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10763 SW GREENBURG ROAD STE B �IY�IIi I { J LO N I 10763 SW GREENBURG ROAD _ 4 SUITE-E } Lo 7= 0It4 It �. ►ru, r ' v 4 � I �t • 1 f w I r CITY ��� ©� �����® BUILDING PERMIT PERMIT#: BUP1999-00446 DEVELOPMENT SERVICES DATE ISSUED- 10/12/1999 13125 SW Hall Blvd., Tivard, OR 97223 (503) 639-4171 PARCEL: 1 S135BC-00201 SITE ADDRESS: 10763 SW GREENBURG RD B SUBDIVISION: ZONING: C-G BLOCK: LOT: JURISDICTION: rIG —REISSUE: FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION_ CLASS OF WORK: ALT —FIRST: 1,000 sf N:J S: c: W: TYPE OF USE: COM SECOND: sfPROJ_ECT OPENINGS? TYPE OF CONST: 5N sf N: — S: E W: OCCUPANCY GRP: B TOTAL AREA: sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 9 BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT": MEZ7?: REQD SETBACKS — _ REQUIRED FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKI.: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 1,500.00 Remarks: Tenant improvement. Owner: Contractor: BELANICH, ROGER M JUSTICE CONSTRUCTION BY SOUTHLAND CORP 68890 NICOLAI ROAD PO BOX 711 RAINIER, OR 97048 ORIGINAL D�, TX 75221 one. Phone: 503-556-1644 lone. Qeg#: LIC 52751 FEES REQUIRED INSPECTIONS ___ Type By Date Amount Receipt Framing Insp sp PRMT KJP 10/12/1995 $51.00 99-318994 Gyp Board Final Inspection 5PCT KJP 10/12/1995 $4.00 99-318994 PLCK KJP 10/12/1995 $32.50 99-318994 EXPIRED FIRE KJP 10/12/199E $20.00 99-318994 Total $106.50 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 wlthir, 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law rerytlir��s you to follow the rules adopted by the Cregon Utility Notification Center. Those rules are set torth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUN,, by calling (503) 246-1987. Pennitee }; r Slgnature: ,� �1.� ----- – Issued By: – Call 639-4175 by 7 p.m. for an inspection the ne:ct business day CITY OF TIGARD Commercial Building Permit Application Plan Check# 1':125 SW HALL BLVD. New Construction and Additions RecdBy_ d_____Byd__ TIGARD, OR 9722.3 rate Recd 10 -/ (503) 639-4171 , Date to P.E. /c, -/ ;Z 40-7C— Date to DST /O -/2 Print or Type Permit# incomplete or illegible applications will not be accepted Related SWR# Called_ Name of Development/Project Job I Q1 b3s.W 6meQ,v 6ak ' (2d - – Existing Building A New Building O Address Street Address Suite (p-1103S.-VJGaeevOV1.1Rd -9 h Building Bldg# City/State Zip Data Ti bAfLA 7 a.13 Existing Use of Building or Property: Name Property R '3 2,2 M. 13el ,wtcl �v � P� .Sales 3'e(LV6off Owner Mailing Address suite Proposed Use of Buildirg or Property: a2 U-10 1'7 f h RveS,t r� 40 -' u iM E��� C f ,S CO-?S f S'Mv I(-e City/State Zip Phone No. Of Stories. B o h e ti l 4d S-48s ys s Occupant Name Sq. Ft. Of Project' ��,1 C1�u�1 3. Ca. ! 00.0 Name — Occupancy Class(es)Contractor �lAs�te "����J3t,LG('�1 [? Prior to permit Mailing Address Sultp e Type(s)of Construction Issuance,a copy of all licenses (° t 8 it U N r c oL a R.d are.required It City/State Zip Phone.yp3 - Will'his project have a Fire Suppression System? expired In C O.T. Yes No database RN 1 u' R OR `47oy� 'Is(- Americans with Disabilities Act(ADA) Oregon Const.Cont.Board Uc.# Exp.Date S a -7 S) 3 I,R,�/�O Valuation X 25% =$ Participation�MP /"`�`J Complete_Access ibili Form Name Project $ Architect N �ti Valuation – Mailing Address Suite Plans Required: See Matrix for number of sets to submit City/Slate Zip Phone on back 1 Engineer Name A rl I hereby acknowledge that I have raad this application,that the Informat;on ''+ given is correct,that I am the owner or authorizer)agent of the owner,and Mailing;,ddress Suite that plans submitted are in compliance with Oregon State Laws Signature of Owner/Agent Dale Ct!y/Slate Zip Phone ��— S I,-4e U It il,C�_t lit.0 __ Contact Person Name Phone 7 Irdicate typo of work New O Addition O Demolition o .S A W A L'( °1 5 '4 3 5 4 S c Accessory S!rLiCfUrP O Foundation Only O Alteration O ____Repair r., other o FOR OFFICE USE ONLY Descriptlon of work: -- M­111a /TL# Land Use: Notes /,� Parke: Estimated#of Employees TI If the above figure Is not supplled at the time of application,the city will calculate the fee based upon the number of parklnQspacos. Note: Site Work Pei mit Application must precede or accompany Building Perrnit Application EXPIRED iAdsts\forms\comnew doc 5110199 COMMERCIAL PLAN SUBMl T TAL 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. Atter plan review approval, Plans Examiner will contact the applicant to request additional plan sets for distribution purposes. (Copy for Contractor, City, V'ashington County, Tualatin Valley Fire & Rescue) Total # of T"DE OF SUBMITTAL Plans KEY: Submitted S (Private) 1 S = Site Work B (New or Addj —1.__---- g = 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 W& 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) *ByM & P (Alt) 3 � *B & M & P & E(Altj..._._..._ .- 3 �� *B & M & P & E & F(Alt) _ 3 NOTES: *Shaded areas designate ALT submittals only. I\d9t9Worms\ma1rxcom doc 10/30198 Do n et I - j � I o ci It i �°I <tUL . !_ ( � - — L-v I. EN (�7 X N. ti (J i A • '� IR IM1 FYI►M-•� •� �- �•.•\try I�M•.w /�•� • •. —� aT r , .W -7 ' - � S_ _ \ \ t � gTE o M A r.711 f rel Jam_V 8� R^N � a GREENBURG CENTER 10105 6W GREENBURG READ TIGARD OREGON ct1G^na oa.wa Parcel IT - Misc. Shops (N(.T 7-11 ) Property T'ax 1•ot No. 81346485 A tract of .Land located fii the Northwest quart6r of Section 35, Township 1 South, Range 1 West of. the Willamette Meridian, Washington County, Oregon. As described in Hook 304, Page 99 and tiv-ik 166. Par1P 4 and Hook 529, Page 491. feed Hook Records. I d ;� i �_ �'���D BUILDING PERMIT CITY O PERMIT#: BUP2002-00352 DEVELOPMENT SERVICES DATE ISSUED: 8130102 13125 SW Hall Blvd.. Tivard, OR 97223 (503) 639-4171 PARCEL: 1S13513C-00202 SITE ADDRESS: 10763 SW GREENBURG RD SUBDIVISION: ZONING: C G BLOCK: LOT: JUR!GDICTION: TIG r` FLOOR AREAS EXTERIOR WALL CONSTRUCTION REISSUE: � — ------ – .�.—� -- CLASS OF WORK: ALT FIRSTS sf N: S: E: W: TYPE OF USE: CUM SECOND: sf _ _ PROJECT OPENINGS? TYPE OF CONST: 5N sf N:� S: E: W:� OCCUPANCY GRP: M TOTAL AREA: 000 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: GARAGE: sf OCCU SEP. RATED: STOR. Hl: ;t BSMT?: MEZZ?: _ REQD SETBACKSREQUIRED _ FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL:^ SMOK DET: DWELL-ING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 125,000.00 Remarks: Remove existing awning and facia, reconstruct a new parapet,roof drainage,relocate roof vents, mount new signage and re-roof entire structure. A separate sign permit is required. Owner:` — Cuntractor. BELANICH, ROGER M JOSEPH HUGHES CONSTRUCTION 22020 17TH AVE SE#200 7035 SW HAMPTON BOTHELL,WA 9802.1 TIGARD, OR 97223 Phone: Phone: 503-624-7100 Reg #: LIC 45F45 FEES REQUIRED INSPECTIONS –! Type By _ ^Date Amount Receipt — Electrical Permit Required Plumbing Permit Required PRMT CTR �– 8/15/02 $841.80 27200200000 Framing Insp 5PCT CTR 9/15/02 $67.34 27200260000 Final Inspection PLCK CTR 8/15/02 $547.17 27200200000 I Pre-roofing inspection FIRE CTR. 3/15/02 $336.72 27200200000 Total $1,793.03 This permit is issued subject to the regulations contained in the 1 igard 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 worts i3 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 rule:,or direct questions to OUNC by calling (503)246-6699 or 1-800.332-2344. Pe nn it tee ';�" . Signature: �� �' .— - EXPIRED Issued By: Call 639-4175 by 7 p.m. for an Inspection the next business day r _ FOR E USE*ONLY Buildinp- Permit Application Received - a /� ��, ttu�il b DateiB : I Permit No.: Planning Approval Other City' of'Tigard 'rest Form /1" Date/2y: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/13 : Permit No.: —_ Post-Rev Phone: 503-639-4171 Fax: 503-598-1960 " Date/By:y: Land Use Date/ Case No. Internet: www.ci.tigard.or.us Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information TYPE OF WORK REQUIRED DATA: Ncw construction Demolition 1 &2 FAMILY DWELLING Addition/alteration/re lacement Other: CATEGORY OF CONSTRUCTiC.'I Note: Permit fees*are based on the total value of the work performed. Indicate ❑ 1 & 2-Famil dwelling Commercial/Industrial the value(rounded to the nearest dollar)of all equipment,materials,labor, Y overhead and profit for the work indicated on this application. [� Accessory Building Multi-Famil Other: valuation•................................................ Master Builder ....... $ -----. No. JOB SITE INFORMATION and LOCATION Totall arsbedrooms: No.of baths: - numberof(so ..................................... Job site address: /O7(i3 _ _ _ New dwelling area(sq.fl.).................•...•.......• Suite#: 131d=./A t.#: Garage/carport area(sq.1t•)....•....................... Project Names Covered porch area(sq.ft.)............................. Cross street/Directions to job site: --Wetla?/rE ge Deck area tar area.. .......)............................ _ C���G„ ��• ` �/�r,�� Other structure area(sq.ft.)....... ................. .. REQUIRED DATA: _ __ COMMERCIAL-USE CHECKLIST Subdivision: _ Lot#:2t'D Tax map/parcel #:/ Note: Permit Ices•are bused on the total value of tha work performed. Indicate the vuluc(rounded to the nearest dollar)o.`ai equipment,materials,labor, DESCRIPTION OF WORK overhead and prolit for the work indicated on this application. ,� ►�. �/(��—�._JLAAWM If.Clc Valuation....... ........................•...................... $ Existing building area(sq.ft.)......................... _ �• �—� / N�w New building area(sq. ft.)............................... / G Number of stories............................................ PROPE 1'01VNER TENANT Type of construction....................................... _ _✓_ Name: e"0V Occupancy group(s): Existing: New: Address: 210_10 _{ _ --- Cit /State/Zi : a �� NOTICE: All contractors and subcontractors are required to be Phone, licensed with the Oregon Construction Contractors Board under APPLICANT------7T�� -1 JX CON'rA–CTT PERSON provisions of ORS 701 and may be required to be licensed in the Business Name: ♦j edW5 _ jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing,the following reason epplies: Address: City/State/Zip: I JAp —� Phone: � �Tax: _. S BUILDING PERMIT FEES* E-mail: kF Please refer to fee schedule. CONTR OR — -------------- -- Business Name: Fees due upon application.............................. Address: C G.+GI� _`;`� Cit /State/Zi g� Amount received............................................. 5-------- Phone: 'aX. 7 Date received:_.___ CCB Lic. -- r Notice: This permit application expires if a permit Is not ohtalned Althin f( Authorized..�� `lam` !_/C,CZ 180 days after It ha+been ac:epted as eom.'-le. Signature: �i _/ Date:_CJ *Fee methodology set by Trl-County Building Industry Service Board. (Please print name) EXPIRED i Commercial Plan Submittal Requirement Matrix Citi,of Tigarvl TYPE OF SUBMI''TAL # of Plans (Includes New, Additions cr Alterations) Required at Submittal Site Work (must include location of all accessible parking) Plumbing - Site Utilities 2 Building �* Fire Protection System 3** Mechanical 2 Plumbing - Building Fixtures 2 Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, tlh 'Tans Examiner will contact the applicant to request additional sets of plans ;.)r distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). *For over-the-cr inter (.nmmercial tenant improvements, submit 2 sets of plans. **"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level 1" technicians. 1Ad9t.slforrns\C0M-matr1x.doc 9/24101 '1 ELECTRICAL PERMIT- / \ CIT' C�, F TaIi.7ARD RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT#: ELR1999-00238 13125 SW Hall Blvd., Tigard, OR 97223 (5031639-4171 DATE ISSUED: 10/11/99 S11 E ADDRESS- 10763 SW ( PI LN13URG R17 B PARCEL: 1S135BC-00201 SUBDIVISION: BLOCK: LOT: ORIGINAL JURISDICCTION: TIG Proiect Description: Installation of data telecommunication system. A.RESICENTIAL_ _ B.COMMERCIAL_ – AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM- BOILER: 1_ANDSCAPEIIRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: X NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: TOTAL#OF SYSTEMS: Owner: Contractor: ROGER M. BELANICH A-REBS COMMUNICATIONS INC BY SOUTHLAND CORP 5855 SW TARALYNN AVE PO BOX 711 BEAVERTON, OR 97005 DALLAS,TX 75221 Phone: Phooe: 520-0625 Reg 9: ELE 2430RET I_IC 86096 FEES Required Inspections _ Type lay Date Amount Receipt Low Voltage Inspection PRMT DEB 10/11/99 $60.00 99-318974 Elect'l Final 5PCT DEB 10/11/99 $4.80 99-318974 Total $64.80 EXPO F^ This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Coles and all other applicable laws. A!I work will be done in accordance with approved plans. This permit will expire if work is not stgfted within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law req res you to Poll rules adopted by the Oregon Utility Notificatiun Center. Those rules are set forth in OAR 95 -001-0010 throug 95 001-00 0. You may obtain copies of these rules or direct questions OUNC at (503) 24 -1987. Iss d by I _ Permittee 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: CONTRMCTORANSTALLATION ONLY —_ —--- — SIGNATURE OF SUPR. ELEC'N ( Lzr:K DATE: LICENSE NO: -- -- —� Call 639-4175 by 7:00 P.M. for an inspection needed the next business day r_Z�ACITY OF TIGARD RESTRICTED ENERGY ELECTRICAL- APPLICATION Recd b 13125 SW HALL BLVD Date Recd: �- TIGARD OR 97223 F'RINT OR IYT'C V- 503-639-4171 X304 Permit#: F -503-598-1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS CustCall'd WILL NOT BE ACCEPTED Name of Development Project TYPE OF WORK INVOLVED-RESIDENTIAL. ONLY Restricted Eaergy Fee........................................ $60.00 _ S S L rM� I (FOR ALL SYSTEMS) JOB Street Address Ste# ? ADDRESS 10Check type of Work Involved. 7 � ' �.% L)r`E�1� d.c>�, l-'_ City/StateZip Phone# F-1 Audio and Stereo Systems -- -- Ti '�_ c177 Z t� Name Burglar Alarm M ICNgC,L f1• 4 r� -- Garage Door Opener- OWNER Mailing Address City/,, :SLI.; ❑ Heating,Ventilation and Air Conditioning System" Cilate Zip Phone#V L ---— TIC.v�rzD �S? 1Z.2Z yLjsY.`1 NameII ❑ Vacuum Systems' Air cam'S Cc rvrt r11 I NL ❑ Other-- --- - -- - CONTRACTOR Mailing Address r- `' .0 c, _-rAR.ALV AJAJ AJC: TYPE OF WORK INVOLVED -COMMERCIAL ONLY (Door to issuance a Cit /State y ;ip Phone# Fee for each system............................................. E60.00 copy of all licenses Bc../�t1L(LTcri hk)5 341 OC,LS (SEE OAR 918-260-260) are required if Oregon Arltr. Brd Lic.# Exp. Date expired in C O T _ (j _ -Lj Check Type of Work Involved data base) Electrical Contr.Lic # Exp. Date Z � HCI i tO ► -i''" ❑ Audio and Stereo Systems C O.T.or Metro Lic.# Fxp Cate ❑ Boiler Controls Owner's Name 7- —__—` __ ❑ Clock Systems OWNER - Mailing Address APP; ICANT Data Telecommunication Installation City/State Zip Phone# ❑ Fire Alarm Installation This para. , issued under OAE 918-320-370 This applicant agrees to ❑ make unl, estricted energy installations(100 volt arrps or less)under this HVAC permit atid to do the following ❑ Instrumentation 1 Only use electrical licensed persons to de installations where required. Certain residential and other transactions are exempt from licensing ❑ Intercom and Paging Systems These have asterisks(') All others need licensing, 2 Call for inspections when installation under this permit are ready for Landscape Irrigation Control' inspection at 503-639-4175; L—� Medical 3 Purchase separate permits for all installations that are not ready for an +t^y'Nurse Calls P E inspection when the inspector is out to inspect under this permit, ❑ 4 Assume responsibility for assuring that ail corrections required by the ❑ Outdoor Landscape Lighting* inspector are done,and; I ❑ Protective Signaling 5 Assume responsibility for calling for a final inspection when all of the _ corrections are completed U Other Permits are non-transferable and non-refundable and expire if work is riot started within I RO days of issuance or if work is suspended for 180 days. Number of Systems The person signing for this permit must be the applicant or a person No licenses are required Licenses are required for en other installations authorized to bind the applicant FEES: e*' 1— Signature E TFR FEES $� ev ?(") W SURCHAR(3F.(.05 X TOTAL ABOVE) $ Authority if other than Applicant TOTAL $ i Wstskfo<msbesele doc 3/98 �� / CITY OF TIGARD BUILDING INSPECTION DIVISION M3T — 21-Pour Inspection Line. 639-4175 Business Line. 639-4171 BDP — Date Requested w � AM PM _ BLD Location/0' '/�Eng�_�: Suits „ ---- rAEC — C / . Ph (0 �� PLM Contact Person �eU �ti'¢_-- —�- — Contractor Ph SWR _ ELC �`t ( BUILDING Tenant/Owner Retaining Wall ELR Footing Access: ��LL I FPS Foundation �to i -- Fog Drain Sf;N �— Crawl Drain Inspection Notes' Slab SIT _--- - Post&Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing - Firewall Fire Sprinkler - -- Fire Alarm - •� .S s' Susp'd Ceiling - -e� Roof Misc: -- -T -- Final - - - PASS PART FAIL PLUMBING - - - �Post&Beam Under Slab -- Top Out -....._�---------- -- Water Service ----- Sanitary Sewer _ Rain Drains Final PASS PART FAIL -MECHANICAL-- Post&Beam --- - Rough In Gas Line Smoke Dampers - --- - -- _-- _ Final - P RT FAIL CTRIC Low Voltage Fire Alarm ---- -- `� ' SS ART FAIL ------� - Backfill/Grading -- Sanitary Sewer Storm Drain ( }Reinspection fee of$_—_ required befannspection, Pay at City Hall, 13125 SW Hall Blvd Catch Basin ( ]Please call for reinspection RE _ -__ I)]Unable to Inspect-no access Fire Supply Line ADA Approach/Sidewalk ac Inspecir�r Ext �,[� Date -__ Ocher �_ ��� ...-- Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PI-M2001-00606 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/16101 PARCEL: 1 S135E3C-00202 SITE ADDRESS: 10763 SW GREENBURG Rn SUBDIVISION: ZONING: C G -----.BLOCK: LOT:--.----------JURISDICTION::rIG CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 0CCUP4NCY GRP: M FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: —� —SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE. ft DISHWASHERS: RAIN DRAIN: 20 ft Remarks: Replacing 20'of storm sewer line. FEES Owner: Type By Date Amount Receipt BELANICH, ROGER M PRMT CTR 11/16/01 $72.50 27200100000 1.2020 17TH AVE SE #200 5PCT CTR 11/16/01 $5.80 27200100000 BOTHELL,WA 9802.1 Total $78.30 J Phone 1 Contractor: NORTHWEST EARTHMOVERS INC PO BOY. 1467 TUALATIN, OR 97062 REQUIRED INSPECTIONS Storm Drain Insp Phone 1: 503-624-0363 Final Inspection Reg #: LIC 62.761 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You,may obtain cgpies of these rules or direct questions to OUNC by call;ig (503) 246-1987. Iss d By: /\ , Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the nbxt business day Plumbing Permit Applicafiion "Date-teccived: Permit no.: City of Tigard Sewer permit no.: Buildin¢permit no.: Address: 13125 SW Iiall Blvd,Tigard,OR 97221 CiryoJTigard Phone: (503)639-4171 projecUappl.no,: Expire 't: : Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: __. _ Case rile no.: Payment type: 1 &2 family dwelling or accessory Commercial/industrial Ll A Tenaw implovernenl 0 New construction6lj� Addition/al,'erariorUreplacemenl Q food�crvice J()Ther: 1 •� SW V cab - Description Qty. Fee(ea.) Total Job dress:W3 u -- - Ne" I-and 2-family dwellingF only- Bldg. nly Bldg.no.: i'lte no.: (inclndrw too 0.foreachutility connection) Tax map/tax lotlaccountno.: 134.5405 SI 1R(1)bath Lot: ---Block: Subdivision: _ SFR(2)bath Project name _ _ SFR(3)bath City/county: ZIP: Each additional bath/kitchen Descriptiod anon of work on premises: a SlteutNitles: Catch basin/area drain Est.date of completao inspection: D wells/leach lite trench drain Footing drain(no.lin. ft.) 1 Manufactured home utilities Business name: or4 .-1-k 77 Manholes Address: Rain drain connector City; -�— ( f State: ZIP: '1c�t 2 Sanitary sewer(no.lin.ft.) _— ,,, u ,,n Phone: Fax:�y,7 e63-41E-mail: Storm sewer(no. ft.) �'�`E- ��� Water service(no..lin.ft.) CCB no.: G.z 7G I Plumb.bus.reg.no: - Fixture or item: City/metro tic.no.: (;,q.3 Absorption valve Contractor's representative signature: _ Back-flow preventer Print name: n Date:/c Backwater valve Basins/lavatory antc: Clothes washer N l= L`' --- _ --- Dishwasher _ Address_ — c& Drinking fountain(s) City: _ Statc:,,:;� ZIP: I Ejectors/sump Phone: Fax:(,,J? /(, E-mail: Expansion tank Fixture/sewer cap Floor drains/floor sinks/huf; Name(print): _ Garbage dis oral _ _ — Mailing addr.as: _ Hose Bibb City; _ State: ZIP: Ice maker Phone: _ Fax: E-mail: Interceptor/grease trap _ Owner installation/residential maintenance only: The actual installation Primer(s) _ will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) — Owner's signature: Date: Sum Tubs/shower/shower pan Urinal Name: A off„ Water closet _ Address: __ Water heater City: a _ Statet� ZIP:�7zx Uthcr: Phone: c S Fax:dSZ i'i: 3 E-mail: Total Minimum fee................$ _ 7�� v FNot all Jurlsdl aom accept credit cards,please call jurisdiction for more infortnation. Notice:Ibis permit apltlleation ise U Master(and Plan review(at _ %) expires if a permit is not obtained State surcharge(8%)....$ Credit cud rumba _ _ _--_--- - L_- within 180 days alter it has been rixpimr .. � Neme of cardholder u shrnvn on credit card—�--� eceepM�l as complete. _ TOTAI. ..................... $ �_. - S — Cardholder tipWure —Atrnmm to talr,trvtYvt'nat PLUMBING PERMIT FEES: PRICE TOTAL New li and 2-family dwellings only: - PRICE TOTAL FIXTURES Individual QTY ea AMOUNT (includes all plumbing fixtures In ---�-- - - '-'- the dwelling and the first100 ft. QTY (ea) AMOUNT Sink 16.60 _ for each utlli connection _ __ 16.60 $249.20 Lavatory - _- Une i1 ba) th -_- - Tub or T ublShower Comb 16.60 Two 2 bath $350.00 16.60 Three 3 bath $399.00_ _ Shower Only Water Closet - 16.60 _SUBTOTAL - - Urinal - 16 60 __8'/.STATE SURCHARGE Dishwasher 16.60 - PLAN REVIEW 25'/.OF SUBTOTAL �- TOTAL Garbage Disposal ---- 16.60 -- Laundry Tray - 1660 Washing Machine 16.60 F. Drain/FloorSink 2" 16.60 PLEASE COMPLETE: 3" -- 16.60 4,. 16,60 - Quanti�b Work Porformed _ Water Heater O conversion O like kind 16.60 Fixture Type: New Moved Replaced Removed! Gas piping requires a separate mechanical - _i Capped permitSink -- IviFG Homo New Water Service 46.40 - 46.40_ Lavat�or -� - ----- ------ MFG Home New san/Storm Sewer Tub or Tub/Shower Hose Bibs 16.60 -_ Combination - -- Roof Drains 16.60 _ Shower Ong - 16.60 Water Closet Drinking Fountain - -- Urinal --_ Other Fixtures(Specify? 1660 Disnwasher Garbo a Disposal --- -- - Laundry Room Tr a - ___ _ -- Washing Machine - - _ Floor Drain/Sink: 2" -- sewer-1st 100' 55.00 - 3" _- Sewer-Hach additional 100' 46.40 4" _ -- 55.00 Water Heater - Wator Service-1st 100 _ - Other Fixtures Water Service each additional 2.00' - 46.40 (Specify) Stomi R Rain Drain-1st 100' 55.00 -- - Storm&Rain Drain-oach aVDev1ce 100' 46.40 `- Commercial Back Flow Prevevice 46.40 -- Residential Backflow Preveice' 27.55 --- - -� Catch Basin16.60 - inspection of Existing Plumpecially 72.50Re uesled Inspections _ -_ er/hrCOMMENTS REGARDING ABOVE:Rain Drain,single familydw65.25Grease Traps `- 16.60OUTOTALIsornetric or riser diequired if - - -- Ouantl�Total is >9 __-- _- -- - "SUBTOTAL 8%STATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL Required nniy if nxture Molal is>9 - - TOTAL S 'Minimum permit fee Is$12 50•6°b stale surcharge,except Residential Backflow Prevention Devi:.e,which is$36 25+s%state surcharge "All New Commercial Buildings require 2 sets of plans with Isometric or riser diagram for plan review. i:\dsts\forms\plm-fees.doc 08/29/01 NORTHWEST E-ARTHMOVERS, INC. PO BOX 1 467 /� TUALATIN, UR 97062 NORlN.1ET I Tt PHONE' (503)624-0363 Orif M O J FAX: (503)639-1634 DATE: 1 /17/02 ------------- TO: CITY OF TIGARr) FROM. R ATTN: MIKE WHITE CRAIG SMELTER r PHONE: 503-639-4171 PLANNING PROJECT.' Roger Belanich Storm Sewer Repair ,JAN 2001 MESSAGE:' F'Vhefol�lowing ike: are pictures of the repair made to Roger Belanich's storm sewer which was damaged by the roots of the tree in the picture. The repair was done on December 6,2001. Eric with City of Tigard stopped by the site and got permission from you to have us take pictures and then submit them to you who would then submit them to plumbing inspection for approval. If you have any questions please give me or Steve McCallum a call. Thanks, Craig Smelter CITYOF TIGARD _ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00606 DATE ISSUED: 11/16/01 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1 S135BC-00202 SITE ADDRESS: 10763 SW GREENBURG RD SUBDIVISION: ZONING: C G BLOCK: LOT: _ _ JURISDICTION: TIG CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS. CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE_1 RAPS: LAVATGRIES: OTHER FIXTURES: TUBISHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: 2.0 ft Remarks: Replacing 20'of storm sewer line. FEES _ Owner:_ ---- Type By Date Amount Receipt BELANICH, ROGER MPRMT CTR ! 11/16/01 $72.50 27200100000 22020 17TH AVE SE#200 5PCT CTR 11/16/01 $5.80 27200100000 BOTHELL, WA 98021 Total $78.30 Phone 1: Contractor: —_ NORTHWEST EARTHMOVERS INC, PO BOX 1467 %ova, TUALATIN, OR 97062 REQUIRED INSPECTIONS Storm Drain Insp Phone 1: 503-624-0363 Finan Inspection Reg #: I IC 62761 This permit Is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of iSSL,ance, or if work is suspended for mor than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952.0001-0010 through OAP. 952-0001-0080, You Pray�O fatn--pies of these rules or direct questions to UUNC by calling (503) 246-1987. Issued By _ _ Permittee Signature: l _/ Call (503) 639-41TS by 7:00 P.M. for an inspection needed then xt business day BU 1) - Buildin Permit ELC - Electrical Permit Inspection Descri tion Date Passed By Ins ection Description Date Passed By— ion /SetMa Underground cover _ Wall cover Foundation walls Ceilingc -- Footin drain _ Electrical rough-in _ Wate roof bsme walls Electrical service -- Slab — Electrical final Crawl drain Underfloor r insulation post/beam structurali Shear walls/anchors - Restricted Ener Permit + Roof nailing,._ TEILectrical n Descri tion Date PassedNB Firewall voltage Tilt-u anel final Masonry/Reinforcement — ----------- Framiny� __ MFG-Structure set-u MEC - Mechanical 1'ern1it Insulation _ as ection Descri tion Date Passed B Drywall nailing Post/bearr mechanical Sus ended ceilin Gas line Ev ineere_ d soils` Mechanical rou h-in Weldin Lab Final ____-- Fire damper _ Concrete_ Lab Fina_ 1 __. Duct work Boltin Lab Final Smoke detector r__._ Structural observation Mechanical final 1 - Fire rooftn Lab Final Final ins ection _!- _ PLM - Plumbing Permit Inspection Descri tion Date Passed B BUP– Fire Protection c stem Permit _Plumbin underslab — Ins ction Descri tion Date Passed B Crawl drain Srinkler underfloor/slab Post/beam lumbin r S rinkler rou h-in Plumbin to -out_ S rinkler final RP/backflowpreventer Fire alarm final Rain drain Storm drain -- Water service — 5anitar—y sewer -- SIT - Site Permit -- _ Ins etion Descri tib on _ Date Passed B ___ Culvert/catch basin — _ Pum /fill ae tic tank___ _— Footing_g __ — Plumbin finalFoundation walls walls S rinkler sines S rinkler_ underfloor/slab_ Catch basin/Manhole SWR- Sewed Permit Engineered soils Ins ection Uescri tion— DatePassed B Sanitary sewer Engineerin ecce Lance - Final ins ection _ Final ins ection – --- -- - BUP M PLM, StVl2, ELC, ELR, EC, SIT Permits Inspection Record i:\dsts%forms\InspRecordHUP.doe 04/17/01 CITY �� �I���� ELECTRICAL PERMIT _ PERMIT Ar: EL.0 1999-00631 DEVELOPMENT SERVICES DATE ISSUED: 10,'25/1999 13125 SW Hall Blvd.. Tivard, OR 97223 (503) 639-4171 PARCEL- 1S13513C-00201 SITE ADDRESS: 10763 SW GREENBURG RD B SUBDIVISION: ZONING: C••G BLOCK: LOT : JURISDICTION: TIG Proiect Description: Installation of a 200 AMP service/feeders and thirteen (13)branch circuits for a tenant improvement. RESIDEN-1 iAL UNIT _ TEMP SRVC/FEEDERS MISCELLANEOUS__ 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: �^ EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNALIPANEL: i MANF HM/ SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): —SERVICE/FEEDER BRANCH CIRCUITS — — ---� --__ ADD'L INSPECTIONS 0 200 amp: 1 W/SERVICE OR FEEDER: 13 PER INSPECTION: T 201 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ PLAN REVIEW_ SECTION 1000+ amp/volt: A >=4 RES UNITS: > 600 VOLT NOMINAL__ —Reconnect only: SVC/FDR >=225 AMPS. CLASS AREA/SPEC OCC: Owner: Contractor: BELANIGH• ROGER M CITY ELECTRIC +SUPPLY CO BY SOUTHLAND CORP 8070 SAN NIMBUS AVE PO BOX 711 BEAVERTON, OR 97008 DALLAS, TX 75221 Phone: Phone: 641-8012 Reg #: SUP 3592S I_IC 42422 ELE 26-289C FEES Required Inspections _ —Type By Date Amount Receipt Elect'I Service 5PCT DST 10/25/199E. $10.70 99-319296 Elect'I Final IDRM-T DST 10125/199f $133.80 99-319296 Total $144.50 ORIGI This Permit is issued subject to the regulations w.itained in the Tigard Munidpal Code,State of OR Specialty Codes and all other applicable laws All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,or if work is suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adoptee by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules or direct cloestions to OUNC at(503) 246-1987 PERMITTEE'S SIGNATURE,> O � ISSUED BY: O NER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale., lease, or rent. OWNER'S SIGNATURE: _ — DATE:A _ CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: �'�1' �� DATE: LICENSE NO: Call 639-4175 by 7:00pm for an inspection the next business day Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. /C Tigard, OR 97223 Permit # . F66J 1 �1-- ------ Date issued ____—_---------- Phone (503) 639-4'171 i FAX (503) 684-7297 CITY OF TIGARD TDD No. (503) 684-2772 Inspection (503) 639-4175 - — ---� 9. .lob Address: 4. Complete Fee Schedule Eelow: Number of inspections per permit allowed Name of Development_ ----- I ' SiItems Gostreal um ��� Address !U'�a►,J Gr.w•be«._P�. +Q Service included 1 -�T^ 4a. Residential -per unit a 4 C'.ity/StatelZip__,�C 1 --- — 1000 sq ft. or less --_- --- Each additional 500 sq ft or g25 pn Name (or name of business) f G ' -- ponlon thereof -- $2500 Limited Energy Cr171r11P,rC1alX Residential Each Manu1'd Home or Modular _ $6800 Dwelling Service or Feeder 2a. Contractor installation only: 4b. Services or Feeders p G� n Instalietion,alteration,or reioratron $60 00 2 Electrical Contractor-/�,,.�! 200 amps or lees _� E20 00 2 � 201 amps l0 400 amps 2 Ad�ess ��7t� =—h�-� _ $18000 401 amps to 800 amps 2 E 180 00 CIty11 L State _ ZlpiN- - 601 amps to 11100 arnps 2 .L� E340 00 one NO. � �12' — Over amps or pmt° Eso 00 2 Ph Reconnect only Jab NiJ._ — L _�-7 f� 4c.Temporary Services or Feeders contractor's license NG. Installation,alteration,or relocation Contractor's Board Reg. No 200 200 amps or less _— -- Signature of Su r. Elec'n_ 201 amps to 400 amps _T_ $?5t5o o0 - E'5 00 License No. � _-— Phone p._(;�I I-�5 �_ 401 amps to 600 amps -- $110000 < over 600 amps to 1000 vo%s see"b"above 2b. For owner installations: 4d. Branch Circuits Print Owner's Name_----- -- New,alteration or extension per pone I a1 The fee for branch circuits with Address - purchase of service or feeder fee., •, $5 00 State Zip Each branch circuli -�1-�- to The lee for branch circuits wlfhout Phone No.-- purchase of service or feeder fee. The installation is being made on property I own which is Firsi branchcircult $3500 not intended for sale, lease or rent. Each additional branch circuit $5 00 _—— 4P Miscellaneous Owner's Signature,__..__ -- -- -- —" (Service or feeder not Included) Each pump m IrigMlon circle $4000 3. Plan Review section (if required): Each sign or out'ne lighting $4000 ____-- Signal circult(sl or a limited energy $4000 Please check appropriate item and enter fee in rection 613. panel,alleratinn or extension $10000 Minor Labels 1101 4 or more residential units in one structure Service and feeder 225 amps or more 4f. Each additional inspection over System over 600 volts nominal the allowable in any of the above $3500 _Classified area or structure containing special occupancy Per inspe tion $5500 as described in N.E.0 Chapter 5 Per hour -- $5500 In Plant —' Submit 2 sets of plans with application where any of the above Fees: ` I apply. Not required for temporary construction services. 5a f ntNr total above fps $ --nI 1 NOTICE ,",', Surcharge (�"7C iota' fees) Subtotal / woe,(+ $ Enter 25% of lin r PERMITS BECOME VOID IF WORK OR CONSTRUCTION r�b. clan Review it required (Sec 31 $ AUTHORIZED IS NOT COMMENCED WITHIN 160 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS .. Trust Account N $ COMMENCED F? $ - alance Iran f< , �� ®C ������ ,_ MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: 1/7/03MEC22-00531 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED13 PARCEL:: 151315BC-00202 SITE ADDRESS: 10763 SW GREENBURG RD SUBDIVISION: ZONING: C-G BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: OCCUPANCY GRP: 3 VENTS W/O APPL: VENT SYSTEMS: STORIES: _BOILERS/COMPRESSORSHOODS: _ FUEL_TYPES_ 0 3 HP: DOMES. INCIN: I I'G 3 15 HP: COMML. INCIN: MAX INPUT: BTU 15 -30 HP: REPAIR UNITS: FIRE DAMPERS?: 3U - 50 HP. WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: 3 _ AIR _HANDLING UNITS OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 10600 cfm: Remarks: Replacement of(3) Rooftop Units ani,', Raise & Support Existing Gas Piping Owner: FEES BELANICH, ROGER M Description Date Amount 22020 17TH AVE SE #200 �n9LC{'LNI Plan Itc\ 1/7103 $18.13 BOTHELL, WA 98021 1 [hiL'CH] Permit t�cr /7/03 $72.50 1 I',1\] 9'1i,StateTax 1/7/03 $5.80 Phone: Total $96.43 Contractor: _ COMFORT AIR INC 3634 SE POWELL BLVD PORTLAND, OR 97202 REQUIRED INSPECTIONS __________ Gas Line Insp Phone: 236-6929 Mechanical Insp Reg #: LIC 00004307 S.D. Shut-down inspection Final Inspection f his permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore Specialty Cafes and all other applicable laws. All work will be done in accordance with approved pans. This permil will expire if work is not started within 180 days of issuance. or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rule; adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 Issued By: 't tte� _c Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for inspections needed the nekt business day Mechanical Permit Application Date received: // Pertnitno.I'ti1 t; . J� City of TigardProject/appl.no.: Expire date: Crna(7ignrA Address: 13125 SW Hall BI SI Z Date issued: By: -. ' Receipt no.: Phone: (503) 639-41;1 Fax: (503) 598-1960 NOV 2 5 1002 Case file no.: Paymenttype: \ Land use approval: _ Building permit no.: N "&! y dwelling or accessory .I�-&rrimercial/industrial U Multi-family U Tenant improvement uction U Addition/a teration/replacement U Other: iii�§]W KUM11-13 R1,11 Fill I R rfommillimilq WINNOW 611MI-IUNM Job address: /� J �r / / •� Indicate equipment quantities in boxes below.Indicate the dollar Bld .no.: Suite no.: value of all mechanical materials,equipment,labor,overhead, g _-- profit.Value$ /(,67- -0 Tax map tax lot/account no.: _ Lot: Block: _ Subdivision: *See checklist for important application information and Project name: �<ir= �i� r lr,� �s - jurisdiction's f'ee schedule for residential permit fee. 1 City/county: /i ZI�1 ') 2 3 Description and location of work on premises:_ 1, + ' t t t L c-/f S ` 1 t�fr(lu.) total Est.date of completionlinspection: / - /�• (%,? Dcxri tion "y. Ites.unh Res.only Tenant improvement or change of use: Air handling unit Is existing space heated or conditioned?&,Yes U No Air con it oning(site p an require ) (� Is cxislin�space insulated'?U Ye,; U Nn terationofexrsting MECHANICAL CONTAWFOR of er compressors State boiler permit no.: Business name: __ HP --Tons—BTU/14 Address: ' ! _W1 Firelsmoke damper uct smo a etectors City; State' , ,, ZIP:�P7 2 J� eat pump(snc p an require ) Phone: Wil. ) Fax: i �'�' E-mail: ncl replace urnace nt lin r BTUIH Including ductwork/vent liner O Yes U No CCB no.: ;Z3G'' nsta rep ace re ocate eaters-suspen ed, City/tnetro lic.no.: - wall,or floor mounted Name(please print): = ;/,, Vent for a lance other than furnace r Rent on: Ahsorptionitnits,_ BTU/H _Name: Chillers HP -- - _- � Compressors- HI' _ Address' e Environmental exhaust and ventilation City Slate: ZIP_- Appliance vent Phone: Fax: E-mail: ryerex aTi ust ext s,Type res.kite)ert/6azmat hood fire suppression system Name S - Exhaust fan with single duct(bath fans) _Marling address: ,.,!r' � n .x gust system an a cart from heating(u1g nr AC • � •ue p p ng an st ut on(up to ourlcts) City: /f / State: ,/. ZIP: Type; LPG NQ (til Phone: ,P - ?/ Faxes yRJ-J;' E-mail' vel i ingcac a itiona over 4 outlets _ rocesspiping(sc tematicrequire ) Numhcr of oullets _ Name: _ ikir Usied appilonce or eqa pment: Address: Decorative fireplace City: State: ZIP: nsett-type Phone: I Fax: E-mail: no stov pe etstuve Other. — Applicant's signature: _ Date: ter: _ Name (print): Na all jurisdictiotts rcept credit cutis•plew cell jurisdiction rtx more inhxntation Permit fee.....................$ Notice:This permit application Minimum fee................$ U Visa U MasterCard expires if a permit is not obtained � ,_ Plan reVICW(al __ %) $ Credit cardnumher --� �xp� within IRO days after it has been State surcharge(8%)....$ Namecar I r�as inn on credit c -- accepted as complete. $ TOTAL ....................... Cardholder oyisture �� — Amouni 410.4617(6MWOM) MECHANICAL. PERMIT FEES COR''.ERCIAL FEC 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 nlY (Fa) Amt $5,001.00 to$10,000.00 $72.50 for the first 55,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional$170.00 or including ducts&vents 14.002) Furnace 100,000 BTU+ fraction thereof,to and inclucl'ng Including ducts&vents 17.40 $10000.00. - $10,001.00 tc$25,000.00 $148.50 for the first$10,000.00 aild 3) Floor Furnace Including vent 14.00 $1.54 for each additional$100.00 cr 4) Suspended heater,wall heater traction thereof,to and including p 14.00 $25,000.00. or floor mounted heater _ $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 rad 5) Vent not included in appliance permit 6.80 $1.45 for each additional$110,00 or fraction thereof,to and Including 6) Repair units 12.15 _ $50,000.00. $50,001.00 and up $742,00 for the first$50,000,00 and Check all that apply: Boller Heat Air $1.20 for each additional$100.00 or For items 7-11,see orr Pump Cond _ fraction thereof. footnotes below. Comp $ 7)<3HP;absorb unit Minimum Permit Fee$72.50 SUBTOTAL to 100K BTU 14.00 8)3-15 HP;absorb 8%State Surcharge $ unit 100k to 500k BTU 25.60 9)15-30 HP;absorb 2,•/.Plan Revlew Fee(of subtotal) $ unit.5-1 mil BTU 35.00 Required for ALL commercial permits only 10)30-50 HP;absorb TOTAL COMMERCIAL PEPMIT FEE: $ unit 1.1.75 mil BTU 52.20 _ 11)>50HP;absorb -- �- unit>1.75 mil BTU 87.20 12)Air handling unit to 10,000 CFM ASSUMED VALUATIONS PER APPLIANCE: 10.00 Value Total 13)Air handling unit 10,000 CFM+ Descrl Bon: Q� Ea Amount _ 17.20 Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler ducts&vents 10.00 Furnace> 100,000 BTU Including 1,170 15)Vent fan connected to a single duct ducts&vents _ 6.80 Floor furnace Including 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 appliance 445 10.00 permit 18)Domestic Incinerators Repair units _ 17.40 805 <3 hp;absorb.unit, 955 19)Commercial or industrial type Incinerator to 100k BTU _ 69.95 3-15 hp;absorb.unit, 1,700 20)Other units,Including wood stoves 101k to 500k BTU 10.00 15-30 hp;absorb.unit,501 k to 1 2,310 21)Gas piping one to four outlets mil.BTIJ 5,40 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) 1-1.75 mil.BTU _ 1.00 _ >50 hp;absorb.unit, 5,725 Minimum Permit Fee 572.50 SUBTOTAL: $ >1.75 mil.BTU _ - Air handling unit to 10,000 cfm 656 8%State Surcharge $ Air handling unit>10000cfm 1,170 _ Nble eve orate cooler 656 TOTAL RESItJENTIAL PERMIT on- ortaFEF.: $ Vent fan connected to a single duct -448 - Vent system not Included in 656 _ appliance perrult _- Other Ins c Ione and Fees: Hood served by meC`lanIC81 exhaust 858 1 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 In,pections for which no fee�s specifically indicated (minimum charge-half hour) Other unit,including wood stoves, 656 $62 50 per hour Insertsie(c. 3 Additional plan review required by changes,additions or revisions to plans(minimum Gag I in 1 4 outlets 360 charge-one-half hour)$02.50 per hour Each additional outlet 83 'State C.mtractor Boiler Certification required for units>200k BTU. "'Residential AIC requires site plan showing placement of unit. TOTAL COMMERCIAL -1:1S VALUATION: _ All New Commercial Buildings require 2 sets of plans. i:\dsts\forms\mech-fees.doc 02/11102 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DWISION Business Line: (503)639-4171 BUP --- _- Received - Date Requested_ _ r _ AM__ PM_ BLIP Location w ' suite _ PAEC Contact Person Ph ) z -�`�` ���` PLM SWR Contractor __.__.-�_ — __ Ph(____—_) --_ BUILDING Tenant/Owner -_ -- ELC -_ Footing ELC — Foundation Access: Ftg Drain ELR Crawl Drain Slat) Inspection Notes: .�-� SIT __-- Post&Beam =77} Shear Anchors - Ext Sheath/Shear 0 1 e _-- Int Shoath/Shear Framing --- - - - Insulation Drywall Nailing _.- __ -- -- -__. _ --- ----- ----- -- Firewall Fire Sprinkler -- - - - Fire Alarm Susp'd Ceiling -- - Roof Other: Final ----- -.__..---- PASS PART FAIL -- ---- - -.-__------- ------------ ----- _-- PLUMB-ING Post& Beam - Under Slab - --- -- - -------- Rough-In Water Service - ------ - ---- - Sanitary Sewei Rain Drains --- - - --- Catch Basin/Manhole Storm Drain ---- --- - -'�- ` Shower Pan Other: --- --- -- - Final -- PASSPART FAIL --�--�-� - —/-�` -- CHANI / --- ----_. os ea IT— Rough-In --- --- - -- -- ---._.�_._ Gas Line Smoke Dampers - - --- n PART FAIL -ETMTRICAL Service -- Rough-In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of$ ___ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PARTFAIL SITE -_ Please call for reinspection RE:_ __ _ —__._ �� Unable to inspect--no access Fire Supply Line ADAApproac't/Sidewalk Date. Inspector (elL -s zy� _ Ext - Other: Final - 00 NOT REMOVE this Inspectloni record from the Jub site. PASS PART FAIL CITY OF TIGARDI 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Lone: (503) 639-4171 Blip _-- Received _Date Requested _—_ AM - PM BLIP ---- Location ---- _ ---. _Suite - MEC - - --- -- Contact Person __ _-- -----.-_-- — Ph(­­—) -- —-- _ PLM ---- -- - C� � - SWR Contractor__- __---_____._.__—- -� _ Ph( _ _) ��. - BUILDING Tanant/Uw er __ ELC '"O _ _ _ Footing- ----�._ - D", 1 �( c 9 I S p ELC _ Foundation Access: — Ftg Drain ELR Crawl Drain Slab inspection NotesSIT Post&Beam _ _ Shear Anchors Ext Sheath!Shear -�� ^ �2 Int Sheath/Shear Framing _ ...._ �- Insulation . 0 Drywall Nailing r �' �_------------ Firewall Fire Sprinkler ---- -- — ---Fire Alarm Alarm Susp'd Ceiling Hoof Other. - - - - Final PASS PART FAIL PLUMBING Post&Beam - Under S.ab - -- -- --- ---- Rough-In Water Service - — Sanitary Sewer Rain Drains -— Catch Basin/Manhole Storm Drain - - ----- -- -- ----- Shower Pan Other: Final - PASS PART FAIL -MECHANICAL - Post&Beam Rough-In Gas Line Smoke Dampars --- Final PASS PART FAIL -- ELECTRICAL Service Rough-In -- UG/Slab Low Voltage Fire Alarni v Sr? PART FALL Reinspection fee of$ --_ __required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S - 'J Please call for reinspection HE:_ Unable to Inspect-no access Fire Supply line Approach/Sidewalk Date .k�l t �Inspector �ADA �- -ut - Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD __ ELECTRICAL PERMIT \ PERMIT#: EL.C2.002-00528 DEVELOPMENT SERVICES DATE ISSUED: 10/10/02 13125 SW Hall Elvd., Tigard, OR 97223 (503) 639-4171 PARCEL- 1313513C-00202 SITE ADDRESS: 10763 5W GREENBURG RD SUBDIVISION: ZONING: C: G BLOCK: LOT : JURISDICTION: TIG Proje•.t Description: Installaiion of sign lighting for(1)sign. RESIDEN,lt,'_UNIT TEMP SRVCIFEEDE_RS MISCELLANEOUS_ 1006 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGNIOUT LINE LTG. 1 LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/SVC/FDR: 601+amps -1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR- 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION_ 1000+ amp/volt: -4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only. ___ SVC/FDR—225 AMPS: CLASS AREA/SPEC OCC Owner: Contractor: ROGER M.BEI,ANICII ARTICO LITE LLC 22020 17TH AVE SE#200 8621 SE POWELL BLVD BOTHELL,WA 99021 PORTLAND,OR 97266 Phone: Phone: 503-253-9406 Reg #: ELE 26-1128CLS FEES Description Date v Amount — Required Inspections [ELPRMT]ELC Permit 10/10/02 $53.40 [TAXI 8%State Tax 10/10/02 $4,28 Rough-in Elect'I Final Total $57.68 XPIRF--- � This Permit is issued v abject to the regulations contained in the Tigard Municipal Code,State of OR.Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if worts 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 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 OUNC at(503)246699 or 1-800-332-2344. �� Issued By: / l {,tJ'� > Permit Signature: ' OWNER INSTALLATION ONLY I I ir! installation is being made or, property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: - ---- -.-,__–_--- -_–� DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N L I C E N S F NO: _- - —_- _- - ------------- -- Call 639-4175 by 7:00ptn for an inspection the next business day 5CA/ 2U�Z _ vvl� U Electrical Permit Application 1!(e received: /Q//O, 2, Permit no.:CGeiiCr, e4rl52� City of Tigard Project/appl.no.: re date: City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: BykReceiptno.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: _ ❑ 1 8c 2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement Ll New construction U Addition/alleration/replac•enunl U other: <�l,c. _�_ - U Partial JORSITEINFORMATION Job address:�1G (0'3 SE G-iv,vz "\lJ. Bldg! no.: Suite nu.: 1-ax map/lux 10thICCOUn(no. Lot: I Block: I Subdivision: Project name: ;,,k A -rbc (��_ Description and location of work on premises Estimated date of con letionhnspcction: Job no: I ve Max Bu dness name: C1_C \Lb LA j< – Description QIy. (ca.) f olal no.tnsp New residential-single or multi-family per Address: dwelling unit.includes allached garage. City: State: ZIP: q7 Z 3 Serviceincludcd Phone:a5 S-q,(0 (o Fax: S 3 E-mail 1000 sq.It.or less I ) Each additional 500 sq.ft.or onion thereof CCB no.; ILA ( 39 B EICC.bus.IIC.no: �tb'(j?-B CL;, Limited energy,residential 2 City/metro lic.no.: 7 3c)q Limited energy,non.residential 2 7 Each manufactured home or modular dwelling Signature of supervising electrician(re utred) Date Service and/or feeder Sup.elect.name(print) ,,NT f, License no: S G Services or feeders–Installation, alteration or relocation: 200 amps or less 2 Name(print): ),v c , 201 amps to 400 amps 2 Mailing address: Z2 401 amps to 600 amps 2 ?_Q ��s vrUt �� G01 mnpsto 1000 amps 2 City: 1�,6:k- :UJI IZIP: ®UZ f)ver 1(Nx)amps or,nhe 2 Phone4ec,_ E-mail: Reconnect only _ I owner mstallation:The installation is being made on property I own Temporary services or feeder- which is not intended for sale,lease,rent,or exchange according to lnstalldlon,alteralion,orrelocotlon: ORS 447,455,479,670,701. 2(N)amps or less 2. 201 maps to 400 amps __ 2 Owners SI nature: nate --�_ 401 to 600 ams 2 Bench clrcults-new,alteration, or extension per panel: Name: A. Fee for brunch circuits with purchase of Address: _ _ service or feeder fee,each branch circuit_ 2 City: State: ZIP: _ B. Fee for brunch circuits without purchase Fhone: Fax: F.-mail• of service or feeder fee,first branch circuit: 2 Each additional branch circuit Mise.(Service or feeder not Included): 76.ilydwdlings amps-commercial U Health-care facility Fach pun or Irrigation circle 2 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2 U Buildingover 10,W)squmrfeel fouror Signal circuits)or a limited enysemover volts nominal more residential units in one structure alteration,or extension, 2 U Building over three stories U Feeders.400 amps or more *Description: U Occupant load over 99 persons U Manufactured structures or RV parte Loch additional inspection over the allowable In any of the above: U Rgress/Iightingplan U Other Perins ection Submit—sets of pl',m with any of the above. Investigation fee -�-- The above are not applicable to temporary construction service. other — Not all jLu.Actions accept credit cards,pleas call juriuliolotj for marc information. Notice:This permit application Permit fee............I........$ _ U Visa U MasterCard expires it'a permit is not obtained Plan review(at — %) $ Credit cud number, _— ` within I Rt)days after it has been State surcharge(896)....$ _ i?x res accepted as complete. TOTAL Name d cardholder u non credit card s Cardholder sipatare Amount Ola-4615(ILpNCOM) p ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL.ONLY _ Restricted Energy Fee......................................................�— Number of Inspections per $75.00 ermit allowed (FOR ALI.SYS7EM5) Service included: Items Cost Total Check Type of Work Involved: Residential-per unit 1000 sq It or less $145 15 4 ❑ Audio and Stereo Systerns° Each additional 500 sq.ft.or portion thereof _ $33.40 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manufd Home or Modular Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener' Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 7 201 amps to 400 amps $106.85 2 ❑ Vacuum Systems' 401 amps to 600 amps $160 60�___ ? _ 601 amps to 1000 amps __ $240.60 2 ❑ Other Over 1000 amps or volts $454.65 2 Reconnect only _ $66.85_ 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system............................................ ............. $75.00 200 amps or loss �__ $66.85 __ 2 (SEE OAR 918-200-260) 201 amps to 400 amps __ $100.30 _ 2 401 amps to 600 amps $133.75 a 2. Check Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. ❑ Audio and Stereo Systems Branch Circuits New,alteration or extension per panel ❑ Boller Controls a)1 fie fee for branch circuits wifh purchase of service or ❑ Clock Systems feeder lee. Each branch circuit �— $6.65 __ 2 ❑ Data Telecommunication Installation b)The fee for branch circuits wlthow purchase of service ❑ or feeder fee. Fire Alarm Installation First branch circuit $16.85 _ Each additional branch circuit $6.65 v� ❑ HVAC Miscellaneous Instrumentation (Service or feeder not Included) ❑ Each pump or irrigation circle $53.40 _ Each sign or outline lighting _ $53.40 ❑ Intercom and Paging Systems Signal circuits)or a limited energy panel,alteration or extension _ $75 00 _ F-1LandscapeIrrigation Control' Minor labels(10) $12500 Each additional Inspection over ❑ Medical the allowable In any of the above Per inspection $62.50 ❑ Nurse Calls Per hour ---- $62.50— _—- In Plant $73.75_ v ❑ Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fees $ ❑ Othor 1 8%State Surcharge $ - Number of Systems i 2.5`/.Plan Review Fee See"Plan Review'section on $ No licenses are required. Licenses are required for all other installations front of application Fees: Total Balance Due $ _- - Enter total of above fees ❑ frust Arcounl aB -_ 8%State Surcharge $ ---_-------- ----_--.._--_ _�-_� Total Balance Due = All New Commercial Buildings require 2 sets of plans. i 0dstslfoimsklc-fees.doc 08/30/01