Permit I. H R'
CITY of: TIGARD MASTER PERMIT
PERMIT #: MST2006 -10001
° DEVELOPMENT H PMENg Tigard, -639 -4171 DATE ISSUED: 3/1/2006
PARCEL: 2S114BB-19200
SITE ADDRESS: 10252 SW ELISE CT ZONING: R -
SUBDIVISION: RIVERVIEW ESTATES LOT: 038 JURISDICTION: TIG
Project Description: Bonus room above garage.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT:
VALUE:
OCCUPANCY GRP: BDRM: BATH: TOTAL: 0 sf 17,000.00 REAR:
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: BOILJCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
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 FOR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: I SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1 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 Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other
JONATHAN BALLIN OWNER applicable laws. All work will be done in accordance with approved
10252 SW ELISE CT plans. This permit will expire if work is not started within 180 days
TIGARD, OR 97224 of issuance, or if the work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules 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
Phone: 503 307 - 1435 Contact #: of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1 -800- 332 -2344.
Reg #:
TOTAL FEES: $ 493.33
REQUIRED ITEMS AND REPORTS
Issued By : s , 163 4 f,4 : Permittee Signature : Si -€
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business 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.
t'
' Building Permit A 1 a i a ' °�> i FOR OFFIC USI' ONLI'
City of Tigard � Due�B > - Permit No.. OU , — I
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review - -
eview -
Phone: 503.639.4171 Fax: 503.598.196O,p AR 1 2006 Gm "� jlii I '� ' Date/B '' - -/ 4 Other Permit:
Inspection Line: 503.639.4175 11••11 ! � Date Ready/By: ® See Attached Checklist for
Internet: www.ci.tigard.or.us r� AV y ,1.; Notified/Method: Supplemental Information
Bj IM REQUIRED DATA: 1 -AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
K Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
. CATEGORY OF CONSTRUCTION work indicated on this application.
51 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ )
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 0 2,5- L 5- ' r' c:: (,': f� New dwelling area: square feet
C ity /Sta /ZIP: j t ` � .,�- a 2 C' Z -2 q Garage /carport area: square feet
L
Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street /directions to job site: Deck area: square feet
1w r 6 ,,-ti. "> /03 — — C--( ( f. Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: 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
A ' DESCRIPTION OF WORK work indicated on this application.
,4U d / 62 f‘ S 0 eA-L 9ve.- G 6, if) id , (a e,)r2s.%,.,",1, Valuation: $
L../ Existing building area: square feet
New building area: square feet
E. PROPERTY' OWNER ❑ TENANT Number of stories:
. Name: T p , 1 J . r ( tp-L,I (/ Type of construction:
Address: j a LS )___ S L..- C /• 3-e. c. r, Occupancy groups:
City /State /ZIP: T u c . r c/ f 0 G 1) '2.-2- V Existing:
Phone: c5.3 ) c 7- IL( 3 S Fax: ( ) New:
A, APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: r, 5 �o Li-e-- licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
. Phone: ( ) . Fax:: ( )
E -mail:
CONTRACTOR.
Business name:
BUILD ING PERMIT FEES* '
Address: SPIEL S al,,,, L
Please refer to fee schedule.
City /State /ZIP:
Fees due upon application
Phone: ( ) Fax:( )
Amount received
CCB lic.:
Date received: u,.. ,, L - �/� '
Authorized signature: l This permit application expires if a permit is not obtained
. within 180 days after it has been accepted as complete.
Print name: To.-,-, , l„./ - 6,,../ /,', Date: 7 i' . / 41 b * Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building 'Pennits\BUP- PennitApp.doc 12/03 440-4613 T(11/02/COM/W EB)
One- and Two - Family Dwelling ,
Building Permit Application Checklist • FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Daze /By.
Associated permits:
Phone: Fax: 503.598.1960 - ^ '' t , l '
24 -4- Ho Hour r Inspection /� ❑ Electrical ❑ Plumbing ❑ Mechanical Line: 503.639.4175 ...tt j;,
Internet: www.ci.tigard.or.us ❑ Other.
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. 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.
I 1 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 ❑ ❑ ❑
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 . • ilicable 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 11" 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 measures 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.
I:\ Building \Permits \BUP -RES- PermitApp.doc 2
.Electrical Permit Application - FOR OFFICE USE ONLY
City of Tigard I Rece
Permit No.:
..77e/O-6— /azr0
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4 z` 11 14,144''• l�''• Date/B . Other Permit:
Inspection Line: 503.639.4175 A l Date Ready/By: tuns: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction IX Addition/alteration /replacement Please check all that apply:
El 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
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑S over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons 0 Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting RV park
❑Health -care facility ❑Other:
Job no.: Job site address: I G ZS Z s W ._ E I , c,l l , Submit 2 sets of plans with any of the above.
City / State/ZIP: J t r _ a n 0 2 G/ ) -Z. Z, y The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: •1 Project name: FEE* 'SCHEDULE
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: D„/ 6,.,,, -j? fa 7 , r � -, CI l'-0- G t New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 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 ) r 1-; dwelling, service and/or feeder 90.90 2
4A G A . Z r v ! t3 r ban 5 f U cs •^ Services or feeders installation, alteration, and /or relocation
o l 3 y . t , 200 amps or less 80.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
' / 401 amps to 600 amps 160.60 2
Name: o , t - u,. p,. t n 601 amps to 1,000 amps 240.60 2
Address: 102_5 L 51, C— i , S,y L r. Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZI: 1 / c , f f( J 0 // el) Z 2. L ' Temporary services or feeders installation, alteration, and/or
(S ,, ) 3 a -2 _ L/ 3 ( ) relocation
Phone: o S Fax: 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: _ l• , / . Date:_ 2/ '2 Branch circuits - new, alteration, or extension, per panel
®. APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: G,, ,e_ ^-e_ 0 5 ,,,/b,.9 `-(_ branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee
Address:
first branch circuit / 46.85 2
Each add'I branch circuit to 6.65 _ _ 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
Business name: V l � A r._ fl w extension. Describe: Page 2 2
Address: Jl/ `� Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Investigation per hour (I 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)
� J j , State surcharge (8% of permit fee)
Print name: `� . ! (� I � Date: Z / Z A 0 TOTAL PERMIT FEE
Authorized signature: I..i _ ,(o.1- - 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 Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440-46 IST(10/02JCOM/WFB
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
i:\ Building \Permits\ELC- PermitApp.doc 04/03
r
Mechanical Permit Application FOR OFFICE USE-ONLY
l' • City' Of Tigard • Received Permit No.: r
13125 SW Hall Blvd., Tigard, OR 97223 "' G _ /Nay
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /�x �„ . , p��g Other Permit:
Inspection Line: 503.639.4175 el 4 I i Date Ready/By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us "
g Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
1:1 New construction ® Addition/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- family dwelling ID Commercial /industrial ID Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
Multi Master builder For special information use checklist.
ID y ❑ ❑Ot her: Description I Qty. I Ea. I Total
JOB SITE_ INFORM ATION AND LOCATION Heating /cooling
Job site address: 102_9 Z SW E I t 5-2.- Ai (re qq conditioning o heat pl ump euires site plan shhowing acemm
ent) 14.00
City /State /ZIP: T ,-- e ,r, f p(e_ g -7 ZZ Li Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street /directions to job site: Duct work 14.00 i
rd Hydronic hot water system 14.00
P ,,! wr/'. /cc.s — _.--> E i' - c.f. Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
�
Gas fireplace 10.00
/
,/ / /c I e f V en. pliaziry► b 2vt vS r oD in Flue vent for water heater or gas
fireplace 10.00
(o4v N GAr.c Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
ig PROPERTY OWNER • ❑ TENANT Chimney /liner /flue/vent 10.00
_ Other: 10.00
Name:
JDn o,.,),,,,.. 6, , I • n Environmental exhaust and ventilation
Range hood/other kitchen
Address: l 0 2_5 Z S w ti -e- C...-t equipment 10.00
City/State/ZIP: t f�� r 0,2 co 2_ . y Clothes dryer exhaust 10.00
�J Single -duct exhaust (bathrooms,
Phone: (cc ) 30) -t N 3 S Fax: ( ) toilet compartments, utility rooms) 6.80
(4 APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: ce,,,G• -. S c, G ✓ $5.40 for first four; $1.00 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: WalUsuspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR • Barbecue .
Business name:
Clothes dryer (gas)
' Other:
Address: e- Cri.c. ix Jh MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) F es: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: i... - This ` This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ,Jpp o 4_ i). , , ap-/ I, , Date: 2 IV, 6 * Fee methodology set by Tri- County Building Industry Service Board
i:\Building\Perrnits \NEC- PermitApp.doc 12/03 440-4617T(11 /02/COMIWEB)
■
Mechanical Permit Application - City of Tigard •• 3
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.
i:\ Buildin \Pcrmits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD fil S T
BUILDING DIVISION PERMIT #: ZQD(o - 000
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 .. �11u4l ii °j t
Inspection Requests (24 Hrs.): (503) 639 -4175 :. ''I.L.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
7v Je4 f-A. 1o"L Ie'r
SITE ADDRESS: / b �S� ci CLASS OF WORK:
SUBDIVISION: l� LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 — ( 3 —0(° Pour Time:
I
Code # Inspection Description Confirm # Contact # Message 1
to 9 q / . 29 9 307-144-35-
one b7er-A 6/
Correction uctions: •
•
4. _�C�',r - „/"r f�`T� GPI
1 1/-- tL c j ()SC R Sz__.Ct� /& 1 (1 e
E A -:-- - - A r - c ---, _ _ • ii b
x,45 ! s • //p EV /' ci'7 I =i. Qzz L/F(-
.E_ / ssu&
PASS I 'A " APPROVAL CANCEL ❑ NO ACCESS
FAIL , CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector Date 1.. O 6Dhone #: (503) 718-
`