Permit •
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00540
111 DEVELOPMENT SERVICES DATE ISSUED: 1/15/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12210 SW KELLY LN PARCEL: 2S103CC -08600
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 033 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: DM170QA2 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1,570 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,620 sf GARAGE: 405 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 308,033.70
OCCUPANCY GRP: R3 BDRM: 45 BATH: 3 TOTAL: 3,190 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: 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: EAADDL BR CIR: SIGNAL /PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 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: $ 5,621.47
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
Tigard other Muni Code, State work k w Specialty Codes and
4230 GALE WOOD ST 4230 GALEWOOD ST, STE 100 all other applicable laws. All work will be done in
STE 100 LAKE OSWEGO, OR 97035 accordance with approved plans. This permit will expire if
LAKE OSWEGO, OR 97035
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
5p3 forth in OAR 952 - 001 -0010 through 952 -001 -0080. You
Reg #: LIC 387 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control 681 -44 Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr Gyp Board Insp Appr /Sdwlk lnsp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line lnsp Storm drain lnsp Mechanical Final
Foundation lnsp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final l Z----,
Issued By : _ _,., . _' Permittee Signature : .,(/
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
rti
}' I City ®� Tigard d Date received: j L 10 05Q9 '4 Permit uj�l o.: �p j [�/6
Project/appl. no.: Expire date:
City of Tigard
Address: 13125 SW Hal t i : ;� �)�j 97223
Phone: (503) 6 • iih Date issued: �I Receipt no.: Q1
Fax: (503) 598 • i' 04 ' ase file no.: Payment type: r
� l � � �
u Z� .
Land use approvals . _ i • 1 &2 family: Simple Complex:
=r
r 1 (t)
'T'YPE OF e PER M I I' ; <'. x *ks }' '` ' & 4 c'� ' W F ;r l a4,...' .;; � k �
❑ s
1 & 2 family dwelling or acces hig ommercial/industri. ❑ Multi - family , New construction ❑ Demolition
Addition/alteration/replacement ❑ Tenant improvement Fire sprinkler/alarm Li Other:
ment ❑ Ft
J lli „; n?' f ' <:,:- -ter X . °x .. NI - s `'` G 4A 3?� ' `� �` 'r ' �-
- -4--- s . ' ' � '' ' .' ..: . , J O SITE TI�OI%N 1 ` �, • a ,. , Wit '
Job address: 1-t 1. 4 Bldg. no.: Suite no.:
Lot: Block: Subdivision. i (2 / ' IC Tax map /tax lot/account no.:
3`.
Project name:
Description and location of work on premises/special conditions:
w rx - y 4 - .. .OWNER ` _ - :. - ,`, ' ._ FOR SPECIAL INFORMATION; USE. CHECKLIST '
y I- M _ ' '4 septiccapacrty solar, etc ) tt {V 1 -
Mailing address: ityjirarMINEINalZiniartaa 1 & 2 family dwelling: ti
1011111 A ZIP: - ) WI Valuation of work $ b
Phone:. '��'jl '�l 4
No. of bedrooms/baths 2 l 7i
Owner's representative: AW _ Total number of floors •• _
Phone Fax E-mail: New dwelling area (sq. ft.) lin
^Pi '" r r.. 43L`$� x ,t A �, �Xi. ?{' s � 5
lr•
,,., �; 4 �. . ,• 8 , N '. zx i f :. , ZR1 ' °' ? = ;4 i Garage /carport area (sq. ft) ,4-
Name: \. e1\ Y A Covered porch area (sq. ft.)
Mailing address: c- ' ; _, c 5 a . ,�j' Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industriallmulti- family:
. CONTRACTOR Valuation of work $
Business name: MI' amrgi Existing bldg. area (sq. ft.)
Address: : ".� ` i &_a �— New bldg. area (sq. ft.)
City: State: ZIP:
Number of stories
Phone: I Fax: I E -mail: Type of construction
Occupancy group(s): Existing:
CCB no.: 2) S rj �j
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
'.,, ,* 4 ,�: aARCIIITUT /DESIGNER s,H i >,.; tt ka
4 „ 4 „� m *�) a „ , A; ,�« z ,,,�,.„„ a ,.,,. � „_, ���,,, ,�,�, ,�,�o, licensed with the Oregon Construction Contractors Board under
Name: ( -1Lj,.‘� -, L r- provisions of ORS 701 and may be required to be licensed in the
jurisdiction where work is being performed. If the applicant is
Address: ti•� �L� �� x�V
City: State: I ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
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 srovisions of laws and o dinances governing this 0 Visa ❑ MasterCard
work will be compl wi h, , whether sb cified 1erei resat j Credit card number: / /
I J � t—�I r
Authorized s1 naturs' A f ? - i / .. CC: ` � � Name of cardholder as shown on credit card Expires
-- ,
Print name: '� � - K... 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)
a
•
•
A lb One- and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
-
• Associated permits:
CuyofTigard City t� of Tigard
UT2 0 Electrical 0 Plumbing O Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 1 o , ther:
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 f ' d R ;P
TIIE FOLLOWING ITEMS ARE 'FOR PLAN REVIEW ° ' • - • Yes No .N /A
1 Land use actions completed. See jurisdiction criteria for concurrent revi ws c� v I'
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc."
4
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. X
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan ❑ permit required. Include drainage -way protection, silt fence design and location of ; j
catch -basin protection, etc. J(
I0 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
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
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 ,
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,
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.
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.
.1;' 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 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 (6/00/COM)
,i • • • • „ a -r ,, ... -�,. y` 1.,, ,�, „.. f ,,,,: .,pig '1 .._,. 3'�.,.
., A IVlechanacal Permit App , $ y � " $-,- -� , z . . ,; a , _ 41:
_ n .
Date received: Permit no.: H67 • 3 - 00590
^ I. �: City Tigard
i and P ro ecUa PP 1 no.: Expire date:
Q ( , V
City o'Tigard Address: 13125 SW Hall 13113 'd` al$ l 97 J Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 fFC .i v 2003 Case file no.: Payment type:
Land use approval: CITY OF TIGARD Building permit no.: .
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
Iew construction ❑ Addition/alteration /replacement ❑ Other.
" JOB'SITE'INFORMATION . ` a 'g :. . ' '' COMMERCIAL1`VALUAT - ION - SCHEDULE 4t r *4:
Job address: „M ' �� ,, . `a , Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite •.: value of all mechanical materials, equipment, labor, overhead, •
Tax map /tax llot/account p rofit.
account no.: Value $ '
Lot: Block: Subdivision: ' *See checklist for important application information and
Project name: 4 r jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: ° 24 1 & 2TFAMILY °DWVEI I ING PERMIC FEE'SCIIEDULE °'
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCI
. 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? ❑ Y es ❑ N o Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
rte*. rF lea ya r. k�3 w s -uri 3 fK+.$✓„
,s ue y MECHA:NI,C 'agfikQNT�RAG tOktc rat Y, Boiler/compressors
�� State boiler permit no.:
Business name:
I ej MINIM HP Tons BTU/H
Address: � �etb Fire/smoke dampers/duct smoke detectors •
� r
• IZEIZEM ZIP: it Igo Heat pump (site plan required)
�' Install/replace furnace/burner BTU /H
Phone: Fax: E -mail:
Including ductwork /vent liner ❑Yes ❑ No
CCB no.: — , • Install/replace/telocate heaters - suspended,
City/metro lic. no.: N/A wall, or floor mounted
. Name (please print): ' to 2 ��� Vent for appliance other than furnace
CONTACT .: PGRSON : Refrigeration:
Absorption units BTU/H
ME tom .. A , a, Chillers HP
Compressors HP
Address: &a_ �l Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust ,
OWNE Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
EMIIIM �� Exhaust fan with single duct (bath fans)
Mailing address: i Mai Exhaust system apart from heating or AC
�
Fuel piping and distribut (up to 4 outlets)
City: � � YPe� T LPG NG Oil
Phone:. 2 Fax: E - mail: Fuel piping each additional over 4 outlets
• .. . ENGINEER - Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: [State: [ZIP: Insert-type
Phone: Fax: E -mail:
V, ', rI' Woodstove/pellet
Other:
Applicant's signatu " Date: /I M MO Other.
Name (print): j -,' ', . a ,
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
0 Visa 0 MasterCard Not Th permit application Minimum fee $
expires if a permit is not obtained Plan review (at _ %) $ / / Credit card number: Expires within 180 days after it has been
p State surcharge (8 %) .... $
complete.
com as
Name of cardholder as chows on credit card accepted P
S TOTAL $
Cardholder signature Amount ) 440 -3617 (6r00/COM)
Plumbing Permit Applicati ®n 4X44 , '.: � ,.-, 's :: hat ,; , .
Date received: Permit no.:Ihr Y3-a 4
�. ►s
EZ SII 11 gard Sewer permit no.: Building permit no.:
T 25 SW H allRE
City ofTigard Project/appl. no.: • Expire date: •
Phone: (503)- 6394171
Fax: (503) 598 -1960 DEC 1 v no Date issued: By: Receipt no.: ■ .
•
Land use approval: _ F FGA D — Case file no.: Payment type
•
1112Y.." t5F'PEBMIT l
Cl 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
b: New construction 0 Addition/alteration/replacement 0 Food service 0 Other:
JOB SITE NFOBMATION . , FEE SCHEDULE (for special information use c hecklist)
Job • Description Qty. Fee(ea.) Total
Bldg. 0 �t. _AA �' New 1 - and 2- family dwellings only:
Bldg. . n no.: o.: Suite no. (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: -- SFR (1) bath
ot P'
L ' Block: Subdivision: yiyA ,�� SFR (2) bath
• Project name: %. SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Est date of completion/inspection: Drywells/leach line/trench drain
—. - — . Footing drain (no. lin. ft.)
k +,
' I'LCIAIIHNG. • CONTRACTOR„ • t , Manufactured home utilities
Business name: (`V\ O F i � Q I Manholes
Address: ' Rain drain connector
_t ■ State Z IP . _ Sanitary sewer (no. lin. ft.)
Cit Storm sewer (no. lin. ft)
Phone: �"1 1 Fax: E -mail: ~ • 1 Water service (no. lin. ft.) IIIII
CCB no.: t ', • - 7 k - I Plumb. bus. reg. no: -
Vilp Fixture or item:
• City/metro lie. no.: N/A / C ' / Absorption valve
Contractor's representative signature •/ �v %1 / �. �- Back flow preventer
' � P\- I a��1� Backwater valve IIIII
:;A: F F:'''V , " ! '..'CO`1`' c( �. "I'I Rs(1 . ;'! s l te r , } n ; ` :1 41 Basins/lavatory i
i ` . ( �� D' ' 1 e Clothes washer
Name: �- > N Dishwasher
Address: • i / 1c ,V Dnnkins fountains) la
City: State: ZIP: Ejectors/sump
Phone Fax: E -mail: Expansion tank
''� '. OW \1 R. - . Fixture/sewer can _—
Floor drains/floor sinks/hub
Name (prim): �u`; lL at t ✓` ri Garbage disposal = MI
Mailing address: 1 Hose bibb
���A , Ice maker
City: ._ � . _
Phone: f , - , J Fax: 4 .7-'7 i E-mail: Interceptor /grease trap
Owner installation /residential maintenance only: The actual installation Pnmeri sl
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
-• . NGINGEK Tubs/shower /shower pan
Unnal
III
Name: Water closet
Address: Water heater
City: State: r ZIP: Other.
Phone: I Fax: E -mail: Total
Minimum fee S
Not all l jurisdictions accept credit cards, please call jurisdiction for more information.
foration.
Notice: This permit application
Plan review (at _ %)
0 Visa O hlisterCard / expires if a permit is not obtained
C.cdit card number. / w ithin 1 d ays after it has ben State surcharge (8 %) ...• $ -�—
Expires TOTAL C ----
accepted as complete.
-- None -ot- cardholder -as-shown- on -credit-card
s Cardholder signature Amount 440 -1616 (600eCOM)
e e r ct v ' t e�d
• " Electrical Permit Application - . o e fi; i � i z,- •
Date received: Permit no.: N5T216o _403-e/4
_71 1-1,1 . City of T i'I ° ' lily Projecdappl. no.: Expire date:
City of Tigard Address: 13125 - e ► • • v , Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598- 1960CEC I V Z not J Case file no.: Payment type:
Land use approtaY OP TIGARD
_ .... c..,... 5IUN
TYPE OF PERMIT' .
• ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
V. New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
n � _ .1 JOB STTE INF.ORMATION,� { = i ¢ �§ t s r .iaz } ., , -. , .
L s .i'.33, ., IPZ,:r / '. � V �" ; ` i i 4 f ?'46," A r .: ., r • '
Job address: � .�y���� / �ffir ,A •
Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivisi - . .VMa !WO 7 .
Project name: I Description and location of work on premises:
Estimated date of completion/inspection:
r r b FEE -.SCHEDULE t I.;� i ;,;, � `l
�'�,.;� t?4� � ON I'RI�C� • I ()ft`s !� ^l'•l'(IC � \;I•10?� �� 4 � ",._, ���`.�ir�"• w . .� m''` ",`•fi ... _ ...
Job no: 1. t Fee Mart
Business name: ,/ ‘ Description Qty. (ea.) Total no. lnsp
_ Llf � — New residential - single or multi-family per
Address: " a ' dwelling unit. Includes attached garage.
=� • s ZIP: i ......, , Service included:
Phone:L i •: Fax: E - mail: moo sq. ftorless 4
0 t Each additional 500 sq. ft. or portion thereof
CCB no.: y Elec. bus. lie, no: �/ �s L energy, res 2
C' Limited energy, non - residential 2
Each manufactured home or modular dwelling
, nature al electrician (required) Date Service and/or feeder 2
Gti Services or feeders- installation,
Sup elect. name (print) _ 9 „ License no: I ' alteration or relocation:
I r - ` ^P' PR
` OPT R;I'Y (0:t4tR,f, '"" t ' L' v • ` 200 amps or less 2
(prim): 1. ilk ►J�.r1
Name \ \.G 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: � � )� r� . ' I • 601 amps to 1000 amps 2 If
City: c 11 L State ,AF ZIP: j - 20 3 Over 1000 amps or volts 2
Phone: , • h . � - / � ar -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary servicesorfeeders -
which is not intended for sale, lease, rent, or exchange according to installation alteration, or relocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
- - „ - ,.EN z f ,, , . 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: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: Email: Each additional branch circuit: .
'. PLAN REVIEW. (Please check all that apply). ;'°'°' Misc. (Service or feeder not included):
irrigation circle ri
i
Each pump or rg
O Service over 225 amps- commercial ❑Health -care facility Eac . 2
O Service over 320 amps rating of 1 &2 0 Hazardous location Each sign or outline lighting
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories 0 Feeders, 400 amps or more •Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan 0 Other. Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application $
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %)
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 (6/0000M)
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1 - S TREET TREE CERTIFICATION
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, Owner/Age
(PLEASE PRIM) nL for r3c70 (Pe■ r / - 55 e .77'-e_ 1-le
(PERMIT HOLDER)
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Do hereby C60:ify thAt the following location 0-
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A meets City of Tigard/Washington County ■
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land use and development standards for street tree installation.
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
// , J BUP
Received Date Requested 7` -13 e �`' AM PM BUP
Location / 2 Z/ O Suite MEC
Contact Person • D Ph ( ) Q - 6 -C - 9 9 PLM
Contractor /2 ,1 Ph ( ) SWR
UILDI Tenant/Owner ELC
Foo ELC
Foundation 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
•Ot --r
Final
PART FAIL
Po . :eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
•
CEO
P SS PART FAIL
IC L
Post & Beam
Rough -In
Gas Line
• • Dampers
1
PART FAIL
Service
Rough -In
UG /Slab •
Low Voltage
�rm
Final' Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 9 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL