Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00362
v ��Ul DEVELOPMENT SERVICES DATE ISSUED: 8/26/03
.13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12410 SW ASPEN RIDGE DR PARCEL: 2S110BC - 07700
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 048 JURISDICTION: TIG
REMARKS: Construction of new SF detached residence.
BUILDING
REISSUE: DM186 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1,554 sf BASEMENT: 750 sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,921 sf GARAGE: 590 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT: 5
VALUE: 409,358.40
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,475 sf 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:
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: 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: 8 201 - 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: SIGNAUPANEL: 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: $ 6,688.27
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 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 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: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
5p3 forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
LIC
Reg #: 3873 may obtain copies of these rules or direct questions to
1 5 &S 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 Storm drain Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Foundation lnsp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
Post/Beam Structural Mechanical lnsp Shear Wall lnsp Insulation lnsp Appr /Sdwlk Insp
Issued B : ����h _ Permittee Signature` /` /�')C Y , �Jll./
By
Call (503 639 -4175 by 7:00 p.m. for an inspection needed the next business da
, pr., 2- 2 —�
G Pr Z-1 �
�iiilei Permit Application i�� ; .,/ ` - , f
�" I I City of , I V E D Date received: -i' - d 3 Permit no.Egit� _.. pm3 , f
City of Tigard
Address: 13125 SWK Hall Blvd, Tigard, OR 97223 �ojecUappl. no.: Expire date:
Phone: (503) 639 1 ,,. Date issued: Bye Receipt no.:
Fax: (503) 596 OF TIGARD l Case file no.: Payment type:
Land use ARI NG DIVISION / /C 1 &2 family: Simple Complex:
,44„-?-'7,0!;_',34,,---1,,,4.-',.W% x , I - "" o iERM1T rl �t ,w } 4 } ! a , ,� tea
f ,_a' iv rA:,- t , ., ,7 ._, T s 'tt 4, ,i nY t..s a, s n ,'x
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ,'New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
Job address: Ir I () ,� j ' • 0,A ? 0.1 ' `. I Bldg. no.: I Suite no.:
Lot: z_10 Block: IS ubdi ision: ( j vi . 9? I T ax map /tax lot/account no.:
1e -
Project name: ' ;
Description and location of work on premises/special conditions:
', r �J4~�.� x ,� �� t 7 ��?�;�, ���� O�VN It � � -� >�. "'" � $ ' , �rE iSPEE�I I RM #ATiON11SEaC�I3�CK1,1ST���
Name: ,■1'\ pY �ej (Floodplam�septtc capactty,olar, e f t ).
Mailing address: : l ,,t,VC A. Jt if ) 1 & 2 family dwelling: �/ W p
�� ��� ZIP: . 2). 3 Valuation of work $ / 0 / 3.51.
.,
Phone: . T irMialliM,
: sEa , li s l !L-
�►1 . - mail: d rccr_:::;
Owner's renreseel: ative: 1 i l-.7 "-'t! - , -; , _ -� No. c ;:' bu� Total number of floors ;2.
Fax E-mail: , ' New dwelling area (sq. ft.) -4--
,� , .: n � � : ¢ � �4 w xx�t.�m�., i � ; E� fin'
� fir A PLI'GAN W. A Garage /carport area (sq. ft.) G C) - 44
1� A L Covered porch area (sq. ft.) / / 7
Mailing address: -- a CC, _ �; Deck area (sq. ft.) /6 z
City: I State: I ZIP: Other structure area (sq. ft.) ..0.09A /At 75
Phone: Fax: E -mail: Commercial/industriallmulti- family:
,c'At `. COI '` -,, ; _ a -, ., • Valuation of work $
Business name: 01 Existing bldg. area (sq. ft.)
1\ 1'i `., New bldg. area (sq. ft.)
Address: AA, AL .. au
City: State: ZIP: Number of stories
Phone: I Fax: I E -mail: Type of construction
CCB no.: 2) 5 c5 "2-j5 Occupancy group(s): Exis •
City/metro lit io New:
4 , „ Notice: All contractors and subcontractors are required to be
H
x 4 ; ;ARCII'ITET/DCTE$INER F f ' licensed with the Oregon Construction Contractors Board under
Name: (•: . , provisions of ORS 701 and may be required to be licensed in the
Address: , • ). 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:
ENGINEER '
Name: ,. Contact person: Fees due upon application $
Address: •, Date received:
City: (State: IZ1P: • 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 i rovisions of 1 ws and o dinances governing this Cl Visa Cl MasterCard
work will be compli wi b,, whether cified il i ere r �tot. Credit card number: / /
1� j I �_ �j Expires
Authorized si natu • A A ' / A i .. { - ..re: r '" Name of cardholder as shown on credit card
$ Print name: •.>_ . I }_ 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 (6/0O/COM)
C'
One- and Two - Family Dwelling {
Building Permit Application Checklist - Reference no.:
ryofTigard Associated permits:
City
City of Tigard 0 Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, 04 97223 O.Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TILE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. V
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.
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 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 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.
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, `l
fireplace construction, thermal insulation, etc. J�
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.
•
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 ". 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 (6 )0ICOM)
r id.
•
Mechanical Per 17 i . 1 $ , . �� '''-'1.70--7,=-4- .: L
�� Date received: Permit no.:7„ + �
?
illio,
"^ 1'Iiw City and JUL 15
�� ": � of Tigard 2003 Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Ti $i a f `l GARD .
Phone: (503) 639-4171 u Date issued: By: Receipt no.:
Fax: (503) 598 -1960
BUILDING DIVISION Case file no.: Payment type:
Land use approval: Building permit no.:
tyir Y ^ 3 r s ':.', fr. k iti. n} � �1 : , ..1 x l `'�i pit m;; X :,'."' i Z ; '. .t ti�' ' % - ' ?'.'+ i . ;: :. ++
* `''
�. ?'. } ` 7 4 a S 7,:i - .r ; ,, ` , r 4. .., t TYPE O F PERMIT ,.,� s :,, . > ..t,, } � , ,_, ,,4 . . . t
❑ 1 & 2 family dwelling or accessory ❑ CommerciaUindustrial ❑ Multi- family ❑ Tenant improvement
New construction ❑ Addition/alteration/replacement ❑ Other.
'!: `' ° JOB SITE INFORMATION ''° tea• COMMERCIAL VALUATION 'SCHEDULE
. Job address: i 10 50 �� , A! TOM 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: 7' Block: Subdivision: �1 %► *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: ('' FAMILY DWELLING; PERMIT FEE
Description and location of work on premises: AND:COi4IMERICALIINDUSTRIAL EQUIPMFNI'SCHEDULE
- 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 ❑ No Air handling unit CFM
g P Air conditioning (site plan required) _
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system In
h r a MECHANICAL - CONTRACTOR -: 7. , _ Boiler/compressors
brm II■■
State boiler perm it it no.:
r, HP Tons BTU/H
Address: �� Fire/smoke dampers/duct smoke detectors _
�� Z IP: - yam Heat pump (site plan required) ■
Phone: -�
��� _ ' Fax: E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: , InstalUreplace / relocateheaters— suspended, ■--
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): lr i�'� !i �JJV Vent for appliance other than furnace MI '.,,. �• ".'4. (c 1�r -s *+ '� ar, Refr
, , , . 5 h . CO . ,,,-.4,(:,-;,,,,,,,t.,..,,,,,,., t l' , AA r..` I - Absorption units BTU/H
/ / Chillers HP -_—
♦- MI
Address: Compressors HP
A A -- R �t Environmental exhaust and ventilation: ■ --
City: State: ZIP: Appliance vent
Phone: Fax E-mail: Dryer exhaust :
#,' �, � k �:� � kg's #� Hoods, Type U lures. kitchen /hazmat • • ' - '(�?t��,t I 4, W t� i � ^ ' ",, -
hood fire suppression system
V II i � _� Exhaust fan with single duct (bath fans) - __
Mailing address: le �� , �
/ 1`i Faust system apart from heating or AC �
Fuel piping and distribuon ( up to 4 outlets) ■--
�. 13 ZIP w 3_� Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets —
_ ENGINEER. - Process piping (schematicrequired) INI
Number of outlets IIII
Name:
Other listed appliance or equipment:
111
Address: Decorative fireplace
City: State: ZIP: Insert — type NM
Phone: 11121.11111.1111 E -mail: Woodstove/pelletstove -
Other: i
Applicant's signatu ":4 ��' Date: =Q3 Other: MI
. Name (print): ,(:., •' . 11111
Not all jurisdictions accept credit cards, please call jurisdiction for more i nformation. Permit fee $
Notice: This permit application Minimum fee $ .
Cl Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / / Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ .
Name of cardholder as shown on credit card accepted as complete. TOTAL $
S —_—
Cardholder signature • Amount 440 -46i (6100/COM)
Plumbing Permit Application y o 1 + M w �, k ►tr $ s� ;, Y: .
® S���s rt %'� lr�?� t5'�• s Asa �;1`� .a u �.�� vA!}'+,�y� tii`,;.r :.,4?
1 � p.d t i ii. �.' n' y+ '�.. '
�� It V r E D Date received: Permit no. r , j _0D3 , J
L>s'iii Cit of 'I'i g �rd
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd. Tigard, OR 97223 tredate: •
City of Tigard Phone: (503) 639 - 171 JUL 15 2003 Project/appl.no.: P
Fax: (503) 598 -1960 Date issued: By: Receiptno.:
CITY OF TIGARD
Land use approval: RIM DING DIVISION Case file no.: Payment type:
' TYPE OF PERMIT' '... .
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
►- New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other.
JOB SITE INFORMATION FEE' SCHEDULE (for speciai'infurmatibn use checklist) :-.''"
Job address: 1�! Description Qty. Fee(ea.) Total
Zv �� 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 -4-1. I Block: I Subdivision: 1 - I vuelpA SFR (2) bath
Project name: - SFR (3) bath
City /county: j ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Est_ date of completionfinspection: Drywells/leach line/trench drain
• -- Footing drain (no. lin. ft.)
. ' _ PLUMBING 'CONTRACTOR • - Manufactured home utilities
Business name: ,71 L Manholes
Address: -- ) •
• ) 1 ., • Rain drain connector
City: -�\ • State ZIP: Sanitary sewer (no. lin. ft.)
E -mail: Storm sewer (no. lin. ft.)
Phone: _ Far: Water service (no. lin. ft.)
CCB no.: [ Cj�3�"-Z LI -] I Plumb. bus. reg. no: - - - ' Fixture or item:
City/metro lic. no.: N/A `✓ . �/ / Absorption valve
Contractor's representative signature Back flow pre'-enter
Print name: , M • ® Backwater valve
CONTACT` PERSON' - Basins/lavatory
t Clothes washer
Name: ` 1� � ���I N Dishwasher
Address: _ 'ALA' , / / lr.. .V - Drinking fountain(s)
City: I State: ZIP: Ejectors/sump
Phone: [Fax: E -mail: Expansion tank
d' d -s `¢- OwNl k ; :� ; j7 Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): s. , _ "t-^ Garbage disposal
Mailing address: - • • • • - } 1 • Hose bibb •
City: _ O • � OT ASA Ice maker
. Phone: y - ,. I Fax: l ,E-mail: Interceptor /grease trap
Owner installation/residennal 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
ENO INEL'R. - Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: ZIP: Other.
Phone: [Fax: { E -mail: Total l t
Minimum fee $
Na all lunsd coons accept crcd t cards, please call jurisd ct on for more inromudon. Notice: This rmit a lication
Pe PP Plan review (at _ %) $ �—
CVisa ❑ htssterCarti expires if a permit is not obtained
C.edit card number. / / within 180 days after it has been State surcharge (8 %) • $ �—
Expires TOTAL $ -----
accepted as complete.
Name of ;cardholder ss shown oa cmdit card
S
Cardholder signature
Amount 4404616 (6‘03C01,0
4 Electrical ]Permit Application . .: . f- .' :. ' .
P ermit no.: Th51:710 - 06 '
Date received: �,
j; City of Tigard RECEIVED
Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 JUL •-15 2003
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approval: GU ;LDING DIVISION
Cl 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
V. New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
>. , . . -..- , _• 4'71,A-1' ' «p,: .- JOB SITE. INFORMATION ' - - - - • •
Job address: ']/ 0 e ' u M Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: - ' Block: Subdivision: ��p� WM
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
. CONTRACTOR ' ITLICr\ PION _ FEE SCHEDULE '
'I . • -. .
Job no: _ A Fee Max
Business name: •, ` Description Qty. (ea.) Total no. Imp
- ` � / � � New residential - single or multi- family per
Address: AP il _ �` at� dwelling unit. Includes attached garage.
='/ . I:1 ZIP: • a„.. Semceinclutied
Phone: ter. I jJ Fax: E -mail: 1000 sq. ft. or less 4
. . . i
Each additional 500 s ft or portion thereof ___—
: no.:
AIM
bus lic no. Limited ener resi ___ 2
C Limited energy, non- residential ___ 2
Each manufactured home or modular dwelling ■■.
nature of supervising electrician (required) Date 3V Service and/or feeder 2
Sup. elect name (print): 1 � License no � OZ
Services orfeeders — installation, IIII.
....a. &, r a or reloca
s t a y 1' 0... ,;: -nu h s�P, : ROP1RI:YweOW,iN,I Rs t F3�az. ; s -''M . ``t .._. 200 amps or less 2
Name tint { 201 amps to 400 amps ___ 2
(P ) y � ► t... �(��t�r>. 401 amps to 600 amps • ___ 2
Mailing address: D � is �)iO �. ' OM 601 amps to 1000 amps __ 2
City: t - al r img ZIP: d / i Over 1000 amps or volts ___ 2
,
Phone: Reconnect only _ 1
Owner installation: The installation is being made on I own Temporary services or feeders - 11111.1.117 .
which is not intended for sale, lease, rent, or exchange accordin to installation, alteration,
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps _M_ 2
Owner's signature: Date: 401 to 600 amps ME_ 2
�,:�, ;- - _ .s Y:. ENGINEER,_,., -
�srr ° , • .,� •
• 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
State: ZIP: B. Fee for branch circuits without purchase
City: of service or feeder fee, first branch circuit: 2
Phone: Fax: E - mail: Each additional branch circuit: ._
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): IIIIII
i
Each p ump or irrigation circle 2
O Service over 225 amps- commercial 0 Health -care facility Eac
❑ Service over 320 amps - rating of I &2 0 Hazardous location Each sign outline lighting __ 2 _
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ■. ■ 2
❑ System over 600 volts nominal more residential units in one structure alteration, or extension*
Cl Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ 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 O Other. Per inspection __ (_—
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 for more information. Notice: This permit application
0 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
$
Cardholder signature Amount 440 - 4615 (&V0rCOM)
• FOR OF USE ONLY -
Electrical Permit Applicaa�o i Received /� Electrical
,� %
Date/By: ! 4 o / 6 ' Permit No.: l 7 56
•
Cl of Ti and A . Planning Approval Sign
City g OCi I l� [) 9 2 ®1' Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -59S 9603. VI A ,„ : D , , , , . Post Review Land Use
r I ti 1 (+" Date /By: Case No.:
Internet: www.ci.tigard.or.us BUILDING, , �, ei I i Contact J s.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 • ''' Name /Method: l ay Supplemental information.
:f�'�,m t4:,° "�.. �9�� e x �� a WF � a.g��R r k.,� _ as.r __ t, � ,_ .aF.s.e a �, � � t
' to r _. TVa O RAN OItk . ,. 4; . ns..n .-.-: ;F,P REVIEW:(Please'chec that applkgM' ; ` , A
New cons truction El Demolition 0 Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration/replacement III Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
'° ° I & 2 family dwellings four or more residential units in
.�,,�,.,. � ,_ ,. ��,CATEGQRY,�OFCQNSTRTCTIq ;, „, - .
� ;:._ y g
g 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: El Egress/lighting plan ❑ Other:
-- - , ,. art, Submit sets of plans with any of the above.
,;,;,,, �� JOB,, SIT «EINFORMATIQN;and LOCAT ¥I®N _. .., The above are not applicable to temporary construction service.
Job site address: (ZLl f d 5tJ 45ff) Ea /2 ' r . "n 3 '# IFEE=* SCHEDULE . ?. , r . ,.,�.- -, > '
Suite #: _. Bid' . /Apt. #: l Number of inspections per permit allowed
Project Name: 0 frl j `fie /15,..1g3 / e , , Description Qty Fee (ea.) Total
New residential- single or multi - family per
Cross street/Directions to job site: 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
Limited energy, residential 75.00 2
Subdivision: /t rj Ga/Z} Lot #: qr Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
service and/or feeder 90.90 2
:�.„�.` DESCR "t°N ®F : . .�.' - .. _.
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
k El 'TENANT 601 amps to 1000 amps 240.60 2
PROPERTY�OWNER.,. ,. R.:.3:,� , �_ 454.65 2
Name: 1Jl,� Over 1000 amps or volts
�) ,L aY1,.„5� Reconnect only 66.85 2
Address: L i2 3 6 6,/kL 572.? E2'l SU/ -/oe- Temporary eration or services relocati o on: rfeeders - installation,
/� `2
City /State /Zip: 1-A. j,C " 6514)C6 C5a- z3 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps
�, �) ? Q'' ^� 100.30 2
/v !�/ U� / COj� 401 to 600 amps 133.75 2
P ' tli APPLICANT ::-- -D : "- CON, TsACT PERS01',,, ,, Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
., . - Each pump or irrigation circle 53.40 2
�q C TRACTOR
.. ,. � Y - 60 - _-- '' -- a . . Each sign or outline lighting 53.40 2
Job No: Z -2 , , Signal circuit(s) or a limited energy panel,
Business Name: �� � /l C l L L alteration, or extension Page 2 2
Description:
Address: 0 00 5 („if
/� Each additional inspection over the allowable in any of the above:
City /State ip: �i f 6 1 _ 7 7 -7
j Per inspection per hour (min. I hour) 62.50
Phon 57Q " g1,7 Fax573--,g3 - 9 v415 Investigation fee:
Other
CCB Lic. #: 132222 Lie. 31 473 „:
;: „„ ',. a..., .i� -:. ElectricaliPermlt,Fees *Y�..'`� ctz*, ,.. �'M&,`-
Supervising electrician Subtotal $
sit. ature re•uired: op. � . Plan Review (25% of Permit Fee) $
Print Name: „,, �r ___ 1 .�i.� 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
ri Heating, Ventilation and Air Conditioning System
In 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
n Boiler Controls
n Clock Systems
ri Data Telecommunication Installation
n Fire Alarm Installation V
n IWAC ;
El Instrumentation
n Intercom and Paging Systems
[1 Landscape Irrigation Control
n Medical
n Nurse Calls
r i Outdoor Landscape Lighting
El Protective Signaling 1 •
•
F7 Other ,
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:S,Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
1
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 ST 3 - 36 2
INSPECTION DIVISION Business Line: (503) 639 - 4171
13UP
Received ! Date Requested /0?- AM PM BUP
2
Location ' WI / {pi / / ? /L'Suite MEC
Contact Person 0/4?--/e- Ph ( ) oZ99 PLM
Contractor Ph ( ) SWR
BUILDIN Tenant/Owner ELC
0o in ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear /�, ` -
J �
Int Sheath /Shear - ( )k E -U�v U` £
Framing
Insulation
Drywall Nailing
Fi rewall I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
dad
PART FAIL
ING
Post & Beam 4
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
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 El Please call for reinspection RE: i Unable to inspect - no access
Fire Supply Line
ADA / -.7 3 -0 1
Approach /Sidewalk Date LJ Inspector A ® Ext
Other
Final DO NOT REMOVE this inspection recor rom the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: <\ (503 , ) 639 -4175 MST 3 o3 . .
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested / — 2 3 AM PM BUP
Location / a y l b A-4-:* If Suite MEC
Contact Person Ph ( ) O 1 7 — 4 ($ 3 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
'' "- F ting ELC
F undation / Access: , _____
F Drain j ELR
Crawl Drain 1
Slab / Inspection Notes: \ SIT
Pbst & Beam
il 'hear Anchor-
xt Sheath/ : ear
t Sheath/' ear
Fra\ning •
InsLlatio
I ' all ailin_
'ire pri - er 4 �j' T� K ���wt, l: XC'e P v r / c () `
- re A - m
Ceiling
,r
a,
•', SS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other
ma
SS P RT FAIL
NICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
r ir
PART FAIL
ICAL -
Service
Rough -In
UG /Slab
Low Voltage
Fire _farm
'ART FAIL
0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ura-`-•" Li Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA -7
Approach /Sidewalk Date � 7 J Inspector 7 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL