Permit I.
A
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00154
� DEVELOPMENT SERVICES DATE ISSUED: 8/19/03
�=-� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12245 SW THORNWOOD DR PARCEL: 2S110BC -05400
SUBDIVISION: THORNWOOD ZONING: R -
BLOCK: LOT: 025 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: DM17C STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 29 FIRST: 1,372 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,628 sf GARAGE: 425 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 288,340.90
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 3,000 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: 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: 5 201 • 400 amp: 201 - 400 amp: 1st W/0 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: $ 5,665.55
DON MORISSETTE HOMES INC DON MORISSETTE HOMES INC This d Mu n is subject to the regulations contained ie the of OR.
4230 GALE WOOD STE #100 4230 GALEWOOD ST, STE 100 all o thh Muniica ble a law State s. All work will be d olt Speodes and
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 all oer appllica w done e C it
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
5o 3 � forth in OAR 952- 001 -0010 through 952 - 001 -0080. You
LIC
Reg #: 3 8 7 7 8 may obtain copies of these rules or direct questions to .
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Mechanical Plumb Top Out Exterior Sheathing Insr 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 lnsp Gas Fireplace Water Line Insp Plumb Final
Post/Bea I - . ' - Mechanical lnsp Shear Wall Insp Insulation lnsp Water Service Insp Building Final
Is-ued By : ,i, _ /; t i / .ai Permittee Signature : \<-
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day •
Building Permit Application
Mill Date received: L / ( 0 Permit no.:( p5 / S
,
1,y. City of Tigard
CiryoJTFgard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Project/appl. no.: Expire date:
Phone: (503) 639 -4171 • Date issued: (B I Receipt no.:
Fax: (503) 598 -1960 C \ / I Case file no.: "yment type:
va Land use approval: — ,N +,'11 `r' 18E2 family: Simple Complex:
U
_ 3
TYPE OF !'ER�'I1T
❑ 1 & 2 family dwelling or accessory ❑ Commee g rib5 •' . .V\ 4 ulti- family , 'New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant r ii • m ' nt ❑ Fire sprinkler /alarm ❑ Other.
JOB SITE INFORMATION
Job address: „, V ' ,. `11J\( v 1 , . - . -- Bldg. no.: Suite no.:
Lot: , ) 3 I Block: (Subdivision: � IA,7 . , I Tax map/tax lot/account no.:
Project name: P-7
Description and location of work on premises/special conditions:
' FOR SPECIAL INFORMATION, USE Clil1 EKl:i5 "I
E - L -�� M�n 1 4AA (Floodplain, septic capacity, solar, etc.)
g addre
Mailing R� «���'
�� ' �t�!� �- ��-. 1 & 2 family dwelling:
131§11H �,'� ZIP: . x). 31111 Valuation of work $
Phone:. e �J garrigaffinig No. of bedrooms/baths ?") 4 I I
Owner's representative: VFORIEr of Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
' APPLICANT Garage/carport area (sq. ft.)
r ff i n M a 1 r L J ! 'mk a Covered porch area (sq. ft.)
Mailing address: +y-y ♦ a_ Pt., Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial /industriaUmulti- family:
' CONTRACTOR Valuation of work $
la El= �- iL fill a Existing bldg. area (sq. ft.)
�
New bldg. area (sq. ft.)
Address: . t v a. _
Number of stories
City: State: gyp;
Phone: I Fax: E -mail: Type of construction
CCB no.: 5 -2j Occupancy group(s): Existing:
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
lts�!� • : 0 provisions of ORS 701 and may be required to be licensed in the
,L
Address: i c tm7ts jurisdiction where work is being performed. If the applicant is
City: State: 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: ZIP: 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. • • rovisions of 1 ws and vlin aces governing this 0 Visa 0 MasterCard
work will be compl - • wr • , whether ifie4 tierei t. Credit card number: / /
n �1 � � ' L/C / pia
Authorized si a atu • i �1 f-e Name of cardholder as shown on credit card $
Print name: lir a - T C..p t (. 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 M
Building Permit Application Checklist Reference no.:
City of Tigard City of Tigard
Associated permits:
`J g 0 Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 O Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
TIIE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
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 K 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 stricture (including decks); location of wells/septic systems; utility locations; direction indicator, lot x
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."
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. x
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required 1'
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 (6100/COM)
Mechanical Permit Application
... Date received: K l � 0 3 Permit no tle• Arso3 - i
J1. Il
4.4 1- . .� � . City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By 1 Receipt no.:
• Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: ayment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement •
,iew construction 0 Addition/alteration /replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE -
. Job address: 1. c'-'(Gj f7\/V \ "(nom _ DC. Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: r -9. 3 j 'Block: 1 Subdivision: )Th(n1/‘J 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE::
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCIIED t+ 0
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? 0 Yes 0 No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No _ Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
�}� State boiler permit no.:
�S��i� /�f� �LJ HP Tons BTU/H _
Address: dair Fire/smoke dampers/duct smoke detectors
City: 14,,,, Lt 7m ZIP: -1r 1 a Heat pump (site plan required)
-
Phone: ___4 _ 'Fax: E - mail: Install/replacefumace/burner BTU /H
Including ductwork/vent liner U Yes 0 No
CCB no.: 'F-- r• =5(1) InstalVreplace/relocate heaters- suspended,
City/metro lic. no.: N/A wall, or floor mounted
(please print): , �
f c� ,� Vent for appliance other than furnace
Name lease tint : � L � - � (
CONTACT PERSON Refrigeration:
Absorption units BTU/H
� / i ` Chillers HP
i �� Compressors HP
Address: FM M 4 Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Fax: E - mail: Dryer exhaust
0 \V N E R Hoods, Type I/ lUres. kitchen/hazmat
hood fire suppression system
IMIIVEir, 111 _ 1 (t�,� - Exhaust fan with single duct (bath fans)
�x� _ tit de
Mailing address: / - dra1al Exhaust system apart from heating or AC
City: - „. , State•e��l ZIPR j�) �jj Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: l�ia Fax: E 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
Phone: Fax: E -mail: Woodstove/pelletstove
Other:
signaru , ,�,m �/ Date: ) (, Other.
Name (print): kL) ?i f Inal re /
T
Not all jurisdictions accept credit cards. please call jurisdiction for more information. Permit fee $
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan review (at %) $ ,
Credit card number: Expires w i t hin 180 days after it has been ( )
p State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount 440.4617 (6XIICOM)
Plumbing Permit` Application
Date received: t f 05 Permit no.: ►� ��3 .�
�,e� 1 Ci o f Tigard
�� �,� � S ewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, T igard, OR 97223 ProjecUappl.no.: Expire date:
City ofTigard Phone: (503) 639 -4171 r
Date issued: Receipt no.:
Fax: (503) 598 1960 1
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
0 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
►: ew construction 0 Addition/alteration/replacement 0 Food service 0 Other.
- • JOB SITE INFORMATION. IFEE: SCHEDULE (for special information use.checklist)
Job address: 1 iv vr�
`` ��^ J 0 nw %, D( Description Qty. Fee(ea.) Total
New 1- and 2- family dwellings only:
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: sr Block: Subdivision: L,J {(■ I,' I 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.)
Manufactured home utilities
Business namc N(LV 1 N Lo t-1,13 I 1.10 Manholes
��_ 1
City: Address: ,�r��- Rain drain connector
Sanitary sewer
City: i►lJftat _vg , State ZIP: ' (no. lin. ft.) (
Phone:( 1 _-fiL1 ip Fax: E -mail: Storm sewer (no. lin. ft.) ___
t Op-7 ( -7 i _1.-m Water service (no. lie. ft.)
CCB no.: L l Plumb. bus. reg. no: - Fixture or item:
City/metro lic. no.: N/A — Absorpt valve
Contractor's representative signature _ — Back flow preventer
Print name:. 1Cilll • � Backwater valve ,
C'ON"fr1C'•1' PERSON Basins/lavatory
1 1 SPee- )I e Clothes washer
Name: ,_ Dishwasher
Address: L r (,L) C'I ,vP , Drinking fountain(s)
City: I State: ZIP: Ejectors/sump
Phone: Fax: E -mail: ' Expansion tank ,
Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): ` ;(■S H/ )IS cE -. Garbage disposal
Mailing address: . ' • "• 24, • 1 . r " Hose bibb
City: _() , State , ZIP:9`2C Ice maker
. Phone: -",� I Fax: -70 . 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)
Owners signature: Date: Sump
• ENGINEER Tubs/shower /shower pan
Urinal
Name: '
• Water closet
Address: Water heater
City: t State: I ZIP: Other. ,
Phone: I Fax: [ E-mail: Total
Minimum fee $
'Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
0 Visa 0 MasterCard if a permit is not obtained Plan review (at %) $
Credit card number. • I / within 180 days after it has been State surcharge (8 %) ...• S
Expires TOTAL $
accepted as complete.
Name of cardholder as shown on credit card
S
Cardholder signature Amount / .1.10.4616 OA:MOM)
caton 9 FOR OFFICE USE ONLY
Electrical P ; � 6pplii Received Electrical rn ' K ^ �_
��� Date/By: Permit No, V • lat �v 3 -- J I5t
City of Ti a Planning Appr al Sign
13125 SW Hall e 1 l 2003 Plan Re : Permit No.:
Plan Review Other
Tigard, Oregon 97223 DateBy: Permit No.:
Phone: 503 -639 bF A l3 3 - 598 -1960 Post - Review Land U se
GI 17 t � DateB Case No.:
Internet: piNIS ICI y'
"""" (ul�' 1 Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 - Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
New construction El Demolition ❑ Service over 225 amps- ❑ Health -care facility
0 Addition/alteration /replacement El Other: commercial ❑ Hazardous
❑ Service over 320 amps - rating of ❑Building Building over er 10 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
N 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
El Accessory Building El Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
El Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 122 y 5 S t.) 16RA) /4 /Qo j2 DX_ FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
/ Al Description Qty Fee (ea.) Total
Project Name: p0 M O�Q /ASS -/a n
Cross street/Directions to job site: B () LC. 6?Od4,j� New residential - single or multi - family per •
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: 77fc1i ..0 /, pa J) Lot #: 25 Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
jg PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 _ 2
Over 1000 amps or volts 454.65 2
Name: D p/ f Qr 0g /53js 'j7 Reconnect only 66.85 2
Address: L 36 6,--At GJOQ j , 5 Wirmo Temporary services or feeders - installation,
alteration, or relocation:
City/State /Zip: L c F 05/4)q/, adz. 97 200 amps or less 66.85 1
Phone: 337- 75--3 r I Fa}C', 3 87 - '7G / 201 amps to 400 amps 100.30 2
❑ APPLICANT ❑ CONTACT PERSON Branch n h c amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
Address: A . Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit • 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Job No: ° �D 2 Each sign or outline lighting 53.40 2
Signal circuit(s) or a limited energy panel,
i alteration, or extension Page 2 2
Business Name: i t , �.. —
Description:
Address: / 0, i' 5 9 G y
C / St ate /Z1 y� cf Each additional inspection over the allowable in any of the above:
lt
Y P ,kL O tfr 0 /C . / 7a0'7 Per inspection per hour (min. I hour) 62.50
Phone: 3sl, - ,x492 ' Fax: /0913 —5yys Investigation fee: . —
CCB Lic. #: ? 22? 2 Lic. #: _ ye 3 C Other:
�J y Electrical Permit Fees*
Supervising electrician 4 Subtotal $
si: ature re s wired: ..00�.4i / _�i Plan Review (25% of Permit Fee) $
Print Name: L,fz / 0� 7 � i c. Viz? State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
is \Dsts \Permit Forms \ElcPermitApp.doc 01/03
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
❑ Burglar Alarm
Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems •
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems _ V
❑ Data Telecommunication Installation
❑ Fire Alarm Installation `
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑. Landscape Irrigation Control
• ❑ Medical
❑ Nurse Calls
Outdoor Landscape Lighting
❑ Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations V
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received XS SO Date Requested ` - 7Z 2 � � AM PM BUP
Location lZ- 2 4/ 5 Suite MEC
Contact Person G Ph ( ) 02 g -/f3 7 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
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
• . -
Fin -
PART FAIL
1 : NG
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O
rn
AS PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
S u ampers
Final
PART FAIL
. R
Service
Rough -In
UG /Slab
Low Voltage
Fire • arm
- Ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line may,,,
ADA Date D Inspector "� y ector 7 ) 7. Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL