Permit 9/Si9/D ' ., OA
C 1 OF tIGARD MASTER PERMIT
PERMIT #: MST2003 -00359
6 . � i1 r, � DEVELOPMENT SERVICES DATE ISSUED: 8/8/03
mIliii 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12170 SW KELLY LN PARCEL: 2S103CC -08700
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 034 JURISDICTION: TIG
REMARKS: New SF detached, Path 1. 9/30/03, adding (1) laundry tray.
BUILDING
REISSUE: DM194 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,612 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,708 sf GARAGE: 588 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. sf RIGHT: 5
VALUE: 321,056.40
OCCUPANCY GRP: R3 BDRM: 5 BATH: 3 TOTAL: 3,320 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 4 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: 2
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 5
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: I
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAUPANEL: 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: $ 5,733.54
DON MORISSETTE HOMES INC - DON MORISSETTE HOMES INC This permit c l Code, to the regulations contained C o i the
Tigard h r applicable Municipal Code, State work k w Specialty Codes and
4230 GALEWOOD STE #100 4230 GALEWOOD ST, STE 100 all other applicable law All work will be done i
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 t
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: 503 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: v4- 3 87 3 7 5 583 3 may obtain copies of these rules or direct questions to
1 OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8' Footing Insp Post/Beam Structural Plumb Top Out Exterior Sheathing Insr Rain drain Insp
Grading Inspection Foundation lnsp Post/Beam Mechanical Electrical Service Low Voltage Rain drain Insp
Sewer Inspection Post/Beam Structural Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp
Sewer Inspection Post/Beam Structural PLM /Underfloor Framing Insp Gyp Board Insp Water Service lnsp
Sewer Inspection Post/Beam Structural Mechanical Insp Shear Wall Insp Rain drain lnsp Water Service lnsp
/. I l
Issu • By : /A. ,• �.li« - ! Permittee Signature :.,0.P.Q._
Lttic ifif—: ----
r
- -- Call (503 639 -4175 by 7:00 p.m. for an inspection needed the next business day
Pr-- 7— 2 1 °U) T P7- 5-q-& , NL
' . -� . 3 -ov q �
1uilding Permit Applicatio . - • c)'°. -) . 7
q ' ` _r \ Datereceived: 7 dS 09b . P ern i it - n o :: _ '�, : 3
�` � � I� Tigard P no.: Expire date: ;:
City of Tigard Address: 13125 S W Hall Blvd, Ti r eR 97223 qv � .,...
Phone: (503) 639 -4171 f 1 b D ate issued: By: Receiptno.:
Fax: (503) 598 -1960 ���'
• . t t , se file no.: Payment type:
Land use approval: Gcc*- -� / * 1 &2 family: Simple Complex:
16�, ' `, Iv er ir, .s ! x I'E' F PER\lfl4 _ `t° :
. . , , p fi
_,-.O .v 1 4 : . tr r3 '4:.•''-' fi: •:.W r ` 2 ..i 1,.. R. A. - ..s l'•Yt Aq ...
❑ 1 & 2 family dwelling or accessory 0 Commercial/indu 0 Multi- family. :: New construction 0 Demolition
❑ Addition/alteration/replacement 0 Tenant improvement O'Fire sprinkler / ❑ Other:
,
: b '
.s JOB SITE 'oni i. IO .. . ' .� '`� t " a` �...•
-" ' - "r .` ��:- x,.� -xa< .es�. :a -... >a ��:.�- rw,srP : +_...,+,sac .�.�sF.,,,,�«�.= .�,x ,rr».4;t`k'r` z�*.�*.".�5."� 4
Job address: ` ve_ . . Bldg. no.: I Suite no.:
Lot: I Block: ISubdivisioi � %y} �3 Kra I Tax map /tax lot/account no.:
Project name: /
Description and location of work on premises/special conditions: p,..... 41 , �
OWNER FOR SPECIAL INFORMATION, USE CHECKLI.ST .
Name:' = 1m�i 6 (Eloodplam septicxapacity solar; etc) , _
Mailing address: ` IVEV M W' �� M I & 2 family dwelling: A y p
City: ' ZIP: - '77, i� Valuation of work $ 321 056.
Phone:. r aelitji rizaM� , -mail: , No. of bedrooms/baths ar
Owner's representative: , Will j e co.' LY, Total number of floors or
Phone: Fax: E-mail: New dwelling area (sq. ft.) ay
,: _ � � t:seank a APPLICANT x "� , - r '`. , Garage /carport area (sq. ft) . e '9 C3
Name: �' A 1 Covered porch area (sq. ft.)
Mailing address: ,-;_ a. a Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industriallmulti- family:
}S r :r .�, . Valuation of work $
.�: *ice ., ,, GO _ NTRACTOR - +t �:..-
Business name: ' Existing bldg. area (sq. ft.)
New bldg. area (sq. ft.) re - V" Address: ,4vL� �L
Number of stories
City: State: ZIP:
Phone: I Fax: I E -mail: Type of construction ...
CCB no.: .?j 5 Occupancy group(s): Existing.
_ New:
z,
Cit,' ro lic no
Notice: All .;u, t.,rs and subcontractors are required to be
4Y R b : 1? 14a : .L'CT /DI' F2:J ce S. k- - b
-� �� - .� �. �:�..� nr� _ � �_ �,_, - . ��, licensed with the Oregon Construction Contractors Board under
provisions of ORS 701 and may be required to be licensed in the
- jurisdiction where work is being performed. If the applicant is
Address: .4'1i kp C
City: State: I ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: IZIP: Amount received $ -
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A provisions of I ws and o dinances governing this 0 Visa ❑ MasterCard
_ ___ _ work will be.compl - • wi , whether _ r
cified_ier iot. _ _ _ re c / _ _ -
qq � j�J 1� Expires
Authorized sit, atu _ • , ' i i A i " �ite: 7 f l / 1o � Cdit ard number: Name of cardholder as shown on credit card
Print name: w� a � T i ( -}-. 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)
•
One- and Two- Family Dwelling •
U Building Permit Applrca ron Checklist
Reference no.:
���.c.', -J II I/ !rte
o v —1 _ Associated permits:
City of Tigard City of Tigard a � , J h 0 Electrical ID Plumbing CI Mechanical
Address: 13125 SW Hall Blvd, Tigard, O)3. 97223,JY ❑ Other:
Phone: (503) 639 -4171 44 ", A , /l`1
Fax: (503) 598-1960 '� frl " - - , _10
TILE FOLLOWING ITEMS ARE REQUIRED FOR PLAN'' �V.
REVIE
1 Land use actions completed. See jurisdiction criteria for concurrent reviews!
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
•
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application. X
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of , f
catch -basin protection, etc. J�
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state A
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed r/
if copyright violations exist. J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot v
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor. plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, [ ,.
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, X
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable. J�
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing �\
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. •
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". �(
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (M)OICOM)
Mechanical Permit App N� x f�, : . �' o- -4 -y ,� r . , , T '�
A, -Mechanical
Date received: I /4 0') Permit no.: 5 oo
:4„,„...,6,.. City of Tigard . ,� S I ' o ecUa I 1 PP no.: Expire ire date:
City of Tigard Address: 13125 SW Hall Blvd, Tig %? .
Phone: (503) 639 -4171 Date issued: By: Receipt no.: _
Fax: (503) 598 -1960 A. I. 1 Case file no.: Payment type:
Land use approval: ��11" o v. T1k oe ding permit no.:
v m r .,. '� - 0 w 4 r" a v �I r a a
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement . •
X Iew construction ❑ Addition/alteration/replacement ❑ Other.
:, "'` '. " JOB SITE INFORMATION "" ' " `` ' 4 ` ` `' "' ." VALUATION SCHEDULE - -
Job address: i c ..4 `—) O G . Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite n value of all mechanical materials, equipment, labor, overhead,
profit. Tax map /tax lot/account no.: p Value $ '
Lot: r " / 'Block: 1 Subdivision: t j ( *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: [ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE .SCHEDULE'
Description and location of work on premises: AND COMMERICALIINDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: •
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
dt T''- -' +s° :t ` ".' ,titECF1ANICAL CON;,' R"ACTOR : "" ':` ',# Boiler /compressors
State boiler permit no.:
Business name: 4 ` ► �gkei / HP Tons BTU/H
Address: air ib Fire/smoke dampers/duct smoke detectors
City: i b 1 W ZIP: k47 1 Heat pump (site plan required)
ty• �� Install/replace furnace/burner BTU /H
Phone: ,b . , Fax E -mail:
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 'F-.) ) Install/replace/relocate heaters- suspended, •
City/metro lic. no.: N/A wall, or floor mounted
(please print): 1 O ip f� ��/
Name lease not L � . i � -- t (•-l�� Vent for appliance other than furnace
A CON' ACT BL RtiON . Refrigeration:
,.. f,
.. °�,... A .n+ .� .., r . �- Absorption units BTU/H
Name: - EP--71 :\ ,pc-AP Chillers HP
Compressors HP
Address:
,_ ' 4_ 46 (' 4f • Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: IFax E-mail: Dryer exhaust
a r r r Hoods Type U IUres. kitchen/haamat
i `,9 °+'� r m • 1' 1 ,w , " F R + �� ' "` hood fire suppression system
�� a .l� �� 1 Exhaust fan with single duct (bath fans)
Mailing address: IF SillWa IT 4� t VI Exhaust system apart from heating or AC
Fuel piping and distribu (up to 4 outlets)
City: �• State' 7 411 ZIP --2() Type: LPG NG Oil
Phone: " 7- . /r Fax: E -mail: Fuel piping each additional.over 4 outlets
ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: [ZIP: Insert - type
Woodstove/pellet stove
Phone: Fat: ?E -mail: L- Other
. - Applicant's signatu " �I , / 772 i I Date: / ' 'y / U3 Other.
Name (print): fY( I'l- f �n, t
f . /
Not all jurisdictions accept credit cards, please call jurisdiction foe more information. Permit fee $
0 Visa ❑ MasterCard Notice: This permit application Minimum fee $ I / . expires i a permit is not obtained Plan review (at %) $
Credit card number: E _ z ties w i t hin -I 80-days`after-it has been
a State surcharge (8 %) .... $ •
Name of cardholder as shown on credit card accepted as complete.
S TOTAL $
Cardholder signature Amount 440 -4617 (ytxllCOM)
Plumbing Permit Applicati ®n ` , 0' : rr .; r. , ; �; ns;
Datereceived: 1 a 3 Permitno.:, yf , _co 3 6 •
'''°`�tt�l'; Cit of T1 and u r , � ®
" y g Sewer permit no.: Building permit no.:
- Address: 13125 SW Hall Blv
City of Ti phone: (503) 639-4171 Project/appI. no.: Expire date: •
Fax: (503) 598 -1960 .L 4 1 Date issued: By: Receipt no.:
0 1GP�1�D Case file no.: Payment type:
Land use approval: iNi U l 1 90" •
• t Q, r ,- - r i , < �4,, : <t L. ai iY.Yi :OF:PERAil' _ `t a. x ,:::...,
,-
,#u""s .. 5n'°.� -''fi t+b'1�_�r:..�� a.. mac �.r ^` . -:
0 & 2 family dwelling or accessory 0 Commerciallindustrial 0 Multi- family 0 Tenant improvement
•: New construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOB SITE INFORMATION •° FEESCHEBIULE: (for ' special iiformation use checklist)
Job address: a -70 -,--'/) i Ic, 1.4'1_ • Description Qty. Fee(ea.) Total
New 1- and 2- family dwellings only:
Bldg. no.: Suite rib .. (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot_ "m- Block: Subdivision: VYL= ' ' S SFR (2) bath
Project name: / If SFR (3) bath
City/county: I ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Drvwells/leach line/trench drain
Est date of completion inspection: • Footing drain (no. lin. ft.) •
- • ' PLUMBING CONTRACTOR Manufactured home utilities
Business name: ` 7j L ttr I Manholes
Address: .k2 • Rain drain connector
6Jl �', ZIP: Sanitary sewer (no. lin. ft.)
r■�1j�ai E -mail: Storm sewer (no. lin. ft.)
Phone: --- Fax:
_ ;ti Water service (no. lin. ft.)
CCB no.: ,. - 7 k.- I Plumb. bus. reg. no: - Fixture or item: •
City/metro lic. no.: N/A — Absorption valve
Contractor's representative signature `�. Back flow preventer
na . i i IGI/Tl Backwater valve
s . E`; : CONTACT PERSON Basins/lavatory
Clothes washer
Name: ) {�--i • Sp���I „le Dishwasher
Address: A i " / / ,V Drinking fountain(s)
City: I State: ZIP: Ejectors/sump
Phone: Fax: E -mail: ' Expansion tank
OWNER : , : Fixture/sewer cap ._ Floor drains/floor sinks/hub
-
Name (print): \ 1 :att G arbage disposal
Mailing address: T � Hose bibb -
City: L _ D . State , I ZIP:q 7 , , Ice maker
. Phone: .7- `"7 - I Fax: 7-7k1 .E-mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primers)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s). basin(s). lays(s)
Owner's signature: Date: Sump _
Tubs/shower /shower pan
LNGINGL:K " ; -, Urinal
Name: Water closet _
Address: Water heater _
City: I State: I ZIP: Other.
Phone: I Fax: I E -mail: Total
. Minimum fee ................ $
Not all jurisdictiau accept credit cards, please call cunsdicuon for more infomutioo. Notice: This permit application
C Visa O MasterCard Plan review (at expires if a per -tit is not obtained
_ %) I I State surcharge (8%) .••• $
C.edit card number. w ithin 130 days after it ha teen
Expires TOTAL $ _____---
accepted as complete.
Name of cardholder as shown on credit card
$
440 — $616 (baOR OM)
Cardholder signature Amount
•
•
• • • 1 ` <; ' 1 r i t,v r) . 5 F'1` : ..t
' Electrical Permit Applicati s ' , ; , . { gib _„> ,,�uu . 0 , ,,, 1�. , ;, . ,,
V Date received: IN p Permit no.:
V �1�1 - � 3
0 5
,1°j (1. City of Tigard �`�
Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, 1 :. y, 97223 ^% Q� Date issued: By: Receiptno.:
Phone: (503) 639 -4171 ) L
Fax: (503) 598 -1960 \ \,� 0- , \G V S o ` Case file no.: Payment type:
Land use approval: �0� ■ `` Q
to : , a -F . ,., :-^ <" ': q , ., . .� . V mi.. ' tin "M11. ::4 } (Fiti . . ' F ' � w F i .4-1 ,1 ✓4 1i'� t i y , ` - 'k ,.r ;,,-,,,, teil,;r<4,. . t ,,l ',tr i ' S ,, .l , `,'# t s . i: � "?'
. . . , ' I x ` ' ; f . . n tt .', � a r " :., F PE . ' " ' , F, : l . -4 4'ti - ,..
t �} 5' i t ��v - e �, R.,- -. ,, . fit .? - ., t ..1�� k
Cl 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
►' New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
JOB SITE INFORMATION - .
Job address: -70 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: - W Block: Subdivision: J�V�j� j '���`�
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
• CON RA(_ I OR (\ II,.ON,I , :.,.. % itf. ; t .,,- i t +', 3` f " F'EE,SCHEDULE
Job no:
%� Fee Max
Business name: , , Description Qty. (ea.) Total no. insp
� �- New resi den tial - sing le or multi family Per
l lrg Address: �" .. VP �` ��lg dwell un Includes attached garage.
= ,� ' MS ZIP: • Service included:
Phone: rj M.I Fax: E - mail: 1000 sq. ft. or less 4
' Each additional 500 sq. f . or portion thereof ___—
CCB no.: y Elec. bus. lic. no: Limited energy, residential ___ 2
C �� Limited energy, non- residential ___ 2
Each manufactured home or modular dwelling ■■
nature of supervising electrician (required) Date rare/ Service and/or feeder 2
T ai - T� Services or feeders — installation,
Sup. elect. name (pant): � � 9 :I License no al terat i on or relocation:
( PROPl R1,Y' ' O�ti'NER q .. ' avr t 200 amps or less 2
201 amps to 400 amps ___ . 2
Name (print): A rt~Twi7�lr�7 401 amps to 600 amps ___ 2
, .tt ` G
Mailing address: , �� 3l a zra[/7_J 601 amps to 1000 amps ___ 2
City: L • r inn ` Z IP: Over 1000 amps or volts ___ 2
Phone: , Reconnect only _ 1
Owner installation: The installation is being made on property I own Temporary services or feeders - ill...111111 .
installation, alteration, or relocation:
which is not intended for sale, lease, rent, or exchange according to 2
200 amps or less
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps ___ 2
Owner's signature: Date: 401 to 600 amps ___ 2
, , ENGINEER , ,, yam Branch circuits- new alteration,
„ - or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E - mail: Each additional branch circuit: •___
• PLAN REVIEW (Please _check all that apply)- - Misc. (Service or feeder not included): ■■
❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location Each signor outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ■■■ 2 .
❑ System over 600 volts nominal more residential units in one structure alteration, or extension
❑ Building over three stories ❑ Feeders, 400 amps or more 'Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other. Per inspection __ __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
fee f
Permit ee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan Permit f (at %) $
ID Visa ❑ MasterCard expires if a permit is not obtained
Credit card number. / / within 180 days.after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card •
S
Cardholder signature Amount 440 -4615 (6A0,COM)
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, �/�,�� , Owner /Agent for Doo �oE.-1s 7TE
I > � 1 th �' (PERMIT HOLDER) � ►
(PLEASE PRINT) ►
• Do here ce y tlat the following location ■
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• Y y ■
• meets City of Tigard /Washington County 0- land use and development standards for street tree installation. ► ■
• • • ►►
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ADDRESS: 12 ci V ii y td op
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• ■
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• • LOT: 3 SUB DI VISION: hi k 4 6 , / 5
1 BY:
t 0. DATE: l�- r03
■
■
ED BY: (/� . I ,.V /- DATE: .// -&-3 0- ▪ RECIIV y �' Is
• F
CITY O TIGARD 24 -Hour ti
BUIMIN 1 Inspection Line: (503) 639 -4175 • �u� ; � 3 CO3 V9
INSPECTION DIVISION Business Line: (503) 639 -4171
� cf BUP
Received ate Requested i Z/ ' IP /a c7 AM PM BUP
Location 4 : 7 / 20 / < e. CJ'. Suite MEC
Contact Person Ph ( ) PLM
Contracto Ph ( ) SWR
Tenant/Owner ELC
Footing
Foundation ELC
AcceSs:
Ftg Drain ELR
Crawl Drain _
Slab Inspection Notes: - L , 5 . ,L _ jI 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
hiti
•ASS PART FAIL •
'P ' . BING 'ErAI n
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 - r,'
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line f
ADA �
Approach/Sidewalk Date i � / t o L f Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
•
BUILDING Inspection Line: (503) 639 -4175 NjST ( 3 SI
INSPECTION DIVISION - Business Line: (503) 639 -4171
BUP
Received //� 9 3 'U7. ate Re `� AM PM BUP
Location T 2_I 7 6 /6_4 Suite /1J k /Q`f MEC
Contact Person e- v Ph ( ) c Oq — 4'13 7 PLM
Contractor 2- Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain - ELR
Crawl Drain
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 No
Other: /
Final E'_ Q ' 1L 6 ci
PASS PART FAIL
PLUMBING`, . u s° �{�Q, La 0- -cep 4 fiver
Post & Beam
Under Slab � "e U F` /y.d-- viz 1 '�
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 - a
Service
Rough -In
UG /Slab
Low Voltage
Reinspection fee of $ required before next inspection.. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line *7
J
ADA D l l — Ins actor Ext
Approach /Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour 2 S q
BUILDING Inspection Line: (503) 639 -4175 CIS 3 — n6) ��/
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received 3" (4
Date Requested 1 / / 2 AM PM BUP
Location / 2-1 7D Suite MEC
Contact Person Ph ( ) Q)q �'3 2 PLM
Contractor 14- Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access:
1�� (( \ . 1 y f'� i7 5 td / j` ELR
Crawl Drain "�
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
07, - v u v1 r a �'L � / S A , !tit C v' Framing
Insulation
Drywall Nailing B o ,./l S is C9 Ae D 71' y 7 [ ✓S � G G ed5
Firewall f 0
:
e a (Iowa" - S/ f/Z�c r�l/l /" D e 3 ra t �'l 3
Fire Sprinkler ✓
Fire Alarm ,Q
Susp'd Ceiling L� GI (/1 �VS l� l 1 5 a U 0)✓l 7 SSG l',-
Roof 4-11` / ,.t 9 ( J- - o n 1 51-c t irS
S P RT FAIL
PL BIN Ce — v co // . G'
Po & Be. m `
Un SI. .
5 c,,„ fh 51E- i A li e° >., v/dr- et 0gre_S
Ro gh -I, 7 ®® I
er ' ervice ` f
rev i Gt f, a C(, e o 6 l C �'. 4' �c) ( �j� Gie '@ o f ® ®t/
W-
Sa, it- Sewer 7� r f ,, i a V 9 (/ & I it IP td
Rai •rains
Cat Basin / Manhole
St. Drain
S o , er Pan
•. er.
nal 'Ilk
PA S *ART FAIL
MECHANI L _
Post & Beam
Rough -In
Gas Line
campers
" --.ART FAIL •
ELECTRIC AL
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 111 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA (� tel
walk Date It-z® I nspector G` r dvl Ext Approach /Side
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL