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CITY OF TIGARD
DEVELOPMENT SERVICES
I1 13125 SW Hall Blvd., Tioard, OR 97223 (503) 639-4171
SITE '1 DRESS: 10365 SW GREENL.EAF TERR
St!' iIVISION: SUMMERFIELD NO.5
BLOCK: LOT: o248
REISSUE:
CLASS OF WORK: REP
TYPE OF USE: MF
TYPE OF CONST: 5N
OCCUPANCY GRP: P.1
OCCUPANCY LOAD:
STOR: HT:
I33MT?: MEZZ'l:
FLOOR LOAD:
DWELLING UNITS:
BEDRMS. BATHS:
FLOOR AREAS _
FIRST: sf
SECOND: sf
sf
TOTAL AREA: sf
BASEMENT: sl
It GARAGE: sf
_ REQD SETBACKS _
asf LEFT: ft RGHT:
FRNT: ft REAR:
IMP SURFACE:
BUILDING PERMIT
PERF#VT#: BJP1999-CO297
DATE ISSUED: 1/14/99
PARCEL: 2S 111 CC -18900
TONING: R-12
JURISDICTION: TIG
EXTERIOR WALL CONSTRUCTION
N: S: E: W:
PROJECT OPENINGS?
N: S: E: W:�
ROOF CONST: FIRE RET?
AREA SEP. RATED:
OCCU SEP. RATED:
ft FIR SPKL
ft 'IR ALRM
PRO CORR
REQUIRED
SMOK DET:
HNDICP ACC:
PARKING:
VALUE: � �.JO').00
Remarks: Exr3rior structural repairs - Permit fees cover (2) two individual inspections. Additional inspections subject to
re -inspection fee of $50.00 each. No C of O required.
Owner:
GLADYS GOODRICH
10365 SW GREENLEAF TERRACE
TIGARD, OR 97224
Phone:
Contractor:
I . CONSTRUCTION INC
PO BOX 34
NEWPORT, OR 97365
FEES _
Type By Date Amount Receipt
INSP DEB 7/12/99 $100 00 99-316783
Total $100.00
Phone: 541-764-3858
Rep #: Uc 97820
REQUIRED INSPECTIONS
Mi;c Inspection
Misc. Inspection
Final Inspection
ORIGINAL
This permit is iSSLIed subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty, Codes and all other applicable law All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility
Notification Cente,. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-1987.
i
Permitee
Signature: __��------ ---
ISSUL By:
Call 639-4175 by 7 p.m. for an it spection the next business day
CITY OF TIGARD
13125 SW ..ALL BLVD.
TIGARD, OR 97223
(503) 6394171
Commercial Building Permit Application
New Construction 0TAUditions
Print or Type
Incomplete or illegible applications will not bec�cepted
Note: Site Work Permit Application must precede or accompany Building
Permit Application
I �COMNEW DOC (DST) 5/98
Recd ey_- 1JItf✓. _
Date Recd
Date to P.E. _'—
Date to DST
Permit# 6,P1,179 -
Related SWR #-
caned
Existing Building ISI New Building ❑
Building
Data
Existing Use of Building or Property:
Proposed Use of Euilding or Property'
No. Of
Sq. Ft, Of Project
Occupancy Classes) ��,
Type(s) of Construction
K f n S Will this project have a Fire Suppression System? -- - _ ---- 7
Yes
U No
Americans with Disabilities Act (ADA)
Valuation X 25% = $ Participation
Complete Accessibility Form
Project � $ ----- Valuation
a
/r
PIanS Required: See Matrix for number of sets to submit
on back
I hereby acknowledge that I have read this application, that the information l
given if, correct, that I am the owner or authorized agent of the owner, and
that plans submitted are in compliance with Oregon State Laws
Signattye OwtAfr/A ent , Date
% --UU
Contact Person Nam Phone
��-,'i' rCtl/,r7 S`ll --�76�i"�
FOR OFFICE USE ONLY
MaprTL#' Land Use:�A---- T. ---j
Notes• — --
Name of DevelopmenbPrajed
Job
Address
tiaetAddress
! - 3 (' 5"
Bldg #
C4/State Zip
--- -lrl';MP
OAC `P 7 22
Name
Property:.
Owner
Mailin A rens
Suite
City/State Zip
Phone -
7_ SA a4 P oR 772Z3
Occupant
Name
Name
Contractor
_ K c o N S
Prior to permit
issuance, a copy
of all I,, tenses
Mailing Address
f , 1:1)
Suite
are required ii
expired In C 0,1.
database
City/State Zip
Alfc.-1<0r O:< cf7lIk-
Phone S
71,rl SS s;s
Oregon Const. Cont. Board Lic.#
_ 7
Exp. Date
7 n t
Name
Architect
Malting Address
Suite
Clty/Slat, - —lip
Phone --
Engineer
Name
Mailing Address
Suile �—
Phone
City/State Zip
indicate .ype of work New G Ado lion O Demolition O
Accessi ry Structure O Foundation On. r 0 Alteration O
Repair O _ C.:.er O
—
-
Dascr ptlon of work:
Parka: Estimated # of Employees
If the above figure Is not supplied at the time of application, the city will
calculate the fee based upon Lhe number of parking spaces.
Note: Site Work Permit Application must precede or accompany Building
Permit Application
I �COMNEW DOC (DST) 5/98
Recd ey_- 1JItf✓. _
Date Recd
Date to P.E. _'—
Date to DST
Permit# 6,P1,179 -
Related SWR #-
caned
Existing Building ISI New Building ❑
Building
Data
Existing Use of Building or Property:
Proposed Use of Euilding or Property'
No. Of
Sq. Ft, Of Project
Occupancy Classes) ��,
Type(s) of Construction
K f n S Will this project have a Fire Suppression System? -- - _ ---- 7
Yes
U No
Americans with Disabilities Act (ADA)
Valuation X 25% = $ Participation
Complete Accessibility Form
Project � $ ----- Valuation
a
/r
PIanS Required: See Matrix for number of sets to submit
on back
I hereby acknowledge that I have read this application, that the information l
given if, correct, that I am the owner or authorized agent of the owner, and
that plans submitted are in compliance with Oregon State Laws
Signattye OwtAfr/A ent , Date
% --UU
Contact Person Nam Phone
��-,'i' rCtl/,r7 S`ll --�76�i"�
FOR OFFICE USE ONLY
MaprTL#' Land Use:�A---- T. ---j
Notes• — --
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependent upon submittal of BOTH plans .AND a COMPLETED
application. For an electrical submiftal, the application must contain the
signature of the supervising electrician before plan review will be r,onducted.
"fter plan review approval, Plans Examiner will contact the applicant to request
miditional flan sets for distribution purposes. (Copy for Contractor, City, µ
Viashington County, Tualatin Valle, Fire & Rescue)
TYPE OF SUBMITTAL
Total # of
Plans
Submifte,i_
� �
S (Private)
1 �
3
1
F (New or Add or Aii)
—
I\i (New _o Add or Alt)
V
B F M (New or Add)
1
P (New. Add, or A -it)
-
2
- —
& M & P (New or Add)
�-- W
2
_-- - 2�-- �
�3
E (New, Add, or Alt)
— a
B&F&M&P&E
(New, Add)
*B or B & M (Alt)
1
*B&MRP(Alt)
3
*B&M&P8E(4It)
3
3
NOTES:
*Shaded areas designate ALT submittals only.
I Wsts\torms\matrxcom Aoc 10/30198
KEY:
S
= Site Work
B
= Building
F
= Fire Protection System
M
= Mechanical
P
= Plumbing
E
= Electrical
New
= New Building
Add
= Addition
Al!
= Alternation to Existing
Building
It
CI I Y OF TIGARD BUILDING INSPECT!ON DIVISION MST
24 -Hour Inspection Line 539-4175 Rusiness Line: 639-4171 - — ---�–
(BUP
Date Requested, r- AM �_PM BLD ^�
Location C j�•) `�rlZ'i� ,�� C %Q-.',� Suite _ i MEC
Contact - erson_ Ph PLM
Contractor L Ir f c Y C Ph i SWR
BUILDING Tenant/Owner
Retaining Wall
Footing
Foundation
Ftg Drain
Crawl Drain
Slab
Post & Beam
Ext Sheath/Shear
nt Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc
Final
PASS PART FAIL
PLUMBING
[lost & Beam,
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
Service
Rough In I I
UG/Slab �1
Low Voltage
Fire Alarm
nat h
SS PART FAIL
SITE^
Backfill/Grading
Sanitary Sewer
Storm Drain
Catch Basin
Fire Supply Line
ADA
Approach/Sidewalk
Other
Final
PASS PART FAIL_
Access�
Inspection Notes:
ELR
FPS
SGN
SIT
C-1
( j Reinspection fee of $ _A required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
[ j Please call for reinspection RE - — Unable to inspect - r access
Date / lam' Inspecto---
DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd.. Tiqard, OR 97223 (503; 639-4171
SITE ADDRESS: 10375 SW GREENLEAF TERR
SUBDIVISIC A: S' 1MMERFIELD NO.5
BLO,:K: LOT: 247
Proiect Description: (2) branch circuits to A/C. J06996
RESIDENTIAL UNIT _
1000 SF OR LESS:
EACH ADD''- 5005F:
LIMITED ENERGY:
MANF HMI SVC/ FDR:
SERVICE/FEEDER
ELECTRICAL PERMIT
PERMIT #: ELC2001-00383
DATE ISSUED: 07/30/2001
PARCEL: 2S111 CC -18800
ZONING: R-12
JURISDICTION: TIG
TEMP SRVC/FEEDERS _ MISCELLANEOUS
U 200 amp: PUMP/IRRIGATION:
201 - 400 amp: SIGN/OUT LINE LTG:
401 - 600 amp: SIGNAL/PANEL:
601+amps - 1000 volts: MINOR LABEL (10):
BRANCH CIRCUITS
ADD'L INSPECTIONS_
0 200 am;;: W/SERVICE OR FEEDER: PER INSPECTION:
201 400 amp: 1st W/O SRVC OR FDR: 2 PER HOUR:
401 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ PLAN REVIEW SECTION _
I 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
l Reconnect only: SVC/FDR >= 225 AMPS: CLASS AREA/SPEC UCC:
Owner:
KNUTSEN, JEANE F
CANESSA BARBARA JEANE
SWINGLE, MARY FORD TRUSTEES
PALM DESERT, CA 92211
Phone:
FEES
Type By Date Amount Receipt
PRt ^T CTR 07/30/2001 $53.50 2720010000(
5PCT CTR 07/30/2001 $4 28 2720010000(
Total $57.78
Contractor:
WEST SIDE ELECTRIC CO INC
1334 SE 8TH AVE
PORTLAND, OR 972.14
Phone:
Reg #: U1-15ft06
SUP 1556s
C! F 2b-' 35c
Pequired Inspections
Rough -in
Elect'I Final
Thea permit is issued subject to the regulations contained in the Tigard Municipal Cote. State of OR Specialty Codes and all other applicable laws
Al; will be done in accordance with approved plan. This permit will expire if work is not started within 180 days of issuance, or if work is
A for mure than 180 days ATTENTION Oregon law requires you to tollow rules adopted by the Oregon Utility Notification Center Those
,t forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules or direct questions to OUNC at (503)
1.800-332-2344
--oll S;gnature:d f1 !Cry Issued By:, IL i
OWNER INSTALLATION ONLY _
The installation is being made cn property I own which 1s not intended for sale, lease, or rent.
OWNER'S SIGNATURE:
CONTRACTOR INSTALLATION ONLY
DATE:
SIGNATURE OF SUPR. ELEC'N: "Ih AL_L= _&k_ -r" ` DATE:__.
I ICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next business day
�I
Cily r�a4
Electrical Permit.l
City of Tigard
Addrert: 131LA SW IIM11 R1. d, 'I (I IC(
rhone: (303) 6 39-41 I
r'nn: (509) 598 1900
r .....r ..... nw- ,.i•
►lapliuitlon
dnwnalvxerJ p) Pmtm.; ro,:�L.7 003$3
RECEIVE 6 AuJcoVclyl,no., 1.,y11tdlde;
.014 91223 r'HyrinuKl: �� li) Retelprxu.:�
,1u1- , MINCIrr Nnno,; Iw.yntnllyyc
,11re 1MR Y[ WI NfplleJrlS to Irrnpor ur► courr xellnx rer,irY_ f.._10O�+K____
FM �I �Zwg. u trse�i rwla eNr, V)w,� ll)�riiT' n of t. yip Ihrnirrtlml
Notice; 1111e prmdl eppliePtlon
Ovla UMoraCud erlrucfirapermirlrnot oblelo.d
Crew .rye nwb, __.. _ , _...— 1vilmq 1 go d1Y1 Ort h has peen
lerepled as coulpibrs.
10'd
:-ermit fee ................ 52A.- s U—
Man mview W 9h,I S
Slate tuuhuge (8%)
TOTAL S 7� -
44.4"1' MI -M)
L9L1 S£.! £0S nIMIa31l 19aIS 1S3M Wd I Z : 10 10--�'' - iir
CITY OF TIGARD
r DEVELOPMENT SERVICES
-=--� 13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171
SIZE ADDRESS: 10355 SW GREENLE ^F - TES.":
SUBDIVISION: SUMMERFIELD NO.5
BLOCK: LO 249
REISSUE:
FLOOR AREAS
Description
CLASS OF WORK: OTR
FIRST:
sf
TYPE OF USE: SFA
SECOND:
sf
TYPE OF CONST:
sf
OCCUPANCY GRF:
TOTAL AREA: 0
sf
OCCUPANCY LOAD:
BASEMENT:
sr
GARAGE:
sf
STOR: HT-
ft
BSMT?: NlELZ'7:
READ SETBACKS
FLOOR LOAD:
psf LEFT: ft RGHT:
DWELLING UNI':::
FRNT: ft REAR:
BEDRMS: 3ATH5:
IMP SURFACE.
VALUE: $ 27,957.00
Remarks: Reroof Building #9, 10355, 10365, 10375, 10385, 10395
Owner:
CLARKE, EDWARD H TRUSTEE
10355 bb^J GREENL.EAF TER
TIGARD OR 97224
Phone:
Contractor:
BUILDING PERMIT
PERMIT #: BUP20()4-00121)
DATE ISSUED: 3/22/04
PARCEL: 2S11 1 CC -19000
ZONING: R-12
JURISDICT ON: TIG
_ EXTERIOR WALL CONSTRUCTION
N: 5: E: W:
PROJECT OPENINGS?
N: S: E: W:
ROOF CONST: FIRE RET?
AREA SEP. RATED:
OCCU SEP. RATED:
REQUIRED
ft FIR SPKL: SMOK DET:
ft FIR ALRM : HNDICP ACC:
PRO CORK: PARKING:
JBC ROOFING
12155 SW GRANT AVE STE C
TIGARD, OR 97223
Phone: 503-968- ; 235
Reg #: LIC 98255
REQUIRED INSPECTIONS
Framing Insp
Framing Insp
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Munic,pal Code, State of OR Specialty Codes
and all other applicable law All work will be done in accordance with approved plans This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are stc forth in OAR
952-001-0010 through OAR 952.-001-0100. You may obtain a copy of these rules or direct questio,is to OUNC by
calling ( 503) 246-6699 or 1-800-332-2.344.
Issued by:
Permit tee
Signature:
Call 64A-4175 by 7 p.m. for an inspection the next business day
FEES
Description
Date Amount
---
I lit 1ILD1 11crmit Fee
(TAXI 8%State Surchar)
3/22/04 $139.30
.5/22/04 $11.14
Total $150.44
Phone: 503-968- ; 235
Reg #: LIC 98255
REQUIRED INSPECTIONS
Framing Insp
Framing Insp
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Munic,pal Code, State of OR Specialty Codes
and all other applicable law All work will be done in accordance with approved plans This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are stc forth in OAR
952-001-0010 through OAR 952.-001-0100. You may obtain a copy of these rules or direct questio,is to OUNC by
calling ( 503) 246-6699 or 1-800-332-2.344.
Issued by:
Permit tee
Signature:
Call 64A-4175 by 7 p.m. for an inspection the next business day
Re -Roof'
;Uildin;" 11Cr111it;application
i
.�,/IL..'vi..� Receved �. Icniut
City Ot Tigard Date.� DPS -or) C
13125 SW Hall Blvd., Tigard, OR 9 Plao Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:Other fermis
Inspection Line: 503,639.4175 MAD 1 `; O�% (�4 Date Ready/By: Juru 0 Ste Page 2 for
Internet: www.cl.tigard.ontis I1R ' "Nolified/Method: ISupplemental Information I
F
[] New construction ❑ Demolition
Addition/alteration/repiucement ❑ Otber:
CATEGORY OF CONSTRICTION
❑ I - and 2 -family dwelling
❑ Comm •rcial/industrial
❑ Accessory building
❑ Multi -family
❑ Master builder
Other: gTeq tel HID 01 &" J
JOB SITE INFORMATION AND LOCATION
Job site address:`7! fee- A) i-49d1'le
City/State/ZIP:~� ^-�` �j/Qr k7s 54
Suite/bldg,/apt, no.: Project name: SoA&Moe /Ceev
Cross street/directions to job site:
New building area: square feet
—
Number of stories:
Subdivision: Lot no.:
Tax map/parcel no.:
DESCRIPTION OF WORK
2- 4 y E <S sit - A � it Cs V- F_6 (- -r TA -PA
A-cr_- W I-EC7:>A--PcyQ 'V- 30 —
%r 0e, L l r—z� v!rN i A)
PROPF.RTV OWNER
❑ TENANT
Name: C"'/,"KJrf- Gje>e 1?01C {
Address: /6J 3rJ—
City/State/ZIP:
Phone:( )
Fax:( )
❑ APPLICANT
CONTACT PERSON
Business name:: _
Contact name: DA) _ �J
Address:
City/State/Zlf:
Phone: %Q — �Q� Fax• : ( )_
E-mail:
CONTRACTOR
Business name: G -ierF' FIAJ 4 C
Address: ` 0,- /Jx S. a) �rJ►IQ4A)-r-
city/siate/ZIP: / r A -;,Q_ -
Phone: (At � -- 6�_ 7•o Fax:( )
l CCB he.: y S
Authorized signet �lti+�fit/ p pp p
lc,� _ This permit application es rhes If a ermit Is not obtained
within 180 days after it has been accepted as complete.
Print name: ,- Uat� D �lethodoio f; set by Tri -County Building Industry
eT4iee Board.
REQUIRED DATA: I- AND 2 -FAMILY DWELLING
Permit fees" are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
work indicated on this application.
Valuation: S
Number of bedrooms:
Number of bathrooms:
Total number of floors:
New dwelling area: square feet
Garage/carport area: square feet
Covered porch area: square feet
Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Permit fees' are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
work indicated on this a lication.
Valuation: S
Existing building area: square feet
New building area: square feet
—
Number of stories:
L. Type of construction:
Occupancy groups:
Existing:
New:
NOTICE
All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Doard
under ORS 701 and may be required to be licensed in the
jurisdiction in which work is being perfor-,,.J. If the
applicant is exempt from licensing, th^ :allowing reasons
apply:
BUILDING PERMIT FEES"
Please refer ro fee schedule.
Fees due upon applic r ..t
Amount recei, id
Date received:
i\Bu11ding�Permae\ROOF-PemutAppdoc 12/03 1I0.1613T(I 110'rC.M/wEa)
RE -ROOFING PERMIT CHECK LIST
RESIDENTIAL (One- & Two -Family Dwelling)
-TREPAIR
(major) plan review required by plans examiner:
Building pc,mit is required when structural change-, are made or the space sheathing
is removed or :•eplaced.
SUBMIT TWO (2) SETS OF PLANS SPECIFYING:
A. Roof area and nearest street.
B. Attic vents: Provide l sq. ft. for each 150 sq. ft. of attic space. Vents shall be
located in the upper 1/3 of the roof. Provide 1 sq. ft. for each 300 sq. ft. when
eave and attic venting is provided.
Note: No permit is required for residential re -roof if not more than two (2) layers of
roofing will exist upon completion of the re -roofing.
CO
MERCIAL (includes multi -family and candominiums)
RE -ROOF: Pre -inspection is required for all roofs sloped 2:12 and less. Plea,,
make an appointment by calling the inspection line at 303 639-4175.
PLAN REVIEW:
Note: Depending on the conditions noted at the pre -inspection, plans may be
re wired to address an non-conformingitems.
VALUATION OF PROJECT:
$
_ sq. ft. of roof area
Permit Fee based on valuation:
$
(see Building Permit Pees chart
8% State Surcharge:
$
65% Plan Review Fee:
$
(Requiird iur major repairs of residential and
special purpose roofing of commercialprojects.)—
TOTAL:
$
i•\BuildingU:cmuUte-RoofChecktist.doc 12/24103
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Lii,a: ( i MST
503) 639-4171
N , _ a)1 7-0Received %� � _ Date Requested T'� —U� AM.,.LL PM _ BLIP
Location ` Suite MFC
C� t Person . tour _ Ph ( j . PLM ----.. ---- --
C�,,,ractor --- Ph ( ) SWR - — -
BUILDING
Footing
Foundation
Ftg Drain
Crawl Drair
Slab
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp�'d Ceiling
0
O _
Fin +�
AS PART FAIL
'BING
Post R Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL _
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL _
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART_ FAIL
Fire Supply Lane
ADA
Approacl,/Sidewalk
Other:
Final
PASS PART FAIL
Tenant/Owner _ �,.� �
1 '/� ex-, 4� ELC --- - - -
ELC
Access:
- -----_ _
ELR ---- .. - -
Inspection Notes:
�V
SIT
[] Reinspection fee of $ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
Please call for reinspection RE: _ .- LJ Unable to inspect -- no access
Date Inspector _ _ Ext _
DO NOT REMOVE this Inspection record from the Job site.
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"M OF TIGARD BUILDING INSPECTION DIVISION MST
74 -hour Inspo ,ction Line: 639-4176 Business Line: 639-4171 (13
BUP
—Date Requested _AMN �57pm� BLD
Location -
Suite
, C
Contact PErson Ph Z1,2 — PLM
Contractor Ph SWR
BUILDING
Retaining Wall
Footing
Foundation
Ftg Drain
Crawl Drain
Slab
Post & Beam
Fxr Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Sr sN'd Ceiling
f7oof
Misc.
Final
PASS PART FAIL.
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanif Ary Sewer
Ram 'jrains
Final
PASS FART FAIL
MECHA IGAt ,
.. O55 _PAfn
Rough I �
Gas Line /
Smoke Dampers
it
SS PART FAIL
ELECTRICAL
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART _FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain
Catch Basin
Fire Supply Linc
ADA
Approach/Sidewalk
Other _
Final
PASS PART FAIL
Tenant/Owne_r ELC
�— ELR
Access-
FPS
Inspe ction Notes: SGN
--- --='—C—�f� SIT
�-dip_
'A
4 Y—
] Reinspection fee of $ _ required before next inspection Pay at City Hall, 13125 SVV Hall Blvd
[ ) Plo:ase call for reinspection RF Unable to inspek, no a^cess
Date S1 L' i Inspector— r/� �/ �-- Ext
DO NOT REMOVE this inspection record from the job site.
II
A CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171
SITE A, iDRESS: 10375 SW GREENLEAF TERR
SUBDIVISION: SUMMERFIELD N0.5
BLOCK: LOT: 247
CLASS OF WORK: ALT
TYPE OF USE: SF
OCCUPANCY GRP: R3
STORIES:
FUEL TYPES
MAX INPUT: BTU
6:IRE DAMPERS?:
GAS PRESSURE:
FURN < 100K BTU:
FURN >=100K BTU:
MECHANICAL PERMIT `
PERMIT #: MEC2001-oe270
DATE ISSUED: 7/26/01
PARCEL: 2S 111 CC-- 18800
ZONING: R-12
JURISDICTION: TIG
FLOOR FURN:
EVAP COOLERS:
UNIT HEATERS:
VENT FANS:
VENTS W/O APPL:
VENT SYSTEMS:
BrorL.ERS/COMPRESSORS
HOODS:
0 - 3 HP: 1
DOMES. INCIN:
3 - 15 HP:
COMML. INCIN:
15 30 HP:
REPAIR UNITS:
30 - 50 HP:
WOODSTOVES:
50+ HP:
CLO DRYERS:
AIR HANDLING U14ITS i
OTHER UNITS:
<= 10000 cfm:
GAS OUTLETS:
> 50000 cfm:
Remarks: Installation of exterior A/C unit. Unit cannot be placed within the required setbacks.
Owner
KNUTSEN, JEANIE 1=
CANESSA, BARBARA JEANE
SWINGLE, MARY FORD TRUSTEES
PALM DESERT, CA 92211
Phone:
Contractor:
COLUMBIA HEATING + COOLING INC
PO BOX 230397
TIGARD, OR 97223
Phone: 624-2704
Reg #: LIC 76359
PLM 34-175
FEES
Type By Date
Amount Receipt
PRMT CTR 7/26/01
5PCT CTR 7/26/01
$72.50 272001000C
$5.80 272001000C
Total
$78.30
Mechanical insp
Final Inspection
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rJles adopted in the Oregon Utility Notification Center. Those rules are se' forth in OAP
952-001-0010 through OAR 952-001-0080. You may obtain rnpies of these rules or direct quest;ons to OUNC by
calling (503)246-9189,,_
Issue B!: .: -_Permit!Qe Signaturd; �' __
Call (503) 639-4175 by 7:00 PAM. for inspr.ctions heeded the next bust I ess day
Mechanical Permit Application
City of Tigard 1
f7m,ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639-4171
Fax: (503) 598-1960
Land use ,pproval: _
.01I & 2 family dwelling; or accessory U ('onttner Iill/)ndustrt,11
U New construction U Addition/alteration/replacement
Job address: 10375—
Bldg.
O37S-Bldg. no.: J Suite no.:
Tax map/tax lot/account no.:
Lot: Block: Subdivision:
Project name:
City/county: r ZIP:
Description and localion work on premises:
�[nsha.(l C
Est. date of completion/inspection:
Tenant improvement or change of use:
Is existing space heated or conditioned? U Yes U No
Is existing space insulated? U Yes U No
Date received: ?:: O/
Permit no.I-'E-e 7p01 - .,27o
Project/appl. no.:
Expire date:
fate issued:
By Receipt no.:
Case file no.:
Payment type:
Building permit no.:
U Multi -family
U Other:
U Tenant improvement
Indicate equipment quantities in boxes below. Indicate the dollar
value of all mechanical materials, equipment, labor, overhead,
profit. Value $
'See checl list for important apr' -ation information and
jurisdiction's fee schedule for r, .iential permit fee.
Fee (eq.) Total
Description Qty, Res. only Res. onl)
Air handling unit _ CFM
Air conditioning (site plan require )
75—ration of existing system
Business namState hoilcr permit no.:
e:Iu� hl� - HP Tons B'ru/H _
Address: ? DO k&:l Fire/smoke_ ampers/duct stno a etectors F
City:d State: ZIP: ZZ eat utnp (site plan regt:ired) —
Phone: p Fax: E-mail: nsta rep ace furnace/urner
Including ductµ ork/vent liner U Yes U No
CCB no.: 74035-1 nsta rep ac rc ocate heaters -suspen ed,
City/metro lic, no.: 0 /a'-7 A wall, or floor monmed
Name (please print): - C,1 r �� !/ ent fora iance other t an furnace
Refrigeration:
Absorption unitsBTU/H
Name. � j,�N -�O J cik" j Chillers -------_---- IIP _
Address: J -(`-' - Com ressors _ ill,
Environmental ex gust and ventilation:
City: _ State: ZIP: Appliancevent
Phone• -Z"10 I;ax: E-mail: 7ryerexhaust
K 11 o s, Type / res, itc en azmat
ii"
hood fire suppression system
Name: 3 E'ii, I . .4-C. 16 V, Exhaust fan with, single duct (bath fere) _
Mailing address: —. Exhaust s stcn, eating or AC'5, !_L
city: 4r Slale: 1':tie gan f tit on(optoou
tl^ts)
Type __ t.hf,-__..._. NG Oil
Phone: p Fax: E-mail Fueltin cac,, addmonal over
rocesipiping (sc ematicrequire) _
Name: Mtmber of outlets
ter ffided appliance ui equ pment:
Address: i- Decorative fireplace
City: State: ZIP: Insert - type-
Fax:
Phone: Fax: r E-mail oo stove/�t stove
Ot Fer:
Applicant's sig;naturc Date: & t K;
LName (print): -t-�,AW
Na all Jurisdictions accent credit cards, pleat call jurisdiction for more mRxmation Permit fee ..................... $
U Visa U Mastercard Notice: This permit application Minimum fee ................ $
Credit card number L expires if a permit is not obtained plan review (at , %) $
- t.,sp1fe, within 180 days atter it has leen State surcharge (896) .... S
Name of cardholder as shown on credit card accepted as complete.
S TOTAL ....................... $ Ze
Cardholder signature- - Amount
_ r 440A617 (dOarCnM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEUULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
I TOTAL VAL_UA_TION:
FEE:
f $1_ 00 to $5,000.00
Minimum fee $72.50`
$5,001.00 to $10,000V y..
k72.5 -(er Ihs, st $5,000.00 and
Amount
$1.52 for eaai additional $100.00 of
955
fraction thereof, to and Including
__$1
_
0,000.00.
$10.001 00 to $25,000.00
___ _
$148.50 for the first $10,000.00 and
1,170
$1.54 for each additional $100.00 or
ducts & vents
fraction thereof, to and including
_ ____
$25,000.00.
$25,001 00 to $50,000.00
$379.50 for the first $25,000.00 and -
Suspended heater, wall h atA�� r or
$1 45 for each additional $100.00 or
•,3, `. ,
fraction thereof, to and including
445
$50,00-0 00.
$50,001.00 9hd up
$742.W for the first5Q,000.0 and
T :
1120-er AecF b46iMnal $100 017 of
_
4) Suspended heater, wall heater
_ -
< 3 hp, absorW tW,
ASSUf4&Q VALUATIONS PER APPLIANCE:
Vaaue
Total
description __
Ea
Amount
Furnace to 100,000 BTU, including
955
& vents
—
includin ducts 8 vents
_ducts
Furnace > 100,00 inetu-d,T ' 1
1,170
-
ducts & vents
Floor furnace including vent, ,
55
Suspended heater, wall h atA�� r or
3) Floor Furnace
floor mounted heater
445
_
Vent not Included in apppcan a
ermil
Repair units ' -yam-�
805
_
4) Suspended heater, wall heater
_ -
< 3 hp, absorW tW,
to 100k BTU_,
14 00
3.15 hp; absorb. tine .
7D0
-- -
c r r ;�
101k to 500k BTU
.i:
_
_
15.30 hp; absorb. unit, 501k to 1
2,310
mil. BTU
30-50 hp; absorb. unit,
_
3,400
1.1.75 mil. BTU_
Check all that apply'
>50 hp; absorb unit.
5,725
Air
>1,75 mil BTU
_
Alr handling unit to 10000 cfm
656
Pump
_
AIr tandlidi anit�l0,000 cfm
1,170
_-
Non-ortable eve orate cooler
655
Corn •
Vent fan connected �o e�Sln�le duct
448
_
Vent system not included in
65
7) <3HP;absorb unit
_ ap)lance ermlt
Hood served by mechanical exhaust
656
_
Domestic incinerator
Commercial or industrial incinerator
4590
_
Other unit, including wood stoves,
656
inserts, etc. �.." 1
`•(*
Gas piping 1.4 outlets
360
_
Each additional outlet
63
_
2560
a
TOTAL COMMERCIAL
-
�
VALUATION:
I Wsts\forrnsUnec-h-fees.doc 10/11/00
Description
Price
Total
Table 1A Mechanical Code
Oty
(Ea)
Amt
1) Furnace to 100,000 BTU
—
includin ducts 8 vents
14 00
2) Furnace 100,000 BTU+
,-`-
_including ducts & verts
17 40
3) Floor Furnace
-
including vent
14 00
_
4) Suspended heater, wall heater
or Floor mounted heater
14 00
5) Vent not included it, _r pliance permit
_
6 80
6) Repair units
_
12 15
Check all that apply'
Boiler
Heat
Air
For Items 7.11, see
or
Pump
Cond
footnotes below.
Corn •
"'
7) <3HP;absorb unit
-
to 100K BTU
14 00
8) 3-15 HP; absorb
unit 100k to 500k BTU
2560
9) 15-30 HP; absorb
unit .5-1 mil BTU
3500
10) 30-50 HP; absorb
- `-
unit 1-1.75 mil BTU
5220
11)>50HP. absorb
-- `-
unit >1.75 mil BTU
87 2.0
_
12) Air handling unit to 10,000 CFM
1000
13) Air handling unit 10,000 CFM+
_
17 20
14) Non-portable evaporate cooler
1000
15) Vent fan connected to a single duct —
6 80
16) Ventilation system rot Included in
appliance permit
1000
17) Hood served by mechanical exhaust
1000
18) Domestic Incinerators
_
17 40
19) Commercial or industrial type incinerator
69 95
20) Other units, in(luding wood stoves
10.00
21) Gas piping one to four outlets
_
540
22) More than 4 -per outlet (each)
1.00
Minimum Permit Fee $72.50 SUBTOTAL:
S
8"A State Surcharge
a
25% Plan Review Fee (of subtotal)
Required for ALL commercial permits only
TOTAL RESIDENTIAL PERMIT FEE:
b
Qt:rer Inspections and Fees:
1 Inspections outside of normal business hours (minimum cha,ge-two hours)
$72 50 per hour
2 Inspections lot which no fee is specifically indicated (minimum charge -half hour)
$72 50 per hour
3 Additional plan review required by changes, additions pr rey stons to plans (mrnimun
charge -one-half hour) $72 50 per tour
`State Cnnhactor Holler Certification required for units >200k BTU.
"Residential A/C requires $Ite plan showing placement of unit.
COLUMBIA HEATING & COOLING, INC,
P.O. BOX 2,10397
8900 BURNHAMST. SUITF. E110
TIGARD,OR 97223
303-624-2704
FAX 303-598-0270
SITE PLAN
/
103, s
.!OB SITE ADDRESS,