9600 SW OAK STREET STE 540-1 m
9600 SVV Oak Street#540
CITYOF A l GA R D - CERTIFICATE OF OCCUPANCY
DEVELOPMENT SERVICES PERMIT#: BUP2002-00501
13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-417'o DATE ISSUED: 11/18/02
PARCEL: 1 S 135BD-00100
ZONING: C-P
JURISDICTION: TIG
SITE P JDRESS: 09600 SW OAK ST 540
SUBDIVISION: ASHBR.00K FARM
B' OCK: LOT:005.
-GLASS OF WORK: ALT
TYPE OF USE: COM
TYPE OF CONSTR: 1FR
OCCUPANCY GRP: B
OCCUPANCY LOAD:
TENANT NAME: aSHMFAD COLLEGE
REMARKS: FT-
Owner:
ASA PROPERTIES, INC
BY PAUL DEVILLE
PO BOX 3110
LU02 OF
Contr7ctor:
22.3-9703
SUMMIT CONSTRUCTION
PO BOX 10345
PORTLAND, OR 97210
Phone: F-42-3841
223-9703
Reg#: MET 00003246
LIC 63249
This Certificate issued 113101 grants occupancy of the above referenced
building or portion thereof and confirms that the building has been inspected for
compliance with the State of Oregon Specialty Godes for the group, occupancy,
ancj,uunder whi a referenced permit wa# iseupd.
BUMMING INSPECTOR B L. ' MF1
POST IN CONSPICUOUS PLACE
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 535-4175
MS
INSPECTION DIVISION Business Line: (503)539-4171 - - _- -
BLIPReceived _ _ Date Requested _ - '2 -3 D AM PM BUP
Location ---- -'- G - -(�- - - --Suite .- MEC
Gontact Person Ph( ---- ) CIS. _;Z� PLM
Contractor --.- _-._ Ph( ) --___ _-_ SWR
BUILDING Tenant/Owner -_-_ ELG
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain _ -
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors - —
Ext Sheath/Shear _-
Int Sheath/Shear
Framing --- -
Insulation
Drywall Nailing - - -
Firewall
Fire Sprinkler -. --- -- --
Fire Alarm 7j Z
Susp'd Ceiling
Roof
Other:
Final
PASS PARI FAIL-
-k-UM-9 NG
AILPLUMBING
Poet&Beam -
Under Slab ------------
Rough-In
Water Service ---._ -------- -- - --
Sanitary Sewer Af
Rain Drains - --- - --- ----
Catch Basin/Man e
Storm Drain - - - ---- -� `-
Shower Pan
Other: --_.---
_ S PART FAIL - --- - ---�_----- -
ANICAL
Post&Beam
Rough-In
Gas Line
Smoke Dampers - - - -
Final
PASS PART FAIL - ----- - --
ELECTRICAL
Service
Rough-in --_ — ------- —
UG/Slab
Low Voltage
Fire Alarm �--! --
Final
lPART FAIL L] Reinspection fee of$ __. required befcre next inspection. Pay at City gall, 13125 SW Hall Blvd.
PASSSITE— Please call for reinspection RE: n Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
_._ IntpNslOR_._____._- _ -.a..._..-__---Ext__--
Other:
I
Final DO NOT REMOVE this InspAction record from the job site.
PASS PART FAIL
GIT ' OF TI+GARD BUILDING PERMIT
PERMIT#: BUP2002-00501
DEVELOPMENT SERVICES DATE ISSUEU: 11/18/02
1315 SW Hall Blvd., Tiqard, OR 97223 (5031, 639-4171 PARCEL: 1S135BD-00100
SITE ADDRESS: 09600 SW OAK ST 540
SUBDIVISION: ASHBROOK FARM ZONING: C-P
BLOCK: _ LOT: 005 _ 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? T_
TYPE OF CONS"r: 1 FR Sf N: S: E W:
OCCUPANCY GRP: B TOTAL AREA: 000 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: READ SETBACKS __ __ REQUIR_ED J
"LCOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: N _ SMOK DET:N
DWELLING UNITS- FRNT: ft REAP: ft FIR ALRM : N HNDICP ACC. :'
BEDRMS: BATHS: IMP SUF FACE: FRO CORR: Y PARKING:
VALUE: $ 2,100.00
Remarks: TI Combining 2 suites into 1.
Owner: Contractor:
ASA PROPERTIES, INC SUMMIT CONSTRUCTION
BY PAUL DEVILLE PO BOX 10345
PO BOX 3110 PORTLAND, OR 97210
HONOLULU, HI 96802
Phone: F-42-3841
223-9703 Phone: F-42-3841
Reg #: k23f9703 g0003000g3246
�
— ---- LIC REO8MA INSPECTIONS FEES — _
Description Date Amount r Plumbing Permit Required
�IitII1,I)I Permit Fee 11/18/02 $72.10 Framing I.
Gyp Board ;�isp
I.N 5tate'I'ax 11/18/02 $5.77 Final Inspection
Ilil'1'1ILNI Pln Itv 11/18/02 $46.87
111 SI FLS Nil Rv 11/18/02 $28.84
Total $153.58
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
riot started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-•001-0010 through OAR 952-001-0100. You may obtai-i a copy of these rules or direct questions to OUNC by
c•.illntg (503)246-6699 or 1-800-332-2344.
Issued BY: —
Permittee
Signature:
Call 639-4175 by 7 p.m. for an inspection the next busin'SR day
Building Permit Application
City of Tigard _- Date received4 I I1,•t Permitno.:` /
Address: 13125 SW Ball Blvd,Tigard,OR 97223 Project/appl.no.: Expire date:
City of Tigard Y�Date issued' B Recei t no.:
Phunp: (503) 639-4171 P _
Fax: (S03) 598-1960 Case file no.: Payment type:
Land use approval: 1&2 family:Simple Complex:
U I &2 family dwelling or accessory U Commercial/industrial U Mutu-lannly U New construction U Demolition
U Addition/alteration/replacement enant improvement U Fire sprinkler/alarm U Other:
.110111 SITE INFORMATION
Job address: 9f= :WU _ Bldg.no.: I Suite no.: G
Lot: I Block: Subdivision: Tar map/tax lodaccount no.: _
Project name: d
Description and location of work on premises/special conditions:
Name: WA f�1 _ (Floodislaln,sep'lic capacity,solar,Me.)
Moiling address: t:i (,;yl< 1 /-C) — - 1 &2 family dwelling:
City: �, LU' t State: ZIP: '.Z Valuation of work........................................ $
Phone: 2-
Max: G•mail: Nu,of bedrooms/baths................................. _
Owner's representative: _ _ Total number of floors.................................
I'honc; Fax: _ 113-mail: Nnw dwelling area(sq. ft.) ..........................Garage/carport arca(sq. ft.)......................•..
Name: / Covered porch area(sq. ft.) .........................
Mailing address —� Deck area(sq. t•t.)
City:` U _ Stag
ZIP: structure arca(sq.ft.).........................
Phone: ► E-mail: Commerelal/industriallmulti-family: lit,
Valuation of work........................................ $ �-1 w
Business name: ' ! r' Existing bldg.area(sq.ft.) ..........................
—L —
Address: New bldg.area(sq.ft.)
...............................
Cit 2 Number of stories........................................
y' r Stat ZIP: - Type of construction
Phone: Fnx' ,1 E-mail-
Occupancy .................................... �
, "- r'•f
-- Occupancy group(s): Existing:
('CB nn.: Z _ New:
City/metro lie.no.: Notice:All contractors and subcontractors are required to he
licensed with the,Oregon Construction Contractors Board under
Name: ` C�f�1�1 provisions of ORS 701 and may be required to he licensed in the
Address: �_ ;t ✓ ";c'-r`' ,jurisdiction where work is being performed. If the applicant is
Cit c.Q Sta ZIP: exempt from licensing,the following reason applies:
Contact rsun: �' Plan no.:
Phone 1 . F-mail:
,
Name: Contact person: Fees due upon application ........................... $
Address: Date received:
City: State: ?.IP: Amount received ......................................... $--_
Phone: Fax:_ E-mail: Please refer to fee schedule.
I hereby certify 1 have read and examined this application and the No dl}urisdictiom accep credit cards,please cdl}uridiction fa mote mformatmi,
attached checklist.All provisions of laws and ordinances governing this ❑Vita U MasterCard
work will he compliatd' Yhm erein or not, credit card number - - --
Authorized sign tU _ _ le: None of c older a shown on credo card
5
Print name: KiCV, C aipumte ---- Amount
Notice:This permit application expires if a permit is not obtained within 180 days sifter it has been accepted as complete. 440-461.1(duorcoM)
Commercial Flan Submittal
, Requirement Matrix
City of Tigard
TYPE OF SUBMITTAL # of Flans
(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 plans. 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 S 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-mgtrlx.doc 9/24/01
Accessibility:
Barrier Removal Improvement Plan
City of Tigard
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 arca 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.nay 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,wallpapering. Ill $ '2 �
!p pjy� 25% Barrier removal requirement. •25
BUDGET FOR BARRIER REMOVAL (21$_���---
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 $ —
(h) An accessible entrances $
(c) An accessible route to the altered area: $ 5 1
(d) At least one accessible restroom for $—
each sex or a single unisex restroom:
(e) Accessible telephones: $
(f) Accessible drinking fountains: and $^—. --
(g) When possible, additional accessible
elements such as storage and alarms: $
TOTAL: shall equal line 2 of Value Comautation $_�_ 2
i\dsts\forms\AccessibiUty.doc 06/07/02
CITY OF TIGARD - --
SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2002-00336
1:3125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/13/02
S!TE ADDRESS; 09600 SW OAK ST 540 PARCEL: 1S1 35BD-00100
SUBDIVISION: ASHBROOK FARM ZONING: ( -I'
BLOCK: LOT: oo JURISDICTION: I
TENANT NAME: ASHMEAD COLLEGE
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .3 EDU increase. Previous EDU=22 fpr a total of 352 fixture values. Addition of 4 fixture values,
for a new total of 356 fixture values= 22.3 current EDUs.
Owner: —�
- -- - FEES _
ASA PROPERTIES, INC -
BY PAUL DEVILLE Description Date Amount
PO BOX 3110 [SWUSAI Swr Connect 12/13/02 $690.00
HONOLULU, HI 96802 [SWUSA]Swr Connect 12/13/02 $0.00
Phone:
Total $690.00
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency dues not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located,the installer shall purchase a"Tap and Side Sewer' Perm
Issued by: �I « ` 1r, _ Permittee Signature;'
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the nixt business day
Accumulative Sewer Tally
Tenant NamF: Ashmead Coilegu This SWRA 2002-00336
Address:9600 SW Oak 6yIv This PLM# 2002-00474
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off#, count # value #s values
Baptiste/Font 4 0 0 — 0 0 0
Bath-Tub/Shower 4 1 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/Water Aspirotor 1 0 0 0 0 0
Dishwasher-Commercial 4 1 0 0 0 0 0
-Domestic 2 0 0 _ 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink-2 Inch 2 0 _i0 1 2 1 2 _
3 inch 5 0 0 0 0 0
4 inch 6 0 00 0 0
-Car Wash Dn 6 0 0 _ 0 0 0
Garbage Disposal
Domestic to 3/4 HP) 16 0 0 0 0 0
Commercial to 5 HP) 32 0 0 0 0 0
-Industrial over 5 I-1P) 48 0 0 0 0 0 _
Ice Mach ine/Refrig Prator Drain 1 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 n 0 0
Rec.Vehicle Dump station 16 0 _ 0 0 0 0
Shower-Gang (per head) 1 0 0 0 0 0
-Stall 2 0 G 1 2 1 2 _
Sink-Bar/Lavatory 2 0 0 0 0 0
Bradley 5 0 0 - 0 0 0
_ Cummercial 3 0 __— 0 0 0 0
-Service 3 0 0 0 0 0
Swimming Pool Filter 1 _ 0 �0 _ —0� 0 0
Washer-Clothes 6 0 _ 0 1 0 0 0
Water Extractor 6 0 0 _ 0 0 0
Water Closet-Toilet _ 6 0 _ 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 22 352 352
Capped EDU Credit 0
TOTALS 1 0 352 0 0 1 2 1 4 2 1 356
Current Fixture Value 356 divided by 16 = 22.3 Current EDU 1 EDU = $2,300.00
Previous Fixture Value_352 divided by 16= _ 22.0 Previous EDU
Change 4 divided by 16= - 0.3 over (under) $ 690.00-
Enter EDU Change Here 0.3
HISTORY
M _ _ PLM# EDU# _ _ _ SWR# l--�
PLM# EDU# SWR#
PLM# EDU# — -- SWR# .
Name:r ��%� L= = -- Cate:.Signature of of person that calculated Mis tally sheet and date perfromed Is required
wi
CITYOF TIGARD _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLN12002 R 474
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/13!02
PARCEL: 1 S 135DD-00100
SITE ADDRESS: 09600 SW OAK ST 540
SUBDRASION: ASHBROOK FARM ZONING- C-P
_ BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: AL1' GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
i SINKS URINALS: GREASE TRAPS.
LAVATORIES: 1 OTHER FIXTURES:
TUB/SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: [I plumbing fixture: 1 lav replaced, 1- 2" floor drain, 1 primer, 1 shower tub, 1 water heater.
FEES
Owner: Description Date Amount
ASA PROPERTIES, INC (pLl)MBI Permit Fcc 12/9/02 $83.00
BY PAUL DEVILLE [T'AX1 8`%o State Tas 12/9/02 $6.64
PO BOX 3110
HONOLULU, HI 96802 Total $89.64
Phone :
Contractor: _
JAMES ROOD PLUMBING
2459 SE TV HWY PMB#168
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Rough-in Insp
Phon, : 503-648-3907 Top-out Insp
Reg #: LIC 57355 Final Inspection
P!.M 34-199119
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
Issued By:
,, s Permittee Signature:
4 , C cc LL.,
Call (503)639-4175 by 7:00 P.M. for asp inspection needed the ext business day
Building Fixtures
Plumbing Permit Application
�— - - Date received: R -G c3-- Permit no.: �� i, a .!0.0/ y y
CityCit of Tigard J`
� Sewer permit no.: Building permit no..
Address: 13125 SW hall Blvd,Tigard,OR 97223
City of Tigard phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Dade issued: By: Y,ja) I Receipt no.:
Land use approval: _ Cas-rile no.: I?ayment type.
❑ I &2 family dwelling or accessory U Commercial/industrial ❑Multi-family crf—enant improvement
❑N,:w construction -J Addition/alteration/replacement O Food service ❑Other:
I 1
1oF address: `JGG'O .S(v' �i Description jQty.jFee(ea. ToUI
New 1-and
B'dg. no.: _ Suite no.: �`l�t= -fam ly dwellings only:
(includes 100 ft.for each utility connection)
ax map/tax lot/account no.: SFR(1)bath
Lot: jBlock: Subdivisiorr� SFR(2)bath
Project name: _ SFR(3)bath
City/county: T�4etrs ZIP: Each additional bath/kitchen
Description and logon Of work on prelnises: — Site utilities:
L%(vai L!LA Catch basin/area drain
[ist.date of completion/inspection: Drywells/leach line/trench drain
EFn'
rain(no. lin. fl.)
tWOMEN= factured home utilities
Business narne: Au c� ti,i. 4�, tiS oles
Address: S F at' � N1�_ �f� drain connectorCity: 1 l ,( C YO State::C) - ZIP ary sewer(no.lin, fl.)
Phone: 1 /mob Fax: GwK E-mail: Storm sewer(no lin. fl.)
CCH no.: 5; 7 3 g5' 10 Plumb.bus.reg.no: Water service(no.lin. ft.
City/metro lie.no.: jt e C C �-, .y,1 Qy Fixture or item:
----� -- Absorption valve
Contractor's re resentative si nature;. ,��-� ''
_ --�— �_�_ -- Hack flow preventer
Print narne: .` C ." e c4 t Backwater vaWl.
Ha ' s/lavato - )
Name: Clot es washer
Address: v Dishwasher _
�1 Y1at Drinking fountain(s)
City: ;(kary -��_,5-iat-- ?IP: /� T_ Ejectors/sump
Phone: - `10 Fax: .0 F-mail V, �o Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub "
Name(print): --
_ ..___ Garbage disposal _
Mailing address: _ Ilose bibb _
City: State: ZIPS ^_ Ice maker
Phone: Fax: E-mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actu d installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) _
employee on the property I own as per ORS Chi pter 447. Sink(s),basin(s),lays(s) _
Owner's signature: Date: Sump
Tubs/. ower/shower pan
Urinal
Name___ _ Water closet _
Address: Water heater
City: ------�..— -- State: ZIP: -- Other:
Phone: J Fax: E-mail: Total
Nnt all ji-rialictions accept credit.1d,pkaae ca11 lunadiction for marc information. Notice: This permit application Minimum fee..............) $
O Viae O MagtcrCerd expires if a permit is not obtained Plan review(at ni "n) s
Credit card number _ within 180 days after it has been State surcharge(8 0).... $ L
Name of c ttiholdet o a own on credit car accepted as complete.
CaMhnlda aignaiure Amount 410"1616(600/COM)
PLUMBING PERMIT FEES:
r— �T PRICE TOTAL New 1 and 2-famlly dwellings only:
FIXTURES i_nJivldual) QTY ea AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the tirst100 ft. QTY (ea) AMOUNT
],
Lavatory 16.60 for each utility connection
One 1 bath $249.20
Tub or Tub/Shower Comb. 16.60 Two 2 bath _ $350.00
Shower Only 16.60 Three 3 bath
Water Closet 16.60 _ SUBTOTAL
:Innal 16.60 6%STATE SURCHARGE _
Disnwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 ___ —_ TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
-- PLEASE COMPLETE:
3" 16.6o
4" 16.60
Water Healer 0 conversion O like kind 16.60 Quantic b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved I Replaced Removed/
permit Capped
MFG Home New Water Service 46.40 SinkLav _
tory
MFG Home New San/Storm Sewer 46.40 Tub or
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 1660 Shower Only
Drinking Fountain 16.60 Water Closet _ -
-- Urinal _
Other Fixtures(Specify) 16.60 Dishwasher _
Garbage Disposal
--
Laundry Room Tray
-- —
Washing Machine
_— —_ Floor Drain/Sink: 2"
Sewer-1 at 100' 55.00 — 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
(Specify)
Storm 8 Rain Drain-1 st 100' 55.00 _
Storm 8 Rain Drain•each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40 —
Residential Backflow Prevention Device' 2755
Catch Basin 16.60
Inspection of Existing Plumbing or Speci y 62.50
Re Lasted Inspectionsper/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 1660 --
QUANTITY TOTAL
Isometric or riser diagram is required If
Quantity Total Is >9 — —
"SUBTOTAL i-
8%STATE SURCHARGE
"PLAN REVIEW 25%OF SUBTOTAL
Required only if fixture yly total Is>9 __
TOTAL $
Minimum permit fee is$72 50.8%state surcharge,except Residential Backnow
Prevention Device,which is$38.2.5•8%state surchai;le
"All New Commercial Buildings require 2 sets of plana with Isometric or riser
diagram for plan review.
l:\dsts\forms\plm-fees.doc 12/21-!01
CITY OF TIGARD 24-Hour
BUILDING Inspection Lire: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503) 639-4171
BUP
Received __ Date Reques d-- _ I AM _-__ -- PM_ �.� BLIP
Location -- -.-
O StHs4 .5�7 �.._... .., MEC
` ��i� �7-�-(71 ,_ _ --- -----
Contact Person ___ _-_ _ - Ph(- ) PLM
Contractor - _ ��L�EPh( ) - SWR — -
�4 ELC �� —
BUILDING Tenant/OwnerFooting ELC
ELC
Foundation Access: ELR
Ftg Drain
Crawl Drain --- "— SIT --
Slab Inspection Notes:
Post&Beam ---
Shear Anchors f
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Diywall Nailing
Firewall
Fire'=-pr!nkler -
Fire Alarm
Susp'd Ceiling
Roof
Other:_---- -- --
Final
PASS _PART- FAIL
PLUMBING —
.--._ ---
Post&Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Par,
Other:
Final
PASS PARI FAIL
MECHANICAL -
----------
Post&Beam
Rough-In
Gas Line
Smoke Dampers - --- — --
Final -----
PASS PART FAIL — `- -'-- -—
LECT'RICIC-
Service -
Rough-In ---—--------- — - —
UG/Slab
Low Voltage _--- ---- ------
Fire Alarm
*ST
i'+rtT [� Reinspection tee of$— — _required before next inspection. Pay at City Fall, 13125 SW Hal!Blvd.
PART FAIL
E � PlPase call for reinspection RE:.— Unable to inspect-no access
Fire Supply Line 1
ADA D �f C o �� Inspectors __.__.ExtDate _--
Approaci/Sidewalk "—
Other: _
Final VO NOT REMOVE tlhllx Inspection tocord from the Jab site.
PASS PART FAIL_
F
CITY OFTIGAPD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION D►4':..ON Business Line: (503)639-4171 B � 56BLIP �"'�
Received -_ Date Requested - AM _ -____PM —_ BLIP
Location Suite_ 5r - MEC _
Contact Person 7t� V— Ph(__--_) y 7 �-�' l G __ PLM -
Contractor ___ -_ - Ph ( ) — SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR ------ ---_---- -----
Crawl Drain —
SlaL Inspection Notes: SIT -
Post&Beam -- - -_---
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insu:.ttion
Drywall Nailing - -- -- -Firewall
Fire Sprinkler - - - --
Fire Alarm
Susp'd Ceiling - - - - - --
Roof
Other ------ - ---- -
:SSS-) PART FAIL — -- - -
Post& Beam
Under Slab
Rough-In
Water Service ...... _-- - ___--
Sanitary Sewer
Rain Drains --T
Catch Basin/Manhole
Storm Drain - —
Shower Pan
Other: —_
Final
PASS PART FAIL ---- - ---
MECHANICAL_
Post& Beam
Rough-In
Gas Line
z2moke Dampers -__--
Fir,al
PASS PART FAIL
ELECTRICAL
Service - ---
Rough-in
UG/Slab -
_ow Voltage --- -------- - --- -
Fire Alarm
IFinal ❑ Reinspection fee of$—_ __--requires bef,)re next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS_ PART FAIL
- n Please call for reinspection RE: Unable to inspect- no access
Fire Supply Line
ADA
Approach/Sidewalk Dab_ Inspector ✓ -- Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
,
/� R _—ELECTRICAL PERMIT
CITY OF
I1 T I GA `�D PERMIT EL.C2002-00642
DEVELOPMENT SERVICES PATE ISSUED: 12/17,02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL' 1S135BD-00100
SITE ADDRESS: 09600 SW OAK ST 540 ZONING: C-P
SUBDIVISION: ASHBROOK FARM
LOT : 005 JURISDICTION: TIGBLOCK:
Projact Dos,�ription: Installation of(4)branch circuits.
rRESIDENTIAL UNIT _ TEMP SRVCIFEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGNlOUT LINE LTG:
401 - 600 amp: SIGNAL/PANEL:
LIMITED ENERGY: MINOR LABEL (10):
MANF HMI SVC/FDR: 601+amps 1000 volts
SERVICE/FEEDER BRANCH CIRCUITS _ ADD'L INSPECTIONS
0 200 amp:
W/SERVICE OR FEEDER•. PER INSPECTION:
-
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
EA ADD'L BRNCH CIRC: IN PLANT:
401 - 600 amp: PLAN REVIEW SECTION
601 - 1000 amp: __ >600 VOLT N5M1NAL:�
1000+ amp/volt >=4 RES UNITS:
Roconnect only SVC/FDR—225 AMPS: CLASS AREAISPEC OCC:
` Contractor:
Owner:
ASA PROPERTIES, INC REESE+SONS ELECTRIC
ORT
BY PAUL.DEVILLE PA RHONE
PORTLAND,OR 97236
PO BOX 3110
HONOLULU, HI 96802
Phone: 503-969-2191
Phone: Reg #: LIC 49883
SUP 1691S
_ FEES ELE 26-506C
Description Date_ _ Amount Required Inspections
[ELPRM'I')ELC Pcrmn $fib HO Rough-in
['TAX)80,6 Slatc Tax l21 17,02 $5 ;�' Flect'I Final
Total $72.15
This Permit s issued subject to the regulaoioeds contained. is permithe �gwill expire it work ard Municipa: o senot tsta ate olid withiR. n 1b'lldays of iss issand uance,toreif work is suspended plicable laws. l
work will be done in accordance with app
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by thr,Oregon Utility Notification Center. Those rules are set
forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct quest s to OUNC at(503)24,-6699 or
1-800-332-2344.
Permit Signature:
Issued By:
OWNF_R 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
���.L._cJ�.( .�-- t ' -
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: ----
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
�Datereceived: I,ZI7 p Permitno,:E"(,C'
City Of Tigard Project/appl.no.: Expire date:
City orfTigard Address: 13125 SW(fall Blvd,'figard,OR 97221 Date issued: 13y_*4i
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
t
U I &2 family dwelling or accessory z onunctt:ctl/intlu:incl U Muldi-family cnant improvement
U New construction U Addition/alteration/replacement j t itln•t UPartial
JOB SITE INPORMAtION
Juh address: ry Tax map/tax Iollaccount no.:
Lot: Block: Suhdivision:
Project name: Description and location of work on premises: -- —
Estimated date of com Ilclion/ins ection:
('ON I HU I OR APPLICATION FFE .1-0
Job no: Pee ntax
Business name: �� ic Ileccription_ 0)". (ea.) lotaI no.imp
Ver rtritlenlial cingkormulti faanih lwt
Address: t C drellingunit.Inclmlccatta(IKAgarage.
City: State: Irj ZIP: serllccincluded:
---mail: IU00 sq.ft.or less 4
F'ach additional 500 s+It.or portion thereof
CCB no_: Elec.hus, III:.no: I.Imttrdenergy,residenual 2 _
Cily/n)' ro plc,no,: Limited energy,non-residential 2 _
Fach manufactured home or modular dwelling
;Nam,
quired) plate Service and/or feeder '-
T S Services or feeders-Installation,
l.name(print). License no: ahentlon or relocation:
200 amps or less 2
201 amps to 4W amps 2
ptinl)� 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps_ 2
("jty; Stale: ZIP: _ Over 10(N)amps or volts 2
Phone: Fax: E-mail: Reconnect only I
(honer installation:The installation is being made on property 1 own Iemporaryservic•-erfeeder
which is not intended for sale,lease,rent,of,,=hange according to installation,p%,, a:unnon,nrrelvcaunn:
ORS 447,455,471),670,701. 201 amps of lc-,iX)— -- — - 2
201 amps to 41N1 omps �-- _ 2
Owners si mature; Dale: _.....=401o,600 antic 2
Branch circullc-neN,allrrallon,
or ettension per panel:
Name: _ — A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit -
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee,tint branch circuit: yG k5 `�(r _ 2
Phone: Fa X: E-lilall' Fach additional branch circuit (,
Misc.(Service or feeder not included):
U Service over 225 amps-commercial U Henldi-carr facility
Each pump or irrigation nrelc_ 2
Fach sign or outline lighting 2
Us Scrvi cover 32(lamps-rating oft&2 U Hu�mdous heation g _
familydwellings U Building over 10,oix)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 2
O Building over three stories U Feeders.400 amps or more •Iksn onn
U occupant load over 99 persons U Manufactured structures or RV park tach additional inspection over the allowable In any of the above:
U F".greWlightingplmr U other _----_-_ — l'et inspection
Submit.___sets of plana with any of the above. Investigatinn fee_—_
the above are not applicable to temporary construction service. other _
Pernut fee
Not std Jurisdictions accept cmttl cards,please call jutisthction for more infornmino. Notice: 1 his penny application
U Visa U MasterCud expires if a permit is not obtained Plan review(at _ 96) $
Credit card member: �,__ within 180 days alter it has been State surcharge(8%)....$
Expires accepted as complete. TOTAL .......................$ 2 /
ttarne�r us—own on—c�r�
$
-- Cardholder sipptatlue - — —Amount _ 440.4615 OKIQiCOMI
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below TYPE ed WORK INVOLVED -RESIDENTIAL
-- --- ----
/� Restricted Energy Fee........................................... ......... $75.00
Number of Inspections per permit allowed (FOR ALL.SYSTEMS)
Service included: Items Cost Total I check Type of Work Involved:
Residential-per unit
1000 sq.ft.or less _ $145 15 _ _ 4 U Audio and Stereo Systems'
Each additional 500 sq ft.or
portion thereof $33.40 1 Burglar Alarm
Limited Energy _ $7500
Each Manufd Home or Modular Garage Door Opener'
Dwelling Service or Feeder $9090 2
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less _ $80.30 2 rr�11 Vacuum Systems'
201 amps to 400 amps $106.85 2 l_J
401 amps to 600 amps __ _ $160.60 _ 2
601 amps to 1000 amps $240.60 2 Other
Over 100a amps of volts _ $45465 i 2
Reconnect only _ _ $6685 2
Temporary Services or Feeders e TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each system.............. ......... ............................... . $75.00
200 amps of less $66.85 2 (SEE OAR 918-260-260)
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 1000 volts,
see"b"above. Audio and Stereo Systems
Branch Circuits Boiler Controls
New,alteration or extension per panel
a)1he fee for branch circuits
with purchase of service or C1 Clock systems
feeder fee. _l1
Each branch circuit $6 65 _._.. 2 I__rData Telecommunication Installation
b)The fee for branch circuits
without purchase of service Fire Alarm Installation
or feedor fee.
First branch circuit $4685 _ ❑
Each additional branch circuit $665 ^ HVAC
Miscellaneou- Instrumentation
(Service or feeder not Included)
Each pump or Irrigation circle $5340 —..-- Intercom and Paging Systems
Each sign or outline lighting _ %5340
Signal circuit(s)or a limited energy
panel,alteration or extension $7500 _ Landscape Irrigation Control
Minor Labels(10) $12500
Each additional Inspection over Medical
the allowable In any of the above ❑
Per inspection $62 50 Nurse Calls
Per how $62.50 _
In Plant T $73 75 Outdoor Landscape Lighting'
Fees: Protective Signaling
Enter total of above fees $ -�-___—_ Other
9%State Surcharge $ Number of Systems
25%Plan Review Fee
See"Plan Review"section on $ No licenses are required Licenses are required for all other installations
front of application,
Fees:
Total Balance nue
—�_" -- Enter total of above fens =_
Trust Account# 8%State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i A8ts\roans\etc-fees doc 08/30/01