Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00534
��II DEVELOPMENT SERVICES DATE ISSUED: 1/22/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11550 SW GALLO AVE PARCEL: 1S134DC -11200
SUBDIVISION: CASCADIAN PLACE ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
REMARKS: Construction of new SF detached
BUILDING
REISSUE: MAS2239N STORIES 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT. 23 FIRST: 1,032 sf BASEMENT. sf LEFT. 15 SMOKE DETECTORS: Y
TYPE OF USE. SF FLOOR LOAD: 40 SECOND' 1,075 sf GARAGE 440 sf FRONT: 20 PARKING SPACES : 3
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 5
VALUE: 207,653 00
OCCUPANCY GRP. R3 BDRM: 4 BATH' 2 TOTAL: 2,107 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 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• WISVC OR FDR PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF. 4 201 - 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: 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: $ 7,308.23
This permit is subject to the regulations contained in the
KEYSTONE DEVELOPMENT INC KEYSTONE DEVELOPMENT INC. Tigard Municipal Code, State of OR. Specialty Codes and
PO BOX 476 PO BOX 476 all other applicable laws All work will be done in
LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034 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: 503 635 - 4736 Phone: 503 635 - 4736 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #• LIC 71135 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987
REQUIRED INSPECTIONS
Erosion Control lnsp 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins( Rain drain Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final
Footing lnsp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Foundation Insp PLM /Underfloor Framing lnsp Gas Fireplace Water Service Insp Building Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation lnsp Appr /Sdwlk Insp
Issued By : , Permittee Signature : i 1 a>r� /.r1 i i
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed t e next bu-iness day
1
a f- I2 -i6 -a3 scolavo3 -00
Building Permit Application
Date received: ./a, / " Permit no.: �p�
'till City ®f Tigard , / 5 3
' Project/appl. no.: Expire date: N.
Address: 13125 SW Hall Blvd, Tigard, I ' ,9720
City ofTigard Date issued: Bye Receipt no.:
Phone: (503) 639 -4171 '� `
Fax: (503) 598 -1960 e,
`h Case file no.: Payment type: y
Land use approval: c\cC 0 1 &2 family: Simple Complex:
IIII
TYPE OF PERMIT
I'' 1 & 2 family dwelling or accessory 0 Com �9 D'I stnal 0 Multi- family ' New construction U Demolition
0 Addition/alteration /replacement 0 Tenan improvement 0 Fire sprinkler /alarm U Other:
JOB SITE,INFORMATION
Job address: ; (15 'O jJ ( ' A LLD A-'J . . Bldg. no.: Suite no.:
Lot: ( I Block: (Subdivision: 4A) PIA I Tax map /tax lot/account no.: IS /
Project name: 4 47 47
Description and location of work on premises/special conditions: 'w F
OWNER - FOR SPECIAL INFORMATION, USE CHECKLIST
Name: YST 1• OFiil j ; f. iNc (Floodplain, septic capacity, solar, etc.) \
�
Mailing address: ! b®• 1(p 1 & 2 family dwelling: t
City: 'LA E,60 MEE ZIP: 1103' Valuation of work $
Phone: ( - 4731c Fax: 6}[( - E -mail: No. of bedrooms/baths �{' 2. l f2 _
Owner's representative: 3A M M. 5 e O LR �- Total number of floors 22
Phone: .jA'Wle., Fax: S,R-WJ. E -mail: New dwelling area (sq. ft.) 2I 0' � � l
APPLICANT Garage /carport area (sq. ft.) i-(�® `
�
Name: AR- Covered porch area (sq. ft.) 30 R
Mailing address: Deck area (sq. ft.) PA110 .
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industrial/multi - family:
CONTRACTOR Valuation of work $
� Existing bldg. area (sq. ft.)
Business name: New bldg. area (sq. ft.)
Address:
City: I State: ZIP:
Number of stones
Type of construction
Phone: Fax: I E -mail:
CCB no.:
i ,� Occupancy group(s): Existing:
New:
City /metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITCCT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: 1.1A(, Pp provisions of ORS 701 and may be required to be licensed in the
Address: 1 NVii i Qj'(i jurisdiction where work is being performed. If the applicant is
City: ppRT►'R00 State: Of- ( ZIP: 0V1 209
exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: 2255 —'I NA Fax: 22 E -mail: 5E4 PL
ENGINEER
Name: POW e-IA- Contact person: Fees due upon application $
Address: 445 S i 024.1Y) Date received:
City: eo i 1. j {,jp 'State: ag. (ZIP: /11_1 (p Amount received $
Phone: 2S4 -6212 I Fax: 251 - &16I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all junsdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of la d ordinances governing this ❑ Visa 0 MasterCard
work will be complied wi ethe• spe 'fii I herein or not. Credit card number: I /
Expires
Authorized signature. J ► ► _ Ilt, ' Date: 1 /0. Name of cardholder as shown on credit card
Print name: ( JAMES f�
S PI • f ots'f y $ 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 /00 /COM)
•
•
SITE WORK PERMIT CHECK LIST
Commercial, Multi - Family (R -1 occupancy) and Residential:
Please complete all items below, unless otherwise noted.
Excavation Volume: cu. yds.
Grading Volume:
(Soils report required for >5,000 cu. yds.) cu. yds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to 90% of
maximum density) cu. yds.
Retaining structure? (Check one) ❑ Rock
❑ CMU
❑ Concrete
❑ Other
LI
*Total new impervious area including all buildings,
sidewalks, and paving: sq. ft.
x°..0 << - tt4 jai »T: ;.4 !MAC: =4.
Site Utilities Plumbing Work:
Complete the "TAN" Plumbing Permit Application for site utilities plumbing work.
_» r..# - r.. -'--�_ t[ f .:'t'L`n - aa:'.:s "- ., .'r ..r.PR'k'v °, mad " - Y"a 'k" . "�_ex. =` € °� "�.,, .».'ext:'`
:Plans Required S_ ee Site:Work p:ermitt,=Ap° icatio °Pan, Submittal` Requirement ='4� :,`
:7� . .< -" � ,,,.,n.tan',i ; x ; � ;_,.'
g ttached` The: followin must apcom an.''`thtsa e ° lication s' . „_ - ' :' _
..�. ' 'd';at:�,t%�<e � ' = �sYU:,g.��'” -_ , "" =,°S':.�,`, °...,»
Site Plan with;Vicinity Map: showing; : r ,, ParkliiibT ciudin( A®A)°tand ;
>, *s �c «z ,�,,..�-,; -u ? : »- ,.::3'€`. a _,,`. � i • _ > "3.'' -' :.. . ;•, '' :�" r'�. ,., . ..\ .7,'`
ftADA.co fiance; ,:; ., ^.V°:'4
rn , �; � , � ,. Li^ htrng�`Plan'� - ;
§, GracirnPlanane.detaifs - =a d° " ,'�';h.,
9 „.L n s Plane �� �"
= Erosion Control Plan and3 ° ` °` ` Soils a port cif r mead re
,„, ; , ;,�`;`° -',•;,'rt._ - _r ;.�.; .?,� �. a __ _ =� ,: d;�3s, ' „�` ';:,,:'�`� . =a _ %a°-��',_ ": `"7:' � e�� =^
?z - - ta-;`�' -Er, mas=h°= - `:';.
^:Ret a.�' �` r � "..��,_�_ � ^ � �.,.. � ,� -.� # ,....�
�'?= '�_,^'?..� .. � -; �t_ °a�E�iz° -`..ice -. ��a,. 'r:� �,F��`::.,.� <�i. ^�'rs` - �r =...'. :, ," „sh <;�r ^: _ � �.:`'.r�- : ":«,. �cd,.R-'
*Does not apply to 1 and 2- family dwellings.
tf, 144 ;TY SUBM ITTAL; o m
Requere =atrz
�(Iricludes�YNew; °=Additions or•Alterrations }�
;_.., "Sulmttt
Commercial 4
Multi - Family R -1 Occupancy 4
One- & Two - Family Dwelling 4
NOTE: Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue).
i:\dsts\forms\sitechecklist.doc 09/24/01
M
RECEIVED
11; '07/ 2002 07:04 5033310591 DEC 05 2003 ASSOC PLBG PAGE 01
d`P,1Y U F 6 j 3 1 4 b May 20,<0 6:45 P.01
BUILDING DIVISION
All‘lk PlumbiingPer nut Application
iCity of
Sew Permit no. T t23- ,
Mclean: : 13127 SW Hall Blvd, Tigard, OR 97223 reeehid;
So:werplmnitho.: BuifdMgpermltno,t
�' P (563) d39 -4171 Pro,loci/eppl,no,: tieptee dem
Put: (503) 598•1960 Date boned! I by: IRoceiptno.:
Land use approval: ._ Case file no.: Payment type:
11 P1 NF P110111
• 14 2 family dwelling or memory 0 Commereialllnduetrial U Multi - family 0 Tenant Improvement
BNew conaaucion 0 Mdltlon/alteratlonhnplacement G) Food service 1 0 Other.
r ! II I'pt (pit Al'%I III \ 1'1.1 s( III Ill II WI' ,Vet i: dint brruull elh.vl'ht•l'I.il.1l
i * a L -,. 'u[�i''=3] Tofal
B • .nos }1•• I 4 i I
LX Block: Subdivision: s'ai.. it?J' ` tradlTra■IMIIMIIIIIIII— =II
f rr.yPI f . a.r• :� i tJL'3iiI� —
Descriptioel inn) looati• of • on premiee/: _ Site milkiest 1111111
a. 3 ' ' • Catch bluldarea drain
t • - a of - • • ledon/6u • - • on: — ^ D Oh/leach line/trench d ,„i.
14 I \11:1 \1.1 ON. 111%1111U " L' A no• n, n.
Business' mine: 5 t1Mf t• M u'0 1v • . al • as -
' Addrert ? , • '7r U •!1n • n connector -~w
City! l!efilti %L7_liiitit:_i11! 11�■_1111 N ►
Monet --®, L' KE ;`]MIl Storm sewer rto• n. • 1111111111111111111
CCB no.: • alYall. Plumb, Ws, re no: 1''!' mull T CCIERMAIMMIIIMI MIMI
CI Itnetr• l o. no.: f % - II
A. •.onvalve
Contractor's - aaataGvo e • s �/ /7��1J NO ' ow venter M1111.111.111.111. ►__, . i��� 1 -�; f1r1 Backwater vc w -.
((l♦ 11( ICI J limn, cloth w atery � ■
E
clothes washer
IMIIIIIIIIIIIII
Dishwasher
Ee, I .'1T>ZF O'IIIIIIIIIIIIIIIMI — �
�''• • •ectotWsum • ���(♦
:x . analort ta
I t %% \I i i ` - IN11111111M-
Name • n.: • Q. vNG. Floor •ri nURoore ... U. NM
1 sorter :•a ZIP 1 ' '11111
?horn vutilahll lit 11; fl = • - • • . •.. — NMI
Owner instal ati • ono malntawwe on y: The ectu installation • _ --
wiU be made by me or the mei .. and repair made by my regular R .... : n comma no _ — �
+na a :tr ` G /AIM " " (�Iapter /7, 1 '1 " % 2 Ems' • esiats , vela)
I=\(.1\I 1 it / �11.1011MMIIM
Name: = �
Address;
City: state: ZIP: Odler. ��IMMIIN MOM
Phone: --- _plot: . 18-mall: oral
Nr hatemeur moo r as . men . lam Notice: Thin ryermil applioazion Mlntnt fee ................ $
0 AM O MaraaCard Plan re iow (at .= 55) S
( expires It a permit h not obtained
0161 M M m er - - ( t. Ird within 1S0 days agar it han been States (8%) .... $
i accepted es complete. TOTAL S
Numd 2a ***WI
` l r3alder Ylerala •� Amount' 4404416 (6.90/130,4)
Electrical Permit Ap c d ation FOR,OFFICE USE ONLY .i -f. • i :. •.d ,
Received Electrical l �
I LL C V fr J Date/By. Permit No ' 1 �R5r9003 1' 0063
°° ` Planning Approval Sign
City of Tigard DE
� 0 Date /By: Permit No
13125 SW Hall Blvd. 5 2003 Plan Review Other
Tigard, Oregon 97223 C1T Date /By. Permit No.:
Phone: 503- 639 -4171 g � 1 9 -
p } 1: ^ 41S ^ aD /6 Post - Review Land Use
tu�d p ( Post-Review
y. Case Use
Internet: www.ci.tigard.or.usOIVISIQ '' � ��_ Contact Juns.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 - 4175 "" j ' Name /Method. Supplemental Information.
�,-, , f�, :. : 1 0 : .x „_ ,.: ,u., :. 4 EW Please lie, k 11 that
x�.: °_ :� .3� �- ,,�TYPaE�OF� WORK , ; -�_� , �' :`a .� , � '£ .. �.�.r. ` :iPLAN`�RE�'I , . �c , _ a- °a I ... � ,� , K
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
i f ; , .``� <: '�� <<S;t,CATEGORYIOFpCONSTRUCTIION .; '' „ ' , „;'?6'; , 1',.- `',' I & 2 family dwellings four or more residential units in
-�
I i & 2- Family dwelling ❑ Commercial /Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress /lighting plan ❑ Other
- .,... ,,� n . ,* a,--, .
„_, _ JOB SITE'IiVF[iliIVIATION and =LOCATION , g; - . Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: I i 5 `v :: -!_ _o;, Fn 1 11:"x IA ” >, _
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: 6ASC.A01 j/..1 AAC-P-- Description Qty Fee (ea.) Total 1
New residential - single or multi - family per
Cross street/Directions to job site: \ // dwelling unit. Includes attached garage.
�l� $ 1 O 2 N (J/�'�® Service included:
1000 sq. ft or less 145.15 4
Each additional 500 sq ft. or portion thereof 33 40 1
SC,/qA'v Lot #: ' Limited energy, residential 75.00 2
Subdivision: +_ u Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
r �-. . ,,, ',Agar; x �- service and/or feeder 90 90 2
:,,_ ;. �; .._ DESCRIPTION:.OFNWORIC ° = �,V... k .,:,
S TOM' or feeders - installation,
N i�� 5f� Z J 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
gR01 U" 5� „ < "'`. rat, ,..YS =�.� - .'� °,.�
;TENANT, = - - "! 601 amps to 1000 amps 240 60 2
h
Over 1000 amps or volts 454.65 2
Name: ILV{ r - r) Ni loc- Reconnect only 66.85 2
Address: Po Ws. 1 41 to Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: LAR, OSWLSO o f... 1104 200 amps or less 66 85 1
,r 201 amps to 400 amps 100 30 2
Phone: 6?) vJ' 1.115(o Fax: Q- �� �� 401 to 600 amps 133.75 2
�L'1= , / AMICAN , �' V f .. ONTACT PERSON
_� Branch circuits - new, alteration, or
Name: -1AM &S eop -- P Gj( extension per panel:
/� ` ` A Fee for branch circuits with purchase of 6.65 2
Address: ( AS /T V service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6 65 2
E -mail: Misc.(Service or feeder not included):
? �” ',' ,,; ;Sr ONTRACTO R ; . , t' ' `,'' = E ach pump or irrti c ircle 53.40 2
���•"� �1 =�� �• .=� _'�' ' °° "'��-- E ach si or outline iga li g h t in g 53.40 2
Job No: Signal circuits) or a limited energy panel,
Business Name: lj�/ �� C tL �t �et�L l a! L( - tescrieratiption•
on, or extension _ Page 2 2
Address: j ( - (). 6 - f A Each additional inspection over the allowable in any of the above:
City /State /Zip: S/7.e7, ® �/ (J Per inspection per hour (min 1 hour) 62 50
Phone: / & 7' % , Fax: 4z5 / t t Investigation fee.
CCB Lic. #: / Lic. #: . - 5lo Other .35_,.
.- •< ;z_*' `;re -' ° ," , ; Electi Cal Permit ft;es* ` . .., . ; * °.� ' 4
tcbN Supervising electrlcir-i_v /' - ��<�� Subtotal $
signature required'? [Fa C /1/ - „ c Plan Review (25% of Permit Fee) $
Print Name: ,? m // Lic. #: .0,57,..S State Surcharge (8% of Permit Fee) $
i TOTAL PERMIT FEE $
Authorized ? i L (� � Notice: This permit application expires if a permit is not obtained within
— Signature: ■/ U 1 Date. 1 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
IP J Plt I NI1 • PC' —
(Please print name)
is \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
Garage Door Opener
I I Heating, Ventilation and Air Conditioning System
n Vacuum Systems
I 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
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems -
Landscape Irrigation Control
n Medical .. • .•
n Nurse Calls
I I Outdoor Landscape Lighting
n Protective Signaling
Other
Number of Systems •
* No licenses are required. Licenses are required for all
other installations
i.\Dsts\Permit Forms\ElcPermrtAppPg2.doc 01/03
alk) Mecharucat et ut kpplication .. ` y ,
to a gn= A.1 ® V 6..... l Date received• Permit no c;0, j3
""' _�1 City Of Tigard and
t� b Project/appl. no.. Expire date:
ryofTrgord Address 13125 SW Hall IR 37223
Phone (503) 639 -4171 Date issued. By Receipt no .
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.. Payment type•
BUILDING DIVISION
Land use approval: B uilding permit no.:
, TYPE OF.' PERMIT , '
bi 1 2 family dwelling or accessory 0 Commercial /industrial 0 Multi-family ❑Tenant improvement
caz
New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE ,
Job address: 11 %V' S vIJ 6-,41,1_,C) Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead.
Tax map /tax lot/account no.: profit. Value $ •
Lot. ( (Block: I Subdivision: 64 OP- - *See checklist for important application information and
Project name: . jurisdiction's fee schedule for residential permit fee.
City /county: 'j(X )- ) k,} AS' . ZIP: f '2.2 1. &.2 FAMILY DWELLING PERMIT FEE SCHEDULE
Descnption and location work on premises: AND. COMMERICAL /INDUSTRIAL'EQUIPMENTSCIIEDULE
ti f,V� Fee (ea.) Total
Est. date of completion/inspection: I2.402 10 4 (03 Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes ❑ No Air conditioning unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL, `CONTRACTOR Boiler /compressors
' OL State boiler permit no.:
Business name. IT- , y Cv��i j v `� `'r�N (� � G r� Of�� HP Tons BTU /H
Address: C 3 C.L�?r - lWl> P.-NNW— Fire /smoke dampers /duct smoke detectors
ity 61? k) L411 State: Q ZIP: 1 '1'3 Heat pump (site plan required)
Phone: ' 5 � j 1 - Fax: 5 1 E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 1262 Install/replace/relocate heaters - suspended,
City /metro lic. no.: 112-Co wall, or floor mounted
Name (please print): A SAN 2 Vent for appliance other than furnace
;;f CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: V/l `(S'TCt• PNP. \14C' Chillers HP
Address: r (?- Lii 1, Compressors HP
Environmental exhaust and ventilation:
City: LA yt, 0 60 I State:a(c- I ZIP: cl /C3 Appliance vent
Phone: 31 -4 Ip Fax. plQ --1mt( - E -mail: Dryer exhaust
OWNER Hoods, Type 1/ IUres. kitchen/hazmat
s
)` hood fire suppression system
Name: ilAe- Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone. Fax: E -mail: Fuel piping each additional over 4 outlets
Process (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City. State: ZIP: Insert - type
Phone: I a : /I E -mail: Woodstove /pelletstove
� I Other:
PY
Applicant's signature:A v 41�' Date: 1r7 Other:
Name (pnnt): L ) Mtn PI - i 'bi , ,kr' - '
'Not all junsdictions accept credit cards, please call jurisdiction for more information ermit fee $
n
Notice: This permit application Minimum fee $
I Visa 0 MasterCard expires if a permit is not obtained
. redit card number / 1 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 $
Cardholder signature Amount 440 -4617 (6/00 /COM)
_ A
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I, J M t� �� �-� , Owner /Agent for I $ t 7 N 0 O fr �d 1 NC , t:
(PLEASE PRINT) (PERMIT HOLDER) 0.
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Do hereby g location
ce,ti: tlahe followin
meets , Cit .of T.i and /Washiri on Count
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l and use and development standards for street tree installation.
ADDRESS: 1 1550 `' U &P) L. -c, 1
LOT: 1 SUBDIVISION: A ?1 Chi •
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BY: V��° DATE: ( 1 ...
RECEIVED BY: I ,„ DATE: � ,_2, —eq,
A
CITY OF TIGARD 24 -Hour .
BUILDING Inspection Line: (503) 639 -4175 MST Z3 6 53cz
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
2 � p J �� AM PM BUP
Received
/ Z � Date Requeste
Location // 5 SO `- Suite MEC
Contact Person Ph ( ) PLM
Contractor e-V-L Ph ( ) 5P Z SWR
BUILDING Tenant/Owner ELC '
Footing
ELC
Foundation Access:
Ftg Drain '--1- 3 7 ELR
Crawl Drain T /�, '
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear ,
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
A-.-.2___. j ,,moo l/e/J
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
in n Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PAS PART . FAIL
Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date - 4"/ Inspector 4---- - Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
L PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST t 3 — oos''4
INSPECTION DIVISION Business Line: (503) 639 - 4171
BUP
Received 40i l I O Date Requested 6 i 4 C/ AM PM BUP
Location 1 550 SkA) a. A • Suite MEC
Contact Person J' 1oc. O Ph ( ) Jam 7 3e PLM
Contractor ! .. [ . ��� ! ,ri ' h ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation
Ft g Drai `-C ELC
Access: 19.0-)6 _ 3 Co -1 ELR
4
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal l
Fire Sprinkler _1 C. i
Fire Alarm i' l
Susp'd Ceiling
Roof ) O.t t ��
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
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: ❑ Unable to inspect — no access
Fire Supply Line
7
ADA Date I Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour • -
BI;ILDING Inspection Line: (503) 639 -4175 MST
c: C63
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received / Date Requested 3 AM PM BUP
Location l / ST 570 Smite /- MEC
Contact Person Ph ( ) L , 9 3S- `T 7 3 / ' PLM
Contractor " Ph ( L ) 77 - .9--9 4 0 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: x �]
Crawl Drain trt LISO ' 3 6 ( ELR
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:
tom!! I
PART FAIL
P 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
in,
PART FAIL
EL CTR ICAL
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 / O s
ADA 6-2,
Approach /Sidewalk Date — ¢- Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL