12285 SW KELLY LANE N
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12285 SW Kelly Lane
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MASTER PERMIT
\ CITY OF TIGARD PERM7M MS12'J03-00072
DEVELCUPPIENT SERVICES DATE ISSUED: 4/4/03
13925 SW Hall L;Ivd.,1 Fgard,OR 97223 (503)639-1171
SITE ADL,.ESS: 12285 SW KELLY LN PARCEL: 2S103CC-09600
SUBDIVISION: WHISTLER'S'NALK ZONING: R-4.�
BLG:'K: LOT: 043 JURISDICTION: 'Il(;
REMARKS- Construction of new SF det,chead residence.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REOUIF'EC SETBACKS PEGUIRED
CLASS OF WORK: NEV HEIGHT: 23 FI14T: 1,570 of BASEMENT: of LEFT: 15 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR'.OAD: 40 aEJOND: 1,520 e1 GARAGE: 1,176 of FRONT: 26 PARKING SPACES: 2
TYPE OF CONST: 5l. DWELLINJ UNITS: 1 14PD of IKIGHT: 10
OCVALUE: 328,528 60
OCCUPANCY GRP: R3 P�:ivl: 4 BATH: 3 TOTAL: 3,190 et REAR: 16
_ PLUMBING _
SINKS: I WA'ER CLOSETS: _i WASHING MACH: I LAUNDRY TRAYS' RAIN DRAIN: If., TRAP&.
LAVATORIES: 4 CISHWASHERS: I FLOOR DR/ONS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUBISHOWERS: GARBAGE DISP: I WATER HEATERS 1 WATER LINES: 10 BCKFLW PREVNTW I GREASE TRAPS:
OTHER rIXTURE&
MECHANICAL
FUEL TYPES FURN<100K: BO,LICMP c 3HP: VENT FANS: 4 CLOTHES DRYER: I
„ FURN>-100K: I UNIT HEATERS: HOODS: 1 OTHER UNITS: I
MAXINP btu FLOOR :URNANCES: VENTS: 1 WOODSTOv"S: GASOUTLETS: 1
ELE^TRICAL
RESIDENTIAL UNIT SERVICE FEEDER - TEMP SRVCIFEEDERS _PRANCH CIRCUITS MISCFLLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS I U 200a ro: 0 ;r10 erne:
WISVC OR FUR: PUMPIIRRIGArION• PFn INSPECTION.
EA ADD'L 500SF: 7 201 400 snip 201 - 400 ornp: let WOO SVrIFDn, SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 600 amp: EAADDL BR CIR: SIGNALIPANEL: IN PLANT:
MANU HM/SVC/FDR: 601 !"Ill"-rip! 801.amps•100010: MINOR LABEL:
1000♦amplvolt: PI./N REVIEW SECTION
Reconnect onh. >600 V NOMINA L: CLS AREAISPC OCC:
>e4 RES UNITS: SVC/FDR,-d25 A.:
ELECTRICAL•RESTRICTED Elk tku -
A.SF RESIDENTIAL - B.COMMERCIAL
AUDIO&STEREO: VACUUM SY;1EM: AUDIO&STEREO: FIRE).,ARM INTERL7101IPAGING: OUTCOOR LNDSC Ll
BURGLAR ALARM: OTH: 9011 ER HVAC: I.ANDSCAl511RRIG: PROTECTIVE SIGNL:
GARAGE OPENER CLOCK: INSTRUMEN ATION: MEDIC AL: OTHR:
HVAC. DATAITELE COMM NURSE rALLS TOTAL N SYSTEMS.
TOTAL FEES: $ 5,825.35
Owner: Contractor: This permit Is subject to the egulations contained in the
DOW MORISSETTE HOMES DON MORISSETTE HOMES INC 1lgard Municipal Code,State of OR. Specialty Codes and
4230 GALEWOOD ST 4230 GALEWOOD ST,STE 100 all other applicable laws. All work will be done in
STE 100 LAKE OSWEGO,OR 97035 accordance with approved plans. This permit will expire If
LAKE OSWEGO,CR 0035 work Is not started within 180 days of Issuance,or if the
work Is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phnne: 503-387-7538 Phone: Oregon Utilih'Notification Center. Those rules are set
Forth III OAR'952-00'-0010 through 952-001-0080. Yuu
Meg a: i l 3R7.17 8� may obtain copies of these rules or direct questions to
s C INC by calling(503)246-1987.
REQUIRED INSPECTIONS
Erosion Contru!Insp 8, Post/Beam Structural r)LM/Underfloor Shear Wall Insp Insulation Insp Plumb Final
Grading Inspection PcsNReam Mechanica Mechanical Inc.p Lxterior Sheathing Ins[ Rain drain Insp Final Inspection
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Water Line Insp
Footing Insp Crawl Drain/Backwater Electrical Rough In Gas Line InFj) Appr/Sdwlk Insp
Foundation Insp F,ot(ng/Foundation Dr, Framing In Sae Fireplace Electrical Final
Issued By : LL.b.�d �� - Permittee Signature
Call k503) 639-4175 by 7:(10 p.m. for an inspection needed the next business day
TIG��AR SEWER CONNECTi��N PI:RNtIT
CITY OF TIG --
DEVELOPMENT SERVICES PERMIT#: SWR200?-00062
--- 13125 FW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/4/03
PARCEL- 2S103CC-09600
SITE ADDRESS; 12285 SW KELLY L.N
SUBDIVISION: WHISTLER'S WAI K ZONING: It-4 5
BLOCK: LOT: (0; JURISDICTION: Ilc;
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUII-DII4G3:
INSTALL TYPE: LTPSWR IMPERV S.JRFAt:E:
Remarks: Sewer connection for new SF detached.
Owner: FEES
DON MOP.ISSETTE HOMES
4230 GALEN.r0OD Sl' Qescription _ � Date _ Amount
STE 100 [SWLISA! Swr Conw.ct 4/4/03 $2,300.00
LAKE OSWEGO,OR 97035 [SWUSA]Swr Connect 4/4/03 $0.00
Phone: 503-397-7.538 [SWINSP]Swr Inspect 4/4/03 $35.00
[SWINSP] Swr Inspect 4/4/0:'' $0.00
Con.Tactor:
— Total+ $2,335.00
Phone:
Req #
Required Inspections —
This Applicant agrees to comply with all the rules and regulations of the Clean Water Sd vices. The permit expires 180
days from the date issued. The tor-1 amount paid will be forfeited if the permit c„pires. he Agency does not aimrantee
the accuracy of the side sewer laterals. It the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions frum the distance given. If not so located,the installer shall purchase a"Tap and Side Sewer” Perm
/ ` y
Issued by: Permittee Signaiure:
�.t�-Lc y,._ _
Call (503) 639.4175 by 7:00 P.M. for an inspection needed the next business day
Building Permit Application
Date received: .'/Y C, Pernutno.1Y�-
City of TigardI�[[��''�� —
Address: 13125 SW ,Ia�►O�R 9f22� f'rojecUappl.no.: Expire date:
City ojTigard -
Phone: (503) 639-41 1 Date issued. By: Receipt no.:
Fax: (503) 598-1960 Cp 6 O"� Case file no.: Payment type:
Land use approval: I I�IaF�G 1&2 family:Simple Complex:
.r
D I &2 family dwelling of accessory U Commercial/industrial Cl Mulu-family y>!(Ncw consfnxtion U Demolition
D ddition/allcration/relilaceinent U Tenant improvement U Firc tipnnklcd:rlann U Other:
1Lmll 19 to LU 3d fill 1111101
Job address: I� i-� Bldg.no.: _ Suite no.: _
•.t: Block: Subdivision: _ ( r a 7 `/� j( ax map/tax lot/account no.: ^_
Project name -
Description and location of work on premisesi;pecial conditions:
Name:Vnn
Mailing address: Iv'L• 1 &2 family dwelling:
ity: _ State:[ ZIP:C11 Valuation of work........ ............. ............... $ '
P'tcne: Fax: )- 111 No.of bedrooms/baths................................. /
Owner's representative: ' '_y-V'L I ✓I Total number of Ouors.................................
Shone: Fax. E-mail: New dwelling area(sq, ft.)
L 4 .
Garage/carport area(sq. ft.) ........................
Name: ry t * ` � ' Y _ Covered porch area(sq.ft.) .........................
Mailing address: Deck:u sa(sq. ft.) ........................................ _--
City: State: ZIP: Other structure area(sq.ft.).........................
Phone: l'.rx F mail: Commercial/indugtriallmultl-family:
1 Valuation of work........................................ $
Business name: - Existing bldg.area(sq. ft.) .......................... ,
r- New bldg.area(sq. ft. .........................
Address
City: State: ZIP: Number of stories.........................
Phone: f` ---
Fax: ......... ... ..
—�=ax: E-mail: Type of construction. . . .. .. ....
-T ,...........
--- C ",mC; otri.p('.1' FXlsting:
-�-- __ _ New:
Citv/rnetro lie.mt: -
Not:.••.'.II contta�tors and subcontractors are required to be
t licenseu with the Oregon Construction Contractors Board under
Name: (�,� , t �,, � Y �- l' -_ provisicns of OR,i 701 and may be required to be licensed in the
Addn ss: c�"����� C4, jurisdiction whr:rc work is being performed. If the applicant is
City: State: ZIP; exempt from li:ensing,the following reason applies:
C ntact person: Plan no.: - -
Pbone: ►".�x I[: marl: - -
0010101-IM �m
Name: C'on'act 1k son I ccs due upon a;pl, t ...........................
-
Address: Date received:
City: _ state: 1ZII' Amount received ......................................... $
Phone: Fax: E-mail: _ Please refer to f'ec_schedi le.
I hereby certify 1 have read and examined this application and file Nm All judWictlonr wcep credil cards,please cAll iunsdicU xi for more Infornsarlon.
attached checklist. All-provision.;of Iwi and uidinances governing this U visa LJMaaterCud
work will be complr wt ,whether, cifieJ hcreA t. Credir card numbrr �A irc1_
Authorised si natt: 1 ��� 1 _ _ i Now of M1'holde shown on_rods cid
mint name:� { 7 ZOT 1 I -�- -- t ardEan_ none i S Amount
Notice:Thio permit appli^ation expires if a permit is not obtained within 190 days after it has been accepted as complete. 4404613(&WCOM)
One-and Two-T'ainily Dwelling Referenc
Building Permit Application Checklist Associate pe
-- Associated permits:
City ofrigu,d (city of Tigard
❑Electrical O Plumbing ❑Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 9722 O Other: —_
Phone: (503) 639-4171
Fax: (503) 598-1960
1 111'p ILA t t �iFlORFOUIRED 1VdR PLi%N REVIEW 'No N/A
I Land use acllons completed, See jurisdiction cnterib for concurrent reviews.
2 Zoning.hlocxl plun,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved platAot.
4 Fire district approval required.
5 Septic system permit or authon;.ution for remodel.Existing system capacity _
6 Sewer permit.
7 Water district approval,
b _Soils report. Must carry original applicable stamp and signature on rile or with application.
9 osion control ❑plan 0 permit required.Include drainage-way protection,nit fence design and location of
catch-basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing c-mformance to applicaHe local and star"
building codes. Lateral design dutails and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist.
I 1 Sitelplot plan 4rawn to scale.Tie plan must show lot and building setback dimensions;property comer elevations(if
there is more Urian a 4-11.el--vatioc differential,plan must sEow contour lines at 2-ft.intervals);location of easements and
driveway;footprint cf structure(including decks);location of wells/septic systems;utility locations;direction indicator,lot
area;building coverage ai:ca;percentage of coverage;impervium area;existing structures on site;and surface drainage.
12 Foundation plan.Slow dimensions,anchor bolts,any i old-downs and reinforcing pads,connection details,vent
size and location. _
13 Floor plans,Stro,v all dimensions,room identification, window sire,location of smoke detectors,water heater,
5d
furnace,ventilation fans,plumbing fixtures,bwconies and uccks 30 inches above grade,etc.
14 Cross section(s)acrd detatis.Show all framing-member sizes and spacing such as floor beams,headers,join' _ b-floor,
wall construction,root.:cnstruction.More than one cross sect n may be required to clearly portray construcuvrt.Nhow
details of all wall and mcf sheathing,rooming,roof slope,ceiling loeighl,siding material,footings and foundation,stairs,
fireplace construction, thtrmal insulation,etc.
15 Elevation views.Provide eievbi: . '-ir new construction;minimum of two elevations for additions and remodels.
Exterior elevations must reflect the a.,tual grade if the change in grade is greater than four foot at building envelope.
' Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or literal analysis plans.Must indicate details and locations;for
i,on- rescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member suing,spacing,and hearing
locations.Sbotw:-tate ventilation.
18 Basement and retaining walls.Provide,cross sections and details showing placement of rebar.For engineered
systems,see item 22,"Engineer's calculations." _
19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. _
21 Energy Code compliance.Identify the prescr-ptive path or provide calculations.A gas-piping schematic is required
for four or more appliances.
22 Engineer's calctdatlons.When required or provided,(i.e.,shear wall,roof truss)shall he stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the pn,jert under re%iew
JUWND!�,IIIONAL
23 Five(5)site plans are required for Item I I above. Site plans must be R-1/2" x I or I I" x i
24 Two(2)sets each are required for Items 16, 19,20&22 ahove.
25 Building plans shall not contain red lines or tape-.:,ns.
26 No rolled,reversed or mirrored building plans will be accepted. _
27 —
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 404614(1,WCOMI
Mechanical Permit Application
Date received: Permit no.:
City of Tigard Project/appl.no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd,1 igard,OF 9722?
eceipt no.:
Phone: (503) 639-4171 Date issued: Ity R
Fax: (503) 598-1960 Case file no.: T Payment type: -
Land use approval: Budding permitno..
1
=, 2 dwellinvor accessory ❑Commercial/industrial ❑ Multi-family `I Tenant improvement
ction ❑ Add ition/alteration/repiaectnent U Other:-- - _
Job address: `' 4-- Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: Suite no.: value of alt mechanical matensls,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$
Lot: Block: Suh,iivision: -See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: t �1
Description and location of work on pre-mises: i t i i t i t I D '111101011 rt
--
Fee(m) Trnal
Est.date of completion/inspection: r Description olty. Res.only u
Res, nly
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Ise. ting space heated or conditioned?U Yes Oho Air conditioning(site plan required)
Is existing space insulated?0 Ye, 0 No terauon of( AC system
Boiler/compressors
State boiler permit no.:
7Address:
ss name: ( IIP Tons BTU/H
`T�—�` •iretsmo ce damru uct smoke detectors
-!�i--LIY State, ;,I P: nHeateump(site an required) _
Phone: Fax: E-mail. ns,a rep ace urnac urner_.
Including ductworkAent liner ❑Yes O No
CCB no.: ?jrj��=�(� —,_v- Instal rep ace/re ocatt.heaters-suspended
City/metro lic. no.:N/A wall,or floor mounted
Name(please print): - (S-l Vent orappliance o Fan an furnace
Refrigeration:
Absorption units__ -_ BTU/H _ _po'" `f��-L.- C`„t!rrs __�-- Hr —
Address: i � _ Com rmsors
G cL nvonmentil a iusf and sent at on:
City: State: I ZIP: Appliancevcnt _
Phone: Fax E-mail Dryer exhaust
Hoods, ypr res. tchen/hazmat
hood fire suppression system
Name: , i Exhaust fats with single duct(bath fans)
"% ^�,' iu•t s st.m apart from heating or C.
Making address:
-�� �- Uel piping as dis- IZution(up to out cis)
City: State ?.IP ) Type LPG NO Oil _
Phone: % I F•mail tie i tng each additions over 4 outlets
rocesspiping tschematicrequired)
Number of outlets
Name: --- - — -- _- _ ter 11sled appliance or equipment-
Address:
qu pment:Address: Decorative fireplace
Cit State: ZIP: user-type _
City:
---- - --- Woodstove/olletatove ---
Phone: Fax: F-Mail: Other
5 .4pplicant's si/'nnru o. [)arc:__ �' ;' other,
Name(print): x' ' 'r, i _ _—_--
Not di)arisdic Toru wcept credit cods,pierce cart)uric hction for more intorrtutian Permit fee.....................E
Notice:This permit application Minimum fee................$
D Visa O hlasierCard expires if a permit is not obtained
Plan review(at — 96) E
Credit card number -- --
Expires1- within ISO days after it has been
accepted as complete. State surcharge(8%) ....$
None o car- rr u wn on credit cad p p
Cudholder siqutute Amount 440AII(sAnycoM)
Plumbing Permit Application
Darereceived: Perntitno.:(',Iii/ ;%,',,; ✓✓ i
City of Tigard Sewer permit nt Building permit no.:
i Address: 13125 SW Hall Blvd,Tigard.OR 97223 Project/appl.no.. Expire date:
City of Tigard Phone: (503) 639-1171
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Case rile no.. Payment type:
Land use approval: -
r&t2 y lwelling oraccessoryO Commercial/industrW O Multi-family O Tenant improvement
uction ❑Addition/alteration/replacement CI Food service O Other.
1 1 1 t r
Desai don Fee(ea.) Total
Job address: i t-
New 1-and 2-family dreWngs only:
Bldg.no.: Suite no. (Includes 100 it.forach utility connection)
Tax map/tax lot account no.: SFR(1)bath
LoC Block: Subdi•rision: L U. SFR(2)bath
Project name: L SFR(3)bath
City/county:
ZIP: Each ac Jiuonal batlt/kitchen
Site utilities:
Desctiption and location of work on premises: Catch basin/area drain
=:Drywells each line/trench drain
Est.date of complcdon/inspection: Footing drain(no.lin. f:.)
Manufactured home utilities
Business name �c L Manhole-z
Rain drain connector _ I
Address: Sanitary sewer(no.lin. t't.)
State- ZIP: ---
City: Storm sewer(no. lin.ft-)
Phone: Fax: E-mail: Water service(no. il:t.ft.)
CCB no.: W7 L Plumb,bus. reg.no: Fixture or item:
City/metro lic. no.:NiA �\—�/- Absorption valve
Contractor's representative signature' ; Back Clow preventer
`� L) Backwater vale �1
Print name: {k h�-
Basins/lavatory
Clothes washer
Name: ` - - -- Dishwasher
Address. k ✓"VC Dunking founrainis)
laity- state: ZIP: L-lectorysump
-Phone i tx� E-mail: Expansion tank
Fixtumisewer cap
Floor drains/floor sinksthub
Name (print): �����`� Garbage dispos -
T Hose bibb
Mailing address: e —------ -
City- . l , state _ ZIP C int maker _
Phone: - - max:, 7-7ki E-mail: interceptor/grease trap
Owner insmiladow'residendat maintenance
oniv: The actual in men s l
.Ilation Pn
will be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447 S nki),basims),lays(s)
Date
mp
Owner's signature _
Tubs shower/shower pan _
Unnal
Name --- —_ Water closet
-- Water heater
Address:
City: State: Zip: Usher
E-mail:
Total
Phony: Fax: .....S
__. Minimum ft•e........... -
Nnr all iunsaicunnt ace Fl credit piease earl iunsatction fa m,xe information Notice:This pemilt application Plan review(at _ %) $
O Visa 0 SIasterCardv -��_L expires if a per:.it is not obtained State surcharge(810) .•••S ------'-
Cmditcard number accepted as within IRO das at'er it has been TOTAL .................. ....S
Ewpvef
complye.e,
Name of carJAolaer U rf eon oo ct�ttn cud s ";
bip.1616(6�'t"C
Canfholder:tt�ture Am-ni--
FOR OFFICE USE ONLY
Electrical Permit Application Receivedrr -.c,--, � Hectricnl
Date/B : 12 -b ` Permit No.:
_q _ / (� Planning Approval Sign
City of igard "i E_�/E-1 V E 1 Plan R : Permit No.:
13125 SW Hall Blvd. Plan Review Other
Datc/D Permit No.:
Tigard,Oregon Oregon 97223 Post-Review ,�--- /.and Use
Phone: 503-639-4171 Pax: 503-598-1960 e., Datc/B Od Case No.: _
Internet: www,ci•tigard.or.us ar�ttar; Juns.: See Nage 2 for
24-hour Inspection Request: 503-639-4175 �! ethod: Supplemental Informutlon.
-- TYPE OF WORK PER W Please check all that ap�j,
Demolition SCrvice o er 22 amps- health-care facility
JAed!d
construction -- commari ial ❑Hazardous location
tion/alterationlre laccment ❑Other: ❑Servic,.over 320 amps-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTly dwellings four or more residential units in
RUCTION I &2 fami
Commercial/Industrial ❑System over 600 volts nominal one structure
_ 1 & 2-gamildwelling ❑Building over three stories ❑Feeders,400 amps or more
Accesso Building Multi-Falr►il�_ ❑occupant load over 99 persons ❑Manufactured structures or RV park
Other: ❑Fgress/lighting plan ❑Other:--_____
Master Builder Submit_sets of plans with any of the above.
JOB SiTE INFORMATION and LOCATION rhe above are notarplicahle to len2n:,ary construction service.
Job site aedress: FEE*SCHEDULE
Suite M Bldg./Apt.#: _ Number v:'ins iection�p�termit.Ilowed
-- � ��,t LNewretidendal-i-Ingle
on qq Frc(ca.) i Tout
Project Name: or multi-family pe,
Cross street/Directions to job site: dwelling unit.Includes attached garage.
Service Included:
rl.imi'ted
Il.or less 145.15 4
itional SW .Il.or rtion thereof 33.40 I
__ ner residential 75.00 2Subdivision �it Y S _ 1'Ut#' oagy,non residential 7S 2Tax ma / Ui Cel #: —, nufactured home or modular it �9O
2
service and/or fccder
DESCRIPTION OF WORK — Services or feeders-Installation,
altcratlan or relocation:
- — -- -- -- - 200 amps ut ic::>. 80.30 2
- - --
201 am s to 4W amps 106.85 2
- -- -- ---- - 401 am to 6W amps _ 160.60 _
�-" 601 am to lOW amps 240.60 2
t'ROPERTY OWNER �'i ENANT Over 1110 amens or volts 454.65 2
Name J—__-T____�_ Reconnect only
— 66.85 2
Tempo-ary sc•vices or feeders-installation,
alteration,or relocation:
_.-- b6
2W amps or less .85
Cit /State/Zip: -- _ __���__ — -- 10.30 z
201 amp-,to 4W amps
Phone: Fax 401 to 600 amps _ 133.75
APPLICANT CONTACT PERSON Branch circuits-of- alteration,or
Y —�—__ __----_.__. extension per panel:
Name:
_— A.Fee for branch circuits with purchase of 6,65 2
Address: �___-___�_ service or feeder fce,each branch c uIt
City/State/Zip: �— D.Fee for branch circuits,vithout purchase of 46,85 2
service or feeder fee first branch circuit 6,65 2
Phone: Pax: Each additionol bronct•circuit
--i -- Misc.(Scrvice or feeder not included):
F-mail: -- Each um or iri ation circle _ 53.40 2
CONTRACTU_R _ _._ t.aeh ai ur online H htin Y,- 53.M; 2
Job No: � �• Signal circuit(s)or a limited energy panel. Y Pae 2 2
eC O - alteration,or extension
Business Name: — Description
Address: J SI --- - Each additional inntection over the allowable Im an of the above:
Clt /State�Zi _ _ Per ins coon L!hour(mm. I hour) 62.50
-�-- investi ation fee.
Phone: ? Fax: S�J cher: yJ —
( ('B Lic. #: �32Z2Z Lic. #; 3y__y C 1 lectrical Permit Fees*
Supervising electrician X19' ci Subtotal $ _
_EV
nature required: ��='�°`�~ -- Plan Review(25%of Permit Feel S
c #: State Surcharge(84io of Permit FCC5
Print Name: 8e� ,�Lei�. TOTAL PERMIT FEE S
Authorized / �/ Votice: This permit application expires If a permit is not obtained within
Signature: ��_ —_._.. __ Date: _ I80 da1'f after it has been accepted as complete.
'hce methodolo* set by 1 ri-Counh Building Industry Service(bard.
(Please print name)
i:\Dsts\llemiitFormi\ElcPermitApp.doc 01/03
Electrical Permit Al Aication - Cite of—Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT F%ES:
RESIDENTIAL WORK ONLY:
Fee for all systems.....................................................•...... $75.00
1'heck'I'ype of Work InNfol\ed:
Audio and Sterco Systems*
F] liurglar Alarm
c iarugc Door Opener*
I Icatiq,Ventilation and Air Conditioning System*
UV.1cuun lystems*
F Clher
COMMERCI.'.i.WORK ONLY:
Fee fol Mr-11 System.......................................................... $75.00
(Slit'OAR 91 S.260.260)
Check Type of Work Involved:
Audin and Stereo Systems
Boiler Controls
Clock Systems
Data T;lccommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control*
Medical
Nurse Calls
Outdoor Landscape Lighting*
Protective signaling
Other--_--. -----_._—_°__--
Number of Systems
* NP licenses are required. Licenses are required for all
other installations
is\Dsts\Permit FormsTIcPernitAppPg2.doc 01103
FROM FAX 110. Dec. 23 2001 08: 121FM P4
04/30,2003 (19.68 FA-1 503r'(>4iV0) CITY OF TIGARD
101 UU;f
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 971223
IMPORTANT PERMIT NOTICE
ANSPACH PLUMBING
MARK. A LAW
19360 S FERGUSON RC AD
OREGON CITY, OR 97045
Plumbing Signature Form
Permit ff. MST2003.00072
Date Issued: 414103
Pa rce I: 2 S103CC-09600
Site Address: 12288 SW KELLY LN
SIjbr11Vision: WHISTI.E.R'S WALK
Block' I cit' 043
Jurisdiction: TIG
zoning: R-4.5
Remarks: Construction of new 3F detachead residence.
Your company has been indicated as the plumbing contrac•orfor the permit indicated above In .-irder fu, the
plumbing permit to be valid, please have the appropriate indwidual from your company sign below and return
this; Plumbing Signature Form prk)r to the start of that work to rhe address above, ATTN guilding Division.
No plu.mbin; 'nspections will be auth�xized until this cLolpleted form is received
CWNCR PLUMSI!IG CONTRACTOR:
DON MORISSETTE HOMES ANSPACH PLUMBING
4230 GALEWOOD ST MARK A LAW
STE 100 18380 S FERGUSON Rr.'AD
LAKE ObWEGG, OR 97035 OREGON CITY, OR 9T045
Phone *: 503.387-7538 Phone f!:
503.253.8120
Reg#: LIC 37735
PLM 3.429PIS
AN INK SIGNATURE IS REQUIRED ON THIS FORM
ae
Signature of Author6ted plumhPr
if you have eny questions, please gall !M1.718.2433.
CITYOF TIGARD __ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00242
DATE ISSUED: 6/4/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
PARCEL: 2S103CC-09600
SITE ADDRESS: 12285 SW KELLY LN
SUBDIVISION: WHISTLER'S WALK ZONING: R-4.5
BLOCK: LOT: 043 JURISDICTION: TIG
CL ,NSS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: !r CH BASINS:
_
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS-
LAVATORIES:
RAPSLAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWFR LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Backflow preventer
_ FEES
Owner:
— Description Date Amount
DON MOR'SSETTE HOMES
4230 GALEWOOD ST 1111,11NIM Permit I cc 6/4103 $36.25
STE 100 11,1 N 18" stair Tax 6/4/03 $2.90 _
LAKE OSWEGO,OR 97035 I� Total $39.15
Phone : 503-387-7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone : s(" (,()' 594s
Rag #: 11! \1
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of CR.
Specialty Codes and all other applicable lav�s. 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
r
Issued By: �. '� _ - Permittee Signature: L) _ � _'L'
Call (503f 639-41-15 by 7:00 P.M. for an insN^(;tion needed the naxt bu6lmiss day
0-1 03 09: 45a dan Pdmond-. 503-692-0768 p. l
14
Iltnnbilnu{ Permit A,4)LyC, _ion � � � � -''
—. -- Received Plumhmg
Date/By! Per, r io.f'l�7� oa k�JLI
City of Tigard PlanningApproval sewer
Date/fI : Permit No.,
13125 SW Hall Blvd, Plun Review Other
Tigard,Oregon 97223 Dute/li : Permit No.:
Phone: 503-639-4171 Pax: 503-598-1960 Post-Review Land Use;ate/By Case No.:
Internet: www.ci.tigard.or.us Conti,! Juris.: K Sec Page 2 Cor
24-hour Inspection Request: 503-539-4175 Name/Method: Supplemental Information.
_ TYPE OF WORK _ FEE"SCHEDULE fors eclat t formation use checklist)
New construction Description ITty Fee(ea.) Total
Addition/alteration/replacer ED:emolition
ether: New i-&2-fardly dwellings
_ CATEGORY OF CONSTRUCTION (includes 100 ft.for ea:h is Ility connection
l dwellin Commercial/Industrial SFR 1 bath 2249.20,00
&2-Family
_�_� SFR(2)bath Ko
III-lAccessory Building _ ❑Multi-Famil SFR(3)bath _ 399.00
1-faster Builder LJ Other: Each additional hath/kitchen 45.00
JOii SiTE INFORMATION and LOCATION Fire vprinkler-s . ft.: Palle 2
Job site address-TDO - 41 Ice.(1 cr./1G Site Utilities
,Suite#: $]dp.!Apt. f; Catch basin/area drain IG.60
Pro act Name'W h-i-t-le L,L1 CLE IG LGT L13 Fu ting rain linc/tr_linear
drain 1 ge 2
1 _`-�_ Fuohn drain no.linear ft.j Pu,e 2-
Ct�iss street/Directions to job site: Manufactured home utilities 110.00
5'L0 /I( 5y Y V_e. Mannolcs 16.60
Rain drain connector 16.60
Sunitary sewer(no. linear ft.1 Is c2
Subdivision: (. LL{ Sf t'- l-U CL.fL c JLOt#. 3� Stora,sewt:(no.linear ft. Page 2
._.
�S�- Water service no.linear ft. Page 2
Tax map/parcel#: (�$.•-a Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
�4L/iCtiS L`c.c he:��,rr� vT c;�Gl1 cE daekilow 2reventer f Paget .sir
Backwater valve 1660
L:•)thes washer 16.60
- ---- Dishwasher 10.60 _
Drinkinp fountain 16.60
ROPERTY OWNER TENAN 1i'cetors'sum 16.60 ^—
-hyo _ _
Name: �� P710Y/.SSC �. t'.S ?xpansion lank 16.60
Address fQ30 �V �lt�L c�-'��Y�L Fixture/sewer cap 16.60
_._ Floor drain/floor sink/hub WC-0Cit /State/�71
Garbage disposal _ 16.60
Phone: :
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received __._.____ ____._ Date Requested_ 60 AM__ _ ___._ PM-__- ----_- BUP
Location __-_-- _r-- _-- Suite__--_ - --- MEC
Contact Person — --- ---`_-_— -- Ph (__-_-- ) _ PLMoZ �--
0ontractor _. Ph ( - ) ---- -- SWR _ -
BUILDING Tenant/Owner - -_____ _--_ _- ELC _.....
Footing ELC
Foundation Access:
Ftg Drain ELR __--
Crawl Drain
Slab Inspection Notes. SIT
Post& Beam --- - -------
Shear Anchors --
EA Sheath/Shear -- - --
Int Sheath!Shear
Framing - - - - - - - ---- - ---
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -
Fire Alarm % /
i
Susp'd Ceiling - - -----._ - ------
Roof
Other
Final
_PASS PART FAIL -�-- -� ✓----
PLUMBING - -- -- _— _-- ----
posit& Beam
Under Slab _------
Rough-In
Water Service _ _�-. -------- - --- —
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain - - --- - - - --
Showor Pan -
Ot r Vii%
'PA PART FAIL
- - -- - T F
HANICAL
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final
PADS PART FAIL
ELECTRICAL
Service --
Rough-In
UG/Slab
Low Voltage --— --- - - -----
Fire Alarm
Final Reinspection fee of$-. required before next inspection Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL Unabl f to inspect-no access
SITE �__ [ Please call or reinspection RE:--.--.- __ ___�-_ p
Fire Supply Line
ADA Date ,L .. Inspector / -- --___-- ---Ext ---
Approach/Sidewalk
Other:
Final — DO ASST REMOVE this Inspection record from the Job site.
PASS PART FAIL
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rrITY OF TIGARD 24-Hour
BUILDING inspection L;ne: (503)639-4175 MST
INS;JECTION DIVISION Business Line: (503)639-417'I
_ BLIP
Received Date Requested---- V11A AM__—_ _ PM— BUP
Location —_
_—_—_
Suite MEC _ --
Contact Person �__ — _ Ph( _) PLM —
Contractor —__ Ph(_— ) �_ _____ SWR
BUILDING Tenant/Owner _ - -_ - _ .__�_ ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors ---------_- ------- -_-__.__.. ..
Lxt Sheath/Shear
Int Sheath/Sh^ r
Framing - ------ -
Insulation
Drywall Nailing
r�r��oall
Fire Sprinkler ----________ _ --.-------_ -------.----- -- _ ---_-- -- -- _ ._ .
Firn Alarn
G,jsp'd t;eiling
Roof
Other, ----
--- --- - -
S PART FAIL ___- -
P------
BING
Post&Beam
'Inder Slab --- -
Hough-In
Water Service ---- -- - -
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain -------- - - —-
Shower Pan
othor. - ----- -
FY
PART FAIL - - --- - - - -- -Mr-IN,
ANICAL_
Post& Beam
Hough-In
Gas Line
Smoke Dampers - ---------- -
-S PART FAIL --- -- - - -- ------ - -fteCTRICAL —
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm - - ----
rin ,-+ n Reinspection fee of$ - required before next inspection Pay at City Hall, 13125 SW Hall Blvd.
$S PART FAIL
S C J Pleas F call for reinspection RE. ..... - -_-_ L Unable to inspect--no access
Fire Supply Line
Ap A oath/Sidewalk Date Inspector 14 1 ° __ --_ _ Ext _ - -
Other
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST r7`'-
INSPECTION DIVISION Business Line: (503)639-4171
BUP — - .—
Received __._— Date Requeste AM --- PM_— BUP _--_--
Location _—.-���i2��� %C -.----Suite__--. ___ MEC --_— —
6ontact Person —_ �_ Ph PLM
Contractor __ _ _ Ph(_ _ -) ___._._—. SWR _—
BUILDING ie�ianVOwner — -- _ _—.--.. _ ELC __—.___----
footing - -- ELC -------.-_---
Foundation Access:
Fig Drain ELR
Crawl Drain SIT
Slab Inspection Notes:
Post&Beam - —_ --- -- --- ---- _
Shear Anrhors -
Ext Sheath/Sheaf -------- -�—
Int Sheath/Shear
Framing - ----- --- - A, � 1
Insulation i�11 .._..' \ - �e�� �
Drywall Nailing /
Firewall
Fire Sprinkler --�
Fire Alarm
Suso'd Ceiling ---�- -- -- - —
Root
Other: -------- - - ---.. - --
Final --
PASS PART FAIL
-----------------
PLUM8ING - _---
Post& Beam
Under Slab -- - --- - -. -
Rough-In -
Water Service ---
Sanitary Sewer
Rain Drains f — --
Catch Basin/Manhole
Storm Drain -
ShowerPan
Other:.
Final
PASS PART FAIL
_M_ECHANICAL — __ ---- ---
Post&Beam
Rough-In -
Gas Line _
Smoke Dampers
Final
PASS PART FAIL
Servi
ffi
oltaTerm
F [] Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS ART FAIL
-S�E -- [� Please call for reinspection RE: -.- _ F-] Unable to inspect-no access
Fire Supply Line
ADA Inspwctor -5.�� ~ —_Ext
Approach/Sidewalk Dat4_ .'- _. -
Other:_
Fi,al DO NOT REMOVE this Inspection record from the'jok JItS.
PASS PART FAIL