Permit t /a CITY OF TI MASTER PERMIT
PERMIT #: MST2005 -00006
A li ' DEVELOPMENT SERVICES DATE ISSUED: 2/16/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15131 SW HAZELCREST WY PARCEL: 2S109DA - SR078
SUBDIVISION: SUMMIT RIDGE ZONING: R -7
BLOCK: LOT: 078 JURISDICTION: TIG
REMARKS: New SF
BUILDING
REISSUE: DM199 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,610 sf BASEMENT: sf LEFT: 10 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,890 sf GARAGE: 400 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT: 5
VALUE: 333
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,500 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 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: 4
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 4 OTHER UNITS: 4
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/FOR: 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 +amp6- 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: 0TH: BOILER: HVAC: LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 8,865.99
DON MORISSETTE COMMUNITIES LLC DON MORISSETTE COMMUNITIES ( This permit is subject to the regulations contained in the
4230 GALEWOOD ST # 100 4230 GALEWOOD ST #100 Tigard Municipal Code, State of OR. Specialty Codes
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 and all other applicable laws. All work will be done in
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.
Phone: 503 387 - 7538 Phone: 503 387 - 7538 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
Reg #: LIC 162512 952- 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503) 246 -6699.
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
I / 1
; / , /
Issu By : • / f Permittee Signature : / �C j v
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
•
,. .
, A
Building Permit Application Fol OFFICE USE ONLY
/„.1. 4 -
City Received _ ,i
5 of Tigard
OR 9> SW Hall Blvd., Ti � DatDate/By: " (�
1312 t �— Permit No. o Q 6 d /
Tigard, � v Plan Review
Phone: 503.639.4171 Fax: 503,598. 666 / olop �'�eil\ Date/By: Atf „Z _ /•S - Other Permit: )0 V
Inspection Line: 503.639.4175 L, ._ Date Ready /By: Juris: 0 SSee Attached Checklist for
Internet: www.ci.tigard.or.us JAN 0 7065 Notified/Method: 7 \i Supplemental Information
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New donstruction ❑ 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
,.�,� - i .r: :' <_Z`:. - - , "41`Jrr.4M1,?tt'sa 7t - - - '.'i
- work indicated Gated on this application.
} CATEGORY } OF` " f , . { t , { � `"
� .,
Valuation: $
$l- and 2- family dwelling ❑ Commercial /industrial 6.
❑ Accessory building ❑ Multi- family Number of bedrooms: it
I.
❑ Master builder ❑ Other: Number of bathrooms: 2i` /2 L9
.,�, ;d•tYR:ir .. *o- . as =: "iai- d�;ess rT!fi . - , @ + };' :, "<a:e; , ;iRlt
: ;±ry .:,•} i . _ >,. a` - of 6 ,, , •:: ,,,
Total number of floors: ,A:
r =i` ;w<: � ; � .� `
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Job site address, r � �I New dwelling area � square feet V
7 �1.11� ��rt�� . — . � 600 ■aa i
City /State/ZIP:'I\ Ti Garage /carport area: square feet Z. • Suite/bldg. /apt. no.: Project name: Su *' t RI Covered porch area: square feet ,
Cross street/directions to ob site:
J Deck area: square feet
•
•
Other structure area: square feet
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PivREQ, :. . UIREth .. 1 „, Ti ,
1CO1vIMERC : -: r -
?,�'� = USEI CHECKI IST,`= 1
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Subdivision: Lot no.: 1 8 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 theme
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< >. , work indicated on this application.
... ,ti , .. ,:, . ,.. ....... . ........ . „. _...,.<. ,,.... ,_., Valuation: $
Existing building area: square feet
New building area: square feet
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>. i ;.; %:PROPERT: , „. c�NFIi r: ,r;= = . TE , . T , .: ,-,a?: =:4n ".. Number of stories:
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Name: t ' t G f r v i c S Y Type of construction:
Address: I_ . � � ) v1 . ` t g. 1, Occupancy groups:
City /State/ZIPP: L_ Q ( J - ` ,„02, P 1 C q 20 35 Existing: '
C�
Phone: ✓) 2 D C /j) ' - 755?) Fax: ( 1j) 336(37-- 7(,, 15 New:
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, tAPP, T . ,N ; „, CO T T. .:.sil -% ,' L:”; t''�•
AN �`.,, ,,,, �„ . N C ,PERS.ON s , �'��;•-
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Business name: 5 Kyle NS p\-- e All contractors and s� ubcontractors 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: • s< a CONTRACTOR
/ `� _
Business name: 9N E - ,,, „ ,
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' " t t BUILDING - PERIVIIP FEES
Address: >,,. _... ,, .,_ ,, ,, .,,, .- ,. ,,,
Please refer to fee schedule.
City /State /ZIP:
•
Phone: ( ) Fax: Fees due upon application
( )
CCB lie.: ' 2.532, Amount received
1 1.7./j J ' Date received: Authorized signature: rl ` / / � ,1 ^ / I This permit application expires if a permit is not obtained
lll✓✓✓lll...` V� ` within 180 days after it has been accepted as complete,
: • > -P 1 ,).G
-Print : naive: I 'T1. Y ` °' ►e.. , Date: 12121101 * Fee methodology set by Tri -County Building Industry
Service Board,
i'\ nuitding \Permits\EUP- PcrmitApp.doc 12/03 440- 4613T(I I /02 /COM /WEE)
Plumbing Permit Application FOR OF USE ON LY
City of Tigard Received v ,^
Date/By: Permit No,: 5 cow) W
13125 SW Hall Blvd., Tigard, OR 97223 y ' � I
Plan Review
Phone: 503.639.4171 Fax: 503,598.1960 //sorb, t I t+\ Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 .1 Ail
Internet: www.ci.tigard.or.us a=^ . Date Ready /By: Juris: Ei See Page 2 for
Notified/Method: Supplemental Information
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__ _ .. � ..... ... . . .. .... . � . _ . .... ,, ... .. ... .a., ,:k�fi FEE;.
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on ruc
ew construction ❑ Demolition Description For special information checkll T
Jr-'-. 1 ist.
otal
❑ Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
ATEGOMY ° - 4r- , -, r ': = .;
.. , r - SFR(1)bath 249.20
.
-::LLB
�C
I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath /kitchen 45.00
❑ • lder Other:
r I
Maste builder
Fire sprinkler ( 9 ) g
sq. ft.) Page 2
�. t i}, ;.�i� •''i', i1• ei li t�• �ti ,.r : d ", t:t.
;j' J j3$ : "INTO AT O! T i
', .:,,• .., .,,,..,,.._, -�-:.... .J.. I + Lti.l � f:' Site utilities
Job site address: ► _;,:.
Catch basin or area drain 16.60
City /State/ZIP: In l a i l w A. I ®a 9'1 Drywell, leach line, or trench drain 16.60
Footing drain (no, linear ft.: ) Page 2
Suite/bldg- /apt. no.: g l Project name: s n o t ,,,t la fie4 C
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
g
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: la Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
x:. ,;:, : „:.o > .; ,•,: t� R , ::; Absorption valve 16.60
:;;:; ,t- ids' +;ti,°�Y. ,r : ''t: "iX', •:3i':4'' E -
_ 3 { ia:.. +,:G.,y .14;Ff:Y� "= t'.:: ":- ..�t� " "' +N« V i;�;,,q
e?u: {!. "�x"?'��ra:� «�•. ?, ;Y:� %,D�� ;:�+ iW' : x': 7:.:; Lw.;, �,,. z,.,... , .�..�:•:�,hN.•(.Y,Iirir „�.
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s, �., ,.,, .,,,.., _�..... .. � N . � u ac o preventer = .. ,.. B w pr Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
4•s °'se: /:w�:;,, ,z A, - Drinking fountain 16.60
::PRW M .:N=.94, • ,I.-.0 zz ,. ,:., ,rk;: ��3�.,. :. ._ ;;TENANT 'l',. ' ,; .. >.
>.,..= .,��>. \L .. �3i _ ,i.;'n :.m,'� \',•.t` 4i.. •:1, � =31r °T? r'4t {trt "❑' 1 � , ��i :A a, .'ti
:.'',. w„� es�,t,: =fat.- <.;:r �:..�3a:Y_- .. : :'L ,,zu :�: =1 ' r. , ,.. ,,.a ^ .�. - aa.. _ :.k,t,aa�? „.tiE _,.�.. =.,• - Ejectors /sump 16.60
Name: \ vtONv7` .1 & % ConrYYV Pt { , es Expansion tank 16.60
Address: /il�,,. ' C J p ,, Q 5?-4 1 �-y Fixture /sewer cap 16.60
City /State /ZIP: / t- u j iV Floor drain/floor sink/hub 16.60
�
l l Fax: ( , / -2�I/1/��
Phone: ' 2.q •- 7 i/ • Cx)� � t S Garbage disposal 16.60
`.a'i - g„ - : .,:'t•:i 5tlt_tl, t•.•t, =`:y .. T t�•; :tSF tit` :. - : Hose bib 16.60
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A'EE'LIC ; .j, CONTACT " P E
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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:
. 'x, ,.:. Urinal 16.60
' ,. =+ "CONTRCTOR':
4-
A . , � `• ::.�'. =• k Water closet 16.60
Business
name: f ��A , • ?k • �., :t: i
�
Water heater 16.60
Address: O f I, Other:
City /State /ZIP:.4(.'C Subtotal
� ( - Minimum permit fee: $72.50
Phone: 5)7J•) ( - "'l / 3U, / Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: 1 - 7C.4 tiimbing Lic. no.: 3 ',3 )P0 Plan review (25% of permit fee)
Authorized signature . � / State surcharge (8 %of permit fee)
/�,; TOTAL PERMIT FEE
Print name: . hj N- 1 I I\ Date: i2 S:ZScv 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:\ Building \Permits \PLM- PermilApp.doc 12/03 440.46 16T( I 0 /02 /COM /WEB)
4^
, Electrical Permit Application - FOR'oFFICE USE.ONLY '
' City, of Tigard Received
f. Date/By: Permit I No.: Cira — l /500(p
4 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review (" �"
Phone: 503.639.4171 Fax: 503.598.1960 � d� � ,/� � rfi,lil , ' + ' + j \ Date /By: Other Permit:
Inspection Line: 503.639.4175 c- . Date Ready /By: luris: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
' .'_ ,., :�. , , T O OF WORK' p PLAN Rkytt -8 ,-,
Newconstruction ❑ Addition /alteration /replacement Please check all that apply:
!! ��''
EService over 225 amps, comm'l ❑Hazardous location
❑ Demolition
Other:
;.;. . ,.:.,::.._.;..,u,:,,,;..,.N :....:•t.'.:_• ..... - rating ,
y ,,,, + . , „ , }u , {,•” ,_ _ Service over 320 amps ratin ❑ Buildn over 10,000 sq. ft.
' . ,:. - >; -,, ..•- ,.CATEGORY; OF °CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑Other: EBuilding over three stories ['Weeders, 400 amps or more
;:..•::,.;.: s, = ::,r .,-._,,;...:.:,,....,:. .,,.:_ } ,..;r. >: +;,. -:> :,.,.,,...::.•, -.' :.;,:_,...., -_,.. - ❑Occupant load over 99 persons ❑Manufactured structures or
= JOB SITE?INFORMA eN i ' iC TIe - . _�]Egress/lighting plan RV park
I�. H ea lth -care facil ['Other: no I/ Job site address: y
' Tint' / i.. _ i mi . Submit 2 sets of plans with any of the above.
City /State /ZIP: 11( / /V / /JM1 \\ 0 The above are not applicable to temporary construction service.
1_yf ri�(s #..�;1,iKf -,'', ::.iin,:��"e',Pfy``iN�. +t�. %, - . - - = Is:t H1 1'r:,= i s»ti•:i :.i','
Suite /bldg. /apt. no.: Project name: C �p/����� • e s ri p t i ..?:. _,...,:es„ FEE ; .,SCH Qt y. F,, ,, N • _ ...,. , „ , *
M �` ! ! y ®w �i��� Descrip M Qty. Fee Total
Cross street /directions to job site: // New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: "1 Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 . 2
%�D , ;r ,,. , Limited energy, non- residential 75.00 2
ESCRIPTIUN 1�� E-; - �,
O ORIC�J; :;� _ ;?5
.... , .:�a' ,,,,,,,,,, ,,,,,�., ,...,. ,.- ,...... �'r.'' Each manufacture
, + , :`5::.., ,-„ ._. ,°'•�+;. «�, manufactured or modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
r i f - - �iV+. - i }'J %'1H , .kiT.: t'.,C:i ••.E. - .4+: ek,;� - - -
„;= = °�'x, ° °` <,;:vy,, -
s=RR'OPERT�Yi;?O.W,NER.y i , \.. - ,..: ®:,:' FE iq, . 201 amps to 400 amps 106.85 2
1
s , 2c•,: ,:,{,.. +,,., Ise, ;sr: ^.i, `c _,7•.,, ;t + -... n t =. ::cxz.,.. , <'if.,? ' "'`
r, r,,', � `� ' `� �' `�`'' "`''' 401 amps to 600 amps 160.60 2
Name: )Oy V\0\1' . COm vvnt4I eI 601 amps to 1,000 amps 240.60 2
Address: 2-1 C,(,(>/5 ix Over 1,000 amps or volts 454.65 2
ix only 66.85 2
City /State /ZIP: Lei', - 0, 01 3 Temporary services or feeders installation, alteration, and /or
Phone: 1)�' - ?� Fax:G) — 7(_0(S relocation
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
pl. %.- - _ - sj .., :. k;t •- ,If�f- _ -,', €nals, { .�r «:., ).; :,t,' i`5
'_ jry
.mil o.S��i. -
A.
for branch circuits with
®. APPL :"
..tM. , ;., r r
TCAN= r:;.; %>, +`GO TACT,:aP ,3: F
- ��, = " ::1 _ „�.. , iV ERSON!;l� ' �x,.
=_'.'< s; `c`: service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
Address:
each branch circuit 46.85 2
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-
_ _ : Y:'; - - - -
;:j:z
_ energy ner
panel, alteration, CONTRA
CTOR'�
ton
- gY , or
P
Business name: C'')
extension. Describe: Page 2 •- QL r -C�
l e-'
Address: v Sl' L , L (V\hp„ \ c,4 ' Each additional inspection over allowable in any of the about 2
n V ` 1 -� Per inspection 62,50
City /State /ZIP: 71(.a/i d ` t /r q'� �a_.�{ Investigation per hour (t hr min) 62.50
Phone: ( }b 2.41-1 � )0C ']_ Fax ( /) v✓ 1 Industrial plant per hour 73.75
/� i `� ; y{it:)< :IX - °': S EE EC_TRICAL; *�'. . - ,
CCB Lic.: -I,),�- Electrical Lic,4d, � Suprv. Lic.: 3 ` 5 Subtotal
Suprv. Electrician signature, required: — Plan review (25% of permit fee)
= - � I Date: State surcharge (8% of permit fee)
Print name: �KLA,c, K . ..0 , 'Z 1,2210y
Vd 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- PermiiApp.doc 12/03 440- 4Ci5T(I0 /02 /COM /WEB
- Mechanical Permit Application FOROFFICE•USE'ONLY •
City of Tigard Received �/ WO 62
Date/By: { C G • ._ u t/� " "'
Y' Pemut No.: /VI
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 //e4/411#14, I ,r I Date/By: Other Permit:
inspection Line: 503.639.4175 r. ' I
Internet: www.ci.tigard.or.us W Date Ready/By: Juris' See Page for
g Notifietl/Metho thod: Supplemental Information
�- . __ ,... � ,.» .. �- . - . .TYPE OF .
,.. _ . .WORK ,� :'. -r:,. v...,, .:::' x
,. ,:. �,. p.�: . ,..,. .. •. :..:.. ..- - >+,., _ _ �, s COMIVIERCI AL? FE E . -. S ; .'?�US @ I{LIST i .
r., r a.. ! ., v. � : �l: . . T ee: " S�:e r.s.. .. -- k5 : .. 5• . "_.._, -.. � :i
�.,
... '..�,,: - e. r .: ' :.1-..: ..' �.'ksu•.�rv'.: ;. ::,e :i•:A; ,, .•_: M1_ :r� . .:�� >.:.t
New construction E 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.
::; Value:
�:',:, -�„;'. ;,a:. C'AT'EGORY OF'�:C i N TI2 � TI 's -
„ ....,.: .,,;•_gin ... ,:. t`
t; RESIDENTIAL E'QUIP,MENT %'SYSTEGIS'FEES ;; '`'i;; . •
❑ I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
El Multi-family 111 Master builder 111 Other:
For special information use checklist.
: ",.::,o.,...,,. ......,,.:,... _. x -.:> 4":,'"'-'1'''1"".''''''1W4; esc ion Qty. Ea. Total
D ript'
' . a °� r � AT,J►. �'.m , -q: .`� �_i ... _: � � Heating cooling
Job site address: V ' Air conditioning or heat pump
�� Ir " �� s L � - l.jJV f a a.I L _Z . (requires site plan showing placement) 14.00
City /State /ZIP: - - Wit h y ( • ' Furnace 100,000 BTU (ducts/vents) 14.00
��// ° Fu 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: Su 11 l
s iC Gas heat pump 14.00
Cross street/directions to job site: JJJJJJ 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: Lot no.:
1 Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
'',. ..' -. . dr;;' j r` �. tn, rt:; �. Y = ':� ".•r;�:.. ......... • - atNh� r„ i?a', 4;: a,a��.:,x; #'= l ;n„tx <::..:',:•:, '.a::Sr n..� V } >.. ^.., �. 4, q';::.,.
:.t:, ,• �� :_�;.� � ,ps..; ��k,- �°.x:. ::�, Waterheate
' , F :. .- - r t�( ;' t ,t w - e c :: -'� =':i:'. heater 10.00
:�,;, ,- DES'.CRI -�r:±•?� =x :,�:� ,:� +' =�;:a.:,- �•,�._
.. i ".'ice: '.t��r ?f:'ts t-r5.. .'`k.
, _ : -.. ,. „ -.�77Y ,;_.:,. ,:m'.::•r.n .. - Cl:r».._. �..:_._:. -rst ....a..q s', r > r. -. ,ca. -:ai '4k _•.�..,. >, f°€s��`.�ft';;,'- -°:, , ,..: «��d` ?k'<�,�;�•"��r�t�:[
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
x :.;,. _.. ..,'.,'.,_':;;, - Chimney/liner/flue/vent
PROPERTY :OWN'ER- ,. ;•" r.t,:'' ,• =:'PE ,t, :, ;t
,..:�,�r � -� ; � � . . ,, : ,, : -,,. _ :;,. � Other. 10.00
Name: . \ -),_ `V\ . • • (1nw MI' it li I df Environmental exhaust and ventilation
Address: L )- lAtia • ii {{ !' , (,,,(t/ l / � Range hood /other kitchen
equipment 10.00
City /State/ZIP: OZ A*' . ' q' ')Q Clothes dryer exhaust 10.00
G �-� I Single -duct exhaust (bathrooms,
Phone: � fl -- ✓ / q7 Fax: ( — 2 (e;,1 toilet compartments, utility rooms) 6.80
-" �R:.i• "ii' - '7imrr .,'atno- _ _ _ __ <-as�s,# :.x:: ;rsnrzvs ,, ,�wr �x -
„ >- s .n,• - _ Attic /crawls
=��' :, ❑ � *'AP- ,P..LIC' ,�T: . «'a�a:� :�>; 1 >r;. „a;, �`.CON� ,.�. ;,a�, ace fans 10.00
': P
.k > ^.. , AN., �: t:.,. 0.;.., ACT'r�P�R$.ON - °.,.
,.: r_ _. .. -,o-. .. .,.,.. h... r n, _�- . "x �.. s ^�;aE "�-;��:.9,te .r,.. »�v;t�'�= .�,:, ,.....,,= ati ^Fvx:.., ado, e.. ar v. r,a,,.a.8:- ,:'�.:�t5:;`r °i, 4?i
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
E -mail: Fireplace
Range
,:. CONTRACTOR Barbecue
Business name: ( 1 (� r- d � P/� �7 Clothes dryer (gas)
r" ! v`L (-� Other:
Address: /� L _
N l / ` .`F' I i . firitta` . `—of *. -' 'PRMI, .... r .: � � t /� /� /) �y ��tr ,!,_ .,.....:,_...,,_.,. : M1 n, ......,.:_.u. - . .;-�,' =
City /State/ZIP: V fe")T U T ` t ^` t O 1 - el 7 (.O , (. ' :' Subtotal
Z � Minimum permit fee ($72.50)
Phone: ( )� `�. � ✓- c I Fax: ( ) Plan review (25% of permit fee)
CCB lie.: - 5,D , 1e -c) State surcharge (8% of permit fee)
f C TOTAL PERMIT FEE
Authorized signature: .0,111nririflifffif This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 1 40 \ 0 4f it.,l I Date: rd . zz * Fee methodology set by Tri- County Building Industry Service Board
is \Building \ Permits \MEC- PermitApp.doc 12/03 440 -4617T (11 /02 /COM/WEB)
Nji 5 - c- Ca
0.
STREET T CERTIFICATION i ..
.i ,„„ .
.. ..
%
I, /I/1/'� [ ,ft1� 6 / , Owner /A for /(0/ �?�/ /�5ei/G 4 '� , ::::
(PI E ASE PRINT) 4,
, (PERMIT HOLDER)
- mo .. Id s ,
.
-- Do hereb � � �f� ,. � .: �
G cer ii fy th. olllowing location 3
" , - 'i--
s fit; ! ,
meets
yea ��'rt County
l and use and development standards for street tree installation.
ADDRESS: /5 /3/ ��t'✓ liGi z /G`e6 i -
_ LOT: SUBDIVISION: 66.f r172?/ 'it k
BY: G' ,� DATE: - - 0_5
1 - — r
::
® RECEIVED BY: D ATE: - E y G ` a ,-----
Y ..
6.
n
CITY OF TIGARD
l BUILDING DIVISION PERMIT #: ...MST2005 -00006
13125 SW Hall Blvd. , Ti I Tigard, OR 972 2 3 DATE ISSUED: 2/1612005 503
( ) 639 -4171
Phone: J�i aim m INIf r Inspection Requests (24 Hrs.): (503) 639 -4175 _.
r
INSPECTION WORKSHEET FOR DATE: 5/27/2005 TIME: 7:10AM PAGE: 34
SITE ADDRESS: 15131 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: Q78 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF
OWNER: DON MORISSEI IE COMMUNITIES LLC, PHONE #: 5(3- 387 4538
CONTRACTOR: DON MORI SSE! i E COMMUNITIES LLC PHONE #: 503 -3B7 -7538
Inspection Request Scheduled For: Date: 5/27/7005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 007927 -01 503 -209 -4837 N
Corrections /Comments /Instructions:
6 *) ��;/- (:o- _b, 4rea ccit9#V ALr-7 7,7 C 260 oc
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: .5� 27 --6Y Phone #: (503) 718-
CITY OF TIGARD
. , t. BUILDING DIVISION PERMIT #: MST2005.00006
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1612005
Phone: (503) 639 - 4171 ^ d 4� y�i;
Inspection Requests (24 Hrs.): (503) 639 -4175 , ' '' � ..
INSPECTION WORKSHEET FOR DATE: 6/26/2005 TIME: 7 :27AM PAGE 39
SITE ADDRESS: 15131 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 078 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503.387 -7536
CONTRACTOR: DON MORISSEi IE COMMUNITIES LLC PHONE #: 503 387 - 7538
Inspection p on Request Scheduled For: Date: 5/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 007821 -06 503-209 -4837 N
Corrections /Comments /Instructions:
fr l PASS • ARTIAL APPROVAL El CANCEL ❑ NO ACCESS
( FAIL ‘ LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: —� Date: ' Phone #: (503) 718 -
• s
CITY OF 'TIGARD
,,
BUILDING DIVISION PERMIT #: MST2005-00006
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/16/2006
( Phone: (503) 639-4171 "trill lit
Inspection Requests (24 Hrs.): (503) 639-4175 ...—W --..,
INSPECTION WORKSHEET FOR DATE: 5126/2005 TIME: 7:27AM PAGE: 41
SITE ADDRESS: 15131 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 078 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF
OWNER: DON MORISSE I I E COMMUNITIES LLC, PHONE #: 503-387-7538
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 503-387-7538
Inspection Request Scheduled For: Date: 5/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 007821-06 503-209-4837 N
Corrections/Comments/Instructions:
..../
4111 - '---'41111°Ir -
, -
o- }t/A °.' 40 - ' / ',Ai -0 -
kf PASS 111 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
0 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: 117 Date:--C .--- Phone #: (503) 718-
•
CITY OF TIGA.RD
BUILDING DIVISION PERMIT #: MST2005.00000
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/16/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/26/2005 TIME: 7 :27AM PAGE: 44
SITE ADDRESS: 15131 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 078 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503 - 367 -7538
CONTRACTOR: DON MORISSEI t E COMMUNITIES LLC PHONE #: 503- 387 -7538
Inspection Request Scheduled For: Date: 5/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 007821 -03 503 - 209 -4637 N
Corrections /Comments/ Instructions:
YNPINA ■> 0 9 � ; L., ..,. o _ .
•
►,/ PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION, ❑ ADDITIONAL FEES ASSESSED
Inspector: A,... J �---�' Date ° '' Phone #: (503) 718 -
L�