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12540 SW MAIN ST STE 110
A
CITY OF T I C A R D CERTIFICATE OF OCCUPANCY
DEVELOPMENT SERVICES PEPMIT#: BUP2000-00458
h4 a 13125 SW Hall Blvd.,Tigard,OR 97223 (603)639-4171 DATE ISSUED: 2000
PARCEL: 2S 2102102AC-0070Q
ZONING: CBD
JURISDICTION: TIG
SITE ADDRESS: 12540 SW MAIN ST 110
SUBDIVISION: BURNHAM TRACT
BLOCK: LOT:001
CLASS OF WORK: ALT
TYPE OF USE: COM
TYPE OF CONSTR: 5N
OCCUPANCY GRP: B
OCCUPANCYLOAD: 9
TENANT NAME:
REMARKS: Commercial TI
Owner:
DOLAN+ CO LLC
BY FLORENCE T DOLAN
4025 SE BROOKLYN
PORTLAND, OR 97202
Phone:
Contractor:
GRIGSBY CONSTRUCTION INC
5845 JEAN ROAD
LAKE OSWEGO, OR 97035
Phone: 503-675-8000
Reg#: LIC 45073
a
oc
_J
m
JThis Certificate issued 01/26/2001 grants occupancy of the ab-)ve referenced building or
portion thereof and confirms that the building has been inspected for compliance with the
State of Oregon Specialty Codes for the group, occupancy, and use under which the
reference ,rmit was is
BUILDING INSPECTOR UILDI 1 1
POST IN CONSPICUOUS PLACE
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24--lour Inspection Ling: 639-4175 Business Line: 639-4171
/ BUP Tir d�l�fi$
Date Requested_ �AM PM
LocationI SGV 61Wr. 4r—«0 _ Suite MEC ;ADD -Abd?Z
Contact Person _ Ph ��� �3 _ PLM
Contractor Ph _ SWR
BUILDING i Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SIGN
Slab SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear 7 +� 7
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _
Roof � �a
Mi _ — _
PART FAIL ---- — --�
PLUMBING
Post& Beam
Under Slab
Top Out I — --
Water Service
Sanitary Sewer —
Rain Drains
Final
PASS PART FAIL
C !
Post& Beam --
Rough In
Gas Line —
S Dampers
PAS PART FAIL
ECRTRICAL -
Service
IL Rough In
HUG/Slab ---�_
N low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
to Backfill/Grading -- —"—
J
Sanitary Sewer
Storm Drain [ ]Reinspection fee of S required before next inspection. Pay at City Hall. 13125 SW Hall Blvd
Catch Basin [ Please call for reinspection RE:. ( J Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Inspector Date / / /
Other P� / Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the Job site.
/ \• CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT#: ELC2000-00649
iNA DEVELOPMENT SERVICES DATE ISSUED: 11/28/2000
13125 SW Hall Blvd..Tigard, OR 97223 (503)639-4171 PARCEL: 2S102AC-00700
SITE ADDRESS: 12540 SW MAIN ST 110
SUBDIVISION: BURNHAM TRACT ZONING: CBD
BLOCK: LOT : 001 .JURISDICTION: TIG
Proiect Description: Installation of service and 15 branch circuits. S0(3 Ne . 9135
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/FDR: 601+8mps-1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W/SERVILE OR FEEDER: 15 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amp/volt: >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVC/FDR>=225 AMPS: CLASS AREA/SPEC CC:
Owner: Contractor:
DOLAN + CO LLC PHOENIX ELECTRIC CO
BY FLORENCE T DOLAN 7379 SW TECH CENTER DR.
4025 SE BROOKLYN TIGARD, OR 97223
PORTLAND, OR 972U2
Phone: Phone: 684-3600
Reg#: LIC 00052288
SUP 4140S
ELE 34-247C
FEES Required Inspections_
Type By Date Amount Receipt
Ceiling Cover
PRMT CTR 11/28/2000 $180.05 2720000000( Wall Cover
SPCT GTR 11/28/200( $14.40 2720000000( Elect'I Service
Elect'I Final
Total $194.45
This Fermit is issued subject to the regulations contained in the Tigard Municipal Code.State of OR. Specialty Codes and all other applicable laws.
IL All v ork will be done in accordance with approved plans. This permit will expire if r A is not started within 180 days of issuance,or i(work is
a suFpended for more than 180 days. ATTENTION. Oregon law requires you to follow i ides adopted by the Oregon Utility Notification Center, Those
N rules are set forth in OAR?52-001-0010 through OAR 952-001-0080. You may obtain copies of these rules ordlrect questions to OUNC at(503)
246-1987.
PERMITTEE'S SIGNATUREOA/ r9/'r°����r'74r/ ,fi x�� ISSUED BY: -
0 OWNER INSTALLATION ONLY
W -- -
--� The instal;ation is being rude on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: - DATE:
LICENSE NO:
Call 639-4175 by 7:00pm for an Inspection the next business day
NOV-28-2000 TUE 08;46 AM PHOENIX ELECTRIC, CO FAX N0, 15036843611 P, 02/03
- �
Electrical Permit Application
— nate rocr!ivcd: ii �� Pernlll no.:'&W 2o1y 0 6Y9
City of Tigard RECEIVED Prnp,yappl.no.: — Hxpintdate;
of T ignn! —
/lddresx: 13125 SW Vial] Blvd,Tigard,OR 97223 Varclssued: T1 !heel Itnn.:
Ci l y Y: 1
pl-me: (503) 639-4171 NOV 2 2000
Fax: (503) 599-1960 Caeefilono.: Payment type:
Land me approval: _XMMUK IY DEYE;QP_MENI
1'
U I & family dwelling or accessory lnnirrclaliindusltial U Mull-famlly Q<Cnant improvement
U New conslruclion Addition/altci,uticnrr.:plaumenl 0 Other: ❑f atrial
Is
.fob address; V p (,.) , 131d .no.: I Suite no.: Trx tnalr/rax Jot/account no.:
Lia: 1110t.k; Subtlivision:
I'ruju I nanlr: h T ih cription and location of wodc on rr.miscs: , .a
Fsliultled(late of com Ictionlimpcction: L 2
Job no: �l��s _
-
Business Warne: Dar"riptigrt eat&) Tolwl ne.'na
v�' r IVewntaidarrl siryk of Nwilld#aAly par
Atldrtas; /,3 `3(J Tec_ �w_ Qn dweI111Konktnclydaatt.mirrdgarage,
Cily. i, a State: 0 71P: S ZZ,� 3enitsincluird:
ION a4.ft.or Irre
Phone: � Y-_.3 ,ml :�1e: �r�Y_3� G mnii:
! dh
a y�G Fnch adnnal�' ho0&I.rL or onion themor
CCII nn.: .�. � Elec.bus,lic,no: ��� — Limited enerpy,nmiden0al 3
Ci! ittleirnIie,no.: Urnitedenerry,non-reeldenlal 3
Lino,mnnuractur xi home or modulor dwelling
dLr
---------- , --• - T ' bService
eand/or fee -
— 2i�nawre ofsurvsng ele0rieinu(required) pae - eederwd -
suelrr,oan+c(print):rANJ,
oak P,4,4—J License no:3 163 f,
ahteratton or relerelien:
2nn amps or less 3
Name.(print): 10T; to s 100 amps - 3
_..-. .._--_- -
40111111113 to 600 amp3 2
601 amps to 1000 ampe 1
State:iZ1P: Over 1000 amps or vola 2
Pharr.: �— Fax: F.mall Rtetrneolonly
—�. — --
6kvner installation:Thr inls(allution is hcing made on property I own Tamperwryrerrlceaorfetders-
which is not infendrd for s:dc,lease,rent,or exchange according to 200 t opsfiratterallop,errelogdbn:
O S 447,455,479,670,701. 200 am s t—.4 2
201 amps to 4 ampe 2
Owner Is sl mature; Onte: 401 to RO(t ams 3
Branch eirculta-new,a leralion,
or exle"Ieft per panel.
Nome:_ T A. Pee ror branch circuits with purchase af
Address: service or feeder fee,each branch circuli 3
Cl ly: Stute: ZIP: R. Fre for brtltich 0"Ite without purchase
of service or reeler fee,first branch circtil: 2
L Phnno; tax: 13-mail: t ur.l aT Jili[lopal hfanchclrcu l: --
Abe.($e�ee or feeder net lhcladed)t
U lZervic a over 225 amps-comuvetri&1 0 Heallh,tare racility, Each pump or Irrigation eintla 3
U Servicc over 370 amps•rating of I&I U Hazardous Iut.alit-41 Rach sign or oniline lightingZ
family dwellings ❑Ouilding over 10,000 sgmm-:--at four or gignal eireuir(s)or a limited etletly pnncl,
J USyslcrrtover 6011volts nonllnul mnn,rurldcnikdouihinmm.Ruucluru altara,inn,ercxtrtulon•
U Building overthret stories U Riders,400 mops or mntc •Uoa:rl lion:r.� _
U occupant load over 99 persona G Manufacturd aructuras or RV park F2ch a dil e-nat impeerlon ever the allowable Its stay of Iha aboral
u U Itgres+Jlirhring plan U Mier: Pc ms ecdon
anbmll,—_stets of plane with any of(lie abrtve. I Invcsli,nlinn fee �-
11he ohove or-not applicable to temporary constrtscllon sartiee. other
Nm all lari•:JknlaM acce{M rtMii caar
cud,pfce call jorlsd'ctlnn Cor o-- n inrinna,1w. Notice:Tlile permit nppliication I'r,:rmil fl`.0.....................$
U vi^a O Mastercard expires if a permil is not obtained flan revlcw(at __,_ %) $ _ r
e,c,lu owd ImrnWr• within 180 days after It has been Slate surcharge(R%) ....$ r o
`� neccpted ixc enlnplcic. TOTAL ...$ •
s6ewn on ct 1 card IS_
s
--Cunl'61ld,:r s snatom moon, 41n nali(tM cum)
NOV-28-2000 TUE 08:46 AM PHOENIX ELECTRIC CO FAX NO, 15036843611 P. 03/03
.
Electrical Permit Fees: Limited Energy Fees:
Com Isle Fee Schedule Below: TYPE OF WORK INVOLVED-RESIDENTIAL ONLY
P Restricted Energy Fee................. . $70,00
Number of inspection*per pertnit allowed
(FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work InvolvQd,
Residential-per unit
1000 sq.It.or less $145.15 4 ❑ Audio and Stereo 9y31ems
Each additional 500 sq.R,or
portico thereof $33.40 1 ❑ Burglar Alarm
Llmlted Energy $75.00
Each Manul'd Horne or Modular ❑
Owulling Service or Foodur $90.90 — 2 Garage Door Opener
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alleralkm,a relocallon
200 amps or lets �T $80.70 J .3a 2_" ❑
201 amps to 400 amps $106.85 2 Vacuum Systems'
401 amps to 600 amps S16o,60 _ 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000:imps or volts _ 5454,65 2
Reconnect only 566.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED.COMMERCIAL ONLY
InFtallation,alteration,or relocation Fee for each systirn.......................................................... $75.00
200 amps or less :66.85 2 (SEP OAR 918-260-260)
201 amps to 400 ompa $100.30 2
401 amps to 600 amps , $133.75 2 Chock Typo of Work.Involved:
Over 600 amps to 1000 volts,
see"b"above. Audio Ond Stereo Systems
Branch Circuits ❑
Now,alteration or extension per panel Boiler Controls
a)The fee for branch circuits
witrn purchase of service or ❑ Clock Systems
fbodur fen. Q
Each branch circuit �+� — $6,65 9 1 s ��_ 2 ❑ Dela Telecortxnunicallon Installation
b)The foe for branch circufls
without purchase of service ❑ Fire Alar Installation
or fader fee.
Fir-At boner circuit _ $46.85 -_J r�
Each additional branch circult $6.65 l. HVAC
Miscellaneous ❑ Instrumentation
(Servica or feudur not included)
Fach pump or Inirjatlon circle $53.40
Each sign or ovnlne lighting S53.40__ ❑ Intercom and Paging Systems
Signal clrvuil(s)or a limited energy
panel,alteration or oxtonsion _ $75.00 ❑ Landscape Irrigation Control'
Minor Labels(10) _ S125.00 _
Medical
Each additional Inspection over v ❑
the allowable In any of the above ❑
Per inspection $02,50 Nurse Calls
For hour _ $62.50_
1n Plant $73.75 J Outdoor Landscape UShtln0'
L Fees: ❑ Protecdve Signaling
C Enter total of above frets $ Da'D s ❑ Other
R%State Strrcnargn $ 1 Y. I d Number of Systeme
J 2556 Plan fn vlaw Reelaw"aMaion on Foo
he
See"Pt7ov ' No 11conses are required. Limmas err required for ed ether Install
s S asons —
u front of application. --
u —cl Foos:
a Tara!Balance Due 5 �g I.g s—
( � Enter total of above fees S
YNTrust Account N u_�� _ 6%State Surcharge $
Total Balance Due $
i 41,vofnrrrutelc-fees.doe 10/09/00
CITY OF TIGARD PLUMBING PERMIT ,__
DEVELOPMENT SERVICES PERMIT#: PLM2000-00433
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171 DATE ISSUED: 11/28/00
SITE ADDRESS: 12540 SW MAIN ST 110 PARCEL: 2S102AC-007'00
SUBDIVISION: BURNHAM TRACT ZONING: CBD
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of new plumbing fixtures for commercial TI.
Owner: FEES
Type By Date Amount Recelpt
BY FL + N E T PRMT CTR 11/2.8/00 $72.50 27200000000
40 FLORENCE T YN 5PCT CTR 11/28/00 $5.80 27200000000
4025 SE BROOKLYN _
PORTLAND,OR 97202 Total $78.30
Phone 1:
Contractor:
EAGLE PLUMBING
13801 S FORSYTHE RD
OREGON CITY, OR 97008 REQUIRED INSPECTIONS
Phone 1: 503-650-8703 Rough-in Insp
Reg#: LIC 47914 Underfloor/Underslab
PLM 3-154PB Top-out Insp
Finan Inspection
C
vThis permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
i
Issued By: �,��,o _ y Permittee Signature:
Call(503) 639.4175 by 7:00 P.M.for an Inspection needed the next business day
>t
Plumbing Permit Application
7p,,nt
r Z eF M) Pemhit no.*./e/j
City of Tigard Building permit no,: - "Poo _
40
Address: 13125 SW Hall Blvd,Tigard,OR 97223
Aq
CirvofTigard phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: hy:.L/`;r* Receipt no.:
Land use approval: Case file no.: Payment type:
U i &2 family dwelling or accessory (XCommercial/industrial 0 Multi-family MiTenant improvement
Mk New construction U Addition/alter,5tion/replacement U Food service U Other:
Job address: 0 _ _
Description Fee ea. finial
Bldg.no.: Suite no.: New 1-and 2-famlly weWngs only:
'Tax map/tax loUaccount no.: (ttecluder100It.for eaehuttlftyconnectbn)
SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath _
Project name: SFR(3)bath
City/county: ZIP: Each additional bath/kitchen
Description and location of work on premises: _ Siteutilitles:
Catch basin/area drain _
Est.date of completion/inspection: -dC Lf" Drywells/leach line/trench drain _
Footing drain(no. lin.ft.)
Manufactured home utilities
Business nam, : t�PNa_c` �$c� Manholes
Address: 13 8QA $,_ Rain drain connector
City: ,( State: r-w- ZIP.17 ^ Sanitary sewer(no.lin.ft.) _
Phone: SZ3. -k_87O Fax: .gni Email: Stotm sewer(no.lin.ft,)
CCB_no.: yTg I _ Plumb.bus.reg,no_3 t 5*1 Wp to service(no. lin.ft.)
City/metro lie.no.: Fixture or Item:
Contractor's representative signature: Absorption valve
Print name: Dates Back flow recventer _
Backwater valve _
Basins/lavatory
Name: Clothes washer
Address: Dishwasher
City: State: ZIP: Drinking fountain(s)
Ejectors/sump
Phone: Fax: E-mail: Expansion tank
Fixture/sewer cap
Name(print): I U3-'U lw7 S ka Floor drains/floor sinks/hub _
Mailing address: vy V,AA I N Garbage disposal
—1Z- --� Hose bibb
tl
City: T-1 U State: pL ZIP: _ ice maker
� Phone: Fax: E-mail.• lnlerce for/grease trap
Owner installation/residential maintenance only: The actual installa!ion Primer(s)
will be made.by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s)
-� Owner's signature: Date: Sump
m T•ubs/shower/shower pan
t9 Urinal
W Name: C t �rA,
— Water closet
Address: � -` �_ Water heater
City: r� A State:d ZIP: ��� Other:
Phone: 2 Fax: E-mail: Total
Not all jurisdictions accept credit earls,please call jurisdiction for«xre information Minimum fee................$ �e� s O
Notice:This permit application plan review
U visa LiMasv!tCard expires if a permit is not obtained (at __ %) $
Credit card number: _:. - / I within 190 days after it has keen State surcharge(8%)....$
Expifef TOTAL
Namenfcudhnlderushown oncredit card accepted as complete, .......................a --7k) 0
_ S
Cardholder sisnatme Amount I,61tN616(60YCOM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 24amlly dwellings only:
FIXTURES individual,-_ QTY ea AMOUNT (Includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 2p the dwelling and the first100 ft. CITY AMOUNT
Lavatory 16.60 for each utility connection) _ -
One(1)bath $249.2_0 _
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
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60 -
Washing Machine 16.60
Floor Draln/Floor Sink 2" 16.60
3" 16,60 PLEASE COMPLETE:
4" 16.60
Water Heater O conversion O like ki.mri 16.60 Quantity b I Work Performed
Gas piping requires a separate mechanics; / /G, ,(art Fixture Type: New Moved Replaced Removed/
permit. _ - -- Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 4640 Lavatory _-
Tub or Tub/Shower
Hose Bibs 16.60 Combination _
Roof Drains - 16.60 Shower Only _
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) - 16.60 Urinal _
Dishwasher
_
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer-1 sl 100 55.00 3" -'-
Sewer-each additional 100' 46.40 _ 4" -
Water Service •IM 100' 55.00 Water Heater -
Water Service-each additional 2.00' 4640 Other Fixtures
(Spec fy)
Storm d Rain Drain-1st 100' 55.00
Storm&Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specialty 72.50
Requested Inspectionsper/hr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram Is required if -
Quantity Total Is >9
% 'SUBTOTAL -
8%STATE SURCHARGE - -- -------
"PLAN REVIEW 25%OF SUBTOTAL
Required only If fixture qty.total Is>9
TOTAL $
a
"Minimum permit fee Is$72.50 4 8%state surcharge,except Residential Backflow
Prevention Device,which is$36 25+8%state surcharge
"All New C ommercial Buildings require plans with Isometric or riser diagram and
plan review
L%cistslformsom-fees.doc 10/10/00
CELECTRICAL PERMIT
CITY O F T I G A R D
PERMIT#: ELC2000-00652
DEVELOPMENT SERVICES DATE ISSUED: 11/29/00
13125 SW Hail Blvd.,Tigard,OR 97223 (503)6394171 PARCEL: 2S102AC-00700
SITE ADDRESS: 12540 SW MAIN ST 110
SUBDIVISION: BURNHAM TRACT ZONING: CBD
BLOCK: LOT: 001 JURISDICTION: TIG
Prolect Description: Outline lighting for sign
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
9000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGNIOUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS _ ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 4 3 W/O SRVC OR FDR: 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 o!i!y: SVCIFDR>=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
DOLAN + CO LLC HIGHLIGHT SIGN CORP
BY FLORENCE T DOLAN 8200 SW HUNZIKER
4025 SE BROOKLYN TIGARD, OR 97223
PORTLAND, OR 97202
Phone: Phone: 503-620-8205
Reg#: LIC 00104599
SUP sig517
ELE 26-888CLS
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final `
PRMT CTR 11/29/00 $75.00 2720000000(
5PCT CTR 11/29/00 $6.00 2720000000(
Total $81.00
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 with approved plans. This permit will expire if work is not started within 180 days of issuance,or U work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules , topted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-0010010 through OAR 952-001-0080 You may obtain copies of these rules or direct questions to OUNC at(503)
246-1987.
PERMITTEE'S SIGNATURE 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: __. DATE:
LICENSE NO:
Call 6394175 by 7:00pm for an Inspection the next business day
Electrical Permit Application
Date received: IPermit no.:Ek-,, o
T .ecr✓S Z
City of Tigard Project/appl.no.: Expire date:
City ofTigarr/ Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date is-cued: By:� Rcceiptno.
Phone: (503) 639-4171 — — —
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
U 1 &2 family dwelling or accessory tFo6merc:ial/industrial U Multi-family U Tenant improvement
U New construction U Addition/alteration/replacement U Other: _ U Partial
Joh address,: 1 s¢p C,CO, Bldg. no.: Suite no.: Tax map/tax Iot/account no.:
Lot: Block: Subdivision:
Project nnrne: Description and location of work on premises: hWt W jpA t,t.. 5;
Estimated dale of completion/inspection: 17� D D
". Mwp gMjW f
Business name: N 1 `/&*t r -�',/10, L1�►'l� ^--- De" ion Qty. (OL) Tout no.Ins
or mai
New
Address: gr Sill jt(l�l lClrs - �- raldeNhtI-si ni ft l-faWAY per
daellYrs tarty.Intclades attxitsd prase.
City: r1 17 S(ate:O ZIP: TIA,'43 Serrkehtclr+kd
Phone: /J o- ;o5 Fax:( -'jr) E-mail:NL//,N'f A, 0.1000 sq.ft.orless 4
Each additional 500 sq.ft.or portion thereof
_
CCB no.: /pµf'f9 Flet.bus."C'no: S/(��F-� Limited energy,residential 2
City/metro lic.no.: 3 7(eg Limited energy,non-residential 2
F-Ach manufactured home or modular dwelling
Signature of supervising etmilician(required) Dote Service andlor feeder 2
Sup.elect.name(print): License no: Services or feeders-Installation,
alteration or relocation:
200 amps or less 2
Name(print): �F„p�eJ 4 (e�,, � � 201 amps to 400 amps - 2
Mailing address: 1 d1tAJ �� �� _401 amps tol'10amps - _ 2
601 amps to R'10 amps 2
City: I State:00. ZIP: _ Over l000 amr -volts _ 2
Phone: lool Fax: E-mail: Reconnect only t
Owner installation:The installation is being made on property I own Temporary services orfeeders-
which is not intended for ,lease,rent,or exchange according to Installation,aitenstion,orveloeatlon:
ORS 447,455,4 70 200 amps or less _ 2
201 amps to 400 amps 2
Owner's signatu Date: 8 r'v 401 to 600 ams 2
Lin 1101110 1 Branch circuits-new,alterntlon.
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch cir-uit 1 2
City: r State: ZIP: R. Fee for branch circuits without punch�re
-
Ph mail: of service or feeder fee,first branch circuit: 2
Fax: E-
Each additional branch circuit.
Misc.(Service or feeder not Included):
'i Service o rx 225 amps-commercial Cl Health-care facility Each pump or irrigation circle 2
U Service over 320 amps-rating of 1&2 C]Hamtrdous location Fach signor outline lighting / ( 2
family dwellings U Building over 10,(W square feet four or Signal circuit(s)or a limited energy panel,
C]System over
6W volts nominal more residential units in one structure alteration,orextension* 2
LI Ruilding over three stories U Feeders,400 amps or more *Description: _
U Occupant load over 99 persons U Manufactured structures or RV park Fich additional htspectlon ever the allowable to any of the above:
re
U FgsI7 Other ther. _ Per inspection
:submit sets of plata with soy of the above. Investigation fee
t ast
The above are nopplicable to temporary conruction service. Other
Na all jurisdictiau accept credit cards,please call jurisdiction for mote Inforrrrarion. Notice:This permit applicalie,, Permit fee.....................
U Visa U MasterCard expires if a permit is not obt-,Led Plan review(at _- %) $ _
Credit card number: L_L within 180 days after it has been State surcharge(8%)....$ _
.
Expires accepted as complete. TOTAL $
......................
Name of cardholder u shown on c t card
S
Cardholder signature Amount 44134615 iISKKWOM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
p Ins Restricted Energy Fee...................................................... $75.00
Number of a
Inspections per permit allowed (FOR ALL SYSTEMS)
Service Included: Items Cost Total
Check type of work Involved
Residential-per unit
1000 sq fl or less $145 15 4 ❑ Audio and Stereo Systems
Each additional 500 sq It or
portion thereof $33.40 _ 1 ❑ Burglar Alarm
Limited Energy _ — _ $75.00
Each Manurd Nome or Modular
Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener'
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 $106.05 _ 2 EJ 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 2
Reconnect only $66.85 2
Temporary Services or Feeders V� TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each system................................................. ........ $75.00
200 amps 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 Typo of Work Involved:
Over 600 amps to 1000 volts,
see"b"above. ❑ Audio and Stereo Systems
Branch Circuits
New,alteration or extension per panel ❑ Boller Controls
a)The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder tea.
Each branch circuit $6.65 , 2 ❑ Data l-elecommunication Installation
b)The fee for branch circuits
without purchase of service ❑
or feeder fee Fire Alarm Installatlo,l
First branch circuit _ $4685 _ ❑
Each additional branch circuit $6.65 HVAC
Miscellaneous
Instrumentation
(Service or feeder not included)
l._1
Each pump or irrigation circle _ $53.40 _
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(%)or a limited energy
panel,alteration or extension —__ $75.00 _ ❑ Landscape Irrigation Control'
Minx Labels(10) _ $125.00
Each additional inspection over ❑ Medical
the allowable in any of the above
Per Inspection _ $62.50 ❑ Nurse Calls
Per hour _ _ $62.50
In Plant y $73.75 ❑ Outdoor Landscape Lighting'
a Fees: ❑ Protective Signaling
Enter total of above fees $ _ ❑
Other
N 8%State Surcharge $
-- -- Number of Systems
J 25%Plan Review Fee
See"Plan Review"section on $ No licenses are required Lkenses are required for all other Installations
ro front of application
a - Fees:
J Total Balance Due $
4 Enter total of above tees
❑ Trust Account#_ 8%Slate Surcharge $ _
Total Balance Due $
i:\dsts,fomrsklc-fees,doc 10/09/00
_ BUILDING PERMIT
CITY OF TIGARD
PERMIT#: BUP2000-00458
DEVELOPMENT SERVICES DATE ISSUED: 11/17/00
13125 SW Hall Blvd..Tlaard,OR 97223 (503)639-4171 PARCEL: 2S102AC-00700
SITE ADDRESS: 12540 SW MAIN ST 110
SUBDIVISION: BURNHAM TRACT ZONING: CBD
BLOCK: LOT: 001 JURISDICTION: TIG
REISSUE: FL('!�rt AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT r-'IRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N sf N: S: E: W:
OCCUPANCY GRP: B TOTAL.AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 9 BASEMENT: of AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psi LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: f)o
Remarks: C04ercial TI
Owner: Contractor:
DOLAN + CO LLC GRIGSBY CONSTRUCTION INC
BY FLORENCE T DOLAN 8114 SW NMISUS AVE
4025 SE BROOKLYN BEAVERTON, OR 97008
Pgpone:TLAND, OR 97202 Phone: 641-7343
Reg#: LIC 45073
FEES _REQUIRED INSPECTIONS_
Type e B Date Amount Receipt Mechanical Perm!;Require
Y _
PRMT CTR 11/13100 $358.30 27200000000 Electrical Permit Required
Sprinkler Permit Required
5PCT CTR 11/13/00 $28.66 27200000000 Plumbing Permit Required
PLCK CTR 11/13/00 $232.90 27200000000 Framing Insp
FIRE CTR 11/13/00 $143.32 27200000000 Gyp Board Insp
Susp Ceiing Insp
Total $763.18 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 law. All woi s 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 the rules au,.,1ed by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503)246-1987.
Permitee
Signature:
e: � - - f
Issued B ��j .
Call 639-4175 by 7 p.m.for an inspection the next business day
Building Permit Application
Datereceived: 11-Ig-0c) n=dtno.: a —GdV
Ci of Tigard City �.. Projocdappl.no.: Fix iredale:
City nfTigard Address: 1317.5 SW hall Blvd,'1'igard,OR 97223 P
— . Recei tno.:
Phone: (503) 639A171 Dateiasual: Y
Pax: (503) 598-1960 Case fit:no.: Payment type:
Land use approval: _
I&2(at-lily:Simple Complex:
I
ccesro U Commercial/industrial U Multi-family O New construction ❑Demolition
U l �t 2 family dwelling ora ry
O Addition/alteration replacement U Tenant improvement Q Fire sprinkicc�alarm 0 Other:
I
Job address: Sk_O $%,0 r+'\MN 5'r� ��- Bldg.no.: Suite no.:
Lot: }Uo Block; Subdivision_ _ Tax map/tax IC t/aceount no.: I-a-
'ectname: T. oR 1 LAG �—
ProJ A-t�o� 11 1. F
Description and location of work on preniiscs/special conditions: 1%,. LITMA (AAM, I ki N MCT�4�NU
of vx1CTt1, gulLD14(e_ —
loodploill,seliticc.IP1166.SOW.etc.)
Name:
Mailing address: J Cl U. %I I u E. 1 k 2 fcmlly dwelling:
City: PQState:M P: 9 W 0 9 Valuation of work.. ..................................... $
Phone �Teu9 Faxf' �T't9� E mail: No.of bed wms/baths.................................
Owners representative: p��q� _ ----- Total number of floors...................... ......... —
Phone; 200.59an1 Fax:�l-t9 6a E-mail. New dwelling area(sq.ft.) ............
OaMeicarport area(sq.ft.).........................
Covered pinch area(sq.fQ ........................
Name. C Mo. — Deck area(sq.ft.)........................................
Mailing address: t t S' Svv o R i3 Wb
—�`---�,�•r� Other structure area, (aq.ft.).................
State:oA ZIP• o� -----
City: 0.11..bgb - Comeserc!al/indestdol/multi-family: qOo.
Phone: o� alb n1s Fax:DP*-i 6 a•v Umail: $ 3
Valuation Awork. ........... �
Existing bldg.area(sq.ft.) .......................... I F
Business name: 6R I IoSQ Y C 0 N S-t 00 t--f 12 N New bldg.area(sq.ft.)................................ AM-
Address: tf`f -1 r, At Number of stories........................................ Q
Strrc:p ZIP: V'N
City: U�•ki% C SW (�C Type of cc nstruction...................................: —
Phone 5�3 --- o e o Fax Yf$i61 F'rnail: Occupanc;�group(s): Existing: g(R�Au�oFPux)
CCB no.: New: S•sa-►+��•
City/metro lic.no.: Notice:A.I contractors and subcontractors aro required t�be
licensed with the Oregon Construction Contractors Board under
provisions of URS 701 and may be required to be licensed in the
Name:_(i DA jurisdictioi where work is being performed.If the applicant is
Addr_%s: 441-+5 i� ��W uR ��C' exempt from licensing,the following reason applies:
4 Ci �0.�tlAN� State:6k ZIP:91a o _ —
FContact mmon:� &AuIWQSL1-S Plan no.: _
N Phone n d-ta9aS FaxbT$.'$6.16� E-mail:
MEN-
-� Name: Contact person: Dees due upon epplicadon ...........................$
m
Address:-_-- DAIe received:
—
State: ZIP: Amount rxetved ......................................... -
W City: _ - -- _.
J Phone: I-ax: E mall: _ Pleas refer to fee schedule.
Nd as iu 1$"Om WOW cl"'cam,r�call Juri�r0on tar mar lafem,etloo.
1 hereby certify i have read and examined this application and the is Vice t]MutrtCard
attached checklist.All provisions of laws and ordinances governing this CMM Mi aameu
work will be complied with;wheth r specified herein or not. _
Authorized signaturrt/�i _ Date:
Print name: �01der O e Aanuci
Notice:This permit application expires if a permit is not obtained within 190 days after it has been accepted as complete.
Mx►�ecr�(6loat`otfi
7 d I g I Lt t . 'Y
COO 4Nf'DLL d0 JI,1,1� 0961 965 C04 Idd LZ.:6t IM 00/LZ/OI
i
ELECTRICAL PERMIT-
CITY OF TI GARD
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT 0: ELR2000-00293
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 12/7/00
SITE ADDRESS: 12540 SW MAIN ST 110 PARCEL: 2S102AC-00700
SUBDIVISION: BURNHAM TRACT ZONING: CBD
BLOCK: LOT: 001 JURISDICTION: TIG
Prolect Description: HVAC System
A.RESIDENTIAL _ B.COMMERCIAL
AUDIO 3 STEREO: AUDIO&STEREO: INTERCOM&PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEnICAL:
HVAC: DATAITELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
_ TOTAL#OF SYSTEMS:
Owner: Contractor:
DOLAN + CO LLC AMERICAN HEATING
BY FLORENCE T DOLAN 1339 SW GIDEON ST
402E SE BROOKLYN PORTLAND,OR 972.02
PORTLAND,OR 97202
Phone: Phone: 239-4600
Reg#: LIC 00033135
ELE 26-583CLE
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 12/7/00 $75.00 2720000000 Elect'I Final
5PCT CTR 12/7/00 $6.00 2720000000
Total $81.00
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 with approved plans. This permit will expire if work is
!L not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
pL requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
F' 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or di ct estions tom at (503)
N
246-1987.
J Issued by ��� Permittee Signature
OWNER INSTALLATION ONLY
W
The Installation Its being made or property 1 own which Is not Intended for sale. lease,or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N; _ DATE: _
LICENSE NO:
Cali 639-4175 by 7:00 P.M. for an Inspection needed the next business day
Electrical Permit Application
Date received: Permit no.94 _oZ
City of Tigard Project/ap'pl.no.- Expire date:
CiryofTignrd Address: 13125 SW Hall Blvd,'Tigard,OR 97223 Date issued: By: Receipt no
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
U I &2 family dwelling or accessory Litomrnercial/industrial U Multi-family U Tenant improvement
VNew construction U AdditiorJalteration/replacement U Other: U Partial
Job address: Q (j &IAl_�r Bldg.no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block Subdivision:
Project name: fi2L_MLcMWDescription and location of work on premises: 4C
Estimated date of completion/inspection:
Job no: 80,8 41Fee Max
Business name: Desert en. Total no.hu
Address: :sewreriinNlal-sl orwdd-tswYyger
T dwellilaguall.lntitsdusunchedjpaaa .
City: slate:on- ZIP: 7 pL arer,loe, A ','-
Phone: q— d/G pyo Fax: -V2 E-mail: 1000 sq.ft.or less 4
3313 Each additional 500 .ft.or portion thereof
CCB no.: Elec.bus.lie.no:,16 x-653 GLG' Limited energy,residential 2
City/metro lic_no.: _ Limited energy,non-residential 2
Z -Z Farh manufactured home or modular dwelling
Signature of supervising tlectri n(required) vete Service and/or feeder 2
Sup.elect.name(print): License no: Servicorfeeden-Installation,
alteration or relocation:
200 amps or less 2
Name(print): � 201 amps to 400 amps 2
Mailing address: al / Tt+ - 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: State: ZIP: 47opq. Over 1000 amps or volts 2
Phone: Fax: E-mail: Reconneclonl l
Owner installation:The installation is being made on property I own Temporaryservkraurteeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation:
ORS 447,455,479,670,701. 200 amps or leas 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 sine! 2
11101H&3 1 t ■ranch elrnib-new,alteration,
Name:
or extension per panel:
-- — A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: State: ZIP: B. F«for branch circuits without purchase
4. Phone: Fax: E-mail:
of service or feeder fee,first branch circuit: 2
Each additional branch circuit:
14 as I AM- Mi lin Ifn Mbar.(Service or feeder not Included):
U Service over 225 amps-commetcial U Health-care facility Each pump or irrigation circle 2
U Service over 320 amps-rating of 1&2 U Hazardous location Foch signor outline lighting 2
family dwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel,
U System over 600 volts nominal more residential units in one structure alteration,orextensiono 2
m U Building over three stories U Feeders,400 amps or more *Description:
WU Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over the allowable In wry of the above:
J U EgressAightingplan U Other __ Per ins don
Submit_sets of plans with may of the above. Investigation fee
The above are Dot applicable to temporary construction ser,ice. Other
NM air jurisdictions-emit credit cards,please call jurisdiction for rate infrrmstton Notice:This permit application Permit fee.....................
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit cant number: Within 190 days after it has been State surcharge(8%) ....$
rapine accepted m complete. TOTAL $
Name d cardholder as drown on credit card
.......................
_ S
Cardholder signature Amount
I40.4617(6000R)OM)
Electrical Permit Fees: Limited Energy Fees: `
Complete Fee Schedule Below: TYPE OF WORK INVOLVED-RESIDENTIAL ONLY
Restricted Energy Fee...................................................... $75.00
Number of Inspections per pennilt allowed (FOR ALL SYSTEMS)
Service Included: Items Cost Total
Check Type of Work Involved:
Residential-per unit
1000 sq.ft.or less _ $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq.R.or
portion thered $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular E]Dwelling Service or Feeder $90.90 2 Garage Door Opener'
Services or Feeders ❑ Heaft Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2
201 amps to 400 amps $106.852 ❑ Vacuum Systerw
401 amps to 600 amps $160.60, 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED-COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each system.......................................................... $75.00
200 amps 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 F-1 New,alteration or extension per panel Baler Controls
a)The fee for branch circuits
with purchase of service or ❑ Clock Systems
Feeder fee.
Each branch circuit $6.65 2 ❑ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑ Firs Alarm Installation
or Feeder he.
First branch circuit _ $46.85
Each additional branch circuit _ $6.65 ❑ HVAC
Miscellaneous ❑ instrumentation
(Service or feeder not Included)
Each pump or irrigation circle _ $53.40
Each sign or outline lighting $53.40_ ❑ Intercom and Paging Systems
Signal ckcult(s)or a limited energy
panel,alteration or extension $75.00 ❑ Landscape Irrigation Control'
Minx Labels(10) $125.00
Each additional Inspection over ❑ Medical
the allowable in any of the above
Per Inspection $62.50 ❑ Nurse Calls
Per hour $62.50
In Plant _ $73.75 ❑ Outdoor Landscape Lighting'
Q. Fees: ❑ Protective Signaling
NEnter total of above fees $ _ ❑ Other
8%State Surcharge $ _Number of Systems
-� 25%Plan Review Fee
m See"Plan Review"section on $ Nc ilcenses are required. Licenses are required for all other installations
front of application.
W Fees:
'J Total Balance Due $
r—� Enter total of above fees $_
U Trust Account N 8%State Surcharge $
Total Balance Due $
i:\dstsVomnklc-fees.doc 10109/00
CITY OF T I GA R D MECHAWCAL PERMIT
- DEVELOPMENT SERVICES PERMIT#: MEC2000-00472
13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 12/7/00
PARCEL: 2S 102AC-00700
SITE ADDRESS: 12540 8W MAIN ST 110
SUBDIVISION: BURNHAM TRACT ZONING;: CBD
BLOCK: LOT:001 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15-30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 -50 HP: WOODSTOVES:
GAS PRESSURE: 50+ HP: CLO DRYERS:
FURN <100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <=10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Mechanical tenant improvement
Owner: FEES
DOLAN + CO LLC Type By Date Amount Receipt
BY FLORENCE T DOLAN PRMT CTR 12/7/00 $72.50 2720000000
4025 SE BROOKLYN 5PCT CTR 12/7/00 $5.80 2720000000
PORTLAND,OR 97202 PLCK CTR 12/7/00 $18.13 2720000000
Phone: Total $96.43
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON
STE 1 REQUIRED INSPECTIONS
PORTLAND,OR 97202 Gas Line Insp
Phone:239-4600 Mechanical Insp
Reg#:LIC 33135 Final Inspection
a
it
U)
J_
m_
WThis permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted 'n the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010„through OA 52-001-0080.
You may obtain copies of these rules or direct questions to OUNGAc ( 3)2, 9.
Issue By: Permittee Signature:Call(503) 639-4175 by 7:00 P.M.for Inspections neededslness da %
L
Mechanical Permit Application
Datereceived: tV-1e-eV Permit no.:r WeW—601/7'
cit. of Tigard Project/abpl.no.: Expire date:
Ciryull'i,gnrd Address: 13125"W Hall Blvd,Tigard,OR 97223 Date issued: H Recei tro.:
Phone: (503) 639-4171 - y P
Fax: (503) 598-1960 Case file no.: Payment type:
Land ,ise approval: Building permitno.:
❑ 1 &2 family dwelling or accessory 13ir'fommercial/industrial ❑Multi-family ❑Tenant improvement
W14ew construction ❑Addition/alteration/replacement ❑Other:
Job address: /il;,NO 5'0 rrTsitite
ST _ Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: no.: / value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$
Lot: Block: Subdivision: *See checklist for important application information and
Project name: . jurisdiction's fee schedule for residential permit fee,
City/county: Tr 3410. _ I ZIP:
Description and lo5tion of work on premises:
HE
Fee(e&) ToW
Est.date of completion/inspection: / S X00HVICDeaerl Resodonly Res
Tenant improvement or change of use: '
Air handling unit CFM,�� /
Is existing space heated or conditioned?❑Yes UeNo Ir conditioning(site plan required)
Is existing space insulated'?UOYes ❑No Alteration of existing HVAC system
Boiler/compressors
Business name: mite boiler permit no.:
% HP Tons BTU/II
Address: _—mumT - 1-ire/smoke amper uctsmoke detectors
I ZIP: q-7$L0 cal pump(5 l pan required)
Phone: yG�p Fax:�3y �as8 E-mail: nsta repace umac urner_ 1:11UIH
Including ductwork/vent liner arYes O No
CCB no.: nsTtall/repaT�elrefocate heaters-suspen e ,
City/metro lic.no.: 101-2 wall,or Floor mounted
Name(please print): dXA-r J. S�r't+-t Vent fora lance other than furnace
e etst
Absorption units BTU/H
Chillers_ _ HP
Name_ S Srt!T r „ / tf
Compressors HP
Address: e d N ST -,- --- v rorrse�tn exhand• vest t n:
City: Slate:01Z_ZIP_ 0f7901— Appliancevent
Phone: pd Fax: 34- pr E-mail -- Terex gust
9_R5i_xFs,7ype res. itc a azmat
hood fire suppression system
Name: Exhaust_ Exhaust fan with single duct(bath fans)
Mailing address: A/t f / irof v gr Exhaust system a an from Itassn or
AC
CL City: State: ZIP: 7 Feelog s on up to outlets)
Type: LPG Na Oil
H Phone: Fax: E-mail: Fuel piping each additional over 4 outlets
U) rotes plilift(schematic required)
Fes- Number of outlets
Name:
� siphuace or eq pdsreet:
Address: _ Decorative fireplace
0 City: _ State: ZIP: nsert-ty
W Phone: Fax: -mail: Woes.tov pe et stove
Applicant's signature: Date: - t
Name (print): R0.2MIK S m- r►
Na all jurixlictims accept credit cards,pleas call jurisdiction for more infcwmation. Permit fee.....................a
Notice:This permit application
U visa U MacleH:ard Minimum fee................$ --
expires if a permit is not obtained Plan review(al _ 96) a
t and t card number_ -- — r-�- within 180 days after it has been
ro State surcharge(896)....$ _
--Name cW cardholder as shown on credit card - accepted as complete. TOTAL
Cardholder altnatwe Amount 140.1617( )
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE:,
TOTAL VALUATION: FEE: Description: Pda Total
$1.00 to$5,000.00 Minimum fee$.°.50 Table 1A Mechanical Code 01Y (Es) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
$1.52 tum cash adjitional$100.00 or Including duds 6 vents _ 14.00
fraction thereof,to and Including 2) Furnace 100,000 BTU+
$10000.00. including duds&vents 17.40
$10,001.00 to$25,000.00 $148.50 for the fast$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 550,000.00 $379.50 for the first$25,000.00 and 5) Vent not Included In appliance permit
$1.45 for each additional$100.00 or 8.80
fraction thereof,to and including 6) Repair units
$50,000.00. 12.15
550,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Beller Heat Alf
$1.20 for each additional$100.00 or For Items 7.11,m or Pump COW
fraction thereof. footnotes below. O"P*
7)<3HP;absorb unit
BTU 14.00
A_SSU_MED VALUATIONS PER APPLIANCE: - -15 -
Value Total 8 8)13 3-15 HP;absorb 25�
unit 100k to 500k BTU
Description: Ea Amount 9)15-30 HP;absorb
Furnace to 100,000 BTU,n c!vding 955 un!t.5-1 mil BTU _ 3`•00
duds 6 vents 10)30-50 HP;absorb
Furnace>100,000 BTU Including 1,170 unit 1-1.75 mil BTU 52.20
ducts&vents 11)>F,UHP:
Floor furnace Including vent 955 BTabsorb
- -- unit>1.75 milllBTU 87.20
Suspended heater,wall hfeater or 955 12)Air handling unit to 10,000 CFM
floor mounted heater 10,00
Vent not Included in appllcance 445 13)Air hpndling unit 10,000 CFM+
permit _ 17.20
Repair units 805 _ 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 955 10.00
to 100k BTU 15)Vent fan connected to a single duct
3-15 hp;absorb.unit, 1,700 6.80
101k to 500k BTU 16)Ventilation system not Included In
15-30 hp;absorb.unit,501k to 1 2,310 appliance permit 10.00
mil.BTU 17)Hood served by mechanic.I exhaust
30-50 hp;absorb.unit, 3,400 10,00
1-1.75 mll.BTU 18)Domestic Incinerators
>50 hp;absorb.unit, 5,725 _ 17.40
>11.75 mil.BTU 19)Commercial or Industrial type Incinerator
Air handling unit to 10,000 ctm 656 69.95
Air handling unit>10,000 cfm 1,170 20)Other units,including wood stoves
Non-portable evaporate cooler 656 1000
Vent fan connected to a single duct 446 21)Gas piping one to four outlets
Vent system not Included In 656 5.40
appliance permit 22)More than 4-per outlet(each)
Hood served by mechanical exhaust 656 1.00
Domestic Incinerator 1,170 Minimum Permit Fes$72.50 SUBTOTAL: $
IL Commercial or Industrial Incinerator 4,590
Other unit,Including wood stoves, 656 e%State Surcharge $
Inserts,etc. -_
U) Gas piping 1-4 outlets 360 _._ 25%Plan Review Fee(of subtotal)
Each additional outlet 63 Required for ALL commercial permits only
'J TOTAL COMMERCIAL : TATAL RESIDENTIAL PERMIT FEE: _
m
VALUATION: _
W
.J 0her Inspections and Fees:
1 Inspections outside of normal business hours(minimum charge-two hours)
$72.50 per hour.
2 Inspections for which no fee is specifically Indicated (minimum charge-half hour)
$72.50 per hour
3 Additional plan review required by changes,additions or revietons to plans(minimum
charge-one-half hnu)$72.50 per how
*State Contractor Boller Certification required for units>200k BTU.
"Resldenttal AIC requires site plan shoving placement of unit.
I:\dsts\formsvnech-fees.doc 10/11/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-1171
OUP
Date Requested p 29 AM X PM BLD _
/t D
Location��ih�� �1 Lt/ Suite MEC
Contact Person '5�44&0— Ph G;; Oct ar PLM
Contractor Ph SVVR —
RLII4 Tenant/Owner ELCMmru
Retaining wall ELR ?u�-Q 3
Footing Access: lot how FPS
Foundation
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post&Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post&Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
a C
Service
N Rough In Ajd �
UG/Slab -
Low Voltage
Fir larm
m
W ASS PART FAIL
J
Backfill/Grading
Sanitary Sewer
Storm Drain [ j Reinspection fee of$, required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Unable to ins no access
Fire Supply Line [ ]Please call for reinspection RE: _ _ [ ] t
ADA
Other Approach/Sidewalk DateIVY Inspector Ext
Other
Final
PASS PART__fAILJ DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
• BUP
1 Date Requested AAA PM BLD
Location / 2,1 U SW h'Il�� Suite MEC
Contact Person / Ph S�3 �� � PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC .��✓ -wGf�y
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SIGN
Crawl Drain Inspection Notes:
Slab SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation , N
Drywall Nailing _
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&Beam -
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
Service
Rough In
UG/Slab
Low Voltage
3 F' Alarm
p F
AS PART FAIL — —
u
J
Backfill/G4,, g
Sanitary Sewr-r
Storm Drain ( )Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( ]Please call for reinspection RE: _ �_ [A Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Date 7 Inspector tt--
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Line: 639-4175 Business Line: 639-4171 —
0 .
IBUP
Date Requested / 2'_ AM PM BLD
Location Zy s w /r41rt Suite //0 MEC
Contact Person CYi d Ph 577;- �S-V -6103 PLM 2,acz,-Gy y3 3
Contractor Ph s03 J-7Z_ G/.PL 8WR
BUILDING Tenant/Owner ���-/ h ELC
Retaining Wall IleELR
Footing Access:
Foundation FPS
Ftg Drain SON
Crawl Drain Inspection Notes:
Slab SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Calling
Roof
Misc:
Final
PASS PAR i FAIL
Post$Beam ,
r Sla �pU yl, r ,
Top Out
Water Service _
Sanitary Sewer
Rain Drains _
Fi
PART FAIL
ANICAL
Post&Beam
Rough In /
Gas Line —
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service _
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ please call for reinspection RE: [ J Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Date —+o-i Inspector_ _ Ext �-
_ ��--
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the Job site,
CrTY OF TIGARD BUILDING INSPECTION DIVISION
MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
o SUP
Date Requested / —/d –O AM x PM BLD
Location Suite /1 MEC
Contact Person Ph 0 T205PLM
Contractor Ph SMR
BUILDING Tenant/Owner ELC
Retaining Wall ELR 2LG4)—0G,311t9
Footing Access: �, how o,Y FPS
Foundation (�.� '�""
Fig Drain SGN
Crawl Drain Inspection Notes:
Slab 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
PLUMBING
Post&Beam
Under Slab _
l-op Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post&Beam -- —
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
C
Service
Rough In NO
UG/Slab —
Low Voltage
4rmli� _—
PART F.IL _
Backfill/Grading
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Sripply Line [ J Please call for reinspection HE: to ins___ _ [ J peel no access
ADA
Approach/Sidewalk Date � � In-npector _ Ext
Other ____
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.