Permit / CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 00408
141 DEVELOPMENT SERVICES DATE ISSUED: 9/26/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12432 SW ASPEN RIDGE DR PARCEL: 2S110BC -07900
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 050 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: DM185 STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 32 FIRST: 1,440 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,450 sf GARAGE: 592 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 290,252.80 OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 2,890 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 FD R: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 5 201 - 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: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,708.25
DON MORISSETTE HOMES INC DON MORISSETTE HOMES INC This permit c l Code, to the regulations contained C o i the
Tigard other r applicable Municipal Code, State work k w Specialty Codes and
4230 GALEWOOD ST #100 4230 GALEWOOD ST, STE 100 all other applicable law All work will be done i
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 t
accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: fig- 387 may obtain copies of these rules or direct questions to
1 OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Mechanical Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing lnsr Rain drain Insp Electrical Final
Footing lnsp Crawl Drain /Backwater Electrical Service Low Voltage Storm drain Insp Mechanical Final
Foundation Insp ' Footing /Foundation Dry Electrical Rough In Gas Line Insp Water Line lnsp Plumb Final
Post/Beam Structural PLM /Underfloor Framing Insp Gas Fireplace Water Service lnsp Building Final
Issued By : fa -' _ 1 Z- Permittee Signature : C-'�,
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
- 0 T— F -7- T v rPT. y,6 °
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® ® ® ® � tl ,, _ ,r it -. (/ 'l It PRY U if th \.,A-. ".�.1• . ,e .�,r NC ,��.,1.:f ip? rr '
/ 1 U L � LUJ I� U @% LL V Date received: ' / ('7 Permit no.: Xy �
,,A 1! " ,, City of `Tigard s, ; ,�
Address: 13125 SW Hall Blvd Tigard,) 97223 Project/appl. no.: Expire date: ,°
`OR ' ;
City of Tigard hut, v -- Loth)
Phone: (503) 639 -4171 D'e issued: By: Receipt no.:
Fax: (503) 598 -1960 CITY OF TIGARD Cas file no.: Payment type:
BUILDING DIVISI 1
Land use approval: / 4 y: Simple Complex: i/
4 . '.1 0 f
„ 1.ua + s: " ' ;', P - .c!ti4. �� F-w^ 'i, j
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�s���tu r.. -, �- x:- a ..�..ar,. ,..,.- `+E�`� � ..• fi t� ° _ ,; a� �h`r. ,.�,rr' ,,.aat i .,
CI 1 & 2 family dwelling or accessory ❑ Commercial/indus�❑ Multi - family ,"New construction ❑ Demolition
❑ Addition /alteration/replacement ❑Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
I "S:i`3n � " x'Y - . r v.1T • '` ; .T —M.7 ` •5r ti 1 IY 1 ( a -..
- . ' � '
�� -r, • �JOB�SITE INFORl1'IATION ..� ry - • =.� ,:_� . ,; .
Job address: �' �, �� �SIT Bldg. no.: Suite no.:
' Lot: 4 r Block: Subdivisio : IMilp Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
H , ; ,VD3I. g 4i 4 O1V f NER; � , : i o, � ;; f ; , FOR SP,ECIA164 INFORilr1AT tYs iISEfE1lECK_L '
�� Mil, t! J fi F !.4 1 : G A ir, r s :' � f'� 4 n a" t,f.e'.i .�5Ic tt - ,. , y ,.,
, a a,xst"a septic capacity solar, etc) t , t
Mailing address: y y�.� ���!�"�T
�si��i� G w.► =����i�lin 1 & 2 family dwelling:
Etliffilla EMA ZIP: ' 7) - �""' Valuation of work $ .9*) 25-2,C.1)
Phone:. elf/j/21�"'r� No. of bedrooms/baths 02
Owner's representative: , ,M`�l Er [ Total number of floors 3
Phone: Fax: E-mail: New dwelling area (sq. ft.) ,2 a
., . APPLICANT 4 } ," Garage/carport area (sq. ft) r
Name: i, C)� Y1? A _ ?. s Covered porch area (sq. ft.) 9 Z
Mailing address: r 1 J a , Deck area (sq. ft.) L/ ./0
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commerciallindustriallmulti- family:
• a g - - _ CONTRACTOR Valuation of work $
r �ti'1 ,, �� • t} Existing bldg. area (sq. ft.)
Business name
�� New bldg. area (sq. ft.)
Address: C -� ,' i C.cJ
Number of stories
City: I State: I ZIP: Type of construction
Phone: I Fax: I E -mail:
CCB no.: .3 5 cj Occupancy group(s): sting:
w:
City/metro iic no.: Notice: All contractors and subcontractors are required to be
" ` -, ., . .ARCHITECT /DESIGN ER'
' - - ;•. , '1,-1 • _ licensed with the Oregon Construction Contractors Board under
Name: -i(( (A U..0 provisions of ORS 701 and may be required to be licensed in the
Address: 0-tip C(Fi C "Y°N4 jurisdiction where work is being performed. If the applicant is
City: State: I 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: VIP: 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. • provisions of I ws and ,, , whether cio dinan ces governing this O Visa 0 MasterCard
work will be comp li wt fiecl i1erei t.
j /6 l � Credit card number: / /
x� Expires
Authorized Sl � atU �_ - 1' � I / ` A Oafk'jkL-' 111 IJ Name of cardholder as shown on credit card $ Print name: .11�m � � Cardholder signature Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-1613 (6 )O/COM)
One- and Two- Familly Dwelling
' ' a g Building Permit Application Checklist
Reference no.:
Associated permits: •
City of Tigard CI of Tigard
`J ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
.
i42;, ;r ;,,' THE FOLLO%VING ITEMS ARE REQUIR "FOR PLAN Yes °- No { /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. •
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. k
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 t/
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 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. ! 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.
. 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 t6ro0icoMl
• • • e �; tv.m mil• *�"�, , A- , 'rx -- , ti :. y4tgf 4 . ,"". v ,`;>.
- Mechanical Permit Application : :t r .. - ,,ti -A , i r � :4 fi
, yT�jo -a0 YU d
r Date received: Permit no.:1
..
�r ,1 P' C� V E J Projec
i •� l City of Tigard dappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard;_OR,97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 AUG 0 _ 2003 Case file no.: Payment type: .
Land use approval: a^ITV OC TIC. ,dG2f1 Building permit no.:
+. 0 ` `.. ,"". ` r x. r J TYPE OF PERMIT 1 0*'i _
0 1 & 2 family dwelling or accessory 0 Commercial/industrial O Multi - family 0 Tenant improvement •
X Iew construction 0 Addition/alteration/replacement 0 Other.
. ; „.- x + JOB -SITE INFORMATION .•: ,,, : ^',- .. °� n';COMMERCIAL VALUATION SCHEDULE ''• ':
. Job address: } _ s 7'5 i t. 1 �'�, ��1i i Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite n..: l value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit- Value $ .
Lot: Block: Subdivision: ► ,f�' a . `See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: h & 2'FAMILY DWELLING "P,ERMIT TEE :SCHEDULE . 'x
Description and location of work on premises: AND CONIlVIERICr1UINDUSTRIAL 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? 0 Yes 0 No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? Cl Yes 0 No Alteration of existing HVAC system
.. ' MECHANICAL .'CON TRACTOR. Boiler /compressors
• Business name:��}� State boiler permit no.:
EI.� HP Tons BTU/H
Address: ���� Fire/smoke dampers/duct smoke detectors _
i� ZI
l s RW I 1 Heat pump (site plan required) -�
InstalUreplace furnace/burner BTU /H ■
Phone: �. - ' Fax: E -mail: Including ductwork/vent liner 0 Yes 0 No
CCB no.: , — InstalUreplace relocateheaters— suspended, ■--
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): �►O''j G � � Vent for appliance other than furnace
CONTACT PERSON Refrigeration: 111■■
Absorption units BTU/H
Name: # ' r17 C�`t -1 Chillers HP
Address: Compressors HP
4_ i G ♦ C9 . Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E - mail: Dryer exhaust
Hoods, Type U lures. kitchen/hazmat
' hood fire suppression system
_..in i�R �� Exhaust fan with single duct (bath fans) --_
Mailing address: • 1 `l Exhaust system apart from heating or AC N
���
� ���� �� Fuel piping and distribution (up to 4 outlets) ■ --
Type: LPG NG Oil
Phone: . I� Fax: E - mail: Fuel piping each additional over 4 outlets _
. ENGINEER Process piping (schematic required) - IMMI
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert — type
Woodstove/pellet stove
Phone: Fax: E-mail: / Other NM
.- Applicant's signatu - d ( Date: - 7) 5 (03 Other. 1
Name (print): : • ,
Not all jurisdictions accept credit cards, please call jurisdiction for ore information. Permit fee $
more
Notice: This permit application
0 Visa 0 MasterCard Minimum fee $ I / expires if a permit is not obtained Plan review (a[ _ %) $
Credit card number Expires within 180 days after it has been •
accepted as complete.
State surcharge (8 %) .... $
a cce
Name of cardholder as shown on credit card p p
S TOTAL $
Cardholder signature Amount 440 -4617 (6/tXYCOM)
jy
H it - L t v c u Date received: Perm 5
°'t,cr�y
�; City of Tigard
H Il Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard,,OR •97223
City of Tiga Ah - 0 U LUu Project/appl.no.: Expire date:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 GnTY OF TIGARD Date issued: By: Receiptno.:
Land use approval: BUILDING DIVISION Case tile no.: Payment type:
. _ .TYPE'OF PERMIT _ :
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.
- • : JOB S1TE INFORMATIOPN . - FEE SCHEDULE. (for special information use checklist)
Job address: �rJ� fjo) ' �A, Description Qty. Fee(ea.) Total
a. New 1- and 2- family dwellings only:
Bldg. no.: Sui no.: • (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: �" �� SFR (1) bath
Lot: tFJ1
/ Block: Subdivision: r el SFR (2) bath
Project name: SFR (3) bath
City /county: ZIP: Each additional bathilcitchen
_ 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.)
- .' I'LUMDING •,CONTR c oR, ., _ .-, •_ .. Manufactured home utilities
Business name: p..., `. , L r Manholes
Address: i�b��� i Rain drain connector
�j� ZIP: Sanitary sewer (no. lin. ft.)
City: � � v� �� ao p Phone: ,--1- � E -mail: Storm sewer (no. bin. ft.)
_� Fax: 7 Water service (no. lin. ft.)
CCB no.: [ •.�j L V Plumb. bus. reg. no: - ' J �
Fixture or item:
City/metro lic. no.: N/A �/ �' — Absorption valve
Contractor's representative signature wL/ — Back flow preventer
Print name:
• ' • ► / MilIld J( D Backwater valve
CONTACT PERSON . . Basins/lavatory
Clothes washer
Name:�1� ����I CIE Dishwasher
Address: i . • , V D riiikine fountains)
City: I State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
;V - „OTC \I R '' Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): Alt t x � ” Garbage dispos
Mailing address: .. 1 • Hose bibb •
City: C) State ZIP :C7 7O- e E, Ice maker _ •
. Phone: 1 . - I Fax: 4 .7-70 . E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) .
Owner's signature: Date: Sump
ENGINEER Tubs/shower/shower pan
Urinal
Name: ' Water closet
Address: Water heater
City I State: j ZIP: Other. -
Phone: [ Fax: E -mail: Total
Minimum fee $
N otice: This permit application
Noe all jurisdictions � us
cepe credit cards, please cell jurisdiction f« more m
me tnfoution s permt appion g
�—
G'vsa MasterCard expires if a permit is not obtained Plan review (at %) State surcharge (8 %) •••• $
C.edit card number Expires w ithin 130 days after it has been $ _ -
accepted as complete. TOTAL
Name of cart holder as shown on credit card
Cardholder stgnaturc S Amount / 440 -1616 (M»COM)
Electrical Perm ,• Fra Received FOR OFFICE USE ONLY . ,
Electrical
Date/By: Permit No.:MD/ 3 -0z2
City !; of Tigard DEC 0 2 2003 Planning Approval Sign
Date/By: Sign
No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF T1GAR P Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: '= t- lL- A:Mq6PIVIS • Post- Review Land Use
i/tit Date/By: Case No.:
Internet: www.ci.tigard.or.us - y —
g el I I ,: l` . J ur i s.: ® S ee P age 2 f or
24 -hour Inspection Request: 503- 639 -4175 Name /Method: I I , Su lemental Information.
d efn . de Atle ;. -k;,
„a . fr�p < . `.; +ax. =E I- MAO :. ; s`s ° . � .; zs 1,�- ..E '.�z .4' s ad ; .0 > `': n.�. s - 3,v. ,€ ? '�„'.g
_'�� ��:�_ ' :�.�„�;;:'.: TYPE „ (OF�WaO. % � «,£.���'x��;...F:c�r: �.� .��.., _ ` ��`..'”, �v,.. �e�,..P,,LAN�ItE�',IEWI.(Plea ceck� tliat,appl3')n� =` ��r.sl�'.
1 • Health -care facility
New construction Orher:Isa; o o: = li;_ z . commercia ❑ Hazardous location
Addition/alteration/replacement ❑ ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
f n'I AWA`" ACA'TEGORY =OF,,CONSsTRUCTION,_ ,1"1101( I & 2 family dwellings four or more residential units in
1 & 2- Family dwelling ❑ Commercial/Industrial 0 System over 600 volts nominal one structure
lal
❑ Building over three stories ❑ Feeders, 400 amps or more IN
Accessory Building III Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
El Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
f- JOB. SI-TEfINFORiVIA TION and =LOCATION , 01;436'4 Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
" ac s1t addres ' 't_13'� 414. A S P X71/ , `�` ` u x ` w4 t ; LFEE *SCHEDULE § - '� i , " ' ` :
� - �1 e v rd _ :, i . '; ' Vie" tE E �' _,.. 4, g o-, ' " -
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Only Ai U/7 .5,5 Description Qty Fee (ea.) Total
New residential- single or multi- family per j
Cross street/Directions to job site: c�F �](3VULL M Cil1•'i71I/J dwelling unit. Includes attached garage.
K L{ 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: VA / Gr1®6O Lot #: 5D Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
-- service and/or feeder 90.90 2
a� � ` � 'Ns�:�= =�DESCRIP,�TTQNiQFWORI{� _.� .°: � � - •
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
1 in JW " s 601 amps to 1000 amps �;: KTENA l�IT • ,l ` , ; , . s 240.60 2 p p
Over 1000 amps or volts 454.65 _ 2
Name: 19 o 11 o ._”erirE" Ham C3 IN?. _ Reconnect only 66.85 2
Address: '4230 &A LEwv 19 SIR, Su i Tr706 Temporary services or feeders - installation,
_alteration, or relocation:
City /State /Zip: L 65 ic.) &s 012- c r�ea c 200 amps or less 66.85 1
• Phone: 3 57 — 79"35 I Fax 3 g 7 -76•/s— 201 a ps amps amps 100.30 2
" .1 ON
CTACT PERSONS, 'z_ '
'� � �APPLICAIVT "`�`�`` `� �
� +4� �� -» ��_�� �^t - Branch circuits - new, alteration, or
Nalrie: 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: Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
a t ,, _ _ - . ° I M CTOR M _ _ - _ . _ Each pump or irrigation circle 53.40 2
„, ,_ �, „ _ � CONRA Each sign or outline lighting 53.40 2
Job No: 2 q 2-7 Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2 • Business Name: '' t,A IbGI / E
Address: P p, 60 j, i f
Each additional inspection over the allowable in any of the above:
City /State /Zip: A-L)Ij7r 0 q . ?76o Per inspection per hour (min. 1 hour) 62.50
Phone: 5 p —3 8/82 Fax: 3 3 - s 9. .y
3 —. ii, fee:
CCB Lic. #: 2222 Lic. #: Other ;- `, Electrica t*rtiif,Feis ,2
_ .
Supervising electrician 3q- k/8'3 . Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: i - Aeir of i71 7 5 State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized No tice: 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 A
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
n Heating, Ventilation and Air Conditioning System
I I Vacuum Systems •
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
•
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
n Clock Systems
F - 7 Data Telecommunication Installation
Fire Alarm Installation
n HVAC
n Instrumentation
ri Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
n Nurse Calls
LI Outdoor Landscape Lighting
n Protective Signaling
ri 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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-41 STREET TREE CERTIFICATION
41 1
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_ C as --/- r _ _Si ry..t v 2— /Agent [OF _____ ' .or■ . krno l' . • e llovri e 5
(PLEA sr ',Rim) (ITIMIIT HOLDER)
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l)o hereby certify (hat the following loiation Ot'-
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meets (.2j1 y of 'lipArd/Washington Comity
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71 land use 11K1 development standards for street tree. instalktion.
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ADDRESS: /? LI 3d._ 5 (--ti . As tper‘ a ‘ `A__5-e p r --
LOT:
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56 _ _ _ SMIAVilosl:
• I BY:. I, ••,...-.■ ''''. DATIii: _ 6-4/, 0,/ •
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Pr—*NIT-fiWTTTYTYYTY1/1"firlf"finrYTTY1FITTYY*VTITTYYTTYVYTYYTYYTTYYTIfrfl •
CITY OF TIGARD - 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST d — O d vo�J d
INSPECTION DIVISION Business Line: (503) 639 -4171
// BUP
Received Date equested C � -/ 7 AM PM BUP
Location / a 7 , 3 �. ,/1.� �C� _ Suite — MEC
Contact Person . Ph ( ) ' 9' 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:
—
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
AM. LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125. SW Hall Blvd.
1 PART FAIL
SITE LI Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA 1` -1 ` ^` o 2
Approach/Sidewalk Date — a Inspector 1 v lJ�
Other:
Final DO NOT REMOVE this inspection record rom the job site.
PASS PART FAIL
CITY OF TIGAR°D 24 -Hour (�� p
BUILDING Inspection Line: (503) 639 -4175 MST 63 �vo )
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
`
Received Date R ! 7 AM P BUP
Location / a r L j o4.-1 Suite `- MEC
7
Contact Person 'e2 - Phh c2r)f — 1(g 3 PLM
l
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 9 ,� -
Drywall Nailing G� Ati/
Fi rewal I ! & l x ( ,,/ P p d1.�
Fire Sprinkler `�'' -
Fire Alarm e(J v 9�„S � �v
Susp'd Ceiling .6 1 _ 41A-11 / 7 �Y�`
Roof
Other:
Ina
ZWIP PA FAIL
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
Smoke Dampers
• : T- 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 4 l 7 - , J� Ins ector Ext
Approach /Sidewalk Date � p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL