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10836 SW DOVER COURT .w� 168.b6' E N D` IF ;4: W. NORTH � 7 ui �4T C J 414 L_` c I II i � III iIrn 3 � O5F-c> ONE STOfR40DI Oma! 6� I I� III �-� I �-- - - - -L � � • I ap z IIIIlk I 1 J DRIVE II y Ex.i�tG. Irk/ !l - - - - - - - -- - � - - - - - - - - - - -- - -J - - / – — I -- — — — — — — — — — — — I6'-0.Amkk i43.2�0' • . • . -- — — — — — N 00 111 54' W. 15' PUBLI( 5ANITARY SEWER EA6EMENT SOT 13 51TFLANE � O SCALE: 1- 20- Y N O T LLL PROJECT - ADDITION •Wn •t1 NCTE E.S : OWNER JOHN ETZEL . 10aB& S.U.I. DovEfR CT, 1) LOvATE 4 ✓EF�cIFT' POSITION C.:F ALL UTILITIES, TIGARD, OREGON 91224 SIZE 99d• UyDERGf<?OUND T.4NK5, SPRINKLER SYSTEMS, INDICATES PROPEL~rY LINE — — --- PHONE 503-639-16"18 SEPTIG 5'r&TEr-f F) A DRAIN FIELD5 BEFORE INDICATES Ex15T'G. BLDG. LINE --------- ------ ---- - __ PROJ. ADDRE55 SAME _ SUBDIVISION DOVER LANDING PROCEEDING l,ul ANY EXCAVATION. INDIC'ATE5 NEW BLDG. LINE _— TED FOR NOTIFY 4LL UTILITIES EFFEC: INDICATES NEW ROOF O,L. - -- - - - - - - - - - - - - - - LOCAL REOIJIREMENTS t LOCATES. LOT SIZE 14203 ± 5Q. FT. 2 ! PROVIDE SILT FEN��E IF REQUIRED INDICATES 2'-©• CONTOURS • • • . • ' • • • • • • • . • . • . • • . • FOOTPRINT --- - 24_>1 ( ING. DECK ) 5Q. FT E'.!IST'G 51 TE FOOTPRINT 396� NEU� 3 ) RUN ROOF DRAINS TO APPRQ`✓ED 5�"STEM. TOTAL -- — ''833 SC,;. FT. ( INC. NEW > 4.' CLEAN WATER �-,ERVICE PROVIDER 'RELEASE' LETTER INCLUDED. LOT COVERACsE —__ Ig goy, S 1 COPY-RIC31-IT (C) -2 J02 ED :SPENCER Des lgner NOTICE: IF THE PRINT OR TYPE ON ANY FF-1 I I I I I I I I I ' I I I I I I I I I I � I I I IIIIIII I I I I I I I ( 11 1 1 1 1 1 IIIIIII IIIIIII I l l l l l t I I I � I I I 1 11 1 11 ! III III 1111111 III1 111 I I-I I I C-I 111 I 111 -11 TI 11 11 1 11! Ill 1TI f C f 1111 �1 1 1 1 1 1 1 III III I I I I I I I AllI IMAGE IS NOT AS CLEAR AS THIS NOTICE, IT IS DUE TO THE QUALITY OF THE No.36 c�. m ORIGINAL DOCUMENT E 6Z : EZ Z TZ OZ 6I SI GT ' 9� i sT � T EI ZT iT Yi 6 8 L 8 4 E Z I ��tl��w ILII ILII Ilii�llll�lll'�I�►1 ILII lilt Illi Illi Illi ll111111�H.1.11111 -111 11111111. ILII Illi 1111 ILII ILII ILII ILII ILII ILII +III ILII ill I I I Illl�llll ILII ILII ILII ILII ILII VIII Ilii l 11lllll .11.l 111111(1 llll.11.la.l I 1.LL 1111�1�11 , o cc 0 f � n rt f i r� �I i I 1 I I, 0 7.0836 SW DOVER COURT i CI Y OF T I/ A R D _,_MASTER PERMIT F� PERMIT#: M3-02002-00429 DEVELOPMENT SERVICES DATE ISSUED: 10/22/02 13125 SW Hall Blvd., Tigard, OR 97223 (503)6394171 SITE ADDRESS: 10636 SW DOVER CT PARCEL: 2S115AD-03600 SUBDIVISION: DOVER LANDING ZONING: R-2 BLOCK: LOT: 017 JURISDICTION: I(i REMARKS: 384 square foot addition M existing home. Path 1 _ BUILDINC REISSUE. STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 10 FIRST. "JI ;f BASEMENI sl LEFT. SMOKE DETECTORS: r TYPE OF USE: SF FLOOR LOAD: 40 SECOND. sf GARAGE: sf FRONT: PARKING SPACES: IYPE OF CONST: 5N DWELLING UNITS. FIN'3SMENI si RIGHT: 14 OCCUPANCY GRP: R3 BDHM: BATH: TOTAL: 14VALUE: 25,000.00 / sf REAR: PLUMBING SINKS: WATER CL"SETS. WASHING MACH. LAUNDRY TRAYS. RAIN DRAIN. TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: t CATCH BASINS: TUBISHOWERS. GARBAGF DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: MECHANICAL OTHER FIXTURES: FUEL TYPES TURN<100K: BOIL/CMP�9HP: VENT FANS: CLOTHES DRYER ..RN>000K UNIT HEATERSHOODS: OTHER UNITS. MAX INP: trill FLOOR FURNANCFS VENTS WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS --_ 1000 SF OR LESS: 0 200 amp. 0 - 200 amp: W.!SVC OR FDR: I PUMPIIRRIGATION. PER INSPLCTION: FA ADD'L 500SF: 201 - 400 amp: 201 400 amu'. Isl WIO SVCIFDR. SIGNIOUT LIN LT PE4 40UF. LIMITED ENERGY. 401 - 600 amp: 401 - 600 amp. EA ADDL BR CIR: SIGNALIPANFL: III PLANT: MANU HMISVCIF13R'. 601 - 1000 amp. 601+amps.1000v: MINOR LABEL. 1000-amp/volt: Reconnect only: PLAN REVIEW SECTION —4 RES UNITS: SVCIFDR>�225 A.: >600 V NOMINAL. CLS ARENSPC OCC: ELECTRICAL•RESTRICTED ENERGY A SF RESIDENTIAL - B.COMMERCIAL AUDIO&STEREO VACUUM SYSTEM: AUDIO 6 Sl'EREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT. BURGLAR ALARM OTH: BOILER: HVAC. LANDSCAPPARRIG: PROTECTIVE SIGNL GARAGE OPENER CLOCK: INSTRUMENTATION MEDICAL: OTHR- HVAC. DATA/TELE COMM: NURSE CALLS TOTAL#SYSTEMS: Owner: Contractor: TOTAL FEES: $ 666.19 E fZEL, FRANK JOHN DANIEL L FORNEY This permit Is subject to the regulations contained ill the 10836 , F ANK J CT PO BOX F Tigard Municipal Code,Stale of OR Specialty Codes and 1 1836 S OR 97224 SHERWO18 OR 97140 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 the work is suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Phone Phone 503-625-4975 Oregon Utility Notification Center Those Riles are set forth In OAR 952-001-0010 through 952-0010080 You Reg 0: LIC 79093 may obtain copies of these rules or direct questions to OUNC by caUing(503)2.46-1987 REQUIRED INSPECTIONS Footing Insp Mechanicz.:Insp Shear Wall Insp Electrical Final 1 Foundation Insp Electrical Service Exterior Sheathing Insl Mechanical Final Underfloor insulation Electrical Service Low Voltage Footing/Foundation Dr Elec!rical Rough In Insulation Insp f'InVurldslab Insp . Framing Insp Rain drain Insp 14ued By : L -�1(i JL�L 2 L Permittee Signature Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next iness day , Building Permit Application Date received: /b Permit no.: City of Tigard Project/uppl.no.: Ex ire date: Ciry �fTigard Address: 131:25 SW Pall Blvd,Tigard,OR 97223 Phone: (503) 639-4111 Date issued: Hy• Receiptno.: rax: (503) 598-1960 Case file no.: Payment type: o Land use approi al: - - -� 1&2 family:Simple Complex: N U 1 &2 family dwelling or accessory U Commercial/indusulal U Milli' lanuly U New construction U Demolition U Addition/alteration/replacement U•Tenant improvement U Dire sprinkler/alarm U Other: Joh address: /O F3 v- _ '716. j9LBldg.no.: Suite no.: Lot: Block: Suudivision: Tax map/tax lot/account no.: Project name: - -, Description and location of work on premises/special conditions: Foil Ek 16-7_,W C, ; gol-11 t_� Name: q 1 Mailing address: 0?L3 L%� I & 2 family dwellif �:� City: State: ( 7_IP: Valuation of work.. ,.�?.. :..'.'.:!!!�.... .. $ Z S 00 V - — - - Phone: i2 -/(,/8 IFax: I: mall: No.of be lrooms/baths................................. -- Owner's representative: 'fatal number of floors................................. Phone: Fax: G-Inail: New dwelling area(sq.ft.) ................ ...... Garage/carport area(sq.ft.)............. .......... Nt,me: Covered porch area(sq.R.) ......................... Deck area(sq. ft.) Mailing address: ........................................ -- -- ()(her structure area(s ft.)......................... City: State: ZIP: _ q• -- - Phone: Fax: 1 f mall t trmmerciallindustrial/multi-family: Valuation of wort:.......... ........................ .... �. ----- Existing bldg.area(sq.ft.) ......................... --.-- Business name: DPW I CL L , nal New bldg.area(sq. ft.)................................ Address: P,U cjX _ - State:P>f" ?.IP: � U Number of stories....................................... City: _ Phone• ���� Fax: E-mail: '- Type of construction.................................... CCB no.: --- Occupancy group(s): Existing: New: _ City/metro lic.no.: Notice:All contractc:s and subcontractors arc required to be licensed with the Oregon Construction Contractors Board under "Janne: provisions of ORS 701 and may be required to tx licensed in the Address: - - -- - - - jurisdiction where work is being performed. If the applicant is - - ;- - - exempt from licensing,the following reason applies: City: Stale: LII'. Contact person: Plan no.: — Phone; Fax: - — F-mail - - - - --- � - Name: _ _ Contact person: Fees due upon application ........................... $ Address: Date received: City: State: ZIP: Amount received ......................................... Phone: Fax: E-mail: Please refer to fee schedule. 1 hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards.please call jurisdiction for more irxtn lion. attached checklist. All provisions of Itylvs aqwrftlances governing this O visa o MasterCard work will be complied with, er� c a in or not. credit card number L- � _. s Authorized signatures-- _ Date: ? J Name of cardholder as shown on crrdit cnr Print name:—.��I ��� � Cardholder signature — Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete a.awt,u(fAXWonti One-and Two-l"amily Dwelling Building Permit Application Checklist Reference no.: City(of Tigurd (arty of Tigard Associated permits: - Address: 13125 SW I f ill 111%ti.'I it;int,t)1Z 1)7'2 1 U Electrical U Plumbing O Mechanical Phone: (503) 639-4171 U Other: - Fax: (503) 598 1960 � -- 1I 111"II 1 . t I Land use actions completed.Sec jurisdiction criteria for concurrent reviews. 2 'Zoning.Flood plain,solar balance points,seismic soils designation,historic district,ch.. - - 3 Verification of approved plat/lot. ------ - - 4 Fire district approval required. _ 5 Septic system permit or authorization for remoter. Existing system capacity 6 Sewer permit. -- 7 Water district approval. 8 Soils report.Must carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U permit required. Include drainage-way protection,silt fence design and location o-1- catch-hasin protection,etc. 10 J Complete sets of legible plans.Must he drawn to scale,showing conformance to applic thlc local and state building codes. Lateral design details and connections must he incorporated into the plans or on a separate full-siir V sheet attached to the plans with cross references between plan location and details. Plan review ctmnot he completed it copyright violations exist. I I ,tike/plot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(if — there is mot than a 4-I1.elevation differential,plan must show contour lines at 2-ft.intervals);Ior:ation of easements and ✓ driveway;footprint of structure(including;decks);location of wells/septic systems;utility locations;dircctio^` idicator;lot area;building coverage area;percentage ofcoverage;impervious area;existirp structures on site;and surface drahrage. 12 Foundation plan.Show dimensions,anchor bolls,any hold-downs and reinforcing pads,connection details,vent sire and location. 3 Floor pans.Show all dimensions,room identification,window sire,location of smoke detectors.water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-membLi-sizes and spacing such as floor lmams,headers,joists,sub-floor, wall construction,roof constriction.More than one cross section may he required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and fiiundation,stairs, fireplace construction, tftermal insulation,etc. 15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. _ ?xieriur elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showiag foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for non-prescriptive path analysis provide specif-alions and calculations to engineering standards. 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing _— locations.Show attic ventilation. 18 Basement and retaining walls.Provide crosF 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 b am/joist carrying a non uniform load. 20 Manufactured floor/roof truss design details. -- 21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more appliances. .c.,shear wall,roof truss)shall he stamped by an engineer or 22 Engineer's calculations.When required or provided,(i architect licensed in Oregon and shall be shown to he applicahle to the project under review. 23 Five(5)site plans are required for Item I I above. Site plans must he 8-1/2"x 11"or I I"x 17". 24 Two(2)sets each are;equired for Items 16, 19,20&22 above 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not .icceptcd. 26 "Reversed" building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale.. 28 Site plan to include tree site,type&location per approvsd project street tree plan(if applicable),and COT Street Tree List. Checklist must he completed before plan review start date. Minor changes or rotes on submitted plans may ho in blue or black ink. Red ink is reserved lirr departmen, use only. 440 4614(WW0,1.1) Mechanical Permit Application and Date received: Perm�datc: no.:of Ti nExpire ('in of/;r(nd Address: 13125 SW Itall blvd,"I"i)aud,()k );2?1 —_ Phone: (503) 639-4171 Date issued: By 12eceipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: — Building permit no.: U 1 &2 family dwelling or accessory U Con)mercial/industrial U Multi-family LJ Tenant improvement U New construction U Addition/alteration/replacement U Other: COMMERCIAL-JOB SITE I NFORMATION 0SCIIIEDULE Job address: 7 C:' Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite no.; value of all mechanical materials,equipment,labor,overhead, fax map/tax lot/account no.: profit. Value$ _ Lot: Block: Subdivision: - *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City/county: ZIP: Description and location of work on premises: ' I - Fee(ea.► hotel Est.date of completion/inspection: Dewription (Ay. Res.only Res.only Tenant improvement of change of use: Is existing space heated or conditioned?U Yes U No Air handling unit — —_CFM Air conditioning(site plan req tired) Is existing space insulated?U Yes Cl No 11 Alteration o existing system 3oi er compressors -- - Business name: � State boiler permit no.: C.' HP __Tons DTU/H Address: �p tl e . Firelsmokedampers/duct smo a electors City: ar X072 Stale: elLI ZIP: eP711Y,0 -Heat pump(site plan require ) - Phone: Fax: E-mail:_ nsta repacefurnac umer / ___ Including ductwork/vent liner U Yes U No CCB no.: /OA 83/ nsta Vreplacc re ocateeasels—suspen c , -- City/metro lic.no.: Y_ _wall,or floor mounted Namc(please prinU Vent for ippliance other tion furnace CONTACT PERSON. Ref geral on: Absorption units 13TU/11 Name: Chillers IJp Addie,: CompressorsEnvironmental exhaust and vent at nn: City: State: ZIP: Appliance vent Phone: Prix: E-mail: I Dryerex ausTi stt— --- Hoods,Type /Hires. itc hers/ azmat hood fire suppression system Name: Exhaust fan with single duct(hath fans) Mailing address: Exhaust system apart from heating or AC - City: — State: ZIP: Fuelpiping andistribution(up to outlets) - — — — Type: L1'G NG Oil Phone: Fax: E-mail :uel piping each additional over outer ---- Process piping(schematicrequire ) _ Number of outlets r Name: -— - Other sl spp once or trqu pment: Address: _ Decorative fireplace r'ty: State ._ ZIP: Insert-type ►'none: E. c stov pc elf t stove _Applicant's signatt �_ ( Date: ce 70'' Other: -- Name(print): M &T Z-C — Not W Jurisdictions accrpt ctedit cards,please call jurisdiction for rtxxr Infonr,ation Permit fee.....................$ U Visa U MasterCard Notice:This permit application Minimum fee................$ expires if a p,rmit is not obtained (•redo card numb": -- LL Plan review(at .— 96) $ _ expires within 180 da.s after it has been State surcharge(8%)....$ Name of carttiolder as shown on credit card accepted as cot plete. --- - — $ TOTAL .......................$ cardholder dsnatare Amoonr -- — 440-4617((>rnfVC'OM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE _ Description: Pace Total $1.00 to$5,000.00 Minimum fee$t 1.50 Table 1A Mechanical Code Oty (Ea) Amt $57001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Fumace to 100,000 BTU $1.52 for each additional$100.00 or including ducts&vents 1400 fraction thereof,to and including 2) Furnace 100,000 BTU+ _ $10,000.00. includingducts&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 fraction thereof,to and Including 4) Suspended heater,wall heater $25,000.00. or floor mounted heater 14 00 $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 6.00 fraction thereof,to and Including 6) Ranair units $50000'00. 1215 $50,001.00 and up $742.00for the first$50,000.00 and ChRck all that apply. Boiler Heat Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond - fraction thereof. footnotes below. Conip •• Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit to 100K BTU 14.00 State Surcharge a 8•/. 8)3-15 HP;absorb unit 100k to 500k BTU 25.60 25%Plan Review Fee(of subtotal) $ g)15-310 HP: ab orn 35.00 Required for ALL commercial permits only TOTAL COMMERCIAL PERMIT FEE: $ 10)30il absorb unit 1-11.7.7 5 mil BTU _ _ 62.20 _--- --.._--------- _-- 11)>50HP;absorb unit>1.75 mil BTU 87.20 ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM - 10.00 _ Value Total 13)Air handling unit 10,000 CFM+ Descri tion: Qt Ea Amount 17.20 Furnace to 100,000 BTU,including 955 11N Non-portable evaporate cooler ducts&vents 1000 Furnace>100,000 BTU Including 1,170 15)Ven:fan connected to a single duct ducts&vents 6.80 Floor furnace including vent 955 - Suspended heater,wall Neater or 955 16)Ventilationsystem not included in floor mounted heater appliance ance permit 10.00 Vent not Included in appliance 445 17)Hood served by mechanical exhaust ermit 10.00 Repair units 805 18)Domestic Incinerators 17.40 <3 hp;absorb unit, 955 to 100k BTU 19)Commercial or Industrial type Incinerator 3-15 hp;absorb.unit, 1,700 69.95 101k to 500k BTU 20)Other units,including wood stoves 15-30 hp;absorb.unit,501k to 1 2,310 10.00 mil.BTU 21)Gas piping one to four outlets 5.40 30-50 hp;absorb.unit, 3,400 1-1.75 mil.BTU 22)More than 4-per outlet(each) __ 1.00 >50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: >1.75 mil.BTU $ Air handling unit to 10,000 cfm 656 - - --- - Air handlingunit>10,000 cfm 1,170 6•/.State Surcharge $ Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct 446 Vent system not.ncluded in 656 appliance permit Hood served by mechanical exhaust 656 Other Inspections and Feee: Domestic incinerator 1 170 t Inspections outside of normal business hours(minimum charge-two hours) $62 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 $62 50 per hour Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plans(minimum Gag piping 1-4 Outlets 360 charge-one-half hour)$62 50 per hour Each additional outlet 63 -- - 'State Contractor Boiler Certification required fcr units>200k BTU. TOTAL COMMERCIAL a "Residential A/C requires site plan showing placement of unit 1 Ii VALUA i!ON: All New Commercial Buildings require 2 sets of plans i lAdstslforms�-nech-fees.doc 02/'11/02 Electrical Permit Application "Datercceived: p 4 4 �Permito.: City of Tigard Project/appl.no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receiptno.: Phone: (503) 639-4171 -- Fax: (503) 598-1960 Case rile no.: Payment type: Land use approval: _ U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family CI Tenant improvement U New construction U Add ition/alteration/repiace tile nt U Other: U I'artial Job address: 47 eei 3 SCJ t1Er Bldg. nu.: 1 Suite no.: Tax map/tax lot/account no.: Lot: Block: Subdivision: Project name: _ Description and location of work on premises, Estimated date of completion/inspection: APPLICATIONON I IIA( I Olt Job no: Fee Mat Business name: Description Qty. (en.) Tolal no.insp ---- - New residential-single or mulls-family per Address: dwelling mist.Includes allaclxrl garage. City: _ State: ZIP: _ Serviceincluded: Phone: I E-mail: 1000 sq.ft.or less 4 CCB no.: Elcc.bus.lie.no: Each additional 500 sq.ft.or portion thereof --- Limited energy,residential 2 City/metrolic.no.: __ Limited energy,non-residential Each manufactured home or modular dwelling — Signature of supervising electrician(required) Date Service and/or feeder _ 2 Sup.elect.name(print): License no: Services or feeders-installation, ■Iteration or relocation: 2(x1 amps or less 2 _Name(print): 201 amps to 41x1 amps — - 2 401 amps to 600 amps 2 Mailing address: t� ,--) — / 601 amps to IWO amps - 2 — City: Stater ZIP: 7 LL Over I OW amps or volts 2 Phone: Fax: I E-mail: Reconnect only — I Owner installation:The installation is being made on property I own Temporary services or feeders- which is nol intended for sale,lease, a clunge according to Installation,alteration,or relocation: URS 447,455,479 90 2(x)amps or less N L— 2 201 amps to 4(x)amps _ 2 Owner's si nature: te: c T 401 In 600 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 2 City: State. ZIP: H. Fee for branch circuits without purchase / _ of service or feeder fee,first branch circuit: 2 Phone: I'ax: F-mail- F.achadditional branch circuit: Misc.(Service or feeder not Included): U Service over 225 amps-commercial U Health euefacility Each pump or irrigation circle U Service over 320 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2 familydwellings U Building over ROW square feet four or Signal circuit(s)oralimited energspauel. —� USysteraover 600volts nominal more residential units in one structure alteration,or extension' U Building over three stories U Feeders.400 amps or more •14scnpuon. U Occupant load over 99 persons U Manufactured structures or RV park FAch additional inspection over the allowable In any of the above: U Egress/lighting plan U Other: — Per inspection Submit sets of plans with any of the above. Investigation fee lie above are not applicable to temporary construction service_ other ---- Not all jurisdictions accept credit cards,please call Jurisdiction for morn infomratiau. Notice:This permit application Permit fee.....................$ U visa U Mastercard expires if a permit is not obtained Plan review(at _ %) $ __ E Credit card number L / within 180 days after it has been Slate surcharge(8%) ....$ Expires accepted as complete. TOTAL .......................$ Now of cardiolder as shown on credit card Cardholder signature Am unt 4404613(60WOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Qelor.�: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY LY _ p - Restricted Energy Fee.... —� .................................................. $75.00 Number of Inspection r r permit allowed (FOR ALL SYSTEMS) Service included: Items Cost To$ Check Type of Work Involved: Residential-per unit 1000 sq it or less $145 1 --_ 4 Audio and Stereo Systems" Each additional 500 sq it or portion thereof $33,40 1 l f 1 Burglar Alarm Limited Energy $75.00 LJ Each Manufd Home or Modular ❑ Dwelling Service or Feeder _ $90.90 -- 2 Garage Door Opel 3r' Services or Feeders Heating,Ventilation and Air Conditioning System" Installation,alteration,or relocation 200 amps or less $80.30 _ 2 201 amps to 400 amps — $106.85 2 L_J Vacuum Systems' 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 Other — ------------------- — Over 1000 amps or volts $454.65 _J— Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installe"on,alteration,or relocation Fee for each system.......................................................... $75.00 200 1 trips or 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 New,alteration or extension per panel ❑ Boiler Controls a)The fee for branch circuits with purchase of service or CJ Clock Systems feeder fee. Each branch circuit $6 65 2 Data'(tlerommunication Installation bl The fee for branch circuits without purchase of service ❑ Fire Alarm Installation or feeder fee. First branch Circuit $46 85 _! _ Each additional branch circuit $6.6.5 L— HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle _ $53 40 r- 1 Each sign or outline lighting $53 40 _ LJ intercom and Paging Systems Signal circuits)or a limited energy panel alteration or extension $75 00 Landscape Irrigation Control' Minor Labels(10) $12500 Each additional Inspection over [j Medical the allowable In any of the above rI Per Inspection $62.50 E] Nurse Calls Per hour _ _ $6250 _ In Plant $73.75 _—_ Outdoor Landscape Lighting' Fees: Protective Signaling Enter total of above fees $ F_ Other 8%State Surcharge $ __— T —__,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 anptication _ --— -- ---- Fees: Total Balance Due $ -- Enter total of above fees $— ❑ Trust Account# 8%State Surcharge S _ Total Balance Due s All New Commercial Buildings require 2 sets of plans. i)dsts\torms\elc-fees.doc OF130/01 i'ermit #: ssued by: _ Date: to Statement: Information Notice to Property owners About Construction Responsibilities Note: Oregon Lute. ORS -01.W5(4), requires residenlicul ronso uclion permit uppli- runls trho ore not registered with the ('onslruc•tion ('ontrurrors Arwrcl to sign the /r�!/During crurrment heJitrc�a h;rildin�,permit run he issttcc/. This.slulcrtuenl is required /or residential building, electric(!, ►nerhunirul, uncl plumbing permits. Licensed cn•c•hilerl unci engineer upplicunts, exempt Jrottt regi.strution under ORS -0/.011)(7), need not suhntit this slulement. This slatentent it-it/ he/ilecl with the permit. Fill in the appropriate blanks and initial boxes 1 and 2,and either box 3A or 311: ® 1. i own, reside in, or will reside in the completed structure. ® 2. 1 understand that I must register as a construction contractor ifthe structure is sold or ot►crcd i'or sale before or upon completion. -- 3A. My general contractor is D_A_(_l&t�--L_ (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors hoard. OR 3R. I will be my own general contractor. If l hire subcontractors. I stiill hire only subcontractors registered ssith the Construction Contractors Board. if i change my mind and hire a general contractor. I will contract with a contractor ssho is registered with the CCR and a ill inintediateIN,notify the office iss-ing this building Kermit ofthe name of the contractor. 1 hereby certify that the abm a informationovorrc^t. that i has c read and dig understand the Infer ration Notice to Proper (h^reofpermitapp cspccn. 'hiditivs on the reverse side of this form. ( ) (Date) t i11die copyto issuing agenr•t•pe►vuii lilt-. pink ropy to applivinit) Information Notice to Property Owners About Construction Responsibilities 1olt ihIh hl/w mo"tt;l/ -" f,loi -' l/) 7'rvj 1 �.V l);II tl I'S .1hUI ( r,mkirticliw, It'e.sponsib litivs 11171l eki- •lopcd 1+l•litt• e,(w,:trrwrI; 1l( worm tory BOM'd illlucrortktnct, ►r;lh ORS 701.05 i,,5J. �! -II rt, I 11!1;' :1. ' -1111 11Wlr':II 11 1 t(l coll"ll"Illl it nClt hoillt III 11 mild.,it mlbstiintlal lrnpim ellivill lo an exisli g s1rllcttlrc, A 111all.') illI, h'. Ili`, Uic ln 1't'S�l(411511]��llll`51I�11hA1'tlaSt?f vv1lCertl. �- EMPLOYER RESPONSIBILITIES: 1,1111 flet vI1. II�J�II��II I Illll,l,.lol , Boilld 1�, do Lil!r+t Ili "011.,tlll'-tlll6 Vry�E ssistlrl" Irl (fie t i111.I'.�I. a. I ,. .nlprt�\t°nlcul ra iI It>idcnti.11 ;huct+lrc. \oll\\ill. in illo"t irralull't:,,I)c ruled to Ile;In rml/River;Incl the I,et•I+Ir Ni-ll 1111'. Ill I,,,C1111,11+\(•c. Vi!►It'cnII)II I•.el \;SII 111411,1 k�r+Mill\ \`.1111 Illy 1011,\\\ilw Ora°I;t{n's,tithhttldinrlarfa,� .'..ulcrnl�lt�\cr.\oIlnlu;tt\ithh 'Id i,lcotnet;ixe.Ilumellnftlmee,rnttc�atthetinteetnpl;l, sue paid i im i,%ill lit, irihic It r tilt' i l\ pavmcnt�ever) ifv(,n do)) actmiily\killdiold the it,% frorn Nowernpin\t-cs. Forlllhre nlftutnalihtt.call Ilic( Ircgon f)opt nl Rve.vnul:is 9=1i-80411 1 i►etnplovnient insurance lar: v,an empimer. \oil are required to pa\ a tax h il.uncntnlovinrnt In•,nrance purpnwe oll tilt, \aRe,,t,fallcnlphl\ecs. I-orinoreinfilhttltrtioi-I4call file oregmi hnplowvnt Ikpaluilvntat %8 .ii„1, Workers'compensation insurance: As;Ill �,ou ilre StlVjCC1.11'lliC Olt;l_t+ll `Voll,t.l:} ( olllpel!"iltio11 1.;!\\ ;lild 1111ltit ,'bttm\t,{Ikers'l'Ulrlpcns;ltlt,11ill uraticc for u,tii -Inplo*.ces. It\oIlfalltoobtainlwrkcr,•colllpew,atiolliII,111amc ''011In.IN' he suhlect to Ilellall ie•s dI)(j w ill be l ialdcc ft,r all Llan;t.nsts I killc ul\rug enlpl'.,\et,`,Is tn)ured oll tilt joht I or nlorc 111h.111i'li t,ul. all til_ G,rilrl\rrs'('.IrnEt(nSFlti(nl i)i\I;fnti :it the 17t.I11arI Incnt Iii'(oit"untc1,111(1 l tl l Ink's'j 'O"k it t ,"it!hI�-'4�5. 1 1'.S.Internal RevenueSert,ice: As lilt elllplo\t.I,doll lntl,t\N 4111101d fCdL%II hlc11111t„ulx hoill liable for the tax pa\tricrtt even it tits nll the Ihtertla'I Itt+`^t nut tit'I\iee tt I-?t+7n�R�U•1(1,111. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: ( otle(onlpliancc: As theperlrlitholdcrlot tbi;prl,ject,ctrl;Ircrr:ptrn;ihlrfrrrc;t,l\intiarn failuretunlectctxicrcgnircnlrnts that iim, 1),litought ISI pur attention thrt m.0i in',pectitm� Liability .11141 I,rupvrf� damage i1suralive: l oillact\,+nr insurance a'ount ti•serif\Otl h;I\r adeti(liltc nt,urancc rtn _rage for tccldents aii,l +nil,;!uns uch its tdllijig tool,, paint n\erspra),v\ater tlama"e. I(unl pipe punctures.tire,ur\\vrk.that must he rr dnne inre to tiuperr ise(`ntplovccc: \I,tl.l' ,Ilrr\Ilu h;t\r suf ticienl tinge !;• .:,; ,n t \(lilt CIII ,vecs. I',\IH'r'tl�l" \,I �l,' .Ilri'\ ,11! ,II, , r t„ I t-\ ��;+ ,.�,�.,!r, n� r,11, '�Ittr;atayt\r,tl�('til,t'dlllltett�1C11orkofrt,ll'�h-Ilt;'t1d11111511 ll"I'1.�. .�. I � r,i. I„il t...., �..It;. i•il :1! li?:' "1'. I•I'tlfc,I;,tl'•,..r,t1!( ,, , .Itt 1t@t�l'lt'ttt fill tec�ll:�e�d insptrtlr+tl� - , If\oil hale additional questions. \\rite or call the( u11siructit'll( imtractors Board t 11011ox 14 140, Salem.OR 97,00-itli'. q)1 .� �_ ';, , , i 1, (' ;I is located at %1111 Sumnlcr tit. \F wile :3(14). in �alcnl. I U.1 nr/ CleanWater Services ( hir commitment is c1cor June 21, 2002 Ed Spencer 40'2(3 NE Sandy Blvd. #3 Portland, OR 97212 RE: Addition to single family residence located at 10836 SW Dover Ct., Tigard, OR ) CWS file 2010 (Tax map 2S115AD, Tax lot 03600) Clean Water Services has received your Sensitive Areas Certification Form for the above referenced site. Staff has reviewed the Sensitive Areas Certification Form, site conditions, and the description of your project (see enclosed site plan) and concurs that the above referenced project will not significantly impact the existing sensitive areas found near the site. In light of this result, this document will serve as your Service Provider letter as required by Resolution and Order 00- 7, Section 3.02.1, and your Stormwater Connection authorization from Clean Water Services as requires' by Ordinance 27, Section 4.B. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. This letter does NOT eliminate the need to protect sensitive areas if they are subsequently identified on your site. If you have any questions, please feel free to call me at 503-846-3553. Sincerely, A� Chuck Buckallew Environmental Plan Review Enclosure E.De%elopment Svcs'SP 00-'Toncurrenre LettersQS 115AD03600-no impact to water quality.doc 155 N First Avenue, Suite 270• Hillsboro, Oregon 97124 Phone:(503)8468621 •Fax:(503)846-3525•www.rleanwaterservires.orq z C Z � C r _ olp 1 FF "O-T♦ y r f U F I i I I r t I ryt^ I ® c rT z I z C t i LOT I t 6 I 1 � I � � 1 1 I G SEE 35MM* ROLL# 22 FOR LARGE DOCUMENT CITY OF TIGARD 24-4our �7 BUILDING Inspection Line: (503)639-4175 MST 2—Z)0 INSPECTION DIVISION Business Line: (503) 639-4171 q BLIP Received .__-__—_ Date Requested _ 1 ___ AM—_.__—_ PM ._—__— BUP Location _ g ��� ���'1l-�_ JSuite MEC Contact Person --------_.-...-___�_�� � �z 'h(- ) 5W-9- PLM Ph ! ) - g- to -7 5;�/- SWR — II_DWG Tenant/Owner _ —___ —. ___—_ ELC ---- Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post& Beam Shear Anchors Fxt Sheath/Shear int he th/Shear ns a n Drywall Nailing -- ---- -- - -- - - Firewall Fire Sprinkler -- -------- -- - - ------- -- .._.-_ - -- -- ---- -- . .. . . Fire Alarm Susp'd Ceiling Roof Other: -- -- ---- - — ----- Fina A PART FAIL _ - ---- __-- --- ----- ------ ___ _ INa -- - - - - --- - --- - - - ---- - Pc,s!&Beam Under Slab - -- ------ Rough-In Water Service -- - ---- - -- --- — — Sanitary Sewer Rain Drains --- -- --- --- -- -- Catch Basin/Manhole Storm Drain -- Shower Pan Other ------ -------- Final PISS PART FAIL Hough,i -------.. Gas Line Smoke Dampers FAIL --- -- - 'TRICA s Rough-In UG/Slab I_ow Voltage Fire Alarm -in PART FAIL Reinspection fee of$ —__ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Please call for reinspection RE:— —�—� L'nable to inspect-no access Fire Supply Line _ ADA �,, Approach/Sidewalk Date _I�_Z Inspector _— r �j _ 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 _ Date / uested �/3��- AM--- PM _ l3UP Lo.;ation -�_ �1t-e ---s.�S�--Suite --- - ------- M E=C Contac Person -_ �- Ph _ ( ) - PLM ---------------- --- Contractor_ _ ph(_-_) SWR rBUILDING - Tenant/Owner - _�_-- _ ELC - -- ---- - -- Fouting --- ----- - - Foupidation Access: ELG -_ Fig Drain Crawl Dain ELR Slab Inspection Notes: SIT Post& Beam -- -—- Shear Anchors Ext Sheath/Shear Int Sheath/Shear --- Framing �� iL��p. r�.� ' - L Li,.�4 L. -- Insulation � Drywall Nailing 24Z_Z=c'-V2> "" Firevrall -- Fire Sprinkler Fire Alarm - Susp'd Coiling -- — Rool Other: --- - — inal - - _ SS PA 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 Pest 8 Beam Rough-in - Gas Line — Smoke Dampers - - - -_-- PASS PART FAIL - - - - — -------- --- -- ELECTRICAL Service Rough-in UG/Slab -- Low Voltage Fire Alarm - -�--- - - -- �� Reinspection feq of$- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SITE Please call for reinspection RE:_-__ --- - L _1 Ext Unahle to inspect- no access Fire Supply Line ADA Approach/Sidewalk Date - " �" _3 Inspector -- —_-- Other: _ __ Final - -� DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Businese; Line: 639-4171 MST BLIP _ Date Requested _—AM---PM BLD Location ��/ flu � L/� f��� / 'r �'� _ Suite —. MEC Contact Person Ph PLM Cootractor _1 ��,/� �: .''�1' - Ph ,�`/ "G" . S ' e / SWR BILDING Tenpt/ ner J Z37ELC Retaining Wal / ELR Footing e Foundation FNO NOT REQUESTED 1 b rc�r c(n t. L FPS _ Fig Drain Crawl Drain FOUND DURING RESEARCW �c� SGN + Slab INSPECTION(S) IN FILE SIT Post& Beam Ext Sheath/Shear Int Sheath/Shear - Framing Insulation -�_-��/ -------,. _-� ---- _ ----�_----- Drywall Nailing Firewall Fire Sprinkler Fire Alarm --_- Susp'd Ceiling —-------------------- Roof Misc:_ Final PASS PART FAIL -- - ___.�3��j.L - -- --------- -------- PLUMBING (Post & Beam - - __-_ -.__—�- ---- ----_ ---------- Und,3r Slab Top Out - - - — - -- -- - --- - -- Witer Service; Sanitary Sewer --- Rain Drains Final -- -- -_. PASS PART FAIL. MECHANICAL - Post&Beam ----- ---- -- Rough In — Gas Line Smoke Dampers — Final - - ---- --- - ----- ---- PA S PART :A& ELECTRICAL - Service Rough in - ----- UG/Slab Low Voltage -- — - — Fire Alarm AS3 _ ART FAIL Backfill/Grading -- - - -- ----- ---__ Sanitary Sewer Oform Drain [ J Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Plvd Catch Basin Fire Supriy Line ( ]Please call for reinspection RE: --__ _ [ ]Unable to inspect no access ADA Approach/Sidewalk Date —f /,�- Other InspQctor •mac,-�c '�� _Ext Final —` ,_PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES R-RMIT #: ELC.:97--039,= 13125 SW Hall Blvd., l7gard,OR 97223 (503)639.4171 DATE ISSI_IED: 06/19/97 PARCEL: 2S115AD-031600 SITE ADDRESS. . . : 10B36 13W DOVER CT SUBDIVISION. . . . :DOVER I_P.NDING ZONING:R-2 BLOCK 1-01.. . . . . . . . . . . . . . 17 JURlSDICTIl1N: TIG F=aro j ect Descr•i pt i on : On, branch circuit. Etzel JOB 01018 --RESIDENTIAL UNIT---- ----TEMP SRVs/FE.F_DERS--•- 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . 0 c.ACH ADD' L 500SF. . . : 0 201 - 400 amp. . . . . . . : 0 .JTGN/OUT LINE L"l-G. . : 0 LIMITED ENERGY. . . . . : 0 401. - 600 amp. . . . . . . : 0 SIGNAL./PANEL. . . . . . . : 0 MFINF. HM/ SVC/FUR. . : 0 6011-amps--1000 volts. : 0 MINOR I-ALVEI._ ( ID) . . . : 0 _.. .._.._SE.RVICE/FEEDER------ __-___._.BRANCH CIRCUITS—..-.-.._... -.---r.IDD' L INSPECTIONS--- 0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 F1E7R INSPECTION. . . . . : 0 c'01 - 400 amp. . . . . . . 0 1st W/O SRVC OR FDR. . 1. '-'ER HCJR. . . . . . . . . . . . 0 401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PL..ANT. . . . . . . , . . . ; 0 601 - 1000 amp. . . . . : 0 ---.___.__________-.--F�l_AN REVIEW SECTION------------------ 1000+ amp/volt. . . . . : 0 ) -=4 RES UNITS. . . . . . . . : > 600 VOLT NOhIINnL. . : Reconnect only. . . . . : 0 SVC/FDR > = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner,: ----.______...__------------__.._.____._ _____._..___.__----•--------__-__ FEES JOHN ETZEL type aniol_int by date recpt 10836 �-., DOVER CT PRMT $ 35. 00 JSD 06/ 19/97 9_1-296223 TfCARD OR 97224 5PCT $ 1 . 75 JSD 06/19/97 97-296223 Phone #: 639-1678 Contractor: NW ELECTRICAL_ SPECIALTIES $ 36. 75 TOTAL. ROYAL. EDWARD STEARNS II GIF, SE 69TH CT ------- REDUIRED INSPECTIONS ----- HILL.SBORO OR 971=:.3 Roragh-i.n I I I b it e #: 848 -86711 E 1 e c-t' 1 Final Peg #. . : 001213 This permit is issued subject tj the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other applicable laws. All war;( will be done in accordance with approved plans. This per:,t will expire if work is not started within 180 days of issuance, or if work is suspended for sore than 180 days. ATTENTION: Oregon lai requires you t, follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95c'-0P1 0018 through OAR 952-001-1987. You say obtain a copy of these rules or direct questions to OLK b; �,aW ing (1.'#3)246-'987. - S i g it a t i_iy*g; I s s ra e d R -.-C)WNER INSTALLATION The installation iii being made on pr•opet-ty I own whit:_n is not. i.ntended for e..le, lease, or- rent. OWNER' S SIGNATL.IRE: DATE=: I. ONTRACTUR INSTALLATION ON[ SIGNATURE OF SUPR. ELEC' N- DATE: LICENSE NO: 4 4-++4+i++•+-i++-1-++++++++++++4+++++++++++-+++-F+++++-F++++-4+++++++++-f-4............... Call 639-4175 by 6:00 p. m. for• an inspection needed the next hr_rsirips s day -1 + F4-+++-1-++7++++++++++++++++.+++ 1• r+++++++++4-4+4-++4++++++++++++ F++++4..++++4++++++ CITY OF TIGARD Electrical Permit Application Plat)C;."1% 13125 SW HALL BLVD. Recdby TIGARD OR 97223 Date Recd C '� / / _ Pilose (505)639-4171, x304 Date to P.E. ST Inspection (503) 839-4175 Print or Type Date to D Incomplete or illegible will not be accepted Permit# l -c�3 i Fax (503) 694-7297 Called_ 1. Job Address: 4. Complete Fee Schedule Below: Name of Development N,mber of Inspections per permit allowed Name(or name of business) 1 a, Service Included: Items Cost Sum Address I l - �J � 4a. Residential-per unit [ City/Stats,'Zlp_ , ( ('� 1- L 1000 sq.n.or less $110.00 _ �- -1 C 1 � _ ach additional 500 sq.ft.or Commercial Residential portion thereof - $25,0-, Limited Fnergy $25,00 Each Manufd Home or Modular - Dwelling Service or Feeder $68.00 2 2a. Contractor installation only: -- (Attach copy of all current licenses) 4b.Services r-:^eeders Electrical Contractor NLV t.IFI-ff, ill rn ` L?L,a Q� l nq Installation,alteration,or relocation Address i CJ ` F- ,-,CI4h CA ' 200 amps or less $60.00 2 amity�l- 1`- �rL _State U C - 201 amps to 400 amps - $80.00 7 -Zip �. _.- 401 amps to 600 amps $120.00 _ p Phone No, Pj IO �lqtk 801 amps to 1000 amps $180.00 ? Job No. 1 P,I j Over 1000 amps or volts $340.00 - 2 neconnect only $50.00 2 Elec. Cont. Lice. No. -2fl- (SQ!X Exp.Date t d1ri OR State CCB Reg, No. ExpDgte_ 3 LO rlt? 4c.Temporary Services or Feeders COT Business Tax or Metro No. Exp.Date installation,alteration,or relocation 200 ampc or less $50.00 2 Signature of Supr. Elec'n_�i� 201 amps to 4U0 amps $75.00 401 amps to 600 amps $10000 _ 2 y 7 5` �C �O Over 600 amps to 1000 volts, License No Exp.Date r 9a, _ see"b"above. Phone No.- - - �--�s 3 1!:, 4d.Branch circuits New,alteration or extension per panel 2b. For owner installations: al The It for branch circuits with Purchase of service or Print Owner's Name feeder fee. Address f ach branch circuit $5.00 -- Citi State Zip h) 1 tie fee for branch circuits without purchase of Phone No. service or feeder fee. I first branch circuit ill $35.00 �,T 2 The installation is being made on property I own which is not f ach additional branch circuit- $5.00 _.. 2 intended for sale, lease or rent. 4e.Miscellaneous (Service.r feeder not included) Owner's Sig�atureEach pump or irrigation circle $40.00 Each sign or outline lighting $40.00 2 3. Plan Review section (if required):' Signal circuit(s)or a limited energy panel,alteration or extension - $40,00 Please check appropriate item and enter fee in section 5191Minor Labels(10) $100.00. --- -_W 4 or more residential units in one structure M.Each additional Inspection over Service and feeder 225 amps or more the allowable in any of the above --.System over 600 volts nominal Per inspection $35.00 _ Classified area or structure containing special occupancy Per hour - $55.00 - as described in N.E.C.Chdpter 5 In Plant $55.00 Submit 2 sets of plans with applicaucn where any of the above apply. 5. Fees: fir. � Not required for temporary construction services. Sa.Enter total of alwve fens $ x. 5%Surcharge(.05 X total fees) $ NOTICE subtotal $ 5b.Enter 25%of line So kr PERMITS BECOME VC'D IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if reaulr�'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 CCMMENCED. CJ Trust Account M Total balance.nue $ L\11STSTLC96.APP Rev W96 CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST BLIP —__ Date Requested_ —AM_ PM — BLD ` Location Suite n - ---- MEC Contact Person Ph _ PLM Contractor — r�'��Ct��/ Ph ��' LSWIR .— SCJILDING —i Tenant/Owner _ ELC Retaining Wall — ELR Footing Acci -- Foundation NOT REQUESTED FPS Fig Drain Ins FOUND DURING RESEARCH Crawl Drain SGN _ Slab NO INSPECTION(S) IN FILE Post S Beam SIT - Ext Sheath/Shear Int Sheath/Shear '~ F,a. Ing Insulation ---- -- _--__--- _-.-- -- - -- Drywall Nailing -� —------- T-_ Firewall Fire Sprinkler ---- --- .`---_-__--. __-- - -- - -- ------------------ --- Fire Alarm ------ Susp'd Ceiling Roof -- Misc: - ----- - - Final -- PASS PART FAIL - --------- --- - --- - - - --- PLUMBING Post&Beam -- - -- ._._-----_ Under Slab Top Out Water Service Sanitary Sewer - ---- - ----- - ----- -- Rain Drains Final -- PASS PART FAIL MECHANICAL .____------------ -------- _--------- -- Post 3eant I __-- ff�ough In Gas Line - Smoke Dampers nal' - - r+aS PART FAIL L CTRICAL I _- - - Service - Rough In W:/Slab ow Voltage Fire Alarm Final --- - - -- ---- -- -------------- - PASS PART FAILSITE Backfill/Grading - -- -- Sanitary Sewer - Storm Drain ( ] Reinspertion fee of$ _ required before next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( )Please call for reinspection RE -_- -- ( )Unable to inspect-no access ADA Approach/Sidewalk Other [)ate _ — � - - -_ _ Inspector 1�' .�.� - Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. Y CITY OF TIGARD MECHANICAL. DEVELOPMENT SERVICES PERMIT 131. PERMIT #. . . . . . . : MEC97-0154 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 05/28/97 PARCEL: 2:S115AD-03600 SITE ADDRESS. . . : 10836 SW DOVER CT SUBDIVISION. . . . : DOVER LANDING ZONING: R BL-OCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 17 JURISDICTION: Tl(3 Cl-ASS OF WORK. . :AL1 FLOOR TURN. . . . : 0 EVAP COOLERS: 0 T YPE OF USE. . . . :SF UNIT HEA,fERS. . : 0 VENT F'ANS. . . : 0 OCCUPANCY GRP. . :H21 VENTS W/O APDL: 0 VENT SYSTEMS: 0 STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . ! 0 FUEL TYPES ---- --- _— 0-3 HP. . . . : 0 DOMES. INCIN: 0 3-15 HP. . . . : 0 COMML. INCIN: 0 MAX INPUT: 0 ETU 15--30 HP. . . . : 0 REPAIR UN T TS: 0 FIRE DAMPERS . . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0 GAS PRF_SSURE. . . : 50+ HP. . . . : 0 CLO DRYERS. . : 0 NO. OF UNITS---------- AIR HANDLING UNITS OTHER UNITS. : 0 1-'URN ( 1 00K FATU: 0 ( 1.0000 c f m: 1 GAS OI.J f LETS. : 0 FURN ) -100K ETU: 0 > 10000 rfm : 0 Remarks : instl 1 air handling unit // air conditioning units cannot be placed gatside sttbacks Owner-: __._..----.________._________---__.----•--..____.___.___..______...__.._...----.__._ FEES JOHN ETZEL.. type amol.int by date---- -r•ecpt 10836 SW DOVER CT PRMT $ 25. 00 'TAT 05/28/97 97--295128 TIGARD CR 97224 5PCT $ 1. 25 TAT 05/; 8/97 97-2951 -8 Phone #: 639-1678 SUN GLOW INC E'4':='8 SE 105TH AVE. PORTLAND OR 97216 -------_.------_--_.--__--_______-______.___ F'h o n e #: 253--7789 f 26. 25 TOTAL Reg #. . : 000004 REQUIRED INSPECTIONS ----- -- This permit is issued subject to the regulations contained in the Mechanical Ins p Tigard Municipal Code, State of Ore. Specialty Codes and all other Mi sc. Inspection applicable laws. All work will be done in accordance with Final Inspection approved plans. This permit will expire if work is not started Nithin 18N days of iscaance, o; if work is suspended for more than 188 days. —•��-� � --- Permittee Signotr.l : U .t T s s i_r e d B y . itall for inspection — 639-4175 "ity of Tigard MECHA141CAL PERMIT Planck/Rec. # 13125 S1P! Hall Blvd. APPLICATION Permit # -'-igard; OR 97273 (503) 639-4171 15escription Table 3A Mechanical Code QTY PRICE AMT Job .l (, tis 7 c 1� - - ► 1) Permit Fee !) 0 0.00 Address Le — - �� Q c� 17 7/,.� _> 2) Supplemental Permit 3.00 ",. Furnace to 100,000 BTU - 1) incl. ducts &vents 6.00 urnace 100,000 13TU + '— Owner �L y�.C' ,� r.�_, _� 2) incl. ducts &vents 7.50 Floor Fumance — 1> incl vent �uspenueu neater, wail neater - 4) or floor mounted heater 6.00 Jccunant Vent not incl. uT-i Repair of heating, rehig. _ 6) cooling, absorption unit 600 Boiler or comp, eat pump, air Bond. _j 7) to 3 HP; absorp unit to 100K BTU 6.00 — comp, eat pump, air cond. COntr3rtOr 'l ! r �~ 8) 3-15 HP; absorp unit to 500K BTU 11.00 comp,meat pump, air con . 9) 15-30 HP, aosorp unit .5-1 mil BTU 15.00 Boiler or comp, heat pump, air cond. ryNC 1 10) 39-50 HP; absorp unit 1-1.75 mil BTU 22.50 ereby ac now ledge t at I have re-4d this—application, Tat the Boiler or cornp,Tieat pump, air con information given is correct, that I am the owner or authorized 1 1) > 50 HP, absorp unit 1 75 mil BTU 37 50 agent of the owner, that plans submitted are ;n compliance with _ Air nandling unit to State laws. that I am registered with the Construction Contractor's 12) 10,000 CFM 450 l Board, that the number given is correct. (If exempt from State Air handling unit registration, please give reason below) 13) 10,000 CTM + 7.50 an porta e — _ 14) evaporate cooler 4 50 — Vent Tan connected —- 5) to a single duct 300 enti ation system not 21 16) included in applidnce permit 450 f10I,1011!1,1 ar 6R0 �- 0o serge �y 17) mechanical exhaust 4 50 scribe worx new addition7T additionalteration repair L omrnercia or industrial to be done residential J& non-residential Q 18) type incinerator 30.00 -xisting use c —iS ear i e, woods-*uve, water — building or property _— I �.. _ 19) heater, solar, clothes dryers, rtc. 4.50 Proposed use of 20) Ga" piping one to four outlets 2 00 building or property —_ — Type of fuel -oil Q natural gas _/ LPC r 21) More than 4-per outlet (each) — L 00 (Id � electric Q Minimum Fee $25.00 SUBTOTAL PERMITS BECOME VOID IF WORK OR CONSTRUCTION — — AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OP. 596 SURCHARGE 7 IF CONSTRUCTION OR WORK IS SUSPENDED OR — - ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL AFTER WORK IS COMMENCED. - — � -- 707AL ec,al Conditions -- - ----- .��cird,c,rsMecl.cWt RECEIVED MAY 2 8 1997 COMMUNITY UEVU19PMENT