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15800 SW HALL BLVD Ln S r 07 r G I i 1 1 i i ..... 15800 SW Hall Blvd CITYOF TIGARD CERTIFICATE OF OCCUPANCY DEVELOPMENT SERVICES PERMIT#: BUP2003-00085 13125 SW -all Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3,20/03 PARCEL: 2S112CC-0 1100 ZONING: R-12 .JURISDICTION: TIG SITE ADDRESS: 15800 SW HALL BLVD SUBDIVISION: BLOCK: I.OT: CLASS OF WORE: ALT TYPE OF USE: COM TAPE OF CONSTR: 5N OCCUPANCY GRP: A3 OCCUPANCY LOAD: T'ENANI NAME: -TIGARD FRIENDS CHURCH REMARKS: Replac- teams at portecochere Owner: f TIGARD FRIENDS CHURCH 7130 SW BEVELAND TIGARD, OR 97223 Phone: 503-848-9494 Contractor: J R WARREN CONSTRUCTION 6429 SE HEIKE HILLSBORO, OR 97123 Phone: 503-848-9494 Reg#: I IC 26030 This Certificate issued 5/8r113 grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for compliance with the Sta" of Oregon Specialty Codes for the group, occupancy, and use under whiorli h6jeterenced permit WMIS40110d 7al&Ln ffURbING INSPECTOR -��- —-_ BU OFFIC A_ ----- POST IN CONSPICUOUS PLACE CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 (� BUP Received Date Fiequest d S �U - AM---.. PM -_____ _ BUP _ --____- Location �— ----Suite -- - MEC . --- --- Contact Person __ _-__------ ._ Ph ( ) �� rJoZ PLM _ Contractor _ Ph( --- ) _- _ SWR -- --- --- WILD TenanUQwner - -- --- ---- -- -- ELC - - 00 ELC Fo ndation AGGf SS: Ftg Drain ELF 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 _ Susp'd ."oiling --_ ---- - — Roof Other: —. - --- -- -- A PART FAIL -- — ------- - - MBING --- --._ -- ---_� Post R Beam Under Slab --- — Rough-In Water Service ----- -- — -- `---- Sanitary Sewer Rain Drains ----- - - Catch Basin/Manhole _ Storm Drain - - - — Shower Pan Other: Final PASS _PART FAIL MECHANICAL _ _ - -- - - - ---- - -- -- - Post&Beam Rough-In — Gas Line Smoke Dampers -- Final PASS PART FAIL -- - -__- - ELECTRICAL _ - oerVir:e Rough-In _ UG/Slab Low Voltage ---- - -- Fire Alarm FinRI Reinspection fee of$_ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd PASS PART FAIL SITE _ ] Please call for reinspection RE:__—_�___-___-_�_____ Unable to inspect-no access Fire Supply Line -M , ADA Data Sc Inspector------_�� ' "'N Ext------- Approach/Sidewalk Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD BUILDING PERMIT PERM11 #: BUP2003-00085 DEVELOPMENT SERVICES DATE ISSUED: 3/20/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 15800 SW HALL BLVD PARCEL: 2511200 01100 SUBDIVISION: ZONING: R-12 BLOCK: LOT: _JURISDICTION: TIG REISSUE: l FLOOR AREAS _ ` EXTERIOR_ WALL CONSTRUCTION CLASS OF WORK. R f, FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf _ PROJECT OPENINGS_? TYPE OF CONST: 5N sf N: V S: E: W: �^ OCCUPANCY GRP: A3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: ___ READ SETBACKS _ REQUIRED_ FLOOR LOAD psf L-EFT:� ft RGHT: �ft FIR SPKL: SMOK_DET__: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : !INDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR. PARKING: VALUE: $ 19,000.00 Remarks: Replace beams at portecochere Owner: Contractor: TIGARD FRIENDS CHURCH J.R. WARREN CONSTRUCTION 7130 SW BEVELAND 6429 SE HEIKE TIGARD, OR 97223 HILLSBORO,OR 97123 Pt;one: Phone: 503-848-9494 Reg #: LIC 26030 FEES REQUIRED INSPECTIONS Description Date Amount FooUFuund Insp BUPPLNJ Pin Rv 2/20/03 $146.71 Framing Insp FLSJ FLS Pin Rv 2/20/03 $90.28 Final Inspection BUILD] Pennit Fee 3!20/03 $225.70 1'rAXI s%state'rax 3/20/03 $18.06 Total $480.75 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done it accordance with approved plans. This permit will expire if work is not started within 130 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-00 i-0010 through OAR 952-001-0100. You may obtain a copy of these riles or direct questions to OUNC by calling (503)246-6699 or 1-800-332-2344. P Issued By: 5/�1 CL LL( L4 t_L L Permittee Signature ---- �� �a-�y qA Call 639-4175 by 7 p.m. for an inspection the next business day ...x`11`"II1g Permit • ReceivedBuildingBuildingr... - Z Date/B . - � Permit No.: •'Q� CityC11 of Tigard Planning Approval Othcr g Date/By: _ Permit No.: 13125 SW Hall Blvd. Plan Review other �U Tigard,Oregon 97223 Date/By; Permit No.: Phone: 503-639-4171 Fax: 503-59$-1960 Post-Rev'ew Land Use Date/By: Case No. Internet: www.Cl.tigaiT.Or.u3 Contact Juris.: J@ See Page 2 for �q1 24-hour Inspection Req test: 503-639-4175 Name/Method: _ Supplemental Information TYPE OF WORK REQUIRED DATA: New construction_ Demolition 1 &2 FAMILY DWELLING Addition/alteration/replacement I El Otlter: _ CATEGORY OF CONSTRUCTION Note: Permit Pecs*are based on the total value of the work performed. Indicate ` I &2-Family dwellinL _Commercial/Industrial the value(rounded to the nearest dollar)of all equipment,materials,labor, overhead and profit for the work indicated on this application. Acce,rBuildin Multi-Family Master builder Other: Valuation........................................................ $ JOB SITE INFORMATION and LOCATION No.of bedrooms: No.of baths:__ Job site address: I$1 00 5%A 141.11-1,116.40�i '(!no Total number of floors..................................... New dwelling area(sq.fl.).............................. ------ ------ f Suite#: Bldg./Apt.#: ._ - Garage;carpon area(sq. fl.)............................ —------ , . Project Name:CWx►►P.41��RTECOtNrRr _01FA y�� t Covered porch area(sq. R.).......... . ............. . Deck area(sq.ft.).......................... .._..... .. Cross street/Directions to job site: - - Other structure area(sq. fl.)........................ . . '-Oq-wae.0 Pv.12-1AAvv% jtp t 1E oN%Tot U,L,r4 H At t-- 'B1-11V REQUIRED DATA: - COMMERCIAL-USE CHECKLIST Subdivision: ---- -— Lot##:- — -- Tax map/parcel #: Note: Permit fees'are based on the total value of the work performed. Indicate DESCRIPTION OF WORK the value(rounded to the nearest dollar)of all equipment,materials,labor, -- pverhead and roti►for tb w� i indicated a is application-, _.-QI�Sr ���-�,,�OCM ER£ i�E.QL_�• 3'A'rrm7 f `� _o r+M tD'g�b X1411�1s Valuation......................................................... A—T AwA DS0x „ Em Existing building area(sq. ft.)......................... —x% � New building area(sq. fl.)............................... Number of stories... ...... . ............................... PROPERTY OWNER ____J TENANTType of construction....................................... Name:7t C-0 C-pMw Uiii 1- { 1� flS tNv►R� Occupancygroup(sl Existing: '/ Address: It GO 5Yq NA LL.. SL-4P_ New: Cit /State/Z Ml►U C)P-E . 9�2.?4 Phone. So'� bib" Vi, Fax: NOTICE: All contractors and subcontractors are required to be APPLICANT CONTACT PERSON licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Business Nante: J,a.W A NLCLtA Wt4ST"VT%W jurisdiction where work is being performed. If the applicant is exempt Contact Name: from licensing,the following reason applies: � Address: kpkk; S E.• 4 _iK_c Cl•_ Cit /State/Zip: ;uy o JW • V M J-112. - -- - Phone So''?)V%V-J qr< I Fax: o _VIS43 - — ---- ---- -e—li til! !thyLL 50,5I S-71b BUILDING PERMIT'FEES" -r CONTRACTOR Please refer to fee schedule. -` Business Name:3.9. A04LP4 ST. Fees due upon application.............................. $ Address: ko Lk; LT. City/State/Zip: 't LL•S %b 1-0 (Ip044 �'{�_23 — Arnaunt received........ .................................... S Phone b%kb-.1444 1 Fax Date received_-__.____.—_ CCB Lic, #: 4 0'SID Authorized l� r_ -� Notice: This permit application expires If a permit Is not obtained i0thin Signature: ..W Date��wJ�d3 tall days after It has been accepted as complrte. f a_, !—�� � _ _— •Fre mcthodolow set by?rl-(banty,Bulldin�InduatrY Slrvlc $o, (Please print name) • 1-�l I I I Lr �I 013sts\Permil Forms\BldgPcrmitApp.doc 01/03 f i Commercial Flan Submittal j l:equh ement Matrix i C'i{r of'Tigard TYPE OF SUBMITTAL. # of Plans (Includes New, Additions or Alterations) Required at Submittal Site Work 4 (must include location of all accessible parking) Plumbing - Site Utilities "' 1 ' 2 Building �* Fire Protection System 3 Mechanical 2 a Plumbing - Building Fixtures 2 Electrical 2 a' Plan review is dependent upon submittal of a completed application aft d 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 & Rescue). *For over-the-counter commercial tendri?improvemert.s, submit 2 sets of pians. **"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. hdsts\forms\c0N1-matrix.doc 9124/01 r'iTV OF TIGARD 24-Hour .�il_DING t Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP Received Date Requested _ AM _ PM _— BUP Location 6) Suite— MEC Contact Person K�)C Ph( ) �� GU 3 D PLM Contractor _ Ph( ._ ) _ SWR BUILDING Tenant/Owner �c cC � >✓�G � _ v ELC � dO 2-2 2- Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors _ --- Ext Sheath/Shear v __ Int Sheath/Shear Framing - ----- -- Insulation Lam- ' � � E Drywall Nailing 0 L.G"��C- Firewall �G71L1. - —�% Fire Sprinklers T —. Fire Alarm Susp'd Ceiling - Roof Other: - -- - - - Final -------^^ f PASS PART FAIL - -- _- PLUMBING Post& Beam Under Slab - — — — -- Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole t SS -Ips n�, js�C S Storm Drain Shower Pan Other: Final --' PASS PART FAIL — - — ----- - _MECHANICAL Post& Beam Rough-In Gas Line Smoke Dampers _-- Firal PASS PART FAIL ELECTRICAL Service Rough-In UG/Slsb Low Voltage Fire Alarm inaF u PARFAIL Reinspection foe of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. T Sj n Please call for reinspection RE: Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date. fix - Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITYOF TIGARD __ SITE WORK PERMIT DEVELOPMENT SERVICES PERMIT# : SIT2001-00003 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED : 2/26/01 SITE ADDRESS: 15800 SW HALL BLVD PARCEL : 2S112CC-01100 SUBDIVISION: ZONING : R-12 BLOCK: LOT: JURISDICTION : TIG CLASS OF WORK: PAVINGY: Y RESO. NO: TYPE OF USE: COM GRADING ?: Y VALUE: $61,000.00 EXCV VOLUME: 100 cy LANDSCAPING?: Y FILL VOLUME: 150 cy SITE PREP ?: Y ENG FII-L?: STORM DRAINS?: Y SOILS RPT REQD?: IMPERV SURFACE: 0 sf Remarks: Parking lot addition. Owner: -- -� --- ---- __ TIGARD FRIENDS CHURCH FEES-- ---- 7130 5W BEVEL-ANDType Fly Date Amount Receipt TIGARD, OR 97223 PLCK CTR 1/18/01 $345.13 27200100000 FIRE CTR 1/18/01 $212.39 27200100000 PRMT CTR 2/26/01 $530.97 27200100000 Phone: 5PCT CTR 2/2.6/01 $4248 27200100000 Contractor: _! Total $1,130.97 PORTLAND ROAD & DRIVEWAY CO IN - - �— - 0500 SE JENNIFER Sr CLACKAMAS, OR 97015-9511 Phone: 503-650-5006 Reg #: L 1C 2271 Required Inspections Erosion Control Insp 846-8444 Grading Paving Insp Strm Drain Insp Culvert/Catch F isin Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laws All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987 - 77 Permittee Signature: Issued By: Call (503) 9- 175 y7- P.M. for an inspection needed the next business day Building Permit Application City of Tigard Datereceived: I i'lo, Pecmltno.. zit awe j5 Address: 13125 SW Nall Blvd,Tigard,OR 97223 Prolocr/appl.no.: Expire date: City of Tigard g Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503) 598.1960 Case file no. Payment tylx: Land use approval: �; r&2 family:simple Complex; e \1 U 1 &2 family dwelling or accessory U i'ominerciallindustrial U Multi-family U New construction U Demolition U Addition/alteration/replacement U Tenant impriwentent U Fire sprinkler/alarm U Other: 300 SITE LNFORRIATI-ON' Job address: f t a I Bldg.no.: _ Suilc no.: Lot: Block: Subdivision: _ Tax map/tax lot/account no.: Project name: Description and locatior,of work on pti-enises/special conditions: 1 1 1 Name: FQ1S+1/D (1-M _ „ Mailing address: 1&2 famBy dwelling: City: % State:�SZIP: Cl 71,Z 3 Valuation of work...................................... . Phone: 11"ax: E-mail. No.of bedrooms/batlts................................. caner s representative: / Total number of floors................................. Phone: I,,x: E-mail: New dwelling ---� — arca(sq.ft.) .......................... APPLICANT Garage/carpori arra r- ft N .................... Name: (,u, � Covered pon.h area(sq.ft.) ......................... Mailing address: 7t 2, > S:ct1 f Deck area(sq.ft.)........................................ City: State:�ti LIP: L 1 Other structure area(sq.ft.)......................... ~ 1— CommerclaUindustrial/multi-family: Plto�,c: Fax:._ E-mail: 1 1 Valuation of work........................................ $ (c (E►01+ Business name: Existing bldg.area(sq.ft.) .......................... } New bldg.area(sq.(t.) — Address: :r. CitY: State: -,r ZIP: ,• Number of stories........................................ ` Phone: Fax: E-mail: TYP"of construction........................ ........... CCB no.- — Occupancy group(s): Existing: _ City/metro tic.n --� �— New: Notice:All contractors and subconuvictors are required to be t licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may be required to be licensed in the Addms: jurisdiction where work is being performed.If the applicant is City: State: 7,Ip; exempt from licensing,the following reason applies: Contact person: _ — Plan no.: --- - Phone: Fax: I::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. I hereby cettify I have read and examined this application and the Na all Ju—d*IK-wu wcW pedis arils,r4ftw cal{judAk ion for mare torormanae attached checklist.All provisions of laws and ordinances governing this U Visa U MasterCard work will be complied with,whether specified herein or not. crcdit cud number Authorized signature:_____ DRtc: ---iv.W d rM „ „m peau e.nt Print name — -- —. c __w $-- �natre Amount Notice:This permit application expirrs if a Permit is not obtained within 1 R(1 days after It has been sevepted as complete. 4e1a�u(fical DM) n2'0/�4 1t` CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00012 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/27101 SITE ADDRESS: 15800 SW HALL BLVD PARCEL: 2S112CC-01100 SUBDIVISION: ZONING: R-12 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: A2 1 FLO k DRAIN°. TRAPS: STORIES: WATER HFATEr.S: CATCH BASINS: 1 FIXTURES _ LAUNDRY IPAYS: SF RAIN DRAINS: SINKS: 4 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: 100 ft Remarks: Plumbing permit for site utility work associated with parking lot addition. _ Owner: — ---- -= Type By Date FEESAmount Receipt TIGARD FRIENDS CHURCH OR 9722233 PRMT CTR ?_i26/01 $72 50 ?_7200100000 TIGARD, OR 97 7130 SW 2PLCK CTR 2/26/01 $18.13 27200'100000 5PCT CTR 2/26/01 $5.80 27200100000 Phone 1: _ Total $96.43 Contractor: PORTLAND ROAD & DRIVEWAY CG 10500 SE JENNIFER ST CLACKAMAS, OR 97015-9511 REQUIRED INSPECTIONS Phone 1: 503-650-5006 Storm Drain Insp Reg #: LIC 2271 Final Inspection This pt--mit 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 pans. 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 95?-0001-00'10 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued By: _ Permittee Signature:�?ty/, Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application Date received: i to Ic, Permitno.: `zL)oI C'oor Z� City of Tigard — -J Sewer permit no.: Building permit no Addrrss: 13125 SW Hall Blvd,Tigard,OR 97223 — --- -- CityojTigard phone: (503) 639-4171 ProjecUappl.no.: —_ Expire date: Fax: (503) 598-1960 'Date issued: Sy: Receipt no Land use approval: Case file no.: Payment type: ❑ I &2 family dwelling or accessory ❑Commercial/industrial ❑Multi-family !J Tenant improvement ❑New construction U Add ition/alteration/n.placement :I Food scrvice '21'Other:FEYNCIIII)l Information we check 1-4) e Job address: !,u -t-'ro'- ;j Description U ..f Fee(!!.) Total Bldg.no.: 1 gpo ';1(k) t} SVi*=.c -- _ - New I-and 2-family dwellings only: Tax map/tax lot/account no.: (Includm 100 0.for Tach utility connection) SFR(1)bath Lot: Block: Subdivision: SFR(2)bath ---- Pr_oject name: SFR(3)bath City/county: — ZIP: Each additional bath/kitcher. Description and location of work premises: Silleuililitles: AT)b, ��-o-I Az �t}1(rj�,�(T Catch basin/area drain Q � Est,date of completion/inspection: Drywells/leach line/trench dr in p Footing drain(no.lin.ft.) I Manufactured home utilities _ Business name: _ Manholes Address: Rain drain connector City: State: ZIP: Sanitary sewer(no.lin. ft.) Phone: Fax: I E-mail: Storm sewer(no.lin.ft.) CCB no.: Plumb.bus.reg.no: Writer service(no.lin.ft.) _ City/metro lic.no.: Fixture or Item: Contractor's representative signature: —-- Absorption valve Back flow preventer Prim name: Datc: Backwater valve 1111101 I= Basins/lavatory Name: __17_007 1-1 %Jk Jf turd (2e, A.) Clothes washer Dishwasher Address:/eIZY' cit J ojo,r%&. `r Drinking fountain(s) City: /I^a ,'f/'f,, a State:' ZIP: Ejectors/sump — -- Phone: ,� /r;n ,;:. Fax: -mail: Expansion tank Fixture/sewer cap _ 1%/ R1 7 1�+l CYtAt - ' Floor drains/floor sinks/hub Name (print): --� f c�� Garbage disposal Mailing address: -...c T-&V'l t o,4 : [lose bibb_ City: _i State: ZIP: Ice maker Phone: Fax: E-mail: Interceptor/grease tra Owner instal lation/residential maintenance only: The actual installation Primers) _ will he made by rile or the maintenance and repair made by my regular Roof drain(commercial) employee on the property 1 own as per ORS Chapter 447. Sink(s),basin(s),lays(s)__— Owner's si nature: Date: Sump _ Tubs/shower/shower an _ Name: Urinal^ _ --- ater closet Address: Water heater City: State: ZIP: — _ Other:-- Phone: _ Faxes E mail: Total Ncm all indsdictioru accept credit carts,plow can iuri,.ktion for u.. Informarlon. Minimum fee................$ Notice:'this permit application ]Visa U MasterCard expires if a permit is not obtained Plan review(at — %) $ _ Cn.dit card numha.__- --- —�� State surcharge(8%)....$ — - within 190 days alter it has been TOTAL ....................... accepted as complete. S Name or ean.::older as shown on credit card —��Eiydholtler signature ��— --Amouni_ 410-4616(&MICOM) PLUMBING PERMIT FEES: -� Ne PRICE TO'iAL- w'i and 2damlly dwellings only: FIXTURES (Individual) AMOUNT (Includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (aa) AMOUNT for each utility connection) Lavatory 16.60 $249.20--1--' -_ - - - �- One 1 bath _ Tub or Tub.!Shower Comb 16.60 Two 2 bath $350.00 Shower Only --_- 16.60 -_ Three 3 bath $399.00 _- Water Closet 16.60 SUBTOTAL Urinal 16.60 8%STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL _ 1+ Disposal 16.60 TOTAL t.aundry Tray 16.60 /hashing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4" 16.60 --- Water Heater O conversion O like kind 16.60 Quantity b f Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ ermit. __ -__^ Capped MFG Home New Water Service 46.40 Sink _ MFG Home New San/StormSewer 46.40 Lavato _- __ Tub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Orl _ Drinking Fountain 16.60 Water Closet Other Fixtures(Specify) 16.60 Urinal_ Dishwasher Garbage Disposal - Laundry Room Tray Washina Machine Floor Drain/Sink- 2" Sewer-1st 100' 55.00 �• �� -, Sewer-each additional 100' 46.40 _ 55.00 Water Heater I Waley Service-1st 100' -- Water Service-each additional 200' 46.40 Other Fixtures _ (specify) Storm&Rain Drain-1st 100' 55.00 Storm&Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential flat mw-Prevention-Device' 27.55 - - -- ' Catch Basin 16.60 /��' ' Inspectio,l of Existing Plumbing or Specially 72.50 Re uestad Inspectionsper/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 -- Grease Traps 1660 -- ------ QUANTITY TOTAL Isomefnc or riser diagram is required If ----- OoanttTotal Is ,9 _ 'SUBTOTAL --- -- 8%STATE SURCHARGE ~ - - "PLAN REVIEW 25%OF SUBTOTAL Required only If fixture qty total Is>9 TOTAL s *Minimum permit fee Is$72 50+8%slate surcharge,except Residential Backflow Prevention Device,which N$3625+e%state surcharge "All New Commercial Buildings require plans with Isometric or riser diagram and plan review I:\dsts\torms\plm-fees.doc 10/10/00 M CITY Cl F TIGARD ELECTRICAL PERM1� PERMIT#: ELC1999 10292 DEVELOPMENT SERVICES DATE ISSUED: 5/17/99 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S112CC-0 i 100 SITE ADDRESS: 15800 SW HALL BLVD SUBDIV!SION: ZONING: R-12 BLOCK: LOT : JUPVSDICTION: TIG Proiect Description: Electrical for a new sign or outline lighting. RESIDENTIAL UNIT TEMP :;RVCIFEEDERS — _ MISCELLANEOUS 1000 SF OR LESS: — 0 - 200 amp: PUMP/IRRIGATION. EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG- 1 LIMITED ENERGY: 401 - 600 amp: SIG�'AL/PANEL. MANF HMI SVC/ F71R: 601+amps - 1000 volts: MINOR 1-1EL (10): _ SERVICE/FEEDER --- BRANCH CIRCUITS _ _ ADD L I-WiPECTIONS 0 200 amp: W/SERVICE OR FEEDER: — PER INSPECTION: 201 400 amp: 1st W/O SRVC OR FDR: 0 PER HOUR: 401 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ PLAN REVIEW SECTION 1000* amplvolt: >=4 RES UNITS: > 600 VOLT NOMINAL: _ Reconnect only: __. __ SVC/FDR >= 225 AMPS: _CLASS AREA/SPEC OCC______ 11 Owner: Contractor: TIGARD COMMUNITY FRIENDS CHURC YOUNG ELECTRIC SIGN CO 15800 SW HALL BLVD 416 FAST 41 ST ST TIGARD, OR 97223 BOISE, ID 83714 Phone: Phone: Rcg 0: LIC 000693 ZIJP 445SIG ELL 37-51 CLS FEES _ — Required Inspections Type By — Date Amount Receipt Elecf'I Final 5PCT GEO 5/17/99 $2.00 99-315358 PRMT GEO 5/17/99 $40.00 99-3153580 R I n Total $42.00 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laws. All work will be done in accordance% ith 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 Notlication Center Those rules are set forth in OAR 952-001,-0010 through OAR 952-001-0080 You may obtain copies of these rules or direct questions to OUNC at(503) '246-1987 7. / / - Permit Signature: �t) Issued By: OWNER INSTALLATION ONLY —_-- The installation is being made on property I own which is not intended for salE, lease, or rent. OWNER'S SIGNATURE: —. — _ — DATE:------ CONTRACT OR ATE:—_— - CONTRACTOR INSTALLATION --_-----— —--- --------_-— _—--- \ _ONLY � �Y� DLJ B'Z —SIGNATURE OF SUPR. ELEC'N: : LICENSE NO: — _ ----- -- -- Call 639-4175 by 7:00pm for an inspection the next business day CITY OF TIGARD Electrical Permit Application Plan Check# 13125 SW HALL BLVD. Recd By C` ( TIGARD OR 97223 Date Ree'd_- _.- Date to P.E. _ Phona (503)639 4171, x304 Print or Type Date to DST- Inspection (503) 639-4175 Permit 4�C -1 -onay12- Fax (503)684-7297 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fee Schedule Below: Name of DevelOpmantNumber of Inspections per permit allowed Name(or name ofbusiness) Ticlard Community Service included: Items Cost Sum Friends Church Address s _ � }- _ -.�____�_ 4a. q,it t or -per unit 1000 sq. loss s $11000 4 City/State/Zip_ `r__;r-d_QR--- 7 2 21 -- Each additional 500 sq,ft.or Commercial❑ Residential ❑ portion thereof $25.00 1 I imdod Energy J $25.00 Each Manu1'd Home or Modular Dwelling Service or Feeder $68.00 22a. Contractor installation only: (Attach copy of all current licenses) 4b.Services or Feeders FlectricalContractor Youu Electric Sian _'�� Installation, aeon,orrelocauon �- l 200 amps oorr less $60.00 2 Address22_0 -$ LPE _ _- 201 amps to 400 amps $80.00 2 -----State gam__ Zip--9_7-Z1-G__ 401 amps to 600 amps - $120.00 _ 2 Phone No._ _ter g. �� 601 amps to 1000 amps $180.00 2 Job No. a n n Over 1000 amps or volts $340.00 2 z --�3 2 3 44 --- --- Reconnecl only $5000 2 Elec. Cont. Lice. No. _ 7 1--meq_Exp.Date____-OR State CCB Reg, No. 6 9 3 n -Exp Date 9--?6-9_9- 4c.Terimorary Services or Feeders COT Business Tay,or Metro No. Exp.Date 1 a-i_ci Installation,alteration,or relocation 17 - 200 amps or IFiss $50.00 _ 2 Signature of Su r. Elect. 201 amps to 400 amps $75.00 2 g p 401 amps to 800 amps $100.00 r? Over 600 amps to 1000 volts, Ic License No... L k S Exn.Date see"b"above. Phone N0. S03-220-8167 --- 4d.Branch Circuits Now,alteration or extension per panel 2b. For owner Installations: a)The fee for branch circuits with purchase of service or Print Owner's Name feeder tee. Address v_ Each branch circuit $5.00 ---,--- --- -- b)The fee tar branch circuits City State Zip _ without purchase of Phone No._ ,�--_-_ __ I service or feeder fee. First branch circuit $35.00 The Installation is being made on Droperty 1 own which is not Farh additionri branch circuit, $5.00 -_ intended for sale, lease or rent. 4e.Miscellaneous (Service or feeder not Included) Owner's Signature Each pump or Irrigation circle $40.00 Each sign or outline lighting -� $40.00 3. Plan Review section (if required):' Signal circult(s)or a limited energy panel,alteration or extension $40.00 Minor labels(10) _ $100.00 -- -- Please check appropriate Item and enter fee in section 5B. - 4 or more residential units in one structure 4f.Each additional Inspection over _Service ano feeder 225 amps or more the allowat,;,,in any of the above Svstem over 600 volts nominal Per Inspection $3900 - ....... _ _-!.'lassifled area or structure containing special occupancy Per hour $55 00 -- - T as described In N.E.C.Chapter 5 In Plant $11500 ---- Submit 2 sets ul plans with application where any of the above apply. S. Fees: Not required for temporary construction services. 5s,Enter total of abovo fees $ 5%Surcharge(.05 X total lees) $ --2-nn NQTI-QE Subtotal $ - - 5b.Enter 25%of line So tot PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if reaulred(Sec.3) $ ---- NC.1 COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. T I T ruat Account# _ $ 42. 00 Total balance Due 10STMELC99 Am nev 9/96 - C: i'Y OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 - BUP _ `— Date Requested �`�-�� FSM PM BLD Y-- Location ��d �y 5� ' �� _ Suite MEC Contact Person _ Ph �Z 3 GsZ S��'G PLM 2 Zs= c- Contractor Ph SWR __— FUI_LD ING Tenant/Owner ELC Retaining Wall _—_ ELR Footing Access: FPS ---- Foundation —_ Ftg Drain SGN Crawl Drain Inspection Notes: Slab ------- ------- -- _ SIT- <�C3 L Posr& Beam Ext;,heath/Shear _ Int Shiath/Shear — Framing --_ ___—_—�----------- —.------ -- --- Insulation Drywall Nailing ---- -- --- — ---- -_— — ------ --------_Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling _—�_—__ _-----------_— --__.---- ----- --_ -- ---____ Roof Misc:_ --- - ---- -----— -- --- —_ ------ Final — — PASSPART FN! -.------._----___—_-----_-------^�_--_. ------.__.--_-_-_. PLUMBING Past& Beam ------- -..�- ----------�_..—.—�___-____ —..----------- Under Slab --- --- --- ---- ---— -- -- -- Top Out Water Service Sanitary Sewer Rzin Grains Final ----___..�------------_ _ �-- ----- -- - — PASS PART FAIL MECHANICAL - .._. ___-- ------- --- -- ------- --- Post&Beam ----------- ._... ---- Rot.gh In Gar,Line -- ----- Smoke Dampers Final ----- —-- ------ - ----— PASS PAIT FAIL. ELECTRICAL ------ Service Rough In - UG/Slab Low Voltage Fire Alarm Final -__--- — PASS PART FAIL - -- Sandav Sewer Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd ,atch Basin ( ]Please call for reinspection RE _._ _--- —__ ) ) Unable to inspect-no access Fir a upp y Line ADA Approach/Sidewalk Other Date - i A �_ Inspector _^ Ext VL -PART FAIL DLJ NOT REMOVE this inspection record from the job site. CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 ST INSPECTION DIVISION Business Line: (503)639-4171 Received Fc _ Date Requested_______ _ __ AM PM BIjP .- Locetion �L_ _ Suite—_ _ MEC Contact Person __._ — Ph( ) © U PLM Contractor_ ----- ------ P"h"(" /—) - SWR -- -- . - -- BUILDING r Tenant/Owner � _., 1d.[ � _ —_ ELC — Footing ELC Foundation Access: L-1, u-..� t Ftg Drain ELR _ Crawl Drain RITC / Slab Inspection Notes: „ Post& Beam f �' `' Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - — — Insulation Drywall Nailing — - _- - Firewall Fire Sprinkler -- - -- - --- - ----- - Fire Alarm Susp'dCeiling ---- ----- Roof Other: -- Final PASS PART FAIL__ -- PLUMBING Posi&Beam Under Slab -- --- Rough-In Water Service -- - Sanitary Sewer Rain Drains ------__ _ Catch Basin i Manhole Storm Drain - - Shower Pan _ Other - Final PASS PART FAIL ------ - ��-- MECHANICAL /- Post&Beam Rough-In Gas Line Smoke Dampers --- - - Final PASS PART FAIL2- -- --- ELECTRICAL C. w-Z^ d Service Rough-In UG/Slab Low Voltage Fire Alarm Final SPART FAIL Reinspection fee of required before next inspection. Pay at Ciiy Hall, 13125 SW Hall Blvd. Please call for reinspe tion RE:- ____— [] Unable to inspect-no access $Wrepply LineADA Approach/Sidewalk Date 1I_ _ Inspector __ ---__.—Ext_ Other - --- DO NOT REMOVE this Inspection record from the Job site. PART FAIL