Permit ■
' I. ( MASTER PERMIT
K PERMIT #: MST2005 00081
c7 Il DEVELOPMENT SERVICES DATE ISSUED: 3/30/2005 i.
; AO 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA SR021
SITE ADDRESS: 15436 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 021 JURISDICTION: TIG
Project Description: New SF.
BUILDING
REISSUE: DM170 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,570 sf BASEMENT: st LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,620 sf GARAGE: 407 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 TURD: sf RIGHT: 5
VALUE: 308
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,190 sf REAR: 10
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: 3 . CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 6 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: 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
DON MORISSETTE COMMUNITIES LL DON MORISSETTE COMMUNITIES LL and all other applicable laws. All work will be done in
4230 GALEWOOD ST # 100 4230 GALEWOOD ST #100 accordance with approved plans. This permit will expire
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 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: 503 387 - 7538 Phone: 503 - 387 7538 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 #: LIC 162512 direct questions to OUNC by calling 503 - 246 -6699 or
TOTAL FEES: $ 8,699.47 1 - 800 332 - 2344.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Engineered soils
Issued By : CL, Permittee Signature :
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.
:, Building Permit A, '. • Weal l i ; 1 + ' FOR OFFICE USE ONLY •
City of Tigard Dat:
PemutNo.:
13125 SW Hall Blvd., Tigard, OR 97223 Y', w /� D ` , ������ 000
g Plan Review /_
Phone: 503.639.4171 Fax: 503.591 , t 11 Z /44r A , �, p 1 Date/B • �j •� — -- Other Permit. (A ai li 7 I
Inspection Line: 503.639.4175 `��„ Date Ready / y : _ Juris: ® See Attached Checklist for
Internet: www.ci.tigard.or.us 1 Notified/Method: _2/6 1 ( Supplemental Information
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New construction ❑ Demolition Permit fees* are based on the value of the work performed.
VVVVVV \\\\\\ Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
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. °. ,. -; ,F.. 3 ,•. r a r .., Valuation: S , �O� 183 0 . i t, i
1- and 2- family dwelling Commercial /industrial
❑ Accessory building ❑ Multi - family. Number of bedrooms:
L
❑ Master builder ❑ Other: Number of bathrooms: e
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Job site address: i .,%0 C fee() 1 P J L Ii New dwelling area: 'a, c 0 square feet
City /State /ZIP:.-11 U f i ( r` Garage /carport area: (,,1 -1 square feet
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Suite/bldg. /apt. no.: Project name: Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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Subdivision: axy\ 1 t ' \a Q Lot no.: 9 1 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
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Valuation: $
Existing building area: square feet
New building area: square feet
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Name: (�V G C M M l u f� , l,c-Q) Type of construction:
f
Address: c— Y
Occupancy �� � v� �j( L, l.� upancy groups:
City /State /ZIP: L � l.)3.,'U L 1 ( q 2 ! o 3 i E7 Existing: •
Phone: ,2 )� > `�2) Fax: ( . ,5 67 71. [ 5 New:
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Business name: 5 ���i f All contractors and subcontractors are required to be
t+
Contact name: 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:
T x `ii = .
Business name: 9 � l Ce k '' ' " ',�?. 4 i?;E S e' 1 B «,i':r UIliDING = P ���::r.. - ERMI,T. FE27S *+ ;; r;t.
Address:
Please refer to fee schedule.
City /State /ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
CCB lie.: _ Amount received
( (0 -)\-
`'5 i
aket_ Date.received :
n Authorized signature: ' Igt,bfrie This permit application expires if a permit is not obtained
/ � � within 180 days after it has been accepted as complete.
Prinl.name: 1 •, ( '>�� )/ Dat e: )� I O�
* Fee methodology set by Tri -County Building Industry
%;,.
`' ►`v Service Board.
_ v . t
t, "' ; :r • 1.- .:: is \Building \Permits \BUP -Pere iApp.doc 12/03 440- 4613T( I 1 /02 /C0M /WEB)
■ 4 t
. .
Numbing Permit p I e li ° Q FOR OFFICE USE" ONLY _
ri City f Tigard ` �4 Receive M _
Y g Date Permit No., L GO U I
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503,639.4171 Fax: 503.598.t( {g 1 0� �I 1 2005 1i�Mijl�� � f' Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639,41 H ,--% I
t
lntemet www.ci.tigard.or.us = ^^ Date Ready /By: Juris: S See Page 2 for
g Notified/Metho .
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I�New construction 1'� 11 �� J Demolition For special information use checklist.
Y Description I Qty. Ea, Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
, .t.. `+�a f'
r
� 7 ORY
=I
EG� F`t TRUCT O'
�CAT , O C,UNS1 p�: =1 ;aF SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath /kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
��„ ;' JOB- ' �D;•liOG`'T +ION'r,,i� :� €7
,
...y tL:.,. . =: ...- -,,� ..,.:.. ,.ti_.:'L ��J", t.. �{FKS S_, "'. ^,'2:S' =�4:', �= 5 ',,dt,�` - o•:,1c� sn:- ' .,�,T5.1.':fr.�tti'ra�_r .e „.. ^= .�..f: • -.... vi :•.... ;: site utilities
Job site address: FJLi•3 5 ��ce,,p LPJI� t Catch basin or area drain 16.60
City /State /ZIP: Drywell, leach line, or trench drain 16.60
(GC l ��
Suite /bldg, /apt. no.: J Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: e UY\A ( e- '? Lot no.: a
Water service (no. linear ft.: ) Page 2
�C. Fixture or item
Tax map /parcel no.:
,.,, :::, '.t ut , >Y :. ;t „ts :_, :. �„ Absorption valve 16.60
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;g ° .. - �; :. ' �. t '.,,,>,..< DESCRIE2IQN'i.O ;WORK > . t• 'ig,, -, _,. , :? �5. s
., .' .:... ..... ...: : #Y ,. -.. ` =,. ,+.., fiiz,.ir<Y.':ri,.,. ,,,J., ,.,y, .,SJ,,. x o ;.,: } o.a, ,� �' '.7;x`.4, _ - _, iY.x,
.,., � ?x„ �: -,.:, ...s s- .�,.. ,.. Na ,,.,�„ rs�•. _ ._ ... ..,ti- �;, , _�,�., <, B preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
T�
;,t`,:: ,_,+ , = ,s.. , :,, ;,.Yt, sr .- Y;rn n Drinking fountain 16.60
,ur.� „' §, - ;fX _ :'.4 +.:: 1 ' , ;=;c xrsia r '�j ," l " n',r' " r. ' *: ti`�vi -,
PRO . R'.; r st ='; TENANT .fx= _ 1
". ; � tr vt ��•sra= : :,t,:,._,�., t.. r. .£ �' .�.s�...., . - .,w.:,t
� j ( Ejectors /sump 16.60
Name: v'A5t& (' ern WIWI t ±)� (, Expansion tank 16.60
Address: 'L l ein i. . • YOt: I d7 Fixture /sewer cap 16.60
City/State /ZIP: ! Floor drain /floor sink /hub 16.60
Phone: j �)'7 7 , Fax: ()� (a( Garbage disposal 16.60
:: - r - -�,- .;;;�. .'rz< - - - .0 : ,•;a;.* .,,,;:,,� 0
F.;: s.'i.: t ; : > ,t�, , ,::.,r Hose bib 16 6
t f:i r S < r
APPLICAN &A ., ,`_ z = � ; 1. 1 , GONTAC I „EBS , •f r•
_ ... -- ._...._,., t,; ��e��1�',•.,,.._.., ,.- .,.A <,.,.'�'.'sz��7.._.�... ._.�.:r,�',�s1_4 „c•.,�,7:• Asap :;:��x::ra�:�.;;;fi���u:�a.,r.‘i Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax:: ( ) Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
s
�: - a� l° Water closet 16.60
Business name: t o 19r1'y‘.b yA5 Water heater 16.60
Address: 11Q /
4 .),4
l Other:
`� 'X.�'�� C /F� Subtotal
City /State /ZIP:
�) 6 �6 J r ( ( ) Minimum permit f ee: $36.25
Phone: � � � Fax: Residential backflow minimum permit fee: $36.25
CCB Lic.: I 0 ^hnnbing Lie. no.: ./ 'JC)1713 Plan review (25% of permit fee)
Authorized signature �, State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name: x � 3 N-e„' I i. Date: -1 l This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\ Building \Permits \PLM- PermitApp.doc 12/03 440 -4616T(10 /02 /COM /WEB)
■
Mechanical .
]Per i. a ��'
Xn at1; ir, FOR OFFICE USE ONLY
City of Tigard t
i Date/By: : l
Date/By:
Permit No,n M�OU� Od0
13125 SW Hall Blvd., Tigard, OR 97223 l t
Phone: 503.639.4171 503.639.4171 Fax: 503.598.1960 1 Plan Review
1.
20 //•har�dlMiv 1' I +i\ Date/By: Other Permit: 1
Inspection Line: 503.639.4175 MAR p �'.I Date Ready /By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
•:,A - OF TIGARD
:..-r ,..... s_ ..� , ., ,.: ..;..,�, .,,.• ,< ... - , ,... w s - �,... ^ . ��COIVIIVI�ERCIALI' D : E NS_:.
USEiCI
/.: � ._- ., .:z ?� =� ,.. ... _ .: ,�� .. , .'.� >�:� . ... � .:. . • .�3 ,�:, �, S'C1iE UL .I�ECICI;I
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Mechanical permit fees* are based on the value of the work
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.
:: 3'. ` , <I:', ,- ± %r,'z tii
r ` ^: =a� = ;'GAT GO ;OFGONSTRUCTIO. °' ` z� lt,:�� Y Value:
,
`~ p.' -RESIDENTIAL EQUIPMENTYS
r • T *,':j`
c] 1- and 2- family dwelling ❑ Commercial /industrial El Accessory building EQUIPMENT $ STEMS FEES
For special information use checklist.
❑ Multi- family El Master builder ❑ Other:
Description Qty. Ea. Total
. r.... t: . t • a '' Vii': % "•"
a,:„ : JO.B�, SITE: INEORIVfATNNDi: hb�' ATION; ��' i;' �`$ a =1r•s' =•= ;;'�:���a;`:i
� zz. ... ...._ .�..., ,i•..�,.., IO ' �A
mss... - :.,•.,.., t,. + , ,,t, ' 4z.'4,,.•,:•- Heating cooling
Job site address: Air ( c _:, ceen e,tcrQ Air conditioning or heat pump
/' (requires site plan showing placement) 14.00
City /State /ZIP: — ���A,/,(,f, i U Furnace 100,000 BTU (ducts /vents) 14.00
I� Furnace 100,000+ BTU (ducts /vents) 17.90
Suite /bldg. /apt, no.: I Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: 3( ( .L ` A Lot no.: t g
Flue /vent for any of above 10.00
"` ` 1 `� Other: 10.00
Tax map /parcel no.: Other fuel appliances
_ - - _ __ _ - 'a 1.; ; +C t: ti•,,: Y'c:x,5,4.'3.i-- „i'%'(`; {[” * ±,�;.�r - _
: l:,:/� :'� ; x.,15; yrf, °'\ - - - - _ ti �.t _ °Pk� :i "::.:
' f ~i - - �..'<, 4x1.... .A +, - ��Y• ,.�+' :r YA.'•�'u W
e:; ±� - \ . ix�:. , a :,�':�';:' , Water heater 10.00
� �..� .•a` °i CRIP I N��OF, f)=i`.�,. - a�n,r;�,��.,<.�
Gas fireplace 10.00
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
PROPE :. M „ - .,:::a,:':.•€ :: Chirnne /liner /flue /vent 10.00
R •
Y,.. i..e= i . }:� ri
; — +d rt v, _... , .34f. ":ii1vT�•t. .1. - ... -. Other 10.00
Name: \ AM/ � stir t � kP,S �� } C / Environmental exhaust and ventilation
Address: V v", / •y , ,- L 1.e.., l Range hood /other kitchen
lll...le'/// equipment 10.00
City /State /ZIP: / C k v e l J tL q 70 -- S Clothes dryer exhaust 10.00
E ` ,^ Single -duct exhaust (bathrooms,
Phone: .� —
' � Fax: ( 1 MO I toilet compartments, utility rooms) 6.80
,•i S:`Y !6',`, {,y zii:p',', t ` }fir: .. =t .e " "'.;T: F z.e .: .•a •s!`t; '!ffi
�C:.. ' - S <''i, . }:jt':� ., 1.' j•:+'tvx �Jv {i: ^' ',5,� (;j' zrt ;;~- ::_. ace fans 10.00
r2
, ,: 52.-A, ,,, . ,: =;,r Attic/crawlspace 'AE:�LT T,. ,,i;��w.�:a c +,;,;,,.. .:�.. .CO T. �' �:.� +. P
;;❑•. t� ,. �•,1� ° ° . .,14. •, .t4c. N ,ACT, >P;ERSON .s�L;;,,,
.,, _ -„ . - ..-... " ,. <u... n ,,._•> .. ... .. . .. .. .•., :....:h - „�.. a;- 1,�.,�,;d- #ie"k „_ .
. ..•,.. ,.,:�,:�: -a, ,: +4. , r, �,v„4f,- w. ».,,- ,• +v+r�`.:..u�f
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: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail:
Range
, 4 f •:CONTRACTR�.�'•: b :�_'�', = ,!'.;a” Barbecue
O :.ors;•. ,. .`nN'�'°:�� -,, z. .,..,.- ,..
Business name: �, it i - i t--- ' 11 OA/ � / dry C” /7 Clothes dryer (gas)
L t'C� Other:
Address: �.:�. °
/� • —) 1!t xtx,l: "fir °y.StrSnr. >,: , C •.: A :; .<x?,- : * s ;: e
�✓ l I , t �,,,_¢ s . NICAI:P;ERiVI'IT E % , = : W . :V
We \'\ Y . �-' 1 ( t 7( ) LY l5 _a�:.,,_x::, , r ,:e,:7, are: '- :,, •. :... _..e... ,.c. .
City /State /ZIP: Subtotal
Phone: ( j - --� - , l' y Fax: ( ) Minimum permit fee ($72.50)
�d 1 Plan review (25% of permit fee)
CCB lie.: . C�1 — State surcharge (8% of permit fee)
? /y ' TOTAL PERMIT FEE
Authorized signature: •��' �C This permit application expires If a permit is not obtained within 180
o� _ - . _
'rt ` days after it has been accepted as complete.
Print name: f'" Y�f /rk- 1 ' I r tc I Date: 'B, q (U� * Fee methodology set by Tri- County Building industry Service Board
i:\ Building\ Permits \MEC- PermitApp.doc 12/03 \�� /art """"'�u4 440.461 7T (I I /02 /COM /WEB)
Electrical Permit gu, Received Applicati . -'- _"° --rFoROFFICEUSEONI;Y}
City of Tigard �� �� Date/By: Permit No.:
y: 5�02� ni 0y)
13125 SW Hall Blvd., Tigard, O 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.196 1*. d� u�l Date /By: Other Permit:
Inspection Line: 503.639.4175 MAN V � ooK
" al I Date ReadyBy: Juris: H See Page 2 for
Internet: www.ci.tigard.or.us O F TIGA Notified/Method:g �O _ �5 f ' ar Supplemental Information
CITY ;,Dstlif ISM PLAN REVIEW
pd New construction w i Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
El Demolition [1] Other:
['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
g 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑Buildin over three stories ['Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑ Other:
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
❑Health -care facility ❑Other:
Job no.: 3 N g& I Job site address: ! .5 �3 S G1 G I- / Fe" tow Submit 2 sets of plans with any of the above.
City /State /ZIP: --1---. � _/ %3 J i A 223 The above are not applicable to temporary construction service.
4 / ] !/� ( l FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: s � �r •
�n e r •r . Co osolo ib 1-44.Description I Qty. I Fee. I Total I **
Cross street/directions to job site: p New residential single- or multi - family dwelling unit.
, e),/ �( Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: S V M M, Q d q e_ Lot no.: al Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK • Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Al ex. /LOUS w 'ar, Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
/� 401 amps to 600 amps 160.60 2
Name: // 0A/ 1 — 601 amps to 1,000 amps 240.60 2
P'
Address: y.2..3 torAG we � S E % ,SrJ /TE lOd Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: L-kIe—B 5w e s-6 4 le, 4:17 Q 35 - Temporary services or feeders installation, alteration, and /or
y relocation
Phone: (503) 30_ 71- I Fax: ( 76, I 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: Date: 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: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) l Fax: : ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
. extension. Describe: Page 2 2
Business name: V 14 r an t c LL C.
Address: A �c
Each additional inspection over allowable in any of the above
< (I • 6 6 �! /� 2 33 0 Per inspection 62.50
City /State /ZIP: e CO M 4 ,v- �/ 0)2 A ! 7 7 s , Investigation per hour (1 hr min) 62.50
Phone: (5 3 57, - k 62 Fax: (5 Lo, 53 -9 yys-- Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: ' 3 72 2 -2 I Electrical Lic.: 3y _ y8.3 c Suprv. Lic.: Uu 3 S Subtotal
Suprv. Electrician signature, required: /�w 7 t — Plan review (25% of permit fee)
Print name: /f - ! D ( / � `y / Date: 5 _ State surcharge (8% of permit fee)
/h , ^r/V 0! d 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 Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\Building\Pernuts\ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /COMIWEB
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:
n Audio and Stereo Systems* •
n Burglar Alarm
n Garage Door Opener* •
n Heating, Ventilation and Air Conditioning
System*
I • _ .. '�� is
Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
•
i I Audio and Stereo Systems • ; • •
n Boiler Controls •
n Clock Systems
I Data Telecommunication Installation
Fire Alarm Installation
HVAC
n Instrumentation
Intercom and Paging Systems
n Landscape Irrigation Control*
Medical - . .•*
PI Nurse Calls
•. . ;
I Outdoor Landscape Lighting*
•
I 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
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CITY OF TIGARD
' . .
BUILDING DIVISION' ' A PERMIT #: MST2006-00081
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2005
Phone: (503) 639-4171 4,4T4p t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 7/15/2005 TIME: 7:11AM PAGE: 54
SITE ADDRESS: 15436 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 021 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE •
DESCRIPTION: New SF. 7/12105 Add AC unit.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503.397.7539
CONTRACTOR: DON MORISSEI I E COMMUNITIES LLC PHONE #: 503
Inspection Request Scheduled For: Date: 7/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final " 011504-05 503-209-4837 N
Corrections/Comments/Instructions:
0.
■ - , F.E- ..t. i c, `P'• t 1 . .,.' L.
•
•
N p PASS Vi ' L 0 CANCEL 0 NO ACCESS
n FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G-- N e,, Lk
,..
Date:. l‘ 0 5 Phone #: (503) 718-
CITY OF_TIGARD
BUILDING DIVISION ' • PERMIT #: MST2006 -00081
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2005
Phone: (503) 639- 4171����gN��iigl @1�����
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/15/2005 TIME: 7 :11AM PAGE: 52
SITE ADDRESS: 15436 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 021 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF. 7/12/05 Add AC unit.
OWNER: DON MORISSEzI IE COMMUNITIES LLC, PHONE #: 503- 397 -7538
CONTRACTOR: DON MORISSL.I I E COMMUNITIES LLC PHONE #: 503.387.7538
Inspection Request Scheduled For: Date: 7/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 011504 -07 503 -209 -4837 N
Corrections /Comments /Instructions:
1* PASS n PARTIAL APPROVAL ❑ CANCEL (l NO ACCESS
n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: D ate: i Phone #: (503) 718-
. ,. .
CITY OF TIGARD
. ,
BUILDING DIVISION ' .' . • A
PERMIT #: MST2005-00081
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/3042005
Phone: (503) 639-4171 , .7441 t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 7/15/2005 TIME: 7:11AM PAGE: 51
SITE ADDRESS: 15436 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 021 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF, 7/12/05 Add AC unit.
OWNER: DON MORISSt. i I E COMMUNITIES LLC, PHONE #: 503-387-7538
CONTRACTOR: DON IVIORISSE. i i E COMMUNITIES LLC PHONE #: 503-387-7538
Inspection Request Scheduled For: Date: - 7/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 01150408 503-209-4637 N
Corrections/Comments/Instructions:
•
•
.'''---
r PASS El PARTIAL APPROVAL El CANCEL fl NO ACCESS
n FAIL 0 CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
Inspector: Date:7 Phone #: (503) 718-
CITY OF TIGARD • t.
BUILDING DIVISION' PERMIT #: MST2005-00081
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/30/2005
Phone: (503) 639 -4171 �n u,1041. t
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/19/2005 TIME: 7 : 08AM PAGE: 75
SITE ADDRESS: 15436 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 021 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF. 7/12/05 Add AC unit.
OWNER: DON MORISSE] I E COMMUNITIES LLC, PHONE #: 503 - 387 -7538
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503 -387 -7538
Inspection Request Scheduled For: Date: 7/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 011680 -01 503. 209 -4837 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL •'CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ! Date: 7 /q -''O Z Phone #: (503) 718-