Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00296
�!�I DEVELOPMENT SERVICES DATE ISSUED: 8/22/03
"�---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12240 SW WHISTLER'S LN PARCEL: 2S103CC - 09900
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 046 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: DM199 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 28 FIRST• 1,610 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,790 sf GARAGE: 652 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD sf RIGHT: 5
VALUE: 330,700 80
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3,400 sf REAR 15
PLUMBING
SINKS: 1 WATER CLOSETS. 3 WASHING MACH. 1 LAUNDRY TRAYS. 1 RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 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: 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 W00DSTOVES: 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:
EAADD'L 500SF: 7 201 - 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: $ 5,804.08
DON MORISSETTE HOMES DON MORISSETTE HOMES INC This permit is subject to the regulations contained in the
Tigard other Municpal Code, State work k w Specialty Codes and
4230 GALEWOOD STE #100 4230 GALEWOOD ST, STE 100 all other applicable laws..
ve 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 - 3875 Phone: Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 -001 -0080. You
Reg u: L1 5Q �3 - 387 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 Ins l Rain drain Insp Electrical Final
Sewer Inspection Underfloor insulation Electrical Service Low Voltage Storm drain Insp Mechanical Final
Footing Insp Crawl Drain /Backwater Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Foundation Insp PLM /Underfloor Framing Insp Gas Fireplace Water Service Insp Building Final
Post/ am Structural Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
�
Issue By : i /nr 13 C Permittee Signature : \CD ,A
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
o _ aS -cr-3 .0)/e.-e'163r e)62 J
Building Permit Applica
": \ U Date received: a ? 9
1 1y � City of Tigard [ � a , Permit no.: ' �,� ,
Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 972 ,,N
Phone: (503) 639 -4171 1t;L ,, 1 L Date issued: By: Receipt no.:
Fax: (503) 598 -1960
Gay o T IG i. r f i Case file no.: Payment type:
Land use approval: r ,ull DING D I I l 1 &2 family: Simple Complex:
, `tf' °':t'I'YPE:)l PERMIT t( qf; +f,.1 : W
❑ 1 & 2 family dwelling or accessory 0 Commercial/ind trial 0 Multi- family ,,New construction ❑ Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION - ,� t in'. , - a 5: uk; .II
Job address: I I V \ I� / Bldg. no.: Suite no.: Wi
Lot: IM Block: Subdivision: VAMIgria Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions: C
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: �JM ��� l ' (Iloodplaiu, septic capacity, solar, etc.) E
Mailing address: " Elaii.e 1 & 2 family dwelling:
City: I) ZIP: .2 ila Valuation of work $
Phone: . re —2— 75 Fax) ) -7 , -mail: No. of bedrooms/baths
Owner's representative: , if CO' rl t_ Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
Name: i♦ 1m J isir C
&_
Covered porch area (sq. ft.)
Mailing address: 1Y'_, g (L. 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 $
Existing bldg. area (sq. ft.)
Business name: 1 (�il]�tt`, New bldg. area (sq. ft.)
Address: _ia.7L.� W dinMIIIIIMIMIN
City: Number of stories
ity: State: ZIP:
Phone: I Fax: I E -mail:
Type of construction
CCB no.: 5 ?-) Occupancy group(s): Existing:
New:
City/metro lic. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: ( L .k la_ dilliiiIrak ,. provisions of ORS 701 and may be required to be licensed in the
Address: ,�
• C _.4.1. 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: IZIP: 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. • t rovisions of 1 ws and o dinances governing this ❑ Visa ❑ MasterCard
work will be compl - • wi pp , whether ified 1ere i t Credit card number: / /
lj : 7 1 0 3 Expires
Authorized Si: a , / ` A Name of cardholder as shown on credit card
Print name: •±>_ t (K $
v 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 (6r0C/COM)
•
One - and Two - Family Dwelling
Building PermitApplicati®n Checklist Reference no.:
Associated permits:
City of Tigard City of Tigard b 0 Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, 04 97223 • 0 Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
f ?� • T11E IOLLO'VING ITEMS ARE REQUIRED•F'OR PLAN'REVIEW ' r't . , Ycs -No "'Nit
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 pemlit required. Include drainage -way protection, silt fence design and location of ,/
catch -basin protection, etc. J�
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 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 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. / X \
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 • �r4
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 - 1/2" x 11" or 11" x 17 ". k
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. 4404614 (6J00/COM)
_ . - . y 4 . , , .
Mechanical Permit Application . , . .
� ;A
Date received: 7 / 03 Permit no.: .0p�
ttt.,
A r City of Tigard Projecdappl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
-
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
ii ; ;'. TYPE OF PERiMIT 4 ,i, ,{t't , ,xtG ''i' y� ,;
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
'Iew construction ❑ Addition/alteration/replacement 0 Other.
ti% ''' ' `c a' JOB,SITE INFORMATION ' .' '' COMMERCIAL VALUATION SCHEDULE
Job address: it Maril l A rOWNWPAMM j
MINN Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax ma. /tax lot/account no.: profit. Value $ .
Lot: /1A Block: Subdivision: rf ' 'See checklist for important application information and
Project name: r4VMMII= 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 CONMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: III
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 -
NtECFIriNIC'.1L''CON'IR `�' ° — Boiler /compressors I■■
�}� State boiler permit no.:
HIV HP Tons BTU/H
Address:e Fire/smoke dampers/duct smoke detectors _
�. E A ZIP: °I016- Heat pump (site plan required) ■--
Phone:� . 'Fax: E -mail: Install/replacefurnace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.: _ II Install/replace/relocate heaters - suspended, ■ --
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): 4rirj L' ' ON R ent for appliance other than furnace : == •
k` r ' ' CONT 1C "f PERSON _ efiigeration:
Absorption units BTU/H
E i , Chillers HP 1
4 � Compressors HP NM
Address: _ 4_ Environmental exhaust and ventilation: ■ --
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust : =_
Hoods, Type U Wres. lutchen/hazmat
',N . � � } `'' w :, O. \1' N E R - hood fire suppression system • r. + , + 3 4' , x • . r, �1
111 lM art •� � Exhaust fan with single duct (bath fans) -__
Mailing address: Illyeri 1 W INEffed Exhaust system apart from heating or AC
� ��.� � Fuel piping and distribution (up to 4 outlets) ■ --
� CiirSY��LOltf/�� Type: LPG NG Oil
Phone: I�Jdi Fax: E -mail: Fuel piping each additional over 4 outlets _
ENGINEER Process piping (schematic required) INE
Number of outlets ME
Name:
Other listed appliance or equipment:
III
Address: Decorative fireplace
City: State: ZIP: Insert - type
Phone:
IMINIME E -mail: Woodstove/pelletstove 11.1
Other: MI
Applicant's signatu" . Date: --) MAI Other. Ell
Name (print): , -' - 7 MI
Na te all jurisdictions accept credit cards, please call jurisdiction for mo 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: En tr/ w i t hi n 1 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 (NOOrCOM)
■
• • • • s �.2 v . A N�'•'a+� v'�' om . :: v-!,t , .3 �ty' Y Y.Yi' - 4 7'. . , ;> I ` 7 5 ' :,�.�;��.
Plumbing Per A pp l ic ation
Datereceived: / ,0 Permit no.: / 5r „ _
-�°e,� 1 � City of Tigard Sewer permit no.: Building permit no.:
" �� fi Address: 13125 SW Hall Blvd. Tigard, OR 97223
City of Tigard Phone: (503) 6394171 Project/appl.no.: Expo date:
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
".• l : ' x, .,TYPE OFD PERMIT " ' ,, t 1' , T , y d
? a
„5, f .
''"l"4,{ St 4.1'; 'ri 1 _7 -' d '.5 .;� �!,.k'�!t :L , t:= 1 frr,•4 k!. ..4 3 7 , A_N. o- �n ..,air -
O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
New construction 0 Addition/alteration /replacement 0 Food service 0 Other.
JOB SITE INFORM ATION . _ , FEE ''SCHEDULE ( for •special information use checklist)"; = .
Job address: 1 i , • 1 i Actato. . r Descri , don Qty. Fee(ea.) Total
New 1- and 2- family dwellings only:
Bldg. no.: Suite no.: (includes 100 ft. for each utility connection)
Tax mae/tax lot/account no.: SFR (1) bath
Lot l l / Block: Subdivision: G/ W' SFR (2) bath M
Project name: \AAA 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
T . Footing drain (no. lin. ft.) ___
' PLUiIIRING. CONTRACTOR , - ..'--• ' ' Manufactured home utilities
Business name: 1p. `7 L • Manholes MI
Address: Rain drain connector 1.11—
�/ ZIP: Sanitary sewer (no. lin. ft.)
��� � � Storm sewer (no. lit. ft.)
Phone: y 1 II, Fax: E -mail: _ Water service (no. lin. ft.) I MIN
CCB no.: "7 L � Plumb. bus. reg. no:
V Fixture or item:
City/metro lic. no.: N/A �/ '� Absorption valve
Contractors representative signature _� ./C Back tlow pre "enter
III IM 1 I I • i — I a 161 D« Backwater valve
' ; .. ` CON"f,\('[ PERSON Basins/lavatory
Clothes washer
Name: 1 �-� �N -D E Dishwasher 11111
Address: "A' / / tc, .V - Dnnkina fouruain(s)
City: State: ZIP: Ejectors/sump
Phone: I Fax: E -mail: Expansion tank;
OWNER Fixture/sewer cap 1.1.1
_ Floor drains/floor sinks/hub _
Name (print): 1 j Att Garbage disposal ME
Mailing address: • " • s 1 0 Hose bibb =
City: L .. ") . �� �� Ice maker
Phone: j • - j ir Fax: liallinSITE Interceptor /grease trap 11111 —
Owner installation/residential maintenance only: The actual installation Pnmer(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
Tubs/shower /shower pan
ENGINEER Urinal
Name Water closet
Address: Water heater
City State: ZIP. Other
Phone: I Fax: E -mail Total
Minimum fee $
Nor all iunsdscuons steps credit cards, please calf iunsLcuon for mote information Notice: This permit application
Plan review (at _ )
C Visa MasterCard � expires if a permit is not obtained State surcharge (8%) •• -• $
C.edit card number. Expire w ithin 180 d ays after it has been TOTAL $ ---
accepted as complete
Name of cardholder as shown on credit card
S
■ Cardholder signature Amount / 4.10 -1616 (60000M)
(Electrical Perm' I 0 eation FOR OFFICE USE ONLY
Received Electrical . � •
Date No S �� I --Ce- I
City of Tigard cvn Planning Approval Sign
Date/B Permit No
13125 SW Hall Blvd. �i' 15 Plan Review Other
Tigard, Oregon 97223 D Date/B Permit No •
Phone: 503 -639 -4171 Fa 90- A k O� 1 Post- Review Land Use
D , � i -r a�.t' Date/B Case No.:
Internet: www.ci.tigard.or.tgg, �I
� rail luns.: El See Page 2 for
24 -hour Inspection Request. 11 ��``�� 03- 639 -4175 " Name/Method Su i demental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
0. New construction ❑ ❑ Service over 225 amps-
0 Health care facility
Addition/alteration /replacement ❑ Other: commercial ❑Hazardous location
❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in IR
1 & 2- Family dwelling ❑ Commercial/Industrial 0 System over 600 volts nominal one structure
Building ❑ Multi- Family ❑ Building over three stones ❑ Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ 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: 12 V-I () -. 3 i j w}J /S7}� 5 LA' FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: po,, 99.9,l, 5 y o - TT&_ E3 Description Qty Fee (ea.) Total
—
New residential - single or multi - family per
Cross street/Directions to job site: /2 ) S / 57,1Er 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: (yg/Sjz5 l.A.4-)k Lot #: Lll, 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
Ist PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: 0 0A/ M ori.55 tf7 E Reconnect only 66 85 2
Address: 913 0 GALE W OA?) Sr 507E760 60 Temporary services or feeders - installation,
City/State/Zip: /) - 7 alteration, relocation:
Cit
Y P� L,�-� C V Ste % ( 3r2-- 3r2-- � � . 770.3s 200 00 amps s or or less 66.85 1
Phone: 357 --2c--3 e- Fax: 3 7G/ 201 amps to 400 amps 100.30 2
❑ APPLICANT I ❑ CONTACT PERSON Br n 600 c rmps 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: 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
� �� Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
i p e alteration, or extension Page 2 2
Business Name: h / l° )14.1-, 7 I .0 - Description:
Address: f, (), ,R s--9 ely
Cit City/State/Zip: 4 p Q V� / Each additional inspection over the allowable in any of the above:
Y p • AL O HA O ll� • � , Per inspection per hour (min I hour) 62.50
Phone: 3 6- a c FBX: — l'yLr Investigation fee. _
CCB Lic. /3222Z_ Lic. #: :, L
- r c Other
/ Electrical Permit Fees*
Supervising electrician AI Subtotal $
si: ature re wired: L / Plan Review (25% of Permit Fee) $
Print Name: L, iMEMIIP,1 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 pnnt name)
i . \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:
El Audio and Stereo Systems
❑ Burglar Alarm
El Garage Door Opener
Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
1
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
O Clock Systems
O Data Telecommunication Installation
0 Fire Alarm Installation
•
n HVAC
❑ Instrumentation
O Intercom and Paging Systems
Landscape Irrigation Control
❑ Medical
O Nurse Calls
ri Outdoor Landscape Lighting
❑ Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
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I (PLEASE PRINT) (PERMIT HOLDER)
•
• ►
• ►
. • ►
• Do here certify that the following location ►
• meets City of Tigard /Washington County ► ■
land use and development standards for street tree installation. ►
■
I ADDRESS: / Z.2VO Gk..) jJ 576 /L L) 0 ■
A O• 1 LOT: `/6 SUBDIVISION: /iJHH/STte2S b -�e- O•
/2-9 DATE. /zs� �
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CITY OF TIGA.RD 24 -Hour"
BUILDING Inspection Line: (503) 639-4175 3--OO -9 (a
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requ t d 1 . - 7 6-O AM PM BUP
Location /(7-f7 5 'C/ -I Suite MEC
Contact Person A Ph ( ) 1 5 - 7g 51c2.- PLM
Contractor Ph ( ) SWR
ILDIN Tenant/Owner ELC
•
o g
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
Oth - •
tali mal
PART FAIL
I'- G
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
•
Storm Drain
Shower Pan
Other:
Final
�S T FAIL
/MECHANIC
Post & — Beam
Rough -In
Gas Line
Snake Dampers
= PART FAIL
RICAL
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 a-"?
Approach/Sidewalk Date l 1 — l U Inspector Est
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
ST .5-.-
INSPECTION DIVISION Business. Line: (503) 639 -4171
BUP
. Received Da Re a ed 1 �I AM PM BUP
Location /;2 T 0 S -e-eC C Suite MEC
Contact Person /7V Ph ( ) S 6p 5‘5 , 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 — / y —
Fire Alarm
Susp'd Ceiling . ..#40.2 / .' . - / ���i� ...■
Roof _ C
Other:
Final e /_
PAS , — PART FAIL
7sos 8f Beam
- Under Slab
Rough -In •
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
ir:" _
•A - • RT FAIL
I CHA IC
1'os : Beam
oi.• it In
e
A Dampers
4 r Fi'al
PASS PART 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 / +
l o ' /
Approach /Sidewalk Date 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 Gip 3 — 0 0 2 7bp
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received (� /' 5 Date Requested Z- • AM PM BUP
Location /2 _ r W 0 ' / Suite MEC
/
Contact Person / / l Ph ( v )) Z—e r'!' —' elw 7 PLM
Contractor () /Pi 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 •
V'co k : 4/c pre iv _ c4 u ( ''
PART FAIL nn
PLUMBING /i vie ( p "e 9 if I\ "ed. (_r
Post & Beam f
Under Slab ci-D Lj t4 P G1 Q- d2 IC t
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
PASS PART FAIL
MECHANICAL
Post & Beam '
Rough -In
Gas Line
Smoke Dampers
Fin
PART FAIL
_CCECTRICt
Service
Rough -In No A ,/c
UG /Slab
Low Voltage /Yd 6 -L• Il
Fir=
-
41%
� •A ART FAIL
SI El Please call for reinspection RE: El Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date (2 - — inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
r PASS PART FAIL
I