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Permit
, , ' MASTER PERMIT CITY O F T I G A R D • PERMIT #: MST2005 -00142 ilil DEVELOPMENT SERVICES DATE ISSUED: 6/6/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA -07300 SITE ADDRESS: 15120 SW HAZELCREST WY ZONING: R - SUBDIVISION: SUMMIT RIDGE LOT: 050 JURISDICTION: TIG Project Description: New SF. BUILDING REISSUE: DM199 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,610 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,790 sf GARAGE: 655 sf FRONT: 15 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: 1 THRO: sf RIGHT: 5 VALUE: 330 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,400 sf REAR: 15 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 5 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: 7 201 - 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 REVIEWSECTION 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 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: $ 10,797.76 1 - 800 - 332 - 2344. REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 Engineered soils Issued By : ._ _ ..ice -% .' _ ;/�_ Permittee Signature /( L 7 ` 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 l ' � ; P FOR OFFICE: USE ONLY Cit of Ti and Received j�J _ y g DateBy: `''� 7 - 0 -2 �- Permit No, � 0D j yZ 13125 SW Hall Blvd., Tigard, OR 972a, (� 1.9 '2005 Plan Review Phone: Phone: 503.639.4171 Fax: 503.598. / ` Other Pernut: J N�p'�I� +� Date/By: d� O D /3 Inspection Line: 503.639.4175 'IL Date Ready /By: Jun ® See Attached Checklist for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: JJ (f Supplemental Information BUILDING DIVISION : �.- ..._ .. .. : � ..... .. ..:.::..... � , - �s..:. _ ..Y. ^. _.•,:,:: yam: «t:, „g;: :t l ORK , ; - ;RE ATA 1` D;2 EAMILYD' 'ELL;IN ,..�.:..�t. „�;s�:.,,3., - TYP,- E•:OE..,W,• :.;�:__° ���.�,.: U'IItED,D W G= >�: . :. -"<..a .,_, t., ..- ...- . ^ °.er -p: `� ..,. - z., 4 . . !r .4 , �f....... , - , ....., �... .... . ..— � ............ .. :. 5,.., �,,.-. .__..� .: .S. -, •. �•c. -: �., .. 7...,iw",.: ,.x,- __.,, ,_ -._-. .... .. i;, •...t1- .iw :r u:i. Y:..,...<,.... .:1 ^�: °.`r•` � •:.. ,) „- - .,, - , ,: ,, ..wi . ' : . a .. ....�::..N1�.'?z"'�'_a- .;..,:.;. .a ,;.,�, •.,:: - Ir. r.: , 1 ,f " c •.,• . .:.!. .., �: . .. ,.te.: . — a, New construction � ❑ 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 ;�,- .�;,�,. ,rcaaz =�- - �=,;:' �� -i -- work indicated on this application. ::�.. \yt:� �:� <..�:,7., � {� erg PP fr ,, Yw '�< >.. - ; F'''•CONSTRTJCT?IOP,: ��w'���:<_ .x dCATEGORt :,Q : "i`�:h�. - `:�� ":fr, -< ,,,>:.._ c. '� 4' { t , . , :_ . ,• >� - ., �..'t;4;.,.e t L 'x'ta'� .- >vl, - s, d . . ..F{ �:.� }3!'y ?; :�; ;,y: �.r"iiA" -'. fi S': �i. S^ 7:,- gte ;•`���i:':Egprk..,.,:>st >' «. r• .,,i(i. ran ..,. . * c :,r.. n;i:.. �.,_,. Valuation: $ 330 a�� . )- ❑ 1-and 2- family dwelling ❑Commercial /industrial ❑ Accessory building ❑ Multi - family Number of bedrooms: • 9 ❑ Master builder ❑ Other: Number of bathrooms: a I Ia i4," F``�,.s' ,... ; „,1_: .E7. , :. , : , • _i r; - . _r, srl: s,';, iTi - Total number of floors: g �_<:, ,,, ^- sw`- J©B.,STTE:� >IPI ORm i :: ;,;,,.- . > :dal r -.., . z::_,..:•: t 1:: " !La - ' ? .: ��,' K' �:� ".�` *.�t±rc.'„'k:.yr.W 'H {�E�.;: °;n;'.', , a." �i;'• �i S:. tas�zq;:«::;.. L. �.', ��. jl `:.,if;'�.:Y.Firx�itt; G °�:xxiica¢r�� �'�� Job site address: � } ' ? s� t ` New dwelling area: 2 L Go square feet City /State /ZIP: .1\ I ( CAC_ Garage /carport area: ( square feet 1 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 :'.�: +1 "`v?s• :r42. ry,0,i"c..rv�rt' S ..:.� -:.. PLC: `.' Y, .�, , ... - ...�: _...,.. r '!R'F}Q rail . D ' : ebkiVIFI 'G1f d P'. 'US) i CIiECKLIS ' 4:�' ,,,;,,.r, . °a,:0r,:!i i:. � t :r!-'ft'ti: a t:. ,eaA;,:;::�:cazc= : q...:�,.!;w_,�ta:.a..: Subdivision: a ) \M l 2ic``coL. Lot no.: 5Q Permit fees* are based on the value of the work performed. � Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the , '"'.. =r; r.,DESGRIPTIUNi��`OF?WORIC� =z - "�� `�;''ar;� :.�rr�s�ttJa't; "il.• -= work indicated on this application. - :'',�."''� --:i' - .)5'�}:r =. =�. -! ?a:. �;:y ,f., '�it�t�•��' r ';�,�, « „a.::`t:4,. !!: ?EP >z ^�a: "�i= ��.i1 Valuation: $ Existing building area: square feet New building area: square feet - __ raa.trFP:, -'"+',-- •�•,k_r: {a? _ %g ; s ; da:;: �.X'a'f ! ":fC¢ ".:}t ^< , .y... - � t r,. �, x-c:.,i „ " '!!.°t t6 ^'• ,r,:�: ;`th ; ut, r -:�•.f -. ;xt: = P 0WN.Ii)R, ' 4 5 dik$M . };:- 5,. 5° ®lrn �A i ik a - x .: Number of stories: ;:�?:Et,'.vtl_�r V� ,.,rya: .}.`' ^nt',e... s a , Y ..4 ,r,' -F ,<k.•u.: rS, i : :tn; '-'.�i:' *, ,c. ,..)' ,.�- ... -:. a. y n: ti h;' S'.,! k�i.;" 3i.._..,,_ _.- ars�s.3�h' ...........:.�.,ii ��...t;3 t,,.. ;'. ?1"�;.. :_rt. <t x. _s_,..<, ^�sr�.:R ,. �a,, 3 .- ,�r'R., v:ac..,,,.••s'r_.S Name: MI , 4' ` i - -, Cc mm Qty t l E,<: Type of construction: Address: 1i , Y 0.�0 C� s-1 t l� 1. Occupancy groups: City /State /ZIP: LL � G �� + 0A. q. 6.5 6 Existing: Phone: ( 4 : / ) 3 j ()�'- ✓ 5?) Fax: (�) .3 ii7 -- 7 I S New: 'S::' . L,,, ::x':7,2 ? xtr rt: ":' S,i,`• - i- � � °c� ...CONTA : ?PERSONs1 <' "•, a��.. �1::; >,._ . t �,:.... , ® ,k„ - r.,,;� :5c4,::,, ❑t. -_:.; � .�:,,', -:.. ;s'� � r .,., i'••S'tir' "._ - ,. - .,.r.: - to „.,'e. a', : ;4.. ,'21',_- ... �. "1'. ' :;.r`' : i .( %; 4i' .;::: ":::�FY. .. ... . . - - .... ,. ,,. v .t > , .. ., 5. ,.:..; :;Is 8 5 ,i..t., i(" ,. ,d•. .�L-Y Y^ 1 .,,. "S• t..a ..i. ... .....,:,1,�,,..,a..d,..ti,.,.�s ,_ r.., -.,. x2. •::#.vb�,.:r.,..,,,..:., ,_._e..s�r;>'•a «..wuxf:';... : . . ..Y,".,. , ',.4's- d +t'4fi - ..c« 'N�iI'ICE - _ �- �; tA tt , .; ., - r i:. ptg n.kr� +iv .nt•1}s„' "a '`•x;? •'fi•_,.: �1 -\ �E, PS ?Ot ."� � - (�sy llco n t ct rd�Tr•r.-Fft s subcontractors r;�_...iied5 : g.w�s:d : , i Business name: All contractors and subcontractors are required to be 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: Business name: 55s1--1,C..., � y'� ... .. . . .... . _._ r . . . . ?xt:: ;tk =1;r r z •- t;'•j ; � ��4: �' i, .BUILDINGs�PERiVIIT „I'I;ES*< Address: Please refer to fee schedule. City /State /ZIP: Fees due upon application Phone: ( ) Fax: ( ) Amount received CCB lie.: .55�- Date received: Authorized signature: ! ; �� / T his permit application expires if a permit is not obtained -' � i t ' }' within 180 days after it has been accepted as complete. Print name:. 4 - Ti r i(Jr Date: f../ / I Lit l � S * Fee methodology set by Tri- County Building Industry 11 / Service Board. i' \@uilding \Permits \BUP -Pei nitApp.doc 12/03 440- 4613T(11/02/COM /WEB) , ' Plumbing Permit Application FOR OFFICE USE ONLY City Of Tigard • RE!iew ive Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 D d j ��`� P Phone: 503.639.4171 Fax: 503.598.1960 44/0.. ik Other Permit No.: 24- Hour Inspection Line: 503.639,4175 !III Date Ready /By: Juris: 0 See Page 2 for Internet: www.ci,tigard.or.us Notified/Method: supplemental Information �: U^." ate;:_ - t _ " �rF -• � ..�,;. ^= t r RK.,,=.� :�'-': 'FEE D. :•.. . :f.,r_.0 ,.,.:, .�.b.�:,. � :_ 1P YP Ea OR . O c � �. _ _..,,.. � ,. .,SCH'E UIiE1,.. �:�> _ .<:�:...zv.,.. _.;t,.,._�' ....w, - +s. s. . . <.,. _..- aa .-. ..__ u:_....,dte..:'i......,., <. �.,....: �, .- ..�c,....._....c.�.- ,- a..... -. -. . a ... e;.alt.�.,. s.. ,._. _,. -.,. .. :..�'.,,-. New construction El Demolition For special information use checklist. I Description Qty. Ea, Total ❑ Addition /alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) i r ,GATE 'ORY ,OF,CONSTRUCIIION6111 ....,a<'.. h „'_ ,w R (1) bath r,:��� G f SF () 249.20 •... � -.per. r:'�a , .�'y�:.�t. .t., _.'F -'FS. , .,...:, :4 ; ,::� y ;,.:,�,.�..� •, .. : � .. .. ...... .0;,�;3:: _.. n,... .rfi`.L., ,';'9_... • -..., a;:. _.., . ..i n..v ❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath /kitchen 45.00 ❑ Master builder ❑ Other: x: . :,,:;,_ „m. ;.<... - .y1,•: •<� ... saz, I � .T•ii litemp,.., .s < Fire sprinkler ( sq. ft.) Page 2 " ; „ . :° i ? , ;F. R..1;. .` is a. t :1: : JOB'. SITE:;; INRORMATION;.AND;'LO'GA i^ ,:a'. .,. • ,. .. ,. ._ �> ra<:: �.:: ai.:. c.., �.', tia� ..�t:xt,.,.a's` :. ... ... ...... ., :.§ +.;., . .-. � «a.._,. n•sr.:.;6:'''.:.....I: , -_.,., site utilities Job site address: 5' ` Ha _ Catch basin or area drain 16.60 City /State /ZIP: I t j(\j f i ()AZ_ AZ_ . Drywell, leach line, or trench drain 16.60 Suite /bldg. /apt. no.: 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: 5upnn4 ( t w i/' i Q ! Lot no.: s , Water service (no, linear ft.: ) Page 2 Tax map /parcel no.: " '(�` Fixture or item F: ; z. • «. +,, rte: 3,:: ;-- '.:xkru m =, .t n'•:•: ,;_ :,`A:,. ;, _ Absorption valve 16.60 ,; " - - •= i ,.f'x�:�.x ":,3, :��. ^. :;�C' �1.lh,i�:i'a rY'1x., ' >;� ?r'U•'f +f rr�''"ri,�` $�'r' - .,a ,t, PP9 IP IL9 tOFr`SWRWA .' . „,., ,:;,tar „ :y „:,.. <� t- ; x„ {�. "°;.'<'� .,•d: ,?,��h��,•:,�,`•' .:5... .,'<.,.�,.,:,i „_,1..`�a:2. #,', _J,:;.��, , �.. , ;., 4 ,�,:;�.ta..:.4z , ,:��'.��,,.a:, ....,..._..; kart` ��,.,._ a�r_ mr.:.: 5��, �,, �a: �,.,.�;:��:c,.sk..:,,�.�.,.,... ...,�, - n.,,�r,•. ., , ��,.r:��r•- ,.,,�,.- ,_�.i,.�,R;n Backflow preventer Paget Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ,': . ?z:t; a-; �u• r; r.; t'fa::et "xItai'ili -at ;.v lo s, +a;^ Drinking fountain 16.60 � t : .m . ":.. ,:w,: A ,'_ ,try ,., , PRQ IOWNER V . , G ' -r, ;1- Ta)E ''AN§r, a + ' ` .�, .; <..:, :, .« ._ .z t a.. � ,a. �r.�r, v.w >.r�:;,:.•__ ,.:��,`, . _ ;7sl Ejectors /sump 16.60 Name: �. �� c./ , , 4,u'M� l jt �} I r l a Expansion tank 16.60 Address: • • Le" GA ,,, � (�. -. [ Fixture /sewer cap 16.60 City/State/ZIP: l ) Of- -G Floor drain /floor sink/hub 16.60 Phone: j.27) 3 27 7,1) Fax: ►�7�ta( Garbage disposal 16.60 .s:: s ., x # „ at ::,'a:.2, +.rt , arp' a = :,n•.,:a u : =;tr Hose bib 16.60 'RPIIIC/AN:?,:• :; +.�,.tis. etl t: �*i# : *F ,q�; :- ^ -J : < s; ' t ti :%• .r,; q - ' ®�A ..� :., ;>�;,7 .. � :;G NFrArCT,PER59►�r�,_ �. -. '., -.. _.. :f....- ,f: -�.. .i< ..:��v,:.:'_1?':.. .'Y. ..':i. _,.. .L'- '+1�_.:.::i2, ?`1::hli. , _�.. ��., " �:'v,t.::1�1r�:�S$Ct�: {r .':.� : 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: ( ) Fax: : ( ) Sink /basin /lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 f' _ C TRA '7 ..r . l�i _ `c Watel closet 60 Business na t 6 me: V 4 ` ' ",r� ` ? ` ,, V K� iC� ���r�� Water heater 16.60 Address: 10 . -: L L�tl Other: • City /State /ZIP:.4` f/ X.�'� -G Subtotal � / Minimum permit fee: $72.50 Phone:,))( -- 3 l Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: I os�'1 v� In 3 mbin Lic, no.: - /3. Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature` t. '■ TOTAL PERMIT FEE Print name: NH N'K- -li t �� Date: L_/ /I ij' Q . 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. 1:\ i3uilding \Pcrmits \PLM- PcrmitApp.doc 12/03 440- 4616T(10/02/COM/WCa) Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard Received Permit No.: ''// /5/2_ ' 13125 SW Hall Blvd., Tigard, OR 97223 P Review ��S��Op, �U /r • Phone: 503.639.4171 Fax: 503.598.1960 Aor Ad�t jrl p I tt� Date/By: Other Permit: Inspection Line: 503.639.4175 -!' I I Date Ready /By: Juris: IZ See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information ,.r, .•,,s-_�r� t., .f � �o- 1... . . - � t om. _ , t,. ems...., -. - '�,... <' ..,,- : ;- . - :TI'.PE; O >i �:: ::�:�'� - ' M1VIi �R �, : ,....�. ,. M.,.,.� -.�., , ,.. ,- ,,� , 4,... -_ ,...: ,... _ . ..s +' . .'r::��f�:;5 ChA i? i�tFEE.�,'SCHED.UIiE'r.'•_..USE GIiE(!ICL IST; New construction ❑ Addition /alteration /replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. ' : �iln4;: _ a:Ngn't h:e• : � ;+fk::.- - -'a: CiN.'_ - ni3i�f, - is CSS'::i �:t:: tl ..,.�-•':: " Y1 .ti':7 •.• _ - - l gill tit -:,.: 'sa;;. _ - - .1..p �y .. r' .t� ; :I , i,.�� �. f,r °�J.;ii•;;,�,�% +- . 4p,��1: Value: $ � , _;lr� . CATEGORYLOE :,CONSTRUCmION; <�ts ° °s 1 RESIDENTIAL E QUIPMENT ' / *i'''," : ;- ❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. Ea. Total - :`.:�''" nf':t •: JOB 'iSITCIN'FORIVIATIONrAND. LOCATIONS R�' ?, '(,;"��`,.- _• _ �. Heating/cooling Job site address: 15i uj SL�J HG�2L'(C•re3# - ( ` r , ` Air conditioning or he6tP pump ) J (requires site Ian showing placement) 14.00 City /State /ZIP: _ . . i DYE 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 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 E.-. Flue/vent for any of above 10.00 Subdivision:S 1M 1 ' `( -&.:: A Lot no.: 0 Other: 10.00 Tax map /parcel no.: (� 5 Other fuel appliances :'S :,,4 - ,;. ek: ray• :c - : Fo ' Asa , .arw > m. , �.��.:!, - ,}_ ,, i. ,, I ie:s, -•�� =.;i.- ? ti - - ?;" - - _ ` }°5 "� ;3;i, nixi: ".,3,v "'(c ;. >. n `':Y :�;�;: -r •.�:�w:; - s ; ^= q i < r�,. � zvn..,t.- . -„ .�.� Water heater 10.00 "�,4:,;. „f. fi-„g r;�:, DESCRy,M .P,,, ;:. :�, -.- •�r .., i�'?,n. ...- .'•k:..:,.: .- .�, -.. r, St. ��,.: .,�,�;'i';�e?1" :,:t'`�"f= r:i?X'i�. ,rn�. �g� .. .... ... . . . ..: i . ..�,';r. >.:��.. ^,.tax ,t %•: ... ..., n.:.,, ,.: +;,- r.,rt '�'.. , . 4,,.�. ,., . , ��,3 - -.,, :, .. „.a 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 :«:: ::<.:: z::,,a;��:� men Awr u ;Ns :.°a �;. - ,..,�.: — i v - 1 4 ,v i i , l rr. �:. Chimney/liner/flue/vent 10.00 ; r P :,,+ Y,.., E Y , I 3 I' . OWN R - � <,:� , w ., = ❑ :ENA`IT= s;«:,; += ,. .n;�� =' :,.;psi, ° r �„�; s ' r ,',;'< ": „ :; �.,..,... � r:,�..,..:.��s:�:; ,�,_��._,,:::..t ,<:, _.._ �: �=: t-, �_ __._- .,,� ��. =Mir = >4..�'� -- w, :, Other: 10.00 Name: Y11.j `. � 1 1 Environmental exhaust and ventilation Address: ?- , Da. / ' 0 I Range hood /other kitchen ' L equipment 10.00 City /State/ZIP: �� Clothes dryer exhaust 10.00 � r ,., ingle -duct exhaust (bathrooms, Phone: -CJ % f — � Fax: ( .t-7 •— - t(% (� toilet compartments, utility rooms) 6.80 4 a; ;'. 'ti +-r : rt _: ::r vr; _ i i:'irfY . �r.�;r €V';''; " 4! :�: n, , r«S� c�:, �:- :rr;: _ , u t!w - s G r7 ,n'r :- * - xro! ace fans 10.00 , ' , . 3 :=• /_`' r,: Ft .,r`-':'_ ' Y�.r,E i :4:Se..F:., .a,.n'tY "`r "`sr:,'..7.� , i g.W,' ? ila .:'g, ,:,' r., i : ..d 4 Attic/crawlspace _A * ,,., Mrp ;; „ n i=' ; C NII GT'.:P a P .- ,..,,:,,:; _.., - ,. , err a n'.,..,�.z:'?.<en.. �:5:er; { �tcr h °,� -e�"� i;..A, "e,,..... .,., M,,,.. ......n,.,,ts•,.:a'a,w,.`!v:, ;•:a*..... ;:va- ,:,�'a` ?: 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 - K { : - is ... x: FI .Ni2i% 'Se: `.-:;j t.GONTRACTOIt: - - - Barbecue .,� ..-,, :�: Vii: - =, Business name: Q /7 (' v Clothes dryer (gas) �� ^' Y 64, t 1 1 t � Other: Address: � L 1 irt, s, _ ....... ._. " _.. is; ;' 1VIECFI� - *AY; EERIVIIT FEOgk V l ._ Y�. O - e l 7C� .,,: r... .: _.,1:...:x:....� y,.',_,,.s _;z,,:..,u:, � Subtotal ,i._ .} ..:., . City /Slate /ZIP: Subtota Minimum permit fee ($72,50) Phone: ( � �. I Fax: ( ) Plan review (25% of permit fee) CCB lie.: '..5 ?1 State surcharge (8% of permit fee) TOTAL PERMIT FEE 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: '� 4 1 i it ,1 I 2 ' ° N Dater fi I l a 5 * Fee methodology set by Tri- County Building Industry Service Board is \Building \Permits \MEC- PcrmitApp.doc 12/03 440 -46 17T (I I /02 /COM /WEB) Electrical Permit Application '; `., r ,, `;FOR USE ONLY' City of Tigard RECEIVED ` Received I_ / D � Mar Permit No.: '', C 7_ ‹ a 0 /1 -0 �� d- 13125 SW Hall Blvd., Tigard, OR 97223 \ � il�ii !, Pho 503.639.4171 Fax: 503.598.1950 yya<m 50 r � id i� ll !!�i; , �' \ Other Permit: J Inspection Line: 503.639.4175 J L 1 9 2005 WI. i Date • e. d /B \ 7uris: H See Page 2 for Internet: www.ci.tigard.or.us otifie.•a .d: 1 Supplemental Information Z1-'''' ,;rs %. - ! 'x t"•°e,.r`.' . .,.. I", I :"7,1M-0-4 • 4„ ,, z Kt7r i+ 7 aC- _ e` p „,,,,,. r y �aarr iiEi � ,a - :'.�_�: se1�;. ,� _ " '_ >s t i �• ;. 7 t w i N RF a� I ':: . K New construction 11 As dition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other: Service over 225 amps, comm'l ❑Hazardous location l °x :.:..,.._; :n, = =' ,,_ #..._ a ,,, :k,. ,u, ;. °h; .= a s EService over 320 amps - rating ❑Buildngover10,000sq.ft., n' � . �� vcr �CSeeyti rO. ICONS: R cr' ON*s.:# : �, a•3 Y dwellings s t{ v yb a Ty �� cl;4 - : , t ''3, s. of 1 -and 2 -famil dwellin s 4 or more new residential .„�? +. +�",:�a:�.°:::'.. * 2Yr' i� ryw l x� e` ��isL�t� «'�';•.�M £+n"tixS4aa'4'� 4 • .3iM :�.ii:" Y �i; �t:4. A l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder ❑Building over three stories ❑Feeders, 400 amps or more ❑ Other: ❑Occupant load over 99 persons EManufactured structures or ; I t N flai 0 O W �. �, TI OI Y r i ' � ❑ Egress /lightingplan RV. park . r.°a,a+ a,,ta,.. 4r.rc'ar ., s- a . .. -, Wi t - . J ❑Health -care facility ❑Other: Job no.: y . � Job site address: ' 72 /_ , AC / -z «3? /Submit 2 sets of plans with any of the above. City/State /ZIP: '� I 0 , e , 9 223 The above are not applicable to temporary construction service. /� '_^ ax � "' ;+z E " T,: ' :. ' .:•. K=;',.; ::' . Suite/bldg. /apt. no.: I Project name: / Ens, S�CHED LE, ' :� �64 /4),„, s , '7 ♦ D escription I Qty. I Fee. Total .. Cross street/directions to job site: g ' E I � New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: 5 044 Lot no.: 5 6 Ea. add'1500 sq. ft. or portion 33.40 1 �� Limited ener gy, residential 75.00 2 Tax map /parcel no.: lu % , k4 * , , Limited energy, non - residential 75.00 2 , t.f..;r`. dz,;&?. ;? k : ^'` -r{ „ aU'`.,,, 4"s,`a.. p. A � G Y VSVV' _.`.. �S, 'E:',ti";,? .A. NN �lr: i i .rF .3�:R : r ,, � T O ' ORKR� , 1., n , +.�:- c,4,,.,,: Each manufactured or modular - dwelling, service and /or feeder 90.90 2 A ai jie aYZ 641124 C,- Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 _� , r w o V, ett fi ;,s, , mix ri; =„; .,a �, ,.:at.,rr »,gi =. _ ,.. t A4 201 amps to 400 amps 106.85 2 ..��, .- ' Via, � x ,r: r.�� :' *�,:�:�:„ P P ;s ; .;.. -, P1 0 p ERT,. (): Rte. a: i W e y g ' • , 4, s r,:.:t ; . ...., .n5:` -« ,< „aa , xe : . r3:ar,sits?„ x : f,. .ti;" 6 a3 ^ ; �` 401 amps to 600 amps 160.60 2 Name: p i J e2/ (. C �� j! � /7-y 601 amps to 1,000 amps 240.60 2 Address: <Z 3 0 �� -42)0 57-e6-67-- 5V117- . 4 Over 1,000 amps or volts 454.65 2 Reconnect only • • 66.85 2 City/State /ZIP: LA-leg O5r,,..)g -d c5E. 97x35 Temporary services or feeders installation, alteration, and/or relocation Phone: 52i)) 3 75--3 ( 57' Fax: 4s-9) - 3 F---7 - - 1G t' " 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 -., usa^z •;ua...,.A.. . -•:ru n -a�. : ' u =sx °' r'cd. ;?;^•=v e �: = a r M 7 ria , a y 1 A. Fee for branch circuits with � r;IC6v x -5 ,- -, �.. • ]�-,,,44,,,, o � izs ll; ��',. Sis�� �=�' ',�.' "`;. i� �"x:� �. .r � �`�` '� �� .rz"'` r ° service or feeder fee, each Business name: branch circuit 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'I branch circuit 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 - R.# • L y _`gitiR k _ir, -,. , .- >:. . • energy panel, alteration, or • 4 �t9j extension. Describe: Page 2 2 Business name: `.i L2�� [� c Address: �) / Each additional inspection over allowable in any of the above 1 ` v ' 23:e �j Per inspection 62.50 City /State /ZIP: �G�� li'ZG -1/" 1- Investigation per hour (t hr min) 62.50 Phone: (533 35 Z Fai: ( (9 93 - Qee Industrial plant per hour 73.75 .� `'' ,� ^��w g am. .. ». � axFas ^'` xtana CEi.E EEN �IT'•� ES* �" CCB Lic.: /3222 2 Electrical Lic.: 3 Le , -3 Suprv. I,ic.: Al , ,33 - Subtotal Suprv. Electrician signature, required: / J / � Plan review (25% of permit fee) Print name: A- -4 na 7/ / d � .�� Date: P 4 State surcharge (8% of permit fee) r � 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 \Permits\ELC- PermitApp.doc 12/03 440- 46i5T(10 /02/COM/WEB Electrical Permit Application City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* (l Burglar Alarm • ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: C3; ` LY7.7. 1a1RV-' 'y �: 3 ty�'- altr f :a,'�f.� , ±Y7c•,a':c', {:' . T'y �s.�'-.i'1 '�% : a. " a:3 .+"x ^'S 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 N AAAAAAA AAAAA ®AAAAA.AAAAA AAAAAAAAAAAAAA ,a AAAA ® AAA a AAAAA ®AAA { S TREE. TR EE N CE TIFI ATI R C O H ". t 1 I, t t,a- i4- r A- A-r e , fi "� Owner/Agent gent for p Wl o A. s S S� Try. Co�+.,,,,.'�` r - LLC ; ® (PLEASE PRINT) ,, (PERMIT HOLDER) ® ` ® , ® i• /, �� t o. �? Do hereb � �� � r � ° �: � F y cent fy f�l a:�t t5 e ` fol o win y g location Alit l�� a ia.....x.. �.:' ^. 'Le»i 0 �Y`�, 9 'iii v a ,; .) I ' meets ty .of ton county 1 land use and development standards for street tree installation. 0. 11 0> (� 12 0 � Sew 14-142.r - -_ 1.6 e, r..s d v '5 19 SUBDIVISION: c oam ,, ,)-- LOT: � _ ei,,, .. 4 ® BY: ,'` �' DATE /0 -- 5 --t).5 I . / ., , 4 RECEIVED BY: DATE: / F?.. DI- CITY OF TIGARD "). ( • c BUILDING DIVISION • PERMIT #: MST2005-00142 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6)6/2005 Phone: (503) 639-4171 atMi Inspection Requests (24 Hrs.): (503) 639-4175 m 11.. INSPECTION WORKSHEET FOR DATE: 10/5/2005 TIME: 7:00AM PAGE: 2 SITE ADDRESS: 15120 SW HAZELCREST WY CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE LOT #: 050 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE DESCRIPTION: New SF. OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503-387-7538 CONTRACTOR: DON MORISSi 1 t. COMMUNITIES LLC PHONE #: 503-387-7538 Inspection Request Scheduled For: Date: 10/5/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Finat inspection 017541-02 503-209-4837 Corrections /Comments/ Instructions: ■!. UlleiTDD e/g mimo•• • Ak A. SS P RTIAL APPROVAL CANCEL NO ACCESS I FAIL fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED • Inspector: —1111.11111111111111 Date: 47. C ' S " Phone #: (503) 718- _ CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 -00142 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2006 Phone: (503) 639 -4171 �a atian�Nll Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/5/2005 TIME: 7:00AM PAGE: 3 SITE ADDRESS: 5120 SW HAZELCREST WY CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE LOT #: 050 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE DESCRIPTION: New SF. OWNER: DON MORISSEI I E COMMUNITIES LLC, PHONE #: 503.387 -7538 CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503- 387 -7538 Inspection Request Scheduled For: Date: 10/5/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 017541 -01 503 - 209 -4837 N • Corrections /Comments /Instructions: k ASS J II PARTIAL APPROVAL ❑ CANCEL El NO ACCESS ❑ FAIL / % CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspecto • Date: ` Phone #: (503) 718 - CITY OF TIGARD BUILDING DIVISION PERMIT #:2as /(/ 2 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 azioo I Inspection Requests (24 Hrs.): (503) 639 -4175 - AL INSPECTION WORKSHEET FOR DATE: eye+ TIME: PAGE: SITE ADDRESS: \ G 1 Z,0 A---A.,..(26,rejtA-- CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: n v CONTRACTOR: PHONE #: � -/ — ' 7 Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1 7 7 2-, Date: I 2 A Phone #: (503) 718- CITY OF TIGARD `M s 11 BUILDING DIVISION PERMIT #: oDd Sy -a D //2 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 iddy�n�i �l�`t Inspection Requests (24 Hrs.): (503) 639 -4175 'I .. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: /5 / a 6 , / d CLASS OF WORK: SUBDIVISION: / LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: V ig _, vs-- - 627,... Inspection Request Scheduled For: Date: /D /Y Pour Time: C• - - - -ction Description Confirm # Contact # Message /9 op,„-� • rections /Comm- is /Instructions: • ,. PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS FAIL ❑ C LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED / 0 � II II Inspector: / Date: V �� Phone #: (503) 718- 2.- k)