Permit y C ITY TIGARD MASTER PERMIT
PERMIT #: MST2004 -00145
s �l� DEVELOPMENT SERVICES DATE ISSUED: 6/9/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6391171
SITE ADDRESS: 12420 SW WINTERVIEW DR PARCEL: 2S110BC -04300
SUBDIVISION: THORNWOOD ZONING: R -
BLOCK: LOT: 014 JURISDICTION: TIG
REMARKS: New SF detached.
BUILDING
REISSUE: DM199AS STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,490 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,890 sf GARAGE: 406 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 322,924.80
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,380 sf REAR: 15
PLUMBING
SINKS: 2 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: 0 SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
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: WISVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 • 400 amp: 201 - 400 amp: 1st WIO SVCIFDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v. MINOR LABEL:
. 1000+ amp /volt :
PLAN REVIEWSECTION
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: $ 6,094.72
This permit is subject to the regulations contained in the
DON MORISSETTE HOMES DON MORISSETTE HOMES INC Tigard Municipal Code, State of OR. Specialty Codes
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 and all other applicable laws. All work will be done in
STE 100 LAKE OSWEGO, OR 97035 accordance with approved plans. This permit will expire
LAKE OSWEGO, OR 97035 if work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days.
Phone: 503 387 - 7538 Phone: ATTENTION: Oregon law requires you to follow rules
5p3�387 5 g adopted by the Oregon Utility Notification Center. Those
Reg #: LIC 35753 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Ersn Cntrl 681 -4444 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins Gyp Board Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
P. - . =earn Struc 1 : Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp Building Final
• Issued B : • _ J �� 6Veritat4; Permittee Signature : Y
- Call (50 . • • -4175 by 7:00 p.m. for an inspection needed the next business day
$.1 q1.z .=
Date receiv / �/ Permit no: �1 �j ��Oj)�/ -ODJt S .
.: `l,
„ City of r . ig d f
,A4-_,.!!!4) 1 8 , , Project/appl. no.: Expire date:
City ojTigard Address: 13125.SW ;Hall Blvd; Tigard 1 ^ 7223 •
Phone: (503) 639 - 417101 T Y O F TI GA R D Date issued: By: Receipt no.:
Fax: (503) 598 1960 �U�L ®ING DIVISION Case fileno.: Payment type: •
Land use approval: 1 &2 family: Simpl. , Complex:
a 1 '1;t1..' ,1, is ." z' t r-r T'1,�PaE x itTl 11 i . y 3 , `- Iii fi r eik f' .
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ,New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
AT .Ih z.. irk - s' PJOB SITiIINFOI is TION i gl ' itk ask .Ida lLyt
Job address: k�f ,�j� PT , _ Bldg. no.: Suite no.:
Lot: \ 4 I Block: Subdivision: Iry - Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
is , a t "OWn
iiit` '{ ! , • x 1.ORtlif
Stri INI ORMt1¢T10N CIlLCKLT Z '
AUSE
f r rnk ?: �� st � ,� . , p,� - r�•.aa�a fl �C���3w�M. `:��`+ >,. f
1 A�s 0 1'\2r . ;� ((Flo :solar ;c .) ` 4 � �''
Mailing address: Arz,wi : ' 1 & 2 family dwelling:
City: ; t , , StateL T" ZIP: - 1 'Z) . .7 Valuation of work $
_-----p
Phone: 7 - 7Cjlf , Fax 10 -7i- , -mail: No. of bedrooms/baths
Owner's representative: , , , L,� i• ( 6 i - i _ Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
,,,x t . r d APPLICAN `" t -. , Garage/carport area (sq. ft) 4_
Name: k cv ,Y i?-. Covered porch area (sq. ft.)
Mailing address: L ,,y - . a \ J Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industrial/multi- family:
r
ONT
t ifi t V- 1 C .
RACCOR i ', Valuation of work ) $
MEM > ""�`� i+ Ex bldg. area (sq. ft.
SIE TA��' New bldg. area (sq. ft.)
Address: a A `� OW Number of stories
City: State: ZIP:
Phone: I Fax: I E -mail: Type of construction
Occupancy group(s): Existing:
CCB no.:
73'7 New:
City/metro lic no.: .��:rtp3sa,«.� Notice: All contractors and subcontractors are required to be
° 7 7, lt' � �,•. , iiWiDESIGNER " }°`
itc- - -h ,,,,,,, .'„� � ��" licensed with the Oregon Construction Contractors Board under
Name: ( -la i„ kn S(-0 ME11111111111 provisions of ORS 701 and may be required to be licensed in the
Address: A y i ��� j u ri sdiction 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:
r ` E i tt� ,:.ESOWE -E: 4z7 "f :` ...4' 4 1-W aa°a aa'4' rl'Il t, (.t air- r +i: .. r x1 t.'
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: (ZIP: Amount received $
Phone: I Fax: 1E-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 i rovisions of 1 ws and ovlinances governing this ❑ Visa ❑ MasterCard
work will be comph r wt II, whether cified Herein Credit card number: / /
Expires
Authorized si : natu , a ® i j .� :[e: ✓' Name of cardholder as shown on credit card
$ Print name: X " ` 4 2123:. i (.K- 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 (6N0/COM)
One- and Two-Family Dwelling : _ o-
h.
Building Permit Application Checklist Referenc . _ .
Associated permits:
City ofTigard City of Tigard b ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
- ∎' Yr TILE I ITEMS FOR PLANrREVIEWr Yes yNo F N /A,
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. MIR
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control Cl plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
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
if copyright violations exist.
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 _1
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.
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,
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.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of 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.
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.
Pint" ,. � ,�. t, tr - , 4 1s; �t
JURISDICIIONALS k 't t� i -, A
X 13. �.. .
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 (Moo /COM)
Mechanical Permit Application ti 2..s. 4 , v ° . e Y> , (1,� °�; ,^ nr , * d a l
� w R E C E 1 / E D Date received: Permit no.: f k51 , _ 046'
. I'. City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd •Tigard, QR.•97
Phone: (503) 639-4171 MIA I 1 o LUUt{ Date issued: By: Receipt no.:
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: BUILDING DIVISION Building permit no.:
" f '4 l ;• r } F.,yl ,�r•" -. , y V . rc'T [', '*�!i�a`k ' Y ^�r ili wJ; . .- a , ,
������ � � .: ,� -�`., � �� 'TYPE OF PERMITS �[�;�.I � - ::::i„.-
*, . 7% , 1 , ,:' .
... Y , .. 1;
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family ❑ Tenant improvement
,'Jew construction ❑ Addition/alteration/replacement ❑ Other:
y:a� sue. � L`� ��,- ._..�._
;f+�. t ' iteM JOB SITE INFORMATION ; COiNS1ERGIAL VALUATION S:61 DULEM E
Job address: f t.j \ M Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment. labor, overhead,
Tax map /tzx lot/account no.: profit. Value $ •
Lot: I I- Block: 1Subdivision: '1\0( r .tv7) - 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: 1, & 2FAMILIND�YELLING PERMITiFEE3SCHEDi ,
Description and location of work on premises: ,D�s_1�EQUIPr: ® E
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res.only Res. only
Tenant improvement or change of use: HVAC: •
Is existing space heated or conditioned? 0 Yes ❑ No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
' "'"°�'- ; ,•av ° ' :. ac �r..w•FK4T�•� Boiler /com ressors
,. �'" `r i MECF .Vgi a 7671lR01711 '� c,: ,: • P
s.� _ w State boiler permit no.:
� n.Lf1 tLy HP Tons BTU/H
Address: O f Fire/smoke dampers/duct smoke detectors
City:\\ LQ ■ State: " ZIP: 7i , Heat pump (site plan required)
Phone:,... fj - V. Fax: — 1 E - mail: Install/replace furnace/burner BTU /H
Including ductwork /vent liner 0 Yes 0 No
CCB no.: •?),L ••3(1) InstalUreplace/relocateheaters- suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): K 0 • l � - tag" NELL_ Vent for appliance other than furnace
' Z A �,. r ONT C „ - IZtitJ �'�. - Absorption t units BTU/H
Name: is, %. ` ■L Chillers HP
Compressors HP
Address:
,_ iik&..' C (SI- 41 . Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E - mail: Dryer exhaust
” {� ' ' � �' `` # t ��ii O�1 - N E RY fVf , Hoods, Type U lUres. kitchen/hazmat
-+ '0'-M - : � -' 2��y�6Y4•a --'•' ' hood fire suppression system
Exhaust fan with single duct (bath fans)
�!
Mailing address: 1 _ n 7 Exhaust system apart from heating or AC
Ai t`�
/� Fuel pip and d (up to 4 outlets)
.
City: , State • ZIP `2')
Type: ype: LPG NG Oil
Phone: )7 j2 Fax: E Fuel piping each additional over 4 outlets
�� v fl Y E,iiT S " °t i:NGINEI:R `fl+ ? lrt '( Y
'�,1Y[,?_:� +1�kw s..n..r .:4Cr.' �.•' �ar� .....,.�.. ..1?�,oa<�T �1l.nl}?-- r.JZ3���� Process piping (schematic required) ��
Name: Number of outlets
. Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: Woodstove/pellet stove
J Fax: E - mail Other:
4 Applicant's signatu ":oi', je Date: - I1 , Ot her. ^�
Name (print): .,/ ; , .
No all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
Notice: This permit application Minimum fee $
0 r edi c 0 MasterCard
ard number: / expires if a permit is not obtained
Credit c s w ithin 180 days after it has been Plan review (at %) $ •
Expires State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
S
Cardholder signature Amount 440-4617 (6A0/COM)
Plumbing Permit Application 4 d r .k . . {: � it. :_u ..�:ra .� �� - ,
Date received: Permit no. — »( - j �
City of et'i ardf ��'
1 r� y g Sewer permit no.: Building permit no.:
i
t'' Address: 13125 SW Hall Blvd, Tigard, OR 97223 Y 1 8 projecUappt.no.: Expire date:
CiryojTigard Phone: (503) 639-4171 vj 2004
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
CITY OF TIGARD Case file no.: Payment type:
Land use approval: RI ill D!Nr_., r!rr!0!0N
t �i 4 Y AK : ""... h r..TY E O FR RMTT` ,� k c geMat � 4.;; 4
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi family 0 Tenant improvement
New construction 0 Addition/alteration/replacement 0 Food service 0 Other
% '' '`' OBSIIEIPIFaiiStAi O ^ er ° ter Atit solitnfomiati nrisech " ec T.44)
Job Descripdon Qty. Fee(ea.) Total
Bldg. address: t ��� e./ 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: ,` WAN SFR (2) bath
Project name: SFR (3) bath
City /county: I ZIP: Each additional bath kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Drywells / leach line trench dram
Est. date of completion/inspection: �"e ma c. 14 Footing drain (no. lin. ft.)
V ;; . ,, � 4 4 4PLL11113INC z CU i,Id21,;G:fOR d .v al �',n'o Manufactured home utilities fill
Business name: II., ...211P L i Manholes MI-
Address: VRAIIIN • Ram drain connector _
EMIUMv �j ZIP: Sanitary sewer (no. lin. ft.) M
_�1
Phone: Storm sewer (no. lin. ft.)
Fax:
�� E -mail: _ ;hiti Water service (no. lin. ft.) MI
CCB no.: t ('rj L - ( — I Plumb. bus. reg. no:
'V Fixture or item:
City/metro lic. no.: N,A / %/ Absorption valve
Contractor's representative signature i ,_ Back tlow preventer
1M� . i =M LIT I Backwater valve
' � ~ - CUN R 1 , P IlSTN;, ",;, tit = . ` Basins lavatory
au t 3Y.'
Clothes washer
Name: 1 {��- j �_�� ,....1E- Dishwasher
Address: • A ' / / 1c. V — Drinking fountain(s)
City: State: ZIP: Ejectors/sump
Phone: Fax: E -mail "� Expansion tank
�,rr - (( ) ' �liit:..7 Fixture/sewer cap
1ti._ v.. " ,rca - �i`� :! V<.:,+ Floor drains/floor sinks/hub
Name (print): \ . L Garbage disposal •Irt Mailing address: Hose bibb
1 City: _ Env ZIP: "DIi Ice maker
1 Phone: — I , — jor , Fax: i trap
�E -mail: Interceptor /grease
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)
Date Sump ,
Owner's signature: ,; otr „Ac- .: Tubs/shower /shower pan
"` ' `1: I � vasca � .,: "'N P' :s': Uri nal
Name:
Water closet
Address: Water heater _
City: State: ZIP: Other. _
Phone: Fax: E -mail: Total
Minimum fee $
Not all lum.lcuons accept credit cards. please call jurisdiction for more information. Notice: This permit application %
Plan review (at %) S
C visa ❑ MsstcrCard / ! expires if a pe mit is not obtained �,) $
Expires "'lain 130 d after it has been surcharge (8 TOTAL .0 =
C.edit card number 5
accepted as complete.
Name •)( cardholder as shown on credit card
s
440 - 46l6 (6A 3 CO 41 )
Cardholder signature Amount
�leccalperae��tApplicati®a y i s,,�r �. ._ � ' :
Date received: Permit no p// ?Tao/) q - 00/ e =_
`"t }S I .
,,� l �,,, City of Tigard ® Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW 1 1 4
d Tl1pad, OR— 23 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598-1960 .
py 1 b 20011 Case file no.: Payment type:
Land use approval: , „r - r;r = Apra
' �a�, ►�. : � .._._•2Pfi. •.._ _..�a .. - - - te I <
rat l
�' ;,,t`T YPE OF PERMTT� `' '� ' `;: �� .�'�`� ��' ,
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
■' New construction 0 Addition/alteration/replacement 0 Other. 0 Partial
A ` 'I*s' IR-Iti ` JOB STIE INF 0-1 TIOIV 4 �, 'a•„ `� - �Y-,~ etr",,7
t.
sir v%�. y
Job address: Lj0- "k/\f ' i A Lira iTi Bid_. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 1 # Block: Subdivision: ♦ I NUU - •
Project name: I Description and location of work on premises:
Estimated date of completion/inspection: _ _
T M L )N I VC niVW j:P(FIC \ I_ ar\ 4° "` , i i1 . � ``'lt �SCHEDUI E -t ig r '
Job no:�'p� -. Fee Max
c�(J l I Description Qty. (ea) Total no. iacp
Business name: �`�y EL_( 1�- -1C_. New residential - single or multi- family per
Address: ' - Hp _ • r,,,` di(`igt "—AI dwellin unit. Includes attached garage.
=t . �- 1 ,91 ZIP: # NW/ Service included: 4
1000 sq. ft. or less
Phone: ,j l a".: Fax: E a Each additional 500 sq. ft or portion thereof
CCB no.: y Elec. bus. lic. no: - ,� L irrutedenergy,residential ■ 2
C: Limited energy, non - residential 2
1 Each manufactured home or modular dwelling — D ate Service and/or feeder 2
nature of supervising electrician (required) Services or feeders— installation,
l /
Sup elect. name (print): �� 1 tr t+!'Jj License no.
alteration or relocation.
'}'%, �. ay2 i ► > ,�.... ..,tom ,e - a
,' ,,.., ,>,. Z lR( ) I le I Y , (-) SITl _ ,; 200 amps or less 2
` � 201 amps to 400 amps 2
Name (print): 1 �r �����r� 401 amps to 600 amps 2
Mailing address: 1. a% ,)110 S • _7 601 amps to 1000 amps 2
Cit c State '" ZIP: 7C) Over 1000 amps or volts 2
Phone: , ,,/� .
- Fax: - --2 - mail: Reconnect only 1
Temporary services or feeders -
Owner installation: The installation is being made on property I own installation ,alteration,orrelocation:
which is not intended for sale, lease, rent, or exchange according to 200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
221 .,..' , t EN GINEERT l Branch circuits - new alteration,
._ � or extension per panel:
Name: A Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I 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:
^- •I1_ +iRIR1k'1{Ji€'�i`t'. Ai7"Y, - i,
} }- PLWR:giti t are )<i all f jW,., ., _ a Misc. (Service or feeder not included):
O Service over 225 amps-commercial 0 Health -care facility Each pump or irrigation circle
O Service over 320 amps- rating of 1&2 0 Hazardous location
Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, orextension•
2
O Building over three stories 0 Feeders, 400 amps or more • Descri ption:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection 1 1 1 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction fa more information. Notice: This permit application Plan review (at _ %) $
❑ Visa 0 MasterCard expires if a permit is not obtained
/ / within 180 days after it has been State surcharge (8 %) .... $
Coedit card number. Expires $
p accepted as complete. TOTAL
Name of cardholder as shown on credit can
$
Cardholder signature Amount 440 -4615 (6*COM)
06%08,2004 14:57 FAX 5035931960 CITY OF TIGARD IA Z001
CITY OF TIGARD Credit No -: 2003 -00001
Date Issued: 3/28/03
Engineering
r t; , i Authorization
�� J 1 Date: 3/28/03
TRAFFIC IMPACT FEE
CREDIT VOUCHER Land Use
Casefile No.: SUB 2000- 00006
In accordance with Ordinance 379 (Washington County Traffic Impact Fee Ordinance) Don
Morissette ores, Inc.
(name or
d•velope')
is entitled to $ 168:151.00 in raffic Impact Fee Credits that can be applied to TIF charges for
development on lot(s) \ 101 of the Thorn od Supdivisign Development. The use of TIF credits are
subject to the rulers and limitations of the TIF Ordinance which are listed on the back of this
voucher. WARNING: This voucher must be presented at the time of issuance of the building
permit, o ' d- - was granted, iiiiii n a of an Occupancy Pe it
lib- 0 11) IF \L (010 r
Ne-- Ale•cik. L. P Duap4A$
1 Da e Per ± 4/ 0;8 m Lot Numbers Credit Used d Balance
Beginning Balance $ 168.151.00
4- f -As n(12oo3 - oo?1t /S" _ g?3ft.) /45,76/
0-g - ,„s-r .xao3- oejo 2- ya n.. 3 ft) _ /63 VI 4 ,3yo Ilk) 4 141
p :• Ms r.2093 -cam 133 /0 a 3$o IS t 1 590
_a 03 _ rm57 orv,. Oo I(. ,A.3 q1U 15 . 1 B.
51a�1 _ fis1 )--,, -op/ iv .3 .3q, ,a.) /5'3, / tn. coo 36
; 30 10 S. _ o v , ro(91 b ' - f o ? - ? , ) A l i . , Or _ ..
401a3/ � e ms7 —< ;471 -.oar g1 a 3 ?a- /vq a5! - tr ____,4f_______
n,<raora - 43 . e _ - /41 r lvl-
Balance carried forward to TIF Credit No.
,�,,, • Ordinance 379 provides for an expiration 10 years from authorization.
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST ° 3004 1 - 0 6/ 6.a
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received // Date Requested BUP
Location / a JJ `T '• D Suite MEC
Contact Person kaT-aQ-€./ Ph ( ) . PLM
Contractor Ph ( ) SWR
ILD Tenant/Owner ELC
Footing • Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam � - �� e,
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
ifigg
a ' 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
Service
Rough -In
UG/Slab
Low Voltage
Fi = • larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
o'A PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line 9)----a3 ADA � 17 Approach/Sidewalk Dat Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175 MST .00 41 -b0 / 'IS
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 9 -- ° 1 3 AM PM BUP
Location / Y) Suite MEC
Contact Person - Ct�QAi Ph (_ ) 0 i- tg,37 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 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:
PART FAIL
ME ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
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 D �i2 /0 Inspector I I t� Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST SOD —dU/ �
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 7 AM PM BUP
Location 1 � 2 -0 Suite MEC
Contact Person Ph ( ) 4 1137 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Sfab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear a'VLs
Int Sheath/Shear
Framing I i i tr C f RA-I-S L " PAleAce. (.6677/ '1(cZ17CA -
In
D sulation l a �p> /4- -/G } d
Drywall Nailing ✓ n
Firewall 4 r — >
Fire Sprinkler
Fire Alarm 4 i
Susp'd Ceiling
Roof % ' EE 0 A247: C4 L- nom / -L CA0c ' )
Other:
al'
ASS PART F
PLUMBING s 4%' - 04
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
.u
- PART FAIL
ECTRICAL •
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE fl Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 9 — 2 3 - 0 4 - Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
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STREET TREE CERTIFICATION [ .
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I, _ -..1._. al- 4- 4-64re .._,(, / Agent for Doti HP ft/ C.CE 7TE API E 5
(PLE/ist: Plum) (PERMIT MADER)
4 i)o herehy certify Illat the following location
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meets City of 'I'igaid/Washington County
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44 land use and development standards fom street tree. installation.
: . ADDRESS: /1-2_0? 4 oir`ei - tv y i
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r//-■----/----- SUBDivistOri: -Thovivi4/000 . .
. I BY: DATE: q-21-0/
....
4 _ 4 IdiCEIVED BY: 1-1/VIT.:
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