Permit f •
..
, A CITY OF T I G A R D MASTER PERMIT
,f I DEVELOPMENT SERVICES PERMIT #: MST2003-00481
DAT
L E ISSUED: 10/21/03 /21/03
� JI I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639
SITE ADDRESS: 13750 SW 124TH AVE PARCEL: 2S103CC -06700
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 014 JURISDICTION: TIG
REMARKS: Construction of new SF detached residence.
BUILDING
REISSUE: DM181 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,600 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,700 sf GARAGE: 640 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,300 sf VALUE: 323,626.00
REAR: 15
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: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
MECHANICAL OTHER FIXTURES:
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: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O 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: LANDSCAPEJRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,721.38
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
Tigard other r applicable a Code, . All work OR. Specialty Codes and
4230 GALEWOOD ST 4230 GALEWOOD ST, STE 100 all other applicable laws. All work will be done in
STE 100 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
g forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: 9 3
387 7 553 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Structural Mechanical lnsp Shear Wall lnsp Insulation Insp Water Service lnsp
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insl Gyp Board Insp Appr /Sdwlk lnsp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain lnsp Electrical Final
Footing lnsp 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
-c------ 1--e_.„,_
Issued By : _ Permittee Signature :
Call (503 639 -4175 by 7:00 p.m. for an inspection needed the next business day
_ rr' , , -35
T l /0-es-03 ■
Building Permit Application
Datereceived. G x 9- %. 615 Permii no.: , -, � - .
, fi l l Tigard City of Td , �/
�, r:;1 Project/appl. no.: Expire date:
City ojgard Address: 13125 S lv 97223
Phone: (503) 639 - / ' Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type: c
l5'
Land use approval: T/(, 1 &2 family: Simple Complex:
r
TI'PE OF PERMIT -�
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial Cl Multi - family ,'New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
• 0 C • i„e x ..,,,,,;w ,; °" JOB SITE INFORMATION C *
Job address: , 7r7 '
j1) ' e-. Bldg. no.: Suite no.: b
Lot: 1 Lf Block: Subdivision: 6,1- 1lyK;( (_ I Tax map /tax lot/account no.: aS /03C;� - 7a)
Project name: /e4/ S
Description and location of work on premises/special conditions: \
OWNER
FOR SI 1_(1.11, INF01111:1 "f 101, l`SE C11h:CKLIS'I'
ins iyr �� ►.Z� � p �. , ( Floodplain ,septiccapacit■,solar,etc.)
Mailing address: j e '�� � ff � ra 1 & 2 family dwelling:
City: , , Stated ZIP: 1 ] Valuation of work $
Phone:. - Ar Fax( )•- 7 -mail: _ No. of bedrooms/baths 7 ' I le
Owner's re presentative: X ; *4 i 7Grk trl Total number of floors 0-
y
D` ^ (Fax: E-mail: New dwelling area (sq. ft.)
I. + .;,:. y:. �' Garage/carport area (sq. ft.) a/47/ id_ �
OM or /ha / Covered porch area (sq. ft.)
Mailing address: t , -,�J _ e a , ^ Deck area (sq. ft.)
City: [State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi- family:
CONTRACTOR Valuation of work $
Existing bldg. area (sq. ft.)
sue- rl(��L� New bldg. area (sq. ft.)
Address: ,� L,r �� Number of stories
City: State: ZIP:
Type of construction
Phone: I Fax: I E -mail: Occupancy group(s): Existing:
CCB no.: .7) 5 Cj.j" New: _
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: (.i,i, y S -J cc; provisions of ORS 701 and may be required to be licensed in the
Address: c " - ..62.4,-), CL (. 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: IZIP: 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 I ws and o dinances governing this 0 Visa 0 MasterCard
work will be compl • a win , whether cified herei t. Credit card number: / /
J / 1 C Expires
Authorized Si! atu = � � A it�fGd,4 4� e � Name of cardholder as shown on credit card
j
Print name: I IC— "' y I 1 ( r._ $
C ar dh older 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.VO/COM)
One- and Two - Family Dwelling
' Permit Application Checklist Build g Permit Application Chkli Reference no.:
City of Tigard Cl of Tigard Associated permits:
�,1 g ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ 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.
•
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. x
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 , j
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.
// 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, `,
fireplace construction, thermal insulation, etc. h
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." _ K
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.
JURISDICTIONAL SPECIFICS
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 (6ro01COM)
. .
._
A Electrical Permit Application . �
k �h1! e H E G E I V E D Date received: I Permit no . o_411
}t��lll City of Tigard Project/appI.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd,3jg@rd,) 7 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 CCr
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approval: RI IILnING r iVICl0f•.
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
r. New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
JOB SITE INFORMATION •
Job address: 2J 7c 9 7 i�� k e , Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 1 411 Block: Subdivision: VV t.'�i -(
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
` �L Description Qty. (ea.) Total no. rasp
Business name: l�l 1 New or multi-family per
Address: ' ., . • � ` alttt, dwellin unit. Includes attached garage.
ZIP: Service included:
�t , �� • .--..- 1000 sq. ft. or less 4
Phone:2 -1.j - I !.j Fax:
Each additional 500 sq. ft. or portion thereof
CCB no.: y Elec. bus. lip. no: . , Limited energy,residential _ 2
Limited energy, non- residential 2
Each manufactured home or modular dwelling
nature of supervising electrician (required) Dale Service and/or feeder 2
Services or feeders — installation,
Sup. elect. name (print) 1 '�j Licens no
�� alteration or relocation:
PROPERTY OWNER 200ampsorless 2
201 amps to 400 amps 2
Name (print): l lb. rr. SW A 401 amps to 600 amps 2
Mailing address: _ x) 1 F e 1iOitl■ c5 • 601 amps to 1000 amps 2 1 City: L,0 IState 1 ' ZIP: - 2( Over 1000 amps or volts 2
Phone: , AA /7- ,3 Fax: - - 'r -mail: Reconnect only t
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 installation, alteration, or relocation: 2
200 amps or less
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER 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: [ State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: [Fax: Email: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
i
Each pump or irrigation circle 2
❑ Service over 225 amps - commercial 0 Health-care facility E a c — 2
O Service over 320 amps rating of 1 &2 0 Hazardous location Each signor outline lighting
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension` 2
Cl Building over three stories ❑ Feeders, 400 amps or more *Description:
Cl Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan 0 Other. Per inspection I I I I
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 junsdictioa for more information- Notice: This permit application
❑ 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%) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
s
Cardholder signature Amount 4444615 (6400/COM)
Mechanical Permit Application
A Date received: Permit no.: 01)3 o VS,'
�, �•� i!^ • City of Tigard n , ; o' r:1--,,
Projecvappl. no.: Expire date:
Phone: (503) 639 -4171 SEP
City of Tigard Address: 13125 SW Hall Blvd, Tigard, b1 Date issued: By: f Receipt no.: _ •
Fax: (503) 598 -1960 2 •
ZOOS Case file no.: Payment type:
CITY C)F Building permit no.:
Land use approval: BIB , , TIGAfir)
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement •
X 1ew construction ❑ Addition/alteration/replacement ❑ Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE • . Job address: ; 3 `l , `��'" e' Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
profit. Tax map /tax lot/account no.: p Value $ '
Lot: I!� 'Block: I Subdivision: , `See checklist for important application information and
Project name: WM, jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COi4IMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
Fee 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 ❑ No Air conditioning unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
;MECHANICAL CONTRACTOR Boiler /compressors
Business name: State boiler permit no.:
�� MiS _ HP Tons BTU/H
Address: � Fire/smoke dampers/duct smoke detectors
City:Wei Lt r State: :V ZIP: Ilrefill Heatpump(siteplan required)
Phone: Fax: E -mail: InstalUreplacefurnace/burner BTU /H
/� Including ductwork/vent liner ❑ Yes ❑ No
f--
CCB no.: ? „, 0 -� ( ' re) Install/replace/relocate heaters -suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): ' iv t' — Pjjo' NhZL__ Vent for appliance other than furnace
Refrigeration:
CONTACT PERSON
Absorption units BTU/H
EE L e t r- `. ''' -k-10--1--, Chillers HP
Address: Com.ressors HP
rte_ ♦ b t Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
_Cr► �7, ■ Exhaust fan with single duct (bath fans)
Mailing address: / IA Exhaust system apart from heating or AC
� Fuel piping and distribution (up to 4 outlets)
�. ZIP A►� Type: LPG NG Oil _
Phone: . J71 Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: Fax: E -mail: Woodstove/pelletstove
� Other:
. 4 . Applicant's signatu ":,., m� ', mem Date: ' / o d Other.
Name (print): .(,- , , •
T
' Not all jurisdictions accept credit cards, please call jurisdiction for more information.' Permit fee $
Not This permit application Minimum fee $
❑ Visa ❑ MasterCard / expires if a permit is not obtained
Credit card number: E
Expires within 180 days after it has been Plan review (at _ %) $
x •
p State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount , 440.4617 (bOZVCOM)
• Plumbing P lication
Date received:
Permit no.: 2 a /3 i o Q
r; City of Tigard
) Sewer permit no.: Building permit no.:
Address: 13125 SW Hall ;Siva. TigaTd.3113 97223
City of Tigard Project/appl. no.: Expire date:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 CITY OF TIGA ION Date issued: By: Receiptno.:
Land use approval: Case file no.:
B UILDING DIVIS Payment type:
TYPE OF PERMIT
0 I & 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:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: ( c ' l ,, • • / 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: A ' Block: Subdivision: 1, ArrI '�7 SFR (2) bath
Project name: wCLA r SFR (3) bath
City /county: ZIP: Each additional bathAcitchen
_ 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.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: ` 7 L i Manholes
Address: Z • Rain drain connector III �irll�al .va O ► S tate• . Z1P: Sanitary sewer (no. lin. ft.)
E - mail: Storm sewer (no. lin. ft.)
Phone: y :-� • _ Fax: , ' Water service (no lin. ft.)
CCB no.: [ C-? ■--( % I Plumb. bus. reg. no: - - _ Fixture or item:
City/metro lic. no.: N/A � Absorption valve
• Contractor's representative signature .✓i/ .,. ����y,y� Back flow preventer
Za ► i — ' �i�ih Backwater valve
CONTACT PERSON Basins/lavatory NE
— =
1 qP - Clothes washer
Name: � - N E Dishwasher
Address: • A i i f b . :Ni. - Drinking fountain(s)
City: State: Ejectors/sump
Phone: IFax: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): . L� t x-�` Garbage disposal Mailing address: �► M Hose bibb ■ City: L _0 , State . ZIP:( 7C) Ice maker Phone: I - i Fax: •.7-7k E -mail: Interceptor /grease trap
Owner installation/residenrial maintenance only: The actual installation PnmerKs)
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) li
Owner's signature: Date: Sump
MI
ENGIN Tubs/shower /shower pan
Unnal
Name: Water closet
Address: Water heater
City State: I ZIP: Other
Phone: Fax: E -mail: Total
Minimum fee ................ $
Noe all luns3icu accept cept credit cards, please call lunzdicuon for more informauon. Notice: This permit application % �_
Plan review (at )
0 Visa ❑ MasterCard expires if a permit is not obtained State surcharge (8%) .... $
C.ufit card number. Expires w ithin 180 days after it has been $
accepted as complete. TOTAL
Name of cardholder 3.S shown on credit card
S
Cardholder signature Amount 440 - 4616 (6e0 COM)
Electrical Permit Application Received FOR OFFICE USE ONLY
Electrical ,/,
Date/By: Permit No.: VviS72cv3 `t` a
City of Tigard DEC 9 2003 Planning Approval Sign
y g Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGARD Date/By: Permit No.:
Phone: 503- 639 -4171 FaR 1 503L59B I6GION Post- Review Land Use
o'd ,Ai i <'v Date/By: Case No.:
Internet: www.ci.tigard.or.us ■ I
- � Contact Juris.: See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 � " Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
tg New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
E] Addition/alteration/replacement ❑ Other:
commercial Sery Service over ❑ Hazardous
❑ 320 amps- rating of ❑Building Building over o location
ver er 10 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
U 1 & 2- Family dwelling n Commercial/Industrial ❑ System over 600 volts nominal one structure
Accessory Building El Multi- Family ❑ Building over three stories ❑ Feeders, 400 amps or more
❑ 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.
' 3 (0 S t ' , ` Z zf zt A ti
Job site address: W The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: p i ,&,j frld ,Sr$ef'1"'r f />1 Description Qty Fee (ea.) Total
New residential- single or multi - family per j
Cross street/Directions to job site: 12 / Sr," dwelling 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
Subdivision: L,(jjjs7102.5 1...4)4A_ Lot #: / Li Limited energy, non residential se 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 - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
'® PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
� / Over 1000 amps or volts 454.65 2
Name: DOA) Mptl�SSL72 MiC . . Reconnect only 66.85 2
Address: y23,5 &4 0 sr; 5117-E Icy. Temporary services or feeders - installation,
City/ State/Zip: / eV alteration, or relocation:
Y p: 1djk ZS'(. ae,-La C. 1 . 7Q�3S� 200 amps or less 66.85 1
Phone: 58- Fax: 187— - 74 j r- 201 amps to 400 amps 100.30 2
❑ APPLICANT ❑ CONTACT PERSON Branch n 600
ch amps 133.75 2
c
Bran circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: a ?ay Signal circuit(s) or a limited energy panel,
Business Name: alteration, or extension Page 2 2
is ./ - Description:
,
Address: i, B ,4-174,.
Each additional inspection over the allowable in any of the above:
City/State/Zip: A t6 /f4 d uo. 17cie Per inspection per hour (min. 1 hour) 62.50
Phone: 3g Fax: 1.,.9 3 - y,-/t/� Investigation fee:
CCB Lic. #: , 3222 Lic. #: 341- y p c Other:
Electrical Permit Fees*
Supervising electrician l✓ Subtotal $
signature required: /J Plan Review (25% of Permit Fee) $
Print Name: 4 j'6.rJ,u� ic- ✓ ge. State Surcharge (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)
i:\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:
Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
El Heating, Ventilation and Air Conditioning System
n Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
• Boiler Controls
n Clock Systems
n Data Telecommunication Installation
• Fire Alarm Installation
HVAC
❑ Instrumentation
• Intercom and Paging Systems
• Landscape Irrigation Control
O Medical
Nurse Calls
• Outdoor Landscape Lighting
0 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
4
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 44iP
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received ° «1/ D ate Requested fVz�/ AM PM BUP
Location / 3 750 / 2c/ Suite MEC
Contact Person % a Ph ( ) ? — «P3 7 PLM
Contractor )/1/ 11/1//— Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: A , � SIT
Post & Beam !
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall 2 1 yc ,"�
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Susp'd Ceiling
Roof St1
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Water Service �� b
Sanitary Sewer \ l h
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
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'ART FAIL
MEC' ICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In C . l aZ /i/ ) 9
UG/Slab
Low Voltage
Fi = larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S 111 Please call for reinspection RE: • Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date _ ( Inspector / 0 - 1 Ext
Other:
Final DO NOT R OVE this inspection record from the jo ' site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 3 — 660'1
INSPECTION DIVISION • Business Line: (503) 639 - 4171
BUP
Receive / 5 Da a Requested R 3 ("/ AM PM BUP
Location /,' 7 /2c/`‘ J Suite MEC
Contact Person Ph ( - «,3 7 PLM
Contractor Ck Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear ( /U cc_cJ C�r"�( - L t4c -v� t— . -�ffC.
Insulation
Drywall Nailing �2 z572 cr
Firewall = _.
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Fire Sprinkler2 n� � � �� ` �
Fire Alarm
Susp'd Ceiling CLG —c Ga a44, � / :mots rs> ��� - z - 1---
Roof 164
Ot _ :
S PART
MBING
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
oke Dampers
PA
ECTRICAL
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 fl Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Dater — d 4- Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL