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11900 SW GREENBURG ROAD-3 i N O O s Gl ;L7 LT] CTl 7 C x 0 I CITY O F TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: ELC98-0615 13125 SW Hall Blvd.,Tigard,OH 97223(503)639-4171 DATE ISSUED: 10/09/98 PARCEL: 19135DD-04400 SITE ADDRESS. . . : 11900 SW GREENOURG RD SUBDIVISION— . : ZONING:C---P BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . JURISDICTION: TIG ProJ ect De scr i pt ion: Installtion of 14 branch circuits. --Tce, *-,59409J --RESIDENTIAL UNIT----- -.59409JUNIT----- ---TEMP SRVC/'FEEDERS---- ------MISCELLANEOUS------ 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH ADDIL 500SF. .. ., - 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 600 amp.. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0 MANF. HM/ SVC/FDP. . : 0 601+amps-1000 volt a. : 0 MINOR LABEL 0 ----SERVICE/FEEDER---- -------BRANCH CIRCUI 'S---___ ----ADD' L. INSPECTIONS--- 0 200 amp. . . . . . .. 0 W/SERVICE OR FEEDER: 0 PER INSPFCTION. . . . . 0 201 400 amp. . . . . . : 0 1st W10 SRVC OR FDR. : I PER HOUR. . . . . . . . . . . : 0 401 600 amp. . . . . . . 0 EA ADDIL BRNCH CIRC: 13 IN PLANT. . . . . . . . . . . • 0 601 1000 amp. . . . . : 0 --________________PLAN REVIEW SECTION-------- 1.000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR >= 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner-: FEES 13 & B LITHO (MIKE STEVENSON) type amol-Int by date recpt 8849 SW CENTER STREET PRMT $ 100. 00 DEB 10/09/98 98-309887 TIGARD OR 97223 SPCT $ 5. 00 DEB 10/09/98 98--309987 Phone 0: Contr-actor,: rRAHLER ELECTRIC CO $ 105. 00 TOTAL 11.860 SW UREENBURG RD -- FEQUIRED INSPECTIONS TIGARD OR 97;7-",23 Elect' ] Sr.,rvice Phone #: 639-4627 Elect' l Final Reg #. . : 000374 This permit is issued subject to the regulations contained in the Tigard Nvnicipal Cod!, State of Oregon Specialty Codes and all other applicable laws. All work mill be done in accordance witn 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. ATTENTION: Oregon 1l-requires you to follow the rules adopted by the Oregon LRility Notification Center, Those rules are set forth in OAR W-W17 throujRJR W. -MI-1987. You may obtain a copy of these rules or direct questions to by c 11' (503)246-1987. Parmittpe Signati-ir Issi-lec By : ----.---._____________.___---_OWNER TNSTnI..I. ATTON ONI Y ---------- The installation is being made on property I own which is not intended fol sale, lease, or rent. OWNER' S SIGNATURE: DATE: INST8ELATION RIGNATURE OF SUR R. ELECIN: OL DATE: /1) ITUENSE NO: 4 ............f.........4++++4-+++4-++-+-++++,+++4-++-+,+++++4.................4•.........4 4 Call 639-4175 by 7:00 p. m. for- an inspection needed the next bUSiness day +•+..............4•.++++++++++•4.+++++++•++-F+•.+++++++f•+++++++.+++++++++++•++++++++++++++. . __J i4jt1P 6,';L7 CITY OF TIGARD E=lectrical Permit A '-1 Plan Ch L pp��At�l�EIt.' � 13125 SW HALL BLVD. nec'd Bk TIGARD OR 97223 OCT l) 9 199 Date Rpc'd1t'� - Date to P.E. Phone (503) 639-4171, x304 Print Or Type Date to DST Inspection (503) 639-4175 �.E(Ir;iTY IIFVFLOPMENI Permit ft lC i ? c' Fax (503)684-7297 Inccmple'(e or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development_ - Number of Inspections per permit allowed Name(or namo of business) B & B LITHO _ Service included: Items Cost Sum Address- 11900 SW GREENBURG ROAD _ 4a. Residential-per unit TIGARD OR 97223 1000 sq.11.or less $110.00 ___-A__- 4 City/State/Zip_ Each additional 500 sq.It.or portion thereof $25.00 Limited Commercial El Residential ❑ _ - t Energy $25.00 Each Manutd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder -- $88.00 (Attach copy of all current licenses) 4b.Services or Feeders Electrical Contractor i RAl i L E R ELECTRIC CD�'IPAN Y Installation,alteration,or relocation Address 1 113 R B 200 amps or less $60.00 _ 2 201 amps to 400 amps $80.00 City TIGARD State OR Zip 97223 401 amps to 600 amps _ $120.00 Phone No 503) 639-4627 601 amps to 1000 amps _ $180.00 Job No. 58695 Over 1000 amps or volts $340.00 Elea Cint. Lice. No._ -13C Exp.Date is 30 99 Reconnect only $50.00 OR S',ate CCB Reg No. 3 7 4 10 F_xp.Date712199 4c.Temporary Services or Feeders COT Business Tax or Metro No. 1971 Exp.Date-7777t Installation,alteration,or relocation / 200 amps or less $50.00 2 Signature of Su r. Elec'n L�l% t t2.Gam.- 201 amps to 400 amps $75.00 _ 2 9 p ------- 401 amps to 600 amps _- $100.00 ; Over 600 amps to 1000 volts, License No. 18165 Exp.Date _ see"b"above. Phone No. - j --- - - 4d Branch Circuits New,alteration or extension per panel 2b. For owner inlgpu�ATIBN a)The tae for branch circuits with purchase of service or Print Owner's Name_-L feeder lee. Address EEch branch circuit $5.00 _ b)Thi fee for branch circuits City- _ State vul lFzip--- wi!hout purchase of Phone No. _- service or feeder lee. First branch circuit 1 $35.00 The installation is being made on property I own which is not Each addI1iooal bronr;Sr circuit $5.00 +� intended for sale,lease or rent. 4e.Miscellaneous (Service or feeder not included) O`.vner's Signature-- _ Ea,;h pump or Irrlgatic. circle $40.00 Each sign or outline lighting $40.00 _ 2 3. Plan Review section (if required):' Signal circuits)or a limited energy - panel,alteration or extension $40.00 Minor Labels(10) $100.00 -- Please check appropriate item and enter fee in section 5B. 4 or more residential units in one structure 4f.Each additional Inspection giver Service and feeder 225 amps or more the alloa'rihle In any of the above System over 600 volts nominal Per Inspection $5555 0 ----- Classified area or structure containing special occupancy Per hour $ .000 as described In N.E.C.Chapter 5 In Plant - 'Submit 2 sets of plans with application where any of the above apply. Jr. Fees: 10 Not required for temporary construction services. 5a.Enter total of above fees $ 5%Surcharge(.05 X total lees) $ NOTICE Subtotal $ - 5b.Enter 25%of lino 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if reauireyl(Sec.3) $ - -- - NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ - IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY ^ TIME AFTER WORK IS COMMENCED. lJ Trust Account a__� f u�.'Ju c Total Balance Due W -- - ----I hDSTMELC7fi APP Rev 9106 CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Linc: 6394175 Business Phone: 639-4171 Date Requested: ,I' lJ 9 7��. / / —_ A.M.�� - P.M. MST: Location:��— s w C7 G? DUP: — Tenatll:— 13 &— L- / Suite: Bldg: NII'.C: Contractor: > •t /—+ ,{� _Phone: / PLM: _ Phone: .lamELC: -- --- ELR: — �SIT: BUILDIN. BLDG(con't) PLUMBING 1V?ECHANICAL LECTRICAL > SITE — Site Post/Iiearn Post/Beam PostMetun �Zov1-1 rMervicC Sewer/Stone Footing Roof UndFl/Slab Rough-In Ceili ig Water Line Slab Framing Top Out Gas Line Rough-In UG Sprinkler Foundation Insulation Sewer ffood/Duct Recot sect Vault Bsmt Damp Drywall Stonn Furnace "Temp scrvice MISC. Masonry CcOing Rain Irwin A/C IJG Slab Sheat/Sheath Fire Spklr/Alin Crawl/Found Ili I Icat Pump Low-vDit _ Approved Approved Approved Approved Approved Appr/Sdwlk Not Approved Not Approved Not Approved Not ved Not Approved FINAL FINAL FINAL FI FINAL � r P<f1 4".- 0 "0 Call for reinspection 0 Reinspetlion fee of S —required before next inspection 0 Unable to inspect Inspector: — _ Date: / / Page of CITY O TIGARD -CTRICAL r'ERMTT DEVELOPMENT SERVICES PERMIT it: E1_C97--071P 13125 SIN Hall Blvd., Tigard,OR 97223 (503)639.4171 HATE I SUE D a 1 rr/�^ 17", !''AF2CE1.: 'i S 1.3 SDI)•-21/+ PEEN BUR'--,:), RD C?CI'.. . . . . . . . . . . L.CT. . . . . . . . . . . . JURISDIC:TTCIN: TIC, a•ject. Insta'.1 a first branch circuit for an existing coeaercial rant ocepy, RMII71rNTi( ', I1NT7 TI^Mr' WO SF" OR LESSi. . . ., 0 0 200 amp. . . . . . . : 0 F''_JMr,/TF1RT0ATInPJ. ')r-H MOD' I- 50WIF . 1 x:01. 400 amp. . . . . ., . 17 ;.101`1/OUT 1_TNE 170. .• :1MITED ENERGY. . . . . 0 /101. 600 tramp. . . . . . . . 0 ST.f':,101. !PONIF1... . . . . . . : 0 ')Nr. !Ifi^ ' ^VC,, Df?, . : 0 r01 MThlOR l.fiElr:l... ( 7 171` SF'RVTCE'/rE EDEP ---SRANCH r'.qCUITr - --._.ADD' L TNr3PT'177TL1Nc;...-.. 200 amp. . . . . . 0 W/CERVI(F rr rC:f 1"''-R ,,I r'rr TPJ5r=1C7CTT0r1. :. . • . - i'1 400 amp. . . . . . , 17 1st; W/0 SRVC nF' r'nr,, a 1 P117-F, HOUR. . . . . . . . . . . .. . F,00 a MI-r. . . . . . .. 0 rr, FDD' i., f�RNCI'I 1.RC 17+ 1h! PL.ANIT. . . . 1"700 amF'. . , . . : 0 _.__._._._._._.._...___.__ ...-._._.frL.f1N W7VIFW 'SECTION......__....-- ~1711111 -.1 Fri c�1. � 0 ) -41 Rr7' I...!IhITT . . . . . . `. (11110 r'rrr:n(?rf: ort? Y. 171 1JC/FDR ) ''E'S AMP% CLACKS "r,r•n rr-r type ,A1flor.tr1t M NTr'R ,STREET rPMT V10 't 7)11??'7 1 I'.ti ^•�'1 ^r,. f} T(.J i hip P17 n,i..I T RFrn T N ----- _.. Cei 1 ;i rig Cover LIt1der yr u ui ',1 f,, 7 W l 1. CpV@i Ait is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all licable laws. 1111 work will be done i^ accordance with approved plans. This pproit will expire if work is not started within s of issuance, Or if work is suspended far tore than 180 days. ATTENTION= Oregor law requires yr, i tr ro117w the rules adn,' Oregon Utility Notificatior) Center, Those rules are set forth in OAP 9W-001-K!0, vr-, may At- !hese r"alts or direct questions t0 CL'NC by calling 15 246-1987, ,;rl-'00 _nWNCR INSTAI_l...nTTf--' ti cti _s G CITY Of-TIGARD Electrical Permit Application Flan Check s 13125 SW HALL BLVD. Rec'd By TIGARD OR 97223 Date Recd Date to P.E Phone (503) 639-4171, x304 Print or Type- Date to DST__V Inspection (503) 639-4175 Permit# e "6 Fax (503)684-7297 Incomplete or illegible will not be accepted Called - 1. Job Address: 4. Complete Fee Schedule Below: Name of DevelopmentU & H LITHO -d Number of Inspections per permit allowed Name(or name of business) B & 4 LITHO Service included: Items Cost Sum Address 11900 $W GREENBURG ROAD _ 4a. Residential per unit Cit /State/Zi _ TIGARD OREGON 97223 Each sq.rLorlos5 01+,0.00 ____ 4 y P + ac Hh additional 500 sq.ft.or Commercial Q Residential ❑ Liportion thereof $25.00 _ 1 Limited Energy $25.00 _ __._ Each Manut'd Home or Modular 2a. Contractor installation only: Dwelling Servire or Feeder .__ $68.00 (Attach copy of all current licenses) 4b.Services or Feeders Electrical Contractor F R A I I I-E R ELECTRIC COMPANY installation,alteration,or relocation Address 11860 5'd GREENBURG ROAD - 200 amps or less $60.00 2 ---- 201 amps to 400 amps $80.00 _ . 2 City T I BARD State (1R Zip 81223 401 amps to 600 amps $120.00 2 Phone No. 639-4627 601 amps to 1000 amps $180.00 Job No. 57696 - Over 1000 amps or volts - $340.00 _ Elec.Cont. Lice. No. 3 4-1.1 E Ex Date Floconnect only __ $50.00 p� to/t/g;a OR State CCB Reg. No. 3741(1 Exp.Date 7/2/9H 4c.Temporary Services or Feeders COT Business Tax or Metro No. 1836 p.DateInstallation,alteration,or relocation 200 amps or less $50.00 2 201 amps to 400 amps $75 00 Signature of Supr. Elec'n / '� � 401 amps to 600 amps $1o000 _ Over 600 amps to 1000 volts, License No. 7845 Exp.Date 10/98 see"b"above. Phone No. 619--AL2 4d.Branch Circuits New,alteration or extension per panel 2b. For owner installations: a)The fe3 for branch circuits with purchase of service or Print Owner's Name feeder fee Address Each branch cirr•.ult $5.00 _ -- -- b)The fee for branch circuits City State Lip without purchase of Phone No. service or feeder fee. First branch circuit 1 $35.00 _35 011 2 The installation is being made on property I own which is not Each additional branch circuit- $5.00 2 intended for sale, lease or rent. 4e.Miscellaneous (Service or feeder not Included) Owner's Signature _ Each pump or Irrigation circle $40.00 - Each sign or outline lighting $40.00 3. Plan Review seLition (if required):' Signal circuit(s)or a limited energy- panel,alteration or extension $40.OU Please check apprr rpriate Item and enter fee in section 5B. Minor Labels(10) $100.00 4 or more residential units in one structure 4f.Each additional Inspection over _Service and feeler 225 amps or more the allowable In any of the above System over 600.,olts nominal Per inspection $35.00 Classified area or structure containing special occupancy Per hour $55.00 - as described In N c C.Chapter 5 In Plant $55.00 _ 'Submit 2 sots of plans with application where any of the above apply. 5. Fees: Not required for temporary construction services. 59.Enter total of above fees $ 5%Surcharge(.05 X total fees) $ - 1 75 - NOTICE Subtotal $ - -- -- 5b.Enter 25%of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Pian Review It reguired(Sec.3) $ NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OT 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account M a 36.75 Total balance Due 10stMELc96AP P rrm arse CITY OF T'IGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Linc: 639417 Business Phone. 639-4171 Date Requested: •2., / L � ---�._ A.M. ---- IM. MST: Location: }�� 9 d C��'F—I✓�a t� ��____ __ BDP: _- Tenant: ,C� I'�`G`f-Q S11ite:—.T__I3ldg: , MEC: Contractor: l_A4 E/_ECT Phone: — _— PLM: 0vmm --- —Phone: _ E_LC: 7,�-'— ELR: SIT: BUILDING BLDG(con't) PLUMBING MECHANICAL 0,LECTRICA SITE Site Post/Beam Poa1/ care Post/Bemn er,ervrce SewLr/Stonn Footing Roof UndA/Slab Rough-In Ceiling Water Line Slab Framing Top out Gas Line Rough-in U(i Sprinkler Foundation Insulation Sewer Ilood/Dticl Reconnect Vault B,mt Da np Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Drain A/C UG Slab Shear/Sheath Fire Spklr/Alm Crawl/Vownd Dr Heat Pump L w Volt Approved Approved Approved Approve ` Approved EAppr/Sdwlk Not Approved Not Approvrd Not Approved o oved Not Approved FINAL FINAL FINAL FINAL FINAL /C Coo CaU101 GUQ �e ,be.eh rhih�r 1,46�� 0 Call for reinspection Reinspection fee of S rettuired before next inspection C3 Unable to inspect Inspector: _ --- Date: ..� �`` I _( Page of ^. CITY GF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT 0: ELC98--0002 DATE ISSUED: O1/O2/98 y, 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PARCEL: 1S135DD-04400 SITE ADDRESS. . . : 11.900 SW GREENBUR(.3 PP SUBDIVISION. . . . : ZONING:C-P BLOCK. . . . . . . . . . . LOl.. . . . . . . . . . . . . JURISDICTION: TIG Plro.j ec_t Descr•i pt i on : Install 2 branch circuits without feeder. ---RESIDENTIAL-UNIT----M ---~TEMP SRVC/F-EEDERS------- -----MISCE:.LLANEOUS-------- 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP'/IRRIGATION. . . . : 0 EACH ADD' L 5O05F. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 l_.IMITEP ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0 MANF. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0 -- --SERVICE/FEEDER---- ----BRANCH CIRCUITS-------- ----ADD' L. INSPECTIONS—- 0 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0 01 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0 401 600 amp. . . . . . : 0 EA ADC' L_ B RNCH C I R(-.: i IN Pl._AN1 . . . . . . . . . . . : 0 601 1000 amp. . . . . • 0 --- ----- - - ----- -FLAN REVIEW SEC1 1000+ amp/volt. . . . . : 0 ) -4 RES UNITS. . . . . . . . : ; GOO VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR > = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner- : ------ --------- ---.._.._.-_---- -_-----_._.._.. - -- - - - ---- FFES - B R B LITHO (HIKE STEVENSON) type amoi_tnt by date recpt 11900 SW GREENBURG RD PRM-1 f 40. 00 DRA 01 /02/98 98-30221c. TIGARD OR 97223 SPCT $ c'. 00 DRA 01 /02/98 98-302211=' Phone #: Contractor-: FRAHL.ER ELECTRIC CO $ 4;=. 00 TOTAL 11860 SW GREENBURG RD -------- RFG)U I RED INSPECTIONS -- TIGARD OR 97223 Ceiling Cover Elect' 1 Service Phone #: 639--4627 Wall Cover Elect' 1 Final Reg #. . : 000374 This permit is Issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 188 days of issuance, or if work i! suspended for more than 188 days, ATTENTION: Greqon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-881-8818 through OAR 952-991-1987. You may obtain a copy of these rules or direct questions to Ol1NC by calling ( 3)216-;987. t - ' t>ermittee Si n�+t1-irse : r(I 8y -� -, _ __ --•---------__.__.._.__..__._-_--OWNER INSTALLATION ONLY--------------- ---------------- The installation is being made on pr•oper^ty I own which is not intended for, save, lease, or rent, OWNER' S SIGNATURE• DATE: _ - ------- -- ---------CONTRACTOR INSTALLATION ONLY--- ------ -------------- SIGNATURE OF SUPR. ELEC' N: ��--yJ�/ [ 1Gi-�-- - DATE: LICENSE NO: ++++++++f+++++++++++++++++++++++++++++++++++++++++++++++++-+++++++++++f+++++++ .;_ Call 639-4175 by 7.00 p. m. for an inspection needed the next business day +++++++++++++++.1-++++++++.4-+++++++++++4•++++++,F++++++++++++++++++++++++++4 1 t++++-4 rd CITY OF TIGARD Electrical Permit Application Plan Che -ate 13125 SW HALL BLVD. Head . l `` Date Rec'd1 -� %Q TIGARD OR 97223 Date to P.E. Phone (503)639-4171, x304 Date to DST Inspection (503) 6;39-4175 Print or Type Permit If "LC-if� "G,7l� Fax(503)684-7297 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Sc{":�dule Below: Name of Development Numhar or Inspec:'ons per permit allowed Name(or name of business) B & B LITHO _ _ Service inclu&6: Items Cost Sum Address 11900 SW GREENBURG ROAD 4a. Residentint-Peru 1000 sq.It.u le.s $110.00 4 City/State/Zip T 1 GA RD• OgE ,()[j q72 2 3 `_- EaL r additional 500 sq It portion thereof $25.00 Commercial ® Residential ❑ I imited Energy $25.00 Each Manurd Hcme or Modular Dwelling Service or Foeder $68.00 2a. Contractor installation only: (Atloch copy of all current licenses) Ins Services or feeders Electrical Contractor F RAI I LE R E LE CT R I C CO. Installation, or le alteration,or relocation Address 11860 SW GRFUIB 1RG ROAD) 201 amps to 400 - $60.00 2 201 amps►0 400 arnpa $80.00 2 City TIfARD State OR Zip 97221 401 amps to 600 amps $120.00 _- 2 Phone No. 639-4627 601 amps to 1000 amps _- $180.00 - 2 Over 1000 amps or volts $340.00 ____- 2 lob No. S 7881 Elec. Cont. Lice.No. 1a_1 1f. _Exp.Date_ 1 n i 1/gu Reconnect only $50.00 2 OR State CCB Reg. No. 37410 Exp.Date 7/- /2/98 4c.Temporary Services or Feeders COT Business Tax or Metro No. 1987 Exp.Date 12/1/98 installation,alteratiun,or relocation 200 amps or less $50.00 Signature of Su r. Elecn /4'�✓ hilae 'wu 201 amps to 400 amps $ 0 Si ' L y p 401 amps to 600 amps .` $100.00 over 600 amps to 1000 volts, License Nr _ 8165 Exp,Date 10/1198 see"b"above. Phone N - - 4d.Branch Circuits Nnw,alteration or extension per panel 2b. For owner ins S: a)The lee for branch circuits with pi�� CATION purcheae of sarvlca or Print Owner's Name - feeder fee. Addf999_ _ _ - Each branch Circuit $5.00 - b)Tho fee for branch circuits City _ State__JMpwithout purchase of Phone No. __ ,_.._ I service or feeder fee. - first branch circuit $35.00 3S-0n The Installation is being made on property I own which is not Each additional branch circuit 1 $5.00 6.99 __ intended for sale,lease or rent. 4e.Miscellaneous (Service or feeder not Included) Owner's Signature ___ Each pump or Irrigation circle $40.00 _ Ea:.h sign or outline lighting $40.00 3. Plan Review section (if required): Signal clrcuit(s)or a limited energy- panel,alteration or extension $40.00 Minor Labels(10) $100.00 Please check appropriate Item and enter fee in section 5B. _ 4 or more residential units in one structure 41.Each additional Inspection over Service and feeder 225 amps or more the allowable In any of the above _ 55.00 System over 600 volts nominal Per inspection $ 5.00 ---_ Classified area or structure containing special occupancy Per hour 55 as described in N.E.C.Chapter 5 In Plant $55.00 Submit 2 sets of plans with application where any of the Ptuve apply 5. Fees: Not required for temporary construction services. 59.Enter total of above fees $ 5%Surcharge(.05 X total fees) $ 2.00 NOTIGE Subtotal $ ---- 5b.Enter 25%of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required(Sec.3) $ NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ --- IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY El TIME AFTER WORK IS COMMENCED. Trust Account u� _ - S 011. Total balance Due L -- 1108MELC9e APP Rev 9M CITY OF TIGARD BUILDING INSPECTION DIVISION MST _------_-_ -- ---.. --- 24-Hour Inspection Line: 633-4175 Business Line: 63�071 1 BUP Date I"equestedAM _PM --- BLU Location L ` is Suite _- MEC Contact Person j l l lL;` S t�ic�r�Cc / Ph _ PLM Contractor r`��<� sc[ Ph _1. SWR --- BUILDING Tenant/Owner -_bL�— ,' c � ,�, ELS qG -.� Retaining Wall Y Footing Access: i 1 FPS /nc�d ,✓rv�� Foundation Q�� V Ftg Drain SGN _. Crawl Drain Inspection Notes Slab �. --------- ---�- - SIT _-- Post&Beam Ext Sheath/Shear I All kc Int Sheath/Shear Framing _—�_.--- ---..---__ -- -- Insulation Drywall Nailing - ---- -� --- Firewall Fire Sprinkler - Fire Alarm Susp'd Ceiling -- - Roof Misc._ i Final ---- PASS PART FAIL - PLUMBING -- Post&Beam _ Under Slab --- -- _-- --- --- Top Out Water Service - - -Sanitary Sewer Sewer Rain Drains -- — --- - ------ _-- -- -- - Final PASS PART FAIL_ ---- -- MECHANICAL .__----.-_-_—__-..— Post& Beam -_ - -- - -- Rough In Gas Line _ Smoke Dampers Final PASS PART FAIL --- ELECTRICAL Service --- ---- -- ------Rough In In UG/Slab -------- - ---- Low Voltage _ Fire Alarm Fin AS PART FAIL -- Backfill/Grading Sanitary Sewer Stoim Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ ]Please call for reinspection RE: -_ __,__. [ ]Unable to inspect-no access Fire Supply Line ADA r� Approach/Sidewalk Date •,�-J ��-_Inspector_ Geste — __Ext Other - Final PASS !,ART FAIL DO NOT' REMOVE this inspection record from the job site. CITY OF TIGARD ELECTRICAL P'ERMTT DEVELOPMENT SERVICES PIE.RMIT #: ELC98-0237 13125 SW Hall Blvd., Tigard,OR 97223 (503)6394171 DATE ISSUED: 05/07/98 PARCEL.: 1 S 135DD.-04400 SITE ADDRESS. . . : 11.900 SW GREENBURG RD SUBDIVISION. . . . ZONIN(3:C- P' BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . . JURISDICTION: TTG Piro J ect Description: Install I branch circuit without feeder. ------RESIDENTIAL UNIT----- ---TEMP, SRVC/FEF_DERS--_--._ -----M I SCELLANEOUS....__...._...... 1.000 SF OR LESS. . . . : 0 0 - 2O0 amp. . . . . . . : 0 P'l.1MFI/IRRIGATION. . . . : 0 EACH ADD' L 5O0SF. . . : 0 201 - 4O0 amp. . . . . . . : 0 SIGN/OUT LINE I_TG. . : 0 LIMITED ENERGY. . . . . : 0 401. - 600 amp. . . . . . . : 0 SIGNAL../P'ANE:L_.. . . . . . . : 0 MANE. HM/ SVC/FDR. . : 0 601+amps-••1000 volts. : 0 MINOR LABEL_ ( 10) . . . : 0 --_SERVICE/FEEDER---- -----BRANCH CIRCUITS------- -_-ADD' L. T NSFIFCT I ONS--- 0 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PIER INSP'ECTION. . . . . : 0 201 _, 400 amp. . . . . . : -1 1st W/O SRVC OR FDR. : 1 PIER HOUR. . . . . . . . . . . . 0 '+CU 1. - 600 amp. . . . . . : 0 EA ADD' L_ BRNCH CIRC: 0 IN FIL-.ANT. . . . . . . . . . . : 0 601 -- 1000 amp. . . . . : 0 --._____.___.__.______FLAN REVIEW SECT ION----.----_______.______.. 1 OOOr- amp/vol t;, . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) FOO VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR > _ 225 AMPIS. . : CLASS AREA/SPIE:C OCC. : Owner: ----- --- _---------___._._---_________-__-_.-___-__-__.._.._.....____.__ FEES --------- ----- B R B LITHO (MIKE STEVENSON) type amount by date recpt 1. 19O0 SW GRF_ENBURG RD P'RMT 0 35. 00 DLH 05/0-1/98 98-3O5``170 TIGARD OR 97223 '_i PICT $ 1. 7c DLH 05/07/98 98-305-4/0 Plhone #: Contractor: FRAHLER ELECTRIC CO $ 36. 75 TOTAL 11860 SW GREEN131JR0 RD ------- REQUIRED I NSPIECT I ONS - - TIGARD OR 97223 Ceding Cover Elect' ]. Servicr� Phone #: 639--4627 Wall Cover Elect' l Final Reg #. . : 000374 This permit is issued subject to the regulaticns contained in the Tigard Municipal Code, State of Oregon Specialty Code, 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 188 days. ATTENTION: Oregnn law requires you to follow the rules adopted by the Oregon Utility Notificatinn Center. Those rules are set forth in O�lR 952-091-0010 through CZAR 952-01-1987. You may obtain a copy of these rules or direct questions to OLK bi, calling 15031246-1981. PIermittee SignatI.rre : p�fiIc Issmed By :---_.-/t,L_ -a/-jfr__�,�_- __.OWNER INSTALLATION ONLY----_--_--____.._____._____._.._._._.._.. . -Che installation is being made on property I own which is not intended for• sale, lease, or rent. OWNER' S SIGNATURE: DATE: --__._-------.____--------•.---(:ON'1RACTOR INSTALLATION SIGNATURE OF SUF'R. ELEC' N a DAT F: LICENSE NO +++++++++++++++++++++++ .++++++++++++++++++++++;•++++++++++++++++++++++++ Call 639-4175 by 7:00 p. m. for an inspection needed the next bosi.ness day ++++;-+++++.++++++++++++++++•f++++++++....+++++++++++++++++++++++r-+++++++++�+*++c++ f CITY OF TIGARD Electrical Permit Application Plan Check# 13125 SW HALL BLVD. Recd Dy TIGARD OR 97223 Date Recd � 7 Date to P.E. Phone(503)639-4171, xsoa Print or Type Date to DST Y Inspection (50'; f:9-4175 Permit k {;1�'' '17-A-3;7 Fax(503) 684-,'L97 Incomplete or illegible will not be accepted Called -_ 1. Job Address: 4. Complete Fee Sch&dule Below: Name of Development GREE11BURG PROF. CENTER_ Number of Inspections per permit allowed Name(or name of business) R R R 1 T THO Service included: Items Cost Sum Address 11900 S.W. GREENBURG ORAD 4a. Residential-per unit City/State/Zip_ TIGARD, OREGON 97223 1000 sq.It or ies; Nicoli Engineering , Inc. PO Box 23784 Tigard, Oregon 97281 • Phone. (503) 620-2086 * Fax: (503) 684-3636 July 17, 2001 NEW 01-0514 City of Tigard Building Department ATTN: Robert Poskins, CET, CBO, Senior Plans Examine:- 12355 xaminer12355 SW Hail Blvd Tigard, OR 97223 RE: Southwest Family Medical Offices, Phase I 11900 SW Greenberg Road Tigard, OR 9722.3 B U P- 2001-00244 Dear Mr. Poskins: The following is our responses to your fax dated July 6, 2001. Our numbered items correspond to those listed on your fax General Comments: P!ease note that some Phase II documents have been revised. Some of your review comments where applicable or overlapped onto Phase II (sheets 2.4 and 2.5). Revisions have 'jeen noted with a delta 1 and dated 7/12101. Also, our clients have purchased a computer s,stem for storing their"charts". Therefore the "chart" area has been reduced in size. Exam room s number 9 and 12 have been relocated to a portion of the area previously designated as "charts". The rooms which where designated for exam rooms 9 and 12 are now for processing the chart>-- 4^d an office for the person in charge of the charts. 1. All bathrooms shall be accessible OSSC, Section 1146.2.1 All restrooms have been revised to meet the accessibility requirements. Grab bars have been added to the restrooms sheet 2.1). Also, the shower and restroom in Phase I! (south addition sheet 2 4) was revised 2. The reception counter shall ue accessible. Provide a section 36" wide and not more than 36" off the floor, OSSC, Section 1109.23.2 The counter has been designated as accessible (sheet 2.1 and 2.5, north addition). Provide 2 sets of revised drawings: Three sets of revised drawings have been sutri',,,ad for your review We would like one stamped set for our records. I will be out of the office from July 19 to July 27. If you require additional information or have any comments, please leave them with Heather, as I wil! be checking in for messages Sincerely. II D. Andrews Manager Idaihrnb enclosures X 1J 0105141Let1er51ReVan%o to Plan Rewew doc r'ag�t n1 I CELECTRICAL PERMIT CITY O F T I�A R D PERMIT#: ELC2001-00495 DEVELOPMENT, RVICES DATE ISSUED: 10/15/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 1S135DD-04400 SITE ADDRESS: 11900 SW GREENBURr, RD SUBDIVISION: ZONING: C-P BLOCK: LOT : JURISDICTION: TIG Proiect Description: Service change and branch circuits. RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: 1 SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL.: MANF HMI SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER _ _ BRANCH CIRCUITS _ ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: 42 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: > 690 VOLT NOMINAL: Reconnect only: SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: ACME ELECTRIC 53i SE ASH ST. Phone: Phone: 503-872-9777 Reg#: ELE 26-10940 SUP 2867-3 ILIC 147132 FEES Required Inspections _ Type By Date Amount Receipt Ceiling Cover PRMT CTR 10/15/01 $386.15 2720010000( Wall Cover Elect'I Service 5PCT CTR 10/15/01 $30.89 2720010000( Elect'I Final Total $417.04 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 it work is not started within 180 days of issuance, or if work is suspended fur 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 952-001.0080. You may obtain cies of these rules or direct questions to Permit Signature: Issued By: �c��rw _ OWNER INSTALLATION ONLY 1 lie installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: __— DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: J-;)'l a*.1211LC� r.G� ____ DATE:_ __— LICENSE NO: —0 L,J j — — -- — --- Call 639-4175 by 7:00pm for an inspection the next business day Electrical Permit Application Datcreceived: U Permit no.:Cf ',10/_ V95 City of Tigard Project/appl.no.: Expire date: Cilyn/Tigard Address: 13125 SW Fall Nivel,Tigard,OR 23 Date issued: Fay, Receipt no.: Phone: (503) 639-4171 — Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: :UNcw 2 family dwelling or accessoryfrAd(litit)n/alter;i(ion/replaceinent ommercial/industrial J Multi-family U Tenant improvement construction U Other: J Partial Joh address: ) U Bldg. no.: I Suite no.: ITax map/lax lot/account no.: _Lot: Block: _ Subdivision: Project name: n�i�G4L p Fh C� Description and location of' on premises:g ,�C,,, ,ai9�jG= Estimated date 4cont letitm/inspectitm: CONTRAtIT011 APPLICATION, I'VE S( 111H)ULE Fee Job no: _ Mas ne55 name: C _ Descri rtion "y. (ra.) Total 110.insp BusNew residential-singleor multi-family per Address: S AS ��— d"ellingunit.Includesattached garage. City: Slate: ZIP: Cy , Service included: Phone. . Fax: E-mail: �,I-0.1- 10rx1sy.fl.orless --_1 F.ach additional 500 sq.fi.or portion thereof CCU no.: 7 EIeC.bus,tic,no: YACa Limited energy,residential Cil nctro lic,no.: Limiledenergy.non-residential 0 Fuch manufactured home or modular dwelling ignature of su Sery sing cleelrician(required) ��— male Service and/or feeder Sup.elect.name(print e License no: Services or Feeders-Installation, alteration or relocation: 2(x1 amps or less 2 Name(print): I t t 201 amps to 400 amps 161Y, 2 - - 401 amps to 6(x1 amps Mailing a'dress: _— 601 amps to IO(x)ams 2 City: State: ZIP: Over I(xX)amps or volts 2 Phone: _�ax': I E-mail: Reconnectonly I Owner installation:The installation is being made on property 1 own Temporary servicesorfeedem- which is not intended for sale,lease,rent,or exchange according to lnslallauon,alteration,orrelocatlon: ORS 447,455,479,670,701. 200 maps or less' 2 2(11 amps to 4011 nntps 2 Owner's 51 nature: Dale: 1 401 to 6W ams 2 Branch circuits-new,alteration, or extension per panel: Name: _ A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 442 City: Slab 1711 B Fee for branch circuits without purchase ------- of service or feeder Ice,first branch circuit: 2 Phone: Fax: I, tn:ul Each additional branch circuit: Misc.(Service or feeder not Included): Service over 225 amps-commercial U Ficalth"care facility Each pump or irrigation circle _ -' U Service over 320 amps-rating of l&2 U Hazardous location Each sign or outline lighting 2 familydwellings U Building over 10,000 square feet four or Signnl circuit(s)or a limited energy panel. U System over600 volts nominal -ore residential units in one structure alteration,orexlension* _ 2 U Building over three stones Feeders,41x)amps or more *Description: U(kcupant load over 99 persons U Manufactured structures or RV park F✓ach addill,nal imarectlon over the allowable In any of the alcove: U Fgress/lightingpinn U()ther J__._.__ ----.-- perinspecuon — --� Submit.___sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. other Permit fee.....................$ Not sit Jurisdictions accent credit cants,piraw CRIT jurisdiction Gx mole Infotnlatinn Notice: I'his permit application U visa U MastoWard expires if a permit is not obtained Ilan review(at _ 9h) $ credit card number: ,_— -- — within 180 days after it has been State surcharge(8%) ....$ xplrcs accepted as complete. TOTAI. .......................$ Name of cardholder as shown on credit car a Cardholder signature _ Amount 440J615(6MIUOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fie Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY /� Restricted Energy Fee...................................................... $75.00 Number of Inspections per permit allowed) (FOR ALL SYSTEMS) Service included: Items Cost Total y Check Type of Work Involved: Residential-per unit 1000 sq ft or less $145 15 _ _— 4 ❑ Audio and Stereo Systems" Each additional 500 sq it or portion thereof $33,40 1 ❑ Burglar Alarm Limited Energy $75.00 _ Each Manufd Home or Modular I Dwelling Service or Feeder $90 J.90 _ 2 J Garage Door Opener` Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $1030 2 ❑ 201 amps to 400 amps _ $10685 1O� 2 Vacuum Systems' 401 amps to 600 amps $16060 2 601 amps to 1000 amps $240.60 2 ❑ Other Over 1000 amps or volts $454.65 i_-- 2 - Reconnect only $66.85 Y _ 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system................................................. ........ $75.00 200 amps or less _ $66.85 2 (SEE OAR 918-2F0-260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 �— 2 Check Type of Work Involved. Over 600 amps to 1 U00 volts, see"b"above. ❑ Audio and Stereo Systems Branch Circuits ❑ New,alteration or extension per panel Boiler Controls a)The fee for branch circuits with purchase of service or L� Clock Systems feeder fee. Each branch circuit s€65 &121z)2 ❑ Data Telecommunication Installation b) 1110 fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. first branch circui: $46.85 ❑ Each additional branch circuit $6 65 HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle _ $53.40 Each sign or outline'ighting $53.40 ❑ Intercom and Paging Systems Signal circuit(s)or a limited energy panel,alteration or extension $7500 ❑ Landscape Irrigation Control' Minor Labels(10) $12500 — Medical Each additional inspection over ❑ the a:lowable in any of the above ❑ Per inspection _ $62 50 Nurse Calls Per hour _ _ $6250 in Plant _ $73.75_ ❑ Outdoor Landscape Lighting' Fees: Protective Signaling Enter total of above fees $ ?� r/ Other 8%State Surcharge $ Number of Systems 25%Plan Review Fee See'Plan Review"section on $ _ ' No licenses are required Licenses are requ red for all other installations front of application — ! Fees: Total Balance Due $ r-� Enter total of above fees $ LJ Trust Account# 8%Stale Surcharge S Total Balance Due All New Commercial Buildings require 2 sets of plans. i:klsts\forms\cic-fees.doc 08130,'01 CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00398 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/22/01 SITE ADDRESS: 11900 SW GREENBURG RD PARCEL: 1S135DD-04400 SUBDIVISION: ZONING: C-." BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING M1:ACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: LAVATORIES: 33 OTHER FIXTURES: 1 TUBISHOWERS: 1 SEWER LINE: ft WATER CLOSETS: 7 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing TI. Other fixture is drinking fountain. Owner: FEES BEN STUTZ Type By Date Amount Receipt 1128 SW ENGLEWOOD PRMT CTR 10/22/01 $747.00 27200100000 LAKE OSWEGO, OR 97034 PLCK CTR 10/22/01 $186.75 27200100000 5PCT CTR 10/22/01 $59.76 27200100000 Phone 1: 503-245-9474 Total $993.51 Contractor: ANCTIL PLUMBING INC 16900 SW MERLO RD BEAVERTON, OR 97008 REQUIRED INSPECTIONS Phone 1: 503-642-7323 Rough-in Insp Reg#: LIC 24184 Underfloor/Underslab PLM 26-162PB Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. ILA f Issued 13y: 4 j� Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day lo I Plumbing Pernut Application Date received:'/Q/ Permit no.: 3,99 City of Tigard `J b Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 CiIYofTigard Phone: (503) 639-4171 Project/appl.no.: Expire date: Fax: (503) .59R 1960 �U, Pow/-O��.t�/ Date issued: Receipt no.: (1 \ Land use approval: l/ / Case file no.: Payment type: LII ❑ 1 &2 family dwelling or accessory Ali Commercial/industrial U Multi-family U Tenant improvement U New construction XA(I(lition/alteration/replacement U Food service U 011.e.r: 1 \ Job address: l�C)C S,W, G Rr e=./ /3 4 Desert tion Fee(ea.) Total Bldg.no.: Tax map/lax lot/account no.: Suite no.: New 1-and 2-family dwellings only: (Includes 100 fl.for each utility connection) SFR(1)hath Lot: Block: Subdivision: SFR(2)bath Project name: SFR(3)bath City/county: ZIP: _ _ Each additionalbath/kitchen Description and!.cation of work on premises:_ Site utilities: _ Catch basin/area drain _ Fist.date of completion/inspection: Drywells/leach line/trench drain — Footing drain(no. lin. ft.) _ n Manufactured home utilities Business name:` y Manholes Address: C �' Rain drain connector _ City: State:r ZIP: 2 Sanitary sewer(no.lin.ft.) - Phonc.: -03 (oy� yz mail: Storm sewer(no. lin. ft.) — CCB ao.: [1 8 y I Plumb.bar.;. reg. no: ,z (� Water service(no.lin. ft.) City;nlctro Iic.no.: /g �8 Fixture or item: Absorption valve Contractor's representative signature: — Back flow preventer Print name: ,' i), Date: Backwater valve 9110 alto cc= Basins/lavatory Name: _e� P/1/Cti - Clothes Hasher Address: .0 0 & w, ��R�p /C d Dishwasher Drinking fountain(s) City: .o„ , State:pl2 I zip: Ejectors/sump Phone: 73 13 Fax:( A_7,? E-mail: Expansion tank -- MOM Fixture/sewer cap Name(print): , Floor drains/floor sinks/hub Mailing address: — — Garbage disposal Bose bibb City: _ _ State: ZIP: _�— Ice maker Phone: _1 Fax: E-mail: Interceptor/grease trap -- (hsner installation/residential maintenance only: The actual installation Primcr(s) will he made by me or the maintenance and repair made by my regular R(x)f drain(commercial) _ employee on the property I own as per ORS Chapter 447. Sink(s),basin(s), lays(s) O%ener's signature: Dat(:: - Sump Tubs/shower/shower pan Urinal Name: - -_--- ------_.-- Water closet Address: _ Water heater City: State: ZIP: _ Other: Phone: v Fax: l:-mail — Total _ 7y e Nn(till jutisdictions accept credit cards,please call itinuliction I(x nwrr uif mneGon. Mini mum fee................$ , O Visa U MasterCard expires iia p Notice: Thts ermni application Plan review(at _ 170 $ /9& ' nnit s not obtained 7(c TOTAL Credit card number _ J �_. within 190 days after it has been State surcharge(8%,) ....$ _�— - p / t hrs .......................$ 1 s Neme of cardhobkr as shown on credit cud BCCCpICd a5 COmpICIC. - �_- ('ardhohlct sir.naturr Amount 4104616(MMOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES Individual QTY ea AMOUNT (Includes all plumbing fixtures In PRICE TOTAL Sink 2 16.60 33 20 the dwelling and the first100 ft, QTY (ea) AMOUNT Lavatory 16.60 for each utilityconnection) — c�vqsoOne(1)bath $249.20 Tub or Tub/Shower Comb. 1660 Two_(?)bath — $350.00 Shower Only 16.60 1 t.,r,.oIThree 3( )bath —_ $399.00 Water Closet 16.60 ----_ _SUBTOTAL Urinal 16.60 --8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.60 _— TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 3" _ 16.60 6.60 - PLEASE COMPLETE: 4" — 16.60 Water Heater O conversion O like kind 16,60 / Quantit b•Work Performed Gas piping requires a separate mechanical I 6,(0 Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46,40 Lavat!r — - -• Tub or Tub/Shower Hose Bibs 16,60 _ Combination Roof Drains 16.60 — Shower Only- Drinking Fountain 16.60O Water Closet— �_ Other Fixtures(Specify) 16.60 — Urinal — Dishwasher _ _ Garbage Disposal — Laundry Room Tray _ -- --- -- Washing Machine Floor Drain/Sink: 2" Sewer-1st 100' 55.00 — 3„ Sewer-each additional 100' 4640 __ —4" Water Service-1st 100' 55.00 Water Heater Water Service-each additional 200' 46,40 Other Fixtures (Specify) Storm 8 Rain Drain-1st 100' 55.00 Storm 8 Rain Drain-each additional 100' 46,40 r _ Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 — - — Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections _ er/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 6525 Grease Traps 16.60 --- — -- QUANTITY TOTAL — — Isometric or riser diagram Is required if ---� Quantity otal is >9 -- -- 'SUBTOTAL ----- — -- 8%STATE SURCHARGE - - - -- __ .5 9, V ------ - "PLAN REVIEW 25%OF SUBTOTAL p Re uired only it fixture qty total is>9 ----- TOTAL a r "Minimum permit fee is$72 50•8%state surcharge,except Residential Barliflow pievention Device,which Is$36 25+8%stale surcharge *#All New Commercial Buildings require plans with Isometric or riser diagram and plan review i\dsts',forms\plm-fees doc 10/10/00 CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2001-00253 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1012.2101 SITE ADDRESS; 11900 SW GREENBURG RD PARCEL: 1S135DD-04400 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG TENANT NAME: SOUTHWEST FAMILY MEDICAL OFFIC USA NO: FIXTURE UNITS: 117 CLASS OF WORK: ADD DWELLING UNITS: 6 TYPE OF USE: COM NO. OF BUILDINGS: 1 INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: Increase of 6.3 EDU's. Previous value count was 16, this project capped 32 va;ue units but was only being billed for 16 so was only credited for 16. They added '117 units for a new total of 101 fixture units or 6.3 EDU's. Owner: FEES BEN STUTZ 1 128 SW ENGLEWOOD Type By Date Amount Receipt LAKE OSWEGO, OR 97034 PRMT CTR 10/2210/ $14,490.00 27200100000 Phone: 503-245-9474 Total $14,490.00 Contractor: Phone: Reg#: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side s3wer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located,the installer shall purchase a "Tap and Side Sewer' Perm i Issued b : Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next business day kccumulative Sewer Tally cn 3 Tenant Name: _ u%Nt�F`moi �AN�GY ��yT) This SWR# Address: /l oo /-,,) WeA)oy _ This PLM#: 610o/ 6 Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New # Value Capped off value added# added #s total Count off#s count value values Baptistry/Font 4 _ Bath-Tub/Shower __ 4 Jacuzzi/Whirlpool 4 Car Wash-Each Stall 6 _ Drive Through 16 Cuspidor/Water Aspirator 1 _ Dishwasher-Commercial 4 _ -Domestic 2 Drinking Fountain 1 Eye Wash 1 Floor Drain/sink-2 inch 2 3 inch 5 _ 4 inch_ _ 6 -Car Wash Dm _ 6 Garbage Disposal 16 Domestic(to 3/4 HP) Commercial(to 5 HP) 32 Industrial(over 5 HP) 48 Ice Machine/Refrigerator Drains 1 -Oil Sep(Gas Station) 6 Rec. Vehicle Dump Station _ 16 Shower-Gang(Per Head) 1 -Stall , 12 P �.- Sink-Bar/Lavatory _ 2 Bradley 5 Commercial 3 -Service 3 SwimminPool Filler 1 Washer-Clothes 6 _Water Extractor 6 _ Water Closet-Toilet 6 Urinal 6 TOTALS ( �' �� 117 /1 r' Total fixture values:_ divided by 16 _EDU �' O a 30th $ �� /17(9" HISTORY 1-7 �a�efci�e-�, / �r'�{ (16 zA j _. PLM# _EDU# SWR# PLM# EDU# _ SWR# ^LM# EDU# SWR# PLM# EDU# SWR# v PLM# _ EDU# SWR# _ PLM# _ EDU# SWR# PLM# EDU# SWR#� r PLM# EDU# SWR# J I klsts%swrtaly doc. � (� L.V 7— T F�/ l�12� 7>>�i►Jln �l�C?� row MEMORANDUM CITY OF TIGARD, OREGON TO: Building file/Sewer Tally File FROM: Debbie Adamski DATE: Scptemhcr 11, 2001 SUBJECT: 1 1900 SW Greenburg Rd, Southwest Family Medical Office Per the application for plumbing permit, PLM2001-0039$, they would he capping more fixtures than they were bcing billed for. They capped 32 fixture units, but were only being billed for 10 (ixturc units. Plumbing inspector, Bill LeFvvc, did a walk-through fixture count on 9/7/01. Per his count the piumhing contractor had capped, (3) water closets, (3) lays and (1 ) urinal. This adds up to 32 fixture units. As the address was only being billed for 16 fixture units, or 1 EDU, that is all tliev will be credited for. t CITY OF TI GA R D _ BUILDING PERMIT PERMIT#: BUP2002-00532 DEVELOPMENT SERVICES DATE ISSUED: 12/10/02 13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 SITE ADDRESS: 11900 SW GREENBURG RD BLDG 1 PARCEL: 1S135DD 04400 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG _ REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: OTR FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? TYPE OF CONST: sf N: S: E: W: OCCUPANCY GRP: TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: R_EQD SETBACKSREQUIRED _ 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: PRG` CORR: PARKING: VALUE: $ 5,245.00 Remarks: Sign- electrical freestanding located at street. Owner: Contractor: STEVENSON, MICHAEL J + KAY L CLASSIC SIGN SYSTEMS z"825 DELLWOOD DR 17300 SW UPPER BOONFS FERRY RD LAKE O`+W►=GO, OR 97034 PORTLAND, OR 97223 Phone: Phone: 638-7446 Reg #: LIG 00077863 FEES REQUIRED INSPECTIONS Description Date Amount Foundation Insp Ifit 1111)l I'mili Fcc 12/10/02 $100.Q0 Final Inspection �l3t'1111LNj I'In 11% 12/10/02 $F5.59 I A\1 K".n Stag. fax 12/10/02 $8.07 Total $174.56 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 952-001-0100. 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: .��•C.t. LL l G= �- L�L( C __ Pe im ittee Signature: L Call 619-4175 by 7 p.m. for an inspection the next business day (C)�) . t � vc� L/ Building Permit Application .g ��'\ Datereceived: permit no,: J'-W' - �,1t!r' ()1' ,1 v s--"f Address: 13125 SW Hall Blvd,Tigard,OR 97223 ProjecVappl.no.: F.>piledate: ('ih nl7if•nrrl �QU� Phone: (503) 639-4171 I}EC L Date issued: Hy:" I�, Receipt no.: Fax: (503) 598-1960 Case file no.: payment type: CITY OF TIGARD Land use approval��..�t I&zfamil IQ DIVISION y:Simple Complex: J I & 2 family dwelling or accessory U Commercial/industrial U Multi-family U New constn ction U Demolition U Addition/alteration/replacement U Tenant improvement U Firc sprinkler/alann A()the : S L CT fU JOB SIT F 1 ' Job address: Bldg.no.: Suite no.: Lot: Block: Subdivision: VTax map/tax lot account no.: I v Project name: S n�,L Lt,L1_CS:t- CCL,, A, -N S-- Description and location of work on premises/special con itions: X)e4-,I.J e_1e_CQLr-4r a7 C S �;o Name: O • lrE Mailing address C 1 2 family dnclling: City: j p_4-r,. State:Q 'LIP: 22- Valuation of work........................................ Photie:24 t S 1 Fax: 113-mail: No.of bedrooms/baths................................. -- Owner's representative: c/ C �~t-�->I1t ek Total number of floors................................. _ Phone: Fax: E-mail: New dwelling area(sq, ft.) .......................... 11,10 Garage/carport area(sq.ft.)•..............•......... - -- - Name: rch area(s ccFSt FLt.f'Yt-v. r'�"t S-t�C.lC1h Covered FK' q. ft.) ......................... Mailing address: !ijpp W&tgki-, Deck area(sq.ft.) ........................................ City: `C l r- State:0 ZIP: 2 Other structure area(sq.ft.)....................... . _ Phone: ,C Fax: Email: CommerciaUlndwttrhllmultl-f>imlly: _ Valuation of work........................................ $ Existing bldg.area(sq. ft.) ........ Business name: (; CLc � r��. •• Address: c�� New bldg.area(sq.ft.)............�'� 0C ... ........... Number of stories.....................� .✓......... Ems.✓ Cit State: ZIP: 2-2-3 Type of construction 1 F.6 Y: Gt r !isti . . y _Phone: Fax:(02706E-mail- Occupancy group(s): Existing: { CCB no.: -7'7f91d I _ - New: City/marc,lie.no.: _1Jg Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may he required to be licensed in the Address: - jurisdiction where work is being performed. If the applicant is City: State: ZIP: exempt from licensing,the following reason applies: Contact person: a Plan no.: - I' ►r Fax: I E-mail: Name: Ali (.o(, L t i f r\ac, Contact person: Fees due upon application ........................... $ Address: PU t1 2 3-I S IA Date received: — City: T _ _—mat;:0W_ ZIP: (I-) 2 b' Amount received ......................................... $ -- Phone: Lp , p Fax: 3ik mail: _ Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards,please call joriuliction for mere information attached checklist. All previsions of laws and ordinances governing this U Visa ❑Mwter(•ard work will Ix compliedits er specified herein or not4LI42- Credit card number.. Expires Authorized signature:_ Date: Name of cardholder as shown on credit car S Print name:,—_ _ Cardholder signature _ Amnunt Notice:"this permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. "Y461.1 WXYCOM) Commercial Plan Submittal Requirement Matrix City of Tigard TYPE OF SUBMITTAL # of Plans (Includes New, Additions or Alterations) Required at Submittal Site Work 4 (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 pians. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). *For over-the-counter commercial 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 "3" technicians. iAdsts\forms\COM-matrix.doc 9/24/01 U75 �! .G t5 � — o LL �� 6O Ot o � oa � m - o� Uh UL 00 CITY OF TIGai,l; 12�) Approved.................................. I z ronditionally Approved.................... _ x R -� f or only thea8 described in' i'o PERMIT NO V rk Ll 22-- -- O X � r See Letter to: Follow..... •.• •••. ( I U- M � ga �) Attnch.. cu J Job Artdrem . r ey 5 15R � R i i7p y s L .. R3 N U C > W acs w °'C -' a) ° , af° �it° L � t� z � t«-0 .�' tyi aat ') � � � F0 m co _rn cn co `8 X pp U � � Q � � 5 I / W" 101 xvi 1._ r �4 A" 101 xv'1 rr I ` II � N � a r L Nicoli Engineering Inc. PO Bo; 23784 Tigard, Oregon 97281 - Phone: (503) 620-2086 - Fax: (503) 684-3636 STRUCTURAL CALCULATIONS FOR: SIGN POLE AND FOOTING FOR: SOUTHWEST FAMILY PHYSICIANS 11900 SW GREENBURG ROAD TIGARD, OREGON D PRO �� REGON \qq0 N.— CLIENT CLIENT : CLASSIC SIGN JOB NO.: 021110 PREPARED BY : SET CHECKED BY ENK DATE : 11--25--02 PAGE OF I 1 A-r1'AG+1 He9 r or- slb►J 41 A S S iac 00 �1�� -2jr r llk4 A0 012IL-kSP 10 -- _ - - — PROJECT 6LA5S1� 51-a�S - SaU-rNWC-51 rk� IIL.Y P�4'(SlC,44S PREPARED BY DATE JOB N�. �l✓1' ll f 25�oZ PAGE N0. OF -gp s l c WIND 5?C-Q V = 80 M P+A 70 p s I6►J - �2,�;I r� 2- PROJECT PROJECT Gl.,&SS IL SIONaS - SWCtIL-F 'f 'FOAll PI'W(, ,ANS PREPARED BY SVT DATE I -2 S-�2 JOB NO. O Z �I I p PAGE NO. S OF ��x 8 �lb►J N r'r°-w l CXR) ►�'� 1 1 I �SZo ►� Z,- 0, �WLs I I PREPARED BY DATE PROJECT - Z s O2 JOB NO. O21 �o ---- PAGE NO. 0(- � � Cn AT L c4-,a-r I CN = TSO ( - 4-3zc, -fit. IbJ I I I PROJECT 6L#3SIG Sq:20_5 SoUjgi,,C-S"r P��1IL14 P41S-I', IANS PREPARED BYDATE JOB N0. 12�- �z i--� —- 110 I PAGE N0, S OF Aso* Ca RAVS WC—64T5 C P) — GANG RCTS IG Cal 1 P r - � •�� ( P�55'UV-1If�� 'LgVJ 14)(3% z� 12 4.1:T) (r0o5Lo t � - --- __ - - $o ' PRCJECT - (.\ssi � S i (��)S ' Sou �Ua�-i►�� y�IClr>NS PREPARED BY 5e-.r DATE II-25-pZ JOB NO. 02 � -PAGE N0. OF _ CITY OF TIGARD ELECTRIGAL PERMIT PERMIT#: ELC2002-00632 DEVELOPMEN r SERVICES DATE ISSUED: 12/10/02 13125 SW Hall Blvd.,Tigard. OR 97223 (503)639.4171 PARCEL: 1S135DD-04400 SITE ADDRESS: 11900 SW GREENBURG RD BLDG 1 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG Project Description: 1 each sign lighting. RESIDENTIAL 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: 1 LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/SVCI FDR: 601+amps-1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: list W/O SRVC OR FOR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amplvolt: >=4 RES UNITS: >600 VOLT NOMINAL: Reconnect only: SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: STEVENSON,MICHAEL J +KAY L LUMINITE SIGN CRAFT INC. 2825 DELLWOOD DR 9033 SW BURNHAM LAKE OSWEGO,OR 97034 TIGARD,OR 97223 Phone: Phone: 503-639-4991 Reg #: LIC 116449 ELL 34-530CLS FEES SUP 159SIG Description Date Amount _ Required Inspections 1E1-PRMI-I F.LC'Pcrnnt 12.10102 $5340 TAXI P,'n State Tax 12110102 $4.27 Rough-in _ Elect'l Final Total $57.67 R This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of Or'.opecialty 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 .wrk is suspended f,)r 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 obta in copies of these rules or direct questions to OUNC at(503)2466699 of 1-800-332-2344, Issued By: z,LL_/.�,_r_2 til_ Az�)Ct_al Permit Signature: OWNER INSTALLATION ONLY The installation is being made on property own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _ DATE:___ _ CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: i�_ _ _ DATE:----- LICENSE ATE:__ --LICENSE NO: tVl 'C) Call 639-4175 by 7:00pm for an inspection the next business day Electrical Permit Application Datereceived: Pcrmitno._-"(— f �l City of Tigard V r Project/appl.no.: Expire date: ('try t,f Tixnrd Address: 13125;W Hall 131VKW; '9722 ` Date issued: Ry:'i�b I Receipt no.: Phone: (503) 639-4171 --- Fax: (503) 598-1960 DEC 1 U 200? Case file no.: Payment type, Land use approval: ,;ijy LZF TI(-;w1iu U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construt tion U Addition/alteration/replacement 1,♦d Other: 1� ( U Partial .1011 SUI 1. 1 Joh address: pp c LL.) t f _J Bldg.nu.. — Suite nu.: — Tax map/lax lot/account no.: 1 Lot: Block: Subdivision: Prgject name: Fam ' YS1 taut Description and location of work ort premises: Estimated date of completion/inspection: OL - O CONTRACIFOR APPLICATION SC111111".11ill 1,11 Job no: F'ee Max �- Description Qty, (ea.) Total no.ins Business name: r r r1 _ t Ne"residential-single or multi-fandly per Address: duellingunit.Includes allachedgarage. Oily: a116L State:p 'LIP: Z 2 Serviceincluded: Phone: .St.510 Fax: p E-mail: 1000 sq.ft.or less CCB net.: q y r 1.41 Elec.bus.lic.no: _ L 11Foch additional S00 sq.ft.or portion thereof Limiteee Limited energy,residential = City/metrolic.no.: .) 4c 9 Limited energy,aurt-residential _ - ` 7 s Fach manufactured home or modular dwelling T `— /� Service and/or feeder Si t col pervi t 'c AF in UCylllfed) Date <� Sup.elect.rrtime(print): r 4 License no •i Servlt'esarfeeders••Inatallatlon, alteration or relocation: 200 amps or less 2 Nance(print): ( L / c,�UG r L1 4 201 amps to 400 amps _ 2 401 amps to 600 amps 2 Mailing address: p IM0 601 amps to 1000 amps _ City: t (r..q-14 S(ate:p ZIP: C- Over ltxx)amps orvolis 2 Phone: 5• 13 1 Fax: I E-mail: Reconnecionl _ I Owner installation:The installation is being made on property 1 own Iempororyservices orfeeders- which is not intended for sale,lease,writ,or exchange according to Installation,alteration,or relocation: 2011 amps or less 2 ORS 447,455,479, ,701; 201 amps to 400 amps 2 Owner's si gnatu-c: Date: ! t �- 401 to 600 am Is 2 Branch circuits-new,alteration, or c xtenslon per panel: Name: i(-L)f j Ey-)a Lt t Vx U ,--,-__ A. Fee for branch circuits with purchase of Address: P013 ;Z?j service or feeder fee,each branch circuit _ 2 Cil y: jQ C(a- State:C R I ZIP: q-72-$ B. Fee for branch circuits without purchase of service or feeder fee,first branch circuit: 2 Phone: . C'• 2.0,S(v 34, E-mail: Each additional branch circuit: Misc.(Service or feeder not Included): U Service over 225 amps-commercial U Health-care facility Fach Pump or imgation circle _ 2 U Service over 320 amps-rating of 1&2 U llazardous location Fach sign or outline lighting 2 familydwellings U Building over 10,(100 square feet into or Signal circuit(s)or a limited energy panel, U System over 60x1 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(lccupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over the allowable In nnv of the above U Fgress/lightingplan AOther: Perinspection Submit._-__sets of plans with any of the above. Investigation fee J _ The above are not applicable to temporary construction service. Other -J1 Not nn juriulicrions accept credit card%,please can jurisdiction for more lnformsllnn. Notice:This pennit application Permit fee................. _ U Viso U MasterCard expires if a permit is not obtained Plan review(at _ %)) $ $ Credit card number within 180 days tiller it has been State surcharge(8%)....$ Expirer accepted as complete. TOTAL $ Name of cardholder u shown on credit card — Cardholder signature S Amount EXPIRED IRED 4404613(6i00/COM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Restricted Energy Fee............. ...................................... $75.00 Number of InsE2ctIons per permit allowed (FOR ALL SYSTEMS) Sorvice included: Items Cost Total I Check Type of Work Involved. Residential-per unit 1000 sq ft or less _ $145 15 4 ❑ Audio an i Stereo Systems' Each additional 500 sq.It or portion thereof $33,40 1 ❑ Burglar Alarm I imited Energy _ $75.00 Each Manufd Home or Modular Dwelling Service or Feeder $9090 2 ❑ Garage Door Opener' Services or Feeders ❑ Installation,alteration,or relocation Heating,Ventilation and Air Conditioning System' 200 amps or less _ $80 30 _ 2 201 amps to 400 amps $10685 2 ❑ Vacuum Systems' 401 amps to 600 amps $160,60 2 601 amps to 1000 amps $24060 _ 2 Other Over 1000 amps or volts _ $45465 _ 2 Reconnect only _ $66 85 2 Temporary Services or Feeders _ TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration.or relocation Foe for each system......................................... ................ $75.00 200 amps or less $66.65 2 (SEE OAR 918-260-260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $13375 Y 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. Audio and Stereo Systems Branch Circuits ❑ Boiler Controls New,alteration or extension per panel a)The fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. Each branch circuit �Y $665 _ 2 ❑ Data Telecommunication Installation b)The fen_for branch circuits without purchase of sen•Ice or feeder fee. F-] Fire Alarm Installation First branch circuit $46.85 Each additional branch circuit _ $665 ❑ HVAC Miscellaneous (Service or feeder not included) ❑ Instrumentation Each pump or irrigation circle $5340 Each sign or outline lighting �_ $5340 r•cr ❑ Intercom and Paging Systems Signal circuit(s)or a limited energv panel,alteration or extension _ $7500 _ ❑ Landscape Irrigation Control' Minor Labels(10) _ $125.00 Each additional inspection over ❑ Medical the allowable In any of the above Per inspection _ $62.50 CJ Nurse Calls Per hour _ $6250 _ In Plant v — $73.75 — �l Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fees $ _ Other 8%State Surcharge $ .�7•r� --- - - - -- - -------- -- - _---_Number of Systems 25%Plan Review Fee See'Plan Review"section on $ No licenses are required Licenses are required for all other inslalla!ions front of application -----------.__.__ Fees: Total Balance Due $ Enter total of above fees $ E] frust Account# 8%State Surcharge $ All New Commercial Buildings require 2 sets of plans. Total Balance Due i\dsls\fomts\etc-f'ecs.doc 08/30/01 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503) 639-4171 _._ BUP Received --- Date Requested /_I-)-y - -__ AM--__-_ PM_ — BUP Location . o VSd✓ y � ��- -�Z-:� �_-____-__-Suite ____-_ MECSLG-v} 7 Contact Person --/------_.__... - __-_. Ph PLM Contractor_ _---------_...._ _ Ph (--) ---------- -- SWR — BUILDING Tenant/Owner . ___—__� __-_.-- ---. ELC Footing ELC Foundation Access: (Ir ? Fig Drain ELR Crawl Drain Slab Inspection Nates: SIT Post&Beam -- --- - ------------ _ _ _ Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - --- - --- -..-- - - --- Insulation Drywall Nailing - - -- --- Firewall Fire Sprinkler -- -- ___ - --- - ----- -- Fire Alarm Susp'd Ceiling - _ _ -------- --- -- - --- -._--- - Roof Other - - - Final -^ PASS PART FAIL PLUMBING - -- -- -- -- --- --_ Post&Beam Under Slab -- ----- ------ - Rough-In Water Service ----- Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain -_ - --- --- - ----- -- -- ShowerPan Other: -- --- - - - - - --- ----- - - Final PASS_ PART FAIL Post& Beam Rough-In - -— --- - -- ------ - -- Gas Line Smoke Dampers ---- - -- - - — A PART FAIL - CTRICAL Service Rough-In UG/Slab Low Voltage _ -- - -- - - - Fire Alarm Final U Reinspection fee of$__ --required before next inspection. Pay at City Hall, 13125 SW Hall Blvd PASS PART FAIL SITE T Please call for reinspection RE: ❑ Unable to inspect--no access Fire Sdpply Line l y ADA / Approach/Sidewalk Date _ 1L_ Inspector — __Ext-_ Other: Final DO NO REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP — 3 Received Date Requested_____l' - AM_____ PM BLIP Location G -�. ySuite ��, _ MEC Contact Person PLM — Contractor Ph ( ) _ SWR BUILDING _ Tenant/Owner _ .�_ � _�� ' 7 ELC Footing Foundation Access: —""'- ELC -_- Ftg Drain Crawl Drain Slab Inspection Notes: SIT -____ Post& Beam Shear Anchors -- ----- - ------------- Ext Sheath/Shear IntSheath/Shear Framing ---- -- -- ..------ - . .- -- - -- - ------- Insulation Drywall Nailing --- ----- Firewall ----_-.._.-- Fire Sprinkler Fire Alarm Susp'd Ceiling -- ----.. -..- --- ------ - Roof Other: --- --- ------ -- __._ __— Final — PASS PART FAIL - - -- -- PLUMBING ----T_--_ Post& Beam Under Slab Rough-In Water Service Sanitary Sewer _ Rain Drains - --- -- - ------- -- --- Catch Basin/Manhole Storm Drain -- - --- Shower Pan Other: — Final PASS PART FAIL - - - — --- MECHANICAL Pest& Beam Rough-In Gas Line Smoke Dampers - -- --- -- Final - PASS PART FALL -- -- — - _ ELECTRCAL _. I Service Rough-In UG/Slab -i-- — - — Low Voltage — _— Fi Alarm -- PART FAIL Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. _ SITE Please call for reinspection RE:__ - _ - u Unable to Inspect-no access Fire Supply Line ADA / Approach/Sidewalk fine- C-1 a Inspector 4({Y Ext Other: Final _ DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP Received _Cate Requested _ �� AM PM BLIP Location / eq& _ _ Suite__._.-.___-_—_ - MEC _ Contact Person Ph(---- -.-) PLM 120 d Contractor �2.e _-- --- Ph (---- ) -a_"--71 SWR -- — BUILDING Tenant/Owner ELC Footing ELC Foundation Access. Fig Drain ELR Crawl Drain - -�--- Slab Inspection Notes: SIT Post& Beam _-_-- Shear Anchors --- --------- - Ext Sheath/Shear Int eat /Shear Framing Insulation Drywall Nailing ------ --------- -- - Firewall Fire Sprinkler - -- -._...--- - ----- - - - - --- ---- Fire Alarm Susp'd Ceiling -- Roof Other: --- - Final PASS _PART FAIL ---- PLUMBING G Post&Beam Under Slab - - - ------ - - ----- - - - Rough-in Water Service --- Sanitary Sewer Rain Drains -- - - ----------- - - -- Catch Basin/Manhole Storm Drain - - - --- -- - ---- - ----— -- --- -- Shower Pan Other: -- - - - - ----- -- - ----- ------ _. . - ----- -- -- --_ AS PART FAIL ----- - - -- . --- -- - - - --- -- - -— - -- MECHANICAL Post R Beam Rough-In - - -- ----- -- - - ----- Gas Line Smoke Dampers - - -- - - - --- - - - - - - Final PASS PART FAIL - -- - - -- - - -- - -- ---- - ELECTRICAL Service Rough-In UG/Slab Low Voltage Fire Alarm Final E] Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PXIT FAIL SITE _ _ n Please call for reinspection RE:_ - _-_ -_ r Unable to inspect- no access Fim Supply Line ADA C Approach/Sidewalk Date _ Inspector d Ext Other: - Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIT_ CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP Received �— Date Re uested �_�Z __ AM___..____PM BUP _ Location --�-1- 1 -G Suite MEC _— Contact Person — k— PLM i `� (---) ��' _ Contractor---. ----- -_._.---_.--- Ph(__---) _—�--_ SWR ----___-- BUILDING __ Tenant/Owner _ _ ELC Footina 1LC Foundation Access: - Ftg Drain ELR Crawl Drain _ Slab Inspection Notes: SIT Post R Beam Shear Anchors - Ext Sheath/Shear int SheatidShear - - Framing Insulation C, l Drywall Nailing — ----- -- _. Firewall ` ) Y-k L U Fire Sprinkler - -- J _ ----- - --- -- --- Fire Alarm Susp'd Ceiling - ._.. -- --- - -- --- - --- - Roof Other: -- Final SS PART FAIL_ PLUMBING Post&Beam -- - ------- Under Slab Rough-In Water Service Sanitary Sewer Rain Drains -- - Catch Basin/Manhole Storm Drain - --- ----_ - - - - --- -- Shower Pan Other: -- - --- --- -- ---- -------------- Final PASS PART FAIL ---_----_..-- - -- _ _- -- _-_-- _-- MECHANICAL Pos;& Beam - Rough-In -_--- Gas Line - - -- -_---- -- Smoke Dampers - -------- ___ - _-_ __-------- ----- __-- -- Final PASS PART_ FAIL - - - --- - --- ----------- -- ELECTRICAL_- Service �- Rough-In /Slab Fire -- ------------ Fire Alar --- FReins ection fee of$_. -- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.SS PART FAIL SITE 1 Please call for reinspection RE C� Unable to inspect- no access S --- — Fire Supply Line ADA Approach/Sidewalk Data___. -__.�� specto -�_- ` G'-''�"'"Q Ext Other: Final DO NOT REMOVE this Inspection record ffom the Job site. PASS PART FAIL CITYOF T I G A R D BUILDING PERMIT PERMIT#:DEVELOPMENT SERVICES DALE SSUED: 111/280/ 00307 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639-4171 PARCEL: 1S135DD 04400 SITE ADDRESS: 11900 SW GREENBURG RD SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ADD FIRST: sf N: S: 1 HR E: W: 1 HR_ TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? TYPE OF CONST: 5N sf N: S: E: W; OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF CONST; FIRE RET? OCCUPANCY LOAD: 24 BASEMENT: sf AREA SEP. RATED: 2HR STOR: 1 HT: ft GARAGE: sf OCCU SEP. RATED: BSM'1'?: N MEZZ?: N 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: $ 190,901.40 Remarks: Phase 2. for building additions Cad North and South ends of existing building. Owner: Contractor: BC ASSOCIATES LLC OWNER 1128 SW ENGLEWOOD DR LAKE OSWEGO, OR 97034 Phone: 503-684-7592 Phone: Reg #: _ FEES REQUIRED INSPECTIONS Type By Date Amount Receipt FooUFound Insp Final Inspection PLCK CTR C/27/01 $610.55 27200100000 Footing Drain Footing Drain FIRE CTR 8/27/01 $375.72 27200100000 Post/Beam Insp PRMT CTR 11/27/01 $1,099.20 27200100000 Slab Insp PLC2 CTR 11/27/01 $103.93 27200100000 Plumb Top Out (additional fees not listed here) Framing Insp Gas Line Insp Total $2,341.30 Insulation Insp Firewall Insp 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 questions to OUNC by calling (503)246-6699 or 1-800-332-2344. Permittee Signature: Issued By: -- Call 639-4175 by 7 p.m. for an inspection the next business day Building Permit A tic tion City of Tigard ( �� Datereceived: � 7 F'ermitno.: Address: 13125 SW Hall Blvd,Tigar 7223 Projcct/appl.no.: Expire date: City ?f Tigard Date issued: R Recei t no.: Phone: (503) 639-4171 Y� i P Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: _e2p 0000(o _ 1&2 family:Simple Complex: U I &2 family dwelling or accessory J t'ommcrrial/in(lusu cal J Multi-family LWew construction J Demolition aV1+d(liti(in/alteration/replacement Yl rn;inl irnprmcnicnt J Fire sprinkler/alann J Other: _ JOB SITE INI:ORr*]A'I*ION Job address: 1101 .b,V.1, C„� IpEgdn tj, Bldg. no.: Suite no.: Lot: I Block: Suhrfivi arm: Tax rnap/tax lot/account no.: 151 35 DD bO Project name: Description and location of work on premises/special conditions:�'li�a_ 2__ L11?1Nla-_p� T_ _QPt L C1d� o __J 1!WL 2LKLn_ &WISIpNS � (I loodplaiii,septic capaciti.,solar,etc.) Mailing address: e p.UJ, I At 2 family dwelling: City: State: ZIP: 01'103 Valuation of work........................................ $:- Phone Fax:Q4 F-mail: No.of bedro(mts/haths................................. Owner's represcntative:JlM�A KC"We., e Blew I mural number of floors................................. — Phone-,-Sol. OW. 2-08✓ 1: nrul New dwelling area(sq.ft. O19arage/carport area(sq.ft.) ........................ Name: Iroi Al�;, OVLMV rr- Covered porch area(sq.ft.) ......................... - — Deck area(sq.ft.) Mailing atltlo.�• .................................. City: State: ZIP: - - Ocher structure area(sq. ft.)............ ............ - - ('ommercial/industriallmulti-famlly: I q C' q d I Phone: l ,t� F mail i Valuation of work......................... ... ......... $ kS(?.LOD L .y� Existing bldg.area(sq. ft.) iH!'St;,.WA......... AX h�_ Business name: �(2/J� Address: New bldg.area(sq.ft.).P.NM. .I�:..Zr.......... 21 23$_.. City: State: ZIP: Number of stories........................................ - I;Ix: Type of construction.................................... V^N Phone: E-mail: _ Phone: Occupancy group(s): Existing:CCB _ - _ New: Cily/rtu•tarn lie it(), - Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may be required to he licensed in the Address: -- jurisdiction where work is being performed. If the applicant is City: _ State: ZIP: exempt from licensing,the following reason applies: Contact person: Plan no.: — — --- Phone:--- I aV E-mail: Name: fatkllr.E0_HL r w f'ontact personjjHAjjMW Fees due upon application ....... ................... $ - Address: 1po. _pA_Z�- _ Date received: City: _ Stateo ZIP: 'g-riati Amount received ......................................... $ - Phone:50-*-LQV.2V , Fax:W.3`V,, E-mail: Please refer to fee schedule. hereby certify I have read and exnmined this application and the Not all jurisdictions accept credit cards.please call jurisdiction fm more Infortnation attached checklist. All provisions of laws and ordinances governing this U visa U MasterCard work will be complied with,whether specified herein or not. Credit card number - � _—Expires l�— Authorized sigpo _1 Date: �'�'Qr Name of cardholder as shown on credit card _ Print name: `-. 17. AR (Q��a, S SAL Cardholder sij'naturc Amount Notice:This permit application expires if a permit is not obtained within ISO days ager it has leen accepted as complete. 140-M13(fMOCCIM) r COMMERCIAL PLAN SUBMITTAL REQUIREMENT MATRIX Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional plan sets for distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). Total # of TYPE OF SUBMITTAL Plans KEY: Submitted S = Site Work (must include S (New, Add or Alt) 4 location of all accessible parking) B (New, Add or Alt) t* j B = Building F (New, Add or Alt) 3** F = Fire Protection System M (New, Add or Alt) 2 M = Mechanical P (New, Add or Alt) 2 P = Plumbing E (New, Add, or Alt) 2 E = Electrical - -- ---- -_----- - New = New Building Add = Addition Alt = Alteration to existing building *For over-the-counter commercial tenant improvements, submit 2 sets of plans. **"New" requires that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. I'\dsts\forms\matrxcom.doc 10/27/00 SUBJECT: ACCESSIBILITY BARRIER REMOVAL IMPROVEMENT PLAN REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241. (1) Every project for renovation,alteration or modification to affected buildings and related facilities shall be made to insure that the path of travel to the altered area and the restroom, telephones and drinking fountains are readily accessible to individuals with disabilities unless such alterations are disproportionate to the overall alterations in terms of cost and scope. (2) Alterations made to the path of travel to an altered area may be deemed disproportionate to the overall alteration when the cost exceeds twenty-five percent(25%). VALUATION of all renovation, alteration or modification being done, excluding painting, wallpapering. [1]$ O.CaD multi�ly- 25% Barrier removal requirement. .25 BUDGET FOR BARRIER REMOVAL [21$ 31 , Sao_ In choosing which accessible elements to provide under this section, priority shall be given to those elements that will provide the greatest access. Elements shall be provided in the following order (a) Parking $ !p onro (b) An accessible entrance: $ 9, Doo (c) An accessible route to the altered area: $ 3 oho (d) At least one accessible restroom for $ each sex or a single unisex restroom: (e) Accessible telephones $ (f) Accessible drinking fountains and $ 3, 5 oo _ (g) When possible, additional accessible elements such as storage and alarms $ TOTAL: Shall equal line 2 of Value Computation_ $ '(1111'1 um1 nru ,.till, COUNTYWIDE TRAFFIC 1 M PACT FEE PAYMENT OPTION FORM ' Ra Date Site Address Protect Name ��' r e flan Check # I realize that I must make a decision on payment of the traffic is Impact Fee(TIF)at this time. Therefore. I request the following (choose whichever option or options are applicable): Cash or Check F] Credit Vouchcr Bancroft or Installment Payments or The Ordinance allows for deferral of payment of the 'I IF until issuance of the occupancy permit if the T?F is greater than $5,000. It' the TIF meets this requirement, I also request this option. I understand the TIF must be paid prior to issuance of an occupancy permit. 1 also understand that the '11F will be recalculated based on the prevailing rates at the time of payment. Please be advised that TIF rates may increase up to sic percent each July Ist. This rate increase is not subject to appeal. (OWNER/APPLICANT OWNER/APPLICANT cc: Building Permit File Payment Option Notebook i:\dsts\forms\tifsub.doc 11/27/01 DATE Aug 1, 2001 PLANS CHECK NO BUP2001-00307 PROIFUT TI11T �— COUNTYWIDE Southwcst Family Medical Office TRAFFIC IMPACT FEE WORKSHEET APPLICANT Ben Stutz �— (FOR NON-SINGLE FAMILY USES) MAILING ADDRESS: 1128 SW Englewood RD. CITY/ZIP/PIIONE Lake Oswego (503) 245-4479 TAX MAP NO.: 1 S 135DD04400 — SITES NOADDRESS: 11930 SW Greenburg RD. LAND USE CATEGORY RATE PER TRIP _ RESIDENTIAL $ 22.6.00 --i— —'— BUSINESS AND COMMERCIAL. $ 57.00 X OFFICE $ 207.00 INDUSTRIAL $ 217.00 INSTITUTIONAL $ 94.00 PAYMENT METHOD: CASH/CHECK - - --------------------- CREDIT X BANCROFT(PROMISSORY NOTE) LAND USE CATEGORY DESCRIPTION OF USE WEEKDAY AVG INSTITUTIONAL ONLY -- -- 720 Medical Office TRIP RATE WEEKEND AVG TRIP RATE DEFER TO OCCUPANCY 34.17 BASIS. ------ --- --- --- applicant proposed the addition of 1,900 Sq. Ft. to existing medical office building CALCULATIONS' J� TIF = AVG. TRIPS X T G S F. X RATE PER TRIP $13,439 = 34.17 X 1.9 X $207 TRANSIST AMT =$1,105 = I RIP GEN X 17 PROJECT TRIP GENERATION 65 FEE --- $13,439 FOR ACCOUNTING PURPOSES ONLY ADDITIONAL. NOTFS No credits are assumed ROAD AMT $12,3_3_4_ TRANSIT AMT _ $1,105 PREPARED BY S.S. Casper I:TIFWKST.DOC (DST) EFF: 07--01-98 Return Recorded Docurrent to: City Hall Records Departmen' City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 IMPACTTRAFf IC Installment Payment Application and Disclosure In the Matter of the Traffic Impact Fee for Southwest Family Medical Offices Tax Map 1S135DD Lot Number(s) 4400,4405,4406 and as further described in Deed# Building Permit# BIJP2001-00307 Site Address 11900 SW Greenhurg Rd Subdivision Case File# SDR2001-000.06 TIF Land Use District C-P To Be Billed To: Ben Stutz Address: 1128 SW Enqlewood Lake Oswe o OR 97034 _ 5( 03)245-A479 To the City of Tigard In accordance with the provision of Oregon Revised Statute 223 230 and Washington County Cod 3.17 which relates to the imposition of a traffic impact fee for the financing of major collector roads and arterials of Washington County, I/we HEREBY MAKE APPLICATION AND AGREE, JOINTLY AND SEVERALLY, to pay my/our traffic impact fee, as has been determined by Washington County Code 3.17 in 20 semi-annual installments of the amount financed together with one-half of one year's interest thereon at a rate of 7,01 annual percentage rate on the unpaid amount owed The lien date is the first day of the month following the date the application is signed The first payment is due six months thereafter and at six(6)month intervals thereafter for a period of 10 years Each installment payment will include principal and intereot If I\we neglect or refuse to pay any part of the installments provided herein, including interest,within one(1)year after the same shall have become due and payable, then the whole amount of the unpaid assessment shall become due and payable at once and shall be collected in the manner provided by law including foreclosure on the above-described real property The traffic impacl fee,annual percentage rate of interest(7.01 %)and finance charges which Itwe agree to pay are as follows HIGHWAY TRANSIT 1) Amount of Traffic Impact Fee................................................... $ 12,334 ILIL5 2) Amount Finanreed ...........................................................................$ 1334 1 105 3) Equal Semi-Annual Principal Payments.........................................$ 616.70 55.25 4) Interest on Balance at Rate of _.................................................. .7.01 % I\We understand that the amount owed, as stated above, shall be a lien on the above-described subject property pursuant to Washington County Code 3 17 060(C)and ORS 7.23 230(3) DATED this2 8 day of_N C t 4 •L h�"20 Gtl— Sign re of Property Owner(s) Signature of Property Owner(s) STATE OF OREGON ) Name(Please Print) Eh v+-•�'� - _.__J ' '� ��._____-_._____—. County of Washington ) Address Z S L -� w�• K /J/,__Gc/Lf GJGv c SUBS ` IBED AND SWORN TO BEFORE me this day of /J/(� U. _,20 y-4v_3 _(�I 1 c la A ie&. c - / -- -- Notary Public for Oregon �� OFFICIAL SEAL My Commission Expires �c�. SHERMAN S.CASpER /vf NOTARY PU3LIC-0REGM COMMISSION N0.323409 MY COMMISSION EXPIRFS MAY 13,2009 i\dsls\t ATIF-Pavinstall doc 11 OVID1 CITY OF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC201 00377 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1 PARCEL: 1 5135 1 �135DD-04400 SITE ADDRESS: 11900 SW GREENBURG RD SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ADD FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: _ FUEL TYPES _ 0 - 3 HP: DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPt!T• BTU 15 -30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 -50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: A AIR HANDLING UNITS OTHER UNITS: FURN >=100K BTU <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Installation of(2) nevi,roof top HVAC and (3)existing.Note all units require structural framing changes at all locations. Owner: _ FEES BEN STU fZ Type By Date Amount Receipt 1128 SW ENG,LEWOOD PRMT CTR 12/17/01 $72.50 2720010000 LAKE OSWEGO, OR 97034 PLGK CTR 12/17/01 $18.15 272001000C 5PCT CTR 12/17/01 $5.80 272001000C Phone:503-245-9474 Total $96.45 Contractor: SPECIALTY HEATING & COOLING 9528 SW TIGARD ST TIGARD, OR 972.23 REQUIRED INSPECTIONS Y__ Gas Line Insp Phone:620-5643 Mechanical Insp Reg #:LIC 66578 Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State -)f Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain co of these rules or direct questio to OUNC�by calling ciI Fm � ce-Permittee Signature: Issue By: _C g Call (503) 639.4175 by 7:00 P.M. for inspections needed the next business day 44, Mechanical Permit Application Date received:/o J•9 O/ Permit � no.: �f�! �, T7 City of TigardProjecUappl.no.: Expiredute: City(!fTigard Address: 13125 SW Hall Blvd."1'i!ard,UR %172?3 Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (.501) 598-1960 Case file no.: Payment type: may, Land use approval- _ B,tilding permit no.: ��► U 1 &2 family dwelling or accessor•v U Commerc;al/industrial U Multi-fancily U Tenant improvement U New construction U AddlGoiVitileralionhrplacenu•nl U Other: Job address: �./ } � CJ _-� t� r e e... ,% ILh I Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: _ Suite no.: value()fall mechanical materials,equipment,labor,overhead. Tux map/tax lot/account no.: profit. Value Lot: Block: �Sut)division: •lice checklist for important application information and Project name:$ u ri w es ` jurisdiction's fee schedule for residential permit Ice. City/county: I ZIP: Description and location of work onremiscs: 41 C " +M f ly r} 1'ce(en.) Total Est date of completion/inspection: p,.�,( N c I�scri ion _ spy. Rm.only Res.only ) Tenant improvement or change of use: : it handling unit CFM Is existing space heated or conditioned. f(1 Yes ❑No Air cond itioning(rile plan required) Is existing space insulated?U Yes U No Alteration of existing IlVACsyslem --" 1,111 Kill I L10 INLIX11LIG10111 L I= oiler/compressor% Business name: Wx - i ,� / ,,� , State boiler permit no.: Address: S -� n4 g-j Coe — HP —Tons-BTU/1-1 -- ire/smo c ampers/duct smo celectors City: ,y R,�p Stale:[/\ ZIP cat pump(silt plan required) --- — --u -- Phone: _ Fax: E-mail: I nstal Ureplacefurnacce urncr_ - t" i/ l CCB no.: 5S' Including ductwork/vent liner U Yes U No nstal/rep ace rclocal^heaters-suspended. City/metro lic.no.: wall•or floor mounted Name(please rint): -� ,Ve-, vent for ap ianceother t an furnace 7Absorption al on: unitsNTI1/FI Name: • � "r N.�Address: sors — M, isironmental exhaust and vent tat on: City: State: ZIP: _-- Appliancevenl Phone: Q -5-jq Fax: E-mail: Dryerex aunt -- -- -""-- ocs, ypel/ /res. ilchen/hazinat hood fire suppres:,ion system Name- " _ Exhaust fan with single duct(hath fans) Mailing address: S-w e uW/e —,0 c Exhaust s stem a art from heating or AC ue p p np,a,n sl ut o t(up to outlets) Slate: ti ZIP:�j 3 Type. I_I'G _ NC Oil Phone: Fax: E-mail: Fuel piping each nal over 4 outlets — Process piping(sc ematicrcquirc t Nantc; --� i— Number of outlets — Other I[drd app ante or Address: ` I)C, Deu,t:Itivefircplacc _ ('icy: _ — State: 'LIP: nscrt--tyhe Phone: F F:-;nail oo stov pe etstove -- -- Applicant's signature: /'j, C+atOther: - Other: Name (print): /<,p ,,,a hN oma+ --- Not all Jurisdictions accept eiedit tarda,please call Iorisdiction Int more Information Permit fee.....................$ C1 Visa LJ MasterCard Notice:This permit application Minimum fee................ credit card number. ___--- / / expires if a permit is not obtained , �--`- Plan review(at — 9f,) spire, within IRO days after it has been State surcharge(8%)....$ Name of carcatodder as shown on credit card accepted as complete. _ Cardholder signature Amount 440A17(6MOsr'OM) 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 f,Ainir_wm fee$72.50 _ Table 1A Mechanical Code Oty (Ea) Amt $5.001 00 to$10,000.00 $7[.50 for the first$5,000.00 and 11 Furnace to 100,000 BTU $1.32 for each additional$100.00 or including ducts&vents _ 1400 fraction thereof,to and including 2) Furnace 100,000 BTIJ+ $10,000.00, Including ducts 8 vents 17.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or including vent 14.00 fra.:hon thereof,to and including 4) Suspended heater,wall heoter $2_5,000.00. or floor mounted heater 1400 $25,001_00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional$100.00 or 680 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 Purnp Cond - fraction thereof. _ - footnotes below. Conip Minimum Permit Fee$72.50 �Y SUBTOTAL: 7)<3HP;absorb unit to 100K BTU 1400 - - ---e - 8)3-15 HP;absorb 8/.State Surcharge $ unit 100k to 500k BTU 25.60 25%Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb 35.00 Required for ALL commercial onlyunit.5-1 mil BTU _ _ TOTAL COMMERCIAL PERMIT FEE: $ unit 301.7 mil absorb unit 1-1.75 mil BTU 52.20 - --- ---- - -- - ------ -- -- 11)>50HP,absorb unit>1.75 mil BTU 87.20 _ ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM _ _ 1000 Value Total j3 )Air handling unit 10,000 CFM+ Description: QtyAmount _ 17 20 _ Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler ducts&vents Z 1 ( u _ i000 _ Furnace>100,000 BTU Including 1,170 15)Vent fan connecter)to a single duct ducts&vents6.80 _ Floor furnace including vent- 955 _ 16)Ventilation system not included in Suspended heater,wall heater or T 955 appliance permit ---1000-- floor 000floor mounted heater 17)Hood served by mechanical exhaust Vent not Included in appiicance 445 1000 permit 18)Domestic inciner: tors Repair units 805 1740 <3 hp;absorb.unit, 955 to 100k BTU 19)Commercial or industrial type incinerator ---- 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,501k to 1 2,310 21)Gas piping one to four outlets mil.BTU 5,40 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each)1.1.75 mll.BTU 1.00 _ >50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $ 3-1.75 mil.BTU _ All,handles unit to 10,000 dm 656 8'/.State Surcharge Air handling >10,000 cfm 1,170 Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: S Vent fan connected to a single duct 446 � T Vent system not Included in 656 _ e fiance i rmit Hood served by mechanical exhaust 656 Other Iecdons and•ees: T Inspections outsWe of normal business hours(minimum charge-two hours) Domestic incinerator 1,170 _ _ $72 50 per hour Commercial or industrial Incinerator 4,590 2 Inspections for which no fee is specifically indicated (minimum charge-half hour) Other unit,Including wood stoves, 656 $72 50 per hour Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plane(minimum Gag piping 14 outlets 360 G_y_1charge-one-half hour)$72 50 per hour Each additional outlet 63 ip 'Stale Contractor Boller Certification required for units>200k R1 U. TOTAL COMMERCIAL / -Residential A/C requires site plan showing placement of unit VALUATION: __ 7�� 1 All New Commercial Buildings require 2 sets of plans. i\dsts\forms\mech-fees,doc. 08129/01 ILVINicoli Engineering , Inc. PO Box 23784 Tigard, Oregon 97281 • Phone: (503) 620-2086 a Fax: (503) 604-3636 October 2, 2001 NEW. 01-0514 City of Tigard Building Department ATI-N. Robert Poskins, CET, CBO, Senior Plans Examiner 12355 SW Hall Blvd T igard, OR 97223 RE: Southwest Family Medical Offices 11900 SW Greenberg Road Tigard, OR 97223 SIT - 2001-00020 BUP- 2001-00307 Dear Mr. Poskins The following is our responses to your letter dated September 6, 2001. Our numbered items correspond to those listed in your letter. The site permit documents have been noted with a dated 10/02/01 and thi building permit documents for phase 2 have been noted with a ® dated 9/25/01. General Comments: • There was a transposed reference number on sheet 2.2. The elevation reference targets referenced a sheet 3.2, which should have read sheet 2.3 This mistake was revised. • The owner has requested that the south addition non-bearing walls be adjusted and the shower be eliminated. These adjustments can be found on sheets 2.1 and 2.4. • The owner has also made modifications to the reception/waiting room counter and charts area. The owners are using electronic charts therefore the charts area was modified. Site: 1 We have submitted our documents to Mr. Eric McMullen D.F.M. at Tualatin Valley Fire and Rescue. To date we have not received a response. If you have received a response, please notify our office. 2 The accessible parking space adjacent to the building has been relocated refer to sheet C1.2 of the site permit documents. Building: 1 Per our telephone conversation we have selected the interpretive ruling to resolve this issue Refer to sheets 0.4, 2.1 and 2.4 of the phase 2 building permit documents. 2 A draft stop plan has been added to sheet 2.1 of the phase 2 building permit documents. Energy Code: 1. The energy calculations have been enclosed as requested. X W 010514\Letters\Response to Compliance doc Pao,1 1 i Special Inspections: 1. One of the inspection program forms was for structural masonry. We are not proposing sed Nicoli Engineering, Inc. will any new masonry. When openings in masonry are propo provide structural observations. 2. Inspection program for structural observations will be performed by Nicoli Engineering, Inc., This form has been signed. If you have any questions regarding theses matters please do not hesitate to contact our office. Sincerely, James D. Andrews Project Manager jdalhmb enclosures rpye z of� %\J,010514\Letters\Response 10 Comp6nnr.e dos Accumulative S9wer Tally Ten.3nt Name: Southwest Family Medical Center This SWR#2001-00253 _ Address: 11900 SW Greenburg Rd This PLM# 2001-00398 _ Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off#s count # value #s values Baptis /Font 4 —0 0 0 0 0 Bath-Tub/Shower 4 0 0 0 0 0 -Jacuzzi/Whirlpool 4 0 0 _ 0 _ 0 0 Car Wash- Each Stall 6 0 0 0 0 0 Drive through 16 0 0 0 0 0 Cuspidor'W ater Aspirator 1 0 0 0 - 0 _0 --� U 0 Dishwasher- Commercial 4 _ 0 ' 0 0 - Domestic 2 01 0 0 0 0 DrinkingFountain 1 0 Eye W,sh 1 0 ' 0------ 0 0 0 Floor Draini6ink-L inch 2 , 0 U 0 0 3 inch 5 1 0 0 0 0 0 4 inch 6 / i 0 U 0 0 Car Wash Dr , 6 !0 - 0 0 0 _ U Garbage Disposal Domestic(to 3/4 ;AP) 16 - 0 !0 0 0 0 Commercial(to 5 HP) 32 - 0 0 0- _ 0 0^_ Industrial(over 5 HP) 48 _0 0 U 0 0 Ice Machine/Refrigeralor Drain 1 0 0 0 0 0 Oil Sep(vas Station) 6 — 0 0 Rec.Vehicle Dump station 16 0 0 -_ 0 0 -- 0 Shower-Gang ( er head) 1 _ 0 0 -Stall 2 _ 0 0 1 2 1 2 _ Si.-*- Bar/Lavatory _ 2 0 3 6 33 66 30 60 _- Bradley - 5 _ 0 - 0 Commercial 3 0 0 - 2 Service 3 0 0 0 0 _ 0 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 - 0 0 Water Extractor 6 0 0 U 0 0 Water Closet-Toilet 6 0 3 - 18 7 42 4 —24 Urinal 6 0 16 0 - 1 -6 Previous EDU Count 2 32 --T- 32 TOTALS 0 32 T —330 30 44 117 37 119 Current Fixture Value 119 divided by 16 - 7.4_Current EDU 1 EDU = $2,300.00 Previous Fixture Value 32 divided by 16 = 2.0 Previous FDU Change__87 divided by 16 - 5.4 over (under) $ 12,420.00 Enter EDU Change Here 5.4 HISTORY Nates Per Amanda PLM# _ EGU# SWR# —_ -- PLM# EDU# SWR# --- r —_PLM# EDU# SWR# Date: I( ELS ame: rte. Uk Sig-iature o/ver on that calculated this tally sheet and date perfromed is required CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP ,,SOUL 0030 Received —___ / Date Requested __ - AM___ PM BUP -- Location __ _--J �� '1 Suite MEC -- - Contact Person _ _��<�- �.Ph(- ) 7' /,;L�O PLM Contr - __ Ph(----) �� - SWR �� Tenant/Owner - - - uJ O _ ELC - Fo0ing ELC - Foundation Access: Ftg Drain ELR Crawl Drain - Slab Inspection otes: - SIT Post& Beam ---- --�� - -- ----`- _�--- - Shear Anchors _--- Ext Sheath/Shear — Int Sheath/Shear Framing --- _ - - - ----- - -- ----- Lam-.- -- - -- Insulation _ Drywall Nailing -- - -- ---_ - - - Firewall �(f Fire Sprinkler - - --T--- Fire Alarm _ Susp'd Ceiling --�- Roof PAnT FAIL PLUMBING _-- - -- - -- -- Pnst&Beam Under Slab --- Rough-In Water Service - Sanitary Sewer Rain Drains -- Catch Basin/Manhole Storm Drain - --- — — Shower Par O'her ---- - -- —------- r ,al PASS PART FAIL_ MECHAAICAL - Post& Beam - Rough-In -- -- - - __—_- - -- — -- - Gas Line Smoke Dampers - -- - - --- -- - Sinal PASS PART FAIL -- — - --- ELECTRICAL 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 PART FAIL SITE Please call for reinspection RE: Unable to inspect--no access Fire Supply Line _�� ADA Date- I I L/ Inspector -- Ext Approach/Sidewalk Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF T I GA R D CERTIFICATE OF OCCUPANCY DEVELOPMENT SERVICES PERMIT#: BUP2001-00244 13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 7/23/01 PARCEL: 1 S135DD-04400 ZONING: C-P JURISDICTION: TIG SITE ADDRESS: 11900 SW GREENBURG RD SUBDIVISION: BLOCK: LOT: `CLASS OF WORK: ALT TYPE OF USE: COM TYPE OF CONSTR: 5N OCCUPANCY GRP: B OCCUPANCY LOAD: 55 TENANT NAME: SOUTHWEST FAMILY MEDICAL REMARKS: Tenant Improvement 6412 s f. (Note this is Phase 1 of a 3 phase process. Additions to this building are not authorized under this permit. Owner: HEN STUTZ 1128 SW ENGLEWOOD LAKE OSWEGO, OR 97034 Phone: 503-245-9474 Contractor: 620-2086 OWN ER Phone: 620-2086 Reg #: This Certificate issued 12/23/02 v,,ants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for complia eIwith the of Oregon Specialty Codes for the group, occupancy, and I�rtder which a referenced permit wa ;�iue�d. 8lJILl7 NG INSPECTO -- _ BUILDI F ,CIAL POST IN CONSPICUOUS PLACE CITY OF TI GA R D CERTIFICATE OF OCCUPANCY DEVELOPMENT SERVICES PERMIT#: BUP2001-00307 13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 11/28/01 PARCEL: 1 S 135DD-04400 ZONING: C-P JURISDICTION: TIG SITE ADDRESS: 11900 SW GREENBURG RD SUBDIVISION: BLOCK: LOT: CLASS OF WORK: ADD TYPE OF USE: COM TYPE OF CONSTR: 5N OCCUPANCY GRP: B OCCUPANCY LOAD: 24 TENANT NAME: SOUTHWEST FAMILY MEDICAL REMARKS: Phase 2 for building additions @ North and South ends of existing building Owner: BC ASSOCIATES LLC 1128 SW ENGLEWOOD DR LAKE OSWEGO, OR 97034 Phune: 503-577-8585 Contractor: 620-2086 OWNER Phone: Reg #: This Certificate issued 1/11/0.1 grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for compliagce with the StVr-IJV'erenced 'Oregon Specialty des for the group, occupancy, under whichre permit w� ued. B IL ING INSPECTOR BUILDW9 OFFICIA-LBUILD —� Pos*r IN CONSPICUOUS PLACE CITY OF TIGARD 24-Four BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP Received _ _—_Date Requested = - AM___�� PM BLIP Location —_�� , Suite_ MEC Contact Person ---------..-- _-- Ph ) _��_Z� 7 33 PLM _-------------- Contractor—. - -- - - ------ - Ph�- ) - -- SWR ---------- - BUILDING v Tenant/Owner _� ELCad lI -'00 Footing --�--- ------ Foundation ELG Fig Drain Access: Crawl Drain ELRx'. '� Slab Inspection Notes: SIT Post& Beam ---- Shear Anchors -- � Ext Sheath/Shear Int heath/Shear pp Framing ---- - - ---- ---- -�L.l� �Ck�1= )o`Z Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other. Final - — PASS PART FAIL T -7 u�` L r7--�`5 --- PLUMBING Post& Beam �- Under Slab 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 Dampers Final PASS PART FAIL - — -- — ------ _ ELECTRICAL Service - - - - — - - Hough-In UG/Slab - - _— Low Voltage - Fire Alarm PART FAIL Reinspection fee of$ required before next i;spection. Pay at City Hall, 13125 SW Hall Olvd Please call for reinspection RE _ _ C� Unable to inspect-no access Fire Supply Line ADA �/�,� Approach/Sidewalk Date, _ �` �Q Inspector -� � Ext Other: _ -- - Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL. CITY OF TIGARD WASHINGTON COUNTY OREGON VOLUNTARY COMPLIANCE AGREEMENT AND TEMPORARY CONDITIONAL CERTIFICATE OF OCCUPANCY RE: Tax Map 1S135DD Tax Lot 00400 BC Associates, LLC 11900 SW Greenburg Rd., Phase i 1128 SW Englewood Tigard, Oregon 97223 Lake Oswego, OR 97034 for SW BC Associates, LLC, owner or party respo ible for the above property and for the work done on it under Permit BUP2001-00244, agree to the conditions set forth below and promise to fully comply with them. This is a Temporary and Conditional Certificate of Occupancy issued today for a period not to exceed thirty days, by which time the following conditions must have been met and approved by the City of Tigard: Permit BUP2001-00244 and all work thereunder must be completed and have received final inspection approval from this office, including the resolution of any outstanding conditions, corrections, ancillary permits and fees, and specifically including all other outstanding permits relative to this construction project. understand that with this agreement the City will withhold further legal or enforcement action regarding these conditions until Thursday, January 16, 2003. Upon compliance with a I the above conditions, this case will be closed and a permanent Certificate of Occupancy wiil be issued. I further understand that if these conditions arp not complied with fully, this Temporary and Conditional Certificate of Occupancy will become void at the close of business on Wednesday, January 15, 2003, and I may then be sewed with a Summons and Complaint without further notice. Signed: lr_- --fit Date: /z_ic Title: Ow nv�� Zdf'2�-Ti'tle. /1-Signe Date: � CITY OF TIGARD WASHINGTON COUNTY OREGON VOLUNTARY COMPLIANCE AGREEMENT AND TEMPORARY CONDITIONAL CERTIFICATE OF OCCUPANCY RE: Tax Map 1 S135DD Tax Lot 00400 BC Associates, LLC 11900 SW Greenburg Rd., Phase II 112.8 SW Englewood Tigard, Oregon 97223 Lake Oswego, OR 97034 g� �z�z , for SW BC Associates, LLC, owner or party responsi P for the above property and for the work done on it under Permit BUP2001-00307, agree to the conditions set forth below and promise to fully comply with them. This is a Temporary and Conditional Certificate of Occupancy issued today for a period not to exceed thirty days, by which time the following conditions must have been met and approved by the City or Tigard: Permit BUP2001-00307 and all ,vork thereunder must be completed and have received final inspection approval from this office, including the resolution of any outstanding conditions, correctiuns, ancillary permits and fees, and specifically including all other outstanding permits relative to this construction project. I understand that with this agreement the City will withhold further legal or enforcement action regarding these conditions until Thursday, January 16, 2003. Upor, compliance with all the above conditions, this case will be closed and a permanent Certificate of Occupancy will be issued. I further understand that if these conditions are not complied with fully, this Temporary and Conditional Certificate of Occupancy will become void at the close of business on Wednesday, January 15, 2003, and I may then be served with a Summons and Complaint without further notice. Signed: /"' Date: /Z Title: i Signed: �� Date:�u � itle: i i CITY OF TIGARD -- BUILDING PERMIT PERMIT#: BUP2001-00244 DEVELOPMENT SERVICES DATE ISSUED: 7/23/01 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1S135DD-04400 SITE ADDRESS: 11900 SW GREENRURG RD SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION_ CLASS OF WORK: ALT FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? _ TYPE OF CONST; 5N sf N: S: E: W: OCCUPANCY GRP: B TOTAL AREA: O 00 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 55 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 ri_RS PKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:Y BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 65,000.00 Remarks: Tenant Improvement 6412 s.f. (Nota, this is Phase 1 of a 3 phase process. Additions to this building are not authorized under this permit. Owner: Contractor: BEN STUTZ OWNER 1128 SW ENGLEWOOD t_AKE OSWEGO, OR 97034 'hone: Phone: Reg #: FEES _ REQUIRED INSPECTIONS Type By Date Amount Receipt Mechanical Permit Require PLCK CTR 7/3/01 $359.35 27200100000 Electrical Permit Required Plumbing Permit Required FIRE CTR 7/3/01 $221.14 27200100000 Framing Insp PRMT CTR 7/3/01 $36.00 27200100000 Gyp Board Insp PRMT CTR 7/23/01 $552..85 27200100000 Susp Ceiing Insp (additional fees not listed here) Final Inspection Total $1,213.57 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OP. Specialty Codes and ::11 other applicable lav:. All work will be done in accordance with approved plans. This permit will expire irwork is not started within 180 days of issuance, or if work is suspended for more than 180 &ys. ATTENTION: Oregon law requires ,,ou to follow the rules adopted by the Oregon LIfility Notification Center. Those rules are set forth in OAR 9.52-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503)246-6699 c,, 1-800-332-2344. Pe rm Ittee Signature: Isse : G'_ ucf y ,.all 634'-4175 by 7 p.m.for an4noection the next business day CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: "LM2001-00406 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/10/02 SITE ADDRESS: 11900 SW GREENBURG RD PARCEL: 1S13EDD-04400 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MAC14: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS- 2 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: UR:NALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 3 TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 24 ft DISHWASHERS: RAIN DRAIN: 62 ft Remarks: Site Improvements. Installation of(1)catch basin, (1)area drain, (3) rain drain connectors, 62'of storm sewer and 24'of water service. _ Owner: _ FEES _ --— ----- –- -- Type Ely Date Amount Receipt BEN STUTZ ENGLFWOOD PRMT CTR 6/10/02 $193.00 27200200000 1 EN T LAKE W EGOR 97034 PLCK CTR 6/10/02 $48 25 27200200000 SPCT CTR 6/10/02 $15.44 27200200000 Phone 1: 503-245-4479 _ Total _ $256.69 Contractor: ANCTIL PLUMBING INC 16900 SW MERLO RD BEAVERTON, OR 97008 REQUIRED INSPECTIONS Phone 1: 503-642-7323 Water Service Insp Reg #: LIC 24184 Storm Drain, Insp PLM 26-162PB Storm Drain Insp Storm Drain Insp Rain Drain Insp Rain Drain Insp Rain Drain 'nsp Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all ether applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 da\/s of issuance, or if work is suspended for more than 180 days ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. 11 If If Iss d By: U �`. Permittee Signature: / /?: _ _ Call (503)t39-4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Per>init Application Date received:��%D � ' Permit no.: City Of ' igard Sewer permit no.: Building permit no.: Address: 13125 SNJ Ifall Bl%d,"I iyard,OR 97:21 r'in u/Tigard Phone: (503) 639-4171 Project/appl.no.: Expirc date: Fax: (503) 598-1960 Date issued: By: Receipt no Land use approval: 5pp�.gew 1- 0000 (! Casc file no.: Payment type: U 1 k 2 family dwelling or accessory &T'tmmmrrcial/industria!;.1t'C IHPFoV. 0 Multi-family U Tenant impiovrn10.nl U New constniction U Add ition/ulterationhepla-tile W U Food service *$eL-YOlher: Sis'sQp►__AQO�Q JOB SITE INFORMATION1 t t t Job address: I)c�,r•ription �lt�. I'ce(l`A.) -hIIIAI _ 114 oa _�•+ �—�E - =- — Ncry 18n( 2-family dwellings only: Bldg. no.: Suite no.: _-- , - (in(iudes100f1.for cachutilit}connection) Tax map/tax lot/account no.' _ SuhdSFR(I'thath - Lot: I31ock: ivision: SFR(21 bath Project name: 6 GutN4IFPrf M)l€QI4k1e SFR(3)bath _ City/county: 1111 lII': 7 2 2 3 Fach additional bath/kitchcn Description and location-o mrtnk 1�n Irreniisrs:51TP_ IMPfT�111fE1N�1t1 tiltcutllitles: -_-- Catch basin/area drain V[ 't 2._ t — Drywells/leach line/trench drain list.dale of complrtionlinsltcctittu — — - a footing dctin(no. lin. ft.) PLUMBING1 1 Manafaclured home utilities Business name: r• ��L, _ Manholes Address: _ _ Rain drain connector City: State: ?.IP: Sanitary sewer(no.lin. ft.) 0 N Phone: Fax: E-mail: Storm sewer(no.lin.ft.) !� CCB no.: Plumb.hos.reg. no: Water service(no. lin. ft.) = Fixture or Item: City/metro lic.no.: Absorption valve Contractor's representative signature: _ ^—_ Back Ilow prcventrr_ — Pnnt name: Date: Backwater valve 1 1 Basins/lavatory _— Name: oWMtER _ Clothes washer —= Dishwasher Address: 11-1.Q !—. t,t,lIfIA L_)<JC7Qp Drinking fountain(q) - City pyyl Q_—_-- State ZIP: �7t)'!� Ejectors/sump ` Phone}. tf, 1 I;tx: -JE-mail: Fnsiontart:/sewer caprains/floor sinksftduh Name(print>: �►,M ASQ� Fge disposalMailing address: ibb City: State: _ LIP:_ cc maker Phone: -- Fax F mail ---- lntcrceptor/grease trap _ Owner in stallation/residential maintenance only: 11me actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof a-ain(commercial) employee on die property I own as per ORS Chapter 447. Sink(s),basin(s), lays(s) Owner's signature: __ Date: _ Sump NowTubs shower/shower an Urinal _ N_a_me: KILO,-% t� 416tINIRM04411 -4f1TfAVtJ."0A Watcrclosct _ ddres,, PO_IbC 23?$-_4__ Water heater City tate: Z1P��1us Other: Phong6j.Vq -,jo9& I'ax6M E-mail: Total or — Minimum fcc................$ Not all juriutfctions accept credit cards,picric call jurisdiction for more inrorrnation Nnti„e:ntis permit application Plan rt;view(at 7S' �') $ � C� O Visa U MasterCard cxpircs if a permit is not obtained 1 — - Cfedit card mtmb t`-_ ___ -� within 180 days aft..it has been State surcharge(8%)....$ N q Expires - accepted n::complete. TOTAI .......................S —–Nan,of cardholder u shown on credit cud – S _---� Cardholder iignaturc Amour 440-4616(6MWOM) PLUMBING PERMIT FEES: — PRICE TOTAL New't and 2-family dwellings only: FIXTURES (individual) QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT LL avatory16 50 - for each utility connection - --- One-�1 1 bath 5149.20 Tub or Tub/Show6-Comb 16.60 - -- — _ Two(2)bath 3351100 Shower Only 18.60 Three bath _ 3399.00 Water Closet 16.60 -- — __ SUBTOTAL Urinal _ _-- 16.60 _— 8%STATE SURCHARGE — Dishwasher 16,60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 1660 TOTAL Laundry Tray Washing Machine 16 60 Floor Drain/Floor Sink 2" 16.60 — 3" 16.60 PLEASE COMPLETE: 4" 15.60 'Nater Heater O conversion O like kind 16.60 Quantic b Work Performed _ Gas piping requires a senarate mechanical Fixture Type: New Moved Replaced Removed/ permit. - - _Capped MFG Home New Water Service 46.40 MFG Home New Sari/Storm Sewer - 46.40 - Lavatory Tub or Tub/Shower Hose Bibs 16 6U Combination_ Roof Drair a 1660 Shower Drinking roontain 16.60 Water Closet — Other Fixtures(Specify) 1660 Urinal __. Dishwasher _ Garba a Dis usal Laundry Room Tray _ -- Washing Machine _ Floor Drain/Sink: 2" Sewer-1 st 100' 5500 — 3" -- Sewer-each additional 100' 46.40 4" - Water Service-1st 100' 55.00 Water Heater _ Water Service-each additional 200' 46.40 Other Fixtures S eci _ Storm&Rain Drain- 1st 100' 55.00--- -(Specify) - — Storm d Rain Drain-each additional 100' 4640 Commercial Back Flow Prevention Device 46.40 -� Residential Backflow Prevention Device' 27.55 - Catch Basin 1660 - - Inspection of Existing Plumbing or Specially v 72.50 — — - Requested Inspectionsper/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 6525 _ Grease Traps 16.60 QUANTITY TOTAL — ---— --- Isometric or riser diagram is required if ---- -�--'_" -- -------- Quantity Total is >P __— 'SUBTOTAL -- — — - ---- —__ _ 8% STATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL - -_ RP111i d only it fixturo qty total is>9 TOTAL `Minlmum permit.ee Is$12 50•9%slate surchar6i,excei,t Residential Backflow Prevention Device,which is$36 25•e%state surcharge ..All New commercial Buildings require plans with isom.aric or riser diagram and plan review. I'\dsts\forrns\plm-fees.doc 10/10/00 CITY OF TIGARD ELECTRICAL ENER - RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT#: ELR2002-00059 13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 DATE ISSUED: 4/3/02 SITE ADDRESS: 11900 SW GREENBURG RD PARCEL: 1S135DD-04400 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG Project Description: Tenant Imp,ovement - thermostat wire for HVAC - Job No.00125 A. RESIDENTIAL B.COMMERCIAL _ AUDIO & STEREO: AUDIO& STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: HVAC: X PROTECTIVE S'GNAL: INSTRUMENTATION: OTHER: TOTAL#OF SYSTEMS: 1 Owner: Contractor: HEN STUTZ SPECIALTY HEATING + FABRICTN 1128 SW ENGLEWOOD 9528 SW TIGARD ST LAKE OSWEGO, OR 97034 TIGARD, OR 97223 Phcne: 503-245-9474 Phone: 620-5643 Reg#: SUP 366LMS LIC 66578 ELF 34-34CRE FEES Required Inspections Type By Date Amount Receipt Wall Cover PRMT CTR 4/3/02 $75.00 2720020000 Elect'I Final 5PCT CTR 4/3/02 $6.00 2720020000 Total $81.00 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 wort: 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 susp-3nded 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 952-001-0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246-1987. Issued by /lL �� _ Permittee Signature OWNER INSTALLATION ONLY The ins:,illation is being made on property I own which is not intended for sale. lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUr'R. ELEC'N DATE: LICENSE NO: ----A—^--�--- --- - - Call 639-4175 by 7:00 P.M. for an inspection needed the next business day c18: E,r; Spec i a 1 t, j Heating 503 59S 0718 p , Electrical.Permit Application nalerecotvat, r�rlliill Clay Of j 1IU'1 ,.,� (� jecdappl.no.: f xpuedatc: Cifyof Tigard Address: 13125 SW Hall Dial,', t 97223 [yatcissued-iq�k —� Phone: (503) 6394171 By liecelpti o.: Fax: (503) 598.1960 case are Ito: Payment type; Land use approval, p ii-.! K.0 ❑ 1 A--2 family dwelling or accessory �1Comtnercial/industrial U;\Muhl-family O Tenant improve)vent 1 New c...t'u Ilion CJ4> �AdditlonJaltuatiort/ropincclucnt 1 r,thcr: __ O 1'artidl .10FISITIF INFORMATION Job adtJn s;. J W6 re pr ,�P 131dF.nu.: Suite no,: Tax snap/tax lotlaccount no.; LuL• Block: Subdivision. Project name: _ lh seri tion and location of work on premises: (t/�Q1 Estimated date of comp)elivn/inspection: _v775 T r CONTRACTOR ----- Job tlo! C P.7Ca�v' _ _ Pee Max BLOW"natno: — Iksetiprivn _ �'C/�4-� - fy►g Qtr. (cal 7 pial uo Insn Addrt,gs: q6; ?j �� Q -- -v Nei+rcsidmittal•sit le or niald-faintly per - --- _ dNrllin>k wdl.Inrlud,y utlsdrerl pprs(;r. City;i/q4-Ice Stateop- zip'. q 7� Z3 srnitrtaclaticd Phone. 1rax,jf -0?,( E-mail: i(oucy n ary : 4 Each addiIIona)500 s ft.of put thereof CCB no,: (e(0575- Elec,bus.tic.no. 3 - y'C C7 q' 1 -- __ --� [,invited energy,resrtlertunl _ Z City/metro tic,no.: /1' Limitedevergy.non-reaidendal 2 �j1'/,�!?1 //iS•C ,> !//V0 y., Poch manufactured home or modular dwelling s,gnelt re of supelvising electrician(requited) cute Service andlot feeder I Sup.elect.namcnate-�/`K9 ,��{.p1S UcallseIto, , 95 Scnkceorfccdcrs• InaLll�rron, - alteration or relocation: 200 amps or Icss Name(print): SW I-C�-Ya c' alc9i�I 1V S 201 amp:to Otto Malting address: t Q 7d S t) e�,e- eT - 4O I amps to 500 amps - 2 —�. 60 1 amps to 1000 strips 2 City: 141d slate'44 j ZIP: Over 1000 nmpn or volis— Phone: Fax: E-mail: A_J(ortircion!y _ I Owner installation:Tho iner�lladon is being made on property i own Temporal acrvicra or feeders- which is not Intended for sale,leiise,rent,or exchange acconling to MWallatina,alteration,atretotatiasst OILS 447,455,479,670,701, 200ampsnrlcm 2 201 amps to 400 amps _ - 2 r+r Tier's 5i mature• Date; 401 to GOOamps 2 Mgtiiiiiiiiiiiiiii Stench circuits-new,alteration, or cxtensioo per penal: Neu' - A Hee for branch circuits with purchase of Addtuss: _ service or feeder fee,each branch circuit City- -- SIatC: Z1P: —� l). Fee lot btynchcircuiowithout purchase - of servicu or feeder fix,first hranch circuit: Phone: 1 ax E nl.dl: FAch additi,mnl h,Zroch circuit - Misr.(Service or feeder not Included): - U service over 22,5 mnps•conunercod U ifealllt-"v fscility rAch �mp or inigadon circle ❑Service over 32Uamps-rating of I&2 ❑HrvudouelocoUon Fac si noroudinc lighting2 family dwellings U Hmiding c-,r 10,000 square feet four or sisno citcuit(s)or a limited energy panel, -' - U Systemover 6Wvolt%nominal mon•msidrntialunits Inone structun• idwation,orcrtension' O BuildBtg overrhnx stunt U Feeders,400 rumps or more *Dell i turn-- _ --_ l]Occupant load over 99 p,emonk t I Manufactumd structures or RV park Voeh addit+onal rwp.-rion over the alio%able in any n(tho al.n. O ttgress/lighdngplan 1.Other _.-- ---�.— I 1'erius recuotl BtlbMsit___ sch of plata..ill troy of the aborti. Inveatigntirn+fee_ - The above HIPC not applicable to temporary consdnction service. Other ---- �� Nn,an iuri.aiduvmr seeapt crernt cemdr,please call)unOctien Gr utm lufarmulon. Notice:This permit application Permit foc................... U vasa U MasterCard expires if a permit is not obtained Plan review(a( __ %) $ :rcdi raid uumha _ within ISO day:i after it has been State surcharge(8%) ....$ _ rp far accepted as complete. 'i'07'AL $ _ Name , `� crvn on c it card arilhnlrkr aignatwe Anmunr s,t �Rlt(61xt/COh(1 ELECTRICAL PERMIT CITY OF T I G A R D — — RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT#: ELR2002-00044 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/22/02 SITE ADDRESS: 11900 SW (_REENBURG RD BLDG PARCEL: 1S135DD-04400 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISG.CTION: TIG Proiect Description: Installation of burglar alarm. A.RESIDENTIAL _ B.COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: -!NTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDT' AL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: BURG ALARM X TOTAL#OF SYSTEMS: 1 Owner: Contractor: STEVENSON, MICHAEL J KAY L ADT SECURITY SERVICES, INC 2825 DELL-WOOD DR 2815 SW 153RD DR LAKE OSWEGO, OR 97034 BEA✓ERTON, OR 97006 Phone: Phone: 503-469-7244 Reg #: LIC 59944 ELE 26-209CLE FEES _ _ Required Inspections _ Type By Date Amount Receipt _ Low Voltage Inspection --`- — � PRMT CTR 3/22/0 $75.00 272002000E E!ect'I Finsl 5PCT CTR 3/22 02 $6.00 2720020000 Total $81.00 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 952-001-UO10 through OAR 952-001-0080 You may obtain copies of these rules or direct questions to OUNC at (503) Issue87 d ---- - Issued by Ztt - Permittee Signature _AOWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale. lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF Sl1PR. ELEC'N QATE: LICENSE NO: ----- ------- ------ -------._�_ Call 639-4175 by 7:00 P.M. for an inspection needed the next business day 03/21/2002 10:46 FAX 5094897210 ADT SECURITY lei 00j Electrical Permit Application 4-ity of Tiget'd�� ProJecUappl.no.: Expirtr.,�date: buy o fFigald "Wdm s: 13125 SW Hail Date i99t1Ui_ Dy, rS Rccciptno.: Phone: (503) 639.4171 — - — Fax. (503) 598-1960 Cruse file,no,: - Payinent typc: Land use approval: , �,.r i� J ( U I &.2 family dwelling or accessory Is(_,(1 tmercia11industnal O Multi•farnily U Tenant improvement U New construction 1.1 Addition/alter-iLtrin/replacernen( U(Miter- U Partial INFORMATIONjonsilm I oil— Job address. 1000 rd(A u f Lill . no.: Shite nl;l Tax[lisp/tax iot/account no. iterI Block: _ Subdivisi n: -- _ - - - Project name-.Ste.) F2z,'ht F' t,;•t t�S I Description and location of work op ererdises: lsumnrr.J date ul cutnplcliutt/ittspt:otion: V _ y/ Job no: � ?- I W 8 J y i7 __ Fee i tsc Business name:-A� r I)cscriplinu t�ty, (ca) Total no.int AddrPs&: q NeMresidrniisl siogkormulli-famdrlrr 221St SU) LIbrA r_adwdllnCwtiCIncludes zMeliedprage.. Clty: y State:QR 7.I1': Q Sn cert atelndrd Phoneme `�' 100 Fax �'7. 11 mall; I'M eq.fL or if -- - �- —�—�— Bach additional 500 sq.R of portion dm=f CCB n0_ _ Elec.bus.LIC.no: .� - — .�-- Limited energy,rtsidend■l 2 City/me ic,nu.: Umitedcnaigy,non-Milontin! 2 Each nianufi: ELECTRICAL PERMIT- CITYOF TIGARD RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT ELR2002-00057 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/3/02 SITE ADDRESS: 11900 SW GREENBURG RD PARCEL: 1S135DD-04400 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG Prosect Desrription: Tenant Improvement A. RESIDENTIAL _ B.COMMERCIAL_ AUDIO & STEREG AUDIO & STEREG: X INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: 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: 2 J Owner: Contractor: BEN STUTZ ACME ELECTRIC 1 128 SW ENGLEWOOD 537 SE ASH ST. LAKE OSWEGO, OR 97034 Phone: 503-245-9474 Phone: 503-872-9777 Reg #: ELE 26-1094C SUP 2837-S LIC 147132 F_ FEES Required Inspections Tye Ely DateAmount Receipt Ceiling Cover P PRMT CTR 4/3/02 $150.00 2720020000 Wall Cover I 5PCT CTR 4/3/ 2 $1200 2720020000 Elect'I Final Total $162.00 l�— This Permit is issued subject to the reguwations contained in the Tigard Municipal Code, State of OR. Spe.ialty 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 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246-1987. 7 Issued by ui yrs _ 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: CONTRACTOR INSTALLATION ONLY SIGNA'i URE OF SUpR. ELEC'N _ DATE:— LICENSE NO: Call 639-4175 by 7:00 P.M. for an inspection needed the next business day Electrical Permit Application Datcreceived: Permit Q 'i Cit of Tigard : ��"`�`� ' y . � Projecdappl.no.: Expire date: CitynfTigard Addreh: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: g Phone: (503) 639-4171 Y: Receipt no.: Fax: (503)598-1960 Case file no.: Payment type: Land use approval: U I &2 family dwelling or accessory lid Commercial/industrial U Multi-family U Tenant improvement U New construction ❑Aelnlilii+n/alterationlreplaicmr nt U Other: _ U Partial ti Joh address: r „/,-_ 1W Bldg yno.: Nuile no.: 'I•ax map/tax lot/account no.: Lot: Block: Subdivision: `/-`��L�� - - - Project name: (/�' Description and location of work on premises: Estimated date of complet on/inspection: y - - ----- 1 I'm Business -Max name: �L.I1� _— Ikcrriplion Qtr. (ca.) total no.insp New residential-single or mum-family per Address: S 3 S s h dwellinganit.lnclndesailachedgeragc. City: fin/, ZIP: L Z3 Seri Weinc•ludd: Phone: ax: E-mail: I(W sq it or less t CCB no,: do r�3 3 EICc,bus.lic.no: �,` /0 G Fach additional 500 sq.ft.or portion thereof Limited energy,residential 2 City/metro Ilc.no.: _ t.imitedenergy,non-residential 2 ja. 1 _ !, J_-0L Each numufaclured home or modular dwelling Si nature of su;irvising electrician(requited) Dat - Service and/or feeder 2 Sup.elect.name(,+rind S ih—� LicensenorZQj Scrvlceaorfeedem-installa(ion, dteration or relocation: 2111)amps or less 2 Name(print): 201 amps to 400 amps 2 Mailing address: _ -- 401 ampo to 600 amps 2 601 amps to 1001)ampti 2 City: _ State: In Ovel "'00amps orVolts --- 2 Phone: J l ax: 1 E-mail: Reconnect only ---— I Owner installation:The installation is being made on property I own Temporarysenicesorfeeders- which is not intended for sale,lease,rent.or exchange according to Installation,alteration,or relocation: ORS 447,455,479,670,701. 2110 amps or less 201 amps to 400 amps - -- 1— Owncr'% si mature: Date: _ 401 to 6M am+t --- — - Branch circuits-new,alteration, Name: or extension per panel: A. Fee for branch circmts with purchase of Address` service or feeder fee,each branch circuit City Slale: I_I I+: B. Fee for branch circuits without purchase - — Phone: E-mail: - of service or feeder fee,first branch circuit: _ 2 C'ax: Each additional branch circuit: -- Mich.(.service or feeder not Included): U Service over 225 rungs-commercial U Health-care facility Each pump or irrigation circle 2 U.Service over 320 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2 familydwellings U Building over I OAOO square feet four or Signal circuit(s)or a limited energy panel, U System over 600 volts nominal more residential units in one structure alteration,or extension' 1 U Building over three stories J Feeders.400 amps or more •Desci r tion: U Occupant load over 99 persons U Manufactured structures or R V park FAch additional Inspection over the allowshle in any of the alcove: U Egress/Iightingplan U 011ie. Per inspection Submit iris of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all lurisdictiom accept credit cards,please call Jurisdiction for more in_rmm ion. Notice:This permit application Permit fee.....................$ _ U Visa U MasterCard expires if a permit is not obtained Plan review(at — %) $ _ Credit cad number within 180 days after it has been State surcharge(8%) ....$ _- x�re' accepted as complete. TOTAL $ ....................... Nam c o r o own on credit e - _ S Cardholder d tore '-- —Amount -- 44014615(OYOOICOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE OF WORT. INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00 Number of Inspections per permit allowed1 (FOR ALL SYSTEMS) Service Included: Items Cost Total y Check Type of Work Involved: Residential-per unit 1000 sq ft,or less $145 15 _ 4 ❑ Audio and Stereo Systems` 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 WjLation 200 amps or less $130.30 _ 2 201 amps to 400 amps $106.85 2 ❑ Vacuum Systems' 401 amps to e00 amps $160.b0 2 601 amps tro 1000 amps _ $240.602 ❑ Other__ Over 1000 amps or volts $454.65— 2 Reconnect only $66,85 v 2 Temporary Services or Feeders TYPE OF WORK INVOLVE.) -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each systern................................................... ... $75.1'j0 200 amps or less _ $6685 —A 2 (SEE OAR 518-260-260) 201 amps to 400 amps $10030 2 401 amps to 600 amps $1-`13 /5 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 ❑ Boiler Controls a)The fee for branch circuits with purchase of service or ❑ Clock Systems feeder fee. --— Each hrencir circuit $6.65 Data Telecommunication Installation h)The fee for branch circuits without purchase of service ❑ or feeder fee. Fire Alarm Installation First branch circuit $46,85 — Each additional branch circuit $6.65 HVAC Miscellaneous ❑ Instrumentation (Service_or feeder not Included) Each pump or irrigation circle $5340 Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems Signal circult(s)or a limited energy panel,alteration or extensio $7500 _ _ Landscape Irrigation Control' Minor Labels(10) _ $12500 Each additional inspection over A Y __ C] Medical the allowable in any of the above Per inspection $6250 ❑ Nurse Calls Per hour — - -- $62.50 _ In Plant $73 75 C� Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above.fees $ _ E-] _—i— ^-- Other 8%State Surcharge $ — Number of Systems 23%Plan Review Fee See"Plan Review',section on $ Nn I renses are required Licenses are required for all other installations front of application Fees: Total Balance Due $ C 0 Enter total of above fees : S n 0 _ ❑ Trust Account ft — 8%State Surcharge : /7, 00 -- ------ —– -�-�-�---�- ---- — Total Balance Due S� D o All New Commercial Buildings require 2 sets of plans. i,tdsts\fornvlelc-fees.doc 08/30/01 I � �►RD BUILDING PERMIT CITY OF TIG _ PERMIT#: BUP2001-00244 DEVELOPMENT SERVICES DATE ISSUED: 7/23/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: IS135DD-04400 SITE ADDRESS: 11900 SW GREENBURG RD SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG REISSUE: _ FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ALT FIRST: Sf N: S: E: W: 'TYPE_ OF USE: COM SECOND: s;' _ PROJECT OPENINGS? _ TYPE OF CONST: 5N sf N: S: E: W: OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 55 BASEMENT: sf AREA SEP. RATED: STOR: SIT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZ.Z?: _ READ SETBACKS REQUIRED FLOOR LOAD: psf EFT.- ft RGHT: ft FIR SPKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:Y BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 65,000.00 Remarks: Tenant Improvement 6412 sT (Note this is Phase 1 of a 3 phase process Additions to this building are not authorized under this permit. Owner: Contractor: BEN STUTZ OWNER 112.8 SW ENGLEWOOD LAKE OSWEGO, OR 97034 Phone: Phone: Reg #: _ FEES REQUIRED INSPECTIONS Type By Date Amount Receipt Mechanical Permit Require PLCK CTR '/3/01 $359.35 27200100000 Electrical Permit Required Plumbing Permit Required FIRE CTR 7/3/01 $221.14 27200100000 Framing Insp PRMT CTR 7/3/01 $36.00 27200100000 Gyp Board Inso PRMT CTR 7/23/01 $552.85 27200100060 Susp Ceiing In.;p (additional fees not listed here) Final Inspection Total $1,213.57 This permit is issued subject to the regulations coi7lained 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 riles or direct questions to OUNC by calling (503) 246-6699 or 1-800-332-2344 Permittee Signature: 1 / Vssued By: Call 639-4175 by 7 p.m. for an inspection the next business day 7/40 Building Permit Application 6't-- �,` Date received: -,3 -O t Permit no. d e -t n� City of Tigard Address: 13125 SIN Hall Blvd.'Fi J'ird,OR 97221 ProjecUappl.no.: Expire date: City of Tigard phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503)598-1960 Case file no.: Payment type: Land use a; -)roval: .-t7�1-U0 �1a_4't✓I`�DIN� l&2 family:Simple Complex: U 1 &2 family dwelling or accessory U CommerciaUindustrial U Mule-family U New construction U Demolition U Additiori/alteration/replacement '('Tenant improvement J fire sprinkler/alarm U Other: 1 411111.INFOIIM��ION Joh address: Bldg.no.: Suite no.: L.ol Blcx k: Subdivision: Tax map/tax lot/account no.: Project name: ejD41TH1.11'e * IL'� Mfr�l'�Il.�tli O__ 1Le1Ftt Description and location of work on premiscs/special conditions: ' 1MPQrW�MIl:NTS �'HAr� pH�'� 2 Plrhlt�l L�!bR-_S•b,!�_. --- - Name: sM STUTZi— Mailing address: 112 -- N btu aoD 1 &2 family dwelling: City: p State 7 Valuation of work.... ................................... $ Phone: 'L Fax: E-mail: No.of bedro ones/baths................................. owner's represcraative: lop _ t j ,� Total number of floors..... ........................... Phone: - t a: I: mail: New dwelling area(sq.ft.) .. ....................... — Gamge/carport area(sq.ft.)......................... Name: Covered porch area(sq.ft.) ......................... — --- Deck area(sq.ft.) ........ Mailing address: .. . . ....................... City: State: i:IP: Other.;tincture area(sq. ft.)......................... Phone: f , ( ,, . ('ommerciallindustrhUmulti-family: 1 t.RACI OR Valuation of work........................................ $ tzk Business name: Existing bldg.area(sq.ft.) .......................... Loi 412-._ Address: - New bldg.area(sq.ft.) ................................ ----- ----- 1 Cit : State: ZIP: Number of stories........................................ y Phone: - Cux: E-mail: fype of construction........I........................... _ $N CCB no.. Occupancy group(s): Existing: __ F 2 -- New: City/metro lic.no.: Notice:All contractors and subcontractors are required to he licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may he required to he licensed in the Address: -- jurisdiction where work is being performed. If the applicant is Cit _ State: ZIP: exempt from licensing,the following reason applies: Contact person: Plan no.: - — Phone: Fox E-mail: — — Niune: &ontact person:d1hAVApM jjpIuc upon application ... ....................... $ Address: Date received: City: p _ State:017LZIP:1"ITO I_ Amount received ......................................... $ Phone: (pW-14 _ Fax E-mail: Please refer to fee schedule, I hereby cettify I have read and examined this application and the Not dl Jurisdictions accept credit cards,plena:cell Jurisdiction for more information. attached checklist.All provisions of laws and ordinances governing this U visa U Mastercard work will be complied with,whether specified herein or not. Credit card numher ---. _�J� p)W7 u Expires Ire Authorized signatur � _ Date: _ '2•0� Name of cardholder shown no credit card _ $ Print name: ., toCardholder olpature Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete 440.4613(arooICoM) COMMERCIAL_ PLAN SUBMITTAL.. REQUIREMENT MATRIX Plan review is dependent upon submittal of a completed application .and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional plan sets for distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). ---- ---------- -----__-- -Total # of - TYPE OF SUBMITTAL Plans KEY: Submitted S = Site Work (must include S (New, Add or Alt) 4 location of all accessible parking) B (New, Add or Alt) 1* B = Building F (New, Add or Alt) 3** F = Fire Protection System M (New, Add or Alt) 2 M = Mechanical P (New, Add or Alt) 2 P = Plun n:ig E (New, Add, or Alt) 2 E = Electrical New = New Building Add = Addition Alt = Alteration to existing building *For over-the-counter commercial tenant improvements, submit 2 :gets of plans. **"New" requires that plans bear the original seal of an Oregon iiktensed fire suppression engineer, or NICET level "3" technicians. I\dsts\forms\matrxcorn doc 10/27/00 SUBJECT: ACCESSIBILITY BARRIER REMOVAL IMPROVEMENT PLAN REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241. (1) Every project for renovation,alteration or modification to affected buildings and related facilities shall be made to insure that the path of travel to the altered area and the restroom, telephones and drinking fountain- dre readily accessible':)individuals with disabilities unless such alterations are disproportionate to the overall alterations in terms of cost and scope. (2) Alterations made to the path of travel to an altered area may be deemed disproportionate to the overall alteration when the cost exceeds twenty-five per-cent(25%). VALUATION of all renovation, alteration or modification being done excluding painting, wallpaperirg (1] $_ i �o0o _ mi.rlt y: 25% Barrier removal requirement. A_ .25__ BUDGET FOR BARRIER REMOVAL [2] $ _ 1_(V ,S5 Q__ In choosing which accessible elements to provide under this section, priority shall be given to those elements that will provide the greatest access. Elements shall be provided in the following order: (a) Parking Joy • b�w;,,� k..K t.0-t�;�.a� � .ti1Q.v�.t N,..0 S.�,Y,e 4,�, • N t W 1r��d.s we.l1.Yo.&l 2-) (b) An accessible entrance J • NAO 4. -c, (PA••at 27) (c) An accessible route to the altered area: $— _TSDKAW °'' ,�.Y�1 /pc,tr a tier. Swl-a�� (d) At least one accessible restroom for $ each sex or a single unisex re tr om • ��W d�t�et/to Ilea U&V.Y. Lt 2) (e) Accessible telephones: $ (f) Accessible drinking fountains and • Cec.-ntwt-p a 0_e4JdrAi- A" (g) When possible, additional accessible elements such as storage and alarms: $ TOTAL: Shall equal line 2 of Value Computation $_� D 11�1` _ i 1dsts\farms\access.doc CITY OF T I G A R D _____ SITE WORK PERMIT DEVELOPMENT SERVICES PERMIT # : SIT2001-00020 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED : 6/10/02 SITE ADDRESS: 11900 SW GREENBURG RD PARCEL : 1S135DD-04400 SUBDIVISION: ZONING : C-P BLOCK: LOT: JURISDICTION : TIG CLASS OF WORK: ADD PAVING ?: N RESO. NO: TYPE OF USE: COM GRADING ?: VALUE: $20,025.00 EXCV VOLUME- cy LANDSCAPING?: Y FILL VOLUME: Cy SITE PREF' ?: N ENG FILL?: N STORM DRAINS?: Y SOILS RPT REDID?: IMPERV SURFACE 2,238 sf Remarks: Site improvements for Phase 2 additions. Owner: — — BEN STUTZ FEES 1128 SW ENGLEWOOD Type By Date Amount Receipt LAKE OSWEGO, OR 97034 PLCK CTR 8/27/01 $159.19 27200100000 FIRE CTR 8/27/01 $97.96 27200100000 PRMT CTR 6/10/02 $244.90 27200200000 Phone: 503 245-4474 EROS CTR 6/10/02 $80.00 27200200000 Contractor: ERPU CTR 6/10/02 $26.00 27200200000 OWNER ERPC CTR 6/10/02 $26.00 27200200000 5PCT CTR 6/10/02 $19.59 27200200000 Total $653.64 Phone: Reg #: Required Inspections Erosion Control Insp 846-8444 Excavation Strm Drain Insp Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to ollow rules adopted 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 questions to OUNC by calling (503)246-1987. Permittee Kignature: Issued By, Call (503) 639-4175 by 7:00 P.M.for an Inspection needed the next business day wilding Permit Application Date received: -] Permit no:S y T,ZAP/_a6 City of Tigard tA k Project/apnate: t.no.: Expire d �. CirpojTigard Address: 13125 SW Hall Blvd,Tigard,023 `N Phone: (503) 639-4171 Date issued: Ry Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: � Land use approval: S b fit.. 2O01_�DDOO(� 1&2 family:Simple Complex: — TYPE OF'PERN.11T C U 1 &2 Wilily dwelling or accessory idconunercial/industrial U Multi-family U New construction U Demolition ` U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm kfOthcr. -51 Tl✓ 01 SITE INFORMATION Job address: I I Q 0(7 MW , 6I%5-r-_MfwaE„ Il;Idf,.no.: Suite no.: r Lot: I Block: _ Subdivision: _- _ _ _ Tax map/lax IoUaccount no.: 151 3r Project name: je 0FrjCF y Description and location of wAkt %mises/special conditions: 51TE IK Pl2UVMMrR__M?rP Oi%NIR 1:011 SPECIAL INFORMATION, �SL CHECKLIST Nanu': PMPTUTZ lainseiliait (FloodpMailing : 112 _.� �.►�.1• Er1 b,�)c1GbD _ _ t & 2 fam8y dHcllinf;: City: g Statc:p ZIP: 61,7DY,+ _ Valuation of work........................................ $ Phone: Fax: E-mail: No.of bedrooms/baths................................. _ Owner's representative: I Total number of floors........................ ........ Phone: .4 Fax: p E-mail: New dwelling area(sq.ft.) .... ..................... --- Garage/carport area(sq ft.)......................... Name: 13r:::k ffiuT 2, Covered porch area(sq. ft.)......................... Mailing address: 1124 el. N(_%LE UU Deck area(sq. It.) ...................................... . ---_ City: Stu State:pst ZIP -1 p 3 Other structure area(sq.ft.)......................... �o _9 4_ - ----- Phone)5o3,_ Fax: E-mail: CommerciaUindustrial/multi-family: KIM M Valuation of work 61TP. Business name: �t o 0 Q� Existing bldg.area(sq.ft.) .......................... -- - New bldg.area(sq.ft.) Address: -- ................................ City: ^� Staic. ZIP Number of stories........................................ _ Phone: Fax: E-mail: Type of construction................................... _ CCB no.: New:group(s). Existing: _ New: City/metro lie.no.: Notice:All contractors and subcontractors are required to be AR01111TU-TiDESIGNM licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may be required to be licensed in the Address: jurisdiction where work is being performed.If the applicant is City: _ State: ZIP: - exempt from licensing,the following reason applies: Contact person: Plan no.: -- — Pltone: -- . ,, - E-mail: �— — - ENGINEER NaARFMI,l Contact person;jm `ees due upon application ........................... $ •�.`�7 • I�J Address: Date received: City: -(jy:bla�pState:6r_ ZIP: q-1 AS 1 Amount received ......................................... $! __ Phone:50 +W- fj Fa.,&+"->slr e-mail: Please refer to fee schedule. hereby certify I have read and examined this application and the Not all jurisdictions attar,credit cards,please tali jurisdiction for mate inrorrnstion attached checklist. All provisions of laws and ordinances governing this U visa U MasterCard work will he complied with,whether specified herein or not. Credit card number- Authorized sigp Date: f)-10-0 j_ Name of cardholder a shown on credit card Print name:._�J)✓t_ ---- — S -- Cardholdet signature Atnoual Notice:Phis fwniiiI application expires if a permit is not obtained within ISO days aftet it has been accepted as complete. 4404613(M)OA-OM) SITE WORK PERMIT CHECK LIST Commercial, Multi-F if.,ily (R-1 occupancy) and Residential: Please complete all items below, unless otherwise noted. Excavation Volume: —� cu. yds.- Grading Volume: Soils report re uig red for >5,000 cu.yds _ -_ �_ cu_ yds. Fill Volume: (Fill exceeding 12" in depth shall be compacted to 90% of maximum density) _ cu. yds. Retaining structure? (Check one) ❑ Rock ❑ CMU U Concrete ❑ Other *Total new impervious area including all buildings, sidewalks, and paving: sq. ft. Site Utilities Plumbing Work: Complete the "TAN" Plumbing Permit Application for site utilities plumbing work. Plans Required. See "Site Work Permit Application - Plan Submittal Requirements" attached. The followingmust accom this application: _ -- --Site Plan with Vicinity Map — *Parking (including ADA) and showing ADA compliance _ Lighting Grading Plan and details *Landsca inq Plan Erosion Control Plan and details Retaining Structures Site Utility Plan and details Soils Report (if required) (showing connection to approved system) *Does not apply to 1 and 2-family dwellings. I:\dsts\forms\sitechecklist.doc 05/31101 Robert Poskin, CET' CliO-Senier Plan Examiner 13125 SW Hall Blvd. 'Tigard, Oregon 97224 CITY OF TIGARD (503) 639-4171 X 392 FAX (503) 684-7297 OREGON Email - hohpra�ci.tigard.or.us Date: September 6, 2001 Applicant: I3en Stutz '%o Nicoli Engineering Address: 11() l3ox 23784, Tigard, OR. 07821 Phone Numhcr: 503-620-2086 FAX: 503-245-4669 Permit Number SIT# 2001-11011211 - B11P# 2001-11113117 Project Location: 11900 SW Greenhurg Itoad, 'I'igar(i, OR. )7224 Oceupar-y Classification: "it" Type of Construction: VN Sprinkler System: No Location on Property: Complies w/ 513 Occupant Load: 28 Height and Number of Stories: ('(implies with table 513 Allowable Area Basic: WIMI Multiple Story: N/A Yards: N/A Sprinklers: N/A Total Allowable: 811011 Area Separation Walls: yes Exterior Wall Protection: Ves - South Wall Vour plans have been reviewed for compliance; the following issues require your attention: Site: 1. Fire Hydrant number and location, and Fire Department access shall he approved by IN114. Pleuse have Eric McMullen DFM, pro-ide me with a letter of approval. 2. The site requires three (3) accessible parking spaces. The space ),(iu are showing adjacent to the building does not comply with OSS(', Section 1104. Building: 1. I'hc arca separation wall on the south face must extend horiiontalh, to line 1 at grid line "A". Vou may elect to use an ICIM interpretive ruling and utilize one-hour walls 10' 11" hack parallel and perpendicular near the exit on this face. OSS(', Section 504.6. 2. Provide draft stops in accordance with OSS(', Section 708.3.1.2 1;J 25 SW Hall Blvd., Tigard, OIC 97223 (503)639-4171 TDD (503)684-2772 - -- -- - Pale 2 continued —Stutz Energy Code: 1. Provide forms 2a through 5c less Special Inspections: Provide the information highlighted in yellow and return forms to me. Provide two (2) complete sets of revised plans. If you have questions, please call me at 503-639-4171 X 392 Sincerely, \ Ro -rt Poskin CET CBO Senior Plans Examiner dl II / LLJ CJI o tS ui : w 6O u; Q i �-- _ .•, �� , wOC 6' 1 ® °V31 o n uiii in like