13725 SW HATHAWAY TERRACE J
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13725 SV,'t IATHAWAY TERR
\ CITY O 1 1 I G A R® _ MASTER PERMIT
PERMIT tt: MST2003-00466
DEVELOPMENT SERVICES DATE ISSUED: 10/15/03
1::125 SW Hall Blvd., Tigarcl, OR 97223 (503) 639-4171
SITE ADDRESS: 1372.5 SW HATHAWAY TE'�R PARCEL: 2S103CC-08000
SUBDIVISION: WHISTLER'S WALK ZONING: R-4.5
BLOCK: LOT: 027 JURISDICTION: TIG
REMARKS: %onst. new SF detached residence.
BUILDING
REISSUE: DM191 STJRIES: 2 FLOOR AREAS REQUIRFD SETBACKS REQUIRED _
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 2,725 st BASEMENT. sf LEFT: 5 SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,400 sl GARAGE: e66 sf FRONT: 15 PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: I NIRD sr RIGHT: 5
. 15
OCCUPANCY GRP: R3 BURM: 5 BATH: 4 TOTAL. 3.425 VALUE1 .305 10 sf PEAR: 15
,- PLUMBING
SINKS. I WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY 1 RAYS: ' RAIN DRAIN: 100 TRAPS:
LAVATORIES. DISHWAS''ERS: I FLOOR GRAINS. SEWER LINES: 100 SF RAIN URAINS: 1 CATCH BASINS:
TUB/SHOWERS: I GARBAGE DISP I WATER HEATERS WATER LINES. 100 BCKFLW PREVNTR. GREASE TRArs:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<TOOK. BOIUCMP<3HP VENT FANS: 5 CLOTHES DRYER: 1
GAS FURN—100K. 1 UNIT HEATERS: HOODS: I OTHER UNITS: I
MAX INP blu FLOOR FURNANCES. VENTS: I WOODSTO"ES: GAS OUTLETS: 5
ELECTRICAL
r RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp. 0 -200 amp W/SV'C OR FUR. PUMPARRICATION: PEI INSPECTION:
EA AD01 500SF. 7 2ul 400 amp 201 400 amp: 1st WIO SVCIFDR: AIGN/OUT LIN LT: PER HOUR:
LIM11En ENERGY: 401 600 amp: 401 - 600 amp EAAODL BR CIR SIGNAL/PANEL: IN PL ANT:
MAAII HMISVCIFDR: 601 1000 amp: 601+ar"pa•1 WGV: MINOR LABEL:
1000+amolvalt:
PLAN REVIEW SECTION
Reconnect only:
>-4 RES UNITS: SVCIFDP>=225 A.: 600 V NOMIN41- CLS AREAISPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B COMMERCIAL
P.UDIO 6 STEREO. VACUUM SYS"EM: AUDIO 8 S7EREO: FIRE ALARM. INTERCOMMAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANt'SCAPEnRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK. INSTRUMENTATION. MEDICAL: OTHR:
HVAC. DATAfTELE COMM: NURSE CALLS: TOT-L N SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,928.34
DON MORISSEiTE HOMED DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
4230 GALEWOOD ST#100 4230 GALEWOOD ST,STE 100 Tigard r applicable
Code,State o k wOR. Specialty Codes and
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035 all other applicable laws. All work will be done it
accordance with approved plane 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
Ptorla: 503-387-7538 Phone: Oregon Utility Notification Center. T�,ose rules are set
187 7 forth in OAR 952-001-0010 through 952-001-0080. You
Rap N: Jq may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Erosion Cootrol Insp& Post/Beam Mechanica Plumb Top Out Exterior Sheathing Ins; Rain drain Insp Elech:cal Final ^,
Sewer Inspection Underfloor insulatlin Electrical Service Low Voltage Storn drain Insp Mechanical Final
Footing Insp Crawl Drain/Backwater Electrical Rough In Gas I-Ine Insp Water Line Insp Plumb Final
Foundation Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service 1,1sp Building Firal
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr/Sdwik Insp
Issued By : ar r Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITYOF T I GAR D SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2003-00348
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/15/03
SITE ADDRESS; 13725 SW HATHAWAY TFRR PARCEL: 2S103CC-08000
SUBDIVISION: WHISTLI'lk") \\:U K ZONING: R-4.5
BLOCK: LOT: ��' '_ JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF IISE: SF NO. OF BUILDINGS:
INSTALL TYPE: L.TPSWR ;MPERV SURFACE:
Remarks: Sewer connection for new SF dwelling.
Owner: _--_ -- FEES
DON MORISSETTE HOMES Description Date Amor►nt
4230 GALEWOOD ST#"00
LAKE OSWEGO,OR 97035 1SWUSAJ Swr Connect 10/15/03 $2,400.00
JSWUSAJ Swr Connect 1Oil 5/03 $0.00
Phone: 503-387-7538 (SWINSPJ Swr Inspect 10/15/03 $35.00
ISWINSPI Swr Inspect 10/15/03 $0.00
Contractor. -- -- --
- -- - r---- Total $2.435.00
Phony:
Reg #:
rrRequired Inspections
This Applicant ag .es to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date +6sur.:d. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of tho sido• sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all direc'ions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Perm
Issued by: �;A..�. iL�.�L ,�'-� ' Permittee Signature:
Call (503) 639-4175 by 7.OU P.M. for an inspection needed the next business day
_ q _o3 MA ✓ ' /
�y Date received:>< 7 PeJ
\ 113...,r.�l� i ♦,.! 1=a ,.j��� Ie1d+V{til Jn
Tigard
. 'l C,`. . .F H , ( �, Permit no.:
City of 1gaird -
Address: 13125 SW Had Blvd,Tigard,OR 97223 Project/appl.no.: Expire date:
Cih..;Tigurl Phone: (503) 639-4171 Date issued: eceipt no..
Fax: (503) 598-1960 CI f Y OF TIGARU Case file no.: Payment type:
Land use approval: 131111.DIN(; MVISION 1&2 family:Simple Complex:
U I &2 family dwelling or accessory U Cominercial/industrial U Multi-family , <New construction U Demolition
U Addition/alteration/replacrment U Tenant improvement U Fire ;prinkler/alarm U Other: _
NNNW�
Job address: I � Bldg.no.: Suite no.:
Lot: 1 Block: Subdivision: — Q ( i /tax lot/account no.: 1,
Project name.: f
Description and location of work on premises/special conditions:
Name: Y It . l"
Mailing address: �L' �- 1 &2 family dwelling:
City: State( f work.. _
Phone: - Fax: 7 -mail: No.of Fxdroums/baths.................................
Owner's representative: Iv 1
P-6-A-ftTotal number of floors.................................
---- --
Phone: Fax: E-mail: New dwelling area(sq. ft.) .......................... _ 7
Garage/carport area(sq.ft.) ........................
Name: �V j� Covered porch area(sq. tt.) .........................
Mailing address: C1. v Deck area(sq.ft.) ........................................ ---
__
City: I State: I ZIP: Other structure area(sq. ft.).........................
Phone: Fax: E-mail: Commercial/industrisUmultl-family:
OHM I Valuation of work........................•............... $
Existing bldg.area(sq. ft.) .......................... _
Business name:
Address: New bldg.area(sq. ft.)................................
�^ Z Number of stones— ........................................
City: Suite: ZIP: �
Typeof construction....................................
Phone: [!Lax: E-mail:
--- Occupancy group(s): Existing:
CCB no.: _� — New:
City/metro lic.oto.: Notice:All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
Name: , provisions of ORS 701 and may he required to be licensed in the
Address: N (, jurisdiction where work is bung performed. If the applicant is
----
City: State: :_IP: exempt from licensing,the following reason applies:
Contact person: Flan no.:
Phone: Fax: E-mail.
Namn• Contact person: Fees due upon application ........................... $_
Adthr Date received:
City. State: ZIP: Amount received ......................................... $
Phone: ax: E-mail: Please refer to fee schedule.
1 hereby certify I have read and examined this applicatioa and the Not all junxlictiont acro credit cards,please till jurisdiction for more intonrarien.
attached checklist.A rovisions of 1 ws and odinances governing this U Visa U Mactercar.'
work will be complt ep wil4,whether cified�ereifi ratot. creel+i card ntimner _
v �) �� xpircs
AUthOri2ed 91 BtU+ ' V_Loa t � Name of cardholder as shown on credit card s
Print name: 4 Z f tZil ( � � Cardhr4der si�ture Amount
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613(twtll(7oM)
One- and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
permits:
City of Tigard U Electrical 0 Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97223 UOther: _
Phone: (503) 639-4171 - ---Fax: (503) 598-1960
REQUIREDTAF t011.1,6WING ITEMS ARE 1
1 Land use actions completed.See jurisdiction criteria for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved plat/lot.
4 Fire district approval required. _
5 Septic system permit or authorization for remodel. Existing system capacity ^,
6 Sewer permit. _
7 Water dutrict 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 of
catch-hasin protection,etc._
10 J_ Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state
building codes. Lateral design details 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 drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is more then a 4-ft.elevation differential,plan mast show contour lines at 2-ft.intervals);location of easements and
driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator,lot
area:building coverage lea;percentage of coverage;impervious area;existing structures on site;and surface drainage.
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
_ sine and location. _
13 Floor plans.Show all dimensicns,room identification,window size,location of smoke detectors,water heater,
fu mace,ventilation fans,plumb,ng fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor,
wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show
details of all wall and roof sheath.ng,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thermal ir,sulation,etc. _ _
15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels
Exterior elevations must reflect the actual 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 lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections and details showing placement of mbar.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. X _
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.
22 Engineer's calculations.When required or provided,(i.e.,shcar wall,roof truss)shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
23 Five(5)site plans are required for Item I1 above. Site plans must be 8-1/2" x 1 I"or 11"x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 above.
25 Building plans shall not contain red lines or tape-ons.
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 plats may be in blue or black ink.
Red ink is reserved for department use only. 4444614(MlWoM)
Nlecha.- ical Permit Application
Date received: — Permit no.: ' ,-•j _
City of Tigard Projecl/appl.no: -Expire date:
City ofTigard Address: 13125 SW Hall Blvd,Tigard.OR 97223 --
Date issued: ,y: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _ Building permit no.:
TYPE OF PERMIT
O 1 &2 family dwelling or accessory 0 Commercial/indusuial 0 Multi-family 0 Tenant improvement
(Yew construction 0 Addition/alteration/teplacement Q Other.
JO*Sffg INFORMtION1SCHEOULE
Job address: ") -r: I Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: Suite no._ value of all mechanical materials,equipment,labor,overhead,
Tax ma /tax lot/account no.: profit.Value$ _
Lot: Q7 jBiock. Subdivision: ^f' 7 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: _ 1 a l
Lkscripdon and location of work on premises: .. _______.__
11114010 a' , .r ` III w I 1111 A
Fee(ea.) Total
Est.date of completion/inspection: ff Description _ Qty. Res.onl Res.only
Tenant improvement or change of use; Air handling
CFM
Is existing space heated or conditioned?O Yes 0 No dling unit
rcon i,^ ��(she p an requit )
Is existing space insulated?0 Yes O No Alteration o exis,.ng�AC system
391111111 M011M Boiler/compressors
Businces name: State boiler permit no.:
1 — HP Tons BTU/11
Address: Uusmoke dampers/duct smo ce detectors _
City: U State• ZIP: eat pump(site plan required
nstal re
Phone: - Fax: E-mail: p ace iniacurner T /
Including ductwork/vent liner 0 Yes 0 No
CCB no.: _ ——
Insta rep ac-re ocateheaters-suspen ed,
City/metro lic. no.:N/A wall,or floor mounted _
Name(please printC (� ent forappliance o-thcr an furnace
Refrigeration,
Absorption units BTU/H
Name: Chillers HP
Address �Xti �� �l� -- Com rcssors (T
nv ronmenta e. ust an ventilat on:
City: State: ZIP: _ Appliance vent
Phone: Fax: E-mail: ryerexhaust
Hoods.Type U Wres.kite a aamat
hood fire suppression system
Name: �'� 1 ' Exhaust fan with single duct(bath fans)
Mailing address: haust s stem a art trom heating or C
City: State ZIPSFuel piping an t ut on(up to 4 outlets)
Type: LPG __ NG Oil
Phone: 7- Fax: E-mail: fuel piping each additional over 4 outlets
rocess piping(schematic required)
Name: Number of outlets
ter listed app ance or equipment:
Address: — Decorative fireplace
City State: �71-ZI�P: nsert-type
Phone: — - — F a�. - -- •mail: stove/pe letstove
Other:
5 ,4pp/icanr's siRnuru Date:_ of trf — _
Name(print) fi.�yi +_1I; [y I
Not all junsdkuons Supt credit cards,please earl)uhutiction for more informrian. Permit ... .. .........$ _
O Visa ❑Mast-rCard Notice:This permit application Minimumm feeee................$ _
/ expires if a permit is not obtained plan review(at _ "6) $ _
Credit card number within 1 g0 da}s ager it has been
—�W— Expires State surcharge(8%) ....$
None of cudholder as shown on credit cud $ accepted as compltt- TOTAL ................... ...$ _—_—.---
Cardholder sipature Amou!L—j 4404617(WWOM)
Plumbing Permit ppl'cntion
Date received: Penrutno.:ili,'l..i'� i
City of Tigard sewer permit no.: Building permit no.. —
Address: 131231W Hall Blvd.Tigard.OR 97223 -- --
City of Tigard F'roject/appl.no.: Expire date:
Phone: (503) 539-4171
Fax: (503) 598-1960 Date issued: By R:-- iI
Cue file no.: Payment type:
Land use approval:
11
1
O 1 &2 family dwelling or accessory 0( ummerci•il/industrial 0 Auld-family 0'tenant improvement
`!ew construction LI Addidon/alterauon/rrpli cement ❑ Fari service 0 Onccr.
1 : 1 N1131
Job address: _ (� Description eZty. Fee(ea.) I Total
New I-and 2-(artily awelliagv only:
Bldg no.: Suite no.. (includes 100 ft.for each utility connection)
Tax map/tax lot/account no.: SFR(l)bath
Lac Bit; k: Subdivision: �`�- SFR(2)bath
Project name: SFR(3)bath _
City/county: ZIP: Each additional badvkitchen
Description and location of work on premises: Si(eutilities:
Catch basin/area drain
Est.date of cam Pic tionrnspection: Drv•wellsrleach line/trench drain
Footing drain(no.lin. ft.)
4lanufactuted home utilities
Business name L .— L a es
Address: jj� 1 Rain drain connector
City: State• ZIP: Sanitary sewer(no. lin. ft.)
E-mail! Storm sewer(no.lin. ft.)
Phone. -�" Fax: Water service(no.lin. ft.)
CC3 no : I Plumb. bus. reg. no, - Elxture or item:
Citymetro lic. no.: NSA Absorption valve
Contractor's representative signature,irk-----r.�! Back clow re-:enter
Print name. �� U Backwater vaise
Basir.-Aavatory
Clothes washer��r lJ��� Dishwasher
Address: Dnrt)ane fountsinls)
Citi _State: ZIP: Eie:tors sump
Phone — F E-mail: Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub
Name(print): Garbage disposal
Mailing address==�
r Hose bibb
Citv ZIP: Ice maker
Phone• - •m.til: Interco tor;greasetrap
Owner instaUurionlruidenda/maintenance only: The actual installation Pnmensl
will be made bs me or the maintenance and repair made by my regular Roof drain(comr.rrcial)
employee on he propem l own as per ORS Chapter 447. SiM(s1, basints), lav,:(s)
Sum
Owner's signature _ Date:
Tubslshow•er/shower pan _
Lnnal _
Name: Water closet
Address 4�4 iter heater
Cin —_-- state: ZIP: emer
Phony. Far. E. moil. Total
Plan
fee............) $
Na ill jwis.Lciiau accep:rcdit cods.please call(unyycuon fa mwe mtarruum Notice T}tt5 N^'ttit application lib) S
C Visa O MuterGrd expires if a pe-nit is not obtained Plan review(at --__
C.edit cud number — Est pue within ISS)da%s ager it has been State surcharge(3"0l ....$ ._.
accepted is;arnpletr TOTAL .......................S
Name ar=.ft der u sAown oe credit cud
Cuuhpider apnatute Am,wM 4ao.-1616(MM 141
i
------------------------ --
AkDON MORISSETTE OBE ,
a0 >tas 1N c0 RP 01 AT 30 LOT: 27
a s a o 0 A L R w o 0 D 0 T R m ! T DATE: 8/19/03
L AM 2 0 6 w 2 a 0. 0 1 5 5 0 a 0 7 0 s
(s0s) ss7 - lase► PAN (648) 487 76 16 PROPERTY: WH9TLER'3-WALK
CITY: TIGAVD
.3CALE: 1"=20'
PLAN No.: 191
OPTION 1 ELEVATION
LU
319 34 311 316
I I
1 r — !I6 316 ref
aid
31 e'
\ 'CM
1 f
310
\ I n 1 3, ft.
q.
- I a
3ty beth ---
.6A?.c 31e 38 I -
�1
PIA?C. , FF E. 31"' 32�' r
r _l�
\
465 sq_ ft.
1 3 car gar.
\ i i FFE. 318'
( --- - - - --rt 01-
320' a I®4.ID2�' I aro i l�
�I �I
� r1
n
LEGEND LCAT COVERAGE �
LCT AREA: 6 2 A 9G. FT. LUT r1�1
BUIL7ING ARE 2.x55 9C.
oc:RSENTAGE. A;119, (7;40 6(q. ft.
•Rr— ..P 71�et�
('1'fY O 'I IGARI) - 51'1'M. PLAN ItF.VfN.V►'
B1.III.1) NG PE RMl'1 Nt).:
PLANNING Dl%'I',It►N:
r >rc,vv.� ❑ Not Appro-vOl
Required ,etl,iu -s- �n
cls,. .S ;trees Side-
Ga
ide: - - �5 I
(a:rrage: �°-, Ftrar i
ghlw ived [) Not Approved
,rial , �i ifknl,:r 3v i
.i<<xirrrum {3uillur{ Ilc�ig st _ lee, No
Vti` Servi;: ftr�,vitl�r Letter Required: 0 Yes I
❑ Received
e.
(Nli1NEl: INc; 1;11:,P:1R I MEN
`T: roved
Actual Slope:-L_-"- 16 Approved ❑ Not App
Site 1'lesr �-Approved 103 AV rr►ved
H
Nulr',:
l
Electrical Permit Application Received1'lectncal
Date/By: permit Na � ) -
Cit of Tigard r Planning Appr val Sign
E'v
City �+ R EC Date/By Permit No.:
13125 SW Hall Blvd. Plan Revie v Other ---
Tigard,Oregon 97223 �, Date/B : Pt im,it No.:
Phone: 503-639-4171 Fax: 503-59>�440 ) Post-Review Land Use
Internet: www.ci.tigard.or.us Date!B . Case No
Contact Juns.: See Page 2 for
24-hour Inspection Request. 503-639.A 175` Name/Method: _ tiu t tlenrental Information.
bulLl)Ihll,DIVI(;10N --
i TYPE OF WORK PLAN REVIEW(Please check all that apply)
New consh•uetion _ Demolition Service over 225 amps. Health-care facility
rommercial ❑Hazardous location
Addition/al«ratlOnireplaCement Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION_ I&2 family dwellings four or more residential units in
1 & 2-Family dwelling Commercial/Industrial ❑System over 600 volts nominal one structure
❑Building over three stones ❑Feeders,400 amps or more
qAccesso Building Multi-Famil ❑Occupant load over 99 persons ❑Manufactured structure+or RV park
Master Builder Other: ❑Egress/lighting plan ❑Other'
JOB SITE INFORMATION and LOCATION Submit -_seti of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: •2 Sk1 _ FEE*SCHEDULE
Suite#: Bid r�,/Apt.#; _ _ Number of ins ections per perMit allowed
Project Name: cr
Description Qty Fee it T,lsl
Pro •
New resldemiai-single or multi-family per
Cross street/Directions to job site: /z/5 .� dwelling unit.Includes attached garage.
Service Included:
1000 sq.ft.or less 145.15 4
Each additional 5W sq.ft.or ppnion thereof _ 33.40 1
Subdivision: //,SLV Lot#: Limited encrily,residential — 75.00 2
Limited energy,non residential 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and or feeder 90.90 2
Services or feeders-Installation,
alteration or relocation:
200 amps or less 80.30 2
----- ----- 201 amps to 400 ampl 106.85 2
401 amps to 6110 amps _ 1601A) 2
PROPERTY OWNENT 601 amps to Ill()0 amps _ 240.60 2
S SST, __LfJL-- Over t amps or vons 454.65 2
Name: Reconnect only 66.85 2
Address: 423 p (AZ-UXao 5/7, sU//-r/GD Temporary seri Ices or feeders-installation.
Cit_ )�e/Zi4n alteration,or relocation: - ^
City/State/Zip: � �� W� , 21X1 ar r.:or!�ss 66.85 1
Phone: 3 - �, Fax: _ 201 amps to 41X1 amps _ 100.30 2
APPLICANT CONTACT PERSON 401 it)6181 amps 133.75 2
Branch circuits-new.alteration,or
Name: extension per,panel:
Address: A.Fee for branch circuits w A purchase of _
service or feeder fee,each branch circuit 6.65 2
City/State/Zip: B.Fee for branch circuits without purchase of
service or feeder fee,first branch circuit 46.85
Phone: Fax: ^T Each additional branch circuit 6.65 '-
P-mail; S1isc,(Service or feeder not included)
CONTRACTOR Each pump or irrigation circle 53.40 _ 2
— Each sign or outline lighting 53.40
Job No: A I Si4nal on,or
or i limited energy panel.
Business N,,ne: C alteration,or estenshm _ lac 2
Description.
Address: C
City/State/Zip:�Slate�Zl A Each additional inspection user the allowable In anv of the abose: _
/4 Gd� Q_! Per inspection per hour(min, I hour_)
Phone: ?5j--&,Z x I Fax: 6,13- 1,9* 1 Imesti anon fes
_CCB Lic. #: Lic, #: y OtherElectrical Permit Fees*
Supervising a ectrician C, _ Subtotal S _
signature required' Plan Review 254'o of Permit Fee) S
Print Name•.L t Lt . #; State Surcharge 81N of Pemut Fee) S
TOTAL PERMIT FEE I S
Authorized Votive: This permit appdcation expires if a permit is not obtained within
Signature: _ Date. _ 180 days after It has been accepted as complete.
*Fce.rethodoloKv set by Irl-County Iluilding Industry Service Board.
IPlease print name
i:�bsts\Permit Fortm\ElcP•;nnitApp.doe 01,03
Electrical Permit Application - City of Tigard
Pagc 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: _.—
Feefor all systems............................................................ $75.00
Check,i%pe of%Sork Involved:
❑ Audio and Stcrco Systems*
E] liurglar Alarm
Garage Door Opener*
I Icating,Ventilation and Air Conditioning System*
C7vacuum Systems*
Other ^_
COMMERCIAL WORK ONLY:
— S75.00
Fee for each system..........................................................
(SEE OAR 918-260.260)
Check Type of Work Involved:
Audio and stereo Systems
Boiler Contrnls
Clock Systems
Data Telecommunication Installation
0 Fire Alarm Installation
[j IIVAC
instrumentation
Intercom and Paging Systems
Landscape Irrigatinn Control*
Medical
Nurse Calls
Outdoor t..andscape Lighting*
E] protective Signaling
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
I'st0rrrnit Fottm\ElcPerm:tAppPg2 doe 01 03
4
CITYOF TIGARD _ PLUMBING PERMIT _
DEVELOPMENT SERVICES PERMIT#: PLM2004-00043
M DATE ISSUED: 1/213/04
-0, 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
P<1R C EL: 2S 103CC-08000
..ATE ADDRESS: 13725 SW HATIiAWAY TERR
SUBDIVISION: WHISTLER'S WALK ZONING: R-4.5
BLOCK: LOT: 027 JURISDICTION: TIG
CLASS Or WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF ;SE: SF WASHING MACH: EACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_
FIXTURESLAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINAL": GREASE TRAPS'
LAVATORIES OTHER FIXTURES:
TUBISHOWERS SFWER LINE: ft
WATER CLOSETS. WATER LINE: ft
r,ISHWASHERS: RAIN DRAIN: ft
Remarks: If backflow preventer installation.
F=EES _
Owner: _
Description Date � Amount
DON MORISSETTE HOIJIES _
4230 GALEWOOD ST#100 11'LUMUJ Permit Fee 1/28/04 $36.25
LAKE OSWF_GO, OR 97635 ITAX] 8%State 1/28/04 $2.90
Total $39.15
Phone : 303-387-75?8
Contracts.
LANDSCAPE OREGON, !NC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
RP/Backflow Preventer
Phone : 503-692-5945 Final Inspection
Reg #: I I( 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0100
You may obtain copies of these rules or direct questions to OUNC by calling (5()3) 246-6699.
Issued By: r? !�c _ Permittee Signature:
Call (503) 639.4175 by 7:00 P.M. for an inspection needed the next business day
Jan 26 04 04: 11p dan edmunds 503-692-0768 p. 2
** ,
TIFFICE USE
ONLY
Plumbing Per l-Ull. Received Plumbingg 3
Date/By! Permit N �—
Planning Approval Sewer
City of Tigard Date/By: Permit No.: T
13125 SW Hall Blvd. JAN 2004 Plan Review Other
Tigard,Oregon 97223 H I. t'-te/ay: Permit No.:
Cl7`x�� Date/Post- y: Lund Use
Phone: 503-639-41 i 1 H J,?I OL11 1 S1U '4 patdFiv; Cate No.
Internet: www.ci.tigard.or. Contact JurijCZ Sec Page 2 for
24-hour Inspection Request: 503-•639-4175 Narne/Method:___—____ / Supplemental Information.
TYPE OF WORK _ FEE"SCiiEDULE(fora ectal Information use checklist)
_ Demolition Descrtptlon r?ty. �eeiea.j r Total
Ncw construction _ -- - —'
New 1-dt 2-family dwellings
ddition/alteration/re lacement [l Other_ includes 100 fr.for ea-11 it ility co nectlon
_ CATECOR_V Or CONSTRUCTION SFR 1`hath 249.20
I & 2-Family dwelling Commercial/Industrial SFR 2 bath 399.00
cessory Building Multi-Fami1Y _ SFR(3)bath 399.00
Master Builder __ Other: Each additional bathAitchen 4ge 2
JOB SITE INFORMATION-and 1.,OCATION Fire sprinkler-sg.f1: Page 2 _J
Job site address: 3 Sw l-ta CT
Site Utilities -----�
Catch basin/areadrain 16.60
Suite#: _ B_ l •�A t� �J Drywell/leach,line/trench drain 16.60
Prosect Name:Wh/s t:r-� Footingdrain no.linear R. Page 2
Cross street/Directions to jot)
site: Manufactured home utilities 110,00
Z� �7- I�t `� R Manholes16.60
Ruin drairiun connector 16.60
-t
Sanitary sewer no.linear ft. Page 2
:T— Storm sewer no.linea ft. Pa,e 2 _
Lot tl: 7 Pa c 2
JTax
bdivision: W h t S+I� _ Water service no.linear 11.)
map/parcel#: (01m, �.� _ Fixture or[tem
DESCRiPTION OF WORK Absorption valve 16.60
7rle( �/Ou ) G(W/C e-) Backflow reventer _PML2 �� Backwater valve 1660 J
-- Clothes washer 16.60 I
Dishwasher _ 16.60
_.
Drinking fountain 16.60
PROPERTY OWNER—] TENANT' Ejectors/sump 16.60
Name: I Ik JS Ex ansion tank 16.60
— �f`-m � Fixture/sewer ca 16.60
Address:OrA 30 St,LI 6011-0-AA-)OOCU Floor drain/floor sink/hub 16.60
Cit /State/Zip: L1Y1+: C's t-� 47 -�_�. Garbage dis usal 16.60
Phone: Fax: Ilose bib 16.60
PPL,ICANT CONTACT PERSON Ice maker 16.6_0
Name: �,JlLn Spat•r rno Interceptor/grease trvE 16.60
Address:I�•�y G CLO ►rn�� 20 Primer—value: Page 2
O (2. 970(D 16.60
Cit /State/Zip:'fl,�l����- Roof drain commm•cial) slG,fiO _
PhorleStG (AAL -SR L1.5Fax:S03 Sink/basirt/lavato _ 16.60
Tub/shower/shower n 16.60
E-mail: pe16.60
CONTRACTOR Urinal
Water closet 16.60
$uSlneSs Name:_-MSCCLIC - _ Of�-yQ11 _. Water heater 16.6b
Address: 12�0�' ��
City/Stn,� LS. �.le_�...— other. _
ate/ZiP:-M • f-1,-- tiel Q7UC1'a- Other:
Plumblue Permit Fccs• Q2 j 5
Phone5ba - 5945 Fax`3�3 ( /�- 0710 Subtotal s
CCB Lic. #: -79V`4 Plumb. Lic.#: Minimum Permit Fee$72.50 5
Authorized 11 Residential Backflow Minimum Fee$36.25
� .3(� 'e�•S
Signaarr � � Y2-' _ Date: Plan Review(25%of Permit Fee 5
t--i l to ar r _ —_ State Surcharge 8%of Permit
C—�I (Picase print name) TOTAL PERMIT FEE
Notice: This permit application expires if a permit is not obtained within All new commercial buildlnRs require 2 sets of plans with Isometric or
180 days after It has been accepted as complete. riser diagram for plan revie,r.
'Fee methodology set by Tri-County Building Industry Service linord.
I\Dsts\Pcrmit Forrru\PlmPcr7nitApp d:x: 0110
CITY OF TIOARD
Residential Certificate of Occupancy
3 - L/� ---,1 /
I'crlttit No.: — �'7C� 7 � Address:
Owner/Contractor:
Cate of Final Inspection: '` '���h) Ii/ Inspector:
This structure has been found to be in substantial compliance with the provisions of the 5►ate of Oregon One h Two Family Dwelling
Specialty Code and is hereby approved for occupancy.
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST UG1�(v�v
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received-Z` Date RequEsted--�--l�- AM----PM-- BUP
Location __.. 15uite MEC
Contact Person _ �`3l�'AeAP Ph( ) ��' — q,�-3 PLM
Contractor_ -1�) Y)1, Ph(_ ) -- SWR --- ---
BUILDING Tenant/Owner _ __ ELC
Footing ELC
Foundation Access:
Fig Drain ELR —
Crawl Drain —.
Slab Inspection Notes: SIT
Post&BeamShear Anchors --- " -----
Ext Sheath/Shear
Int Sheath/Shear
Framing ----
Insulation
Drywall Nailing --�`� t'"c3 Ter -- .� x <--
Firewall
Fire Sprinkler - — --- ----- - --
Fire Alarm
Susp'd Ceiling — - -- - -- -
Roof
Fin
ASS PART FAIL--
Post& Beam -
Under Slab — - - -- — -- - ----. _.._ ----
Rough-In
Water Service - -- - —
Sanitary Snwer
Rain Drains - - --
Catch Basin/Manhole
Storm Drain --- ---- ------ ---
Shower Pan
01her'__iner
OAW PART FAIL -----
- -
MECHANICAL
Post R Beam
Rough do -
Gas Line
3raoke Dampers - --- --
WAS '�,PART—
FAIL
U-EUTMAL
Rough-In — -- ---- --- — _ ---- - --
UG/Slab
Low'Joltage — y-- - -------- ---- --- --
Fire Alarm
PARTFAILFAIL F] Reinspection fee of$_ -required before nex"nspection. Pay at City Hall, 13125 SW Hall Blvd
SITE j Please call!jr reinspectiw[.t: _ _— [1 Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date ` t �� Inspector - Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PAnT _ FAILA