Permit t CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00522
A DEVELOPMENT SERVICES DATE ISSUED: 12/2/03
��II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12350 SW KELLY LN PARCEL: 2S103CC - 08200
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 029 JURISDICTION: TIG
REMARKS: Const. of new SF detached residence.
BUILDING
REISSUE: DM198 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1.170 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,480 sf GARAGE: 683 sf FRONT: 20 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 263,233.10
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,650 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: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 4 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 FD R: PUMP /IRRIGATION: PER INSPECTION:
EAADD'L 500SF: 5 201 - 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: 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: $ 5,253.42
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
4230 GALE WOOD ST 4230 GALEWOOD ST, STE 100
Tigard other Municipal e law State work k w Specialty Codes and
all other applicable laws. All work will be done in
STE 100 LAKE OSWEGO, OR 97035 it
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
Sp forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIk 3873755533 3g may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Water Service Insp
Grading Inspection Post/Beam Mechanical Plumb Top Out Exterior Sheathing Ins Gyp Board Insp Appr /Sdwlk Insp
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Rain drain Insp Electrical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Storm drain Insp Mechanical Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Line Insp Plumb Final
Issued By : --r
-ems Permittee Signature : �—
Call (503) 6 9 -4175 by 7:00 p.m. for an inspection needed the next business day
‘. • fO rrT li ?`/-u 3 SWi cxx3 -6o38rt.
Building Permit a pplication i a � } mfl4 �k k 4 ,L ; r s ,i �;
Date
� received: // /D o Permit no.:/hsr , 03.09
i tIll'''' City of Ti CEIVED
F1� , . •
'> = Project/appl. no.: Expire date:
Cny ofTigard Address: 13125 SW Hall Blvd, Tigard, g OR 97223
Phone: (503) 639 - 417 OU 1 ZOOJ Date issued: By: Receipt no.:
Fax: (503) 598 1960 Case file no.: Payment type:
Land use approvaC OF TIGARD 1 &2 family: Simple -7 Complex:
BUILDING DIVISION
TYPE OF PERMIT .
CI 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ›'New construction ❑ Demolition
❑ Addition/alteration/replacement CI Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
,. ,' � y � � ``�« s.� �,JOBaSIZE� ORb 1ATI . w� �� ��r� .. ' n`���' ���x�'s� � �z' .�•.
Job ad` ss: « 7 j , k r i Bldg. no.: Suite no.:
Lot: Block: Subdivision: \A 'IF sor r: Mr ' Tax map /tax lot/account no.: ,AS 0 'r -o Fi'a -e
Project name: '-f. 5
Description and location of work on premises /special conditions: (.. ) 1 112.A,6 C(8
'1`:',M , � F` ,Y'ili OWNER is '
t , ,, ts r � " - , �i � FOR�SPECIAL IN60RMATION, ,USE CHECKLIST
�, 1
��; . �( t�� ; � r/ � g �,(FIo d�pfarn eptrccapacrty so lar,etc.) : P, 4
Mailing address: agm� „ i r " ' ra i 1 I & 2 family dwelling:
City: 111, , , Kf 't ZIP: 'T) Valuation of work $
Phone:. `7- 7S Fax :5i1)-- , -mail: No. of bedrooms/baths L( l 0
Owner's representative: A , , ak F 1 G iii ' ' Total number of floors i
Phone: Fax: New dwelling ar•�a (sq. ft.) er
' ' ` us r' t ",,,, '� . y:. CAI` , f or i fit l � y r ' r ' 0
- : ; - t ....v,::' '_. ' "• :,, ... Garage /carport area (sq. ft.)
Name: V Cpl k - 'C " - ' t, Covered porch area (sq. ft.)
Mailing address: : a- ci. v'r' . Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial /multi- family:
CONTRACTOR Valuation of work $
Business name: k Yl 0 •• p 1 ^ i Its) Existing bldg. area (sq. ft.)
Address: New bldg. area (sq. ft.)
«' ` Number of stories
City: (State: I ZIP: Type of construction.
Phone: I Fax: I E -mail:
CCB no -Z) C7 ?j Occupancy group(s): Existing:
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be •
.- � 4i ;- ARCH.1 CI /DESIGNER °a �.,_ 444 g
•,,; .,�-, '��' ti -gin „�,.,,,,�,, ,�,�, �,,,<� ,, ,� • „ � license with th e Oregon Construction Contractors Board under
Name: (-10 L , , provisions of ORS 701 and may be required to be licensed in the .
Address: c- ){ a. 6L - 6L �• jurisdiction where work is being performed. If the applicant is
City: State: I ZIP: exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
'> • -' ,. ENGINEER
r-
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: (ZIP: Amount received $
Phone: (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 . rovisions of I ws and o dinances governing this o visa ❑ MasterCard •
work will be complt wt.', whether cified__ Herein r��ot Credit card number: I /
t - -/ Expires
Authorized si: atur-• , I A 4 1'1K l Name of cardholder as shown on credit card
■ Print name: t ( / Cardholder signature , l
Amount $
•
Notice: This permit application expires if apermit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/00/COM) .
. /
One- and Two - Family Dwelling " {
1; A I I .+, Building Permit Application Checklist Reference no.:
Cary ofTigard CI of Tigard Associated permits:
`J t� ❑ Electrical ❑ Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
�. a . . Q �L h .,
? THE 'FOLLOWING ITEMS ARE. RE UIRED FOR PLAN- REVIEW��+ �� '-"�' �'� � * {ti,Wes' ..: , l\To'�N /Qk
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.
9 Erosion control 0 plan 0 permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 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.
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.
a ",; VI : ` ' .. .-' , z : JURISDICTIONAL S P ECIFI CS
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 (troo /COM)
., . ...„ . . . .
• ,. Idle chanical Permit A iication . r2a . ti .
r �. ICEI Date rece Permit no. U 3 w 5d- I
fy�l�) ' City ®Y 11 ar Pro ect/a l no.: Expire date:
City of Tigard Address: 13125 SW Hall lVoleigazul, ` R� 7223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 ltll�n
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TIGARD
Land use approval: BUILDING DIVISION Building permit no.:
. TYPE'OF PERMIT y'T 4a , f r � e;, ,� i� x , , t �r=� s „ t e ;.
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
,few construction ❑ Addition/alteration/replacement ❑ Other:
r f t <g � ,, ..IOB SI r i lk, t ' I f MM ; ' COMMERCIAL VALUATION SCHEDUI E +
. Job address: • ' Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: EMIMMIMIE1111 value of all mechanical materials, equipment, labor, overhead,
profit. Tax map /tax lot/account no.: p Value $ '
Lot: Block: Subdivision: f."11,4 r � ' 7 `See checklist for important application information and
Project name: - A i ' jurisdiction's fee schedule for residential permit fee.
', +1' & )FAMII YttDIVELLINGRERMT,rIFEE SCIIEDULE
City/county: � � r
A1�f11 ;CO�IEALIINUSTRIAEEQUIPMDENTSC lEDULE
Description and location of work on premises: ,�., ..., . �,. ,, . :44 ;.fr ;: ,, r ,, �,, y .,, , : - ,.4,,,,, . „..
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 M
i " k' r ` r sr ,' f�1 z ;VIECFl 4 g liRn X.& : = a li Boiler /compressors
�. � .. .. kr . s., , _. �} _ ,�* .., t x ,� ' a State boiler permit no.:
` fir HP Tons BTU/H
Address: „,, Fire/smoke dampers/duct smoke detectors _
s m ZIP: mill Heat pump (site plan required) ■ --
Phone:,/ - ' Fax: E -mail: InstalUreplacefurnacelburner BTU /H
_ Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: , . Installreplace/relocateheaters – suspended, ■ --
City/metro lic. no.: N/A wall, or floor mounted
Name lease rint 112; Vent for appliance other than furnace _
CONTACT PLRSON Absor
_ ,'� ` � �• • `� '�• Absorption units BTU/H ll
1 I li Chillers HP ME
Compressors HP El
Address:
�. ♦ �JT Environmental exhaust and ventilation: ■ --
City: State: ZIP: Appliance vent _ __
Phone: Fax: E -mail: Dryer exhaust
. - _ . t Hoods, Type U II/res. kitchen/hazmat
O�Ia�ER yp ■
hood fire suppression system
• _� .in l it Miran riii Exhaust fan with single duct (bath fans) - .
Mailing address: tr T Exhaust system apart from heating or AC _
g, �
��' �� ZIP ♦ Fuel piping and distribution (up to 4 outlets) ■--
Type: LPG NG Oil
Phone:.j� Fax: E -mail: Fuel piping each additional over 4 outlets _
' .t` - 'ENGINEER - Process piping(schematicrequired) - M.
Name: Number of outlets
Other listed appliance or equipment:
II
Address: Decorative fireplace
City: State: ZIP: Insert – type ME
Phone: Fax: E -mail: Woodstovelpelletstove -
Other: NM
, Applicant's signatu" .4,M7'I GPAI Date: / L' fli Other: ME
Name (print): .' * j MI
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ 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 -be —
State surcharge (8 %)
Name of cardholder as shown on credit card accepted as complete.
S TOTAL $
Cardholder signature Amount 4404617 (6AXYCOM)
P Plumbing Permit Application ®� 9 0 x a t s ., ,, alt ,.. , t ,..
i robing Pe A1118. Applict$ y `�,"x s z h ..< ` y x -,..- t •. ','�'� l ' i s t �'.� '4'; �' u. ` l ss
. E C 1 V D Date received: Permit no.: 5 j a 03_a)5 , s
' j lit City of Tigard Sewer permit no.: Building permit no.:
iryof T Address: 13125 SW Hall Blvd. and OR 97223 ire date:
Ciry oTigard Phone: (503) 6394171 1 Project/appi no.:P
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
CITY OF,TIGARD Case file no.: Payment type:
Land use approval: 1_ • _ - . t o .
,: _, , .. Y , . ,'' ' x- TYPE;OFiPERmir' . . 1. " , ,r /-1 ,, tg,. 1 � ; :
t
0 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
lz New construction 0 Addition/alteration/replacement 0 Food service 0 Other.
JOH STIEINFORMATION • . FEE SCHEDULE (for special information use checklist) .
/ ' G Description Qty. Fee(ea.) Total
Bldg. address: /"\i New 1- and 2- family dwellings only:
Bldg. no.: Suite ..: (includes 100 ft. for each utility connection)
Tax ma./tax lot/account no.: SFR (1) bath
Lot L Block: Subdivision: 1111 ' SFR (2) bath
Project name: Viit M=1 SFR (3) bath
City /county: 1 ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities:
Catch basin/area drain
Est date of completion/inspection: _ Dryweils/leach line/trench drain
— . Footing drain (no. lin. ft.)
• I'LI= ' CONTRACTOR Manufactured home utilities MEI
Business name: TS ` p L v Manholes MI
Address: VIN=12_i Rain drain connector 111111
138211—'"11741U12.1 ZIP: _ Sanitary sewer (no. lin. ft.)
E -mail: Storm sewer (no. lin. ft)
Phone: ,4 '_� Fax: , -1, 1 Water service (no. lin. ft.) I
CCB no.: ( ("7 ( -] Plumb. bus. reg. no: - — spy' Fixture or i tem:
City/metro lie. no.: •/A Absorption valve I
Contractor's representative signature �(/ n ``'' Back flow preventer
1ma
/ l,�r�I. k, Backwater valve
;,(,,� t, <,'t;'t �. „1 - t0'1'AC G • =.
�i -tt ,. � `� ' ; r Basins/lavatory
� 1t Clothes washer
Name: `—i , • /- N ' 1 e Dishwasher
Address: 111/1ki . 0 ,t, ,V — Drinkinc fountain(s)
City: State: ZIP: Ejectors/sump
Phone: 'Fax: 1E-mail: Expansion tank
f. :: OWNER Fixture/sewer cap _
Floor drains/floor sinks/hub
Name (print): : .ait t b` ., - Garbage disposal
Mailing address: 4. '!a�� H ose bibb
City: _0 . State ) ZIP:C7 7N j Ice maker - -=
. I Phone: 71 , — j i Fax: 4.7 E-mail: Interceptor /grease trap
Owner installation /residential maintenance only: The actual installation Primer(s)
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
ENGINEER . - Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: [ State: I ZIP: Other.
Phone: I Fax: 1E-mail: Total
Minimum fee $
Na all jurisdictions accept credit cards, please call jurisc]icuon for more information. Notice: This permit application
Plan review (at %) $
0
Visa MasterCard expires if a permit i not obtained State surcharge (3 %)
C.cdit card number. w ithin 130 days after it has been $
Expires accepted as complete. TOT:%I.
Name of cardholder as shown on credit card
S
4304616 (6r0 COM)
Cardholder signature Amount
� c �y — g
• r m i
JYJ��i. �.YY� �$ 11i�i1.131 a gg�� �" y � ,«. � t l sa "u " ,. .t r . t . `u t. ' ; ,{c' �i " . ,%F, t`r
i � � ®IiH _� a�.a�j,rr��s,,.c_,: a�ec � �:" t i5 �r I
RECE Date received: Permit no.: a3-el/ -
a►}°'� �I City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Bl `ftga'�rd(jO f•,--.J.,,_ . 23 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 CITY OF TIGARD Case file no.: Payment type:
Land use approval: BUILDING DIVISION
�g , TYPE-OF`P ' e . . t r 4. . , i ,t..
� : {.. �r .. � '�� : E . ? „ . d .j}�, afc � s £x 4 : M..1 +., F . : eF° k iV f !y t'° i m F'�
D I & 2 family dwelling or accessory D Commercial/industrial ❑ Multi - family ❑ Tenant improvement
I' New construction 0 Addition/alteration/replacement ❑ Other. ❑ Partial
s ,�, q v r r a '� JOBSI4TE RMATIONP
INFO441:cR :'A. _. x' .�-4- nu 141, ,h 4 .
r�c �` gy ', ^sx' ��r' �?� ' '_'''�..'� +� T 3 -. - . j ES�"". k� r : -. ,��..u�+�4 Ey ���r w , � ..._
.., a;�31 "' .,'�r"'. , <sx� .+#._ .k ..�?�` t ✓f , t,tns,���� �..a. _ . � ., ' -
Job address: �� E I Bldg. no.: Suite no:: Tax map /tax lot/account no.:
Lot: -T"' Block: Subdivision: WV /■_7
Project name: Description and location of work on premises:
Estimated date of completion/inspection
t - <' QS141(t e i 4R''' 1 , ' P1'i 1 4A t)iV ri i ' v -, - • FEE SCHEDULE Y � _ r _; i° =; ,
�'t - ' )<. . n A'9e, a . .. .,...
t R" ..1.:... Fee Max • Job no:
Description
New residential - single Qty. (ea.) Total no. imp gle or multi - family per
- 111
Address: AP il � dwelling unit. Includes attached garage.
+.� ' g • I l Service included: 4
Phone: ��a Fax: E -mail: 1000 sq. ft or less
Each additional 500 sq. ft or portion thereof _= =_
CCB no.: , �� Elec. bus lIC no: i Lim energy, residential 2
C Limited energy, non - residential ___ 2
413 2 Each manufactured home or modular dwelling ■■�
Service and/or feeder
nature of superwsing electrician (required) Date A, grw
License no 9 a Services feeders
n o lca on 11111 ■
Sup elect name (print) �, 9 ttii Zl alteration or relocati
; y F - - 4-, - ...";'' PROPEL R'I Y ( }WNI R; ` =_ "' fi : 200 amps or less 2
201 amps to 400 amps ___ 2
Name (print): \. at 11...e. 401 amps to 600 amps ___ 2
Mailing address: � �►�� '� /
� addrss: , �li�;Rj >♦ R�. S" a 601 amps to 1000 amps ___ 2
City: . • , t.
[ mod" ZIP: , Over 1000 amps or volts ___ 2
Phone:, Reconnect only __ 1
Owner installation: The installation is being made on property I own in tnp adon,a te ,orrelo .
which is not intended for sale, lease, rent, or exchange according to allationiterationorreloca6on:
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 MIMI _ 2
W �; r y Mir ,�. ENGINEER - 1 x Branch circuits - new alteration,
,:- 7 , ;4's, . g f i, -�1.-1 ` r. . el . i . ,.. '' '-. W.' . : i '' ''' = rg'r . '' lea • :. , st x '' ''
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: • __—
`"" R . x G' PLAN REVIEW '. (Please.check all that apply) . . - , misc. (Service or feeder not included): IIIIII
❑ Service over 225 amps- commercial ❑ Health-care Each pump or irrigation circle 2
are facility
❑ Service over 320 amps- rating of 1&2 0 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 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 iniormauon. Notice: This permit application $
❑ Visa ❑ 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
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Cardholder signature Amount 440 -4615 (6/0000M)
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. STREET TREE CERTIFICATION .: i
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i . I, , Owner/Agent for
(PLEASE PRIN1) ,
(PERMIT HOLDER)
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A Do hereby certify that the following location ■
I . meets City of rfigard/Washington County
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A land use and development standards for street tree installation. ■
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' 1 ADORESS: 0, 3 50 5 u3 \z,e M k,- N , I / G-(41- (3)Z. 97;72 3. I■
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' - LOT: 7) . SUBDIVISION: kk WS ) \ 5\ W'PN\ \ I N
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A ' DATE: /--/- 7— ° ■
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RECEIVED BY: ,/, I' or
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171
l BUP
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Received /4 7" � P � Date Requested 4"7i') '*/ M PM BUP
Location / 2 3 50 Suite MEC
Contact Person /.� Ph ( ) ' —4 1I 3 7 PLM
Contractor 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
Other:
Final
PASS PART FAIL
PLUMBING. "
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
• 'S PART FAIL
CHANICAL
Post .& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
'ELECTRICAL
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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date F Inspector Ext
Other:
Final D • NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour ..
BUILDING Inspection Line: (503) 639-4175 MST 5-2Z__
INSPECTION DIVISION Business Line: (503) 639 -4171
(/ , / BUP
Received 9/' T� /cP Date Request d ' — 7 � � AM PM BUP
Location / Z S v Suite MEC
Contact Person ' % Q!k-e. Ph ( ) g — C/137 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing • ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath/Shear .. Jv LIy � _ - 7 _ . 4,5-
Framing •�
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
S S PART FAIL
- - 1 -
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
F in OPART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date — 7'r ��— Inspector 44 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 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested _ AM PM BUP
Location /;,356 ( O i Suite MEC
� �
Contact Person �` e . Ph ( )22 C 7 '/' 3 7 PLM
Contractor 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
Fi rewal l
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
r
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
Service
Rough -In
UG /Slab
Low Voltage 6J-- - C7 0 - 7 a'`
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
an PART FAIL
S Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA c �`
Approach /Sidewalk Date 24' � 04 i Inspector � 1 " Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL