Permit CITY OF T I G A R D MASTER PERMIT
PERMIT #: MST2003 -00117
AN DEVELOPMENT SERVICES DATE ISSUED: 5/14/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13795 SW 124TH AVE PARCEL: 2S103CC -06400
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 011 JURISDICTION: TIG
REMARKS: Const. new SF detached dwelling.
BUILDING
REISSUE: DM182 -2 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,380 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,680 sf GARAGE: 640 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 301,942.00
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,060 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 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: 4 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: 0 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: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/0 SVC/FDR: 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: $ 5,582.19
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
4230 GALEWOOD STREET 4230 GALEWOOD ST, STE 100
Tigard other Municipal Code, State work k w Specialty Codes and
all other applicable laws. All work will be done i
SUITE 100 LAKE OSWEGO, OR 97035 t
accordance with approved plans. This permit will expire if
LAKE OSWEGO, OR 97035
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: 274 - 5223 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #:M-387 3 7 $ 5 3 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 Plumb Top Out Exterior Sheathing Insi Rain drain Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Roof Nailing Mechanical Final
Footing lnsp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
Post/Beam Structural Mechanical Insp Shear Wall lnsp Insulation Insp Appr /Sdwlk lnsp
•
Issued By : ' Permittee Signature : C ...-- 2--.
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
_..4 _, —don 9'
Building Permit Application
Date received. 7 -7 4 Permit no. %, /O -0 /
k a i � City of Tigard
City of Tigard
Address: 13125 SW Hall Blvd, Tigard, OR 97223 Pr °jecdappl. no.: Expire date:
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment y type:
Land use approval: I &2 family: Simple Complex:
T1 PE OF PERIMl'
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family ,&New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement O Fire sprinkler /alarm 0 Other.
JOB SITE INFORIIATION
Job address: gig r opl ai Bldg. no.: Suite no.:
Lot: _ Block: Subdivision: l '"_ AIM Tax map /tax lot/account no.:
Project name: o — 0 y 00
Description and location of work on premises/special conditions:
V ' ' It , ''* '' - - 4111'67*:' , , , . .. IrtVFOlt l' 4'I'ION, USE CIIECHIEIST
O _� n7 (Floodplain, septic capacit, solar. etc.)
Mailing address: i ealricTarMIMILLITOM 1 & 2 family dwelling:
Ea El I Mid '� ZIP: q i""' Valuation of work $
Phone:. r �/ ffIZa, r No. of bedrooms/baths
Owner's representative: , Tare if _ Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.) 1I
APPLICANT a,,= Garage /carport area (sq. ft.) MOO
C ^� Covered porc:1 area (sq. ft.)
Mailing address: a �, Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial lindustriallmulti - family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
Address: .48.4417464t. New o
bldg. area (sq. ft.)
Number of stories
City: State: ZIP: Type of construction
Phone: Fax: E -mail:
CCB no.: IWUNIIIIIIIMMIEMI Occupancy group(s): Existing:
r New:
City/metro lic. no.:
Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
r = provisions of ORS 701 and may be required to be licensed in the
t . W aqt 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:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. • • rovisions of 1 ws and ordinances governing this 0 visa 0 MasterCard
work will be compl - a wi , whether cifierl 1ere ii,g��r t. Credit card number: / /
�I 27
Name of c
Authorized Sl atu � , i A y pppppo e cardholder as shown on credit card
$ Expires
Print name: s_ sj _ t ( 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 (6ro0tCOM)
One- and Two - Family Dwelling
• ,_y, Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City Of Tigard `J g O Electrical ❑ Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 O Other
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
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. F �(
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑ plan ❑ 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 r/
if copyright violations exist. J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner 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 ` ,�
area; building coverage area percentage of coverage; impervious area existing structures on site; and surface drainage. / X `
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. 'X\
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.
JURISDICTIONALSPECIFICS .
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
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 (6/00/coM)
+ Mechanical Permit Application
A. Date received: Permit no.:
l'�l ^ Ci of Ti and �, �'`r__ City g Project/appl.no.: Expire date:
City of Tigard 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 permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family ❑ Tenant improvement
,Iew construction ❑ Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE -
Job address: 1 ? t r) �� Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: ( Suite no.: value of all mechanical materials, equipment, labor, overhead,
rofit. Value Tax map /tax lot/account no.: plue $ •
Lot: I I 'Block: (Subdivision: Lt / 'See checklist for important application information and
Project name: Wt jurisdiction's fee schedule for residential permit fee.
City/county: ( ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
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? ❑ Yes 0 No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name:t ► 4 �,� / HP Tons BTU/H
Address: aN' Fi
�b re/smoke dampers/duct smoke detectors
City: a Li Ear "a ZIP: i1111: 1 A Heat pump (site plan required)
Phone: .b _ 'Fax: E-mail: Install/replacefurnacefburner BTU /H
� Including ductwork/vent liner CI Yes 0 No
`
CCB no.: 7,9'3(" ) Install/replace/relocate heaters suspended,
City/metro lic. no.: N/A wall, or floor mounted
(please print): • , , .
Name lease rint : (�al....._._ Vent for appliance other than furnace
Refrigeration:
CONTACT PERSON
Absorption units BTU/H
Name: # "-- 1`! --k ELL-, Chillers HP
Compressors HP
Address:
4 _ ♦ C 41i . Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E - mail: Dryer exhaust
OWNER Hoods, Type 1/ 11/res. kitchen/hazmat
hood fire suppression system
_T,in T qlaffiR di Exhaust fan with single duct (bath fans)
Mailing address: WiW / 1 Exhaust system apart from heating or AC
.� ���.�11�r �__ Fuel piping and distribution (up to 4 outlets)
��� _ Type: .LPG NG Oil
Phone:. Z 1 it Fax: E - mail: Fuel piping each additional over 4 outlets ■
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: ' State: ( ZIP: Insert - type
Phone: Fax: E -mail: PAS P'' g _ ui � r�� /� J1 i O her: ,
Applicant's si natu " Date:
Name (print): ( L 1 Yr f I ai fir' i 1
T
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
O Visa El MasterCard Notice: This permit application Minimum fee $
Credit card number: expires if a permit is not obtained Plan review (at %) $
expire: within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount 440.4617 (60o/COM)
Plumbing Permit Application
Date received: Permit no.:
,j;� {.'�yi City of Tigard
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Ti phone: (503) 639 171 Project/appl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
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 CI Other.
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
- �
Job address: ✓ V v
t C � ,\ / J �',,, 4'' I Description Qty. Fee (ea.) Total
'
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: 1 I Block: Subdivision: \fA/L,t '' SFR (2) bath
Project name: ,, r SFR (3) bath
City /county: I 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
Footing drain (no. lin. ft.)
PLUiIIIING CONTRACTOR Manufactured home utilities
Business name: N ` p L ' I Ilb Manholes
Address: rairall. i
Rain drain connector
• • Statele ZIP: Sanitary sewer (no. lin. ft.)
City: � w� � Storm sewer (no. lin. ft.)
Phone:( j1 -5L-+ P Fax: E -mail:
swirl. Water service (no. lin. ft.)
CCB no.: [ ()Pr/ Lt [ Plumb. bus. reg. no: - - or Fixture or item:
City/metro lic. no.: N/A ' — Absorption valve
Contractor's representative signature .....;/.....--\ �C � � Back flow preventer
� •
Print name: , 10 'WRAP Backwater valve
CONTACT PERSON Basins/lavatory
Name:
1 f 1 .SPr�DI 1 E Clothes washer
` Dishwasher
. 111a/ Address: '�i / f V , V � Drinking fountain(s)
City: State: ZIP: ' Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap ,
_ Floor drains/floor sinks/hub
Name (print): ` : E'1!''�15E Garbage disposal
Mailing address: - ( PP\T it `T L) Hose bibb
City: L_ _ () .
Stat ZIP:q 7Q- c j Ice maker
Phone: -'52 ,� 1 Fax:g77_7kSE -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)
Owner's signature: Date: Sump
Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: State: ZIP: Other.
Phone: Fax: 1E-mail: Total
Not all junsdictior a accept credit cards, please call jurisdiction for more information. Minimum fee $ ��—
r pt p r Notice: This permit application Plan review (at %) $
❑ Visa 0 MasterCard expires if a permit is not obtained
Credit card number. / w ithin 180 days after it has been State surcharge (8 %) $
Expires TOTAL $ --__-
accepted as co mplete.
Name of cardholder as shown on credit card
S
Cardholder signature Amount 410...1616 (6A0=M)
Electrical Permit Application FOR OFFICE USE ONLY
Y r Received Electrical
Date/By: Permit No.:
City f Tigard Planning Approval Sign
13125 SW Hall Blvd.
y g an Date/By: Permit No.:
Plan R Other
Tigard, Oregon 97223 V Plan Review e : Permit No.:
Phone: 503- 639 -4171 Fax •� 0 Post- Review Land Use
//d er; -4 k Date /By: Case No.:
Internet: www.ci.tigard.or.us ; �3 n . i l
Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 - 63 -4175 ' Name/Method: Supplemental Information.
-� \l OF _.-m ' "`. , �
'�
, „
TYPE OF Wp t'''''' '` PLAN REVIEW (Please check all that apply)
M New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
1 & 2- Family dwelling ❑ Commercial/Industrial 0 System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more IN
Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
VW -.5 The above are not a..licable to tem.orar construction service.
`
Job site address: 137' g L) I A U FEE* SCREDULE
Suite #: 1 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total 1
Cross street/Directions to job site: 2,1 51+ &, 4/41.° C/. New r g unit. n d e or multi - family per
d welling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Lo #: Limited ever 3 , residential 75.00 2
Subdivision: �. Limited energy, non residential 75.00
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK sc and/or feeder 90.90
Services ervie orfeeders - installation,
alteration or relocation:
200 amps or less 80.30
201 amps to 400 amps 106.85
401 amps to 600 amps 160.60
"PROPERTY OWIjER ❑ TENANT 601 amps to 1000 amps 240.60
Over 1000 amps or volts 454.65
Name: Reconnect onl 66.85
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less
F ax: 201 amps to 400 amps 100.30
Phone: 401 to 600 amps 133.75 2
❑ PLIC ` . , ❑ CONTACT PERSON Branch circuits - new alteration, or
Name: M df►S e— k / A j ( • extension per panel: of
Address' 3 i 0-0-9 S f� •I A. Fee for branch f feeder rfee,te each branch circuit 2 in G �4) V service or feeder fee, each branch circuit '
City /State /Zip: LA-((E D5hJ4,5d) ox, B. Fee for branch circuits without purchase of
s service or feeder fee, first branch circuit 46.85
Phone: -3 7 -7 3' I Fax: 3 - K,,,/ 5 Each additional branch circuit am
E-mail: Misc.(Service or feeder not included): El , ,
Each . um . or irri • ation circle
;+IT a,
RAt2; I
E ac h c or out li _ in : II II
Job No: 2.7 � = a i" energy panel,
Business Name: ;1/'. '- � �:�� �. 1 - ; on:
■__.
" ' i s 5'L' additional allowable Each a • L I �l 4 . CO Per ins. -ction . -r hour min. 1 hour IM 62.50 I.
Phone: 5a 3 _ 35 -6,- y1,2 ff Fax: 563— Z5 I , • • ' EMI El
CCB Lic. #: /32222_ • Lic. $3 G
/ G ii
Supervising electricia Subtotal
Sit ature re • uired: . _ � ,i,, Permit
Print Name: i , �. , ,ar.® State Surchar ,te 8% of Permit Fee $
TOTAL PERMIT FEE $
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
• Garage Door Opener
• Heating, Ventilation and Air Conditioning System
ri Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
0 Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
El Fire Alarm Installation
n HVAC
Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
Nurse Calls
ri Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i: \Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
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1 CE TREE TIFICATION R
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• (PLEASE PRINT) (PERMIT HOLDER) ■
•
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• A Do hereby ), ;. o t he following location ■
• ►► ■
A meets City of Tigard /Washington County ■
• land use and development standards for street tree installation. �, ■
• • ■
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• ADDRESS: / 3 7 f 5 S' `, > ' d ie ►
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• /,'41% "�
• • LOT: / / SUBDIVISION: is /eK /'L% �/- ►
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• BY: DATE: 5 '5 ►
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• • RECEIVED BY: DATE: ■
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CITY OF TIGARD 24 -Hour r
BUILDING Inspection Line: (503) 639 -4175 MST 3
— 60 1 L 7
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested g S AM PM BUP
Location / 37 9.c /22 c/ Suite MEC
Contact Person `
Ph ( ) �� 7 i e37 PLM
Contractor Ph (_ ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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 A/ _
UG/Slab
" n
Fi - Alarm
t ia, PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S Please call for reinspection RE: ri Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date d Inspect Eat
Other:
Final DO NOT REMOVE this inspection record om the j site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3-0 d < < l �7
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested o AM PM BUP
Location / 3 7 Suite MEC
�o p
Contact Person Ph ( ) c -C2 � 1 — 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 / 2 7
Fire Sprinkler
Fire Alarm
Susp'd Ceiling fr / r.
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:
- 7 1 PART FAIL
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final I I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE I I Please call for reinspection RE: I I Unable to inspect — no access
Fire Supply Line
ADA "� �'
Approach /Sidewalk Date / Inspector l/ " 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 3 I ( 7
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 7- AM PM BUP
U
Location / 3 7 _` S A=7 Suite MEC
Contact Person Ph ( ) D 9 - /a p 3 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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 �Z h4 / ay` C)Jc
Susp'd Ceiling
Roof
PART FAIL
• BING
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
S•kke Dampers
S•
'ASS 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
Approach/Sidewalk Date �� Inspector ' , Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL