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CZ a mcnZ m r _ < :3 �p7 m 7 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hous Inspection Line: 639-4175 Business Line: 639-4171 - UP _ --_ --Date Requested ' Zn AM_ ,r' PM BLD Location � -, (_ Z!,�f" Suite �_ MEC Contact Person - Ph PLM `� �� '7•S Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain _ -� Crawl Drain Inspection Notes: SGN Slab — ''� — SIT Post& beam - Fxt Sheath/Shear Int Sheath/Shear ------- --_____� Framing -- - - - -- --- _—. Insulation Drywall Nailing --- Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling ---- __— -- _ — --•--.�_ Roof Misc: --- - --- --- — - —_ N_— -- Final PASS PART FAIL Kt:MBINb Post& Beam -- - -- -- -------—�— --- Under Slab Top Out Water Service Sanitary Sewer --- — --- ,grains AS'�) PART FAIL MECHANICAL 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 Fire Supply Line [ ]Please call for reinspection RF:_ _ _ [ ]Unable to inspect-no access ADA , Approach/Sidewalk r?)e - Other Date Inspector EX Final _�.------ - PASS PART FAIL. NOT REMOVE this inspection record froen the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4171/ 0 (E MST _ --- .--Date Requested. AM "M �— BLD Location Suite Contact Person Ph _ PLM Cont.actor __ Ph SWR _— UJLDIN Tenant/Owner ELC _ Retaining Wall Footing Foundation Access: ELR FPS Ftg Drain -------- Crawl Drain I Inspection Notes: SGN Slab Post& Beam --- - ---- SIT Ext Sheath/Shear ^I fy, L �7 ( '1�'� ---- Int Sheath/Shear - Framing Insulation - - Drywall Nailing _- 1 Z ) ce / - Firewall _ Fire Sprinkler t, C1� ` o�`ti C c,(- Fire Alarm - - - Susp'd Ceiling -- --- ---- - ---- Roof - -- Misc: ART FAIL - - -._--- - --tLUANISING Post& Beam Under Slab - Top Out - ---- -- - _ Water Service Sanitary Sewer - Rain Drains - Final P B-S. . .PART FA L M ANICA � Post&Beim--" - - - ----- - --- _ Rough In �- Gas Line Smoke Dampers ?rAS0 PART FAIL tiefICT-RI-C ---- --- - - --- - 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 =ire Supply Line [ ]Please call for reinspection RE___ ___ - ____ _ _ [ ] Unable to inspeci-no access ADA Approach/Sidewalk Da I1 \ Other - v Inspector - � �— _ Ext Final PASS PART FAIL 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 Date Requested— G �- �AM_ —PM RLD Location0 Lq-�] ; I I" Suite -- MEC Contact Person Ph PLM Contractor _ Ph SWR _ BUILDING Tenant/Owner � ti «L r Retaining Wali ELIL' Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes // �� SGN Slab <` w�' , SIT Post& Beam - Ext Sheath/Shear Y �- Int Sheath/Shear - Framing _ Insulation - Drywall Nailing --- -- ------ --- -- -- - - --- Firewall Fire Sprinkler -- Fire Alarm Susp'd Ceiling ----- ---- -------- -- -- Roof - Final PASS PART FAIL -- PLUMBING Post& Beam Under - -- ---- ---- Under Slay Top Cut - V'later Service Sanitary Sewer Rain Drains Final - ----_ PASS PART FAIT_ MECHANICAL --_ Post& Beam - - - -- - Rough In Gas Line --- --- - -- ... Smoke Dampers Finol - --- ---- - ----- ------- - - �ASS PART FAIL -LECTRICAr, _ ---- - - Service Rough In UG/Slab Low Voltage If arm PASS PART FAIL S Backfill/Grading - --- --- -- -� -- -� - Sanitary Sewer Storm Drain [ ] Reinspection fee of$ -_required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basi i Fire Supply Line [ J Please call for reinspection RE _- _ _ ( ]Unable to Inspect-no access ADA n Approach/Sidewalk Date - C/ Inspector Ext Other _ - -- _-. -- Final PASS PART FAIL. DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD MECHANICAL DEVELOPMENT SERVICESF'F_RMIT PERMIT #. . . . . . . : MEC97-0457 13125 SW Hall Blvd., Tigard,OR 97223 (5031639.4171 DATE ISSUED: 11/19/97 SITE ADDRESS. . . : Q.19495 SW LOCUST ST #E PARCEL. 1 S 126DC--04800 SUBDIVISION. . . . : LEHMANN ACRE TRACT ZONING: C-F' BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .004 JURISDICTION: TIG CLASS OF WORN,. . :ALT FLOOR FURN. . . . : 0 EVAF COOI .FRS• 0 TYPE OF USE. . . . :COM UNIT HEAT'EPS. . : 0 VEN-C FANS. . . : 0 OC:CUF'ANI`1' GRP'. . :B VENTS W/O AFFIL.: 10 VENT SYSTEMS: 0 STORIES. . . . . . . . . 0 BOILERS/CC;MPIRESSORS HOODS. . . . . . . : 0 FUEL TYPES------------ 0-3 HF . . . . : 0 DOMES. IIVCIN: 0 3-15 HP. . . . : 0 COMINL. I NC I N: 0 MAX I NF'UT: 0 BTU 15-30 FIF'. . . . : 0 REPAIR UNITS: 1 FIRE DA1y"F'ERS7. . : 30--50 HF'. . . . a 0 WOODSTOVES. . : 0 GAS F'RE 5SIJRE. . . : 50+ HF'. . . . : 0 CLO DRYERS. . - 0 NO. OF UNITS-------------- AIR HANDLING UNITS OTHER UNITS. : 0 URN ( 1001; BTU: 0 l= 1.0000 ctm : 0 GAS OUTLETS. : 0 TURN ) -1O0K BTU: 0 ) 1,0000 cfm: 0 R e m ar-k s : Clinical Researrh TI - relocate 6 existing supplies. Replace existing grilles. Owner: -- - -----______-----.-________.________ FEES CLINICAL_ RESEARCH type amo,_tnt b date- -_-�r-ecpt - 9495 SW LOCUST F'RMT $ 25. 00 J5D 11 /19/97 97--301084 TIGARD OR 972.::3 `PCT E 1. 25 JSD 1. 1/19/97 97-301084 F'I)one #: Contractor: OREGON HEATING A A/C 'INC PCl BOX 397 26. 25 TOTAL DI.INI)FE: OR 97115 Phone #: 538-2953 Rey #. . : 125815 -- - - REDU I RED I NSF'ECT I ONS ----- - This permit is Issued subject to the regulations contained in the Mechanical Insp _ !igard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection arplicable laws. All pork will be done in accordance with - approved plans. This permit will expire if work is not started —Tv-- -_- within 188 days of issuance, or if work is suspended for more than 189 days. ATTENTION: Oreqon law requires you to follow rules _ adopted by the Oregon Utility Notification Center. Those rules are set forth in CAA 952-981-N018 through OAR 952-901- 198. You may obtain copies of these rules or direct questions to OIINC by calling _ - (593)246-9187. Issl.IN By : �// Permittee Si r1nati-ire : {••++++{•t+++4+++•+-F.+++.+-h++.F•F++t...4. ++•F••++++++++4--4•+4•t-4-++-I ++-F+t-h+++tt+++-I- F +t h+•+ F F Call 639--41.75 by 7-00 p. m. For• inspections needed the next bl_Isiness day _ +i--E++f-1 i++{•1 ++++++t++++++++++tt+++++++f•+i+++4+++++++++4-++++++++-F F++-4++++++++++ Plan Check# _ CITY OF TIGARD Mechanical Permit Application Recd By 13125 SW HALL BLVD. Commercial and Residential Dates P.ec'd " TIGARD, OR 97223 Date to P.E. (503) 639-4171, x304 Date to DST PPermit I Print or Type Called _ incomplete or illegible applications will not be accepted _ Name of DevebprneftProiect Description _ Table to Mechanical Code CITY PRICE AMT Job Street Address S�dex A) Permit dee o Address A�r�„� � o- �o.00 Bldg# cny/state Zip 1.) Furnace to 100,000 BTU 6.00 (Ir _ including ducts&vents Name(or name of business) 2.) Furnace 100.000 BTU+ 7.50 Owner 1,-jeA9 ' (0 A'rCr. inducting ducts&vents Mailing Address i 3.) Floor Furnace 600 including vent coy/Slate Zlp Phone 4.) Suspended heater,wall heater 600 ' r _ or floor mounted heater Name(or name of business) 5.) Vent not included in appliance permit 3.00 Occupant Mai-Ing Address 6.) Boiler or comp,heat pump,air Gond 600 _ to 3 HP;absorb unit to 100K BUT** cnylslate Zip Phone 7.) Boiler or camp,heat pump,air Gond. 11.00 3-15 HP;absorb unit to 500K BTU" _ contractor Name 8.) Boiler or comp,heat pump,air Gond. 150 15-30 HP:absorb unit.5-1 mil BT'J"' Prior to permit Mailing Address 9.) Boiler or comp,heat pump,air Gond. 22.50 issuance,a copy j'!, .r.r9 _30-50 HP;absorb unit 1-1.75mil BTU_" of all licenses CRY/State ZIP Phons 10.) Boiler or comp,heat pump,air Gond 37.50 are required if nl.,tipr'r 1�` r 4•-"', >50 HP;absrb unit 1 75 mil BTU" expired in COT Dregon Const.Cont.Board Lie s Exp pate 11.) Air handling unit to 10,000 CFM 4.50 database =r y Y t Architect Name 13.) Non-portable evaporate cooler 450 Or Mailing 14,) Vent fan connect-,to a single dura 300 Fngineer Cnytstate -zip Phone 15.) Ventilation system not included in 4.50 appliance permit__ D..scribe work New O Addition O Alteration• Repair O 16.) Hood served by mechanical exhaust 450 to be done Residential O Non-residential 411 Additional Description of work: 17.) Domestic incinerators 7.50 f27/'A7� �/r7 tCil'r:51i� / `GIFtICS I r !!7r Th��i r �.'ll�,( I t : 18.) Commercial or industrial type 30.00 f /?I 4 et t refe Incinerator Existing use of 19) Repair units 450 building or property 20.) Wood stove 4.50 -� Proposed use of 21.) Clothes dryer.etc 4.50 buildirg or property 22.) Other units 4.50 Type of fuel-oil O natural gas O LPG O electric O ^` 23.) Gas piping one to four outlets 2.00 I hereby acJinowledge that I haw:read this application,that the 24.) More-than-4-per outlets(each) 50 information given is correct,thr,t I am the owner or authorized agent of the owner,that plans submitted are-n compliance with Oregon State OTY SUBTOTAL laws. Slgnaturao C.-merlAgent - i Date T 'SUF31OTAL 1�rrj r- �I 5%SURCHARGE Contact Person Name Phone ^PLAN REVIEW 25%OF SUBTOTAL C ! %i,1 ��'i� ------------ .TOTAL A i:Vnechpmt.doc (rev 9 _ v 'Minimum permit fee is$25+5%surcharge / ell3 "Residential AIC requires ste Ian shcwin9placement of unit.7 J t CITY OF TIGARD DEVELOPMENT SERVICES PLUMBING PERMIT r''F RM I T #. . . . . . . : P LM9 7 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 10/88/97 PARCEL - 1.5')126DC--rA48 r0 '3I TF ADDRFS S. . . : 091;1:35 SW LOCUST ST RE .)US' L_EHMANN ACRE; TRACT ZONING: r .P: flL.Of'K. . . . . . . . . L.OT. . . . . . . . . . . . . ..00,4 JURISDICTION: 1'1G 71--A50 01" WOrK. . :ALT GARBAGE D'I SF'O SAL_S. : L1 MOBILE HOME SP'ACES. : 0 rYF'F: OF IA-SE. . . . COM WASH TNG MACH. . . . . . : 0 BACKFLO' ' f''RE VN'FRS. . : 0 OCCUPANCY ORP. . :P FLOOR DRAINS. . . . . . . Ory TRAPS. . . . . . . . . . . . V, !'TORIES. . . . . . . . . 1� WATER HEATERS. . ,• . . .. 7 CATCH BASINS. . . . . . . . 0 7IXTURE S LAUNDRY TRAYS. . . , . 0 !3F RATIu DRAINS. . . . . : 0 3INESr. . . . . . . . . . 1 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0 _AVATORIES. . . . : I OTHER f'.XTURF"'). . . . . 0 TL1B/SHOWf RS. . . : 0 SEWER LINE ("t ) . . . : 2 4ATER CLOSETS. : 1 WATER L..TNF (ft ) , . . . 0 )I SHWASHE:'RS. . . . v 0 RnTlIJ DRAIN (ft ) . . . : 0 Pvmar'ks : Capping =,.in4+s, moving T ;ink, 1 1< A 1 water- cl.oset. lwner^: __.._ .__..__.. __...._._ ..._.....__._.__._____....___.___._..___..__._•_.._... .... ._.._.._.__.______...._.....__ FEES ...---.--._.._._.....___..._.___.__.. MBM BUILDING type amr)1.rrrt; by date r,ecpt 9W L.'7CU57' PRMT $ ,7'7. 00 B 97--;�,O047,-' r:I.GARD OR `:3722'2, S;P'CT 1 �, . 5 B 10/28/')7 '37 3004 F'ai1P #f: :.rrrt;ract nr._._._....__.__...____.__._.______. _._ ..__ ..,..__.._._._._...._ flrO I='JL_.L..)MI1 I N4G " 165 SW 190'x)•1 AVE- 711. 0111) OR 97007 _._____..___....._ ... ._._.._.__....._._.._.. ......_..._........ rre dt: 2E3. 7,5 TOTAL.. Ren it, 000940 __...._.._ RFOUIRED INE,P'ECTIFINS This permit is issued subject to the regulations contained in the Top---ol.rt Tnsp Tigard Municipal Code, State of Ore, Specialty Codes and all other Mi sc. Irrl:,pect ion applicable laws, All work will be done in accordance with Tnsp e x i s t i n J/r_.a approved plans. This permit will expire if work is not started Final. T n s pact i on within 198 days of issuance, ar• if work is suspended For more than 180 days. ATTENTION: Oregon law requires you to follow rules _____ __,•_ __`_�._.__ _______ _____V._.___.__._ adapted by the Oregon Utility Notification Center. Those rules are _ ....... -.et set forth in OAR 952-OW-0010 through OAA 952-8081408P, you may _ _.. _, obtain copies of these rules or dirert questions to OUNC by calling r 503)24(1-19871 ___._._._.._..__...._ _...._._..___. __._._._._...._..__.....__._.._._.__._- /� M T s Lr n d :`y : _ (� �---- Permitter' r.r n a t l.r r-F_ it 9 _ *+4, e..-._..f44- 1 r_.�_F4-+4.1-++ 1-4-+4+4.4++-rf.-1..p.a...F..V444-44-1...F-4- 4+.++4-++++44 ++-f+•h.{..p44+A4 r r .r..a--r--F.,..,}.r. r , —�0 l f_39- 417"7) try 7:00 p. m. far +.n i tispec°t i on T1epded thre next bi_rs i.rres-s day .1..4-+4.4.+44-1..4.4.+++ 4•..F..r..F.+.r...f.+ 4.4..x.+.+..1.4.4+++++•1-++4-+++•F 4+++4•+,+•.F+ 4•4-+++44+-r..p..r-+++4..++.4.+.4.4 CITY OF TIGARD Plumbing Application Recd By 13125 SW HALL BLVD. Commercial and Residential Date Rec'd '7 TIGXRD, OR 97223 Date to P.E. (503) 639-4171 Date to DST`-�------ Permit* Print or Type Related 5WR t��,�.5;� Incomplete or i�"esgible applications will not be accepted Caged le-,P7-1,7 t, Name of DevelopmenUProject On beck Indlcate Work Performed by fixture. Job Fi f A 01 rcpt c�:�� t r FLXTURES (Individual) QTY PRICE AMT Address I.,L Address =Suite, Slnec �.-I _ { L0 4, t I 9.00 7,o o Lavato ( 9.00 C Bldg• City/State ZI ry /• OL I et ��L�f � -/7 Z S Tub or Tub/Shower Comb. 9.00 Name 1dT-"-`- - Shower Only 1 1n ^W U/o A`i�D�r�7Y� Water Closet 9.00 Owner Mailing Address 9.00 _l _ suite of L/�� . lrie!+wesher 9.00 City/State L� Z Phone Garbagr Disposal 9.00 t'C ( IjF. C1 i :S '•c1.yl Washing t.lachlne 9.00 N e /� /� Floor Otain y i U) . 01,o I It /1 i"5 e0o i GL1 9.00 Occupant Melling Addro7�}}• Suite 3. `i.00 ;l�:' . /r.. -� r%F'c,�l f. , V 9.00 City/State Zip Phone Water Hea'.er O conversion O like kind 9.00 �';,�7 Laundry Room Tray - Name 9.00 Urinal l •` ��Cc�t,Lel N 9.00 Other fixtures(Specify)-Contractor eilingSuit _Address ( p ht 9.00 M-116 ZL' ✓'�� !'- 9.00 Prlo,'o permit �I / i�issuance,atopy CE1 Phone �)l� CSL• `2,7J -_- 9.00 of all licenses are Ornyo�Const.Cont.Boh.d LIc.t1 Exp.Date -• 9.00 required if �yU7 9,00 expired in COT Plumbin Llc.• Sewer-1 st 100" database f�_ -7�;f'PO6 ie �� Sewer•each additional 100' 30.00 25.00 Name Water Servlre-1st 100' 30.00 Architect Water Service ch-eaadditional 200' 25.00 or Mailing Address Suite Storm 3 Rain Drain-1st 100' 30.00 Storm b Re,Drain -each additinnal 100 25.00 Engineer City/Slate ZIP Phone Mobile T-me Space- 25 0 Describe work New O Addition O Alteration Repair O Commercial Back Flow Prevention Device or Antl- 25.00 to be done Residential O Non-residential fk to Device ditional description of work: Residential Backflow AdPrevention Device- 1500 - Any Trap or Waste Not Connected to a Fixture 9.00 Catch Basin 900 Insp.of Existing Plumbing 40.00 Existing use ofper/hr building or properly Specially Requested Inspections 40.00 Rain in,single family dwelling _ 0.00 Proposed use of 30.00 Wilding or property _ Grease Traps 9,00 I hereby acknowleCjr that I have read this apr anon,that the information QUANTITY TOTAL given is correct,V,at I am the own or authortz,-agent of the owner,and I°0rt1etnc or riser diagram.a required M puaniry Total is 9 that tans subr,Med are in m nce wit Ore on State Laws. 'SUBTOTAL -' Slg aturo o Ownergga / Date 6%SURCHARGE ' ontect anon Mein Phone PLAN REVIEW Zf%OF-SUBTOTA-L- only N/ixtute qty total is,9 T-r _,�� TOTAL 'Minimum permit lets is$25 5°4 surcharge,except Residenllal Harkflow Prevention Device.which is$15+5%surcharge Ids"101mam dor 5197 PLEASE COMPLETE Fixture Type Quantity by Work Performed Capped/ Removed Moved Replaced Sink ` Lavatory Tub or Tub/Shower Combination Shower Only _ Water Closet _ Dishwasher Garbage Disposal Washing Machine Floor Drain 2" 3" 4" Water Heater _ Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: w.u�wo.a�le MiN Tenant Name:¢Cly 11) Accumulative Sewer Tally This SWR#: Address: This PLM#: t.- Fixture Value Previous # Previous Credits Capped Rxtures fixtures New New Value Capped off value added # added total #s total Count off#s count value values Baptistrv!Fcnt 4 Bath - Tub/Shower 4 Jacuz/Whpl 4 Car Wash - Each Stall 6 -Drive Though 16 Cusoidor/Water Aspirator 1 Dish..ather -Commer 4 •Domest 2 Drinking Fountain 1 Eve Wash 1 I'loor Drain/sink 2 inch 2 3 inch 5 4 inch 6 Car Wash Drain 6 Garbage Disposal 16 Dom Ito 3/4 HP) Comm (to 5 HPI 32 Ind (over 5 HP) 48 Ice Machine/Refrigerator Drains 1 Oil Seo(Gas Station) 6 Recreational Vehicle Dump Station 16 Shower• Gang(Per Head) 1 -Stall Sink- Bar/Lavatory 2 Bradley 5 Commercial 3 Service 3 Swimming Pool Filter 1 Washer, Clothes 6 Water Extractor 6 Water Closet, Toilet 6 Urinal 6 TOTALS J Total fixture values: �r' divided by 16 EDUUe_ Ltit. �r,4t HISTORY PLM#4---•C)%�hEDUp f SWRp PLM+! EDllp SWRA Pl M# EDU# SWR# M10 EDl1# SWR# PI-M# EDIT# SWR# PUv1# -- FDU# SWR# PL%I# EDIT# SWR# Plh1# U)U,J SWR# CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: O67� DATE ISSUEDD:: 010//14/'37 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PARCEL: 1S126DC-04800 `_;T T E ADDRE.SS. . . :09495 SW LOCUST Sl• #E .1BD I V T S I OIV. . , .• :L_.EHMANN ACRE TRACT 7..ON I NG:C F' hL.00K. . . . . . . . . . , 1_01.. . . . . . . . . . . . . :OO-+ JURISDICTION: TIG f='r o i ect De scr^i pt i on : Installation of 6 branch circuits. ------------- ----RE'SIDENT IAL UNIT--__ ---TEMP SRVC/FEE')ERS--_.--_-- -----MISCELI_1-)NEGUS---__..... 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . 0 PUMP/IRRIOPTION. . . . : 0 EACH ADD' L 500SF. . . : 0 201 - 400 amp. . . . . . . 0 SIGN/OUT L..I NE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL./PANEL... . . . . . . 0 MANE. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 1O) . . . : 0 ----SERVICE/FEEDER---- _---BRANCH CIRCL.)I TS------ ---ADD' L INSPECTIONS—- 0 - C00 amp. . . . . . : 171 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : O 2'01 400 amp. . . . . . : 0 1st W/O SRVC; OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0 401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 5 IN PLANT. . . . . . . . . . . : 0 601 1000 amp. . - . . : 0 - -- ----- - --- -----�=L_AN RE:V I EW SECT I 10004• amp/volt. . . . . : 0 > =4 RES UNITS. . . . . . . . : ) 600 VOL..T NOMINAL_. . Reconnect only. . . . . : 0 SVC/FDR i = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner- : -- -- .._____._____.__-----•.-.-•---------------__------•---_.__.____- FEES CLINICAL RESEARCH type amol.rnt by date recpt 9495 SW LOCUST PRMT $ 60. 00 ORA 10/14/97 97--300025 TIGARD OR 972E3 SPC:T $ 3. 00 DR(4 10/ 14/97 97-300025 Phone it: Contractor-:WILLAMETTE. ELECTRIC INC $ 63. 00 TOTAL P[] BOX 230547 - --- - - REQUIRED INSPECTIONS -_ - TIGARD OR 97281 Ceiling Cover Elect' I Service Phone #: 624-3631 Wall Cover Elect' 1 Final Reg #. . : 000750 This pereit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other applicable lams. All work will be done in accordance With appruVed plans. This pervit 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 tt,e rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 352-001-OOIO through OAR 952-001-1967. You say obtain a ropy of these rales nr direct questions to OUNC by calling 1503)246-1987. r(1J n i L''e r•m i t t e e S i g n a t i_r r-e : JQg),-,,¢��J ----�- -------- -- __.OWNER INSTALLATION ----- I lie instal l.at i on is being made on property I own which; is not in+;ended for s,al e, lease, or rent . OWNER' S SIGNATURE: _•___,_ _ __ �_ DATE- INSTALLATION ATE:INSTALLATION S T F;NAT1JRF OF SUPR. ELEC' N: 6j_t:�J_-- _� DATE: L , L T CENSE NO: _I9 +-+4,+++-+-++++-1-4+4-4.......4...........4................ ......1-+++44................F4...4 Call 639--4175 by 7:00 p. m. for- an inspect inn needed the next bi-rsines5 day 4 ++4++++ + 4-+4-++++++++4 4+++++++++i•+f++++++•+-1-++++++•+-F+++++4_F f-i+++++4++i++++++++i•++ .CITY OF TIGARDEle,%Ftrlcal Permit Application �+ Plan Ch , 15125 SW HALL BLVD. r, fA fi Recd B TIGARD OR 97223 6 ', 8U t" 7-a��7 t7' Date Roc'd Date to P.E. �/ Phone (503)639-4171, x304 ` ) Inspection (503) 639-4175 Print ar Type v Date to DST ---- � Fax (503) 684-7297 Incomplete or illegible will not be accepted Permit#j L rcalled__ �1. Job Address: 4. Complete Fee Schedule Below: Name of Development,, L i„� r l L r rL Number of Inspections per permit allowed Name(or name of business)_ Service included: Items Cost Sum Address_ '9 2 9 L,,, i Y 4a. Residential-per unit City/StatelZip z L�,L 7 2 2 s 1000 sq.ft,or loss $11000 4 --�Y� Each addi tonal 500 sq.ft.or Commercial ® Residential ❑ portion thereof $25.00 1 Limited Energy $25.00 Each Manuf'd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder �_ $6P.OD 2 (Attach copy of all current licenses) 4b.Services or Feeders Electrical Contractor (.. re,; , {f c ��.r I r Installation,alteration,or relocation Address �1 L i1�, ? ?i ; v 1 _ 200 amps or less $60.00 _ 2 - -- 201 amps to 400 amps $80.00 City_ State r-I.� Zip_ ;j , 401 amps to 600 amps $120.002 Phone N 1 ; i _ 601 amp.to 1000 amps $180.00 _--+ 2 Over 1000 amps or volts A 2 Job No. �c 'i $340.00 2 Elec. Cont. Lice. No. ( Exp.Date %� 7 Reconnect only $50.00 2 OR State CCB Rea. No. 7 > -Exp.Date C `r 4c.Temporary Services or Feeders 'OT Business Tax or Metro No.___,__ 4 Exp.Date._k_ '_ Installation,alteration,or relocation rt 200 amps or less $50.00 _ 2 Signature of Supr Flec'n ( /4 201 amps to 400 amps $7500 _ _ z 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No. 1�1 L,�> Exp.Date Ie 1 -`I i see"b"above. Phone No. b z'-, t.L ,'1 4d.Branch Circuits 2b. For owner installations: N(�w alteration or extension per panel al rhe fee for branch circuits with purchase of service or Print Owner's Name_ feeder fee Address____ Each blanch circuit $5.00 2 City----,-..--- b)The fee for branch circuits tate Zio without purchase of Phone No. service or feeder lee. t first branch circuit $35.00 2 The installation is being made on property I own which is not Each additional branch circuit_ 5 $5.001- t 2 intended for sale, lease or rent. 4e.Miscellaneous (Service or feeder not Included) Owner',Slgnatllre Each pump or irrigation circle $40.00 2 Each aign or outline lighting $40.00 2 3. Plan Review section (if required):* Signal circuit(s)or a limited energy panel,alteration or extension $40.00 2 Please check appropriate item and enter fee In section 5B. Minor Labols(10) -` $100.00 _ 4 or more residential units in one structure 4f.Each additional Inspection over _ Service and feeder 225 amps or more the allowable In any of the above System over 600 volts nominal Per Inspection $35.00 Classified area or structure,containing special occupancy Per hour $55.00 as described in N.E.C.Chapter 5 In Plant $55.00 `Sl.ibmit 2 sets of plans with application where any of the above apply. S. Fees: !_ Not required for temporary construction services. 5a.Enter total of above fees $ - 5°!Surcharge(.05 X total fees) $ __3___ IAF Subtotal $ 5b.Enter 25'/.of line 5e,for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review it requir@d(5ac.3) $ NOT COMMENCED WITHIN 180 DA(S,OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED F\)R 'i PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED ❑ Trust Account p Total balance Due S I%DS \ELC96 At nNv n'9fi -- -"'-'--�- - - -__ 1997 ��,,,,,,�Still'1 DEVELOPMENZ 'c0'd �t�101 f i• = T B Q A e CD IL r 401 od mbm medical centers - r� ° �01", �: wooNrigion County, ore'6n ��''d £T50+059+£0S zNi Nnr'N rirF tIn:ST ,�F'c-0T—Lr' CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: ELC97-0699 13125 SW Hall Blvd., Tigard,OR 97223 (503)6394171 DATE ISSUED: 10/20/97 PARCEL: 1S126DC-04800 r'T TE ADDRESS. . 094'35 SW LOCUST ST #F ..1BDIVISION. . . . :LEHMANN ACRE TRACT ZONING:C-•P, BLOCK. . . LOT. . . . . . . . . . . . . :004 JURISDICTION: TIG nro.ject Descript i on : Install signal circuits or a limited energy panel for a tenant ocepy. -RESIDENTIAL UNIT_------- ---TEMP SRVC/FEEDERS_--_._- .._—_MISCELLANEOUS_-___._. .1000 SF OR LESS. . . . : 0 0 — 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 Ff1Cl-1 ADD' L 500SF. . . : 0 201 .- 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : i MAhIF. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : ?i SERVICE/FEEDER---- -----BRANCH CIRCUITS----- ---ADD' L_ INSPECTIONS)—— 2200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0 -01 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 0 PER HOUR. . . . . . . . . . . . 0 401 — 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : Ir 601 — 1000 amp. . . . . : 0 -------------------PLAN REVIEW SECTION---_____._._.____....._ 1.0041+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL.. . : Reconnect only. . . . . : 0 SVC/FDR >= 225 AMP'S. . : CLASS AREA/SPEC OCC. ; Ownera _____________._______._._.___.___.___._____-----.__..---__ ___.._ FEES PACIFIC NW CLINICAL RESEARCH type amol.iri: by date recpt '3495 SW LOCUST PRMT $ 40. 00 GEO 10,'x:0!97 97-300121. i 'rIGARD OR 97223 5PC1_ $ 2. 00 GEO 10/20/97 97-30021. 1 Plione #: Contractor: --- -.•---- - ---- __.__._.____.__._._____._.______.._.____.___._.__.____ __ ____ CHRISTENSON EI....ECTRIC INC 4j'. 00 7'OTOL 111 SW COLUMBIP STE 480 - REDU I RED INSPECTION'S PORTLAND OR 97201 Ceiling Cover Underground Cove Phone #: 241-4812 Wall Cover Elect' 1 Servic:r- Reg #. . : 000004 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 with`n 190 days of issuance, or if work is suspended for more thar 180 Ways. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in T2 952-091-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OLINC by calling (503)246-1987. Fler-mittee Signatr.rrF - / Is-r.led By : _...--__--_.—___--_-------_—....-OWNER INSTALLATION ONLY--_._---_ The installation is being made on property T own which is not intended for 1_;41 e, lease, or rent. OWNE=R' S SIGNATURE: DATE: TNSTAI__L.ATTC)N ONLY- SIGNATURE OF SUPR. EL.EC' N: .__......_._ ` ' .�_ DATE: OUo' � __.. LICENSE NO: .S 4 + +i +++++++++4•+++++.4-++-h-F+.. 4- Call c I. r..r .r.4 4 1 I i ..F++ F++i..}. 1 -F'+++ ++ {..++++-F, 1 1-++++4-4++ ++-F++++-f ++4.4-4 +. f._r `•4.4. 1--I.. 1 4 F -! 7-71 CITY OF TIGARD Electrical Permit Application Plan Check# 13125 SW HALL BLVD. Rec'd By _ TIGARD OR 97223 Date Rec'd Phone (503)639-4171, x304 Date to P.E. Data to DST Inspection (503) 639-4175 Print or Type Incomplete or illegible will not be accepted Permit it ELS rr-�-U Fax (503) 684-7297 Called 1. Job Address: 4. Complete Fee Schedule Below: Name ofDet,.lopmentPACIFIC NW CLINICAL RESEARCH LAB Number of Inspections per permit allowed Name(or name of business) AS ABOVE Service Included: Items Cost Sum Address 9495 SW LOCUST 4a. Residential-per unit Ci'y/State/Zip_ TIGARD OR 1000 sq.ft.or less $110.00 _ 4 -- Each additional 500 sq.it.or Commercial ® Residential ❑ portion thereof $25.00 1 Limited Energy $25.00 Each Manuf'd Home or Modular .00 2 2a. Contractor installation only: Dwelling Service or Feeder $68- - (Attach copy of all current licenses) 4b.Services or Feeders Electrical Contractor CHRISTENSON ELECTRIC, INC. Installation,alteration,or relocation Address III S.W. COLUMBIA SUITE 480 200 amps or less $60.00 2 201 amps to 400 amps $60.00 2 City PORTLAND --State OR. _____Zip-Z201-5886 401 amps to 600 amps $120,00 _ Phone No 503-241-4812 _ 601 amps to 1000 amps $18000 2 2 Job No. 5(19-468h Over 1000 amps or volts $340.00 2 Elec. Cont. Lice. No. 26-34C Exp.Date Roconneci only $50.00 2 OR State CCB Reg. No. 00458 Exp.Date 4c.Temporary Services or Feeders COT Business T"DLMstro No. 5246 Exp.Date_ Installation,alteration,or relocation 200 amps or less $50.00 _ 2 Signature of Supt flecrw _+ '\ 201 amps to 400 amps - $75.00 _ 2 401 amps to 6!10 amps $100.00 _ 2 License No. $73S Exp.l7ate. Over 600 amps to 1000 volts,_ see"b"above. Phone No------5U-24_1_4R1 7 - -� - 4d.Branch Circuits New,alforation or extens'on per panel 2b. ror owner installations: a)The fee for branch circuits with purchase of service or Print Owner's Name_ _ loader fee Address_______ Each branch circuit $5.00 2 -- h)The fee for branch circuits City_ _ State Zip_ without purchnsa of Phone No. __ service or feeder fee. First branch rircwt $35.00 2 The installation is being made on property I own which is not Each additional branch circuit $500 _ 2 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 2 3. Plan Review ser;ion (if required):' Signal circuit(s)or a limited energy panel,alteration of extension 1 $40.1" 2 Please check appropriate Item and enter fee In section 5B. Minor Labels(10) _M �---v- __4 or more residential units in one structure 4f.Each additional Inspection over Service and feeder 225 amps or more the allowable In tiny of the above System over 600 volts nominal Per inspection $3500 _ Classified area or structure containing special occupancy Per haul -- $55.00 as described in N.E C.Chapter 5 In Plant _ $55.00 Submit 2 sets of plans with application where any of the above apply. 5. Fees: Not required for temporary construction services. 5a.Enter total of above fees $ 40. 5%Surcharge(.05 X total foes) $ --2 NOTICE Subtotal $ -49 5b.Enter 25%of line tie for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if require (Sec.3) $ - ---- NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ ---- IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WUNK IS COMMENCED. ❑ Trust Account# Total balance Due $ 4 1\DST5\ELC9G APP Rev W96 Y- CITY OF TIGARD DEVELOPMENT SERVICES FtiLJ T L_.D 1 NG F'ERM T T 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171 PF RM T T #. . . . . . . : BUF'97-•046 7 DATE JESUED: 10/14/97 PARCEL: 1 S 126DC-01+800 .CTE. f�DDRESS. . . : 094'3� SW LOCUST 5T #E SUBDIVISION. . . . : LEHMANN ACRE TRACT ZONING:C P BLOCK. . . . . . . . . . .. L OT. . . . . . . . :00,4 JURISDICTION:TIG REISSUE: --FLOOR-AREAS---------- _--EXTERIOR WAL_I._.-CONSTRUCTION— CA ASS OF WORK. :ALT F I RST. . . . : 0 s f N: 5: E: W 'TYPE OF USE. . . :COM SECOND. . . . 1080 s f PROTECT OPEN J NGS' T '.--------._-.-.-- YPE OF CONST. :`=,N 0 s f N: 5: E: W: OCCUPANCY GRf='. :B TOTAL----------: 1.080 s f ROOF CONST: FIRE RET": OCCUF'ANC;Y LOAD: 15 BASEMENT. : 0 s f AREA SEF'. RATED: STOR. : Vi HT: 0 ft GARAGE. . . : 0 s f OCCU SEP. RATED: E1 MT?: MEZZ" : RREDD SETBACKS...... _____--- Fl_OOR LOAD. . . . : 0 psf LEFT: 0 ft RGHT: 0 ft FJR aPJ;I_ : SMOK DET. . : DWE:LL.ING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM: HNDICF' 11CC: SEDRMS: 0 BATHS: 0 IMF' SURFACE: 0 F'RO CORR: PARKING: 0 Vf:LUE. $ : 35000 R:amarl<s : Tenant improvement Owner: -----__.---------._--_---•---______-------_--__....___.____._--- ---- ----------- FEES 11RM MEDICAL CENTER type amol-int by date- - -reept 9495 SW LOCUST F°RM"f $ c-21.5. 50 DRA 1.0/14/97 97--300045 7TGARD OR 972L'3 F,ET $ 10. 78 DRA 10/14/97 97.--300045 =LCK $ 140. 08 DRA 10/14/97 97--30001.15 2='45-2415 FIRE $ 86. 20 DRA 10/14/97 97-30004 BNK CONSTRUCTION INC Flo BOX 66 CLACKAMAS OR 97015 Phone #: 503--557--0866 - - $ - 452. 56 TOTAL Reg #. . : 001075 -_- - - REDUIRED TNSPECTIONS This permit :s issued subject to the regulaUnns contained in the Framing Tnsp Tigard Municipal Code, State of Ore. Specialty Code-, and all other Gyp Boar-d Ins p applicable laws. All worN will be done in accordance with rpproved plans. This perm will expire if word is not started A._-- within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those riles are set forth in DAR 952-001 x@10 through OAR 952-@0101997. -- - - - Vnu many obtain a copy of these rules or direct questions to OUNC -�- �ly calling (503)246-1987. -- ------- -.--___ f ermittee Si.gnatUre . , 'ems' I s s�_:e B y 1 1. ,_ — __._._�__�,,�_•-----_.__.- r+++++++++++++++++++++++++++++++++++++++++++++++..+++++++++++++++++ Call 639-4175 by 7:00 p. m. for• an insper_tion needed the next b'.Isiness day ++++++++++++44--1-4 +++ f+++•4 1-+++a•+++++ F+4+4-++++++++a-++ 1-+4+++'1-++++++++++4++++++4+4 i 1 City of Tigard Commercial Building Permit Application 13125 SW Hall Blvd. �q � Tigard, OR 97223 ? (503) 639-4171 Job-site Address: —9-4.g5 - (4 �.S. Locums Tenant: Clincal Research Suite # Office Use ORIY Valuation: 35, 000 Planck/Rec Permit# � i �I7: fy.1�� Owner: MBM MEDICAL CENTER Map & TL I Address. _ 9495 S.W. Locust Approvals F:e wired Planning Phone: 245-24154 Engineering Other Contractor: BnR Construction Address: 10730 S. E. Hwy. 212 Type of const: W Clackamas, OR Occupancy class: B2 Phone: _ 557--0866 _ �— Sprinklered? Yes No Contractor's License # ,(1, -, 5 (attach copy of current Oregon license) Sq. ft. of project 1 _j _ Contact name & phone __ Bill Ludwig - 557-0866 Story (1st, 2nd, etc.) 2nd Architect/Engineer: Jon R. Jurgens & Assoc. , Inc. Proposed use: Medical Of f ice 15455 N.W. Greenbrier Pkwy. Suite '260 Previous use: Medical Office Address — .— Beaverton, OR 97006 Note: Plumbing & mechanical plans --- -- — --- must be submitted at time of Phone (503) 690-1779 building permit application. ,108 DESCRIPTION. _Tenant .improvement (Non-Structural) pplicant Signature Phone number Received by: , Date Received: �� Permit# Account Description Amount Amt. Pd. Bal. Due . Bldg. Permit (BUILD) Plumb. Permit (PLUMB) Mach. Permit (MECH) State Tax (TAX) Bldg: Plumb: Mach: Plan Check (PLANCK) Bldg: Plumb: Mach: Sewer Connection (SWUSA) _ Sewer Inspection (SWINSP) Parks Dev Charge 'OKSDC) Residential TIF (TIF-R) Mass Transit TIF (TIF-MT) Commercial TIF (TIF-C) Industrial TIF (TIF-1) Institutional TIF (TIF-IS) Office TIF (TIF-O) Water Quality (WQUAL) Water Quantity (WQUANT) Fire Life Safety FLS) Erosion Cn'rl Permit (ERPRIVIT) Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN) TOTALS- OVER-THE-COUNTER (OTC) PERMIT COMMERCIAL ( STRUCTURAL) BUILDING PERMIT CHECKLIST DESCRIPTION OF PROJECT: �1 CLASS OF WORK: _� CT' i FLOOR AREAS: _ EXTERIOR WALL CONSTRUCTION I — I TYPE OF USE: �'--h FIRST SQ. FT, i C'J: S: E. W: TYPE OF 1 CONSTR: ` V SECOND t n�O SQ. FT. PROTECT OPENINGS?: ' i I OCCUPANCY GRP: i THIRD SQ. FT. i N: S:_____ E: 1N: OCCUPANCY LOAD: � TOTAL SQ. FT. ROOF CONSTP: FIRE RET: i STOR:_ HT' FT: i BSMNT: SQ. FT. i AREA SEP. RATED: i BSMNT?: MEZZ?: GARAGE: SQ. FT, i OCCU.SEP.RATED: t i FIRE FIRE SMOKE HANDICAP SPRINKLER: ALARM: _ DETECTOR: _ ACCESS: =COMMERCIAL INSPECTION ACTIONS _ FEE MENU Foot/Found _ Post/Beam $ �5� Permit Fee ---� _Masonry Framing $ t4e OF Plan Review Insulation Shear Wall r$ 1b 16 5% State Surcharge Firewall LGvn Board ;$ ' FLS Plan Review _ Suspended Ceiling Sprinkler Rough-in $ _ Add'I Permit Fee Sprinkler Final Fire Alarm $ Add'I FLS Pln Smoke Detector Approach/Sidewalk $ Inspection Miscellaneous Final $ MIS Fee FOR OFFICE USE ONLY: TYPE OS USE OPTIONS(COM=commercial; CMS=commercial manufactured structure) CLASS OF WORK OP'f IONS FOR ALL PERMITS(NEW=new; Add=addition:ALT-alteration: ACS=accessor-vfND-foundation: OTR other; DEM=demolition: REP:=repair. FPS=tire protection system. NOTE: USE OTR FOR FENCES. RETAINING WALLS, DETACHED DECKS. SIGNS. AWNINGS, CANOPIES) �ovrcntr2 doc (DST) 4197 OVER THE COUNTERW-IC-1 (attachment to Submittal Criteria) SUBJECT ACCESSIBILITY BARRIER REMOVAL IMPROVEMENT PLAN REQUIREMENT'. OREGON REVISED STATUTE(ORS)447.241. (1) Every projec"for renovation, alteration or modification to affected buildings and related facilities shall be made to insure that the path of travel to the altered area and the restroom, telephones and drinking fountains are readily accessible to individuals with disabilities, unless such alterations are disproportionate to the overall alterations in terms of cost and scope (2) Alterations made to the path of travel to an altered area may be deemed disproportionate to the overall alteration when the cost exceeds twenty-five per-cent(25%). THEREFORE, Each submittal for a building permit shall Include this form providing the following information. [Excluding re-roofing, mechanical and electrical permit applications] VALUATION of all renovation, alteration or modification being done excluding painting, wallpapering. (1j $25.,000 multiply: 25% Barrier removal requirement. 5_ BUDGET FOR BARRIER REMOVAL [2] $ b, �rL_ The dollar amount of the BUDGET established on line (2) in the computation above shall be spent providing the accessible elements in the following order: 1. An accessible route connecting the building to accessible pedestrian waikways, and the public way. $ (including but not limited to curb ramps,detectable,warnings, marked crossings, ramps handrails and landings). 2. Not less than one accessible parking space. $. (including but not limited to adjacent access aisle,signs and ci•b ramp connecting with the accessible route). 3 Accessible entry or entries. $ 850 (including but not limited to ramps,handrails, landings, door sill height,door width and door hardware) 4. An accessible interior route o the altered area. $ (including but not limited to door-ways,maneuvering clearanL,-.;.door hardware and stairways). 5. At least one accessible restroom for each sex. $ 7, 650 6. At least one accessible telephone where public phones are provided. $ _ 7 When drinking fountains are required, fifty per-cent but not less than one shall be accessible. $ 8. Additional accessible elements such as storage, reach ranges, alarms, etc. $ MIAUL; 0all_equal line 2_of Val_ue_Corin oft $ g 5np is otc4.doc(DST) m m m m m m m m m m > E o n ¥ § ¥ b § % ¥ co t \ ° % \ § §n n ■ 2 S E S $ 2 § S e § ) # � � 7 2 M ƒ � ( 9 _% .06 { R (D2 k / f 2 ( K / o K ( \ \ 0 0 ) ( \ k \ > § § \ § § § <. f } a . ) ( \ \ \ ) N $ § § \ § § § § \ § O f q a a , @ ; ) ) ) ) ƒ \ ) ) ) [ $ k oC � � m } \ k } } \ ( - � z f 2 / 2 § § f ° m E f $ m m � q O 4 � E f f E f ƒ f f ƒ 0 r I I I I = I I I = I I $ o \ �Ek k R k \ & & \ \ \ [ ) } \ \ } } ) \ f a. § § \ \ ( § \ § § § £ J @ g ) \ ) \ k } \ \ ) \ A / U&&Cc')7 ( g{ £ JE %5B ¥ m0 A § �2 =$ #= QmEE$ $\}/ as - # {/(§ \� $ qi/a ((co 3 (§/} � 7m0Eg ; ; , _ 2 : m a, � ) �/ EE72 [a) »\ 9 ~ ®2 = 2 \ m 2 , m $ a222 , , =J§ r , a\ 7 � lZf]97an2E/ ;) % ( eR/ , � q a2AE �( ) § \ / aE3 (\kZ «87 J§ @ /§ ° M :3 ( � g { § 7 cl ) an w� W W W W W w w w W � D n n D (�) n n n n ti C C C n ccpp D U cOp Q� OVi A A A O W O V V U 0 O —+ O O N O O O O cD O O N (3) N OD Ln i� W T �) C T 11 T T G) T CJ co 3 N m 3 'arn O (� m co CD 7 fD p° O 0 C ° (� < N _ m N m o fb O a (A D n a @ (np Z7 d C 0 7 U N s 7 C 7 C1 ro (A d a m 8 x 3 � 9 j t0 fOD fD (O to N cn tD tppO O W O cp O 6 O 1D O fD t0 N ril to fD O (D (OD (ODto W (D O O to W (n W W m D a U W 0'i W Q) T p C U U � T m V O O D D D D O cD p D D O O O n n `m m cn U)i cn m ( z z 2 c7 �" '- m m m v O O Ob 0 0 0 o o Z z Z 2 co z zz z Z Z 2 I 0 2 = 2 2 2 = Q = 2 2 oZ 2 C o a a a a a a a n a a ° ° ° a EL a n o. n cn D D ;a :U D C W W co `� ` °�° °�° m ro `v X00 13 CD CL to Ln O O CO fD c0 O 1D S �D A t+(N_1 (D (1) fD fD lU (D to g) 03 m 0, (o, n o n z � wn> Dcn Div= vm Z2 A w Nr a1 o TzrCO 01 m � �� rr m0� Z O cco� famW� a5 ��Ocn-I° cn y cnm rm o 7 O n 8 a 6i Y om.$1 10to,�W too .p vl v ?C) N a C) P m ZF O� 10 Ch y �g —� C) fo� CD_o-aao4y c�vo1 � g ``OAF _ raaM mf ON V'm ao co' m y p m m o Oo n j Day; @ N�� 3 aw CL o 3 P iD cD$ m r a S G) 2 cn n00 °CD m as 3 m n° fD � C7cn o n m O � ; a S °' O N Y N m M k / / \ ) � j k ° / \ \ i ° ( @ ( 2 k 2 / � / K 0 / } I ( , N k ( U) § § § § > n = < @ \ J t / § $ / ■ (D [ � o6 \ ; CL C) m a � f q $ m m § 6 0 � � f ƒF ƒf 0 r = \ \ } \ \ 0 [ w m % -0 % % K k § § § k $ 0 E a X n \ \ \ & _ § § 2 w S 7 ) ƒ / wo \ / c 2 % § � # \ } (D E $ � , , Cl / £ & n < o � � ■ § § § § § k rD > % 0 cn \ ( ( { \ o ; X U) � / / / \ / 0 � ƒ ƒ ƒ ƒ0 r= ± ± ± f ± ) k ( ( ( \ f E 4 § § 4 § @ CL g 0 i m m m m m m m m m m S \ ¥ S b 5 b 5 S S % n ± n n n \n o g o ■ § B § ) / m § \ m / / \ j 9 2 f ® \ § k * / / / to 2 # 2 0 Ll 4 d §$ § \ \ A§ $ to,- K $ n = � i § § § § § $ 2 d § § § § q § 4 § 2 O ƒ k k k k k (C) (D k { \ �� 2 0 o� \ 2 § § 2 § ?q 2 Co 00 CL 0 T, z z s ; G 0 � 2 / a ? / / $ § % § § F \ § 0 � � 0 F 0 0 0 0 0 0 F ƒ r= 0 I I I I I I I = I qo k R E R R k \ k k �E \ / co\ z / z Lu Up z0 G)z co / �m ® � K \ § § § § § § § § \ L \ \ § § § § § ) § \ g ® /%( ( 2{ Dcn0 7 %g �ƒ z \m , 4444: � \ EEg7 [}/ « aak8 �� 8 ° iEakE E 0@ zSm (DaIr0\§ 73 @113 i@� m k ) \/§ f\ 0.60<W @ ` ate 2 / a2 ; & }f % }3 � E+(3@ / \ � \� \ ) § tE\gymR � N m & /mf f � E , 7Ej O /= � ` R8 § J� n [ E \ 7 \\ a 7 f g 2 _ a k \/ \ \ \$ 0 / / / ) ) / / / OD q / \ -0> 6 \ ( \ \ / \ ':t 0 E / ( ( i ( , CD d m Co D n = < m ■ O \ } \ _ 0 \ > \ of m CL § E§ r o¥ « » \ ( ic 01) ? / $ c $ 6 § $ % §/ Ln W ( E$ c 9 0 � 9 c ■k § & ¥ ƒ \ § § § k C-0 § 0 E CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: P /02/2000 00064 DATE ISSUED: 03/02/20 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1 S 126DC-04800 SITE ADDRESS: 09495 SW LOCUST ST A SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 004 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: 2 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SF_V1;ER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace 2 electric water heaters with like kind. _ FEES Owner: Type By Date Amount Receipt BAKER, JAMES +MATHESON, ROBERT PRMT KJP 03/02/200C $50.00 0000401 BAKER, DIANE R 5PCT KJP 03/02/200( $4.00 0000401 9495 SW LOCUST A Total $54.00 PORTLAND, OR 97223 Phone 1: Contractor: KENNEDY PLUMBING 13985 SW FARMINGTON RD RFAVERTON, OR 97005 REQUIRED INSPECTIONS Misc. InspFc'!^n Phone 1: 543-5535 Final Inspection Reg #: LIC 001009 (CORRECT#10967) PLM 34-42PB ORIGINAL T his 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 Ut ity Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAP, 952-0001-0080. You may obtain co s of these rules or direct questions tb OUNC by calling (5Q3) 246-1987. (- E C.vr-�t. Permittee Signature: 1 T E � � kk Issued By: _ L` Call (503) 639-4175 by 7:00 P.M. for an inspection needidthe-next&usine" CIT 111 OF TIGARD Plumbing Permit Application Plan Check 13125 SVV HALL BLVD. Commercial and Residential Recd By_ TIGARD, OR 97223 Date Recd (503) 639-4171 Date to P.E. — Print or Type Date to DS1 Incomplete or illegible applications will not be accepted Permit Related SWR#� Called_ Name of Development/Projeit FIXTURES (individual) QTY PRICE AMT Job n (3 rr\ -{- (15�,( C Sink Address Street Address S ite Lavatory 11.50 Cnrl li' I CC Tub or Tub/Shower Comb. 11.50 Bldg# City/State 7'p Shower Only — - — 11.50 Name — Water Closet 11.50 Dishwasher 11,50 Owner Mailing Address Suite Garbage Disposal 11.50 Washing Machine 11.50 City/State Zip Phone Floor Drain/Floor Sink 2" 11.50 -- Name ,zz ---- 3" 11.50 rY\v f n t'(1 SSC 4" 11.50 Occupant MaillnAddress Sults Water Heater O conversion A(Ilke kind r 11.50 u lid 1 C)c ut,fit" t t Gas piping requires a separate mechanical permit. o Cts/Slate Zip Phone Laundry Room Tray 11.50 ------ 0 CiCsfUrinal 11.50 Name'Ili ( �LI+ri CJ)1 Other Fixtures(Specify) 15.00 Contractor Mailing Address Suite 13`155 5 r rn1/, •I I I I — — — Pttor to permit CJty/State ZIP Phone Sewer-1st 100' 38.00 issuance,a copy 3— Sewer-each additional 100' 32.00 of all licenses are O ego Const.Cont.Board Lic.# E p Datel z required if �1¢ } ---} ,/,� �) .J Ur,lC1 Sarvica 1st 10n, 3800 expired In COT Plumbing Lic.# Exp. ate Water Service-each additional 200' 32.00 J�database -Lk 2 f L3 �, (Y Storm&Rain Drain-1st 100' 38.00 Name Storm&Rain Drain-each additional 100' 32.00 Architect _ Mobile Home Space — 32.00 Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 3200 Pollution Device Engineer I City/State Zip Phone Residential Backflow Prevention Device' 1900. _ (Irrigation timing devices require a separate Describe work to be done restricted energy Permit) New O Repair 0 Replace with like kind. Yes,x}, No 0 Any Trap or Waste Not Connected to a Fixture 11.50 _Residential 0 Commercial O Catch Basin 11.50 Additional description of work: Insp.of Existing Plumbing 5000 per/hr A e yot capping, moving or eplacing any fixtures? Specially Requested Inspections 50 00 -- er/hr Yes O N O Rain Drain,single family dwelling 45.00 'i yes, see back of form to Ind ate work performed by Grease traps V 11.50 / fixture. FAILURE TO ACCU TELY REPORT FIXTURE WORK COULD RESULT IN I REA_SED SEWER FEES. QUANI ITY TOTAL I hereby acknowledge that I have fead this application,that the Information Isometric or riser diagram is required if Quantity Total is >9 given Is correct.thbt I am the"eWn r gr authoilzed agent of the owner,and — 'SUBTOTAL r that plans submitt a!.Pin comooryce wittj Or on State Laws, (1 .0 Signature of Oyer Agenic �" Date — — LSURCHARGE c ,C) Contact Person No e ' I ( Phone G "'PLAN REVIEW 25%OF SUBTOTAL Required only if fixture qty total Is>9 BAATH HOUSES TOTAL �{ 2 BATRItOUSr$250.00 _ 3 BATH HOUSE$285.00 •Mlnlinum permit fee is$50+5%surcharge,except Residential Backflow (This foe Inr.ludss all plum ng flztures iiling sn the flrtst. Prevention Device,which Is$2.5+5%surcharge 100 feet of sanitary sewer storm sewer a water service) t' "All Now Commercial Buildings require pians with Isometric or riser diagram and plan review I%&IiVorrnf 1plumapp doc 15r )9 PLEASE COMPLETE: Fixture Type Quantity by Work Performed _ New Moved Replaced Removed/Capped Sink — Lavatory Tub or Tub/Shower Combination Shower Only Water Closet _ Dishwasher Garbage Disposal Washing Machine _ Floor Drain/Floor Sink 2" 411 Water Heater _ Laundry Room Tray _ _Urinal — Other Fixtures (Specify) COMMENTS REGARDING ABOVE: I WitsVorms'plumepp doc GUM CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4176 Business Line: 639-4171 MST Date Requested 1j l'' " l —AM_ PM BUP BLD Location C S ��L Suite MEC Contact Person � SYiQ,�,�,� ph _ ,,�"M� Contractor Ph SWR BUILDING— Tenant/Owner 'DeRq tTQW 6Y /4-S$0C. ELC Reliaining Wall _ ELR Footing Foundation Access: FPS Ftg Drain �'� 5�� Crawl Drain Inspection Notes. SGN Slab ` Post&Beam ---- — - SIT Ext Sheath/Shear — Int Sheath/Shear _--_ Framing Insulation -� --- — - ------ ___-- Drywall Nailing Firewall ---- -- ------.----- Fire Sprinkler -------------- -- Fire Aiarm --- Susp'd Ceiling Roof -------------- Misc: Final PASS RRT FAIL ---- -- --- -------...- -_._---- [lost&Beam Under Slab Top Out -- --... Water Service Sanitary Sewer w 14 -----` - ---- Rain Drains PART FAIL MECHANICAL. - - - -- Post&Beam ---------- ------__. - Rough In -- Gas Line Smoke Dampers - - Final — --- --- ---- ---- PASS PART FAIL --- ELECTRICAL Service --------_, ----- Rough In UG/Slab —_ Low Voltage -------- ---_— ---- Fire Alarm Final --- --� PASS PART FAIL SITE ------- ------- ------------ Backfill/Grading Sanitary Sewer --- — Storm Drain I J Reinspection fee of$— required before next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ J Please call for reinspection RF - - [ J Unable to inspect-no access ADA Approach/Sidewalk Date 1 sr —_ _ Inspector J/� / � Other T Ext Final - ---- t PASS PART FAIL DO NOT REMOVE this inspection record from the job site. BUILDING PERMIT CITY OF TIGARD PERMIT M BUP1999-00481 DEVELOPMENT SERVICES DATE ISSUED: 11/15/1999 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1S126DC-04800 SITE ADDRESS: 09495 SW LOCUST ST A SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 004 JURISDICTION: TIG REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ALT FIRST: 600 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: sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: b. AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: _ READ SETBACKS REQUIRED FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:Y BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 6,000.00 Remarks: Modification to interior walls, widening access to a non-accessible restroom. Provide signage NOT AN ACCESSIBLE RESTROOM. A plumbing and electrical permit is required. Owner: Contractor: MBM & ASSOCIATES BNK CONSTRUCTION INC 9495 SW LOCUST STREET 10730 SE HWY 212 SUITE A PO BOX 66 TI A n9 OF? 97?.23 CPlione b57A697015 ORIGINAL one: Reg#: uc 107555 FEES REQUIRED INSPECTIONS Type By Date Amount Receipt Framing Insp PRMT KJP 11/15/199 $87.00 99-319759 Gyp Board Insp ng PLCK KJP 11/15/199E $56.55 99-319759 Susi CFinal Insspecpec Insp tion 5PCT KJP 11/15/199E $696 99-319759 FIRE KJP 11/15/199 $34.80 99-319759 Total $185.31 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for rnore than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-1987. Pe nn itee Signature: /X Issued By: Call 639-4175 by 7 p.m. for an inspection the nexi husiness day Clef OF TIGARD Commercial Building Permit Application Plan Check* 13125 SW HALL BLVD. Tenant Improvement Recd By 11 'Date eI I ♦♦ TIGARD, OR 97223 nate oP.E. (503) 639-4171 F~j Date to DST,� f Print or Type Permit*&" Wi'-"OP-01 1 Related SWR incomplete or illegible applications will not be accepted Called _ Name or Development/Project — Existing Building New Building ❑ Job Ae/j/Ix 7 el 01/1 ,Y SSO�. _ Address Street Address Sulte Building (7 " w L�Lc�s fig" Data Bldg* City/State Zip Existing Use of Building or Property: rr Property Name�✓J /`7 __ _ Proposed Use of Building or Property: Owner Mailing Address Suite yf� s W �Q G�i�T- No, Of Stories: City/State lip Phone Sq. Ft. Of Project / 0 Occupant Name —•- --- Pelrll�Te I e >1 ff �v Occupancy Class(es) Name Contractor , f Gp,� -7 Type(s)ofConstruction / Prior to permit Mailing Address Suite — 7 i+ issuance,a copy / / Will this project have a Fire Suppression System? of all licenses _ G Yes n No are required If CllylSta a Zip Phone –'-- ---� 6 expired In C.O T. Americans with 0 Disabilities Act (ADA) I database <<1L/(�lrl�f M16- ,Qg�6 Valuation X 25% = $ � Participation Oregon Const.Cont.Board Lic* Fxp.Dale-�/� J p Complete Accessibility Form --- -- - �0 7� fT Project $ �1r� Name Valuation Architect Q/t! ,%JYA elf'/" PlanF Required: See Matrix for number of sets to submit Mailing Address — Suite on bacl City/State Zip Phone Thereby acknowledge that I have read this application,that the information given is correct that I am the owner or authorized agent of the owner,and that plans submitt4d are in compliance with Oregon State Laws. --Engineer Name �- SignALure of O�/A nt Date r Mai!ing Address Suite � CZ-r?� /�� Contact Person Name Phone G cnylslate Zip -- Phone _-- FOR OFFICE USE ONLY Indicate type of work New O Addition O Demolition O Map/T0 Land Use: Y' Accessory Structure O Foundation Only O AlteratioOK _ Repair O Other —_ Notes: ---of work: TIF Note: Site Work Permit Application must precede or accompany Building Permit Application I\COMNEWTI DOC (DST) 5/96 ,1 r. s COMMERCIAL PLAN SUBMITTAL REQUIREMENT MATRIX Plan Review is depe;ident upon submittal of BOTH plans AND a COMPLETED application. For an electrical submittal, the application must contain the signature of the supervising electrician before plan review will be conducted. After plan review approval, Plans Examiner will contact the applicant to request additional plan sets for distribution purposes. (Copy for Contractor, City, Washington County, Tualatin Valley Fire & Rescue) Total # of TYPE OF SUBMITTAL Plans KEY: Submitted S (Private) 1 S = Site Work B (New or Add) 1 B = Building F (New or Add or Alt) ^ 3 F = Fire Protection System M (New or Add or Apt) 1 M = Mechanical B & M (New or Add) 1 P = Plumbing P (New, Add, or Alt) v 2 E = Electrical B & M & P (New or Add)_ 2 New = New Building E (New, Add, or Alt) 2 Add = Addition B & F & M & P & E 3 Alt = Alternation to Existing (New , Add) _ Building *B or B & M (Alt) 1 *B & M & P (Alt) 3 *B & M & P Alt) 3 *B & M & P & E & F(Att) 3 NOTES: *Shaded areas designate ALT submittals only. Wstslforms`,matrxcom doc 10/30/9y ' SUBJECT: ACCESSIBILITY BARRIER REMOVAL IMPROVEMENT PLAN REQUIREMENT: OREGON REVISED STATUTE (ORS)447.241. (1) Every project for renovation,alteration or modification to affected buildings and related facilities shall be made to insure that the path of travel to the altered area and the restroom, telephones and drinking fountains are readily accessible to individuals with disabilities unless such alterations are disproport.,mate to the overall alterations in terms of cost and scope. (2) Alterations made to the path of travel to an altered area may be deemed disproportionate to the overall alteration when the cost exceeds twenty-five per-cent(25%). VALUATION of all renovation, alteration or modification being done excluding painting, wallpapering (1]$ 6 0 0 67 multiply: 25% Barrier removal requirement. 25 BUDGET FOR BARRIER REMOVAL [2]$ p 6 In choosing which accessible elements to provide under this section, priority shall be given to those elements that will provide the greatest access. Elements shall be provided in the following order: (a) Parking $ (b) An accessible entrance: $ (c) An accessible route to the altered area: $ / Q— t 0 Del y �t //''a l��ti'�t C (d) At least one acccssible restroom for $ each sex or a single unisex restroom: (e) Accessible telephones: $ (f) Accessible drinking fountains: and $ (g) When possible, additional accessible elements such as storage and alarms: $ TOTAL_ Shall equal line 2 of Value Computation lAdst0fomisNaccess doc OVER-THE-COUNTER (OTC) PERMIT PLAN REVIEW COMMERCIAL (STRUCTURAL) BUILDING PERMIT CHECKLIST DESCRIPTION OF PROJECT !r 01 ri Ile- 0 to jet Id CLASS OF WORK 1 FLOOR AREAS: �G' U EXTERIOR WALL CONSTRUCTION TYPE OF USE FIRST SQ. FT. N: S: E: W: — l-, - TYPE OF CONSTR: SECOND SQ. FT. PROTECT OPENINGS?: OCCUPANCY GRP._2 THIRD SQ, FT. N S: E: W n,�CUPANCY LOAD: TOTAL SQ. FT, ROOF CONSTR: FIRE RET: STOR HT: FT BSMNT: SQ. FT AREA SEP, RATED. BSMNT?: MEZZ?: GARAGE SQ. FT OCCU.SEP.RATED: FIRE FIRE SMOKE HANDICAP SPRINKLER: ALARM: _ DETECTOR: _ ACCESS. COMMERCIAL INSPECTION ACTIONS FEE Foot/Found Post/Beam $ _Permit Fee —� 5 Masonry �_ Framing $ r Plan Review Insulation Shear Wall $ _8% State Surchar4e Firewall �. Gyp '-card $ �'� FLS Plan Review _ op Suspended Ceiling _ Sprinkler Rough-in $ Add] Permit Fee Sprinkler Final Fire Alarm $ Add'I FLS Pln Srooke Detector Approach/Sid t,waIk $ Inspection Miscellaneous sinal $ MIS Fee FOR OFFICE USE ONLY: TYPE OS USE OPTIONS(COM=commercial; CMS=commercial manufactured structure) CLASS OF WORK OPTIONS FOR ALL PERMITS(NFW=new;Add addition,ALT=alteration;ACS--accessory;FND-foundation; OTR=other;DEM=dernolition;RFI'=repair,FPS–fire protection system,;MOTE: USE OTR FOR FENCES, RETAIL?ING WALLS, DE-FAC14ED DECKS, SIGNS, AWNINGS, CANOPIE=S) _ __- I\ovrcntr2 doc (DST) 9/99 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 — BUP O _— Date Requested_ �2 b 1 _AM PM BLD Location � s _ Suite MEC Contact Person Ph (o z�� 33f PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS _ Ftg Drain SriN 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: --- n ------- Final ------------ PASSPARI -AIL -- - -- --- - -- ---�—..— ---------- �._._._._ PLUMBING _ Post& Beam I Under Slab 1 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 Service u-953�.>Ct C UG/Slab --------- -------- --- — Low Voltage - Fire Alarm -- 1 PASS ART FAIL Backfill/Grading - - Sanitary Sewer Storm Drain [ J Reinspection fee of$ rerlunr ii hit ur n,xt inspertlon. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ j Please call for reinspection RE: _ [ J Unable to inspect-no access Fire�;upply Line - - - ADA f Approach/Sidewalk Other Date .rC, Inspector - - --. ..1._._-G -- _. .. Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the jolt! site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175�.j Business Line: 639-4171 — - // BUP Date Requested, l�t+tn �(�� AM_ / PM BLD Location gLie; `1w �iOCt,cS�` �'� _ Suite _�_ MEC _ Contact Person <-Q d.rL--1 ��'11 )y t0-' yu�� Ph _ (s-`�.3"S S 3 5� PLM �`�_ C`! Contractor Ph SWR BUILDING Tenant/Owner ELC _ Retaining Wall ELR _ Footing Access: ' �� ) FPS — Foundation Ftg Drain SGN Crawl Drain Inspection Notes: ((0�� t��, U AXC4, 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 A __PART FAIL - ---- ---- Post&Beam - - Under Slab -Top Out ----------------- 1 Water Service -___- 3?nitary Sewer Drains _ -------------__ - - A PART FAIL "-- MECHANICAL Post 8 Beam ------ --_-._—.---- -- - ---- --_- T Rough In -- ----- ---- ----- ---- --- Gas Line --^"----- -- Smoke Dampers Final --------------_-.._�_---- -- PASS PART FAIL _ -- ELECTRICAL - - — - Service --�_---- - -----� --�. _ -. Rough In UG/Slab -- --- -- -- - ---- Low Voltage Fire Alarm - --- -- --------J Final PASS PART FAIL ---- -- ------ - -- - --- --SITE _----___--- Back fill/Grading ---�----------- -^-- Sanitary Sewer Storm Drain l )Reinspection fee of", required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch rsacinUnable to inspect-no access r ire S�rpply Line I 1 Please call for reinspection RE -_y— I 1 p- ADA Approach/Sidewalk Date ) 1 �� Inspector � 1'� �_ --- Ext �! _ Other L---f-- Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD DEVELOPMENT SERVICES PLUMBING PERMIT 13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 PERMIT #. . . . . . . : PL.h198--04 53 DATE ]ISSUED: 12/09/98 PARCEL-. 1 S 126DC--04800 SITE ADDRESS. . . 09495; SW LOCUST ST #A SUBDIVISION. . . . L_E:HMANN ACRE:' TRACT 70N I NG: C,—P BLOCK.. . . . . . . .. . . . LOT. . . . . . . . . . . . . :00.t4 JURISDICTION: TTG CLASS OF' W()RI!. . -AL T GARBAGE DISPOSALS. : 0 MOBILE HOME_ SPAC:ES). : 0 TYPE" OF USE... . . . :COM WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0 OCCUPANCY GRP. . :P FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . . ih STORIES. . . . . . . . . 0 WATER HEATERS. . . . . . 1 CATCH BASINS. . . . . . . . 0 LAUNDRY TRAYS. . . . . : 0 SF REIN DRAINS. . . . . . 0 SINKS. . . . . . . . . . 0 URINE L_S. . . . . . . . . . . .. 0 CREA ',E TRAPS. . . . . . . . 0 LAVATORIES. . . . : 0 OTHER FIXTURES. . . . s 0 TUB/SHOWERS. . . : 0 SEWER LINE (ft) . . . s 0 WATER CLOSETS. : 0 WATER LINE (ft) . . . s 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft) . . . : 0 Remarks : Alter••ati.c!n to replace water heater- with 1ii<e 1<i.nd. Owner: ------------------------------------------------------- FEES --------------- MBM ASSOCIATES type amoi.rnt by date recpt 9495 SW LOCUST PRMT $ 25. 00 DL.H 12/09/98 98-311.398 STE A 5PCT 1 . 25 DLH 12/09/98 98-311398 TIGARD OR 97=23 Phone #: Contractor---------------------------------- KENNEDY PLUMBING 13985 SW FARMING70N RD BEAVE"RTON OR 97005 __—______.______---•------_-----...__.._._.... .. Phone 1t: 643--5535 $ 26. 25 TOTAL. Req #. . : 001009 REDUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Mi.sc. Inspection Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection 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 's 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 952-0001-00:8 through OPO 952-0001-0080, Ynu may obtain copies of these rules or direct questions to Off, by calling (50?1�46-1987. _ r f Issl-red By: -Q�( Permittee -F•+•+++++++++++++ I ++ +++++++•+++•++++++-++i+++++++++++++++•.+•+++++++++ ++++++++++++.+ Call 639-4175 by 7:00 p. m. for an inspection needed the next br.rsiness day ++++++++++++++++++++++++++++++++•++++f•+++++++++++++++++++++++++++++++i+++++++++ CITY OF TIGARD Plumbing Application Recd By 13125 SW HALL BLVD. Commercial and Residential Date Recd [a TIGARD, OR 97223 Date to P.E. -- (503) 639-4171 Date to DST -- Permit i Print or Type Related SWR• Incomplete or illegible applications will not be acc ted Called Name of DevelopmenUProject Job Y brrl Q SSO G FIXTURES (Individual) QTY PRICE AMT Address Street Address Saila Sink `� 95 5�1 oars+ Sr H 9.00 Lavatory 8.00 Bldg 0 ty/State� ZIP Tub or Tub/Shower Comb..kd q�:.�3 9.00 Name Shower Only 9.00 Water Closet 9.00 Owner Mai!�g Address Suitt Dishwasher 9.00 `)r t Garbage Disposal 900 City/State Zip Phone Washing Machine 9.00 Name Floor Drain 2' 9.00 3' 9.00 Occupant Mailing Address Suite 4' 9.00 City/State Zip Phone Water Heater O conversion like kind 9.00 q,DU Laundry Room Tray 9.00 pme Utinal 9.00 CSP PAS U rn 6n q Other Fixtures(Specify) 9.00 Contractor Mailing Addres Suite (3985 �C,rr)i 900 (Prior to issuance 5ity/State Zip Phone 9.00 applicant must Jr(�r, -3 6%3. 5 5 35 9.00 r c provide all Ore on Con t Co t.Board Ltc.* Exp.Date 9 00 cgntradors 4- 2 P3 %_1'p license Plumbing Lic.d Ex .Date 9.00 information if c.0 6 -1 Y Sewer-1st 100' 30.00 expired 1 c 2l0 9 Sewer-each additional 100' 25.00 in COT COT Busin ss Tax or Metro S Fxt . at Water service-1st 100' 30.00 database). 1 -13 Name - Water Service-each additional 200' 25.00 Architect Storm d Rain Drain-1st 100' 30.00 Storm&Rain Drain-each additional 100' 25.00 or Mailing Address Suite Mobile Home Space 25.00 Engineer City/State Zip Phone Commercial Back Flow Prevention Devicu or Anil- 25.00 Pollution Device -leswork New O Addition O Alteration O Repair O Residential Backflow Prevention Device' 15,00 o be done: Residential O Non-residential O Any Trap or Waste Not Connected to a Fixture 9.00 Additional description of work Catch Basin `- 9.00 Insp.of Existing Plumbing 40.00 � �G CC 6 0. L LlDper/hr Specially Requested Inspections 40.00 Existing use of per/hr budding or propertyRain Drain,single family dwelling 3000 "ropused use of Grease Traps 900 building or property _ _ --' QUANTITY TOTAL Are you rapping moving or replacing an fixtures? Yes N Isometric or riser dWgiarn Is required if Ouanity Total Is >9 5, Y PP g 9 p 9 Y p O (If yes see back of form) _ 'SUBTOTAL j 1 hereby ac nowledge that I have read this application,that the information 5%SURCHARGE �given is correct,that I am the owner or authorized agent of the owner,and thaff clans submitted are in compliance with Oregon State Laws, PLAN REVIEW 2E%OF SUBTOTAL S19,natur-9-of Owner/Agent Date Reouired only Rflxtum gry total s,9 _t � TOTAL Contact Person Na Phone •Minimum permit fee is S25+5%surcharge,except Residential Backflow r �, , •+( �� $rj35 Prevention Devine,which is 515+5%surcharge I tdIMP"app doe 511117 PLEASE COMPLETE AS APPROPRIATE TO PROJECT: _Fixtures to be capped, moved or replaced Qt Sink Lavatory _ Tub or Tub/Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain 2" 3" 411 Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: 'cr. brmsco Cx SN7 CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM1999-00406 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/01/1999 SITE ADDRESS: 09495 SW LOCUST ST A PARCEL: 1S126DC-04800 SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 004 JURISDICTION: TIG CLASS OF WORK. DEM GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: GOM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: A_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: TUB/SHOWERS: 2 SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Cap off 2 lavatories, 2 showers, and 1 toilet in existing commercial building. Owner: FEES - -- MBM & ASSOCIATES Type By Date Amount Receipt — 9495 SW LOCUST STREET PRMT KJP 12/01/199 $57.50 99-320095 SUITE A 5PCT KJP 12/01/199 $4.F,' 99-320095 1IGARD, OR 9-1223 Total $62.10 Phone 1: Contractor: MARXMEN PLUMBING INC 9(365 SW 163RD AVE BEAVFRTON, OR 971107 REQUIRED INSPECTIONS Phone 1: 579-2200 Insp existing/capped fixtures Reg #: LIC 00102432 Final Inspection PLM 34-161 PB ORIGINAL -f his 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 riot 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 52-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503 4 1987. 'I�JA Issued By: �,-,Q'C"W`-4- Permittee Signature: A Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next b "s day CITY OF TIGARD Plumbing Permit Application Plan Chock#_ 13125 SW HALL BLVD. Commercial and Residential _ TIGARD, OR 97223 �rl ��(` Date Recd (503) 639-4171 Date to P.E Print or Type Date to DST _ Incomplete or illegible applications will not be accepted Permit I ooyol'� Related SWR Called Name of DeveI ment/Prof ct a f 4- FIXTURES (individual) QTY PRICE qAMTJob Chas J.LU , t -. ,U%+ �r Sink -- 11.50 Address Street Address Suite Lavatory1150 Tub or Tub/Shower Comb 1150 Bldg# City/State ZIp1J d j Shower Only11.50 Namg 1 r Water CloseUUrinal (Specify) _ / 11.50 l l r t 1 ti Dishwasher L 11.50 Owner Mailing Address / Suite Urinal 11.50 Garbage Dispusal 11.50 City%gtale Zip Phone _ Laundry Tray 11.50 Name Washing MachinelLaundry Tray (Specify) 11.50 M M'PlTu)vsnCA AsO; Floor Drain/Floor Sink 2" 11.50 Occupant Mailing Address Suite 3" 11 50 _S it, L,L-A,t City/State Zip Phone 4 11.50 _ Water Heater O conversion O like kind 11.50 Name ( _Gas piping requires a separate mechanical permit. y„ Aft-kV_L6.9 MFG Ilome New Water Service 28.00 Contractor mMailing Address _ Suite MFG Nome New Sanlstorm Sewer 28.00 1SS' °• �10�►`� t Hose Bibs 11.50 Prior ti,permit CP/State Zip Phone r Roof Drains issuance,a copy PCI.L) CirI00'7 5Zg.-n-co 11.50 of all licenses are Oregon Const Cont.Board Lic.# Exp ate-- Drinking Fountain 11.50 required if L1�C{3Z I U 7 lx / Other Fixtures(Specify) 15.00 expired in COT Plumbing Lic # Exp Llate database PIP Name Architect _ sewer-1st 100' 38.00 Or Mail ng Address Suite Sewer-each additional 100' 32.00 Engineer Ci.y/State Zip Phone Water Service-1st 100' i 38.00 9 __ Water Service each additional 200' 32.00 Describe wore rn ine Storm 6 Rain Drain-1 st 100' 3800 New n Repair O Replace with like kind Yes O No '6 Rain Drain each additional 100' Rr dential O Commercial O 32.00 Ac.�lition al description of work; Commercial Back Flew Prevention Device 32.00 ^ Residential Backflow Prevention Device' _ 19,00 l - - Gatch Basin 11.50 Are you capping, mov ojleliLg any fixtures? Insp.of Existing Plumbing or Specially Requested 50,00 Yes 'e' No O Inspections per/hr If yes, see back of form to indicate work performed by Rain Drain,single family dwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps _ 11 50 WORK_COULD RESULT IN INCREASED SEWER FEES. ---- I hereby acknowledge that I have read this application,that the information QUANTITY TOTAL givers is correct,Thal Iam owner or authorized agent of the owner,and Isometric or riser diagram Is required if Quantity Total is >9 that pians sub m d are i c m liance_ h Oregon State Laws. "SUBTOTAL 51 natur of O rlAgen Date Gtv 1�. ii I-q 9 8% SURCHARGE ., Contact rso Name(-) hone _ f\,.-tf4 r-- Jn{^.�Z� ""PLAN RENEW 25% OF SUBTOTAL 1 BATH HOUSE$178.00 Re wired ony A rixture yty totalis>9 7.BATH HOUSE$250.00 TOTAL 3 BATH HOUSE$285.00 (This fee Includes all plumbing fixtures In the dwelling and the first 'Nlhtlmum permit fee Is$50+8%surcharge,except Residential Backflow Prevention 100 feet of sanitary sewer storm sewer and water service) Device,which is$25+89/6 surcharge "All New Commercial Buildings require plans with Isometric o;riser diagram and plan review 1 klsl slform slplum app doc 10/1/99 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed/Capped Sink_ Lavatory Tub or Tub/Shower_Combination Shower Only Water Closet Dishwasher Urinal Garbage Disposal Laundry Room Tray Washing Machine v _ Floor Drain/Floor Sink 2" 411 _Water Heater Other Fixtures (Specify) — COMMENTS REGARDING ABOVE: I klsfs\formslplumepp doc 1011199 CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR1128L9 0254 DATE ISSUED: 12102/199 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1 S126DC-04800 SITE ADDRESS; 09495 SW LOCUST ST A SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 004 JURISDICTION: TIG _ TENANT NAME: DERMATOLGY ASSOC. USA NO: FIXTURE UNITS: CLASS OF WORK: DEM DWELLING UNITS: TYPE OF USE: COM NO, OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: Dummy permit.Capped off value court of 18. Credit 1 EDU. Owner: _ - _ FEES MBM & ASSOCIATES Type By Date Amount Receipt 9495 SW LOCUST STREET — — SUITE A TIGARD, OR 97223 Total _ Phone: CO"Lractor: MARXMEN PLUMBING INC 9665 SW 163RD AVE BEAVERTON, OR 97007 Pi;one: 579-2200 Reg #: LIC 00102432 PLM 34-161PB Required Inspections ORIGINAL I his Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires 180 days fiorn the date issued The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer' Permit and the Agency will install a lateral. 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 these rules or direct questions to OUNC by calling (503) 246-1987 Issued by: ke��,.er,�) �_ Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day Tenant Name: (w"J, iLf}�—�} c Accumulative Sewer Tally This sWRA: S t✓i2 19 9 °�=`S� Addi ess:.—'j '/ 15 L ',) L U c-4JK f A This PLM#: Fixture Value Previous # Previous Credits Capped Fixtures Fixtures New New Value Capped off value added / added total #s total Count off #a count value values Baptistry/Font 4 Bath- Tub/Shower 4 2 - Jacut/Whpl 4 Car Wash - Each Stall 6 -Drive Through —'6 Cuspidor/Water Aspirator 1 Dishwasher - Commer 4 Dourest 2 Drinking Fountain 1 _Fye Wash 1 Floor Drain/sink 2 inch _ 2 3 inch 5 — 4 inch 6 Car Wash Drain 6 Garbage Disposal 16 Dom (to 3/4 HP) Comm (to 5 HPI 32 Ind (over 5 HPI 48 Ice Mat,:iinp/Refrigerator Drains 1 Oil Sen(Gas Station) 6 Recreational Vehicle Dump Station 16 Shower - Gang (Per Head) 1 Stall 2 n Sink - Bar/Lavatory 2 Bradley 5 Commercial 3 — -- Service 3 Swimming Pool Filter 1 Washer, Clothes 6 Water Extractor 6 —� Water Closet, roilet 6 I Urinal 6 _ -- 2,7 b TOTALS 2 -38 L Total fixture values: U divided by 16 - 13 -75 EDU HISTORY PIM# X76 Q, 6.2 EDU# 1 SWR# 01/ PLh1# EDU# SWR# SWR# S&)X- '4-7 OD�q�Y PLM# EDU# S'NR# PLM# EDU# SWR# PI-M# EDU# SWR# PLM# EDU# SWR# PLMa EDU# SWR# p►R D ELECTRICAL PERMIT CITY O F T I G PERMIT#: ELC1999-00716 DEVELOPMENT SERVICES DATE ISSUtD: 12/01/1999 13125 SW Hail Blvd.,Tiqard, OR 97223 (503) 639-4171 PARCEL: 1S126DC-04800 SITE ADDRESS: 09495 SVr LOCUST ST A SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT : 004 JURISDICTION: TIG Proiect Description: Electric9l TI RESIDENTIAL UNIT _ TEMP SRVCIFEEDERS MISCELLANEOUS_ 1000 SF OP 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 HM/SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS - _ _ ADf ' INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 4 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 OCC: Owner: Contractor: BAKER, JAMES + WILLAMETTE ELECTRIC INC MATHESON, ROBERT T + PO BOX 230547 BAKER, DIANE R TIGARD, OR 972.81 PORTLAND, OR 97223 Phone: Phone: 624-3631 Reg #: LIC 000750 SUP 1965S ELE 34-283C FEES Required Inspections _ Type By Date Amount Receipt y Elect'I Service PRMT BON 12/01/1991 $58.90 99-320096 Elect'I Final 5PCT BON 12/01/199E $4.71 99-320096 I Total _ $63.61 ORIGINAL I - I This Permit is isslle� 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 a000rdance with approved plans. This permit will expire if work is not started within 180 days of issuance,or ifwork 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 throuoh OAR 952-001-0080 You,nay obtain copies of these rules or direct questions to OUNC at(503) 246-1987. PERMITTEE'S SIGNATURE I1G ISSUED BY: , 1 f ' �VVt Ij _ OWNER INSTALLATION ONLY rhe installation is being made on property I own which is riot intended for sale, lease, or rent. OWNER'S SIGNATURE: _ _ DATE:_ _ CONTRACTOR INSTALLATION ONLY _ SIGNATURE OF SUPR. ELEC'N: i t t __ - --')ATE:-LICENSE NO: Call 639-4175 by 7:00pm for an inspection the next business day CITY OF TIGARD �E� Date R ectrical Permit Application Plan Check 13125 SW HALL BLVD. RECEI\►ET� Recd Date )PN ecd 1T-- TIGARD OR 97223Date to P E Phone(503)639-1171, x304 p�� 1 Iyg� Date to DST Inspe-tion (503)639-4175CUMMUNITY ULVELUPMENI Print of Type Permit# Fax (503) 598-1960 Incomplete or illegible will not be accepted Called _ 1. Job Address: 4, Complete Fee Schedule Below: Name of Development_ N1 F,F, M�I �� ( __ Number of Inspections per permit allowed Name(or name of business) ------ J Service included: Items Cost Sum Address 9 S Su,' 'Lc c.,t T- S v _. 4a. Residential-per unit CI /State/Zi T t r k n 1000 sq lt or less $ 117 75 4 City/State/Zip P ,1 1 Z Z 3 -- Each additional 500 sq ft.or portion thereof _ $ 2675 _ 1 Commercial Residential ❑ Limited Energy $ 6000 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 _ 2 (Prior to permit issuance,applicants must provide contractor license 41).Services or Feeders Information for COT data base). Installation,alteration,or relocation Electrical Contractor W. I I a o-e Of F 1e(m it 200 amps or less $ 64.25 2 Address l /; ;tr j y T 201 ampc to 400 amps _ $ 85.50 2 —4, 401 amps m 300 amps $ 128.50 2 City_TT-4 n £tate Ort Zip Z /__-_._ 601 amps to 1000 amps $ 192.50 2 Phone No._ (c 14 3 l _.__— Over 1000 amps or volts $ 363.75 2 Job No._ �t� `�� Reconnect only $ 5350 _ 2 Elec. Cont. Lice. No. ay.Ztr;C- Exp.Date to ' I-dc7_ 4c.Temporary Services or Feeders OR Slate CCB Reg. No.^ 5'u' _Exp.Date re - 4 el Installation,alteration,or relocation COT Business Tax or Metro No. I S f I E7Sp.Date V-t.-cO I 200 amps or less $ 53.50 _ 2 201 amps to 400 amps $ 8025 _ 2 Signature of Su r. ElecIn 401 amps to 600 amps $ 100.00 _ 2 9 P Over 600 amps to 1000 volts. see"b"above. License No. ___Exp.Date_ /� 1-y - ad.Branch circuits Phone No. it IH r --- -- -- New,alteration or extension per panel a)The fee for blanch circuits 2b. For owner installations: with purchase of service or feeder fee. Print Owner's NarneEach branch circuit $ 5 35 - --— _ — b)The fee for branch circuits Address— _ without purchase of service City�_. —�State_ _Zip _ or feeder fee. 7 c Phone No. First branch circuit $ 37 50 � - Each additional branch circuit $ 5 35 Z i�^ The installation is being made on property I own which is not 4o Miscellaneous intended for sale,lease or rent. (Service or feeder not included) Each pump or irrigation circle _ $ 42 75 Iwner's Signature Each sign or outline lighting $ 42 75 Signal circuit(s)or a limited energy * panel,alteration or extension $ 6000 3 Plan Review section (if required): Minor Labels(10) $ 10000 Please check appropriate".em arid enter fee in section 5B. 4f.Each additional Inspection over 4 or more residential units in one structure the allowable In any of the above Service and feeder 225 amps or more Per inspection $ 50.00 ---. Per hour $ 50.00 System over 600 volts nominal In Plot $ 59.00 _Classified area or structure containing special occupancy as described in N.E C Chapter 5 5. Fees: Sa.Enter total of above fees $ ` Submit 2 sets of plans with application where any of the above apply. 8%Surcharge(.08 X total fees) $ Not required for temporary construction services. Subtotal Sb.Enter 25%of line So for NOTICE Plan Review If required(Sec 3) $ _ PERMITS BECOME VOID 1'WORK OR CONSTRUCTION AUTHORIZED Subtotal $ IS NOT COMMENCED WITHIN 180 DAYS,QR IF CONSTRUCTION OR r—� WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS LJ Trust Account# _ AT ANY TIME AFTER WORK IS COMMENCED. I Total balance Cue —Y $ I I:\dsts\forms\cIecIric.doc —J J CITYOF TIGARD CERTIFICATE OF OCCUPANCY DEVELOPMENT SERVICES PERMITM BUP1999-00481 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/15/1999 PARCEL: 1 S12_6DC-04800 ZONING: C-P JURISCICTION: TIG SITE ADDRESS: 09495 SW LOCUST ST A SUBDIVISION: LEHMANN ACRE TRACT BLOCK: LOT:004 CLASS OF WORK: ALT TYPE OF USE: CUM TYPE OF CONSTR: 5N OCCUPANCY GRP: B OCCUPANCY LOAD: TENANT NAME: DERMATOLOGY ASSOC. REMARKS: Modification to interior walls, widening access to a non-accessible restroom Fin31 Building Inspection and Certificate of Occupancy Approved 1/19/00 by Rick Bolen, Building Inspector Owner: JAMES BAKER + ROBERT MATHESON Phone: Contractor: BNK CONSTRUCTION INC 10730 SE HWY 212 PO BOX 66 LKWM"_9697015 Reg #: I IC 107555 This Certificate grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for compliance with the State of Oregon Specialty Codes for the group, occupancy, and use tmder which the referenced permit was issi+ed. BUILDING INSPECTOR BUILOIN FFICIAL POST IN CONSPICUOUS PLACE CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line- 639-4175 Business Line: 639-4171 BUP 4 -oc)y8� Date Requestedi 5 �L AMA)SyPM gip Location ` I �� _' -C'C�_ 1,`, Suite MEC Contact Person _ y_, l� Ph �l GJ �� PLM Contractor Ph SWR ILD (fenajWovvner ELC Retaining Wall ELR Footing - Foundation Access: C FPS Ftg Drain � � (�� ;`l�� T I _(�' �,QC.�_ Crawl Drain Inspection Notes: SGN Slab — SIT Post&Beam -- Fxt Sheath/Shear Int Sheath/Shear -- Framing Insulation —`- Drywall Nailing Firewall - - Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Y rPASA PART FAIL - -_ ----- -. ` PLUMBING — /L Post 3 Beam- - -------- __.----------- r. Under Slab Top Out _ --- ---- Water Service Sanitary Sewer - - - = - --- - -- -- Rain Drains Final PASS PART FAIT_ MECHANICAL Post& Beam ----- Rough In Gas Line Smoke Dampers Final _ -- - - - - PASS PART FAIL ELECTRICAL -- Servire Rough In __ _____---------------- - UG/Slab Low Voltage - - Fire Alarm Final ---- - -- ----- ---- ---- --- __— PASS PARI FAIL SITE Backfill/Grading -- — --- - - - Sanitary Sewer Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hell Blvd Catch Basin Fire Supply Line [ ]Please call for reinspection RE'_--__-____ __-__ _ [ ]Unable to Inspect-no access ADA / Approach/Sidewalk _ l Other Date _ - Inspector Ext D C' Final - - ---------- --- - ----- PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST BUP Date Requested ( 6) AM PM BLD Location I Suite MEC Contact Person Ph /n �� '.5 S 5�; 'L J1 1 �1 –a�/:T S Contractor Ph SWR _ BUILDING Tenant/Owner ��_ C ELC Retaining Wall ELR Footing Access: – F oundation FPS Ftg Drain Ciawl Drain Inspection Notes: SGN _— Slab --_-- —. _-- -- SIT Post& Beam --- F ct Sheath/Shear I Int Sheath/Shear -- ---- -- — Framing Insulation —_-- - - - -— ---_ ------- -- -- Drywall Nailing Firewall --___-- ---- --------- -- --------- --- FireSprinkler --_. --- - -- _.- --...---------- -- -- .- Fire Alarm --- -- -- -- - -- Susp'd Ceiling Roof Mise --- - -- - F nal - PASS PART FAIL — -- --- -- -- - ---- –----- - ----— Post&Beam -- -- --- �- --- - - - -- -- ---- - - - - - - - Under Slab Top Out --- - -- ---- ---- - - -- - — --- - _ Water Service Sanitary Se / ----- ---- - - -- -_ R ' Draii A PART FAIT_ HANICAL Post& Beam - ----_ ..- ----- - - -- -- - -- - Rough In Gas Line - -- - ----- -- - Smoke Dampers -- - ----- Smoke ---- -- Final - -------- -- PASS PART FAIL ELECTRICAL _ --- – Selvice Rough Ir, - Ur:/Slab Low Vol-age ---- -- Fire Alarm Final - ------------ ------- --- --- PASS PART FAIT. SITE Backfill/Grading -- -- ---_. - - -- -___ Sanitary Sewer Storm Drain ( Ri!inspection fee of$ —required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( ] Please call for reinspection RE: — - _ ( ]Unable to inspect-no access ADA Approach/Sidewalk Date Other ----- - _ Inspector -- --- ---- -- Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD - PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM1999-00185 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/16/99 PARCEL: 1 S126DC-04800 SITE ADDRESS: 09495 SW LOCUST ST A SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 004 JURISDICTION: TIG CLASS OF WORK: ALT GARPt,GE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: CUM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEA f ERS: 1 CATCH BASINS: _FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace existing water heater w/like kind. FEES Owner: Type By Date Amount Receipt MBIA & ASSOCIATES PRMT DST 6116199 $50.00 99-316164 9495 SW LOCUST STREET MISC DST 6/16/99 $2..50 99-316164 SUITE A TIGARD, OR 97223 Total $52.50 Phone 1: Contractor: KENNEDY PLUMBING 13985 SW FARMINGTON RD BEAVERTON, OR 97005 REQUIREU INSPECTIONS Phone 1: 643-5535 Final Inspection Reg#: LIC 001009 PLM 34-42PB ORIGINAL This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Srecialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080 You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued By: __ " S '��`_� �� -- Permittee Signature: Call (503) 63�-4175 by 7:00 P.M. for an inspection needhAlfiie next business day CITY OF 'I,GARD Plumbing Permit Application 13%` SW HALL BLVD. Commercial and Residential TIGARD, OR 97223 (603) 639-4171 - Print or Type hy- Incomplete or Illegible applications will not be accepted FIXTUR'—E$ Lndivldual _ QTY PRICE AMT-1 -� - Name of Development/Pr4ect ?:..._-:.. r 11.50 Job ,1��3 n� n�cSE sank Suite Lavatory 11.50 Address Street Address — 11.50 9 4 R 5 5 vD I OCu 9 ,fir _ Tub or Tub/Shower Comb. djdg 0 CNy/Stele Zip Shower Only 11.50 `(1 Q✓ Ci (1-72-2-3 3 Water Closet 11.50 NameC�, --- 11.50 fi (, .5,50 _ CNshweaher -, —y_ — Suite Garbage Disposal 11.50 Owner ailing Address - 1�9 5 IV l(nc ,5-f Sr_ Washing Machine 11.50 City/State ZIP Phone Floor Drain/rloor Sink O� �{ 11.50 Name 4" 11.50 Water Heater O conversion O like kind Occupant i I.60 Mailing Address Suite Gas plpin requires equires a separate mechank_al ermlt. Clay/Stale Zlp Phone Laundry Room Tray 11.50 _ Urinal 11.50 --— 15.00 Name Jther Futures(Specify) Kpr)n Q%- — Contractor Mailing Addrelis Suite J i m g_5 'r,w �G✓min Io✓ _ 36.00 Prior to permit CI(y/State Zip Phone 5 5 0 5 Sewer• at 100' _ issuance,a copy t�y 4f~ ' �t_��5 0 3' ` Sewer-each additional 100' 92.00 of all licenses are Oregon Const.Cont.Board Llc,* Exp.Date Water 6ervlce-1 at 100' 3B.U0 required if 2 f'(7 expired In COT Plumbing t1c,a Exp.Date Water Service•each addl"onal 200' 32.00 database I fJ� ^i Storm&Rein Drain-tat 100' 38.00 Name Stone 6 Rain Drain=each addttlonal 100' 32.00 Architect Moblle Home Space 32.00 or Mailing Address Suite Commercial Back Flow Prevention Device or Antt• T19-00(0) Pollution Device Phone Residential Backflow Prevention Device- Engineer CHy/State Zlp (Irrigation timing devices require a separate Desutbe work to be dons. — restricted energy perme.l Any Trop or Waste Not Connected to a Fixture 11.50 New O Repair 0 Replace with like kind: Yes O No O — 11.50 Pesldentlal O Commercial O _ _,_-_- Catch Basin Y Additional deactiptlon of work:! Insp.of Existing Plumbing 50.00 per Specially Requested inspections J� 50.0000 Are you capping, moving or replacing any fixtures? per/hr Yes O No O Rain Drain,single family dwelling — 45.00 If yes,see back of form to Indicate work performed by Grease Traps 11.50 fixture. FAILURE TO ACCURATELY REPORT FIXTURE _ WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL I hereby acknowledge that I have read this application,that the information Isometric or neer diagram Is required M 6u Totet k >9 given Is correct,that I am the owner or authorized agent of the owner,and 'SUBTOTAL 5 0„ that plans Submitted are in compliance with Oregon State Laws Signature of Owner/Agerft I Date 5%SURCHARGE � 5D Contact P on Name ` P one ""PLAN REVIEW 25%OF SUBTOTAL 7-13 c r3`c Required only if tixture�t _totd le>9----TOT-AL b>9 TOTAL , �exce t Residential Backflow 'Minimum permit fes Is S50 5 A,surcharge, p Prevention Device,which Is$25+5%surcharge 1� ;• �, ilk y '; "All New Commercial Buildings require plans with isometric or riser diagram and plan review i 4sie�rc^"+rinn T,et:n fa->�zeree nnai car enc, %-vi CC: TT 1N4 RR '97 en CITY OF TIGARD BUILDING INSPECTION DIVISION MST J 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -- BUP Date Requested 11 AM_ PM — BLD �.ocation ` G C C.L Suite MEC Contact Person _ Ph `) 6/2 PLM Contractor X _Q,-) t��(� i —� —_ Ph 3 r " �S-_3 SWR _ BUILDING Tenant/Owner ELC — Retaining Wall ELR Footing - Access: Foundation / FPS Ftg Drain Crawl Drain Inspection Notes: SGN _ Slab —_ —_ SIT Post & Beam — -- Ext SheathA hear Int Sheath/Shear — Framing ��- Insulation — — ---- Drywall Nailing Firewall ---~ I-ire Sprinkler !=ire Alarm Susp'd Ceiling — Roof ---.. / ----- -- Final PASS PART FAIL __---- PLUMBING Post& Beam --- ----- Under Siab ,, Top Out -- Water Service � Sanitary Sewer ----- Rain Drains r �, , PAR1 FAIL _ MECHANICAL Post& Beam ----- —.- — _— _ Rough In Gas Line - --- - -- .-- -- -- -- Smoke Dampers Final — - ---- PASS PART_ FAIL ELECTRICAL --- ---- ----- -- --- 'ervice Roligh In (1G/Slab _ Low Voltage — — 1 ire Alarm (-incl -----�— PASS PART FAIL --�-- -------------- - -SITE Ilackfill/Grading - ----------- -------- -- ---- -- - Sanitary Sewer Storm Drain J Reinspection fee of$ — required before next inspection. Pay at City Ball, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: _ —_ —__— — ( j Unable to inspect-no access ADA Approach/Sidewalk Date ) !f Inspector ry� Ext Other Final PASS PART_ FAIL DO NOT REMOVE this inspection record from the Job site. CITY O F T I GA R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00308 13125 SW Hall Blvd.,Tigard, OR 97;:23 (503) 639-4171 DATE ISSUED: 7/20/01 SITE ADDRESS: 09495 SW LOCUST ST A PARCEL: 1S126DC-04800 SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 004 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: J. FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAN' DRAIN: ft Remarks: Capping (2)lavatories and moving (2) sinks. Owner: — _ FEES _ MBM MEDICAL Type By Date Amount Receipt 9495 SW LOCUST PRMT CTR 7/20/01 $72.50 27200100000 TIGARD, OR 97223 5PCT CTR 7/20/01 $5.80 27200100000 Total $78.30 Phone 1: 503-245-2415 Contractor: MARXMEN PLUMBING INC 9665 SW 163RD AVE BEAVERTON, OR 97007 REQUIRED INSPECTIONS rhone 1: 579-2200 Rough-in Insp Reg #: LIC 00102432 Top-out Insp PLM 34-161 PB Insp existing/capped fixtures Final Inspection 1-his 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. 'T his permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 10"L) 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 O R 52-0001-0080. You may obtain copies of these rules or direct questions to OUNC by callin ( 0 6-1987. Issued By: a .1� Permittee Signature u' Call (503) 604-4175 by 7:00 P.M. for an inspection needed the next us) ess day 0 Plumbing Permit Application City of Tigard Dale received: A"/ Permitno.: Address; 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no. Building pennit no.: Ciryn(7'ir cr`1 Phone: (503) 639-4171 Proect/a I.no.: 1 pp Expire datc: Fax. (503) 598-1960 )ale issued: BY: Receipt no.: Li (ltise approval: Case file no.: Payment type,: U I &2 family dwelling or accessory U Commercial/industrial U New constructionU Multi-family LI Tenant improvenu;nl U Addi - - tion/alteralion/replacement U Food service �. U Job address: Q 4145' 5•W Loc,0�C;.r S4 Descrl tlon Fec(ea. Total Bldg. no., Suilc no.: -- New I-and 2-famlly dwellings only: - (Inc:,,des100fl.fineachutllltyconnecllon) Tax map/tax lot/account no.; LoC Block: Subdivision: - -- _- SFR (1)bade Project name: Vt't�tu N--0r j C>< �1_ —� City/county: SFR(3)bath ZIP: -------- _ Hach additional hath/ki lien - Desctiption and location of work on teutilitles: v_.evr ivtr�lrcAL u►,t(t~ t�- �I � - - Catch hasirt/arcadrain Esl.date of cornpletion/inspection: Drywells/lir line/trench drain Fixrting drain(no. lin. ft.) -- — Business name: u Of Manufactured home utilities - iij Address: cl( &!) S.LQ- rb �e_ -----_ Manholes Rain drain connector City: e�fet or�'F3 —7-tale i� 'LIP:C _ - - L�D 'I- Sanitary sewer(no, lin. Phone_�,'t••`�M, 1' Tax;r fljl-1ii l1E.-mail: Storm sewer(no. lin.ft.) CCBno_lpc� �_ Plumh.hus. reg. no: Water service(no.lin.ft.) -- City/metro tic.no.: /I Z, -- Vlxture or Item: Contractor's representative signature r- Absorption valve Print name: oqK►L �E,-z ,ty� Date:` Back(low preventer - O Q Backwater valve — - Basins/lavalory -- — Name: j)(,I� ;f ux-r W_ (.,1u -Fµq L{�/s Clothes washer Address: - Dishwasher - Clty: _ State: ZIP: Drinking fountains) -- Phone: f ( Ejectors/sump - - d� ax: E-mail: Expansion tank Fixture/sewer cap 2 tiQ,r 1I1iCs Name(pent): Floor drainshloor sinks/hub - Mailing address.- Garbage disposal --- City -- State:�7-ZIP: Ilose bibb - - ------- t_-__1- -- Ice maker - Phone: iC l �E mail: Interco or/grease trap - - Owner installation/residential maintenance only: The actual installation Primer(s) - will he"lade 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 --- Tit bs/showcr/shower Nance: IJrinal Address: -��--" — Water closet Cit Water healer City- State: 7_IP: Other: _ — Phone: Fax: E-mail: -- Total 4. Not all jurivlictions accept credit cords,plem call jurisdiction for more information. Minimum fee................$ ��•5� U Visa U MasterCard Notice:'flus permit application credit card numher expires if a pemlit is not obtained Plan review(at — %) $ --"-"--_-- --L-1--- within 1811 days after it has been Slate surcharge(89tH) ....$ ti . -- _— NtmK of cardholder as shown on credit card �— accepted as complete, TOTAL C'radholokr Nsnattue ---- S Amount 440-4616(6 WOM) PLUMBING PERMIT FEES: PRICE I TOTAL New 1 and 24 mlly dwellings only: FIXTURESindividual QTY ea AMOUNT (Includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the flrst100 ft. OTY (ea) AMOUNT 16.60 for each utlll connection) Lavatory _ _ —_ One(I)bath — $249.20 _ Tub or Tub/Shower Comb. 16.60 Two 2 bath _ $350.00 _ Three 3 bath $399.00 Shower Only 16.60 — �__---------- Water Closet 16.60 -- _ SUBTOTAL Urinal 1660 0%`,TATE SURCHARGE Dishwasher 1ti.60 PLAN REVIEW 25"/.OF SUBTOTAL --LAN E---------U TOTAL Garbage Disposal — 16 60 ----- -- --- -- —T� Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink z - _16.60 PLEASE COMPLETE: 3" 16.60 q" 16.60 — _ Q Waxer Heater O conversion U Ilke kind t6 60 uantlty b r Work Performed Fixture T New Moved Replaced Removed/ Gas piping requires a separate mechanical yam' Cawed permit --- _ MFG Home New Water Service 46.40 Sink 46 40 Lavatory MFG Home New San/Storm Sewer — Tub or Tub/Shower Hose Bibs 16.60 Combination _ �— Roof Drains '.6.60 Shower — Llrtnking Fountain 16.60 Water Closet Urinal Other Fixtures(Specify) 16.60 Dishwasher-- Garbage ishwasherGarbs a Disposal —v Laundry Room Tray ---- Washing Machine_ �— Floor Drain/Sink: 2" Sewer-1st 100' 55.00 -- 3" _ Sewer-each additional_10_0 ____ 46.40 4" _ Water Service-1st 100' 55.00 Water Heater Other Fixtures Water Service-each additional 200' 46.40 (Specify) 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 Bzsin 16.60 Inspection of Existing Plumbing or Specially 72.50 erRtr COMMENTS REGARDING ABOVE: Requested Inspections Rain Drain,single family dwelling f5.25 —_ ---- Grease Traps 16.60 — _-- -- QUANTITY TOTAL — — — Isometric or n. +r diagram Is required if —.— Quantity Total is >9 *SUBTOTAL _ 8%STATE SURCHARGE I AN REVIEW 25%OF SUBTOTAL Required only if fixture gt1j total is>9 TOTAL `Minimum permit fee is$72 50+B%state surcharge,except Residential Backflow Prevention Device,which is$36 25*8%state surcharge. "All New Commercld Buildings require plans with Isometric or riser diagram and pian review 1:\dsts\forms\plm-feesAoc 10/10/00 Accumulative Sewer Telly {1�,;'L,' This SWR# Ten,--.it Name: �_ '-�1 dT�lc c..- / , `� �� P,. This FLM#: Address: LN mac l- Fixture I Value Previous Previous Credits Capped Fixtures Fixtures New total New # Value Capped off value added# added #s tota, Count off#s count value values Baptistry/Font — 4 _ — - Bath-Tub/Shower 4 _ - -� -Jacuzzi/Whirlpool 4 -- Car Wash.- Each Stall _ 6 -- Drive Through _ 1.6 -- Cuspidor/Water Aspirator 1 Dishwasher-Commercial 4 -- Domestic 2 -- Drinkino Fountain _— 1 Eye Wash 1 — — Floor Drain/sink- 2 inch 2 --- 3 inch 5 — 4 inch 6 -- ---- Car Wash Dm 6 -- Garbage Disposal 16 _ Domestic(to 3/4 HP) ------ Commercial (to 5 HP) 32 — Industrial(over 5 HP) 46 Ice Machine/Refrigerator Drains 1 — -- Oil Sep(Gas Station) _ 6 — Rec.Vehicle Dump Station 16 - Shower-Gang(Per Head) 1 --- Stall 2 -- Sink -Bar/Lavatory. — 2 -- Brodley ---- 5 --- Commercial 3 -- -- - - -.—_ Service -- Swimming Pool Filter - Washer-Clothes _ 6 — Water Extractor 6 _ _ — Water Closet-Toilet 6 - Urinal _—_ _ 6 _ --- — TOTALS Total fixture values: �' divided by 16 = �ti'S� EDU HISTORY EDU# SWR# 199q PLM# EDU# _ SWR# PLM# I1 -(C q tc EDU# I SWR#1?- c o ?9 / PLM# _ EDU# SWR# — PLM# If oalr E D U# I SWR# PLM# EDU#� SWR# PLM# EDU# SWR# PLM# EDU#i SWR# i idsts\swrtaly doc BUILDING PERMIT CITY OF TIGARD PERMIT#: BUP2001-00265 ^� DEVELOPMENT SERVICES DATE ISSUED: 7/25/01 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 1S126DC-04800 SITE ADDRESS: 09495 SW LOCUST ST A SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: 004 JURISDICTION: TIG REISSUE: _ FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ALT FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? TYPE OF CONST: 5N sf N: S: E: W: OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF COj'4ST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: REQD SETBACKS _ REQUIRED FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:Y BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 18,000.00 Remarks: Tenant Improvement No Change in Occupar, Load O-rner: Contractor- MBM MEDICAL BNK CONSTRUCTION INC 9495 SW LOCUST 10730 SE HWY 212 TIGARD, OR 97223 PO BOX 666q� ��R Phone: CPhCo e b5 -086697015 Reg #: LIC 107555 FEES REQUIRED INSPECTIONS Type By Date Amount Receipt Framing Insp PLCK CTR 7'18/01 $140.47 27900100000 Gyp Board Inn Susp Ceiing lnSp FIRE CTR 7/18/01 $86.44 27200100000 Final Inspection PRMT CTR 7/25/01 $216.10 27200100000 5PCT CTR 7/25/01 $17.29 27200100000 'notal $460.30 This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other zpplicable law. 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 t ian 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in CSAR 952 001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-6699 or 1-800-332-2344. Permittee i Signature: Z� Issued By: Call 639-4175 by 7 p.m. for an Inspection the next business day COMMERCIAL PLAN SUBMITTAL REQUIREMENT MATRIX Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional plan sets for distribution purposes (for Contrar3tor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). Total # of TYPE OF SUBMITTAL Plans KEY: Submitted S = Site Work (must include S (New, Add or Alt) 4 location of all accessible parking) B (New, Add or Alt) 1* B = Building F (New, Add or Alt) 3** F = Fire Protection System M (New, Add or Alt) 2 M = Mechanical P (New, Add or Alt) 2 I P = Plumbing E (New, Add, or Alt) 2 E = Electrical _---- --- -- --__--- New = New Building Add = Addition Alt - Alt-ration to existing building *For over-the-counter commercial tenant improvements, submit 2 sets of plans. **"New" requires that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. 1\dsts\forms\matrxrom.doc 10127/00 CITY OF TIGARDELECTRICAL PERMIT PERMIT ELC2001-00406 DEVELOPMENT SERVICES DATE ISSUED: 08/07/2001 13125 SW Hall Blvd.,Tigard. OR 97223 (503) 639.4171 PARCEL: 1S126DC-04800 SITE ADDRESS: 09495 SW LOCUST STA SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT : 004 JURISDICTION: TIC Proiect Description: Installation of(5)branch circoits for TI. RESIDENTIAL UNIT _ l EMP 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+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS _A_DD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 600 amp: EA ADD'L BRNCH CIRC: 4 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 OCC: —_ Owner: Contractor: MBM MEDICAL WILLAMETTE ELECTRIC INC 9495 SW LOCUST PO BOX 230547 TIGARD, OR 97223 TIGARD, OR 97281 Phone: 503-245.2415 Phone: t 631 Reg #: L 75059 Stat' 1965S ELE 34-283C _ FEES T Required Inspections — Type By Date Amount Receipt Ceiling Cover PRMT CTR 08/07/2001 $73.45 2720010000( Wall Cover Elect'I Final 5PCT CTR 08/07/2001 $5.88 2720010000( To!al $79.33 _ L—This Permit is issued subject to the regulations oontained in the Tigard Municipal Code State of OR. Specialty Cortes 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 ATTENT'ON Oregon law requires you tc follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 th- ,ugh OAR 952-001-0080. You may obtain copies f lhez�e rules or direct quer+ions to OUNC at(503) 246-6699 or 1-800-j32-2344. Permit Signature: �•l ) ri rG i ;y y JtIssued By: _ OWNER INSTALLATION ONLY The installation is heing 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 639-4175 by 7:00prn for an inspection the next business day � U Electrical Permit Application E � rDatcrcMAdeceiv :i'' Permit no,:�L cli,txyo� City of Tigard Pioject/appl.no.: Expiredale: CitygTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223, Date issued: By' Receipt no.: Phone: (503) 639-4171 W' ME- Case file no.: Payment type: Pax: (503) 598-1960 MONE,IV OtVE.I�I , 1 Land use approval _ oo —_— TYPE OF PERMIT U I &2 family dwelling or accessory W Commercial/industrial J Multi-family 1'enant improvcnient U New construction U Addition/alterationhvI•lace tire it( U Other: _ U Pallial JOB SITE,INFORMATION Job address: y y Sys i,, t( T– ____._ Illdg. n...:_ Suite no.: A Tax map/tax lot/account no.: _ l.ot: Block: �Iubdivision: Project name: N t• , bescription and location of work on premises: y, c�„T i,. ��. ��.•. ,.� T — Estimated date of corlpletion/ ction: CONAPPLIC ATIONw„w FEE SCIIEWILE, .. Job no: /I CFee ntax Description or),. (ea.) Ental no.lnslt Business name: W, l R+t+F ne 4'I Ct 1 - L wl-singlem mulli fandly ler Address: 1 e A,,,, 2-rp y 7- __ dwellingunll.includes anachr!igarage. City: ,r slate:c,,t, ZIP: 9,7 zS / Servlcehrcluded; 4 Phone: b tW-3 r rax: L 7q-it/?ATE-mail: loco sq A.or less _ F.ach additional 500 sqftor purtion ther•:of CCB no.: 7TG S �1 EICc.bus.)ic.no: 'i q- Z,i Limited energy,residential 2 City/ etro lic.no.-. i f5' i L Limited energy,non-residential _ 2 / Each manufactured home or modular dwelling Sigaturc of supervls ng ctrician(required) Dat-a Service amllnr feeder 2 t Services or feeders-installation, Sup elecrname(print) r-)'� ti F, F License no: /y4 S alteration orrelocalion: PROPERTY1 200 amps or less _ 2 2"JI amps to 400 amps 2 Name(print): — 401 amps to 6tx)amps 2 m Mailing address: _ 601 amps to 1000 aps _ 2 City: Stale: Z1P: Over 1000 snips or volts _ 2 Phone: Fax E-mail: Reconnect only I vices r feeders- Owner installation:The installation is being made on property I own Temponryaereratio,orreloc tnstallatlon,alteration,or relocation: which is not intended for sale,lease,tent,or exchange according to 200 amps or less _ 2 _ ORS 447,455,479,670,701, 201 amps to 400 amps _ _ 2� Owner's si nature: _ bale: 401 to 600 amps. 2 Is, Branch clrcults-nen,alteration, nrexleruion per panel: Name: _ A. Fee for branch circuits with purchase of Address: _ service or feeder fee,each branch circuit 2 State: City: ZIP: B. Fee for branch circuits without purchase of service or feeder fee,First branch circuit: y 6 2 Phone: I ax: f mall: Fach additional branch circuit: Mlsc.(Service or feeder not Included): UService over2.25amps-commercial Ullealth-care facility Each pump or irrigation circle 2 U Service-)ver.120amps-rating oft&2 U llazaidoushlcation Each sign or outline lighting 2 fandlydwellings U Building over in,o(xl square feet fouror Signal circuits)or a limited energy panel, U System over 600 volts nondnal more residential units in one stricture alteration,or extension* 2 U Building over three statics U Feeders,400 amps or more "Description: U Occupant load over 99 persons U Manufactured structures or RV park F'ich additional inspection over the allowable in any of the above: U Egtess/Iigldingplvn U tither: Per inspection Submit gels of plans with any of the above. Investigation fee 11te above are not applicable to Icmporary conatructIon service. Other -- - — �y _ Permit ICL......................$ Not all)urirdicdm oaccept credit cards,pleme call) This for int infor.nation. Notice: is permit eppllcatlon Plan review(al fir) ------------ U Visa U MasterCard cxnires if a permit is not obtained L-J--� _. within 180 days eller it has been State surcharge(9%) .... Crede card number: Expiresaccepted as complete. TOTAI. .......................$ L!i — Narne of c older as shown on crWIt cart S Cardholder signature Amount 4404613(6i0dCpM) Electrical Permit Fees: Limited Energy Fees: -�-- -- TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: —-! — !" Restricted Energy Fee...................................................... $75.00 Number of Ins ections per pennit allowed (FOR ALL SYSTEMS) Service Included; Items Cost Total Check Type of Work Involved. Residential•p^r unit r- 1000 sq it or less _ $145 15 4 L7 Audio and Stereo Systems Each additionvI 500 sq.It or portion thereof $33.40 1 ❑ Burgiar Alarm Limited Enorg/ $75.00 Ea,,h Manurd Ilomo or Modular U Garage Door Opener' Dwelling Service or Feeder $9090 2 Services or Feeders Healing,Ventilation and Air Conditioning 5ysl in' Installation,alteration,or relocation 200 amps or less _ $80.30 _ 2 f L 1 J Vacuum Systems 2r I amps to 400 amps _ $106.85 2 401 amps to 600 amps $160.60 2 Other 601 amps to 1000 amps $24060 2 Over 1000 amps or volts $45465 2 - ---- - - - - Reconnect only $66.85 _-- 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIk L ONLY Installation,alteration,or rale ation ... $75.00 200 amps or less _ $66.85 _ 2 Fee for each system.................................................... . 201 amps to 400 amps $10030 _ _ 2 (SEE OAR 918-260-260) 401 amps to 600 amps —._-- $133 15 _ J Over 600 amps to 1000 volts, Check Type of Work Involved. see"b"above. Audio and Stereo Systems Branch Circuits New,alteration or extension per panel golfer Controls a)The fee for branch(lrcuils with purchase of service or r-I feeder fee. I_J Clock Systems Fact,branch circuit _ $5.65 _ 2 b)T he lee for branch circuits Data Telecommunication Installation without purchase of service or feeder fee. Fire Alarm Installation rir,l branch circuit Fach additional branch circuit _ $6.65 HVAC Miscellaneous (Service of feeder not Included) Instrumentation Each pump or irrigation circle $53.40 L-ach sign or oullina lighting $53.40 _-_- Intercom and Paging Systems Signal circull(s)or a Nmiled energy panel,alteration or extension $75.00 _ ❑ Miller Labels(10) ^_-� $125.00 _ Landscape Irrigation Control' Each additional Inspection over ❑ Medical the allowable In any of the above Por inspection $62.50 Nurse Calls Per hour $62.50 In Plant ---_ -- $73.75El-- Uuldoor Landscape Lighting' Fees: Prolective Signaling Enter total of above fees $ �. n Other_____------ - --- 8%State Surcharge $ __Number of Systems 251/.Plan Review Fee See`Plan Review"section on $ No licenses are required Licenses are required for all other Installations front of application -_ Total Balance Dur, Fees: Enter total of above fees Trust Accowtl q_ -_ 8%Stale Surcharge s-- —_ Total Balance Due i 4tsus\fbm%\elo-fees.doc 10/09/00 / CITY OF T I GA R D MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2001-00323 13125 SW Hall Blvd.,Tigard, OR r 1113 (503) 639-4171 DATE ISSUED: 9/13/01 PARCEL: 1 S126DC-04800 SITE ADDRESS: 09495 SW LOCUST ST A SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P BLOCK: LOT: OU4 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: 1 DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS?: 30 -50 HP: REPAIR UNITS: GAS PRESSURE: �0 + Hp: WOODSTOVES: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > 100K BTU: <= 10000 Cf m: — OTHER UNITS: > 10000 cfm. GAS OUTLETS: Remarks: Installation of A/C system (2 components) Owner: _-FEES ------ MBM MEDICAL Type By Date Amount Receipt 9495 SW LOCUST —PRMT CTR 9113/01 $72.50 272001000C TIGARD, OR 97223 5PCT CTR 9/13/01 $5.80 2720010000 Phone:503-245-2415 —--- Total -- $78.30 Contractor: THERMOTECH 26716 S. BOLLAND RD. CANBY, OR 97013 _ REQUIRED INSPECTIONS Cooling Unt Insp Phone:503-263-8900 Final Inspection Reg #:LIC 118695 This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stafe of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with appr,wed plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rule, adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling Issue By: �_ ;_«LB, _r';._ {-�. Permittee Signature:\`� �!_ - Call (503) 639-4175 by 7:00 P.M, for inspections needed the next business day Mechanical Permit Application / �J FDarcceivcd: ;�� I Permit no.: _� p i _ 7 City O 'Tigard ( `��/ Project/appl.an.: Expire date: Address: 1 1125 SW hall Blvd,Tigard,OR 97223 Dale issued: By:?i Receipt no.: Phone: (503) 639-4171 _ Fax: (503) 598-1960 {cIf.7ao0i ,,e,�5 Case file no.: Payment type: Land use approval: _ Building permit no.: U I &2 family dwelling or accessory U Commercial/industrial U Tenant improvement U New construction U Addition/alteration/replacement U Oihcr _- lob address: f'�i - <-sc .<1,T Indicate equipment quantities in boxes hrh+w. Indicate the dollar Bldg.no.: I Suite.n� value of all mechanical materials,equipment,labor,overhead, Tax map/tax IoUaccount no.: _ profit. Value$ Lot: Block: I Subdivision: *See checklist for important application inlbrmation and Project name: jurisdiction's five schedule for residential permit fee. City/county: ZIP: FEE-SCIIIE'DULE Dcscn*ptiop and location of wprk on premises: t r F of Tt �i%l�lOtilf,uTS _ Fee(ea.) 'I(lal Est.dale of completiordinspection: heseIp ion Oly. Res.only Res.onl) Tenant improvement or change of use: �(.— Is existing space heated or conditioned?U Yes U N'o Air handling unit - CFM._ - b p it conditioning(site plan require ) Is existing space insulated?U Yes U No teration ofexisting HVAC system iol er/compressors --// f State boiler permit no.: Business name: )y!G �7 HP Tons BTU/FI - Addre53: o �� _ t. ►� Fire/smoke damperqtduct smoke detectors City: StaleD Y I ZIP: Heat pump(site plan require ) _- - Phone: ';� 9�fJ fax: E-mail: Install/replace furnace/burner j + _ Including ductwork/vent liner O Yes U No CCB no.: �, // /', nsta I I/tep ac re locatelicaters-susp�ed, City/mctro lie,no.: _ wall,or flour mounted Narne(please print): Vent for appliance other th:ui furnace r r gerailon: Absorption units._ __ BTU/II Name: Chillers— _ HP _ - -- ----" - Compressors- -- III' Address: Environmental exhaust and vent Ist on: City: - State_ ZIP: _ Appliancevert Phone I;t� 1, mail: I Dryer exhaust II Ifoods,Type res. itc en/hazmat hood fire suppression system _- Name: Exhaust lard:vith single duct(bath fans) Mailing address: Exhausts sterna art from heatiqor C - - ueyam'piping am distribution(up to outlets) City: — -- Slate: LIP: T LPC; _-- NG Oil - -- Plmnc. - - I ar L'-frail: �'u� eT i in each a itiona over 4 outlets Process piping(schematicrequirc ) Number of outlets Name _ J 1 terstedapp ail nee-ore- quipment: - -- -- Address: Decorative fireplace City. -- —---- State: ZIP: nsert--type Phone:--- �— fax: E-mail: - oo stov N- et stove Other: Applicant's signature: ( Dale:See 1 1 f> 1 er: Name (print): L It lAdle Not all Jurisdictions accept credit cards,ple,ue cull Jurisdiction for mote information. Permit fee.....................$ '7441,52 O Visa U MastcrCnrd Notice:'This permit application Minimum fee fee................$ Credit card number — expires if a permit is not obtained E� within 180 days after it has been Plan review(at ) $ r Expires State surcharge(8r>h) $ Rum of car holder ass own on credit card accepted as complete. "" s TOTAL .......................$ Carholder oismilure Amount 4114617(tLt11J('OM► MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: Description: Price Total $1.00 to$5,000.00 _ Minimum fee$72.50 Table 1A M:chanical Code Qly (Ea) 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 for each additional$100.00 or Including ducts&vents 14.00 - fraction thereof,to and Including 2) Furnace 100,000 BTU+ $10,000.00. Including ducts&vents _ 17.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or includ ng vent 14.00 fraction thereof,to and including 4) Suspended`seater,wall heater $25,000.00. _ _ or floor mounted heater 14.00 ` $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional$100.00 or 6.80 fraction thereof,to and including 6) Repair units $50,000.00. _ 12.15 $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply. Boiler Heal Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond _ fraction thereof. footnotes,below. Com « «. 7)<3HP;absorb unit Minimum F,ermit Fee$72.50 SUBTOTAL: $ to 100K BTU 14.00 8)3-15 HP;absorb 8%State Surcharge $ unit 100k to 500k BTU 25.60 9)15-30 HP;absorb 25%Plan Review Fee(of subtotal) $ unit.5-1 mil BTU 35.00 Required for ALL commercial permits only 10)30-50 HP;absorb TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20 11)>50HP:absorb -- - - unit>1.75 mil BTU _ _ 87.20 ASSUMED VALUATIONS PER APPLIANCE: I 12)Air handling unit to 10,000 CFM 10.00 Value Total 13)Air handling unit 10,000 CFM+ Descri tion: Qt Ea Amount _ 17.20 _ Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler ducts&vents _ 10.00 Furnace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct ducts&vents --6.80_ _ rnace ven Floor tui including t 955 16)Ventilation system not included in Suspended heater,wall heater or 955 appliance permit _ 10.00 floor mounted heater 17)Hood surved by mechanical exhaust Vent not Included in applicance 445 10.00 permit 18)Domestic incinerators Repair units 805 _ 17.40 <3 hp;absorb.unit, 955 19)Commercial or industrial type incinerator to 100k BTU 69.95 3-15 hp;absorb.unit, 1,700 20)Other units,including wood stoves 101k to 500k BTU 10.00 15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets mil.BTU 5.40 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) 1-1.75 mil.BTU 1.00 >50 hp;absorb.unit, 5,725 Minlmttm Permit Fee$72.50 SUBTOTAL: $ >1.75 mil.BTU _ Alr handlingunit It to 10,000 cfm 658 8%State Surcharge $ Air handling unit>10,000 cfm 1,170 Non-portable evaporate cooler __ 656 TOTAL. RESIDENTIAL PERMIT FEE $ Vent fan connected to a single duct 446 Vent system not Included in 656 ------- a pliance permit _ Qhbr Inspections and Fees: Hood served by mechanical exhaust 656 1 Inspections outside of normal business hours(minimum charge-two hours) Domestic Incinerator 1,170 $72.50 per hour Commercial or Industrial Incinerator 4,590 2 Inspections for which no fee Is specifically indicated (minimum chargo-hall hour) Other unit,Including wood stoves, 656 - $72.50 per hour Inserts etc. 3. Additional plan review required by changes,additions or revisions to plans(minimun Gas piping 1.4 outlets 360 --- charge-one-hall hour)$72.50 per hour Each additional outlet 63 "Stale Contractor Bolla,Certification required for units>2uok BTU. TOTAL COMMERCIAL `"Residential A C requires site plan showing placement of unit. � VALUATION: I:ldsts\forms\merah-fees.doc 08/06/01 Wall-Mounted Air Conditioners Outdoor Unit rr _ _ ' C0961ICL08d1 G = = C12BI CL1251 wn�lns,; Riminlo I;onlrol!r.: ia. 1 ' 1 • Mon Indoor Url i% KSW51 KS1251 Outdoor Unit C1852/C1.1852 — Wifeless Romnto Controller ------ liiiiw Indoor Unit K_81852 Q1 11H f 1H WASHABIF TP.ONT fiHlllT Wall Mounted Air Conditioners Model No 09K S:Uf19KIS51 17K551/17KL S51 1j11M 4� Unit Model Nr. _- Indoor On't O'tdUnn Indoor Unit nuldoer Unit Indnnr Unit oeldear Un I KS0g51 rp151;c1r951 KS1251 C1251/CL1251 --- K51052 D111f/CL1e5t Perhntnnae&Clecldcei Rnung- ---CapacityATHRnrH Cnollnj 9,000 11,400 17,000I1A,500- --- Haedn -- ---- Oltlwc Hemuvnl lUigll PnnaH 70 I -_- 3,Q Dry Air RlN_d Flow M!gU wl ----------- -- 27Ey240= I _ ;0/2„IaOtID _— p ql SEER 10.0 — ------- HSPF — Volte _ 110 — Running Amps -- Cooling -1.1 — 10.1 - — T.111.e - _ Power Input _CoCpolMg Heegn - --— --- Ha,k-up Heater - Max�mum Fue_e 81te Ampe .-- _. 15 -- --- 10 - --- 15 ----- Features ------- - - ._ ...__ .. -- Contrnls - _-.� Microcomputer Microcomputer -.- — Microcomputer_ Low Ambient Control 09KLSSI Equip 12KLS5t Equip _ IRKLS52 Equip' _ Pan Speeds —__- _ -_ 3 r Automatic 3•Automatic 3.Auto':�ehc _ Timer _ _ - - - -- _ OnfOH/12•Hour•1hr OH__ _On/Off/12 Hour t Ihr Off On/0H/12 Hour+1h'OH (HOriromal) Manuel - - Air Depettion Manual Manuel 1".ncell --Automatic _ Autamellc Automatic -- AlrFlller __ _—_Wsehehle - _ -_ _ Waahehle W,.3hehle Operation Sound Indoor -- -,3g/3,1/3p 01/38/30 /1,138M N' ed0.a dB•A _ Outdoor _ y — — 48 52 -- Flare Type Flare Type Flare Type Refrigerant Piping 11V Discharge 1//•Discharge Ill'Discharge 3/e'Sucllon 1/2'Sielion 578'Suction Rafngeranl Piping Length* _ _Max 50 Fl _._. _--__-. Max,50 Ft Max.65 Ft Elevahon Difference Max.23 Ft Max 23 It Max.Z3 Ft. Dimemlone 6 Weight -----,—__ --- _10518, Outdoor Indoor Outdoor Indoor Outdoor W'dHmght ...------'-`_...----- 105/8' 21.11• —__.ID.W8' 211/1' 117/37' 21-19/32' Depth _. 31.11718' 31.1/2" 3111/16' 311/2' 393/16' 3421x2' • Net - _—.6.31/32' 11.13/3r _ 6.31/32' 11.13132 7-23/32 1219/37' NetWoightLhs 176 661 1711 750 265 1036 Approveie CUL.ARI,MEA CUL.ARI,MFA COL.ARI,MEA Th's is maximum sleveell diedsifffference when the Indoor unit Is located above theoutdoorunit.(Refer rttoAthe table on the heck of the aetelogoe for mem detail I —fin . 7►i ,:�tiaenr % N •�°n /�E d�'R+"�«°,wMu ®IY;,e � "n5 r x• ®7R� 'Y� ® �Inmr Wax",- Nft!"d©f'"`�i7nP� CITY OF TIGARD BUILDING INSPECTION DIVISION 2444our Inspection Line: 639-4175 Business Line: 639-4171 MST BUP Date Requested /Q /U AM PM BLD _ — Location_ ly 5�j.6ez 42- s-f-- Suite MEC _ Contact Person _ Ph PLM SOD!- Dy_30,? Contractor _ _ Ph SWR BUILDING Tenant/Owner Z_fy n _ I ��'L� GELC Retaining Wall Footing ELR ACCP_5ri: Foundation FPS Fty Drain -- Crawl Drain Inspection Notes: SGN Slab ----------- ---- - SIT Post&Beam - - Ext Sheath/Shear Int Sheath/Shear "--- Framing Insulation --f-----�----- --- ------------- ---_---- - Drywall Nailing oe Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling --- - ------ _ ------- - -- ----- ------ - - Roof Misc: - �=---- ------- -- Final --------- - � �_-_ � ---___ --- --- --- PASS PART F L -7- PLUMBING Post& Beam Under Slab Top Out _..- --- - -- -Water Service Service Sanitary Sewer - - ------ -- --_ -- Rain Drains eA AS PART FAIL HANICAL_ ------ -------- Post&Beam -- ------ - ----- - - -- -- - -- --- - - Rough In Gas Line -- - - - Smoke Dampers — F inal -.--- --- -- -- 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 Ply at r;ity tiall, 1312r SW Hall Blvd Catch Basin Fire Supply Line [ ]Please call far reinspection RE:______-_ _ ___ _ f l!nable tc;inspect- no access ADA Approach/Sidewalk Date14)VIO /0 Inspector Other P Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION :4-hour inspection Line: 6 4175 Business Line: 639• / MST Date Requested_ AM PM BLD (fir Location .7 �SUifeI MEC Contact Person ` �- t_ ` Ph c, 2- 25 S PLM — Contractor n _ Ph SWR BUILDING Tenant/Owner >!�D �n � ELC — Retaining WallFooting -- Foundation ~Access: �� r►1) EPR Fog Drain FPS - Crawl Drain Inspection Notes: V SGN Slab n- lac•r�c�L� .�I�l�p ---- -- - Post&Beam SIT Ext Sheath/Shear <. Int Shsath/Shear ---------_-.----__--._ Framing Insulation - - Drywall Nailing Firewall -- -- Fire Sprinkler Fire Alarm -- -- - ------ Susp'd Ceiling h - _ Roof Misc, -- _-.__--- na • --- _ PART FAIL PLUMBING `c Post& Bearn Under Slab Top Out --- - Water Service Sanitary Sewer - -------- _ Rain Drains Final ---- -------- PASS PART FAIL ` MECHANICAL -- -- Post& Bearn - --- ------- - Rough In - --- Gas Line --------- ----- --�___�__ --_ Smoke Dampers Final ----------__ ----_.._______--- PASS PART FAIL ------ ------ ------- ---- -- ELECTRICAL_ -- -- --- Service - Rough In ------- ------ .. - -- UG/Slab Low Voltage -----._.- - - Fire Alarm Final --- -- PASS PAPT FAIL SIT E Backfill/Grading - - ---._ ---- --------------- - Sanitary Sewer Storm Drain ( I Reinspection fee of$ - - required before next inspr,.c tion P,"y at City Hall. 13125 SW I I,,ill l Av(l Catch Basin Fire Supp!y Line I I Plpaso call for reinspection RF - _ - I Unable to inspect -no acrasc. ADA Approach/Sidewalk �. Other I Date I V! l _ _ Inspector �-A .��--�"r� — --T-` Final -- PASS PART_ FAIL] 00 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 BLIP _Date Requested_ _ — AM_ _PM -- BLD — Location 1 `/ �/ `� = �-GC. Suite MEC-,,��)/ Contact Person _ Ph �8'6' D Z�.Sr PLM — Contractor / Ph SWR BUILDING Tenant/Owner 1 `�,yYt_�� v�^-G�, ELC — Retaining Wall ELIR — —_ Footing Access. Foundation FPS Fig Drain Crawl Drain Inspection Notes: ( T�� SGN Slab - !L(Cti U l"J �, LC.t,� .,C�lr! — SIT _ Post&Beam ' Ext Sheath/Shear Int Sheath/Shear Framing ,ifl.�L ------ Insulation Drywall Nailing Firewall Fire Sprinkler _— Fire Alann Susp'dCeiling Roof J Misc: Final PASS PART FAIL -- ----- PLUMBING - Post&Beam Under Slab Top Out ----—__ _---- -- Wafer Service Sanitary Sewer �`— Pain Drains Final P>xS� PART FAIL AJECHANICAL- � Post&-Meam Rough In Gas Line ---- -- ----- Smoke Dampers Finnan ---- ----- - 'PASS PART FAIL MOqOICAL Service _ - --_---- — — Rough In UG/Slab Low Voltage Fire Alarm -- FFial PASS PART FAILSITE _ Backfill/Grading ---— -- Sanitary Sewer Storm Drain [ )Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line I ]Please call for reinspection RE: _— ( ]Unable to inspect-no access ADA Approach/Sidewalk _ j L/ �/ I n Other Date �`_ Inspector 1 � --___,— Ext Final PASS PART FAIL 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 _Requested._ � _AM_ ('M _ BLD Location c� `(_"� � ��I..GJ% _ Suite _ MEPC _ Contact Person _ Ph _ `/ , '�— PLM ---- Contractor Ph _ _— SWR BUILDING Tenant/OwnerELC Retaining Wall ELR Footinq Access, Foundation FPS __-_- Ftg Drain SGN Crawl Drain Inspection ,/ --- Blah -- -- ------� ` ��112r�. 1 — SIT — Post& Beam Ext Sheath/Shear _ Int Sheath/Shear (Framing - ----- --. -- ---- ---- -..--- - - ----- -- - ---- Insulation Drywall Nailing -..-----------.-----------__ Firewall Fire Sprinkler --- Fire Alarm Susp'd Ceiling -____-- Roof Misr.: - -------- ----------_------- _.-_-- - --- -.__-__------- - ---- Final PASS PART PART FAIL ------ -- - PLUMBING Post&Beam - Under Slab ! Top Out --- �- -- Water Service Sanitary Sewer - Rain Drains i Final PASS PART FAIL - - MECHANICAL Post K Beam - --- - "-- - Rough In Gas line -_._- Smoke Dampers Final -- ------ PASS PART FAIL } ELECTRICAL - --�� • ServiceLin tage rm PART FAIL --------- --- --- --- -------- - - - - SITE 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 Supply Line ( j Please call for reinspection RF: , _ _ _ [ j Unable to inspect no access ADA Approach/Sidewalk Other —.—•— Date ira4, p"3r ,;tGY!/__ Inspector_ 41,1,)(A�L —7 0-c ----- —Ext ---— Final PASS PART FAIL 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 _ �Date Requested <1 7 AM PM _ BLD _ Location �1 �l � _ - (i - Suite MEC Contact Person Ph PLM _— Contractor Ph��/ SWR BUILDING Tenant/Owner ^ �L 1-�ti c �-� ri -G_ ELC Ur_:( cx, CU(p Retaining Wr II ELR _ Looting Access: -- FOLlndation FPS Ftg Drain Crawl Drain Inspection Notes: SIGN 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 (lost 8 Beam f--`-f--- —_------. _-- Under Slab —T ZZ'v fop Out Water Service Sanitary Sewer — -------------- --- ------ Rain Drains Final �— PASS PART FAIL MECHANICAL Post& Beam — --- -- — - --- ---- -- Rough In Gas Line ------ — ---- -- -- --- -- — Smoke Dampers Final — �— — -- ------ — --- PASS PART FAIL ELECTRICAL_ ---- Service ----------_�.—__-- -- -- -- - ougfi in l /�lab ---- -- — — — ---- - — --- ------ l_ow Voltage F arm -- F_i PASS PART FAIL SITE 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 Supply Line [ j Please call for reinspection RE J Unable to inspect-no accece ADA Approach/Sidewalk I _. 7 Other nate _ < r — Inspector __— —_� 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#: 4-00001 DEVELOPMENT SERVICES DATE ISSUED: 1/2/04 1/2/04 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 1S126DC-04800 SITE ADDRESS: 09495 SW LOCUST ST A ZONING: C-P SUBDIVISION: LEHMANN ACRE TRACT BLOCK: LOT: 004 JURISDICTION: TIG Project Description: add 2 branch circuits. 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 SVCi 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: 1st W/O SRVC OR FDR: 1 PER HOUR: 4C•1 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT: 601 • 1000 amp: _ PLAN REVIEW SECTION 1000+ampivolt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: BAKER,JAMES + WILLAMETTE ELECTRIC INC MATHESON. ROBERT T+ PO BOX 230547 BAKFR, DIANE R TIGARD,OR 97281 PORI LAND,OR 97 223 Phone: Phone: 503-624-3631 Reg #: LIC 75059 SUP 19655 _ FEES LLE 34-283C Description Date Amount Required Inspections 11 I PRMT) 1.1 (' Pamir 1!2/04 — $53.50 1 1\' R"I',Sraic StitchmPC 1'284 $4.28 Rough-in Elect'I Final Total $57.78 This Permit is issued subject to the regulations contained in the TigaR1 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 952-001-0100 You may obtain copies of these rules ordirect questions to OUNC at(503) 246•66699 or 1 800-P2-2344 Issued By: �L,��ll ! Permit Signature: OWNER INSTALLATION ONLY Thr? 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 639.4175 by 7:00pm for an inspection the next business dly Electrical, Permit Application Received Electrical ---- — I pp Date/B : l ',Y' Permit No.: L'(�Jaty/ City of Tigard JAiv Planning Approval Sign g 4``;J, Date/By: _ Permit No.. 13125 SW Hall Blvd. Ver Plan Review other Tigard,Oregon 97223 L;Uf��yYt�� r��kK� Datc,'B : Permit No.: Phone: 503-639-4171 Fax: 5113/*FN 1�4 ��ry Post-Review land Usc �✓ Date/By: Case No Internet: www.ci.tigard.or.us Contact Juris. g See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information. TYPE OF WORK PLAN REVIEW Please check all that appy _ New construction _ I D [demolition LJ Service over 225 amps- LJ Health-care facility - commercial ❑Hazardous location Addition/alteration/replacement I ❑ Other:— i ❑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 ®Commerciale Industrial ❑System over 600 volts nominal one structure ❑Building over three stories ❑Feeders,400 amps or more Accesso BuildingMulti-Famil P p ❑Manufactured structures or R1'park —_ �—A_ ❑Occupant load over 99 persons Master Builder Other: ❑Eigress'lighting plan 1 ❑Other _ JOB SITE INFORMATION and LOCATION Submit_sets of plans with any of the above. Job site address: y Ski r �,; The above are not applicable to temporary construction service. Lc� ,,.s _ � — FEE*SCHEDULE Suite#: $ldg./Apt.#; _ Number of it!pection�ter�ermit allowed Project Name: e o H w T" n Description Qty Fee Tea.) -i nut New resldential-sin le or multi-family yr Cross street/Directions to job site: dwelling unit.Includes attached garage. Service Included• I(M sq.I).or less 145.15 4 1 rch additional 500 s .tl.or portion thereof 33.40 _ I Subdivision: �— --�[of#: Limited energy,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-Installailon, �, _�� -, 8 _ alteration or relocation: 200 amps or less _ 90 30 2 -- —--------- -- — - 201 amps to 4(10 amps 106.95 -� 2 401 amps to W)ams — I60.6(1 � PROPERTY OWNER T�TENANT 601 am s to 1000 amps _ 240.60 — ] -- Over IOM amps or volts 454.65 2 Name: Reconnect only 66.95 2 Address: Temporary services or feeders-Installation, L_I_t /State/2-ip: - _ _ - -- alteration,or relocation: r�_ rr�� 200 amps or less _ 66.95 1 Plionc. t c1x: 201 amps to 400 amps 100.30 2 APPLICANT CONTACT PERSON U1I w GfN)ams 133 75 2 --- -- Branch circuits-new,alteration.or Name: _ extension per panel: Address: A fee fix branch circuits with purchase of service or feeder fee,each branch circuit 6.65 2 city/state/zip: 11 Pec for branch circuits without purchase of k - -- -- — service or feeder f'ec,first branch circuit 46.95 G - 2 Phone._ Each additional branch circuit b,65 2 E-mail Misc(Service or feeder not included)'. CONTRA:TOR Each um or irrigation cin' _ 53.40 2 — -- Each sign or outline lighting 53.40 1- Job No: '(3 y J- _ Signal circuit(s)or a limited energy panel. Business Name: I I f 4 �� - f'ec t A 1 c alteration,or extension —_ Pae 2 _ 2 lw' - Description Address: ?c) s y } Cit /State/Zi i, x n Z Each additional Inspection over the allowable In env of the abuse: Per inspection per hour(min. I hour 62.50 Phone: 1, Z c - Fax: 7 y• 25 Investigation fee __ _ CCB Lic. #: }� y Lic. #: ti - �'3 r- Other Electrical Permit Feel* Supervising electri,:,an /�� - _ Subtotal Iia 5 ry w si nature re ee is A, Plan Review(25°/o of Permit Fee) S Print Name: I L c.#: I yb 1 S State Surcharge(13%of Permit Fee) S 14 _ TOTAL PERMIT FEE I S S ? , } Authorized Notice: This permit application expires if a permit Is not obtained within Signature: Date:___ Igo days after it has been accepted as complete. 'Fee methodoiogs set M Tri-Count%Building Industry Service Board. - -- (Please print name) -- — i'Dsts`Permit Forms ElePermitApp.doc 01'03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Feefor all systems............................................................ S75.00 Check Type of%Nork Involved- F] Audio and Stereo SyOerns* 7 Burglar Alarm Garage Door()pcncr* Heating,Ventilation and Air Conditioning System* F] Vacuum Systems* 7 Other------ -- -— COMMERCIAL. WORK ONLY: Fee for each system.......................................................... S75.00 (SEE OAR yl H-260.2(iq) Check Type of Work Involved: Audio and Stereo Systems Boiler Controls Clock Systems Data Telecommunication Installation Fire Alarm Installation HVAC Instrumentation Irl,,. ;r and Paging Systems Landscape Irrigation Control* Medical Nurse Calls ElOutdoor Landscape Lighting* Protective Signaling Other - ------ -- - Numhi r of ti .irnu * No licenses are required. Licenses are required for all other installations i'Dsts\PermitForms+lcPermitAppPg2.doc 01/03 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 "ST _ BUP Received -_ Date Requested+`, ,� -_ AM _PM BUP Location � ��y� �,p e�5 _ Suite._ — MEC Contact Person _ Ph( ) - PLM _ Contractor ��Lt�, �=� - - - Ph � ._) � � 1 _ SWR BUILDING Tenant/Owner Footing ELC _ Foundation Access: — Ftg Drain ELR Crawl Drain _ --- Slab Inspection Notes: i SIS _ _— Post& Beam ------ - -- -- - - - - -- Shear Anchors - — ------ -.-- Ext Sheath/Shear Int Sheath/Shear -- - - - Framing - Insulation Drywall Nailing -- --- r'` '� �� r t �� SIS k•C` !J�L' �il�_ ,� _-:I.��)L� Firewall Fire Sprinkler Fire Alarms p [ ,q�� , /� Susp'd CeilingRoof (�� =_+��-+ ��`LL—�- �� 5 � ` Other:- - --- Y -C 1 _�ap �� . fz�� _ �G ► �Q�1L� Final � r A� f i r G, _�� ,. �s---------- PASS PART - FAIL PLUMBING ' " Post R Beam Under Slab `p �Z i�' r 1,�._J_ lamJll �l � Water Service 1) 1 ;L,Lit) (. Sanitary Sewer - Rain Drains - -- Catch Basin/Manhole Storm Drain -- -- -- -__ Shower Pan Other: -- - - - — Fina! ---- `- -'-f PASS PART FAIL - MECHANICAL Post& Beam Rough-In Gas Line - Smoke Dampers —-------___ - - --- -- _ - _ Final 5,_ PART FAIL __ -- Service - -- - - ----- - - __s--- - --- Rough-In UG/SlabLow Voltage Voltage Fire Alarm ---� -------- �� ---,PART FAIL Reinspection fee of$ required before next inspection. Pay at City Hall, .3125 SW Hall Blvd. ,�� _SITE Please call for reinspection RE: _- Unable to inspect-no access Fire Supply Line ADA ll Approach/Sidewalk Date I=-1 C L� Inspector .. Ext N - -__-- Other: '05p - Final DO NOT REMOVE this Inspection record from th(6 job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST _ BUP _ Received Date Reque ted__ 1 __L�Z_ AM . PM BLIP _- Location C � � Suite MEC —_ Contact Person S� Ph( ) _ _ — PLM Contractor --- 11�' ��yy, A IJ /P,h"(- ) la Z�_ ..ilc�1_ SWR BUILDING Tc,,int/Owner .__112 _�<.X�c�YI, ELC� (?o»n ------ Footing ELc' Foundation Access: - Ftg Drain ELR Crawl Drain _ Slab Inspection Notes: SIT Post&Beam Shear Anchors ----'- _ _----__..------- __-- ---- ----- Ext SheathiShear Int Sheath/Shear Framing Insulation - Drywall Nailing ✓ J/ / (!�/'I _ _ ___. Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Root o W Other: - - - Final ----------- PASS_PART_ FAIL — --- - -- - —' PLUMBING `_ Post&Beam -------- Under Slab Rough-In Water Service ------ ---.--- -- -_ Sanitary Sewer Rain Drains ---- ------- -_ Catch Basin i Manhole Storm Drain ---- __ _- - - __--- Shower Pan Other. ----- -- — ---- ------ Final _ SS _PART FAIL MECHANICAL Post&Beam _ --- Rough-In Gas Line Smoke Dampers ---- - ---- ------ Final ----_ __--- - -----------.__ PASS PART FALL -- - -- - -- --------- -_--- - ------ ---- ELECTRICAL Service _ -- -_- -- - -- -------- --- -- Rough-In UG/Slab Low Voltage Fire AliaM Rainspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PARFAIL1 SITE F''ease call for reinspection HE:------- - Unable to inspect-no access Fire Supnly Line ADA / % ,I -r) 4' --�� Approach/Sidewalk Date 1 /_ Inspector . Ext Other: Final DO NOT REMOVE this Inspectlon record f om the job site. PASS PART FAIL