calling (503) 2.f6-1987
� r
i
Permitr�- I/
Signatures—
�f
Issuepy: 1`' ---
Call 639-4175 by 7 p.m. for an Inspection the next business day
CITY CF TIGARD Commercial Building Permit Application Recd By`—�' _
13125'SW HALL BLVD. New Construction and Additions Date Recd
TIGARD, OR 97223 Date to P.E.
Daf DST
(503) 639-4171 Permit# Q ,P299 a�33
Print or Type Related SWR
Incomplete or illegible applications will not be accepted called.
Name of Development/Project
Job Existing Building New Building []
Address Strect Address K,s r Nt� -Suite
Building
I cl-A city/state Zip — Data
7 e) 9 7 2 2 . Existing Use of Building or Propel ty:
Name
Propelty i�Ee��`{ j�saS4uL7" --
Owner Mailing Address f r' /) sine -- Proposed Use of Building or Property:
City/Sta(a � Zip Phone,
No. Of Stories:
c/ZZ Z i
Occupant Name Sq. Ft. Of Project:
Name — Occupancy Class(es)
Contractor K 6, rec" 'C
Prior to permit Mailing Address, Suite
issuance, a ropy r, �_. Types)of Construction
of all licenses �y��_ 61")( j (
are required If City/State Z _ Phone S�f/ Will this project have a Fire Suppression System?
expired In C,O.T ___Nc
Yes
database 9736) '71, _Y-3k5 k _ LN_.__
Oregon Const.Cont.Board Lic.* Exp Date Americans with Disabilities Act(ADA)
Valuation X 25% = $ Participation
7 �� _ "�� c _ Complete Accessibility Form
Name Project $- �-- ----•
Architect _ Valuation 1000
Mailing Address Suite
Plans Required: See Matrix for number of sets to submit
City/State Zip T Phoneon back
En ineer Name - -
9 I hereby acknowledge that I have read this application,that the information
given is correct,that I am the owner o! authorized agent of the owner,and
Mailing Address Suite `— that plans submitted are in comp ionce with Oregon State Laws
Sign alWr� nt � Date
oily/State Zip Phone
Contact Perscr,P!ar,re Phone l/�
Indicate type of work. New O Addition O Demolition O A.
Accessory Structure O Foundation Only O Alteration O
Repair o Other o FOR OFFICE USE ONLY
Description of work:
,p Mapn L# — Land Use: —
5/ K 0 C_7 U �CA L_ _&ft 4�l 4 Notes: `—
Parks: Estlmated#of Employees -- -- -
TIF
if the above figure Is not supplied at the time of application,the city will
calculate the fee based upon the number of parking spaces.
Note: Site Work Permit Application must precede or accompany Building
Permit Application
11COMNEW DOC (DST) 5/98
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependent upon submittal of BOTH plans AND a COMPLETED
application. For an electrical submittal, the application must contain the
signature of the supervising elec, .-..'an before plan review will be conducted.
After pian review approval, Plans t Ya-niner will contact the applicant t 3 request
additional pian sets for distribution purposes. (Copy for Contractor, City,
Washington County, Tualatin Volley Fire s. Rescue)
TYPE OF SUBMITTAL Plans KEY:
Submitted
S (Private) 1 S = Site Work
B (New or Add) -- _ 1 - B = Building
F (New or Add or Alt) 3 F = Fire Protection System
rm, (New or Add or Alt) 1 M = Mechanical
g & M (New or Add) 1 P = Plumbing
P (New, Add, or Alt) 2 E = Electrical
B & M & P (New or Add) 2 New = New Building
E (New, Add, or Al!) T 2 Add = Addition
13 & F _& M &_P & E l 3 Alt = Alternation to Existing
(New , A_dd)_ Building
*Borg & M ( Alt)� _ 1
(Alt) 3
*B & 141 & P & E(Alt) 3
� 'B & M & P & EAF(Alt) 3 — I
NOTES:
*Shaded areas designate ALT submittals only
lost-\fnnns\matrxc-om doc 10;30199
CITY ��F T I G A R D BUILDING PERMIT
PERMIT#: BUP1999-00336
DEVELOPMENT SERVICES DATE ISSUED: 8/2/99
13125 SW Hall Blvd..Tigard, OR 97223 I�IG Tt""NA PARCEL: 25111CC-21800
SITE ADDRESS: 10300 SW GREENLEAF TERR e u
SUBDIVISION: SUMMERFIELD NO.5 ZONING: R-12
BLOCK: LOT: 276 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: REP FIRST: sf N: S: E: W:
TYPE OF USE: MF SECOND: sf _ PROJECT OPENINGS?
TYPE OF CONST: 5N sf N: S: E: W:
OCCUPANCY GRP: R1 TOTAL AREA: sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 1,000.00
Remarks: Exterior structural repairs. Permit fees cover(2)two individual inosections. Additional inspections subject to
re-inspection fee of$50.00 each. No C of 0 required.
O%%f ner: Contractor:
HEI"RY DUSSAULT K CONSTRUCTION INC
103GO SW GREENLEAF TERR PO BOX 34
TIGAPD, OR 972.24 NEWPORT, OR 97365
Phone• Phone: 541-764-3858
Reg#: uc 97820
FEES REQUIRED INSPECTIONS
Type By Date Amount Recsipt Misc. Inspection
�INSP DEB 8/2/99 $100.00 99-317344 Misc. Inspection
_ Final Inspection
Total $100.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through CAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246-1987. !✓J
Pennitee r
Signature: ��"� G A
Issued By:
Call 639-41, 57 by 7 p.m. for an inspection the next business day
CITY-OF TIGARD Commercial Building Permit Application Recd U,L �
13125 SW HALL BLVn. New Construction and Additions Date Re,d ^a 9
Date to P.E.
TIGARD, OR 97223 Date to D3
(503) 639-4171 Permit e 1999-_337
Print or Type Related SWR zx_
Incomplete or Illegible applications will not be accepted Called^ `
Name of Development/Project
Job Existing Building% New Building
Address Street Address �rLf/q 7 Suite
06" f A — Building
Bldgx City/State Zip Data
1079"
�17t x,(� r< 1-Wt Existing Use of Building or Property:
Name -�
Property �� 5
Owner Mallin as ✓�E, sung --- Proposed Use of Building or Property:
City/State Zip Phone � ��-------
No Of Stories:
4 os r 22 --
Occupant Name Sq. Ft. Of Project
-- N,me Occupancy Class(es) y
Contractor c o,_ c --
Prior to permit Mailing Address Suite 1 ype(s)of Construction
c;suance,a copy /
of all licenses C' o7 C1 � .-,5 � 'L/ --�
are required it City/State Zip -� Phone Will this project have a Fire Suppression System?
expired In GO.T Yes ❑ NO
database Nt u Pcer ok 97;65 &,y -3k j —
Oregon Consi.Cont Board Lic.# Exp.Date17" Americans with Disabilities Act(ADA)
Valuation X 25% _$ Participation
f Z�? �/Z y/° f Complete Acces_sibili Form_ J
Name Project $
Architect Valuation —�
Mailing Address -� Suite I I
Plans Required: See Matrix for number of sets to submit
Cityl3tate Zlp Phone on back
Na i
Engineer Name I hereby acknowledge trial I have read this application,that the information
given is correct,that I am the owner or authorized agent of the owner,and
Mailing Address Suito — that plans submitted are in compliance with Oregon State L.ews
Sig r f Ownernth Dat
City/Stale Zip Phone �/ . -, Z
Indicate type of work. New O Addition O Demolition O L �� X/ame�� C`' / Phone
Accessory Structure O Foundation Only O Alteration O J d
_Repair o Other o FOR OFFICE USE ONLY
Description of work: i MapnIs Lend Use:
J( A L �� l'Z Notes:
Parka: Estlmated t of Employees TIF: —
It the abcve figure Is not supplied at the time of application,the city will --
It
the fes based upon the number ofparking spaces. ----�
Note: Site Work Permit Application mils:precede or accompany Building
Permit Application
I\COMNFW DOC (DST, 5198
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependent upon submittal of BOTH plans AND a COMPLETED
application. For an electrical submittal, the application must contain the
signature of the supervising electrician before plan review will be Conducted. "
After plan review approval, Plans Examiner will contact the;applicant to request
additional pian sets for distribution purposes. (Copy for Contractor, City,
Washington County, Tualatin Valley Fire & Rescue)
_^ Total# of
TYPE OF SUBMITTAL plans KEY:
Submitted
S (Private) 1 S = Site Work
B (New or Add) 1 B = Building
F (New or Add or Alt) 3 F = Fire Protection System
M (New or Add or Alt) 1 M = Mechanical
B & M (New or Add) 1 P = Plumbing
P (New, Add, or Alt) 2 _ E = Electrical
B & M_& P (New or Add) 2 New = New Building
E (New, )Gd, or Alt) 2 Add = Addition
B & F & M & P 8 E 3 Alt = Alternation to Existing
'New , Aud)_ Building
*8 or 8 & M (Alt) 4.
*BSM &M & P (Alt) 3
*B &M& P & E(Alt) 3 w
*B & M & P & E & !+(Aft) 3
NOTES:
'Shaded areas designate ALT submittals only.
I 1dsts\1crmslma1rxcom doc. 10/30198
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PERMIT
PE #. . . . . . : C
CITY OF TIGARD DATERMIT ISSUED:. 08/20/96MEC96-121261
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd,Tigard,Oregon 972234199 (503)839-4171 PARCEL: 2SI11CC-21900
SITE 1.03116 SW URLEWLE AV I-ERR
SUBDIVISION. . . . : 5UMMERFIELD N0. 5 ZONING: R-12 PD
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :277
--------------------------------------------------------------------------------------------
CLASS OF WORK. . :ADD FLOOR TURN. . . . : 0 EVAP COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRP. . :R3 VENTS W/O APDL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL TYPES------------- 0-3 HP. . . . : 0 DOMES. INCIN: 0
- /GAS/
3-15 HP. . . . : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15--30 VIP— . : 0 REPAIR UNITS: 0
I- IRE DAMPERS". . .- 30-50 HP. . . . : 0 WOODSTOVES. . : 0
GAS PRESSURE.. . . : 50-4,- HP. . . . : 0 CLO DRYERS. . : 0
NO. OF UNITS---------- AIR HANDLING UNITS OTHER UNITS. : 0
FURN < 100K BTU: 1 < 10000 cfm : 1 GAS OUTLETS. : I
FURN ) =100K BTU: 0 > 10000 rfm: 0
Remarks : Installing a gas fl..tr,nace anti a a'ton A/C unit.
Owner,.- ------------------------------------------------------- FEES
GRIM WENDEL type amount by dente r-ecpt
10310 SW GREENLEAF' TERR PRMT $ 25. 00 CJS 08/E:'?l/96 96-283101
5PCT $ 1. 25 cis 08/20/96 96-28310).
TIGARD OR 97223
Phone #:
SUN GLOW, INC.
2428 SE 105TH AVE
PORTLAND OR 97216 -------------------------------------
1--11-ione #: 775-4184 f 26. 25 TOTAL
Reg #. . -. 48131
REQUIRED INSPECTIONES
This permit is issued subject to the regulations contained in the bas Line In
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical ,Sp
applicable laws. All work will be done in accordance with Misc. Inspection
approved plans. This permit will expire if work is not started Final Inspection
within IN days of issuance, or if work is suspended for more
than IN days.
Per-iij.ttee Sign -,uret . Wcz , lec`
Call for inspection 639-4175
City of Tigard MECHANICAL PERMIT Plancl-dRec. # -16-7-319 3!D
1:1125 SW Hall Blvd. APPLICATION Permit # t'0 cr,'W-n -jo
Tigard,.OR 97223
(503) 639-4171
encrp ion
Table 3A Mechanical Code QTY PRICE AMT
Job 1) Perm! Fee -0- -0- 10.00
Address
2) Supplemental Permit 3.00
b N M O
Furnace to
l,'61 1) Ind. ducts &vents 6.00
p w
Furnace TIN uuu F1 I ul +
Owner 11 ,S ) D tk) , E°c v+ 2);�.irtct ducts Z vents ,7.50
r: C ✓ Floor Fumance
}, incl ,ent , .0
---Tuspenoed neater, wail neater
4) or floor mounted heater 6.00
Occupant u — ""' .ent not incl. in —
5) 3ppliarce permit ^�
"• --Re—pa r orFieating, rem'g.
6) cooling, absorption unit 600
Boiler or comp, heat pump, air cond.
-'l ✓� (eV� 7) to 3 HP; absorp unit to 100K BTU .6,00
MOW Boiler or comp, eat pump, air cond.
Contractor _ ' in` 8) 3•-15 HP; absorp unit to 500K BTU 11.00
14710Bof er or comp, eat pump, air cond.
6) 9) 15-30 HP; absorp unit .5-1 mil BTU 15.00
oiler or comp, heat pump, air con .
10) 30-50 HP; absorp unit 1-1.75 mil BTU 22.50
—F,---re— y acknowledge that ave read this application, t att over or comp,Feat pump, air cond.
I
given is correct, that I am the owner or authorized 11) > 50 HP; absorp un;' 1.75 and BTU 37 50
agent of the ewrer, that plans submittedAiare in compliance with — irr 6—an urn to
State laws, that I am registered with the Construction Contractors 12) 10,000 CFM 2 7 U �C 4 50 ' i)
Boarc that the number given is correct. (If exempt from State Air an u.g unit
registration, please give reason below j 13) 10,000 CTM + 7 50
-Won pporta e
!� cl ('�� - t 4v,i�c 14) evaporate cooler 450
Vent fan connects
15) to a single duct 3.00
Ventilation system no
16) included in appliance permit 450
Hood serve y
17) mechanical exhaust 4.50
escn a workworx new U addlitilin alteration repair Commercial or industrial
to be done residential Q non-residential Q 18) type incinerator 30.00
M6sting use of _ r — ter i.e., wo Mve, water
building or property �, _ ,-Q 4. d�r`^ ` 19) heater, solar, cloth es dryers,
ry ers, etc. 4.50
—cam.----r� �-------� -- —
Proposed use of 20) Gas piping one to tie outlets 2.00
budding or property
Type of fuel -oil Q natural gas (� 21) More i PG � electric Q --tha,i 4-per outlet (each) 200
NOTICE
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Minimum Fee $25.00 SUBTOTAL—
AUTHORIZED IS NOT COMMENCED WITHIN 160 DAYS. OR 50,6 SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR '
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL
AFTER WORK IS COMMENCED.
TOTAL
;necial Condlions
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ELECTICAL ERMIT
CITY OF T I GARD PERMIISSUED
LC96-056DATE Ps /96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 PARCEL: 2rzIlICC-21900
5111. i41)DRESS. . . -. 1013110 ':W GREENLEAF TERR
SUBDIVISION. . . . I SUMMERFIELD NO. 5 ZONINGsR--12 PD
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . 277
Project Description: Installing one branch circuit.
UNIT----- ---TEMP SPVC/FEEDERS----- -----MISCELLANEOUS------
1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADD' L 500SF. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . : 0 401 -- 600 amp. . . . . . . .. 0 SIr. '()i-/PANEL. . . . . . . . 0
MANF. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOe� LABEL (10) . . . : 0
...----SERV I CE/F_r_EDER------ ClR(7UITG--------- INSPEC71ONS _
0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
-_-Vil - 400 ramp. . . . . . : 0
1. 1st W/O GRY('_ OR HDR. : I PER HOUR. . . . . . . . . . . : 0
401 - 600 amp. . . . . . : 0 EA ADDIL BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
bol - 1000 amp. . . . . : 0 REYlEW SECT ION_------._ -
1000.+ amp/volt. . . . . : 0 )=4 RES UNITS. . . . . . . . : ) 600 VOLT N-ui,iliNAL. . 3
Reconnect only. . . . . : 0 SVC/FDR > = 225 AMPS. . : CLASS AREP/SPEC OCC. :
Owner: FEES
WENDALL GRIMM type amoi-int by date t-ecpt
10310 SW GREENLEAF PRMT $ 35. 012.1 DSA 09/03/96 96-263531
9PCT $ 1. 75 D*A 09/03/96 96-283531
TIGARD OR 97224
Phone #:
Lontractor:
GRF ELECTRIC $ 36. 75 TOTAL
15460 SE PARADISE LN
REQUIRED INSPECTIONS
MIJI- 11\10 OR 97042 Ceiling Cover Elect' l Service
PhoTle #: 503--829-4146 Wall Cover Elect' l Final
Req V. . - 10!.343
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of 0re. Specialty Codes and all other ger M i e 'i gnat tire
applicable laws. All mork will be done in accorcance with
approved plans. This permit will expire if work is not started
within IN days of issuance, or if work is suspended for more
than 180 days. 5 5_r.t e dB y
INSTALLATION 0N1._Y ----_____ __._-..__-----
The installation is being made on property I own which is not intended for
lease, or rent.
OWNER' S SIGNATURE: DATE:
INSTALLW 0 0
SIGNATURE OF SUPR. ELEC' Nil UfA
, A DATE:
Aomlrr aF
LICENSE NO:
Call for inspec-tion 639-4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # EtC')6-
Phone (503) 639-4171 Date Issued
CITY OF TIOARD FAX (503) 684-7297
TDD No (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name o€-Deve upmCttt_— Zce�cNumber of Inspections per perm;t allowed
Address_ �G � Ct?r-� Service included Items Cost(ea) Sum
CJtylState/Zip`_ I 4a. Residential -per unit
�� 1000 sq ft or less $11000 _ 4
Name (or name of business) IJr r f /�ys✓1 Each additional 500 sq n or
a portion thereof $2500
Commercial ❑ kesidentlal Limited Energy $2500 1
Each Manut'd Home or Modular
Dwelling Service or Feeder $68 00 2
2a. Contractor installation only: --
G 4b. Services or Feeders
�r Installation.alteration or relocation
I iectrlcal Contractor �' ��` o f 200 amps or less $6000 2
Address f �� _ >_, pG�g�( ;�_ 201 amps to 400 amps $8000 2
City .l I i ,n h State-__.� Zip-_`-1� $
401 amps to 600 amps — 120 00 — 2
601 amps to 1000 amps 5180 00 2
Phone No k ty 1 �} �P _ Over 1000 amps or volts $34000 -- 2
r'
,fob NO. Reconnectnn!y S`000 _ 2
:.,ntractor's license NO.
4c. Temporary Sr+rvlces or Feeders
Contractor's Board Rag No �_r���_ Installation,alteration,or relocation
Signature of Supr Elec'n 200 amps or less 2
to 400 201 amps ps amps $5000 `
L lienee No_ �_� Phone K1c f� �] ---
� 401 amps l0 600 amps __ $7500 2
Over 600 amps to 1000 volts $10000 —
2b. For owner installations: cee"b"above
4d. Branch Circuits
Print Owner's Name _ New alteration or extension per pans
Address a)The rep for branch circuits w/th
—�_ purchase or service or feeder fee. 2
State Zlp Fach branch circuit $500
Phone No _ _ hl The tee for branch circuits without
rhe installation is being made on property I own which is purchase of service or feeder fee. / < <' 2
_
not Intended for Sale, lease Or rent. First branch circuit $3500 2Each additional branch circuli $500
Owner's Signature _ 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or Irrigation circle �_ $40 00
Each sign or outline lighting $4000
Signal circu4(s)or a limited energy —`
Please check appropriate item and enter fee in section 5B. panel,alteration or extension $4000
4 or more residential units in one structure Minor Labels(101 _ $10000 _ -
Service and feeder 2.25 amps or more
System over 600 volts nominal 411. Each additional inspection over
Classified area or structure containing special orcupancy the allowable in any of the above
as described in N E C Chapter 5 $3500
^r•.hrnn __ $5500
!n Plant $5500
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. Jr. Fees:
NOTICE 5a. Enter total of above fees 5 -
5% Surcharge (05 X total fees; $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Svbtotai $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review If required (Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal
Dc _
COMMENCE :. +•... I Trust Account p
I—'enc 5 ---- -- __
Balance Otle $ _—��
CITE( OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: ME02003.00067
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/20/03
PARCEL: 25111 CC-21700
SITE ADDRESS: 10290 SW GREENLEAF TERR
SUBDIVISION: SUMMERFIELD NO.5 ZONING: R-12
BLOCK: LOT: 27 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS WIO APPL: VENT SYSTEMS:
STORIES: BOILERSICOMPRESSORS _ HOODS:
_ FUEL TYPES 0 3 HP: DOMES. INCIN:
LPG 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP: REPAIR UNITS:
FIKE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
_ > 10000 cfm:
Remarks: R �'O !nA -'
(tR_ IL a c.FiYv�JZ; F EE_S
Avner: _
SHIRLEY STARK Description Date Amount
10290 SW GREENLEAF TER
TIGARD, OR 97224 INll tll I'ernu1 I rr 2120/03 $72.50
IIII
A\'18""s(alcl a\ 2/20103 $5.80
Phone: 503-639-4615 l' Total $78.30 '—
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503-656-I 184 Heating Unt Insp
Fina, Inspection
Reg#: LIC 447
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 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 in .,ie Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001--0100 Yoe 1 may obtain copies of these rules or direct questions to OUNC by calling
(503)246-6699
Issued By: �iz1i�� i f LC f- _ Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
[� �r f Date received:= - i, . � Permit no.:
r City of Tigard aEC;L M V t Project/appl.no.: Expire date:
Cir,of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 1 (i� 1 Date issued: By:� Receipt no.:
4 200
Fax: (50?) 598-1960 1 CCS Case file no.: Payment type:
-)F TIGARD Building permit no.:
Land use approval:
O 1 &2 family dwelling or accessory U Commerc ial'industrial Multi familk� U Tenant rov I n
U New construction U Addition/alteration/replacement J OIhcf: - - a -
1 ' SH E' INI,'?KNIA I IoSL COMMPRCIAL VALUATION
Job address: tL. ,/ ,•Pl L 4 1 _ In,.licate equipment quantities in boxes below. Indicate the dollar
Bldg. no,: I Suite no.: v slue of all mechanical materials,equipment,labor,overhead,
Tax /tax lot/account no.: o profit. Value S
Lot: Block: Subdivision: A •See checklist for important application information and
Project name: MIL (� jurisiiction's fee schedule for residential perrnit fee.
City/county: -nC�2��_ ZIP: q1 _
�Act}Qtioo�n and loc ion of vzQrk on pre ' es: .
r�Gt'U t�(�idr l.s Fee(ea.) Total
Est, nrtTMiripletion/inspection: i Description Qty. Res.only Res.only
Tenant improvement or change of use: e A
Is existing space heated or conditioned'?U Y(,s U No Air handling unit CFM
space insulated?U Yes U N(. Air conditioning exi(site plan require )
Is existing�P� A tPrauon o existing _14VAC system
air, -MECHANICAL CONTRU Ell t Boiler/compressors
Business name: !� State boiler permit no.:
LSP It -c - _ HP Tons BTU/H
Address: \55�, _ _ AL) Fire/smoke dampers/duct smoke detectors
City: _ Stat ZIP_ t�-1 — a '
at pup(sitpn requirere
Phone: Fax(%.1 rj(A F-mail_ Install/replace mace unfe
Including ductwork/vent liner U Yes U NO
CCB ng,: L4 U. nsta rep ace/re ocate heaters-suspen e ,
Cit metro lie.no.: 1 cl wall,or flnor mounted
Name ease print): (I-), Vent fora lienee other than furnace
PERSONCONTAC
Absorption units BTU/11
Name: a C_Qsj_ t Chillers lip ---
Address: — — Compressors
Environmentalexhaust an ventilation:
City: State: 'LIP:_ Appliance vent _
Phone: Fax; I E--nail- Der exhaust
bonds,Type 1/II/res. citchen/hazmat
hood fire suppression system _
Name: Qt{ _ Exhaust fan with single duct(bath fans)
Mailing address: Q2 q Exhausts stem a�frc�m heating or AC
�'�� - ,t• S uel piping and ddWrTbution tun 10 4 outlets)
City: R Sia lP: .�J
—�LL'�Ql--��—._..-- - �-_{- TYPc —.__. LFG---_ NG Oil
Phone: Fax: E-mail: Titef i to-e,cT U1f6nal nve'r, out cis
Process piping(schematic required) _
Number of outlets
Name: __ mer�lsterl appliance or equipment:
Address: _ I),corative fireplace
City: _ - State: 'LIP: --_Insert-type_____
o�oc slove/Pe et stave
Phone: Fax: Email: _
Other:
Applicant's signature:: Date: Ut er:
Name(print): `
Not all jurisdictions accept credit cards,please call jurisdiction for more information Permit fee ................... S —
❑Vim ❑MasterCard Notice: This permit application Minimum fee................ 1:L
Credit card number. expires if a perrni! is not obtained plan review(at °01 S
Expires within 180 days after it has been o '�-
State surcharge(8%)...5 5 _
Name of cirdhulder as shown on credit card accepted as complete. 3�
s TOTAL........................ S 18_
Cardholder signature Amount 440.4617(6i00!COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION:_ PERMIT FEE: Description: Price` Total
$1.00 to$5.000.00 Minimum fee$72.50 Table 1A Mechanical Code Qty (Ea) I Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
$1.52 r each additional$100.00 or including ducts&vents _ 1400
fractio.wereof,to and including 2) Furnas,100.000 BTU+
_ $10,000.00. including ducts K vents 17.40
$10,001 00 to$7.5,000 00 $148.50 for the first$10,000.00 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 14.06
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance perm--
$1.45 for each additional$100.00 or 6,80
fraction thereof,to and including 6) Repair units
_ $50,000.00. __ _ 12.15
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. footnotes bPlnw Comp ••
Minimum Permitil Fe 572.50 SUBTOTAL; $ 7)<31-iP;absorb unit
to 100K BTU 1400
-- - 8%Slate Sll•charge $-- 8)3-15 HP;absorb --- --
unit 100k to 500k BTU _ 2560
25%Plan Review Fee(of subtotal) $_ 9)15-3U HP;absorb
Required for ALL commercial permits only unit.5-1 mil BTU 3500
TOTAL. COMMERCIAL PERMIT FEE: 3V 10)30-50 HP;absorb
unit 1-1.75 mil BTU _ 52.20
11)>50HP;absorb
unit>1,75 mil BTU 87.20
Af'SUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM
V --�- Value Total 13)Air handling unit 10,000 CFM+ -- 10.00
Desaipli�on�: , _ rlt (Eat_ Amount _ 17 20
Furnace to 100,000 8 CU,including 955 14)Non portable evaporate cooler -
ducts&vents _ 1100
00
Furnace> 100,000 BTU Including 1,170 d
15)Vent tan connected to a single duct ducts&vents 6.80
Floor furnace including vont _955 _ 16)Ventilation system not included in
Suspended healer,wall heater or 955
floor mounted heater appliance permit 10.00
Vent not included In applicance 445 17)Hood carved by mechanical exhaust
permit 1000 -
1 B)Domestic incinerators
Re air units __ 805 17.40
<3 hp;absorb.unit, 955
to 1001k BTU19)Commercial or industrial type incinerator
3-15 hp;aL:.orb.unit, - - 1,700 �- 69 95 --
101k to 500k BTU 20)Other units,including wood stoves
10.00
15-30 hp;absorb,unit,501k to 1 2.,310
21)Gaspipingona n fot outlets
mu.BTU
30.50 hp;absorb.unit, 3,400 5 40
1-1.75 mil.BTU 22)More than 4-per outlet(each)
>50 h 5,725 1.00
p;absorb.unit, Minimum Permit Fee$72.50 SUBTOTAL
>1.75 mil.BTU _ $
Air handling unit to 10,000 cfm _ 656 - -
Air handling unit>10,000 cfm 1,170 8%State Surcharge $
Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: a
Vent fan connected to a single duct 446
Vent system not included in 656
liance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
Domestic incinerator 1,170
1 Inspections outside of normal business hours(minimum charge-two hours)
�_�- _
Commercial or industrial incinerator 4,59C
$62 5o per now
2 Inspections for winch no fee is specifically indicated (minimum charge-half hour)
Other unit,includinC wood stoves, 656 $62 50 per hour
inserts,etc. 3 Additional plan review required by changes,additions or revisions to plans(minimum
Gas piping 1-4 outlets 360 charge-one-half hour)$62 50 per hour
Each additional outlet l 63
--- ---'F-- - - - *State Contractor Boller Certification required for units>200k BTU.
TOTAL COMMERCIAL $ -Residential AIC requires elle pian showing placement of unit.
VALUATION_ _ -.._ All New Commercial Buildings require 2 sets of plans.
I\dsts\forrns\meth-fees doc 02/05/02
CITY OF TIGARD 24-14our
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171 /
BUP _ —
Received __ Dale Requested _'��__ A PM _ BLIP
Location —_— ?0 _ _ _--Suite ___. MEC 3 _0 -0667
IF
Contact Person _ _ ,---_ Ph( ) c� = L PLM
Contractor __...-------._-----.---_--_-- - � _ Ph(- ) _ S`NR
BUILDING Tenant/Owner ELC
ELC
Foundation Access: '
Ftg Drain j / ELR
Crawl Drain .- i SIT
Slab Inspection otes: ---- --
Post& Beam --- --------.- -_ __ -- ^-__----
Shear Anchors -�J'—
Fxt Sheatti/ShearInt Sheath/Shear
Sheath/Shear
I yarning
Insulation
Drywall Nailing -- -- - ------
---- ------
Firewall
Fire Sprinkler -- --- --- -- - - ----- -
Fire Alarm
Susp'd Ceiling
Root
Other: ---- - - —
t=inal
PASS PARTFAIL --- -C ---- -__—_ -
—
Post& Beam �.
Under Slab — -- -
Rough-In
Water Service -- -- - —
Sanitary Sewer
Rain Drains --- -
Catch Basin/Manhole
Storm Drain - - - —�
Shower Pan
Other: -
Final _
PASS PART FAIL
----- ---------
_M_ECHANIC_A_L --
Post& Beam i-_ -- -
Rough-In --_ ..-- - --- - - —_
Gas line
SrpQ,k7 Dampers -- -- -- - - - --- —
AS,s PART FAIL ---- --- - -- -- ------ - - --
CTRICAL T
Service
Hough-In
UG/Slab
Low Voltage
Fire Alarm
Final I� Reinspection tee of$ __ __ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
PASS PART FAIL
SITE 1 Please call for reinspection RF: Unable to inspect- no access
Fire Supply Line
ADA Approach/Sidewalk Dais Inspector_L__ _ Ext
Other (,
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF T I GA R D BUILDING PERMIT
PERMIT#: BUP1999-00293
DEVELOPMENT SERVICES DATE ISSUED: 7/14/99
13125 SW Hall Blvd.,Tioard, OR 97223 (503) 639-4171 PARCEL: 2S111CC-19600
SITE ADDRESS: 10295 SW GREENLEAF TERR
SUBDIVISION: SUMMERFIELD NO.5 ZONING: R-12
BLOCK: LOT: 255 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: REP FIPST: sf N: S: E: W:
TYPE OF USE: MF SECO ID: sf PROJECT OPENINGS?
TYPE OF CONST: 5N sf N: S: E: W:
OCCUPANCY GRP: R1 TOTAL AREA: sf ROOF CONST: FIFE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOP.: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO C:ORR: PARKING:
VALUE: $ 1,00000
Remarks: Exterior structural repair- Permit fees cover(2)two individual inspections. Additional inspections subject to
re-inspection fee of$50.00 each. No C of O required.
Owner: Contractor:
DALE MAAG K CONSTRUCTION INC
10295 SW GREENLEAF TERRACE_ PO BOX 34
TIGFRD, OR 97224 NEWPORT, OR 97365
Phone: Phone: 541-764-3858
Reg #: LIC 97820
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Misc. Inspection
INSP DEB 7/13/99 $100.00 99-316783 MISC, Inspection
Final Inspection
Total $100.00
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable law. 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 the rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You
may obtain a copy of these rules or direct gyestis o OUNC by calling (503) 246-1987.
Pe nn itee
. i
Slgnaktre:
Issueld By:
Call 639-4175 by 7 p.m. for an inspection the next business day
CITY OF TIGARD Commercial Building Permit Application Recd B .;L —
13125 S'N HALL BLVD. New Construction and Additions Date Recd i9 —
� Date to P.E.
TIGARD, OR 97223 Date to DST.
(503) 639-4171 Permit 1119P/499-cx �3
Print or Type Related SWR:_
Incomplete or Illegible applications will not be accepted Called, %-,"3-99 514�0
(;�:)A-h
Name of Development/Project 1;
Job Existing Buildings New Building [
Address Street Address (.STT ,-ct A Suite
/e!? '1 s ff"C9 I Building
Bldg 0 City/State Zip Data
J/y .<'P p y 9-7 ZZ t Existing Use of Building or Property:
Name
Property
Owner Mailinq Address ��y,,,�t;f Sulte Proposed Use of Building or Property:
I<.z115
CitylSlate Zip Phone No. Of Stories:
Occupant Name Sq. Ft. Of Project:
Name — Occupancy Class(es)
Contractor Ar -"A. 5 Trc'� c /rl A- /J", �c I
Prior to permit Mailing Address Suite Type(s)of Construction
issuance,a copy
of all licensesare required if City/State — Zip Phone S Will this project have a Fire Suppression System?
expired
in7 /I'tr r'�`�7��5 I L,c --jy:s� Yes p _ No
database Americans with Disabilities Act(ADA)
---
Oregon Const Cont.Board Lfc.r1 Exp.Date I
/ Valuation X 25% = $ Participation
C/ % '/ ',f�"/ Com lete Accessibili Form
Name Project $
Architect Valuation
Mailing Address Suite _
Plans Required. See Matrix for number of sets to submit
City/State Zip Phone on back
Engineer Name J — I hereby acknowledge that I have read this applicatio i,that the information
given is correct,that I am the owner or authorized agent of the owner,and
Mailing Address �— Suite that pians submitted are in r•.ompiiance with Oregon State Laws
SignBju/r/�of�n _;," Date-7
City/Stale Zip Phone
ContacttPerson Name Phone j c
Indicate type of work' New O Addition O Demolition O X n J( Ff n�`� I! I
Accessory Structure O Foundation Only O Alteration O
Repair U Other O _ FOR OFFICE USE ONLY _
Description of work: MapfTLN Land Use: �—
_ / ✓. J A :_ 1^} 1��jr'' Notes: --
Parks_Estimated#of Employees TIF:
I if the above figure Is not supplied at the time of application,the city will --
Iccalculate the fee based upon the number of psrkln spaces
Note: Site Work Permit Application must precede or accompany Building
Permit Application
11COMNFW DOC (DST) 5'98
Y
COMI'OERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependent upon submittal of BOTH plans AND a COMPLETED
application. For an electrical submittal, the application must contain the
signature of the supervising electrician before plan review will be conducted,
After plan review approval, Plans Examiner will contact the applicant to request
additional plan sets for distribution purposes.'(Copy for Contractor, City,
Washington County, Tualatin Valley Fire & Rescue)
Total # of
TYPE OF SUBMITTAL Plans KEY:
_
Submitted
S (Private) _ S = Site Work
B (New or Add) 1 B = Building
F (New or Add or Alt) ^3J F = Fire Protection System
M (New or Add or Alt) 1 M = Mechanical
B & M (New or Add) 1 P = Plumbing
P (New, Add, or Alt) ^2 E = Electrical
B & M & P (New or Add) 2 New = New Building
E (New, Add, or Alt) 2 Add = Addition
B & F & M & P & E _ 3 Alt = Alternation to Existing
(New , Add) Building
*B or B & M (Alt) 1
*8 & M & P (Alt) 3
*8 & M & P & E(Alt) 3
*B & M & P & E & F(Alt) 3
NOTES:
*Shaded areas designate ALT submittals only.
I ldsWformslmatrxcom doc 10/30/98
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