Permit C � � MASTER PERMIT
PERMIT #: MST2003 -00046
DEVELOPMENT SERVICES DATE ISSUED: 3/17/03
-'' ''-- -- '''.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13685 SW 124TH AVE PARCEL: 2S103CC -06000
SUBDIVISION: WHISTLER'S WALK ZONING: R - 4.5
BLOCK: LOT: 007 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,304 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,346 sf GARAGE: 621 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 19
VALUE: 261 875.90
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,650 sf REAR: 36
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER ' TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 5 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/F DR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,196.50
This permit is subject to the regulations contained in the
DON MORISSETTE HOMES INC DON MORISSETTE HOMES INC Tigard Municipal Code, State of OR. Specialty Codes and
4230 GALEWOOD ST #100 4230 GALEWOOD ST, STE 100 all other applicable laws. All work will be done in
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
5p
Reg #: LI 387 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Ins Rain drain Insp Plumb Final
Footing Insp Crawl Drain /Backwater Electrical Service Low Voltage Water Line Insp Final inspection
, Foundation Insp Footing /Foundation Dry Electrical Rough In Gas Line Insp Appr /Sdwlk Insp
Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Electrical Final
Issu d By : . _ . :!,.../ % n
k - /ht. ! , Permittee Signature ti_ bin 2.1_,-
.D1/ Call (50 ) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
1 -. C `, , � I _f .i w ., • .0•r !_c Building 0 0 • �A + t o-e 's"� .?r r l " ; r� i i , r , z ; .
Permit App ratio . -. , Y V ' s x , . 4 1 x � n £ � � ; r � � 1 f �, i
/
Date received: I/ /6. Permit no.: /) l 7 W
i qi-1 City ®f Tigard
` - \ Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 -4171 Da te issued:: I Receipt no.:
Fax: (503) 598 -1960 RECEIVE ( <v r
� ` Case file no.: Payment type:
tfi
Land use approval: JAN 2 8 2043 f 1 &2 family: Simple Complex: c\
fi rikk�i ` 1 ip.i"r .:T./ m f " f4r • ati r'� r r,p4 N.;',s -' "ZC,.f+dt f,14..y . :3,1 Y ' 3 Gti ti.s,x r sx TA t . U/
. .:^_: : <, ,:.>y .r,k .,�t ' ,�Mo .tx.s° I:z2 o- I• s.., . ,,I I,,,OC PHR11 . 4i " .'' "ti' t'�'f'_fi ±: ;t;s«, 5 :s t ::T 4 ,.. _,
0 1 & 2 family dwelling or accessory aviwlkWaPiWI 0 Multi- family ;'New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other.
4i.g !P1.,:: rr"t" x , - '�`ii r?: 'e ;;" ' ""Wf4, s't, x . .."44. #' ` y - ` a.A. r,S ir* ;,� ... f-Xt* '�� ^°�z,7":
-*:41:4 ry. ?&)..� €!.e. .:;:? -�"�. _hfu; t �;.a t 4? - as r,,,!- �JOI3SIT_ E II OBVIATION,, . 4 �° i . rte .. l 3 �., •t ,s'
: ._.. ,-� . �. ...--1—i, ..:.- �c.<<...,.r ., .'t- tir�`t�E C1a ,::z�m�'.''»tw: 1n.dz. �-.t .. a:5:, n. .,x....75 rL �,5.rf_
Job address: (Ji ,0f c3 i Bldg. no.: Suite no.:
Lot: '7 I Block: (Subdivision: Awl i ' 1fVt F . I Tax map /tax lot/account no.:
Project name: ; ' x
: ( v ,.'•
Description and location of work on premises/special conditions: i`
s ` hi x, -r, r <; .-W1- c r4i rOic n IAMP -tT , 3'iMi 4 .* 1 INI ORl1'Lr1T USE (:111 l 'ta ;
., F _ re 7...11X•.,.,.' -- ..l 4-, ,4Y. i, .f1A -4 .r f H 7 f 31 M �` µr Y,Q ir}}' S .
r x� ' � 9 � �,'}�t ds- r s °t fi + �. "1r <y�',�4 .�•tr' 1� t?-� . '+' � �« '3 1 r afF�
���I �"- �� { • 1 a " ( I IOOdplain sCpiii F;
iiriYil����Y iv. � _ �yL :�.Lvz ..,,..•�..# ??M_,7.x.... /&.s:.+ › �.+ .rt:.4.4-,s,i...: ;,
" _.., 1. .._
Mailing address: 'es �1 Ri1:ti +'�rt 1& 2 family dwelling: t
�'V ZIP: - '2), "'' Valuation of work $(R6/ . 7.5 . i Ci �
r U
Phone:. �l No. of bedrooms/baths - ( 2 1
Owner's representative: _ .' ,� if Total number of floors
Phone: Fax E-mail: i r
New dwelling area (sq. ft.)
; } �ri',� a+ ,¢ 1! a s+Ri .. i F°,'�` 'r... o. s
'' . _ {a:A x s `Oski•PLI f ifs _ ; :�` 44.17P
. rr i
s.,.,... ,,,,. -. V-., `Garage/carport area (sq. ft)
IEMMITIZ/W4M/b 1 Covered porch area (sq. ft.) / / t✓
Mailing address: .'r'Y1Q_,. a a• Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industrial/multi- family:
. w 4s.e a , r° t t O 1 max . r ,s . Y , � Valuation of work $
. :rrY , 74,: :. , -A'4., .h:, .- r ,� ��•, x .45 s•.�*r c. *�:a
DM= .-.� rd, A;� Existing bldg. area (sq. ft.)
Address:
New bldg. area (sq. ft.)
�vLj= Number of stories
City: State: Type of construction ---.......1/4.
Phone: Fax: E -mail:
— Occupancy group(s): Existing: _
_.Y -.:',.) __? `'j t New:
City/metro ltc no.: _ Notice: All contractors and subcontractors are required to be
'����' *. "'ch. t ''3 , , ARGI I I7 F i /DM SIGNER ^', 47.7r , ' {, ;) J l with the Oregon Construction Contractors Board under
Name: t.& LLui _% provisions of ORS 701 and may be required to be licensed in the
Address: A i C jurisdiction where work is being performed. If the applicant is
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
h k;,.. '�. ,-�R -'� � r�'� P s,�'r �. � iF " �., - _+r` . L� ,vim 5• k j: a�._ ., nt5 ,�. -sy �r -,.
4 - '�. ,a mx ys�F�� ,� 'l ' ENGINLER" k'� � . ,. :�7 7 ? - 1 t n v ` � , '4 s' H Si Y -f 4 '`.
r s! r'+_.. - ,t4 . ,, ,, .:.:: c±'.Kr4k...;.,... , :..:. • —, ur_. ,c `...-- 4':At, --3.3. �: -A..— {X :.+I;.Vd._.4FV,.�an," _1g.. ro:a'ren_AJi'Lf�k'.. w .4` .- a s..at Fi : 14 •,.. ..
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: (ZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A . rovisions of l ws and o dinances governing this 0 Visa 0 MasterCard
work will be compl -8 wi whether ifieed iIereii r t � �/{U � Credit card number: / /
1
Authorized si , 4 atu .: _ , i 1 L - - 1 . e: �� Name of cardholder as shown on credit car Expires
$
+
Print name: •_� ' 4 (l ,r_ Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6&00/COM)
One- and Two-Family )' welling
dll Permit Application Checklist Reference no.: ..,. -.
City ofTigard City ®f Tigard
Associated permits:
❑ Electrical ❑ Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE .TOLL01VI1��C IT ' RE REQ 1%OIt I'L �N REVIE j # a ", ' �� 1,) cst* � \'o
t 'S �a r ...ia"L.. ...._ e.uti _._... ...- . ..._�. t TY' �.. } _.. �1;�05 .r . k .eM rC+ri:r+te. t<.
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 4
3 Verification of approved plat/lot.
4 Fire district approval required. , \
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage -way protection, silt fence design and location of ,`
catch -basin protection, etc. J�
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed J
if copyright violations exist. J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property comer elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot x
area; building coverage area percentage of coverage; impervious area existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
/l c
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, X
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable. J�
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ` \
locations. Show attic ventilation. ' �C \
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load. x
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
c r3 +4„ ' a`ix s �M ;i'�y,'' k �' /# 7 u -ss, z�Y rff � 76Z y = I } i �,tx nra •fin, R
4 , ar mix «�JURISDICTIONALrSPECIFICS 1
.,. f ��a�Crv¢ro.,,. _..�.sF.y� ,l::.., <. ea�`.36.:�ids. 1 tdt,,. ',:"U9s. {�EI Yr e >.. .Ps
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". x
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614 (6d00/COM)
e • Pr: a 1 . °•' 3t 't ;;- s tkora �4 3 a' ,, zt . �
Plumbing Permit. A pp l ica ti ®n w r s: � r1 > - .; >A.-4-.��;1; _ • ,
A Date rec R a b 3 P erm i t no.;�y , o0o G
.- City of Tigard Sewer permit no.: Building permit no.:
e� Address: 13125 SW Hall B lvd. Tigard, OR 97223 Projecdappl.no.: Expire date:
City ojTigard Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
m ow ,,,
xk Y a - _' ^ritx'; .:; 'r r r ; r i'. ? : r; '4 r ,T� !.7 .t� t, .' 4 �' - 'V 'h LM , x-r ,. t :,,,, . ;.
i , s, t ,}, '� k e,,w ti- � - 3 .TYPE` OF PERMIT s t . � n a t' r '.» ,�
.2``•,'�u ���^Lk�i:'.�k?-u'�- w'u4;�s.a P.!".- 7G+� - A�tab �l y.�1.,'�,. >.i�h ""+��sa. .L .♦ �a�s.. .: , A� .as. ...._._.,. :N...�...1?`3�._y;4s�....�����r e «.vim �i 2 rt�w. scL.,. v� .. 5. .
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
►: ew construction 0 Addition/alteration/replacement 0 Food service 0 Other.
"f t k -TJOB SITE INtifit TIQN ;'- & � r V ; SCHEDULE (for special infor :3 s eckltst) `
� c'�� _.w .,... ... , _ .,_._ _... . = _ - -
l Description Qty. Fee (ea.) Total
Job address: '�! /� v Suite New 1- and 2- family dwellings only:
Bldg. no Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: Block: Subdivision: ^l, jj SFR (2) bath
Project name: VV F SFR (3) bath
City /county: 1 ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection:
Drywells/leach line/trench drain
X j , t � ''' , ice [ Footing drain (no. lin. ft.)
l > 'i I L:L \G , k C,U; II! ..0 I ()It.- ,12,;f x_,- ,-4 i ` -' Manufactured home utilities
Business name: (Z_Q(N L i Manholes
Address: j ` • Rain drain connector
��' t 4/� ZIP: Sanitary sewer (no. lin. ft.)
• State Storrn sewer (no lin ft)
City: i►! .tti1� .
(no. . .
Phone: I Fax: E-mail: '�� Water service (no. lin. ft.)
CCB no.: .: [ C 9 ) - 7 l.../ - 7 Plumb. bus. reg. no: Iv _ Fixture or item:
City/metro lic. no.: N/A ‘'' / ' Absorption valve
Contractor's representative signature .�(/ ' � Back Clow preventer
■ 1iM� • i Fj'irIJ Backwater valve
�F�
I tr : "Ph 'ut x V 11C I ; V ` yi a C)\ ". ` qw : t a . g� Basins/lavatory
` , ..Ea. � i t.a4. - k.. „. � t . 1 .RS ? : "x t .. ..'r. . .. �5.- 9 t
`\ ? t Ste_ Clothes washer
Name: \ , NE Dishwasher
Address: • , • ` �C ,, ,V - Drinking fountain(s)
City: State: ZIP: Ejectors/sumo
i
Phone Fax E-mail: Expansion tank
• t� y et ,i., ,.::. () \1 \I 1t a .A. -- -".':'4.-------4.---- F Floor drains/ oor cap
oor dains/ sinks/hub
Name (print): j Alt t �' Garbage disposal
Mailing address: ., _ • • "1 s.► • 1 • Hose bibb
1 City: _ O . State ZIP:Gj” 7c , Ice maker
1 Phone: 7- j I Fax :)7 -7k E-mail: Interceptor /grease trap ,
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s). basin(s), lays(s)
Owners signature Date Sump
� z yhw , " ` � ` o : ;.�k[ \G[N `� � Urin/ hower /shower pan
,., r oc „r., k 74 ,�s?=::,az 4, . _
Name: Water closet -
Address: Water heater ,
City: I State: I ZIP: Other. -
Phone: I Fax: [E-mail: Total
)Minimum fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: Thi p ermit a
—
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number.
within 180 days after it has been State surcharge (8 %) .... $
/ TOTAL $ -______--
accepted as complete.
Name of cardholder is shown oa credit cans S
Cardholder signature Amount 4404616 (6+VOCOM)
Mechanical Permit Application , . . ;,- A u Y, . { ,., •
, A. Date received: ( •,, Permit no.:lyy, ,,O5 •. •
A ';, City of Tigard Project/appl. no.: Expire date:
CifyofTigard Address 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 - 4171 Date issued: By: Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: Building perm;[ no.:
.s �., . : ,, A* , �y^f-p- � . � m '`= :rTYPE'OF PEBMTT =r >' :,A: r .a >,p. s, �.:" s� :A' t, �_ �',..� {,6 s
�) 'k�A z 'w. , 1S�K ,,. . '' 1 , t- ,:r `S r^"Y7 +C C
t" {
nv '<s, �e....�t ws ,..sss ? .::s .� »;�.. r.. i.. �..�� ,.4z,:..�[a ;:3!�,i`.`'s�"w.'�tx ..,�.z.Y.�. _,.. —..... ....r_._..��,_.. ""= •_^w�...n:r a.a�. „_ +.rt_ _'!Sz;W:a�",- '?.,.�•a ,. >- .
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
XIew construction ❑ Addition/alteration/replacement ❑ Other.
y a r x� f APP AITE-INFORI�I t 1 r x ° ; : .' 1 0- PCOMMERCIAL1,,.VA UATION; SC)E[EDULE IS
1Sapy'y5�d'�,wS�._: �ryS 1i.n.w,PuX. ..... �. .vw.. sue. .:.. - ter.. � �Y. L .. �..
Job address: I i r A PPMFIMMINIII Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ "
Lot: Block: Subdivision: ' ' iil��� 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: Nl7& FAMILY D�VEI.LINGryPERi1IIT FEE'SCHEDULE` .....-4.
Description and location of work on premises: !AND COMMERICAL/ INDUSTRIAL`EQUIPMF.NTSCIEDULE.
P P 's'-R..kwre,.. ....411. :h..; r_ sb. ..,.t.i.+t:t.s_:, c:., „s..,k ...,:+,,. Yw,.t, ..,.. a:
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res.only Res.only
Tenant improvement or change of use: HVAC: II •
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
g P Air conditioning (site plan required) -
Is existing space insulated? ❑ Yes ❑ No _ of existing HVAC system I
�,___,,: _' •_ �1ECFIi NIC ;�L .__ _ 1 R_,1C __ ; `.. Boiler /compressors II■■
xnw.�s.}�? •';.��.e,,.f °"�'!" ` /�}� State boiler permit no.:
sII_fr �I.� HP Tons BTU/H
Address: an Fire/smoke dampers/duct smoke detectors _
MEji, Ewa ZIP: ° It Nl Heat pump (site plan required) E
Phone: ..�� - ' Fax: E -mail: InstalUreplacefurnace/burner BTU /H �-
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: — A "A Install/replace/relocateheaters- suspended
City/metro lic. no.: N/A wall, or floor mounted 4111h �--
Name (please print): "4gror eii � Vent for appliance other than furnace 14ditil ral�
`r r' q.g 'Px� ".�t c' A y `CnN 1. 1C =rS I'L12tiON -' =' �. i�'` Refrigeration: ■ --
t.: : , : ' 5 _.°-a.4,;!, �. },.. -.t... 4, .c, r + VA .) --W v_ Absorption units BTU/H
it ` Chillers HP M --
Address: Compressors HP ME
4 ♦ �t Environmental exhaust and ventilation: ■--
City: State: ZIP: Appliance vent
Phone: Fax E-mail: Dryer
o o d s. Type exhaust M o4
; �,� # i� j � �, �` � � � �L�`i�, �"',�,� t n � C +N h R, st�� -��,,,��'�'' � ; Hod 11 II/res. kitchen /hazmat
111 ° - e ^- hood fire suppression system
1121IM sOArt Ef< Exhaust fan with single duct (bath fans) El__
Mailing address: r / ��_ IM7ea Exhaust system apart from heating or AC hiM
.�
Fuel piping and dis +ution to 4 outlets)
cam pa ��. ZIP�� Type: LPG N Oil � -
Phone: �� Fa Email Fuel piping each ad. 'onal ov • outlets
1 .""'17 r` I' fwd , fit •t .t - r ` u � � " sue : ' , .. Process piping schematic required) r
Number
R. r.k....(`.'. A , .,:� ,, ; a 1 N G I t . R d � t ` c + r _t,..ai o f outlets P g ( -
Name: o
Other listed appliance or equipment: � --
Address: Decorative fireplace
City: State: ZIP: Insert - type
Phone: E -mail: Woodstove/pelletstove —
Other:
1.
Applicant's signatu" .� AKIW' Date: � � Othe E
Name (print): .(; , , 7 M
r
Na all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application Minimum fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / s w ithin 180 days after it has been Plan review (at %) $
Expires y State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount 440.4617 (6/0000M)
Electrical Permit App ®n ,� . ,
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Date received: ON 0 1 2 Permit no.: , .r,--, , 0 , -60o rP
1 ; j t . City of Tigard
Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd Tigard, OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
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+• '4. s 7R a } pp 1 . 0- T f :j �i v ,? :. ,d ,� - ' OF PER111ITt N -A 'ij : t t i r if =L �'t !.. " ' l ' S y,�'4 �'t �� -
:,;t; %".'!�!,.. '..,ct.. '� , �:__ �'�..3A.�..iw. `iv����ii:a�: 4, . �a �!&.:4�Y -���TY E� - _ .._..�' � ._���'� M:.l._s . � .�'.1h�3 r,.��. t - ,f'i.x -� ..cr.�.._.��:r
❑ I & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi - family ❑ Tenant improvement
►'. New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
i:: i 'tie y w ;<,44,: :twt. + F =;ST to t` ID. i l Y-s !:.+f,� i ; 9 xy xr .�t.f Y y 6 �, R a - i n 1 t - r A Y Y t , .6
. �e. 3 , wt ,t..JOB SITE INEORivIATION _ . , . 41 %v. ,, .:5,¢ . - .. 2A , >, <. r _ , �`
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_ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
-_ �_
Job address. ` _ t
Lot: ' Block: Subdivision: L ��p /
Project name: Description and location of work on premises:
Estimated date of completion/inspection: _
s - 7 ;, r _.. ,.,;.r `s T I "() z 0-F F . r -o `W ;� � ' FE E'SCHEDULE ? °. -r x
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Job no: _. ,_ Fee Max
Description Qty. (ea.) Total no. lisp
New residential -single or multi - family per
Address: `� _ �` ��� ��� �� dwellingunit Includes attached garage-
real iig JII bi e � r y � f c _ lude �' 4
Phone: 7j i �,� Fax: E -mail:
Each additional 500 sq. ft or portion thereof ��_ _—
: no.: y � ' Elec. bus. lic. no: / li m i tedenergy,residential �__ 2
C
Limited energy, non- residential ___ 2
' Each manufactured home or modular dwelling ■■.
nature of supervising electrician (required) Date (iJL Service and/or feeder 2
License no q -1
Services orfeeders — installation,
Sup elect. name (print) ,.-) A� 1 r a! 'J� /�` alteration or relocation: IIII
^tit' k t '` i t g � ) . * . e '-e jtii,aFa ,, ,. . y lr ! 2
• t• y °?. `. fi r•: i tiT .. _,,- .i„ r, ()�4 � 1 1 R t t t , ...u.:_r .. • >j. ? rf.=_. : 1 200 amps or less
a 201 amps to 400 amps ___ 2
Name (print): `, , SW w
�� 401 amps to t>00 amps ___ 2
Mailing address: ��jl:tlrfiR,a� t � S . 6 01 amps to 1000 amps ___ 2
City: r awn I Over 1000 amps or volts ___ 2
Phone: ,.I.fr ii�jT lam Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to aliation,alteration .
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps ME_ 2
Owner's signature Date: 401 to 600 amps IMINIE _ 2
,t a a Fe d ie is �,,' .41t F ,F" 1,' Branch circuits - new, alteration,
'r._xa'. ? •> ;z rN:�. err E1VGINEE 04 :6: ; .
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit: •__—
t ilt * "' ` ' PI;AN aR +(Please CheCk1145h117apply) � , �?�'��,,E., Misr. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health-care facility Each pump or irrigation circle ME 2
O Service over 320 amps - rating of 1&2 0 Hazardous location Each signor outline lighting __ 2
family dwellings 0-Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel. ■■.
O System over600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more • Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
f
Permit fee $
Na all jurisdictions accept credit cards, please call jurisdictioo for more information. Notice: This permit application Plan Permit
review (at %) $
O Visa 0 MasterCard expires if a permit is not obtained
Credit card number. / 1 within 180 days after it has been State surcharge (8%) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
S
Cardholder signature Amount 440-4615 (6l00/COM)
CITY OF TIGARD 24 -Hour _
BUILDING- Inspection Line. 1 639 -4175 MST `3 Dad �6
INSPECTION DIVISION 1 Business Line: 9 -4171
BUP
Received Date Requested AM S PM BUP
Location 1.? 4 ("t-G - / #e- MEC
Contact Person a- se ( ) Z --" `C / per 37 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam ZVeti �
Shear Anchors / 2S---- > d
Ext Sheath/Shear lD
Int Sheath/Shear 0\a‘)6--\-
c . J, A: 4w65 (z) - A Framing
Insulation U■ OL` S \ ,, , _ D Nb \A/L.S • Drywall Nailing
Firewall t•_. �___ r 1 (-- \/* `M •
Fire Sprinkler �
Fire Alarm 7) lc_- s L.r� — c/ V (3"
Susp'd Ceiling
Roof 44 ` V 12-k Qo-f _ ---
Other:
6 u_s t L.,.„,1 C9_,-4,- g , - 7 AZ" 4
isi PASS PART i sPtDNG .� 1 , L� - . -.4-s —1 �� : �'I� ) --}-fF y J
Post & Beam ri, _ c ��(`-e I D `� Under Slab l J
Rough -In k , • • _ +
Water Service r . �' , �� ��
Sanitary Sewer -
Rain Drains __ "
Catch Basin / Manhole ejk e �� �, 2r� :- W
Storm Drain C
Shower Pan ) `C" --e-�� ki^5 kr-CSL( .
;
Ot , �. l
- • � SS PART � �� ,/�� � /
MECHANICAL lhas 6G�T4" -mot-- – / o
Ro & Beam 7- 7G i64-4 4-,/i — 2 / o
Rough -In �7
Gas Line /
Smoke Dampers
P c: s �d
' . '- PART FAIL // �
CTRICAL 1 , �
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Ill Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 111 Please call for reinspection RE: 111 Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date �/ I nspector Fat
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING —t Inspection Line: (503) 639 -4175 MST yt6
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ( AM PM BUP
Location /3& 8 /g / Suite MEC
Contact Person Ph ( ) 0 — ¥ 3 PLM
Contractor Ph ( ) SWR
BUILDING TenantlOwner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
- Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
U ab
Low o g �—� lL (it L—.
Fir Alarm
SS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinsp -ction RE: ri Unable to inspect — no access
Fire Supply Line
ADA D / 0 0 lea p° or 4" ' 4 , - ; • Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING fie• Inspection Line: (503, : 9 -4175 MST 3 aaa
INSPECTION DIVISION ' Business Line: j;` ,�9 -4171 II W
BUP
Received Date Requested t Z AM / °// PM BUP
Location l 3 e 8"(5 fa Suite MEC
Contact Person Ph ( ) go?-co 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: n SIT
Post & Beam s�- '
Shear Anchors , ""7 ►
Ext Sheath/Shear CJ
Int Sheath/Shear ���
ci. 0 , -L2
Framing \ J/� v(f
Insulation ^� � Cr---0-
4
Drywall Nailing � -�
Firewall ‘(\/- c _ s -A---c--` ._,-- f '--) a ti \ C
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
m in
PART FAIL
P e BING
Post & Beam
Under Slab
Rough -In
Water Service •— -
Sanitary Sewer
Rain Drains -
Catch Basin / Manhole
Storm Drain ''
Shower Pan
•
Ot
PART FAIL '
li CHANICAL ....
r I
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final �,
PASS PART FAIL
ELECTRICAL
po
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line '
ADA Approach/Sidewalk Date (2v Inspector ` v L�
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
7
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41 1 S T 3? 1 , rr ?,- -,-- E CE 4 - 4 : ' - . 7, . i
LA'I'UO
I, 4L k , Owner /Agent for 1)hr) 1 155E17e- }6,t.E- s
44 (PLEASE PRINT) (PERMIT HOLDER)
A Pis-
Do hereby certify that the following location
meets City of Tigard /Washington County Ps-
1 Pe-
A land use and development standards for street tree installation. Of-
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A • ADDRESS: l 3 b85 .51,J ila0 4✓r. 0-
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444 ixt-
® • LOT: 7 S UBDIVISION: b l)Ai 1eff th -1.1C Pl
Al • BY: DATE: 6-16-63
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® RECEIVED BY: _ DATE: (0/ ( /C.)
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