Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00216
') DEVELOPMENT SERVICES DATE ISSUED: 7/20/2005
I
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 110 B B -01200
SITE ADDRESS: 12370 SW DUCHILLY CT ZONING: R -1
SUBDIVISION: AMES ORCHARD LOT: 013 JURISDICTION: TIG
Project Description: 196st. addition. Other mechanical is duct work.
BUILDING
REISSUE CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 12 FIRST" 196 sf BASEMENT' sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SFM FLOOR LOAD: 40 SECOND. sf GARAGE: sf FRONT: PARKING SPACES : 2
TYPE OF CONST• 5N DWELLING UNITS' THRD sf RIGHT: 5
VALUE: 18 110 40
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL" 196 sf REAR. 25
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
• LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS.
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS' WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES'
MECHANICAL
FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS. CLOTHES DRYER:
FURN > =100K• UNIT HEATERS: HOODS" OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES. GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp' 0 - 200 amp: W /SVC OR FDR. PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp. 201 - 400 amp: 1st W/O SVC/FDR: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp. 401 - 600 amp: EA ADDL BR CIR: SIGNAL /PANEL• IN PLANT.
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN 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:
This permit Is subject to the regulations contained In the
Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes
KLUNE, JOHN G + LOIS A TRUSTEES OWNER and all other applicable laws. All work will be done in
12370 SW DUCHI LLY CT accordance with approved plans. This permit will expire
TIGARD, OR 97224 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
Phone: 503 639 - 4959 Phone: 503 475 - 3180 adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through
952 -001 -0080 You may obtain copies of these rules or
Reg #: direct questions to OUNC by calling 503 - 246 -6699 or
TOTAL FEES: $ 567.37 1 - 800 - 332 - 2344.
REQUIRED ITEMS AND REPORTS
//
Issued B y:. � c- , ,e-r_. , ,e-r_. Permittee Signature :\< i
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that businlss day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application FOR OFFICE FICE USE ONLY
City of Tigard E C E V E D A Received
Date /By ' ' / % / Permit No a '.J ___ 0,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi
Phone: 503.639.4171 Fax: 503.598.1960 �" +` I '`''�• Date /B Other Permit
QH,r,�;ll'I
Inspection Line: 503.639 4175 JUL 0 2005 4.61, _ Date Ready/By. 5 l3 See Attached Checklist for -- ��
Internet: www.ci.tigard.or.us Notified/Method ' Supplemental Information
CITY OF TIGARD
....,I, ttc.tf\tll
cii rj��,�t.e rw., �d -
T OF WORK REQUIRED DATA: 1- AND 24AMILY'DWELLING ' ' 0
El New construction El Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
work indicated on this application. i
. CATEGORY OF CONSTRUCTION' ' ° , , i
dwelling 1 Valuation: $ Q
pi
y g ❑ Commercial /industrial p ���
1 -and 2-family
❑ Accessory building El Multi-family Number of bedrooms: t ❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND' LOCATION " . Total number of floors:
Job site address i2 3 - s wAt y ic.G y GT. New dwelling area: � G�� square feet
City /State /ZIP: -77 01 .. ( Ld g--7 Z Z , , Garage /carport area: square feet
Suite/bldg /apt no.: Project name: j i,. A/c ,.....-6. Covered porch area: square feet
Cross street /directions to job site: u 1.. .l�u 4G , , .Qo /
^D 4 , Deck area square feet
f►2 0. q w, ) 2, a a/! o r /94. e- 712-1.88.7 /1-x_ 7-i1agr Other structure area square feet
1...-/4 y ?'e' jgo 7-7 o - 0/- /hIGG. L(Ff o.-' Gft/ ae.7 REQUIRED DATA: COMMERCIAL -USE CHECKLIST'
Subdivision. ,4/`'t 63 157h GWA Lot no.: /3 Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the is
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
/Id D / T /.. To Q er, ►2 # Oeit -s
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER ❑ TENANT Number of stories:
Name: "3-0 ,, _ l t u # tr Type of construction:
Address: /y 3 - 7o $w ! eH „` y G, . Occupancy groups'
City /State /ZIP: '77 /h24 x - 2 y Existing:
Phone: (pa 3) 6 3 9 4/3 s — q Fax: ( 03) 6,3 9 el3S' New.
•
® APPLICANT [ CONTACT PERSON NOTICE"
Business name: All contractors and subcontractors are required to be
' licensed with the Oregon Construction Contractors Board
Contact name:
O FAA/ K Nt under ORS 701 and may be required to be licensed in the
Address: , - 3 - 70 S. 1." -- : ,ACt GO 1 1 ` y C - 7 - , jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
/ — G /P'6 9 apply: 2 , 1,... S eft--Az.- /`asp 0* C
Phone: ( Sb,3) 6 3 y3.s'9 Fax. : (5b3) 6 3 9 e,,33.S- 9
E -mail: �✓ /,f L'
CONTRACTOR - / TO ��
Business name: As /1.- Go ✓b BUILDING PERMIT FEES* r ,
Address:
Please refer to fee schedule.
City /State /ZIP. Fees due upon application
Phone: ( ) Fax: ( )
Amount received
CCB lie.:
/ Date received:
Authorized signature: 4/ This permit application expires if a permit is not obtained
///��� within 180 days after it has been accepted as complete.
Print name: �OHr 'et_ u r• -l8.' Date: 7_ 6 --_0_5- * Fee methodology set by Tri -County Building Industry
Service Board.
i \ Building \Pennits\BUP- PermitApp doe 12/03 440-4613T(I I /02/COM/WEB)
One- and Two - Family Dwelling ,
Building Permit Application Checklist FOR OFFICE USE ONLY ,
City of Tigard Received
Associated
13125 SW Hall Blvd., Tigard, OR 97223 Date/By
Associated permits
Phone: 503 639.4171 Fax: 503.598.1960 .0/ .
24- Hour Inspection Line 503.639.4175r I I ❑ Electncal ❑ Plumbing ❑ Mechanical
Internet www ci.tigard.or.us ❑ Other
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW ' • Yes . No N/A
I 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. Name of district: . ❑ ❑ ❑
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 ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑
basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ' ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size • • •
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property 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.
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 " . ❑ .0 ❑
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 Ore•on and shall be shown to be applicable to the .ro•ect under review.
• JURISDICTIONAL SPECIFICS .
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x II" or 11" x 17 ". ❑ ❑ ❑
24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ` ❑ ❑ ❑
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include tree protection sures as required by conditions of approval. ❑ ❑ ❑
30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9, 1995.
1:\Building \Permits \BUP- RES- PermitApp.doc 2
Mechanical Permit Application FOR OFFICE' usr ONI1 r
City of Tigard R L C E I V E L • Date/By. Permit No. 1 .`J • /00
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 b H,,, y :U ;r; Ft� �•, +\, p�
JUL her Permit
inspection Line: 503.639.4175 iL 0 5 20 III'
� L � ,�1�. `:__, Date Ready/By See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
CITY OF TIGARD
T-Y EtOC'itWOk ISIO 1. COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction JYAddition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY` OF CONSTRUCTION Value: $
1 - and 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial/industrial ❑ Accessory building
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. I Ea. I Total
' JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: /2 3 .70 S k/ Air conditioning ho or heat pump
�i.a G Hr /Lt. Y �?-. (regmres site plan showing placement) 14.00
Cit /State /ZIP: .7 / G tt .�-A c,7zzy
Furnace 100,000 BTU (ducts/vents) 14.00
y /
,/ Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name. p y r A C " ,.. 45- Gas heat pump 14.00
Cross street /directions to job site: u i3u LC- dy . Ductwork 1 14.00
Hydronic hot water system 14.00
�4' D r•- 99' 1 . 4 - d l'C I G H- T d #'' ,A'7 7,2 'r; Art . Residential boiler (radiator or
'7 e dr- e,.../A- Tit, ao TT bt.... Bf 1,/Lt i'"O r Unit h ic) 14.00
S' � Unit heaters (fuel -type, not electric),
Q t-� G-/`f !G t✓7 in -wall, in -duct, suspended, etc. 10.00
Flue /vent for any of above 10.00
Subdivision' 4,.,.,,. c 0 Lotno.: i3 Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
s' Gas fireplace 10.00
/K O t/ 6' 2- h - l r 2 & „ / 5.y-, r ' Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
a- PROPERTY OWNER ❑ TENANT Chimney /liner /fluelvent 10.00
Other: 10.00
Name: -. Oi /t. sa ••-'6' Environmental exhaust and ventilation
Address: /� - r Cr Range hood/other kitchen
Z 3 ' 7t 9 SW z2,,,#-„ t. equipment 10.00
City /State /ZIP: A-/s.. d 977Z2-y Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (; 6 3 ■ ( 4 Fax: (y-a3) 6• 5 y 3S.9 toilet compartments, utility rooms) 6.80
. ❑ APPLICANT ' ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: Other: 10.00
��"" Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail. Range
CONTRACTOR Barbecue
Business name: J r. ,g...,,�
Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal /9 -
Minimum permit fee ($72.50) 72 .56
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee) S , gU
/ TOTAL PERMIT FEE
Authorized signature: (/ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: -- A. y Xt ...c ., Date: 7- s _vs, • Fee methodology set by Tn- County Building Industry Service Board
i• \Building\Permits \NEC- PennitApp.doc 12/03 440.4617T (I 1 /02/COM/WEB)
Mechanical Permit Application - City of Tigard •
•
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00. '
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including '
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
• $1.10 for each additional $100.00 or •
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
. - h
i:\Building\Permits\MEC- PermitApp.doc 12/03 2
Electrical Permit Application' EIV E fl FOR OFFICE ON`i Y •' - ■ '"
In ��a Received
City of Tigard /By Permit No . `3' $' - , 4-. 00
13125 SW Hall Blvd., Tigard, OR 97223 � i� 0 �t Review
_ Phone: 503.639.4171 Fax: 503.598.1960 lJ
4 i H % /g Other Permit Inspection Line' 503.639.4175 Date Ready/By runs EI See Page 2 for
TILT. Internet. www.ci.tigard.or.us CITY OF TI. Notified/Method. Supplemental Information
e.it i - nlVl(C)N
- , l l .ie.« — TYPE Or- -W �ORK - PLAN REVIEW • . a .
• ❑ New construction ® Addition/alteration/replacement Please check all that apply.
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft ,
, CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
El 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
I=1 Multi family ❑ Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
. JOB SITE, INFORMATION AND LOCATION ❑Egress/lighnng plan RV park
/� 01-care facility ❑Other.
Job no.: Job site address: /2 37e:7 5L✓ �u /t /GL y c �, Submit 2 sets of plans with any of the above.
City /State /ZIP: 7 q.7-z s The above are not applicable to temporary construction service.
Suite/bldg./apt. --
no.: Project name: - V FEE* SCHEDULE
7 0 !y r XL "4 " Description I Qty. I Fee. I Total I `
Cross street/directions to job site: u,4 g Le.. Ai j2� / 0 0 . 4 / r New residential single- or multi - family dwelling unit.
Jl/ Includes attached garage.
W /2
99 1 . /64/2 �•
p"442- Z. ..7 1 ,., 66-r--9 or- ,jue. /4,4_,.. 1,000 sq. ft or less 145.15 4
Subdivision: ,4 6,3 OZGHR /RAd Lot no.: /3 Ea. add'l 500 sq. ft or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
. DESCRIPTION OF WORK • Each manufactured or modular
�� dwelling, service and/or feeder 90.90 2
O ✓ /r' 6 Z � CPT d- / Sw J /S / W 1? y U(o /}% d Services or feeders installation, alteration, and /or relocation
/ 200 amps or less 80.30 2
Er PROPERTY` OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
- 401 amps to 600 amps 160.60 2
Name: ��N-,. K i e „-,b.- 601 amps to 1,000 amps 240.60 2
Address: 12 .7e, S'K /�k G ,..// G L.. Y Over 1,000 amps or volts 454.65 2
T Reconnect only 66 85 2
City/State /ZIP: / / A.,2 b 972 " 1i/ Temporary services or feeders installation, alteration, and /or
` � relocation
Phone: ( D3l 6 3 9 �s-9 Fax: (5 b3) 6 3 9 e-c359 200 amps or less 66.85 1
Owner installation: This • ■ tall ion ion is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease � o Chang , t to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: 7 -e S Branch circuits - new, alteration, or extension, per panel
•
' ' Ii APP ICANT a CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6 65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, / 46.85 2
Address: each branch circuit
Each add'I branch circuit 6 65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax :: ( ) Sign or outline lighting 53.40 2
E -mail: ,t-�s} Signal circuit(s) or limited-
' ' CONTRACTOR energy panel, alteration, or
extension. Describe Page 2 2
Business name: 541 - 6-
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone. ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: Electrical Lie.: Suprv. Lie.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tn- County Building Industry Service Board
** Number of inspections per permit allowed
i 1Building\Permits\ELC- PermitApp doe 12/03 440-4615T(l 0 /02/COM /WEB
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
,
❑ Other: •
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00 '
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Bwldmg \Pennits TLC-Perm ttApp doc 04/03
CITY OF TIGARD /'J ,S7 7
BUILDING DIVISION PERMIT # CA S -'ooh I o ,
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 / Alt
I�
Inspection Requests (24 Hrs.): (503) 639 -4175 "._..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: G 376 e_-
7 d v CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3-1(0-0 `o Pour Time:
Code # Inspection Description Confirm # Contact # Message
19 ( ?� z ?9 t 639 - 3� 7
� ►s ec'4 _61-1)6 3a - 9`i n
erections /Comments/ Instructions:
�W CIA / _ �- z
ASS P ' . L APPROVAL CANCEL p NO ACCESS
FAIL CAL" L FOR INSPECTION I I ADDITIONAL FEES ASSESSED
/ V ,
Inspect•r: ■_ Date: E �t' - Rhone #: (503) 718 -ZC
illb
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005- 0021$
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2005
Phone: (503) 639 -4171 *011 Inspection Requests (24 Hrs.): (503) 639 -4175 __..,
INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7:13AM PAGE: 21
SITE ADDRESS: 12370 SW DUCHILLY CT CLASS OF WORK:
SUBDIVISION: AMES ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: KLUNE
DESCRIPTION: ft96t t. addition. Other mechanical is duct work.
OWNER: KLUNE, JOHN G + LOS A TRUSTEES, PHONE #: 503 539 - 4959
CONTRACTOR: OWNER PHONE #:
, I , 1 - A 2' l„ifkkre
Inspection Request Scheduled For: Date: 11/21/2005 Pour Time:
Code # Inspection Description Confirm # Cont._ : Message
120\ Electrical rough -in 022094.01 603-309-9989 N
Corrections /Comments /Instructions:
FLa o k t'o ,k) c 6 pt) D-Ai ,r 0 t c)� P u 1 W/4 )0 o lv
GeL-- --- 7--AA-k__,
730 , -- 7 nn,i vi (24..(_-el_., ; 4 .,
IN•anK / _-,ali I / /. ! ii
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PASS I PARTIAL APPROVAL n CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: N4 � Date: _ i.--- /4L Phone #: (503) 718 -
.
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CITY OF TIGARD
BUILDING DIVISION #: IVfST2006 -00216
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/2012005
Phone: (503) 639 -4171 , u�� ig @'il
Inspection Requests (24 Hrs.): (503) 639 -4175 _�� `__..
INSPECTION WORKSHEET FOR DATE: 8/22/2005 TIME: 7:10AM PAGE: 12
SITE ADDRESS: 12370 SW DUCHILLY CT CLASS OF WORK:
SUBDIVISION: AMES ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: KLUNE
DESCRIPTION: 196st addition. Other mechanical is duct work.
OWNER: KLUNE, JOHN G + LOIS A TRUSTEES, PHONE #: 503.639 -4969
CONTRACTOR: OWNER PHONE #: 503 -475 -3180
Inspection Request Scheduled For: Date: 8/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
335 Rain drain 014023 -01 503- 309-9989 N
Corrections /Comments /Instructions:
FASS PARTIAL APPROVAL ❑ CANCEL • ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (TO hAn�.:►N Ix, Date: 31 .,,'w)r) Phone #: (503) 718-
CITY OF
��mn m ��m TIGARD 4„
BUILDING DUNG DUVUSKON PERMIT #: KAST2006'O0216
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7Y202005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: . 12/1eK2008 TIME: 7:01A14d PAGE:
SITE ADDRESS: 12370 SW DUCHILLY CT CLASS OF WORK:
SUBDIVISION: AMES ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: KLUNE
DESCRIPTION: 196st. addition. Other mechanical is duct work.
OWNER: KLUNE. JOHN G+L0|SATRUSTEES. PHONE #: 503-639-4959
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
615 Mecnanical rough-in 025482-01 503'309-9989 Y
Corrections/Comments/Instructions:
^���o
e��� —'<2- 6e»r~
ASS TRARTIAL APPROVAL El CANCEL | I NO ACCESS
|
I FAIL CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
CITY OF TIGARD " ��
BUILDING DIVISION PERMIT #: MST2005 -0021$
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2005
Phone: (503) 639 - 4171 +��4�i�hl�° +I�
Inspection Requests (24 Hrs.): (503) 639 -4175 .. I...
INSPECTION WORKSHEET FOR DATE: 11/29/2005 TIME: 7:05AM PAGE: 31
SITE ADDRESS: 12370 SW DUCHILLY CT , - CLASS OF WORK:
SUBDIVISION: AIMS ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: KLUNE
DESCRIPTION: 196st. addition. Other mechanical is duct work.
OWNER: KLUNE, JOHN G + LOIS A TRUSTEES, PHONE #: 503 - 539.1959
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
280 Insulation 022577 -01 50:- 309 -9989 Y ( 6
t Af. 4 c2.1- _ -•
Corrections /Comments /Instructions:
N/PASS I I PARTIAL APPROVAL ❑ CANCEL F I NO ACCESS
pi FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspec `'� Date: if 127 /0r Phone #: (503) 718- Z7
CITY OF TIGARD t 1 r 7
BUILDING DIVISION PERMIT #: MST200& -00216
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2005
Phone: (503) 639 - 4171 /, , Inspecti on Requests (24 Hrs.): (503) 639 -4175 :_..
INSPECTION WORKSHEET FOR DATE: 11/22/2005 TIME: 7 :02AM PAGE: 26
SITE ADDRESS: 12370 SW DUCHILLY CT CLASS OF WORK:
SUBDIVISION: AMES ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: KLUNE
DESCRIPTION: (196st. addition. ,other mechanical is duct. work.
OWNER: KLUNE, JOHN G + LOIS A TRUSTEES, PHONE #: 503 - 63949559
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message ce A 3o 1440)
275 Framing 02225901 503 - 309 -9989 N RAA A..
Corrections /Comments /Instructions:
p PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector:
/ / Q Date: C l 2� �J Phone #: (503) 718- 2-
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CITY ������U�������� ,, ~
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'
BUILDING DIVISION PERMIT ~°~°"~^~�""~~= ~=^ ~ "~~^~~"° � kAg[2005'00216
13125 SW Hall Blvd., Tlgand, OR 97223 DATE ISSUED: 7y20/3005
Phone: (503) 639-4171
Inspection Reque�a(24Hmj:(583)G3A'4175 .44 ^ �t.
INSPECTION WORKSHEET FOR DATE: 8/31/2005 TIME: 7 03Am PAGE: 7
SITE ADDRESS: 12370 SW DUCHILLY CT CLASS OF WORK:
SUBDIVISION: AMES ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: NLUNE
DESCRIPTION: 196s�. addition. Other mechanical is duct work
OWNER: N[UNE, JOHN G + LOIS A TRUSTEES, PHONE #: 603-639-4969
CONTRACTOR: OWNER PHONE #: 503'475
Inspection Request Scheduled For: Date: 8/31/3006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
235 Shaarxxe||o/anuhcxm 014699-01 603-309-9989 N
Corrections/Comments/Instructions:
'
S I | PARTIAL APPROVAL 0 CANCEL 7 NO ACCESS
FAIL 7 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector: ��/- �' �� Date: g — Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005- 002'16
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2005
Phone: (503) 639 -4171
A q�p,� i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: Ott} &2006 TIME: 7:06AM PAGE: 16
SITE ADDRESS: 12370 SW DUCHILLY CT CLASS OF WORK:
SUBDIVISION: AMES ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: KLUNE
DESCRIPTION: 196st. addition. Other mechanical is duct work.
OWNER: KLUNE, JOHN 0 + LOIS A TRUSTEES, PHONE #: 603 - 639-4969
CONTRACTOR: OWNER PHONE #: 503- 475.3180
Inspection Request Scheduled For: Date: 8/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
226 Post/beam structural 014393.01 603 - 309 -9989 N
Corrections/Comments/Instructions:
•
K PASS IA PARTIAL APPROVAL n CANCEL F I NO ACCESS
FAIL I/ FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: ALAMEES& Date: 6 2c05 #: (503) 718 -
1
CITY OF TIGARD A
BUILDING DIVISION PERMIT #: MST2005-00216
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2005
Phone: (503) 639-4171 _ 1 ,4 "111°4 / 1 111 1 1lit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8/36/2006 TIME: 7:06AM PAGE: 16
a. MT; 144z_arree56
SITE ADDRESS: 12370 SW DUCHILLY CT CLASS OF WORK:
SUBDIVISION: AMES ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: KLUNE
DESCRIPTION: 196st. addition. Other mechanical is duct work.
OWNER: KLUNE, JOHN G + LOIS A TRUSTEES, PHONE #: 503-639-4969
CONTRACTOR: OWNER PHONE #: 503-475-3180
Inspection Request Scheduled For: Date: 8/26/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
230 Underfloor insulation 014393-02 603-309-9989 Y pm
Corrections/Comments/Instructions:
/407 R-INw — 0 0 t-/A,/-
cs 0 , R — V4 L u c5 4-2. 0
6 -/Nc..-?",K (- 1\t SuL.
I I PASS 11 PARTIAL APPROVAL D CANCEL 0 NO ACCESS
FAIL RI ' ALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
o c,- -
Inspector: .■4111111ril Date: 8 Phone #: (503) 718
WI Ilr
CITY OF TIGARD , -
BUILDING DIVISION M PERMIT #: MjST200& 00 1 i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2005
Phone: (503) 639 -4171 i, „,,, I1\
Inspection Requests (24 Hrs.): (503) 639 -4175 '''..1.
INSPECTION WORKSHEET FOR DATE: 8/18/2006 TIME: 7:06AM PAGE: 47
SITE ADDRESS: 12370 SW DUCHILLY CT CLASS OF WORK:
1 SUBDIVISION: AMES ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: KLUNE
DESCRIPTION: 196st. addition. Other mechanical is duct work.
OWNER: KLUNE, JOHN G + LOIS A TRUSTEES, PHONE #: 503- 639.4959
CONTRACTOR: OWNER PHONE #: 6603- 475.3180
Inspection Request Scheduled For: Date: 8/1812006 Pour Time: 10:00
1 Code # Inspection Description Confirm # Contact # Message
205 Footing 013823 -01 603- 309.9989 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I Date: hone #: (503) 718-
•
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: MST2006 -00215
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/18/2005 TIME: 7:06AM PAGE: 46
SITE ADDRESS: 12370 SW DUCHILLY DT CLASS OF WORK:
SUBDIVISION: AMES ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: KLUNE
DESCRIPTION: 196st. addition. Other mechanical is duct work.
OWNER: KLUNE, JOHN G + LOIS A TRUSTEES, PHONE #: 503- 639 -4959
CONTRACTOR: OWNER PHONE #: 503- 475 --3180
Inspection Request Scheduled For: Date: 8/18/2006 Pour Time: 10 :00
Code # Inspection Description Confirm # Contact # Message
210 Foundation walls 013823 -02 503-309-9989
Y V
Corrections /Comments /Instructions: •
ASS ❑ PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
CITY OF TIGARD - .
BUILDING DIVISION r PERMIT #: MST0050016
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/20/2005
Phone: (503) 639 -4171 ''"j•
Inspection Requests (24 Hrs.): (503) 639 -4175 h- L
INSPECTION WORKSHEET FOR DATE: 8/17/2005 TIME: 7 :05AM PAGE: 92
SITE ADDRESS: 12370 SW DUCHILLY CT CLASS OF WORK:
SUBDIVISION: AMES ORCHARD LOT #: 013 TYPE OF USE:
PROJECT NAME: KLUNE
DESCRIPTION: 195. addition. Other mechanical is duct work,
OWNER: KLUNE, JOHN G + LOIS A TRUSTEES, PHONE #: 503 -639 -4959
CONTRACTOR: OWNER PHONE #: 503 - 475 -3180
•
Inspection Request Scheduled For: Date: 8/1 7/2005 Pour Time: 11:00
Code # Inspection Description Confirm # Contact # Message
205 Footing 013665-01 503 - 309.9989 N
Corrections /Comments /Instructions:
,,1921 — c
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ CALL FOR INSPECTION I .1 ADDITIONAL FEES ASSESSED
Inspector: - Date: / 7 Phone #: (503) 718-