Case File I
i
I
I ,
I I
I \ ,
EXISTWS
RESIDENCE I I \ 1
in I I \
I I ,
' EXISTWs
DECK I I OPEN 1 ,1
I ` SPACE
-
:
EXISTING
DRIVEWAY \ 1
I FF\ELEy
AREA OFI
ADDITION
� (VERIFY F.F.ELEV�I
APPROX. LINE
I \ OF OPEN SPACE 1
. I
• PROPERTY •�--------_ �---------1---- — ---�
I I
LINE �Wj
-- ------- ---------- -—-—-—- —-—- I ----- I ------------------------------�
�'J I
I
l
v ( T E I L AN *I NOTE: BUILDER TO VEI :IFY EXISTG T A B U L A 7 1 C N
SCALE:;UWO'■I'-O" I� GRADES AND SITE CADITIONS.
137ZA&CENRION DR ZONING: R-1
L O T 101 LOT SIZE: 13,31'l sa. FT.
H I L L 5 H I R E E 5 T A T El M 2 BUILDING COVERAGE: 2274 SQ. FT.
W A 5 H I N G T O N COUNTY , (INCLUDING PORCH)
ELOT COVERAGE: (1'1.0 x)
ORGON
NOTICE: IF THE PRINT OR TYPE ON ANYI_-rT.1J11111111111..r�Trtr� 1 1111111 111111 11111 �1 11 ,1111 � 1111 i � t.r ►�� r� rfi � 1 � � L. r� r �� iil � � � Tt1fi�i i � lit � i r�r� � � 1 i � 1111 1111111IMAGE IS NOT AS CLEAR AS THIS NOTICE, lQ 12 .�
IT IS DUE TO THE QUALITY OF THE No.36
ORIGINAL DOCUMENT E
63 S Z LZ 9 Z 9Z Z E Z Z T Z 0 ZY 6 I 8 I L1T 91 T I E Z Z T T T T 6 8 L e E Z I �Itli�w
IIII ('I '
w
N
N
f
H
Q
I
I
Ic
C
13722 SW ASCENSION DRIVE
MASTER P,ERMIT
1*-',E RM I T 1#. . . . . . . (MST96--014,:
CITY OF TIGARD DATE ISSUED: 05/147'9S--
COMMUNITY DEVELOPMENT DEPARTMENT F-IARCEL:
15tl,na!,� ..Tlqjrd,pr�qp-n 97223-Sigg ;1 0 �8941T
DR
SUBDIVISION. . . . : HILLSHIRE. 140CIDS ZON ING.- R7 P,D
BIJIGI;. . . . . . . . . . .I L-.O-r. . . . . . .. . . . . . . 1.0 1.
Remarks: PATH I
----------------------------------------------------------------- BUILDING ------------------------------------------ -
REISSUE: STORIES.......: C FLOOR BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED-•------------
CLASS
EQUIRED—------------
CLASS OF WORK.:NEW HEIGHT........: 23 FIRST....: 1200 sf GARAGE.....: 650 sf LEFT..........: 5 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: I27', sf FRONT.........: 20 PARKING SPACES: I
TYPE OF CONST,:5N DWELLING UNITS: I FINBSMENT: 0 sf RIGHT.........: 6
OCCUPANCY GRP.:k3 BDRM: 3 BATH: 3 TOTAL------: 2471 sf VALUE-1: 171149 REAR..........: 99
--------------------------------------------------------------- PLUMBING ---------------------------------------------------------------
SINKS......... I WATER CLOSETS. 3 WASHING MACH.. : I LAUNDRY TRAYS.: I RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 4 DISHWASHER;... I FLOOR DRAINS..: @ SEWER LINE ft: 0 SF RAIN DRAINS: I CATCH BASINS—: 0
TUB/SHOWERS...: 3 GARBAGE DISP..: I WATER HEATERS.: I WATER LINE ft: IN BCKFL4 PREVNTR: I GREASE TRAPS..: 0
OTHER FIXTURES: 0
----------- MECHANICAL --------------------------------------------------------------
CMP ( 3HP: 0 VLNT FANS.....: 4 CLOTHES DRYERS: I
/GAS/ i FURN )=INK I UNIT HEATERS..: 0 HOODS.........: I OTHER UNITS...: I
MAX INP.: 0 BTU FLOOR FURNACES: @ VENTS.........: 0 WOODSTOVES.... 0 GAS OUTLETS...: I
----------------------------------------------------- ---------- ELECTRICAL ---------------------------------------------------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP' SRVC/FEEDERS-- ---BRANCH CIRCUITS.--- ---- --ADDIL INSPECTIONS--
IM SF OR LESS: I @ - 200 amp..: 0 0 - 200 Amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADDIL 500SF.: 5 201 - 400 amp..: 0 201 - 400 amp..: 0 1st WIT SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp.. : 0 EP ADDL BR CIR: @ SIGNAL/DANEL...: 0 IN PLAN1...... 0
MRNF HM,,SVCiFDR-. 0 601 - I@W amp.: 0 601#amps-1000 v: 0 MINOR LABEL -18: 0
10004 amp/Volt.: 0 ------------------------------------ PLAN REVIEW SECTION ------------------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A. : ) 600 V NOMINAL: CLS AREA/SPC OCC:
----------------I---------------- ELECTRICAL - RESTRICTED ENERGY ---------
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL------------------------------------------------------------------------------
AUDIO & STEREO.: VACUUM SYSTEM..- AUDIO I STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM., : 0TH: A' BOILER.........: HVAC...........: LANDKAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK..........: INSTR*NTA110N: MEDICAL........: OTHR:
MVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL # SYSTEMS: @
Owner: -----------------------------------Cont actor: TOTAL FEES:$ 4101.20
ED FREE" ALEKSANDO KOV4LEV CONST
P 0 BOX 1759 118125 SE TAYLOR
LAVE OSWEGO OR 97035 PORTLAND OR 47216
Phone Phone #: 251-8515
Reg S.. : 106822
This per tif is issued subject to the regulations contained in the Tigard Municipal Lode, State of Ore. Specialty Lodes and all other
applicable laws. All work will be done in accoraance with approved plans. This permit will expire if work is not started within 1.80
days of issuance, or if work is suspended for more than 180 days.
--------------------------------------------------------- REQUIRED INSPECTIONS --------------------------------------------------------- —
Footing Insp PLM/Underfloor Low Voltage Gyp Board Insp Electrical Final
Foundation Insp Mechanical Insp Fireplace Insp Rain drain 'nsp Mechanical Final
Post/Beam Struct Plumb Top Out Gas Line Insp Water Line Insp Plumb Final
Post/Bean Mechan Electrical Servi Gas Fireplace Water Service In Building Final
Crawl Drain Framing Insp = Insulation lisp ppr/5dwlk Insp Erosion Control
P,ei-mittee '.1i.qiiati-ir-e : ssi-ked SI/
Call for, i spection -- 639.-4175
aEbIEK LIJNNLL,' 1 ' UN
PERMIT
pE-CITY OF TIGARD DATEI ISSUED:.
05/ 14/96R96--01.25
141/966 -0 1'`J
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL.: 2S 104 CC—HW 101
131 6 I{811_�Ivd.Tlpmrd,Or_ on p72 3.81pp (503)839-4171
�1 fLD�l�"r�r:�.�. . . : 1. �Ew a• C,rr.1R
:aUBU I V I S I ON. . . . : H I I_LSH I RE. WOODS ZONING: R-•7 PD
CSLOCK. . . . . . . . . . : L..O .. . . . . . . . . . . . . : 101
i v-1,4ANT NAME. . . . .
USA NO. . . . . . . . . . : FIXTURE UNITS. . . . 0 j
GLASS OF WORN.. . . :NEW DWELLING UN T T'3. . : 1
I YPE OF' USE.. . . . . :SF NO. OF BUILDINGS: 1
INSTALL 1-YPE. . . . :BUSWR I MPERV SURFACE: 0 s f
Remarks: PATH I
FEES •.---._____.____._._._._.
OU FREEMAN type amoi_int Ia date recpt
P O REE 1759 PRMT $ 2200. 00 JMH 05/14/96 96-279367
INS')P $ 35. 00 JMH 05/ 14/96 96--279:67
LAKE;. OSWEGO OR 97035
Phone #:
i_antractor:
i.:DNI RACTOR N9T ON r II_E:
$ 2 :35. 00 TOTAL
REQUIRED INSPECTIONS
This Applicant agrees t) comply with all the rules and regulations Sewer Inspecticr
of the Unified Sewage Agency. The permit expires 180 days from ---- ---the date issued. The total amount paid will he forfeited if the (�� .. ----------.._.
permit expires. The Agency does not guarantee the accuracy of the --
side sewer laterals. If the sower is not located at the measurement
given, the installer shall prospect 3 feet in all directions from
the distance given. if not so located, the installer shall purchase
a "tap and Side Sewer" Permit and thpAgen y will install a la�al. _
b_�_"-7--
___._.....
.
I-ted By :
. ' call for inspection - 639--4175
City of Tigard Residential Building Permit Application
13125 SW Hall Blvd. �\e q6
Tigard, OR 97223 ', l r n 1 I /�
(503) 639-4171 1 11")7Z Z.5WA� LS 10.10 LJ f,? . �
Jobsite Address: �',Llr"7 / /d'r6Lri.y
Office Use Only .
Subdivision: f!�
Contact Date 3 / /1 Initials
Valuation:
1 Result -,-Ale I c t,
1 pru f
New Construction Only: (Square Footage)
a.Planck/Rec # (�
r�,_ , Permit # l -94 -
House: �, r/ Garage Reissue of _
1 Map & T # -Y-
Corner Lot? Y Flag Lot? Y (N1, Zone _
Owner: f/tee i-.cet-j 0¢ %% . Plat #
Address: _� l ��'�' ; 7 S�' . Approvals Re uired
Planning Setbacks Solar _
Engineering _—
Phone ( ) Other
��C�'IN vtc , �',q Lt(� �°Oity� ems Required
Contractor: It
d)
Address: e2e Subcontractors �� ---
�
(,� Truss Details
7 _711Ar�� �� 7,%G Other _--�— —
Phone: ( �GJ 3 ) L2 5/.. cpJ�95 Notes 1 I C 4th r• t , ,c
Cont aX's License # /L%C'��<',�?
(attach copy of cur nt Oregon license)
Contact Name: L�y" --
Contact Phone: _3/F- 2 e
Subcontractors: ArchitecVEngineer:
Plumbing: -7A GK SOS/ 'S /-1611",01�'l /Ove Address
Mechanical: P''t /�� ��f/�T/�'� � js!/�•�'_Vlf
(attach copy of current OR Contractor's License
JOB DESCRIPTION: �
Applicant Signatur % Applicant Phone number
,IG9� � /jLl(� v11) 7
Received by Date Received: c.'G Z6 RH
r++uOnbuvNwo
sc�ti►_ r`" ' �" P t
1
Permit Account Oescripdon Amount Amt„ Pd Bal. Due
�yZ
tZ1 t y 4` Idg. Permit (BUILD)
Plumb. Permit (PLUMB)
YAech. Permit (MECH) -415- _
QOMMIN) "_—S___—
yam__ �--�--��.
Bldg: 3016j", S 7. .5 7 !v
Plumb:
i
Mach: Z
Plan Check (PLANCK)
Bldg: cL�� �
Plumb: �_--
Mach:
O/2s Sewer Connection (SWUSA) o u
01
Sewer Inspection (SWINSP) 3.)
Parks rev Charge (PKSOC) '500
Residential TIF (T1F-R) /Z 7o — �
�r/7„
Mass Transit TIF (T1F-,%M / Z o �12 --
Commercial TIF MF-C)
Industrial TIF MF-4)
Institutional ilF (71F-IS)
Cffice TIF (TIF-C)
Water Quality (%AIQUAL)
Water Quantity (WQUANT) _ p
Fire Life Safety (FLS)
Erosion Cntri Permit (ERPRMT) _Ire
Emsicn PlancklUSA (ERPLAN) i , FV
=rasion P!ancklC0 (ER0SN) _ 9y _ c12(I
TOTALS: tP0J�U UO !J,
Solar Balance Point Standard Worksheet
Address ) 'A/ t ' l ! I Z�V .
Box A calculations: North-South dimension for the lot. Box A:
This dimension is determined by finding the midpoint of the North lot line and drawing
an intersecting line perpendicular to that point.
First, determine which property line is the North lot line. The North lot line is the line
with the smallest angle from a line drawn east-west and intersecting the northern most
point of the lot.
t \; \
Lor wRN \ NpihlEflN\>
lOI JNE LOI LINE
North-South
Dimension for Lot:
Measure the distance from the midpoint of the North lot line to the South lot line along
the described line.
t feet
\
N
.,r-. NORTH-SOUTH DIMENSION
Box B calculations: Shade point height for your residence. Box B.
1. Determine whether measurements will be based on the peak or eave of your Which describes
stricture. The orientation of the ridge is also important. your residence?
la: If the roof line runs North-South, measurements will (circle one)
based on the peak of the roof. G Q r,O wv
"°"'"♦ 1A 113 1C
1 b: If the roof line runs East-West and the roof pitch is
less than 5/12, measurements will be based on the
ea,.e. o. 1
SHADE POINT EAIA
If the roof line runs East-West and the roof pitch is
5/12 or steeper, measurements will be based on the
peak.
<,y�(xyNT vncf
I
Box B. continued Box B:
2. Measure change in elevation from front property line to finished Moor elevation. If
the lot slopes up from the front lot line to the foundation, the figure is positive. If
the lot slopes down from the front lot line to the foundation, the figure is negative. ft
3. Measure distance from finished floor elevation to the affected peak/eave. z S� ft
4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West, 3 it
deduct nothing.
5. Subtract one foot for each foot of difference in elevation from the front property
line to the rear property line, if the lot slopes up from the front to the rear. If the
lot has no slope or slopes up from the rear to the front, deduct nothing. - ft
6. Total figure for box B: 1 ft
Box C. Distance to the shade reduction line. Box C:
1. Measure the distance from the North property line to the foundation near the ft
affected peak/eave.
2. Measure the distance from the foundation to the affected peak or eave. 4- ft
3. Total figure for box C:
it is most useful to draw a vertical line to represent the appropriate figure found in box"A"and a horizontal line to represent the
appropriate figure found in box "C". The intersection of the vertical and horizontal lines determines the value found in box "D". The value
in box "D"should be compared to the value in box"B"; if the value in box "B"is less than or equal to the value found in box "D", then
the building is in compliance with the solar balance code. If you have any questions, please contact us at 639-4171,x304 or at the
Community Development Counter.
MAXIMUM PERMITTED SHADE POINT HEIGHT (In Feet)
I
Distance to North-south lot dimension (in feet)
shade 100+ 95 90 85 80 75 70 65 60 55 50 45 40
reduction line
from northern
lot line rin feetL
7040 40 40 41 42 43 44
65 38 38 38 39 40 41 42 43
60 36 36 36 37 38 39 40 41 42
35 34 34 34 35 36 37 38 39 40 41
50 3 32 32 33 34 35 36 37 38 39 40
45 3 30 30 31 32 33 34 35 36 37 38 39
40 2 18 28 29 30 31 32 33 34 35 36 37 38
35 25 26 26 27 28 29 30 31 32 33 34 35 36
30 24 24 24 25 26 27 28 29 30 31 32 33 34
25 2 Z 22 21 23 24 25 26 17 28 29 30 31 32
.Rl 2 20 20 21 22 23 24 25 26 27 28 29 30
15 1 18 18 19 20 21 22 23 24 25 26 27 28
10 15 16 16 17 18 19 20 21 22 23 24 25 26
1 14 14 15 16 17 18 19 20 21 22 23 24
Box D. Maximum allowed shade point height: ! feet
I
' WIA �2 D
;o :�4 ►'v �
ti
dw
- Z 0 7
f
1/0
• rOv��l�
� � I
I /
1 f
r
r
I
1
-s=,
-s
N
Page No. 3 CASE HISTORY FOR CASE NO.: MST96-0142
ED FREEMAN
13722 SW ASCENSION DR
02/12/99
1
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
i
MSTA745 Gyp Board Insp / / / / 08/27/96 A-1 install water proof gypsum at otall DIS KS 04/15/97 KBS
shower
#-2- providde access at jacuzzi
#-3 need clearance at B vent
#-4- gypsum behind furnace not nailed or
taped
N-5- extend gypsum behind furnace to mud
sill
#-6 additional nailing needed at garage
MSTA745 Gyp Board Insp / / / / 08/28/96 contingent to KS report at final PEND RB 04/15/97 KBS
MSTA745 Gyp Board Insp / / / / 08/29/96 to be checked at final PEND RB 08/30/96 RB
MSTA755 Rain drain Insp / / / / 06/19/96 around house ok FAIL MS 06/20/96 MRS
couldn't find crawl drain?
MSTA755 Rain drain Insp 06/20/96 / / 06/20/96 around house ok crawl riot connected to PART GS 06/20/96 GES
rd
Ms'PA 1611 Wet-et Line Insp / / / / 09/05/96 NR MS 09/06/96 MRS
MSTA761 Water Servire Insp / / / / 09/09/96 PASS MS 09/09/96 MRS
MSTA.765 Appr/Sdwlk Insp 10/14/96 / / 10/14/96 Forms destroyed, replace. PASS PI 11/12/96 C•H
MSTA770 Misc- Inspection / / / / 09/13/96 shower pan PASS MS 09/13/96 MRS
MS'iA790 Electrical Final / / / / 01/22/97 seal around doorbell transformer; hall APP GS 01/22/97 GES
bath lite fixture not working; cover pIt
for box in hell under stairs
MSTA795 Mechanical Final / i / / 04/11/97 # 1 nee bldg final this date A/N KS 04/15/97 KBS
MSTA795 Mechanical Final / / / / 04/15/97 PASS RB 04/15/97 RB
MSTA797 Plumb Final / / / / 11/18/96 PASS MS 11/18/96 MRS
A --
CITY OF TIGARD BUILDING INSPECTION DIVISION MSToG�y 44-4e24-Hour Inspection Line: 639-4175 Business Line: 639-4171
I:3UP
/ 2 Date Requested 3,23 23 AM_ PM _ BLD
Location_��.�-Z Z" S c✓ , �,� ! � Suite _ MEC
Contact PersonPh 7lJ ff ff Z L 1 _ PLM _
Contractor-_ _ ��N / _1.�:r✓tTV/4 c s - Ph --r SWR ---
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS _
Ftg Drain
Crawl Drain Inspection Notes: SGN --
Slab - - ----- SIT
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear -`-
Framing -- - -- _
Insulation — - -----
Drywall Nailing
Firewall --
Fire Sprinkler
Fire Alarm --
Susp'd Ceiling -
Roof
Mise -- - -- ----- - - - - -
Final
PASS PART FAIL
PLUMBING _
I'ost& Beam - _- -- - ------— __- �-_--- -------
Under Slab
Top Out --- ----- - - ---- -_— �- - -- -
Water Service
Sanitary Sewer - - ---- ------ —- - —�-_ -
Rain Drains
----___.------ --- --- -.-.-._------------
Final - '-"--
PASS PART FAIL
MECHANICAL
Post& Bezm - - _ - ---- -- --- - -- ----.-
Rough In
Gas Line -- - - - ---- - --- -- -----
Smoke Dampers
FinalPASPART FAIL
Service
Rough In _.._ ----------------- -- � ._
UG/Slab
Low Voltage --- --- ---- --------- � - ----_
Fire Alarm
S APART FAIL __- - ---_--- ------__---
SITE
Backfill/Grading - ----- -- --------- --- -------- --__.
Sanitary Sewer
Storm Drain I ) Reinspection fee of$-- _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspection RE:-_ _ [ I Unable to inspect-no access
ADA �-
Approach/Sidewalk pate 2 Inspector ` -C Ext
Other _-- p
Final -
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4176 Business Line: 639-4171[ QD
BUP
_Date Requested_/' — AM �PM BLD —
Location Z Z �w a S�ovr��``� flr Suite — MEC --
Contact Person _ _ Ph 4i�_T PLM -- --
Contractor _ _ %1 ' _ vPhSWR _ —^
ELC
Tenant/l� 1b k ner G,. .Gl� U6/^ - ----
P-taining Wall \\ ELR —�
f noting Access: ---------__..__�.
Foundation FPS �—
I tg Drain SGN
Crawl Drain Inspection Notes:
r
'lab U SIT
Dost&Beam - I �?
Ext Sheath/Shear -�" x`` V N
Int Sheath/Shear
Framing
Insulation
Drywall Nailing -_ --- -- --
Firewall
Fire Sprinkler -----
Fire Alarm
Susp'd Ceiling - -----
Roof
Misc: - - - ---- -
iSin
PART FAIL - --- - —
'Post& Beam - -- — —
Under Slab -- —
Top C)Lj(
Water Service _
Sanitary Sewn
F[RaIQ Drains
F I
ASPART FAIL
Post 8 -
Rtrttgtllfi
Gas Line - --------�- -
Smoke Dampers
niv-
PASS PART FAIL C
_ TRICAL —
Service ----- ---- - — - -
Ro;igh In
UG/Sian
Low Voltage
Fire Alarm ------ - ------- -- -
Final
PASS PART FAILSITE
BackfilliGrading ----- ----------- ----- - — ----
Sanitary Sewer
Storm Drain [ J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catcn Basin
Fire S apply Line [ )Please call for reinspection RE i [ J Unable to inspect-no access
ADA
Approach/SidewalkDate d ( Inspector_ �&_A Ext �)
Other - ----- --- -�
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 ��
i (' — --
`l) B _
G
Date Requested Z t tZq q AM PM t` BLD
Location_ 2-2. Suite _
MEC _
Contact Person _— Ph PLM /
Cc ntrPh SWR —
UILDI r Tenant/Owner _ ELS; _
Retaining Wad ELR
Footing Access: --
Foundation FPS
I tg Drain
C,-^.il Drain U� �� Inspection Notes SGN —
Slab
Post& Beam — - — SIT
Ext Sheath/Shear
Int Sheath/Shear
Framing Gam, L L 1 `-
1 t �K-
,�
Insulation 1. � —
Drywall Nailingtib.
Firewall -�
Fire Sprinkler �-� b5 �--[-y'1 -�,�� �� ,�,. I `L
Fire Alarm
Susp'd CeilingThr-
Roof _ - —
F`in
( ——
�- �S PART FAIL
BING
Post& Beam
Under Slab
1 op Out —IL t-
Water Service
Sanitary Sewer, --
V Rain Drains n�
Final I - --- -
PASSPART FAIL
MECHANICAL
Post&Beam / ---
Rough In -- -- --
v Gas Line
Smoke Dampers _
Final -- --- -- - - - --- -- -- -
PASS PART FAIL
ELECTRICAL
Service
Rough In -- -- -- - _.— - --- --- -
UG/Slab
Low Voltage — --v-- -�- - -
Fire Alarm
Final -- ------- - -- ------ -
PASS PART FAIL
SITE _— ------- ----------
Backfill/Grading - - --- ------ ---- -- - - --- --
Sanitary Sewer
Storm Drain [ )Reinspection fe,�of$- _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ )Please call for reinspecilui-, 4F ( ]Unable to inspect- no access
ADA
Approach/Si ewalk J,f
Date
U
Other L _ _—._ Inspector
Ext-
Final
PASS PART FAIL Did NOT REMOVE this inspection record from the job site.
C
CANTY OF TIGARD
WMENT SERVICES
A Blvd., Tigard,OR 97223(503)6394171
CERTIFICATE OF
OCCUPANCY
PERMIT #. . . . . . . : MST96-01'4c-
DATE ISSUED: 02/11/99
1. TE ADDRESS. . . : 13722 SW ASCENSION DR PARCEL: 2SI04CC-08200
,(JBD I V 19 1 ON. . . . : HILLSHIRL WOODS ZONING:R-.7 PD
i3LOC K. . . . . . . . . . : LOT. . . . . . . . . . . . . : 101 JURISDICTION:TIG
--------------------------------------------------------------------------------------------
CLASS OF WORK. eNEW
TYPE OF USE. . . :SF
TYPE OF CONSTFR:5N
OCCUPANCY GRP. :R3
OCCUPANCY LOAD:c
Remarks : PATH I
Owners
SCUTT HARELAND
13722 SW ASCENSION DR
TIGARD OR 971223
Phone #t
Uontractore
ALEKSANDO KUVALEV LONST
11825 BE TAYLOR
PORTLAND OR 97216
Phone #: 251-8595
001068
This Cert I fic grants Occupancy of the Above referenced building or portion
eo
thereof and e.n"-.
irms that the building has been inspected for compliance with
the State a Or on Specialty Codes for the group, Occupancy, and Use Under
Or
e
o V� -
which the r , fp f)yicpd permit was issued.
BUILDING INSPLLI"OR 8 44____
-�AL/1 GrDEC 1 1 C��) P E'.R V I'i r?
41"r,W- 4L LJr:E: v I
POST IN CONSPICUOUS PLACE
MASTER PERMIT
CITYOF T I G A R D PERMIT#: MST2000-00466
DEVELOPMENT SERVICES DATE ISSUED: 10/26/00
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 13722 SW ASCENSION DR PARCEL: 2S104CC-08200
SUBDIVISION: HILLSHIRE WOODS ZONING: R-7
BLOCK: LOT: 101 JURISDICTION: TIG
REMARKS: addition of 2 story and basement total of 860 sq ft
BUILDING
REISSUE STORIES:
FLOOR AREAS REQUIRED SETBACKS REQUIRED
LEFT: SMOKE DETECTORS: v
CLASS OF WORK: ADD HEIGHT: FIRST: 320 sf BASEMENT: 0 Ori of
.:
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: _52') at GARAGE: sf FRONT: PARKING SPACES
RIGHT:
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: st VALUE: S 741181'0
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 64000 sf
REAR:
PLUMBING
SINKS WATER CLOSETS: WASHING MACH: I LAUNDRY TRAYS: + RAIN DRAIN:
TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS'.
SEWER LINES: SF RAIN DRAINS: + CATCH BASINS:
TUB/SHOWERS- GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS
OTHER FIXTURES
MECHANICAL —•
VENT FANS: CLOTHES DRYER: I
FUEL TYPES
FURN<TOOK: BOIUCMP<3HP:
MOODS OTHER UNn'S: 1
,;AS FURN>=TOOK: UNIT HEATERS:
MAX INP: btu FLOOR FURNANCES,
VENTS: 4 WOODSTOVES, GAS OUTLETS:
ELE.CTRIC_AL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS _RANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: I 0 - 200 amp:
0 - 200 amp WISVC OR FDR: + PUMPIIRRIGATION: PER INSPECTION:
201 400 amp: 201 - 400 amp: tat W/O SVCIFDR: SIGNIOUT LIN LT: PER HOUR.
EA ADD'L SOOSF: IN PLANT:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADCL BR CIR: SIGNAL/PANEL:
MANII HM/S1rCIFDR: 001 1000 amp:
601-amps-1000v: MINOR LABEL.
1000+amolvolt: PLAN REVIEW SECTION
Reconnect only: —4 RES UNITS: SVCIFDR-225 A. >600 V NOMINAL CLS AREAISPC OCC
ELECTRICAL-RESTRICTED ENERGY
B.COMMERCIAL _
A.SF RESIDENTIAL
AUDIO 8 STEREO: VACUUM SYSTEM AUDIO 8 STEREO: FIRE ALARM RIG:
SC LT:
: OUTDOOR PROTECTIVE SIGNL:
BURGLAR ALARM OTH: BOILER: HVAC: LANDSCAPEIIRRIGVE.
GARAGE OPENER:
CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC.
DATA/TELE COMM, NURSE CALLS: TOtAI.N SYSTEMS:
TOTAL "FEES: $ 1,498.99
Owner: Contractor: This permit Is subject to the regulations contained in the
HARE LAND,SCOTT A+ SUSAN M BROOKFIELD DEVELOPMENT INC Tigard Municipal Code. Stale of OR Specialty Codes and
MEADOW ROAD
13722 SW ASCENSION DR 5335 SW Mall other applicable laws All work will be done In
TIGARD,OR 97223 SUITE 365 accordance with approved plans. This permit will expire d
LAKE nSWEGO,OR 97035 work is riot started with i- 180 days of issuance,or if the
work is suspended for more than 180 days ATTENTION
Phone Ph,.,e: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center Those rules are set
Rep N: LIC 132229 forth in OAR 952-001-0010 through 952-001-0080 You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Erosion Control Insp 8, Unocrfloor inculallon '-lectrical Service Low Voltage Electrical Finol
Footing Insp Crawl Drain/Backwater Electrical Rough In Gas Line Insp Mechanical Final
Foundation Insp Footing/Foundation Dr; Framing Insp Gas Fireplace Plumb Final
Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Final inspection
Post/Beam Mechanica Plumb Top Out Exterior Sheathing Inst Rain drain Insp
Issued By : -
Permittee Signature L�"� Z�� •—
Call�9-4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Application
Date received: Z-06) Permitnti.•- �i
• City of Tigard
Address: 13125 SW Hall Blvd,Tipard,OR 97223 Projecdappl.no.: Expire date:
City of Tigard
Phone: (503) 639-4171 Date issued: By: I Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _ 1&2 family:simple Complex:
❑ I &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction ❑Demolition
�Add i(ion/alteration/replacement ❑Tenant improvement U Fire sprinkler/alarm ❑Other:
3011 SI 11,1 NJ ORNIATION
Job address: /37.ee Jei) /95 1 Bldg.no.: Suite no.:
Lot: I Block: Subdivision: Tax map/tax lot/account no.:
Project name:
Description and location of work on premises/special conditions:
t
solar,tic
Mailing address: �e- 1 do 2 family dwelling:
City: IStateCpf 1ZIP: J Valuation of work........................................ -
Phone. J Fax: E-mail: No,of bedrooms/baths................................. f�
Owner's representative: - Total number of floors................................. L __
Pilone. ' Fax: f;-mail: New dwelling area(sq.ft.
APPLICANT Garage/carport area(sq.ft.).........................
'IE Name: ,�� '
Covered porch area(sq.ft.) ......................... _Q
11
Mailing address: i. Deck area(sq.ft.)........................................ _ Q
City: / state; ZIP: Other structure area(s .ftJ.. rtarrA6rttY� j'.' Y'�
Phone:�.''r' ''ax: E-mail: Commerelal/ludustrial/multi-family:
iduc - Valuation of work........................................ $
Bness name: Existing bldg.area(sq.g.area( q. �ft.) ..........................
usi ��f%�7 -ems' --�`--
New bld s ft.,
Address:
City: .......................... -
State: ZIP: of stories..............................
Type of construction....................................
Phone: Fax: E-mail: Occupancy group(s):(s): E xistin
CCB no.: P y B P g: -
- Ncw: _
City/metro lie.no.: �d!. 'wtiee:All contractors and subcontractors are required to be
ucensed with the Oregon Construction Contractors Board under
Name: qtr provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed.if the applicant is
City: Stater ZIP: exempt from licensing,the following reason applies:
Contact person,: Plan no.: -
Phone: f_ ax: E-mail: —.. --- - - --
Name: G� ,f Contact person: Fees due upon application ........................... $-- _.____---
Address: it✓ Date received:
City: O State: ZIPAmount received ......................................... $
Phone: I E-mail: Please refer to fee schedule
I hereby certify I have read and examined this application and the Not an Jurisdictions accept credit cord+,please c-.ii jurisdiction for more information.
attached checklist.All provisions of laws and ordinances governing this U visa U MasterCard
work will be complied with,whether specified herein or not. Credit cad nutnhet _- --- -_ - _ -__ __ / /
Expires
Authorized Dale: Name or cardholder as shown on ctedlt card
Prot name: — Cardholder si`rratme — s Antoum
Notice:This permit application expires if a permit is not obtained within 180 days alter it has been accepted as complete. 440-4611(wxvCorf)
Mechanical Perna _t Application
-- — Date received: O-1.2 Pe o.;,Z p
City of Tigard Project/appl.no.: Expire date:
City njTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171
Pax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _ Building permit no.:
U 1 it 2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
U Nt ry construction ;KA(Idition/alteratioii;ieplacement U Other.
Job address: 71 Z $<l S'< FiY J r els, Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment.labor,overhead,
Tax map/tax lot/account no.: profit.Value$ 7 _
Lot: Block: Subdivision: 'Sei checklist for important application information and
Project name: jurisdiction's tee schedule for residential permil fee.
City/county:
Description and location of 4ork on premises: ,� _. .o_r_,.
Pee(ea.) Total
Est.date of completion/inspection: Description Qty. Res.only Res.only
Tenant improvement or change of use:
existing space heated or condiGoned?U Yes U No Air handling unit qu CFM
Air con�u Hing(siteplan quire )
Is existing space insulated?U)'c,, 'J Nu Alteration o existing .A system
oiliedcompressors �-
Business name: f �� ,i �n tate boiler permit no.: —
LLl�t_ � r"`f NP Tons BTU/11
Address: _ it smo a ampers/ductsmoke detectors
City: _ State: lP cat pump(sile�an required)
Phone: - Fax: E-mail: nstal rep ace urnac urner_
--- -- — Including ductwork/vent liner U Yes U No
CCB no.: Install/replace/relocateen e
heaters-suspd,
City/metro lic.no.: wall,or floor mounted
Name( lease printf Vent for appliance of er than furnace
e erat on:
Absorption units,____._
Name: ':'�,r Chillers--_—
Address: Com ressors 111'
nv WIT- -ta exhaust wnd ventilation:
City_ — State: ZIP: Appliance vent _ ------
Phone: Fax: E-mail: Dryerex aunt
0o s,Typc /II/res. ilc a azmat
hood fire suppression system
Name: .S c' n/l>�..Z Exhaust fen with single duce(bath fans) T
Mailing address: / 17,`>Z ` z,./I z aust systema art from heating or AC
,,, -_ State ZIP: 'Fuelpiping—and (up to !out cls)
City: j
�'�� Type. __LPG NG UII
Phone:, >{66 Fax: - E-mail: I fuel Erin each additional over 4ouilets
Process piping(schemalicrequirec)
Number of outlets
Name: —
_ Ot er listed appliance or equipment:
Address: _ _ Decorative fireplace
City: State, l.IP Insert-type
-
Phone: Fux: � mail --- oo stov pe et stove
Other.
am
Applicant's signature: Date:
Ne (print): — —
Not alljurisdictions accept credit cards.please tali iutisdiction for more Inf i nWion. Permit fee..................... �.
U Visa U MasterCard Notice: iris permit application Minimum fee................$
Credit card number __. _—.—_—s�� -.�-�__ expires if a permit is not obtained Plan review(at _ %) $
Expires within 180 days after it has been State surcharge(8%)....$
—� -- accepted as complete.
None of Cardholder as shown on credit cud
S TOTAL .......................$
Cardholder signature Amount 4404617(&MCOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
$1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code Qty (Ea) A_rnt
$5,001.00 to$10,000.00 $72.50 for the firs($5,000.00 and 1) Furnace to 100,000 BTU i
$1.52 for each additional$100.00 or Includingducts 8 vents 14 00
fraction thereof,to and including 2) Furnace 100,000 BTU+
_ _ $10,000.00. including ducts&vents 17 40
$10,001.00 to$25,000.00 v $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or including vent
fraction thereof,to and Including 4) Suspended heater,wall heater
_
$25,000.00. or floor mounted heater 14 00
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent nut included in appliance permit
$1.45 for each additional$100.00 or 6 80
fraction thereof,to and including 6) Repair units
_ $50,000.00. 12.15
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. footnotes below. Comp*
T 7)<3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: to -15 BTU _ 14 00
_ 3
8)3-15 HP;absorb
Value Total unit 100k to 500k BTU 25.60
Description: Q _LE J _Amount 9)15-30 HP;absorb
Furnace to 100,000 BTU,including 955 unit,5-1 roll BTU 35.00
ducts&vents 10)30-50 HP;absorb
Furnace> 100,000 BTU Including 1,170 unit 1-1.75 frill BTU 52.20 _
ducts&vents — 11)>50HP:absorb
Floor furnace Including vent 1 955_ unit>1.75 mil BTU 87.20
Suspended healer,wall heater or 955 12)Air handling unit to 10,000 CFM
floor mounted heater _ 1000
Vent not included in applicance 445 13)Air handling unit 10,000 CFM+
permit _. 17.20
Repair units 805 - 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 955 1000
to 100k BTU 15)Vent fan connected to a single duct
3-15 hp;absorb.unit, 1,700 6.80
101k to 500k BTU 16)Ventilation system not included In
15-30 hp;absorb.unit,501k to 1 2,310 appliance permit 10.00
mil,STU 17)Hood served by mechanical exhaust
30-50 hp;absorb.unit, 3,400 10.00
1-1.75 mil.BTU 18)Domestic incinerators
>50 hp;absorb.unit, 5,725 1740
>1.75 mil.BTU 19)Commercial or industrial type Incinerator
Air handling unit to 10,000 chn _ 656 6995
Air handling unit>10,000 cf_m 1,170 20)Other units,including wood stoves
Non-portable evaporate cooler 656 10.00_
Vent fan connected to a single duct 446 1 _ 21)Gas piping one to four outlets
Vent system not included in 656 540 _
appliance ermit 22)More than 4-per outlet(each) T
Flood served by mechanical exhaust 656 � 1.00
Domestic incinerator 1 170 Minimum Permit Fee$72.50 SUBTOTAL: 5
Commelclal or Industrial Incinerator 4,590
Other unit,including wood stoves, 656 -- 8%State Surcharge $
Inserts,etc.
Gas�iping 1 4 outlets 360 25%Plan Review Fee(of subtotal) $
Each additional outlet „ 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
Other Inspections and Feet:
I Inspections outside of normal business hours(minimum charge-two hours)
$72 50 per hour
2 Inspections for which no fee is specifically indicated (minimum charge-half hour)
$12 50 per hour
3 Additional plan review required by changes,additions or revisions to plans(minimum
charge-one-half hour)$72 50 per hour
'State Contractor Boller CertinraUnn required for units>2M BTU.
"Residential AIC requires site plan showing placement of unit.
I:dsts\forms\mech-fees.doc 10/11/00
Plumbing Permit Application
Date received: U- -too Pf it J
Cit of Tigard City � Sewer permit no.: Building permit no.:
Address: 13125 SN' Ifall Blvd,Tigard,OR 97223
CifyofTigord phone: (503) 639-4171 Project/appl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: _ _ Case,file no.: Payment type:
1 '
U 1 & 2 family dwelling or accessory U C onunercial/industrial U Multi-family U Tenant improvement
U New construction "IQ Add ition/aIleration/re placemetil U Food service U Other:
.1011 SITE INF TION FEE SUI I ED1.1 I (for special information use checklist)
PRMA
Job address: 3 ��J �,�rs�o Description Qt . Iee(ea-) Total
Bldg.no.: Suitt:no.: New I-and 2-family dwellings only:
-- (includes 100 t.for each utility connection)
Tax map/tax lot/account no.: _ SFR(1)bath
Lot: I Block: Subdivision: SFR(2)bath -- --- - - - _
Project name: —^ SFR(3)bath
City/county: ZIP: Each additional bath/kitchen
Site
Description and location o work on premises: Catcchh batiea:
Catch dr;.in
Est.date of completion/instwetion: Drywells/leach fine/trench drain
Footing drain(no.lin.ft.)
Manufactured home utilities
Business name: Manholes
Address: _ Rain drain connector
_City: State: ZIP: Sanitary sewer(no.lin.ft.)
Phone: - "�-� ax: E-mail: Storm sewer(no. lin, ft.)
CCB m.: Plumb.bus. reg.no: Water service(no.lin.ft.)
City/metro lic.no.: Fixture or Item:
Contractor's representative signature Absorption valve
Back flow preventer
Print name: bate: Backwater valve
COVACT PERSONBasins/lavatory
Name: Clothes washer
• 'r� -_— - - — Dishwasher
Address: _ __
Drinking fountain(s)
City: State: 71P: _ _ Ejectors/sump _
Phone: ��- Fax: E-mail: Expansion tank
Fixturelsewer cap
Floor drains/floorsinks/hub
Name(print): >'C pr a /a✓ Garbage disposal _
Mailing address: /7y" S C Y s it44 Hose bibb
City: / State ZIP: Icemaker _
Phone: _eleZ I Fax: 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 awn as per ORS Chapter 447. Sink(s),basin(s),lays(s) _ —
Owner's signature: Date: Sum
Tubs/shower/shower pan _
NUrinal
Name: _
--- -- Water closet_
Address:Ci _ Waterheate_r
ty: State: ZIP: Other:
Phone: Fax: E-mail: I Total
Not all jurisdictions rcept credit cards,please call jurisdiction fa more Information. Notice:This permit application Minimum fee................$ _
Plan review(at _ %) $
U Visa U MasterCard expires if a permit is not obtained -
Credit card number _ _.._-.__�� -L L__ within ISO days after it has been State surcharge(8%) ....$
-
—Nameof cardholder dss—how-n nncre---dit-card rXpvrs-- accepted as complete. TOTAL .......................$
S
Cardholder signature '_— Anmum_ 1404616(ISWCOMI
i
PLUMBING PERMIT FEES:
-�-- PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (individual) QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
16.60 for each utility connection) _
Lavatory _ _ One 1 bath_ $249.20
Tub or Tub/Shower Comb 16.60 Two 2 bath $350.00
Shower Only 16.60 Three 3 bath $399.00 —
Water Closet 16.60 --- — SUBTOTAL
Urinal 16 60— e/.STATE SURCHARGE _ —
Dishwasher 1660 PLAN REVIEW 25%OF SUBTOTAL -
- ----- 16.61.. — — - - —— TOTAL
Garbage Disposal _
Laundry Tray __T6 60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3„ i6.su PLEASE COMPLETE:
4^ 16.60
Water Heater O conversion O like kind 1660
_ Quanlit b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
MFG Home New Water Service 46.40 Sink _ _ _ Caed
—_—_
MFG Home New Sart/Storm Sewer 46.40 Lavatory _
-- Tub or Tub/Shower
[lose Bibs 1660 Combination _—
Roof Drains 16.60 Shower Only
Drinking Fountain _76 6-0 Water Closet -- _--
Urinal
Other cify)Fixtures(Specify) 16.60 Dishwasher
Garha a Uis osal _
- —
Laundry Roorn Tray
--- — --
Washing Machine _ --
Floor Drain/Sink• 2" _
Sewer-1 st 100' 55.00 3^ _
Sewer-each additional 100' 46.40 4" --
\11'jter Service- 1st 100' 55.00 Water Heater
_ -- Other Fixtures
Water Service-each additional 200' 46,40
Storm&Rain Drain-1st 100' 55.00 __—
Storm&Rain Drain-each additional 100'--i'ommercial Back Flow Prevention Device
Residential Backflow Prevention Device' 27..55 �^
Catch Barin 16.60 --- —
inspection of Existing Plumbing or Specially 72.50
Re nested Inspections pernir COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 65.25
c3rease Traps 16.60 -- -- ------ --
QUANTITY TOTAL
Isometric or riser diagram is required if
9uantdy Total is >9 —
*SUBTOTAL
8%STATE SURCHARGE - —— ------�-- -- -- --- —
"PLAN REVIEW 25°/.6F SUBTOTAL
Required only if fixture r total is>9
TOTAL S
Minimum permit fee is$72 50-8%state surcharge,except Residential Backflow
Prevention Device,which is$36 25.8%state surcharge
"All New Commercial Buildings require plans with Isometric or riser diagram and
plan review
1:\dsts\forms\plm-fees doc 10/10/00
Electrical Permit Application
Datereceived:
City of Tigard Project/appl.no.: Expimdate:
City gIIgan; Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax. (503) 598-1960 Case file no.: Payment type:
Land use approval: —
1 PERMIT
U I &2 family dwelling or accessory U Commercial/industrial O Multi-family U Tenant improvement
U New constructionJAddition/alleration/replacemcnt -)()lhrr _ -__ U Pallial
11 SITE.INFORMATION
Job address: s Bldg.no.: i Suite no.: ITax map/tax lot/account no.:
Lot: I Block: Subdivision: -
Project name: Description and location of work on premises: 4 '
[Estimated date of completion/inspection:
1
.1011 no: Fee Max
f'•Usiness name: _ ` Description _ (Py. (ea.) 'Total nu.Insp
Ne rrsidential-single or multi-fetidly per
Address: dwelling unit.Includes attached garage.
City: Stale: ZIP: Service Included.
Phone: Fax: I E-mail: 1000 sq rt.or less _ 4
Each additional 500 gq.ft.or portion thereof _
CCB no.: Elec, hus.tic.no: Limited energy,residential 2
City/metro IIC.no.: Limited energy,non-residential 2
Each manufactured home or modular dwelling
Signature of supervising electrictan( sired bate Service and/or feeder 2
Sup.elect.name(print) I iceme no Services or feeders-Inslallatlon,
alteration or relocation:
200 amps or less 2
Name(print): S Ej,�.6 E40
mps to 400 amps - 2
mps to 600 amps 2
Mailing address: ' ��J C' /is:C i� mps to 1000 amps 2City: ` r.. State Cx ZIP:41' 1000 amps or volts 2
Phone: Fax: E-mail: Reconnect only I
Owner installation:The installation is being made on property i own Temporary services orfeeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation:
ORS 447,455,479,670,701. 200 amps or less _ 2
201 amps to 4W amps 2
Owner's signature: Date: _ _ 401 to 600 ams 2
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: t at r 7_I P: B. Fee for branch circuits without purchase
Phone:
--------
""'--�-`--- - of service or feeder fee,first branchcircuit: 2
I ar 1i mail — - __
Fsach additional branch circuit:
I'l,%N It I V11 EW(Please check all that apply) Mhe.(service or feeder not Included)-
•Serviceover225amps-commercial Ullealthcarefacility Each pump or irrigation circle 2
O Service over 320 aatps-rating of 1&2 U Hazardous locat,on Each sign or outline lighting — 2
familydwellings U Building over 10,000 square feet fouror Signal circuit(s)or a limited energy panel__
❑System over 600 volts nominal more residential units in one structure alteration,or extension* 2
O Building over three stories U Feeders,400 amps or more *Description:
•occupant load over 99 persons U Manufactured structures or RV park FAch additional Inspection over the allowable In any of the above:
O Egresstlighting plan U Other: Per inspection (-1—T-
5ubmit—sets of plans with any of the above. Investigation fee _
The above are not applicable to temporary construction service. Other
-- ---- — ----
Not all jurisdictions accep credit cards,please call jurisdiction for more information Notice:'rhis permit application Permit fee.....................$
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit card number __ _ - /— z within 180 d-tys after it has been State surcharge(8%)....$
Explres accepted as complete. TOTAL .......................$
Name o><cardholder as shown on credit card — ---
_-- �' Cardholder signature �— --Amount 4404615(6WICOM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY _
p Restricted Energy Fee...................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service Included: Items Cost Total
Check hype of Work Involved:
Residential-per unit
1000 sq it or less $145 15 _ 4 ❑ Audio and Stereo Systems
Each additional 500 sq it of
portion thereof $33.40 _ 1 ❑ Burglar Alarm
Limited Energy $7500
Each Manurd Home or Modular
Dwelling Service or Feeder $9090 2 ❑ Garage Door Opener'
Services or Feeders L� Heating,Ventilation and Air Conditioning System'
Instaliatir,i,alteration,or relocation
200 amps or less $80,30 _ 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems'
401 amps to 600 amps _ $160.60 _ 2
601 amps l0 1000 amps $240.60 2
Other
Over 1000 amps or volts $454.65 _ 2
Reconnect only — - $66.85 2 --- - _ -
Temporary Services r Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,+Iteration,orrrelocation
200 amps or less $6685 2 Fee for each system.......................................................... $75.00
201 amps to 400 amps $10030 2 (SEE OAR 918-2.60-260)
401 amps to 600 amps $133 75 2
Over 600 amps to 1000 volts, Y Check Type of Work Involved:
see"b"above
Branch Circuits
❑ Audio and Stereo Systems
New,alteration or extension per panel
a)The fee for branch circuits �� Boiler Controls
with purchase of service or
feeder fee. Clock Systems
Each branch circuit $6.65 2
b)The fee for branch circuits ❑ Data Telecommunication Inslallafion
without purchase of service
or feeder fee.
First branch circuit $46.85 C� Fire Alarm Installation
Each additional branch ci, ja $665 ❑
HVAC
Miscellaneous
(SerAce or feeder not included) ❑ Instrumentation
Each pump or rrriyation circle $53.40
Each sign or outline lignting _ $53.40
Signal circutt(s)or a limited energy L� Intercom and Paging Systems
panel,alteration or extension $75.00 _
Minor Labels(10) $125.00 ❑ Landscape Irrigation Control'
Each additloral Inspection over
the allowable In any of the above Medical
Per inspection $62.50 ❑
Per hour _ $62.50 Nurse Calls
In Plant J—_ $73.75
Outdoor Landscape Lighting'
Fees: fr
Enter total of above fees $ L� Protective Signaling
----
8%State Surcharge $ I 1 other ----- --- —_—�—__
25%Plan Review Fee __Ni tuber of Systems
See"Plan Review"section of, $
frorl of application ' No licenses are required Licenses are required for all other installations
Total Balance Due $ Fees:
❑ Trust Account# Enter total of above fees $_ __-
---.- —_--- -- -------_----..__ -- 8%State Surcharge $_
Total Balance Due
r.\dsts\forna\elc-fecs,doc 10/09.'00
I
_ I
SEE 35MM
ROLL# 22
FOR
LARGE
DOCUMENT
CITY OF TIGARD
13125 S.W. MALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
NORTH STAR PLUMBING
1445 SE OREGON ST
SHERWOOD, OR 97140
Plumbing Signature Form
Permit #: MST2000-00466
Date Issued: 10126100
Parcel: 2S104CC-08200
Site Address: 13722 SW ASCENSION DR
Subdivision: HILLSHIRE WOODS
Block: Lot: 101
Jurisdiction: TIG
Zoning: R-7
Remarks: addition of 2 story and basement total of 860 sq ft
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above. ATTN: Building Dept.
No plumbing inspections will be authorized until this completed farm is received
OWNER: PLUMBING CONTRACTOR:
HARELAND, SCOTT A + SUSAN M NORTH STAR PLUMBING
13722 SW ASCENSION DR 1445 SE OREGON ST
TIGARD, OR 9.7223 SHERWOOD, OR 9714G
Phone #: Phone #: 625-2679
Reg #: I If: 00090697
PI M 34-255PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
4&gntuarelo�fAuthorized Plumber
If you have any questions, please call (503) 639-417' , ext. # 310
Electrical Innov. , Inc. 503-632-6534 p. 10
CITY OF TIGARD
13125 S.W. HALL BLVD,
TIGARD, OR 97223
IMPORTANT (PERMIT NOTICE
ELECTRICAL INNOVATIONS
22300 S LEWELLEN RD
BEAVERCREEK, OR 97004-8733
Electrical Signature Form
Permit #• MST2000-nOd66
Date Issued: 10126/00
Parcel: 2S104CC-08200
Site Address: 13722 SW ASCENSION DR
Subdivision: HILLSHIRE WOODS
Block: Lot: 101
Jurisdiction: TIG
Zoning: JR-7
Remarks addition of 2 story and basement total of 860 sq ft
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
'4 appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is, received
nWNFR: ELECTRICAL CONTRACTOR:
HARELAND, SCOTT A + SUSAN M ELECTRICAL INNOVATION5
13722 SW ASCENSION DR 22300 S LEWELLEN RD
TIGARD, OR 97223 BEAVERCREEK, OR 97004-8733
Phone #: Phone #' No business phone
REQ ##: ELL 26 4599L
LIC C0066412
SUP 30215
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signatur 1 Supervising Electrician
!f you have any questions, please call (503) 639-4171, ex!. # 310