9900 SW GREENBURG ROAD STE 100-1 i
E �
H O
H O
�T]
� E
O
O 6)
CI]
C+]
2
G
G�
d
I
f
I
I
_._ 9900 SW GREENBURG RD.
SUITE 100
�� ®� 1 ���R® —_ ELECTRICAL PERMIT
PERMIT#: ELC2001-00148
DEVELOPMENT SERVICES DATE ISSUED: 3/14/01
13125 SW Hall Blvd., Ticlard, OR 97223 (503) 639-4171 PARCEL: 1S126DC-03300
SITE ADDRESS: 09900 SW GREENBURG RD 100
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C•P
BLOCK: LOT : 005 JURISDICTION: TIG
Pruiect Description: Te .ant Improvement- move or relocate lighting and outlets
_ RESIDENTIAL UNIT _TEMP SRVC/FEEDERS _ MISCELLANEOUS
1000 SF OR LESS: 0 ^�P0 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 40' 600 amp: SIGNAL-/PANEL:
MANF HM/ SVC/FDR: 601+amps • 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 400 amp: 1st W/O 3RVC OR FDR: 1 PER HOUR:
401 600 amp: EA ADD'L BRNCH CIRC: 4 IN PLANT-
601 - 1000 amp: _ _ _ _ PLAN REVIEW SECTION __
1000+ amp/volt: —4 RES UNITS: > 600 VOLT NOMINAL
Reconnect only_ _ SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC: _
Owner: Contractor:
AlHERTON REALTY PARTNERSHIP TRI-CITY ELECTRIC
MARTHA ATHERTON 8395 S GRIBBLE
2100 S WOLF CANBY, OR 97013
DES PLAINE S, IL 60018
Phone: 847-298-8600 Phone: 503-266-9995
Reg #: LIC 50888
SUP 2405S
ELE 3-214C
FEES — Required Inspections
Type By Date Amount Receipt
Elecl'I Service
PRMT CTR 3/14/01 $73.45 2720010000( Elect'I Final
5PCT CTR 3/14/01 $5.88 2720010000(
Total $79,33
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR 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 rules adopted by the Oregon Utility Notrfication Center Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at(503)
246-1987
PERMITTEE'S SIGNATURE ') Y ISSUED BY: —/C��r�� � --
/%cam
OWNER INSTALLATION ONLY --�_
The installation is being made on property I own which is not intended for sale, lease, or rent
OWNER'S SIGNATURE: _ DATE:
CONTRACTOR INSTALLATION ONL.'
SIGNATURE CF SUPR. ELEC'N: _ DATE:__
LICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
-- --
"ved: b Permit no.��/-
City Of ' igard Project/appl.no.: Expire date:
Cifyu(Tigard 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: — TYPEOPPERN11111
U I &2 family dwelling or accessory fffi Commercial/industrial U Multi-family 1g1 Tenant improvenwin
U New construction U Adelition/alteration/replacement U Other: U Partial
M- MM
Joh address: t, Bldg.no.: Suilc no.: Tax map/tax lot/account no.:
Lola Block: Subdivision:
Project name: ,M i Description and location of work on premises: -yVj1L76 1 12i5 Lb(4 TIS,
Estimated date of complelio /inspection: / "�� �" 7 '
n
Job no: - ! Max
1)eu•rjption Ql). (ea.a.) llrl.a no.imp
Business name:" , T Newm%idential-shrkkonnulti fnmih IME
Address: Ez, i ,LZ 1 _ dNellingunit.Includesattachedgarage.
City: I Slate' ZIP: ServiceinchA41:
10tx)sq.It.or ICS% a.
Phones; • Fax: r E-mail: Each additional 500 sq.ft.or portion thereof
CCB no.: s - Edec.bus, lic.no: Limited energy,residential 2
City/melro lic.no.: Limited energy,non-residential _ 2
/, 3•./j•D j Gach manufactured home or modular dwelling
Si'inure OF supervising els tri an(required) Date feeder
Service mid/or
Services or feeders-Installation,
Sup.elect.name(print): -Q F (aii ,� License-:2 CSE- sheration or relocation:
200amps or les- '
201 amps to 4(x)amps 2
Name(print): 401 amps to 6(x)amps _ 2
Mailing address: 601 amps to 1001 amps 2
City: Slate: ZIP: i Over I(xx)amps or volts 2
Phone: Fax: E-mail:
Reconneclonly
Owner installation:The installation is being made on property I own Temporary services or feeders-
installation,a]terallon,orrelocalion:
which is not intended for sale,lease,tent,or exchange uLcarcfing l0 200 amp%or less '
ORS 447,455,479,670,701. 201 amps to 41x1 amps _ '-
Owner's si mature: Date: 401 to((x)amps
Branch clrcult iew,alteration,
or extensian per panel:
Name: _ A. tree for branch circuits with purchase of
-- service or feeder fee,each branch circuit 2
Address: _ _ --
City: State: 17.,P: - B. pee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2
Phone: FAX: I usnl Fachadditional branchcircuit:
: Mise.(.service or feeder not included):
Each pump or irrigation circle 2
O Service(vet 225 mops-commereiel J Health-cme tactht Poch sign or outline lighting 2
O Service over 320 maps•rating(I'I AC 2 U Haxartlous location Signal circuiUsl or o limited energy panel,
family dwellings U Building over I OAK)square feet four Or t 2
U System over 600 volts nominal nore.residential units in one structure alteration.or extension*
U Building over three stones U Feeders.41x)amps or more s I)<scri tion. —
U occupant load over 99 persons U Manufactured structures or RV park Fach additional Inspection(ver the allowable In rmy of the above:
•F:gtess/lightingpian U Other I'et inspection
Submlt sets of plain with a(v(f the above. Invesli ration fee
The above are not applicable to temporary construction service. Other
Permit fee.....................$
Nol all jurisdiction&accept credit cards,please call jurisdictim fat more Information Notice:This permit application Plan review(al — �) $
U Visa U MasterCard expires if a permit is not obtained
within 180 days aflcr it has been State surcharge(8%) ....$
Credit carol number: _spires
accepted as complete. TOTAL ................ ......$
Nrnr o�Idet u shown onc—re I— 10� era S
Cc.dhoder rtgnsttue Amount JJ0�6I51M16/('Uhl)
�assa>•
CITY OF T I G A R D BUILDING PERMIT
PERMIT#: BUP2001-00098
DEVELOPMENT SERVICES DATE ISSUED: 3/15/01
13125 SW Hall Blvd.,Tigard. OR 97223 (503) 639-4171 PARCEL: 1S126DC-03300
SITE ADDRESS: 09900 SW GREENBURG RD 100
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P
BLOCK: LOT: 005 JURIS=DICTION: TIG
REISSUE: _FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: FPS FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? _
TYPE OF CONST: 3N sf N_ S: E: TW:
OCCUPANCY GRP: B TOTAL. AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM - HNDICP ACC:
BE.DRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 200.00
Remarks: Relocate two sprinkler heads and remove one sprinkler head.
Owner: Contractor:
ATHERTON REALTY PARTNERSHIP FIRESTOP CO
MARTHA ATHERTON 9384 SW TIGA.RD ST
2100 S WOLFTIGARD, OR 97223
DPSSoAl8
neW26600
Phone: 620-6140
Reg #: LIC 63846
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough-In
PRMT CTR 3/15/01 $62.50 27200100000 Sprinkler Final
5PCT CTR 3/15/01 $5.00 27200100000
Total $67.50
This permit is issued subject to the regulations contained in the Tigard Municipal Code date 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 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) 2A6-1987.
Pe nn itee
Signature: Y4 l!Q
Iss ed By:
Call 639-4175 by 7 p.m. for an inspection the next business day
Building Permit Application
Date received: Permit no.:
City of Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.: Expire date:
City n�Tignrd Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: - - - --- I�'family:Simple Complex:
OF " '\
U I &2 family dwelling or accessory dcommercial/industrial U Mull Liin ;N U New construction U Demolition
U Addition/alteration/replacement If'Tenant improvement ,d firr tilnn kh t darn U Other:
J011 SUE INFORMATION
Job address; S p Bldg. no.: Suite no.: 7jo
r
Lot: I Block: Subdivision: Tax map/tax lot/account no.:
Project name: I .)L L D LA), D?r _-- --_ --
Description and locatinn of work on premises/special conditinwi ,!
FOIPORMATIONj
Name: ,
Mailing address: - I &2 family d"elling:
City: State: jZ11, Valuation of work........................................ $
Phone: Fax: E-mail: No.of bedrooms/haths.................................
Owner's representative: — Total number of floors.................................
Phone: 11 :1; I m:t l New dwelling area(sq. ft.) ..........................
Garage/carport area(sq. ft.)
Name: Covered porch area(sq. ft.) .........................
Mailing address: Deck area(sq. ft.) ...........................•............
Other strucutre area(s .fl.).........................
City: State: ZIP: - ----
--- - ('ommerciallindustramulti-family:
Phone: I�ax: E-mail:-mail: ill
Valuation of work..... .................................. -
Existing bldg.area(st.ft.) ..........................
Business name: �E 570 C-U _
-- New bldg.area(sq.ft.) ...............................
Address:
5W TI&A49 5T Number of stories........................................
City l &A K P Istale: 6 ZIP: 9JU7, ^----
Phone: 0 620-WWI'[,' o f E-mail: - Type of construction....................................
b -(z_41 Occupancy group(s): Existing:
CCB no.: 0 II New: _
City/metro lic.no.: 5 ,f36 J Notice:All contractors and subcontractors are required to he
A111011ITiEtriniksiGNER licensed with the Oregon Construction Contractors Board under
Name: ?oC Wj- tt ec-1-e (L provisions of ORS 701 and may he required to he licensed in the
Address: p 5�l L q�� L jurisdiction where work is being performed. If the applicant;s
City: 6N state:
exempt from licensing,the following reason applies:
Contact person: (e r- Plan no.: ------- -
I'hone: (p- 1gb7. F;tx: (026- l Email:
Name: pContact person: Fees due upon application ........................... $
Address: Date received: S¢
City: State: ZIP: Amount received ......................................... $- G
Phone: Fax: E-mail: Please refer to fee schedule.
hereby certify I have read and examined this application and the Ni 1,jurisdictions accept credit canto,pleme call jurisdiction for more information
attached cite slist.All provisions of laws and ordinances governing this U vt,n U MnsterCard
work will i�complied with,wile er specified herein or not. Credit card number _-___ �xpirc
Authorized signature: of ,r> Date: 3��/ _ Name of cardholder as shown on credit card
Print name:_I,rF>?>V Cardholder signature s Amount
Notice:'Ibis permit application expires if a permit is not obtained within 180 days alter it has been accepted as complete. 4704613(WWOM)
1
Fire Protection Permit Check List
A.) ❑ New ❑ A_ddition ZAlteration ❑ Repair
B.) Modification to sprinkler hearts only:
Describe work to 1. 1-10 heads: No plan review required.
be done: 2. 11+ heads: Plan review required.
Number of sprinkler heads:-_3
Additional description of work: ?-gLoc,n-`- E Z At4D Mw6 nI YJ L;
_Type of S stemComLlete A or B as applicable
_A."S rinkler Wet ❑ Dry _..
Standpipes
Additional Hazard Group
Information Density
Design Area
K. Factor _
Sprinkler Pro ect Valuation: $ va
B. Fire Alarm
Submittal shall Battery Calculations Yes ❑
include: Individual Component Yes ❑
Cut Sheets
Fire Alarm Pry, •ation: $ &--
r ect
!rotect Valuation Subtotal(A & B : $
Permit fee based on valuation see chart : $ 6Ztg--
8% State Surchar e: $
FLS Plan Review 40% of Permit: $
TOTAL: $ 61 V"
I:ldstsVormsTPScheckllst.doc 10/04/00
a
ELECTRICAL PERMIT-
CITY OF T I G A R D
RESTRICTED ENERGY___
DEVELOPMENT SERVICES PERMIT#: ELR2001-00102
13125 SW Hall Blvd.,Tiqard, OR 97223 (503) 639-4171 DATE ISSUED: 4/10/01
PARCEL: 1 S 126DC-03300
SITE ADDRESS: 09900 SW GREENBURG RD 100
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P
BLOCK: LOT: 005 JURISDICTION: TIG
Proiect Description: Data Telecommunication
A. RESIDENTIAL_ B.COMMERCIAL_
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM- X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL# OF SYSTEMS: 1
Owner: _ J Contractor:
ATHERTON REALTY PARTNF.RSHIP AMERICAN TERMINAL SERVICE
MARTHA ATHERTON 10220 SW NIMBUS AVE
2100 S WOLF K'l
DES PLAINES, IL 60018 TIGARD, OR 97223
Phone: 847-298-8600 Phone: 503-684-1684
Reg#: ELE 34.337CLE
LIC 82708
FEES Required Inspections _
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 4/10/01 $75.00 2720010000 Wall Cover
Elect'I Final
5PCT CTR 4/10/01 $6.00 2720010000
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 rules adopted by the Oregon Utility Notification Center. Those rules are set 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)
246-1987.
^ /
Issued by Permittee Signature
��a�
_ OWNER INSTALLATION ONLY
The Installation is being made on property I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N "- DATE:
LICENSE NO: 1 a-!)F—C I
Call 639-4175 by 7:00 P.M.for an Inspection needed tha next business day
Electrical Permit Application
Date received: _ -0/ Permit no. o(OD -Oa C y
City of Tigard Project/appI.no.: Expire date:
C1ry gTigard 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:
OKI]
;UNew
amily dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
nstruction U Addition/alteration/replaccnlrnt U Other: U Pattial
s: li'1('v '., ,, ` ozk,' ;c, J *IV., Bldg.no.: Suite no.: ,(-t, Tax map/tax lot/account no.:
Lot: 1 Block: Subdivis on:
I'r( ject name: DescripIii w and location of work on premises:
F-,Iimateddale ofcom letion/inspection: SCHEDULE� -
Job no: Fee Mat
BUSInCSS name:i�r1U V u 1<t YYU►r" S6mv. '
,L Description Qty, (ea.) tidal no.insp
New res.irkrYlial-single ormulti-family per
Address: I L ) �k, N,,—A 4*k I dwelling unit.Includes attaclrcvl garage.
(`Ily: -124 1" State: UK ZIP: `"y 1� '� Serviceinclurhvl:
i.
Phone: (, _ (�,`;� Fax: L'.)u W%19 1000 s E-mail: q It.or less 4
Each additional 500 s .ft.or poruwm thereof _
CCB no.: }'1 i Elec.bus.tic.no:"� .5 t 1 t l- Limited energy,residential 2
Cit /metro lic.no.: "S c —
y IAmiled -residential
IA 2
Fach manufactured home or modular dwelling
—T -
-Signature of supervising electrician(rr(nl-d) Date_ Service and/or feeder 2 _
Sup.elect.name(print): t i erase n Services or feeders–Installation,
alteration or relocation:
200 amps or less 2
201 amps to 400 amps
address: r 401 amps to 600 amps
Mailing (J v , u t r 601 amps to 1000 amps
City. —1 statdl. l ZIP: (i 1Z" Over 1000 amps or voles -- _'—
Phone: ,Its FF-8x,: I E-mail: Reconnect only I --
Owner installation:The installation is being made on property I own Temporary services or feeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation:
ORS 447,455,479,670,701. 2tx)amps or less ,
201 amps to 400 amps 2
Owner's si nature: Dale: 401 it,6W amps 2
Branch circuits-new,alteration,
or extension per panel:
Name' A. Fec for branch circuits with purchase of
Addres� _ service or feeder fee,each branch circuit 2
City: I Slate: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee,first branch circuit: 2 _
Phone: L-1»all' Each additional branch circuit:
Mbc.(Service or feeder not included):
U Service over 225 amps-uvun,ercial U Health-care facility Each pump or irrigation circle 2
U Service over 320 amps-rating of 1&2 U Hazardous location• Each signor outline lighting2
family dwellings U Building over 10,0(X)square feel four or Signal citcuil(s)or a limited energy panel,
U System volts nominal more residential units in one structure alteration.orextension• 2
U Building over three stories U Feeders,4110 amps or more 'Description:
U Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
•F.gresstlightingplat U Other _ -_ Per inspection j=—T--T
Submit____sets of plans with any of the ahowe. Investigation fee
Tike above are not applicable to temporary construction service. Other
Not all)uriWkuuns accept credit cards,please call)udadiction rtes mom information. Notice:This permit application Permit fee.....................$ _
U Visa U MasterCwd expires if a permit is not obtained Plan review(at _ %) $
Credit card number __. 1 / wi(hin 180 days after it has leen State surcharge(8%) ....$
carnenf— c�r•Ider u a own ntr credit crd 4Expires accepted to com-ilete TOTAL .......................$
L_-- ^ —
Cardholder signature s Amount 440.4615(60"M)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
ir► _
/� Restricted Energy Fee... ................................�............ $75.00
_ Number of Inspections per permit allowed
)I (FOR ALL SYSTEMS)
Service included: Items Cost Total y Check Type of Work Involved:
Residential-per unit
1000 sq ft or less — $145 15 _ 4 Audio and Stereo Systems
Each additional 500 sq ft or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Garage Door Opener'
Dwelling Service or Feeder — $9090 2
Services or Feeders Healing,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 Vacuum S stems'
201 amps to 400 amps $106.85 2. Sy
sterns*
amps to 600 amps _ $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation a for each system.......................................................... $7500
200 amps or less _ $66.85 _ 2. (SEE OAR 918-260-260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see"b"above. ❑ Audio and Stereo Systems
Branch Circuits ❑ Boller Controls
New,alteration or extension per panel
a)The fee for branch circuits
with purchase ofservlce or ❑ Clock Systems
feeder lee.
Each branch circuit $665 2 ❑ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 ❑
Each additional branch circuit $6.65 HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circult(s)or a limited energy
panel,alteration or extension $75.00_ ❑ Landscape Irrigation Control
Minor Labels(10) $125.00
Medical
Each additional Inspection over ❑
the allowable in any of the above ❑ Nurse Calls
Per inspection $6250
Per hour _ $6250
In Plant $7375 _ ❑ Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Fnter total of above fees $ Other
8%State Surcharge $ Number of Systems
25%Plan Review Fee No licenses are required Licenses are required for all other installations
See."Plan Review"section on $
front of application -- —
Fees:
Total Balance Due $
-- Enter total of above fees $_
❑ Trust Account# 8%State Surcharge $
Total Balance Due $
i:\dsts\forna\elc-fees.doc 10/09/00
CITYo f T I G Q R CERTIFICATE OF OCCUPANCY
DEVELOPMENT SERVICESPERMIT#: BUP2001-00090
2001
PARCEL: 1 S12
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 15126DC-03300
ZONING: C-P
JURISDICTION: TIG
SITE ADDRESS: 09900 SW GREENBURG RD 100
SUBDIVISION: LEHMANN ACRE TRACT
BLOCK: LOT:005
CLASS OF WORK: ALT �^
TYPE OF USE: COM
TYPE OF CONSTR: 3N
OCCUPANCY GRP: B
OCCUPANCY LOAD: 38
TENANT NAME:
REMARKS: Commercial TI
Owner:
AI-HERTON REALTY PARTNERSHIP
MARTHA ATHERTON
2100 S WOLF
DES PLAINES, IL 60018
Phone: 847-2.98-8600
Contractor:
INTERWORKS LLC
PO BOX 14764
PORTLAND, OR 97293
Phone: 233-2300
Reg#: LIC 00098655
This Certificate issued 04/09/211111 grants occupancy of the above referenced building or
portion thereof and confirms that the building has been inspected for compliance with the
State of Oregon Specialty Codes for the group, occupancy, and use under which the
referenced permit w 7e d.
BUILDING INSPECTOR ffl-11LDIrsAFFICIAL
POST IN CONSPICUOUS PLACE
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 --- --�
B U P —_--
Date kequested 3 U AM_ PM BLD
Location tJ��G U S�✓ ��/ (� Suite G MEC
Contact Person — Ph r 7� O PLM _
Contractor t < r'�� �'c' • Ph ---- -�-- SWR --
BUILDING Tenant/Owner ELC ;2,Of -,41��ej(jl
Retaining Wail ELR
Footing Access:
Foundation FPS
Ftg Drain - SGN
Crawl Drain Inspection Notes.
Slab --- ---- SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing -_-_-- —
Insulation
Drywall Nailing —
Firewall
Fire Sprinkler --
Fire Alarm
Susp'd Ceiling -----------
Roof
Misc:_ __ _ - -- ._...---- _---
Final
PASS PART FAIL --—
PLUMBING
Post 8. Beam - ------ _-- -- - -s�_._ --- -
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
FASB PART FAIL
MECHANICAL
Post& Beam — -
Rough In
Gas Line -
Smoke Dampei s
Final -
ASS PART FAIL
ELECIJMf
Service
Rough In
UG/Slab --
Low Voltage
Fire Alarm -__ _ ----- -_
rEA
PART
Backfill/Grading —
Sanitary Sewer
Storm Drain �Alse
n fee of$ required before n xt inspection. Pay t City Hall, 13125 SW Hall Blvd
Catch Basin for reinspection RE: C+ dt., to inspect-no access
Fire Supply Line —
ADA
Approach/Sidewalk Date -30 GU Inspector �' Ext
Other _ --
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
ycn fir
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 E3itsiness Line: 639-4171 -- --------
—__Date Requested— `7 _AM PM BLD —
Location--ffU v 56 Suite 100 MEC — - _-- �—
.r Contact Person — ! ����� Ph !�'�P 71' PLM
Contractor j'-�lM r . I�AnI •I� C f,W, H Ph '!� SWR
BUILDING -- Tenant/Owner ,117411 t r-f l� �'s�/f y f,�r• � ELC —
Retaining Wall ELR 0 D !G Z,
Footing Access:
Foundation FPS -
Ftg Drain SGN
Crawl Drain Inspection Notes —
Slab ------- —. _ __ � / ca SIT
Post&Beam �' ---- -
Ext Sheath/Shear
Int Sheath/Shear
Framing ---- -- _ -- —
Insulation
Drywall NailingFirewall
Fire
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling _—
Roof
Misc: ------
Final
PASS PART FAIL -- .------..--.---.
PLUMBING ---
Post&Beam -- ------ -
Under Slab
Top Out
Water Service
Sanitary Sewer _._.-.--------------__--- _ / ---
Rain Drains
Final -------
PASS PART FAIL
MECHANICAL —u
Post&Beam - ---- — --
Rough In
Gas Line --- —---- —
Smoke Dampers
Final -- ---- ---—------ ------
PASS PART FAIL
PLE —
Service
Rough In -- _ ------
Ugalao
Lo — --- _ —r --- — --—
re arm
Fina
AA5 `PART FAIL ----
S
Backfill/Grading —------- ----�—
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Holl Blvd
Catch Basin
Fire Supply Line [ J Please call for rei pection RE: [ I Unable to inspect no access
ADA
Approach/Sidewalk
Other Date 1716,o' _ Inspector —Ext
Final
PASS PART FAIL 00 NOT REMOVE this inspection record from the job site.
i
C,TY OF TIGARD ELECTRICAL IT
RESTRICTED ENERGY
GY
CON 4UNITY DEVELOPMENT DEPARTMENT PERMIT #: ELR96-0240
13125 SW Hall Blvd.T;gard,Oregon 97223e619g (503)639.4171 DATE ISSUED: 07/26/96
PARCEL: 1S126DC-03300
SITE ADDRESS. . . : 09900 SW GREENBURG RD 1%bomr
SUBDIVISION. . . . : LEHMANN ACRE TRACTsIVO ZONING:C-P
BL.00Ki. . . . . . . . . . . 1_01.. . . . . . . . . . . . . :
Flroject Descr-iption :
A. RESIDENTIAL------ --- B. COMMERCIAL--- .____._..__.._.__._.__..____...._._..._.___.._._..__.._._______._._____. .
AUDIO & STEREO. . . : AUDIO & STEREO. . : INTERCOM & PAGING. . :
BURGLAR ALARM. . . . : BOILER. . . . . . . . . . : LONDS�:APE/IRRIGAT. . :
GARAGE OPENER. . . . . CLOCK. . . . . . . . . . . . MEDICAL. . . . . . . . . . . . :
HVAC. . . . . . . . . . . . . . DATA/1"I LE. COMM. . : X NURSE CALLS .
VACUUM SYSTEM. . . . : FIRE ALARM. . . . . . : OUTDOOR LANDSC LITE:
OTHER: . . HVAC. . . . . . . . .. . . . PROTECTIVE SIGNAL. . :
IN5TFRUMENT'AT ION. : OTHER. . :
TOTAL # OF SYSTEMS: i
Owner.: --_.____._.___.____._______________.____._.__..____._.._.._.__.__..____....._._._ FEES
FIRST INTERSTATE: type amot_tnt by date recpt
9900 SW GREENBURG RD PRMT $ 40. 1?10 CJS 07/26/96
SUITE #100 OPCT $ 2. 00 CJS 07i26/9C. 96-260.'170
97223
PhoTie #:
Contractor-:
CuHRISTENSON ELECTRIC INC 42:. 00 TOTAL
1.025x, SW GREENBURG ROAD
----_- — REQUIRED INSPECTIONS
-- --
IIGARD OR 97223 Wall Cover Elect' l Final
1:4hone #: 503--2.41 •-4812 Elect' l Service
Per; #. . : 00549
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other F,er-mitee Signati-Ire
applicable laws. All nark will be donr in accordance W th
approved plans. This permit will expire if work is not started
within 180 days of issuance, or if wor'1 is suspended for more �_!.).CcCL�._ .Cr]1 -.-•--•-- _._.__........
than 100 days. I seLled By
.._—_______._.--OWNER INSaTALLATIOhJ
The installation is being made on property I own which is not intended fcv-
Tale, lease, or rent.
CIWNF R' S S I UNATLIRE: DAT'----
-CONTRACTOR
ATA:-CONTRACTOR INSTALLATION
SIGNATURE OF SUPR. El_EG' N: f7a1:.1.2 DATE_ :
LICENSE N0:
Call for inspection -- 639--4175
Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 PERMIT# C-7Ll396-to aqO
Phone(503)639-4171 /
FAX (503)684-7297 DATE ISSUEDL� � �7L/`Z c�C;
TDD No. (503)684-2772
GOTY OF TIOARD Inspection (503)639-4175 ISSUED BYC�U S
BUSINESS BANKING PLEASE COMPLETE ALL SECTIONS
1STFL SUITE 100
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
9900 SW GREENBURG RD
Address RESIDENTIAL—Restricted Energy Fee. . . . . . . . . 140.00TIGARD OR (FOR ALL SYSTEMS)
City State Zip Check Tye of Work Involved:
PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems
IS Not STARTED WITHIN 180 DAY%OF ISSUANCE OR IF WORK IS SUSPENI)EI)FOR
y
180 HAYS ❑ Burglar Alarm
QUESTIONS? CONTACT WAYNE GRIESENAUER
2. CONTRACTOR APPLICATION ❑ Garage Door Opener'
❑ Heating,Ventilation and Air Conditioning System"
ContractoICHRISTE_NSON ELECTRWfINC _ELECTRICAL ❑ VacuumSystems"
Address
111 SW COLUMBIA,SUITE 480 ❑ 1 tlhcr
_--
PORTL*N]3, OR
- - -- -
7-16-96 JOB:509-8231
Date__ COMMERCIAL—Fee for each system . . . . . . . 140,00
(SEE OAR 918-260-260)
Property Owner FIB/WELLS FARGO
Check Type of Work Involved:
Contractor's Board Reg. No. 00458 _-- ❑ Audio and Stereo Systems
241-4812 ❑ Boiler Controls
Phone# " ❑ Clock Systems
3. OWNER APPLICATION )M Data Telecommunication Installations
❑ Fire Alarm Installation
❑ HVAC
Print Owner's Name Phone No
❑ Instrumentation
Address ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control'
City State Zip ❑ Medical
This Ix,rmit Is issuer)t,,xier OAR 918.320.370.This applicant agrees to make only ❑ Nurse Calls
it energy installations(100 volt amps or less)under this perniit and to do the ❑ Outdoor Landscape Lighting"
follrnving:
1. Only use electrical licensed persons to do Installations where required.(Certain El Protective Signaling
residential and other transactions are exempt from licensing.These have ❑ Other
asterisks(").All others need licensing). --
2. call for an inspection when all of the installations under this permit are ready
for insprrtion at 503-6394175. ❑ Number of Systems
1. Purchase separate permits for all installations that are not ready for inspection
when the inspector is curt to Inspect under this permit. 'No licenses are required. Licenses are required for all o0mi,Irawllatlons.
4. Assume reslxmsibillly for assuring that all corrections required by the inspector
are done.and
5. Assume responsibility for calling for a final inspection when all of the g. FEES
corrections are completed.
The person signing for this permit must he the applicant or a person a. Enter Fetes $ 40.
authorized to hind the applicant.
~ b. 5%Surcharge(05 x total above) $ 2
S ---
e
TOTAL $ 42.
Authority If other than applicant
ENERGARCHP
CIT': OF TIG,ARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business. Line: 639-4171
s`� BUP _
Date Requested ✓ ' —AM __ BLD
Location Q�0 U Sw Gr-eAn6c4 y _ Suite 1 00 MEG,,
Contact Persor, Ph1�3,S f/,,Ie CPIV 2eyl G�
Contractor Ph SWR
BUILDING — Tenant/Owner ELC
Retaining Wa ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN ��—
Slab _ -- — SIT
Post&Steam ---
Ext Sheath/Shear
Int Sheath/Shear
Framing _
Insulation
Drywall Nailing —
Firewall r"
Fire Sprinkler
Fire Alarm )
Susp'd Ceiling
Roof
t,�isc: -- _ ---- -- �' � -s- --
Final —
PASS PART FAIL ---------- ----- — —
Post& Beam --- -- --
Under Slab
Top Out -- — --- — ---
Water Service
Sanitary Sewer ----.--___.---
Rain Drains
Fig ------__— -- --------- ----------- --- --------
69 PART FAIL �- ---.�—�.._ —.._. -- ----- --- -
ANICAL
Post B Beam ------ --- - ----- -—
Rough In
Gas Line — --— ----— - -- —
Smoke Dampers
Final ------ - — _ _—. -------- --
PASS PART FAIL
ELECTRICAL ------- ------
Service.
RoughIn — -- — ------ - --- _-______---.----__-- --
UG/Slab
Low Voltage
Fire Alarm ___--_-- — — ------ -- --.—_
Final
PASS PART FAILSITE
I)ackfill/Grading —— -
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please cal;for reinspection RE' _ --_--_— [ J Unable to inspect- no access
ADA
Approach/Sidewalk Date —. InspsctorU 24,1 Ext
Other ---
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITYOF TIGARD -- BUILDING PERMIT
PERMIT#: BUP2001-00090
DEVELOPMENT SERVICES DATE ISSUED: 3/13/01
13125 SW Hall Blvd.,Tiqard, OR 97223 (503) 639-4171 PARCEL: 1S126DC-03300
SITE ADDRESS: 09900 SW GREENBURG RD 100
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P
BLOCK: LOT: 005 JURISDICTION: TIG
REISSUE: FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION _
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJEC r OPENINGS?
TYPE OF CONST: 3N sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 38 BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: REQD_SETBACKS _ REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT:Y ft FIR SPKL: Y SMOK DET
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDIC:P ACC:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 20,000.00
Remarks: Commercial TI.
------------
Owner: Contractor:
ATHERTON REALTY PARTNERSHIP INTERWORKS LLC
MARTHA ATHERTON PO BOX 14764
211E05S0 S WOLLFF�� PORTLAND, OR 9'7293
L�Rrione I�Q>;6Z3 �6�Ei8 Phone: 2.33 2300
Reg #: LIC 00098655
_ FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Framing Insp
PLCK CTR 3/8/01 $152.95 27200100000 Gyp Board Insp
ng
FIRE CTR 3/8/01 $94.12 27200100000 Susp CFinal Insspecpec Insp
tion
MENU CTR 3/13/01 $235.30 27200100000
5PCT CTR 3/13/01 $18.82 27200100000
Total $501.19
This permit is issued 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 riot 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 Oiegon Utility
Notification Center. 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
Pennitee
Signature: �(�� C✓1...��
Issued By:
Call 639-4175 by 7 p.m. for an inspection the next business day
Building
received:
City of Ti,
I'rojecUappl.no.: Expire date:
CiryojTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: By:r Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: 1 1&2 family:Simple Complex:
U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition
U Addition/alteration/replacement O'f�enant improvement U�irr sprinkler/alarm U Odtcr:
Job address: ^1 '> `� -1 - A; l�oe"Attic 6C 9.7 ).?Ji Bldg.no.: Suite no.:
Lot: CLZ' BI_ock: Subdivision: L e A ?7(°AcT Tax map/tax lot/account no.:
Project name: 1. i+ e U AJwE
Description and location of work on premises/special conditions: A//-W STPUGT✓�'!� l��4 u. /1[a D/Fic�4 oNS
Name:
Mailing address: _2/e5 n c "6t F IQa, 1 &2 family dwelling:
City: � c.,4J u�.s
. State: /C ZIP: -�/ Valuation of work....................................... $ -_ --
-
Phone: Fax: E-mail: No.of bedrooms/baths................................. --_ -
Owner's representative: ,(fi rirll) Total number of floors.................................
aPmhone:/n ,I-i' Fax: .. 'l/s E-mail: New dwelling area(sq.ft.) .........................•
W
Garage/carport area(sq.ft.)......................... --
Name: 7-l )r k i ie/i,rjl j Covered porch area(sq.ft.) ......................... --
Mailing address: k f & Deck area(sq.ft.) ........................................ -
n q )v v State:Q ZIP: 9 3 Other structure area(sq. ft.).........................
City:
Phone: ?1 ''•" Fax:� 7`�/pfi E-mail: Valuation
Valuation of work................•....................... $ %2Giat70
I.xisting bldg.area(sq. ft.) .......................... _
Businessname: /,,, kwS
t; ' New bldg.area(sq.ft.) ...... �r,.1,'.................. --
Address: /--,r' f`- Number of stories �.
City: ! States;; ZIP: Typeof construction......... .... ............... _ -
Phone: hR` Fax: ,i 1? IJBJ E mail: Occupancy group(s): Existing: _
CCB no.: New:
Cit metro lic.no.: Notice:All contractors and subcontractors are required to hr
It
with the Oregon Construction Contractors Board urn r
Name: provisions of ORS 701 and may be required to be license, t,�the
jurisdiction where work is being performed.If the applicant is
Address: e , 4,4
from licensing,the following reason applies:
City: stare:�+ 'LIP: —
Contact person: Plan no.: _
Phone ' Fax:�J �J"' E-mail:
Name: Contact person: Fees due upon application ........................... $ /'/,
Address: Date received:
City: State: ZIP: Amount received ......................................... $—
Phone: Fax: Email: Please refer to fee schedule.
hereby certify I have read and examined this application and the Nor all jurisdictions accept credit cad+,rlease coil jurisdiction for nwxe inrormat+on.
attached checklist. All provisions of laws and ordinances governing this U visa U MeeterCerd
work will he complied with e pecified herein or not. Credit card narotrr — - -_._L�
F.aplrrc
Authorized signature: _ Date: '" Nene or cardholder as shown on credit card
$
Print name:— 7-r. c —ntna,m
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. IMFJ61 (&W/Com)
y9, r —
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to
request additional plan sets for distribution purposes (for Contractor, City of
Tigard, Washington County, and Tualatin Valley Fire & Rescue).
Total # of
TYPE OF SUBMITTAL Plans KEY:
Submitted
--� S = Site Work (must include
S (New, Add or Alt) 4 location of all accessible parking)
B (New, Add c'r Alt) 1* B = Building
F (New, Add or A") 3** F = Fire Protection System
M (New, Add or Alt) 2 M = Mechanical
P (New, Add or Alt) 2 P = Plumbing
E (New, Add, or Alt) 2 E = Electrical
New = New Building
Add = Addition
Alt = Alteration to existing
building
*For over-the-counter commercial tenant improvements, submit 2 sets of plans.
*"New" requires that plans bear the original seal of an Oregon licensed fire
suppression engineer, or NICET level "3" technicians.
lAdsts\fomes\matrxcom.doc 10/27/00
CITYOF TIGARD _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2001-00094
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 03/22/2001
SITE ADDRESS: 09900 SW GREENBURG RD 100
PARCEL: 1 S 126DC-03300
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C-P
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: "Move" one bar sink, one water heater and one hub drain for Commercial TI.
FEES
Owner:
Type By Date Amount Receipt
ATHERTON REALTY PARTNERSHIP
MARTHA ATHERTON PRMT CTR 03/22/2001 $72.50 27200100000
2100 S WOLF 5PCT CTP 03122/2001 $5.80 27200100000
DES PLAINES. IL 60018 Total $78.30
Phone 1: 847-298-8600
Contractor:
MP PLUMBING CO
MILWAUKIE PLUMBING CO
PO BOX 393 REQUIRED INSPECTiONS
CLACKAMAS, OR 97015 _
Phone 1: 655-9161 Rough-in Insp
Reg #: LIC 5002 Top-out Insp
PLM 3-17PB Final Inspection
This permit is issued subject to the ,egulations contained in the Tigard Municipal Code, State of OR.
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 rfduires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forlh in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or jirect questions to OUNC by calling (503) 246-1987.
Issued By: c ' :1<' Permittee Signature:.11A.
Call (503)839.4175 by 7:00 P.M. for an inspection needed the next business day
01/26'01 FRI 10:01 FAX 503 59h 1960 CITY OF TIGARD QJ 001
Plumbing Permit Application
Vt_ L Date received: ? 1 i a Permit no.:/C� -,f '',00 ,
City of Tigard
'``1'� Sewer perniil no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigari,OR 91223
CitynJ'Iigurr! Phone: (503) 639-4171 ProjrcUuppl.no.: Expire date:
Fax: (503) 598-1960 (pkVk.t(jk'�tNt -Date issued: By• Receipt no.:
�np�M1i'111 -
Land use apprcval: -._-- - i ---- Case file no.: Payment type:
❑ 1 &2 family dwelling or accessory Gomm trcial/industial Q Multi-family U Tenant improvement
U New constriction l>3 Additi(n/alternttion/replacement U Food service U Other:
address: / I)escription Qt . Fee(ea.)
lobd
Total
JobBlddre Suite no.: ) Nen'I-and 2-family dlrellings only.
- �� (Includes 100 ft.for a ich Wilily coimodion)
ax map/tax lot/account no.: SFR (I)bath
C Block: Subdivision: SUR(2)bath�-`— - �— --
ject name: r�/ t f SI1t(3)bath - -- --— — --
bty/-r county: Ztp; ' ~ —� Each additional bath/kitchcn - -- — T
escription and tecation of work o premises;� '' / Site utliities:
i l-�1lQ�r,�r Catch basin/area drain ---- -
�L�st date of eompk6orihnspection: �- rywells/leach line%trench drain _
t 1 Footing drain(no.lin.it.)
Manufactured home utilities
Business name: Manholes -- --
Address: A Rain drain connector _
City: Stat 2 -,wer(no.lin.R.)
%one: Ston sewer(no.lin.ft.)
CCB no.; ;y�Q`� Plumb,bus.reg,no: Water service(no, in,ft.)
City/metro lic.no.: ' fixture or Itch:
Absorption valve
Contractor's re resentativo signature:
"Tack flow preventer
Print name: Jute: Backwater valve /
$a:-ins/lavatory
es washer shei (/ Q
Name: Cloth
Address: - Dishwasher
Drinking fountain(s) _^
Citi: _ State: i:TI': Electorslsum
ii
Fax: E-mail: Expansion tank
mmFixture/sewer cap
Name(print): i Floor drains(floor sinks/hub -
Mailing address: t Garbage disposal
----- Ilose bibb
City.`- State: i 11'_- _ Ice m er
lFitone: 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 own as per ORS Chapter,47. Sink(s),basin(s),lays(s) j Awl
;Owner's signature: U.te: _ Sump _
Tubs/shower/shower pan
Urinal
Name: __-- Water closet
Address: Water heater AV
elty: Stete: :IP: Other: - - - ep
Phone: I Fax: E-mail:_ _ Total
a all im+.dkuaa.ccept cmill card,,pleafa call JudAcdon or more lRA omaaoa Notice:This pentul application hllnilnuttt fee................s
V112
U MoalerCerd i'Iaa review(al %) $ .
expires if a pcnnit is not obtained Stale sure e
redh card number —_ —�L within 180 days after it has been B (8%) ....s
Nip roe TOTAL. .......................$ -
Name or cat-&o der u shown on crc i�crd accepted as complete. -
C"oldar slValure Amt ant 4404616(6/0aK'UM)
01/26/0 1 FR 10:01 FAX 503 598 1960 CITY OF TIGARD Z003
PLUMBING PERMIT FEES:
IxfUR n 1fli!_k
O
Tv a Ai7�YN1 ` d l) fuVN �halflx��}��elt �.j P G� TJU�T Sink 18.6) �� ' 1.114 t,0 ) QTY I ,AIIAd
Lavatory 16.6) -. { , 'U�til � •q � i,
One 1 bath 5249.20
Tub or cwo Tub/Shower comtl. 16.6) _Tbath _
_ �(" _- $350.00 —_
Shower Only 16.6) Three _balh _ _ 399.00 —
Wator Closet
_ SUBTOTAL I"" '•I. I
Urinal 16.6) 8%STATE SURCHARGE M;';, l i
Dishwasher 16.6) PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.8'1 TOTAL I —
Laundry Tray 16.61
WIsaing Machine 16.6)
Floor Draln/Floar Sink 2" 16.6)
3" 16.6) PLEASE COMPLETE:
a" 16.6 i _
Wqtar Heater U conversion O like kind 16.67 T Qll'Hilit b Work Perf m d
GIs in requires a separate mechanical Fixturo Type New I'�{Invdd Replaced. Cemciv�dl
MFG Home Now Water Service 48.4) Sink —
MFG Home Now San/Storm Sewer •'6.4) Lavatory
1 ub or ub/Shower
Ho eBibs 16.6) _ Combination _
Ropf Drains 16.61 Shower Onl — _
D king Fountala 16.6) Water Closet
Other Fixtures(Specify) 16.6) Urinal —
I Dishwasher
_ Garbage Disposal
Laundry Roorna Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer-tat 100' 55.0) _ 3' --
Se er-each additional 100' 46.43 _ 4"
Water Service 1st 100' 5503 Water HeaterOth _
Service-each additional 200' 46.4) — (Specify)Fixtures
Winer
5 ea _
Storm 8 Rain Drain-1st 100' 55.03
St nm d Rain Drain-each additional 100' 46 43
imercial Back Flow Prevention Device 46.43 --- - ---
Re id6nliai nackiiow Prevention uavice' 27.55 - — '—
C ch Basin 16.60
In a on of Existing Plumbing or Specially _ 72.t5
—
a( wasted Inspoctlons erlir COMMENTS REGARDING ABOVE:
FU n Drain,single family dwelling 65.25
Gi ase Traps --
-QUANTITY TOTAL
Isometric or riser dlegmm Is requlmd It f!" `--
Quann Total In >0 ___
'SUBTOTAL —
I
" LAN REVIEW 25%of SUBTOTAL
R ulmd arily it future gly total is>a
TOTAL
iMinhnum permit tee Is 172 50.11%state surcharge,except Resider.lal Backflow
Proventlon Device,which Is 33e 25+ll%stale surcharge
M
All New Commerelel Buildings roquirR plane with Isometric or riser diagram and
plan rivOew
N\d5InVir rm%\nim-fens doc 10/10/00