14209 SW TEWKESBURY DRIVE 14209 SW Tewkesbury Drive
A MASTER PERMIT
CITYOF T I G A R® PERMIT #: MST2003-00027
DEVELOPMENT SERVICES DATE ISSUED: 4/14/03
13125 SW hall Blvd.,Tigard, OR 972.23 (503) 639.4171
SITE ADDRESS: 14209 SW TEWKESBURY DR PARCEL: 2S109CB-11300
SUBDIVISION: EAGLES VIEW ZONING: R-7
BLOCK: LOT: 088) JURISDICTION: I RH
REMARKS: New SF detached, Path 1.
BUILDING
RCISSUE:
STORIES: 2 FLOOR AREAS REQUIRED SETBAUC REQUIRED
CLASb OF WORK: NEW HEIGHT: 25 FIRST: 1,219 of BASEMENT: st LEFT: 5 SMOKE DETECTORS. Y
TYPE OF USE: SF F:OOR LOAD: 4U SECOND: 1,421 of GARAGE: 420 of FRONT: 20 PARKING SPACES: 2
RIGHT: 5
TYPE OF CONST: 5N DWE�LIMO1NRD of UNITS; 1 VALUE. 260,079 20
REAR: 24
OCCUPANCY GRP: R3 BDRM: 4 BATH: ] TOTAL: 2,940 sl
PLUMBING
SINKS: 1 WATEP CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: CATCH BASINS
TUBISHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 SCKFLW PREVNTR: I
OTHER FIXTURES:
MECHANICAL
c VENT FANS: `' CLOTHES DRYER: I
FUEL TYPES FURN<t00K: BOIL/CMP 7HP:
GAS FURN>-100K: 1 UNIT HEATERS:
HOODS: OTHER UNITS: I
MAX INP- btu FLOOR FURNANCES•
VENTS: I WOODSTOVES: GAS OUTLETS: I
ELECTRICAL —
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFF.EDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS' 1 0 •200 amps 0 200 amlr. NIS VI;OR FDR: PUMPIIRRIGATION: PER INSPECTION•.
201 , 400 amp 1 st W/O SVCIF DR: SIGNIOUT LIN LT: PER HOUR:
EA ADD'L 500SF: 5 201 ' '100 amp IN PLANT:
LIMITED ENERGY: 401 500 amp: 401 - 000 amp EAADDL BR CIR: SIGNOR LABEL:
MANU HMISVCIFDR: 001 1000 amp:
501+am PS-1000v. MINOR LABEL:
1000+amplvoll: PLAN REVIEW SECTION _
Reconnect only: >,4 RES UNITS: SVCIFDR>-225 A.: >500 V NOMINAL' CLS AREA/SPC OCC.
ELECTRICAL•RESTRICTED ENERGY
B.COMMERCIAL
A.SF RESIDENTIAL
AUDIO B STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOWPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER:
CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
DATA/TELE COMM: NURSE CALLS: TOTAL M SYSTEMS'.
HVAC:
TOTAL FEES: $ 3,367.08
Owner: Contractor: This permit Is subject to the regulations contained in the
DON MORISSETTE HOMES DON MORISSETTE HOMES INC Tigard Municipal Code,State of OR. Specialty Codes and
4230 GALEWOOD ST#100 4230 GALEWOOD ST,STE 100 all other applicable laws. All work will be done in
LAKE OSWEGO,OR 97035 LAKE OSWEGO,OR 97035 accordance with approved plans. This permit will expire If
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those Ales are set
Phone: 503-357-75Phone:38 forth in OAR 952-001-0010 through 952•uJi-0080. You
Rea 0: T 1( 38 7 )�5may obtain copies of these rules or ditect questions to
1( i�3t$ OUNC by Calling(503)246-1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8, post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Electrical Final
Grading Inspection Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Merhanical Final
Sewer Inspection Underfloor Insrlation Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Final
Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Inst. Final inspection
FoundaJ ort-Irralr---,,,'. Footing/Foundation Or; Electrical Rough In Gas Line Insp ApprlSdwlk Insp
Issue; Cy : Permittee Signature
Call (503) 639-4175 by 7:00 p m. for an inspection needed the next business day ,
10� 17
SANIIA►RY•
CleanWater Services
o
()''I c nlnn)III11rlll I, t 1' r
.,I.rrrMc AVS.,Suite 270, Hili3borc, 'fir.,97124
SURFACE WATER
503 648-8621
t; PERMIT
.SSUE DATE 041103 EXPIRA'T'ION DATE f00803 EC EXP DATE f04100PRFERMT118412"i8gI
iTR.UCTURE ADDRESS 14209
20
.TRUCTURE; STREET SW TEWKESBURY
Lp7` 80 HLOCY,
C;ONNE'.CTToN_. NEW OF EAGLES VIEW AT BULL MOUNTI,
YPF. TNSTALLA'TTON- ( 19 ) BLD SWR/E:RO CON/SDC
T'YP1!, OCCUPANCY- ( 1 ) SINGLE F'AMI.LY PARCEL 2S1 9CB 300
QTR SEC 4615 MH 1513"
)WNER DON M(7R I SSETTE HOMES
ADDRESS 4230 (;A.,EWOOJ:; ST, #100 TI�FATMENT PLANT ULTRHAM
LAXE; OSWE:GO OF. 97035
PHONE, 503--38'1 -75"38 WATER DISTRICT1'IGAi3U
FI:XTURF EJ'Q1IIALEN.. - __ ._
'T T DWgT.1.IN(:; RESIDENTIAL!NI 1'S SERV. NETS 0 . 0 11NTTS 1 SERVICE UNITS 1
C'ONNEMON FEES 3URFACE WATER DEVELOPMFNT FEES
SEWER CONNECTION 2300 .00 WATER QUALITY 225 . 1100 a
LESS CREDIT < 225 .00;
' WATER QUANTITY 275. 00
LESS CREDIT v: 0.00
EN01'10N CONTROL
INSPECTION 88 .00
PLAN CHF(;K 57 . 20
USTOTAL 310th . Q)0 SUB'M)TAL 4:'16 . L0
DOTAL 7 4 M . 2 0
NAME DE:NA PHONE
AFFILLTATTON REP
'';MARKS 116420 LOT 80 E;AGLU' S VIEW
Mum h**r to call ft-ir INSPEC' jOr--- 846-8444 " " • . '
:TGNATt_1F+'. \ '! �� TSSUED PY VANDF;RZAIIDEE:
Parire conditions. The applicant agrees to conjAy with all noes and 10gulatlona ct the Unified SewwacW Agency. Wh., calling for an inspection, please
refer to the Perrnit Nurnber The Pennit expires one hundred eighty (180)days from the date of issuance The Agency docs not gunrantee the axurncy
of the location of side sewer laterals
7193 WtITTG - TISA, BLUE -- Accounting, GREEN -Inspection, YELLOW -- Customer
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Building Permit Application
City of TigalCd,01"' \ Date received: J Permit no.:
Cin'.,rAddress: 13125 g
W Hall Blvd,Tigard,,rd,pR 97223 Project/appl.no,: Ex tredate:
ltira�,l —
Phone: (503) 639-4171 `0 1 JtjU" Date issued: fay Rec-pt no..
Fax: (503) 598-1960 J
t It at`t.�l J 1 i Case fila no.: Payment type:
Land use approvah- ISIU 1&2 family:Simple Complex:
0 ! &2 family(;welling or accessoty O Crimmercial/industrial 0 Multi f an„ly , New construction O Demolition
0 Addidon/alte ation/replacement O Tenant improvement 0 Fire sprinkler/alarm O Other. M _
Mimi
Job address: (`'1t�Q �,v ""r( N,1 �C L, 1 Bldg.no.: Suite no.:
l.ot: j 1 Block: Subdivision: �,v \ Tax map/tax lot/account no.:
Project n,ime:
Description and location of wott,on premises/special conditions:
Name: � \
Mailing address: L' 1&2 fs,,aily dwelling:
City: Stater(-m ZIP: ) Val(:ation of work........................................ $ M.
Phone: "7. Fax: -7 -mail: i:o.of bedrooms/baths.... .................. ���
Owner's representative: Total number of floors............................. ...
Phone: Fax E-mail: New dwelling area(sq.f. ... v
Garage/carport arca(q. ft.) •.......................
Name: m,( 1 Covered porch area(sq, ft.) ......................... 2 Z
�dailing address: Gj, Deck area(sq.f.) ............... .... .................. / 0
Cirv: State: ZIP: Other structure area(sq. ft.)_ .. _.................
Phone: Fax E-mail: Commercial/industrial/multi-family:
t11 UAW=
Valuation of work........................................ $--
Business name:
Existing bldg.area(sq.ft.) .......:................
New bldg.area(sq. f.) ............... .....
Address: Z - Number of stories
City: State: ZIP: . ..............
Phone: Fax: E-mail: Type of construction.................................... _
--- 2 --- Occupancy r.. Existing; --
�cw:
Notice:All contractors and subs ontrmctors are requ;:. w be
licensed with the Oregon Conswction Contractors Board under
Y N' irZ provisions of ORS 701 and may be required to be licensed in the
Address: i, CL It YN oc.;1.0 Jurisdiction where work is being performed.If the applicant is
City: State: 'LIP: exempt from licensing,the following reason applies:
Contact person: Plan no.: --
Phone: Fax: E-mail: –
Name: Contact person: Fees due upon application ........................... $
Address: Date received:
City: _ State: ZIP: Amount received ......................................... $
Phone: Fax: — E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not All iudadictiom accept credit cards,please call jurisdiction ra mac Information
attached checklist.AlLprovisions
of I ws and o gfinances governing this t]Visa v MasterCard
work will he compI wt ,whether. cified IHeretfi 1. credit ca-d number
1 II( •,�0�7� Expires
Authorized si etU Nanta of cardholder ase Rhown nn credit card
{ TT S
Print name: WLR ll c,rdtinldr�rlRnuure—_�--- --- ml�—oUo�
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete 440-0611(fwo(COM)
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
City of Tigard City of Tigard Associated permits:
Address: 13125 SW Hall Blvd,Tigard,OR 07223 ❑Electrical U Plumbing O Mechanical
Phone:Phone: (503) 639-4171
Fax: (503) 598-1960
Un
A
1 Land toe actions completed.See j1irisdicuon criteria for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. -
3 Verification of approved plat/loc
4 Fire district approval required. —
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit. —
7 Water district approval. —"oils report.Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
10 3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state
building codes.lateral design details and connections must be incorporated into the plans or on a separate full-size
s' eet attached to the plans with cross references�,jtween plan location and details. Plan review cannot be completed t/
if copyright violations exist. J`
I 1 Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if
there is more than a 4-11,elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and
driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction indicator,lot
_area;building coverape area;percentage of covers e;impervious area;existing structures on site;and surface drainage.
12 Foundation plan.;how•limensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent
size and location.
13 Floor plans.Show all dimensions,Loom identification,window size,location of smoke detectors,water heater,
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc,
14 Cross section(s)and details.Show all framing member sizes and spacing such as floor beams,headers,joists,sub-floor,
wall construction,roof construction.More than one cross section may he required to clearly portray construction.Show
details of all wall and roof sheathing,rooting,roof slope,ceiling height,siding materiot,footings and foundation,stairs,
fireplace construction, thermal insulation,etc.
15 Elevation views.Provide elevations for new construction;minimum of two elevations for additions mid remodels,
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive pa(h)and/or lateral analysis plans.Must indicate details and locations;for
non- rescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and hearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections rnd details showing placement of rebar.For engineered
systems,ser item 22,"Engineer's calculations."
19 Beam calculations.Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20_Manufactured floor/roof truss design details.
21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas piping schematic is required
for four or more appliances.
22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer fir
architect licensed in Oregon and shall be shown to be applicable to the project under review.
�110 14 0 11 Iml N61 111
23 Five(5)site plans arc required for Item 11 above. Site plans must 1w 8-1/2" x 1 1"u( I I i 7".
24 Two(2)sets each are required for Items 16, 19,20&22 above.
25 Building plans shall not contain red lines or tape-ons. —
26 No rolled,reversed or mirrored building plans will he accepted.
27
28 --
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 4404614(600320M(
f
Mechanical Permit Application
Date received:/ 117 Permit no.:NS T ,}
City Of Tigard Project/appl.no.; Expire date:
City ofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 _
Phone: (503) 639-41"1 Date issued. By: Receipt no.:
Fax: X503) 598-1960 Case file no.. Payment type:
Land use approval: Butl:aing permit no.:
TYPE OF PERNUT—
O I—&2 family dwelling or accessory 0 Commercial/industrial 0 Multi-family 0 Tenant improvement
XVew construction 0 Addition/alteration/replaceinent ❑Other: _
0019EM I�M[
!ob address: I J (r�U t l/, 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.: aroftt. Value S
Lott Block: Subdivision: ( (,'�, "See checklist for important application information and
Project name: J jurisdiction's fee schedule for resilential permit fee.
City/county: ZIP: _ t stASU �t 11 1
t
Description and loo•ation of work on premises: 71SLateboilet
l x' I 1111
s aif t a t
Fa(�-) 'fatal
Est date of completioNinspecUon: _ Description Res.only Res.only
Tenant improvement oc change of use:
Is existing space heated or conditioned?0 Yes 0 No
Air unit CFM
[s existing space insulatedl0 Yes ❑No ning(sitep anrequired)
ressors
Business name: � permit no.:
Address: _ HP Tons BTU,H
ire/smoKe ai•per uct smo a etectors _
City: Ll State• ZIP: eat pump(site plan requir )
Phone: Fax. E-mail: nsta rep ace mac umer ---
CC$ no.: _ a v Including ductwork/vent liner Q Yes O No
-- nsta Urep ac re ocate eaters -suspended,
City/metro lic. no.: N/A _ wail,or floor mounted
Name(please print): _ ent for app lance o er an furnace
Ref gerauon:
Absorption units BTU/H _
Name: `lJi�, r�, Chillers HP �-
Address. , �L Compressors HP
City: -- onmenta exhaust ant vend at on:
—_ State: ZIP: Appliance
Phone: Fax: E-mail: ryerexhaust
loods.Type res. tc a azmat
hood fire suppression system
Name: ,nom-iL, i - Exhaust fan with single duct(bath fans)
Mailing address: ) �' aust system a art from heaun ort.
City: -'�sate ?IP 7� ue ptp ng an st ut on(up to 4 outlets)
Phone: I ,t TYfx LPG NC Oil
7- Fax: E-mail: uel ting each additional over 4 outlets
rocempiping(schemati—required)
Name: Number of outlets
Other app ance or equipment:
Address, Decorativefireplace
City _ I State: f ZIP: _ Insert-type
Phone: l=ax.-�� E-mail: stove/pe I let stove
Applicant's si.,uree, Cher:
e __ Date: ter.
Name(print): L' f�(rii l��1
Nd dl JuNsdicaoro accept credit cues,please call iunsdicuon for more mrorr uition. Permit fee.....................$
O Visa O MasterCud Notice:This permit application
expires if a permit is not obtained Minimum fee........... ....$
Cif cud number _.__ _ _._L�__ p Plan review(at %) S _
E,pires within 180 days after it has been State surcharge 8% -`
None or cwdholder u thowa on c v r cud accepted as complete. R ( )""S —
s TOTAL .......................$ ---.
('aretholeter ctgnuurt �mounr —
"GA617 e60WOM1
Plumbing Permit Application
Date received: / 7 � Permit no.:Ny,/;�j��•„�J
City of Tigard
'J b Sewer permit no.: Building permit no..
Address: 13125 SW Hall Blvd,Tigard,GR 972_3 _
Ciry of l i�s�d Phone: (503) 639.4171 Project/appl.no.. re date:
Fax: (503) 598-1960 Date issued: Bic Receipt no..
Land use approval: ^__ Case file no.: Payment type:
t x
O 1 &2 family dwelling or accessory O Cummercial/indusmal O !vlulu-family O Tenant improvement
ew can<t:ucuon O Addition/altemtion/replacement O Food service O Other.
o eN - FEE SOIEDULEr r r
Job address: I I.2(,� 1.i "'uV��t- ,`�I,ly'L _ family tion Y. Fee(rr.) Total
Bldg. no. �Swte no.: � New 1-and 2-family dweWngs only:
(includes 100 ft.for each utility connection)
Tax ma /tax lot/acco int no.: SFR(1)bath
Lot Block: Subdivision: 1 SFR(2)bath
Project name: SFR(3)bath
City/C.-)Ur. ZIP: Each additional bath/kitchen
Descr. -d location of work on premises: SiteutWties:
Catch basirdarea drain
Est.date of cample(ic,t>/inslxrction: Drywells/leach line/trench drain
Fooling drain(no.lin. ft.)
MWASEMIESEMM Manufactured home utilities
Busin:ss name: L Manholes
Addrt:ss: "� Rain drain connector
State ZIP: Sanitary sewer(no.lin. ft.)
Phone: L j Fax: E-mail:
Sturm sewer(no. lin. ft.)
CCH no.: [ plumb. bus. reg, no: -�— Water service(no. lin.ft.)
FLrture or item:
Clh/metro tic, no.: N,A ,�.-�- —;//� Absorption valve
C jntractor s representative signature�L� Bask tlow�:enter
Print name: - t I) - '1 - Backwater valve
B uinsr'lavatory
Name: *J Clothes washer
_ Dishwasher
Address:
La�xvilf Drinking founmin(s)
City- - State: Z1P: _ __ Electorsisump
Phomc Fax: E-mail Expansion tank
Fixture/sewer ca
Floor drains/floor sinksthub
Name (print): ti Garbage disposal
Mailing address: _ T Hose blbb
CityI State I ZIP: -)c 1- Ice maker
Phone: - Fax: 7-7N E-mail: Interceptor/grease trap
Owner insta/lationiresidendal nainrenance only: The actual installation Pnmen s) _
will be made by me or the m•sin enance and repair made by my regular Roof drain(commercial) _
employee on the propem I .)k%- .ts per ORS Chapter 447 Sink(s), basimsl, lays(s)
Owner's si nature: Date: Sump
BEMIS
Turis/shower/shower pan
Unnal
Name ------- — -_ -._ Water closet
Address: _ _ 11 ater heater
City: State ZIP' Other
Ph, ie: Fax: Email: Total
Nd all lun%dlcnom:cep credit card%,piea%e call)unzd1cuon ter more rntorrnauon Notice:This permit application Minimum fee................$
Cl%Isa O MasterCard expires if a permit is not obuined Plan review(at _ %) S
/ / } State surcharge (8%) ....S
Credit card number _ E%greet within 180 das after It has been
None of cardholder v%horn oe cmJtt caul
accepted as complete 'TOTAL .......................S
S
Cardholder signature _ Amount j 440.4616(Mocom)
F.leetrical Permit Application Received Electrical
— Date/I3 : 5 Permit No._ 5�
Planning Approval Sign
City of Tigard DateiB : Permit No.:
Plan Review Other
13125 SW liall 131 id, Date/By: Permit No.: _
Tigard,Oregon 97t?3 Post-Review Land Use
503-639-4171 Fax: 503-598-1960 Date/B CaseNo.: _ _
Contact luris.: See Page 2 for
Internet' www.ci.ligard.or.us supplemental Information.
24-hour Inspection Request: 503.639-4175 Namc/Method:
- - r&2,"I�ircmi
LAN REVIEW(Please check all that apply)
TYPE OF WORK _ Elcaith-care facility
Demolition '125 amps-
N",COriStructiOn — ❑I inzardnus location
Addition/alteration/re 13cement Other: 320 amps-rating of Building a
four or more residential Building over Suuits in feet,re
_ CATEGORY OF CONSTRUCTION dwellings
Commercial/Industrial 600 volts nominal one structure
1 & 2-Famil dwelling ❑Isuilding over three stories ❑Feeders,400 amps or more
_Accessory Building _ MUIti-Tamil ❑occupant load over 99 persons ❑Manufactured structures or RV park
❑1:.gresa/lighting plan ❑Othcr:
Master f luilder Other: Submit—sets of plans with any of the above.
_JOB SITE INFORMATION and LOCATION The above are not■ licable to tem orar construction service.
y,D 9 5�. 'i -NL• '
FEE*SCHEDULE
Job site address: /
Bld /A t#. _ Number of inspections ger )ermlt allowed
Suite#: =— - Descrl tion Qty Fee(ea.) Total
Pro'ect Name' f G�l SSt"r7 f—��—�� New resldential-single or multi-famlly per
Cross stTcct/Directlons to Job Site: dwelling unit.Includes attached garage.
Service Included: 145.15 4
1000 sg.11 or less .40 I
Fach additional 5(N)sq.R.tit rt33
ion thereof 3300 2
Limited ener residential 7500 2
/ 1.Ot#: Limited ener ,non residential
Subdivision: -A ----i `— Each manufactured home of modular dwelling
Tax map/parcel#: 90.9° 2
service and�cr feeder
ESCRIP'I ION OF WORK _ Services or feede�A installation,
alteration or relo►allon: 80.30 2
200 am s or less 106.85 2
201 am s to 4001mps 160.60 2
401 am s to W)ams 240.60 2
TENANT 601 amps to 1000 amps 454.65 2
PROPF,RTY OWNER -over U)11 am s or volts— -- 66.85 2
Name: ----��,—�— Reconnect y _
_ ----- --- Tempnrary scrvlces,rr fecrhrs-installation,
Address: _ ----------- alteration,or relocation 66.851
Cit /State/Zi)�: _ _ —,---.---_ 201 am or 4(10Icss _, --- 100.30 2
% 410
201 am s to ams 133.75 2
Pl1one: Fax: _ 401 to 6(10 am s
APPLIC__ A1VT _ CONTACT PERSON Branch circuits-new,alleration.or
extension per panel:
_Name: _ -- ----- -- A.Fee for branch circuits with purchase of 6.65 2
Address: �_� _ service or feeder fee,each branch circuit
---- B.Fee for branch circuds without purchue of
circuit 46.85
/Zip: 2
/State _ service or feeder fee,iiia/branch 6.65 2
Phone: lax Each additional branch circuit
- �—-"---- Misc.(Sen ice or feeder not included):
--- 53.40 2
E-mail' hack pump or irrigation circle 53.40 2
CONTRACTOR Each sign or outline lighting
-- `-- Signal circuit(s)or a limited energy panel, 2
Job No: _ _ alteration or extension pie 2
Business Name: 4r ► SLC . Description:
Address: --- — Each additional inspection over the allnwabie In an of the�bo0ve:
Cit /State/Ztp: /�L�f�� Per ins coon rhour(min. Ihour) —
�� r r tv Investigation fee: _
Phone:10 j- Fax: �C' ` 2 �- other:
CC_B_Lic. #: X27_ Lie. #: ; ' _ Electrical Permit Teets*
_ Subtotal S
Supervising a ectrician G ---
L Plan Review 25%of Permit Fee S
signature required: — State Surcharge 8%of Permit F'ee S
Print Name: A Lic. TOTAL PERMIT FEE $
/ Notice:-This application expires If a permlt is not obtained within
Authorized I80 dqs ager It has been accepted as complete.
Signature: �__�- Dater__
'Fee methodology set ee Tri-County Building Industry Service Boon.
— (Please print name)
is\Oats\Permit For
nts\ElcPermitApp.doc 01103
Electrical Permit AplAication - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Feefor xli systems............................................................ $75.00
Check'1'ype of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
MOarage Doer Opener*
El I Icating,Ventilation and Air Conditioning System*
Vacuum Systems*
Other
COMMERCIAL WORK ONLY:
—"Feeia—r —system.......................................................... 55.00
(SFC OAR 918-260-20)
Check't'ype mWork Involved:
�) Audio at.'Stereo Systems
C� Boiler Controls
Clock Systems
Data Telecommunication Installation
fire Alarm Installation
lj IIVAC
Instrumentation
intercom and Paging Systems
Landscape irrigation Control*
Medical
Nurse Culls
Outdoor Landscape Lighting*
Protective Signaling
Other ------
Number of Systems
* No licenses are required. Licenses are required for 4111
other installations
i:u)st3\permit FotmslFlcpermitAppP92.doc 01103
CITY OF TIGAR _ PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003-00247
1312.5 SW Hall Blvd., Tigard, OR 5722.' (503) 639-4171 DATE ISSUED: 6/6/03
PARCEL: 2S109CB-11300
SITE ADDRESS: 14209 SW TEWKESBURY DR
SUBDIVISION: EAGLES VIEW ZONING: R-7
BLOCK: LOT: 080 JURISDICTION: URB -
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF VSE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_FIXTURES_ _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS URINALS: GREASE TRAPS:
LAVATORIES. OTHER FIXTURES.
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Landscape Irrigation Backflow
FEES
Owner: --- Description Date — Amount
DON MORISSETTE HOMES [UPLUM131 Permit Fee 6/6103 $36.25
4230 GALEWOOD STREET IUPLPLNI flan Rede%% 6/6/03 $29
SUITE 100
LAKE OSWEGO,OR 97035 Total $39.15 —
Phone : 274-5223
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLON" R4.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
RP/Backflow Preventor
Phone : 503-692-59.15 Final Inspection
Reg #: I'I.M 7904
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 day, of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to toilow rules adopted by the Oregon
Issue By: i _ Permittee Signature: .. Q
Ca!l (SO 639-4175 by 1:00 P.M. for an inspection needed the next l6usiness day
Jun 04 03 10: l la oan Pdmond-, 503--692-0768 P �'
FOR ONLY
Plumbing Permit ApplicationReceived 1'lumbirig "
Permit No.; Nt "f
Planning Approval Sewer
City Of Tigard Date/BX: __ Permit No.:
13125 SW Hall Blvd. Plan Keview Othor
Tigard,Oregon 97223 Do t-Re - LadPermit Use Post-Review Land Ilse
Phone: 503-639-4171 Fax: 503-599-1960 Uate/g Case No.:
Internet: www.ci.tigard.or.us Contact 1u Sce Pa6c 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: V C Su ternentat lnfarmation.
TYPE OF WORK FEE"SCIIEllULE far s ecial Information use checklist)
New construction _ Demolition Description I Qty. I Fee(ca.) Taal
New 1-&2-fancily dwellings
Addition/alteration/replacement UthCC: includes 100 ft.for each u ility connection
. CATEGORY OF CONSTRUCTION SHR 1 bath 249.20
1 &2-Family dwelling Commercial/Industrial SFI 2 bath 350.00
Accesso Buildin Multi_^_Famil SFR. 3 bath 399.00
Master Builder Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire s rinkler• . ft.: Page 2
Job site address;/ let'f(�LL/L Site Utilities
yav q �" Catch basin/area drain 16.60
Suite#: ___ Bid •/A t.#: p ell/leach line/trench drain 16.60
Project Name:F'�L.gtes YlCtL.) r-6 foolingdrain no. linear ft. Page 2
-Cross streel/Directions to job site: _S-L,U LLICYCYI hL Manufactured home utilities 110.00
S LL CL)/ L/•C " Lu% Manholes 16.6U
Rain drain connector 16.60
Sanitary sewer(no. linear ft.) Page 2
Sturm sewer no.linear ft. tj Page 2
St.tudivisiomcrct /Cs Vic<_t�_ Lot#: Palle 2
Water service ina.liner-U._
Tax map/parcel At: Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
pucktlow preventer Page 2 a-
�� Backwater valve 16.60
T Clothes wusher 16.60
------ - — - Dishwasher 16.60
_ Drinkingfountain 16.60 _
PROPE[2_ TY OWNF.R_-TM TENANT Ejectors/sum 16.60
Namc; nL)O k3n_Lly_( g C C _ Lx ansion tank 16.60
Address:Lta30 S LV/ 9t(o-t ac�'et Fixture/sewer ca 16.60
7th f Floor drnin/floor sink/hub 16.60
City/State/Zips C:SC Garha cdis osul 16.60
Phone: Fax: Klose bih 16.60
APPLICANT CONTACT PERSON Ice maker 16.60
Interce tor/ rease trap16.60 Medical as-value; S, Pae 2
Address: kt Primer
16.60
City/State/Zip:71kD t ld(oc)'
Roof drain(commercial) 16.60
Phone: lt��/e�` �S4Y5�—Fax: rp�/c�__O'76 ' Sink/basin/Invato 16.60
Tub/shower/shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR 1660
Water closet
Business Nar71e:e 4lllGll.S1 Water heater 5.60
Address: L.L q `c. S( �Y14 Other:
Cit /State/Zi :7Llt��C ��- `)70 C'cam" other: -
Fax::6;--.- ' Plumbing Permit i<ees•
Phone: D� /`1* Sr,btotal 5 2 _
CCB Lic. #: T7�Oaf Plu_m_b. Lic.#: Minimum Permit Fee S 0 S
Authorized Residential Backflow Minimum Fce$36,2,U 3u a 7
Signature: '�L- U- L4—ML,) Date -- -- Plan Review 2G5%�of Permit Fee) 5
Amer 'Z(J State Surcher a 8%of Pcrmtt Fee 5
(IsLe
Please print name) TOTAL PERMIT EEE 5
Notice: 'rhis petnilt application expire.I($peruilt is not obtained within All new eotnmerelal buildings require 2 sets of plans with isometric or
180 days after It has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-County Nullding Industry Service Board.
i.lbsts\Pcmut Fomu\PlmPermitApp.doc 01/03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 53rD-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST _—_
BUP - -- -
Received -- Date Requested _1 -_ AM _ PM BUP
Location / •Zwc 4 _-----Suite MEC
Contact Person -. _— Ph( ) � PI-M
Contractor Ph( —) SWR -
BUILDI 1 Tenant/Owner _�— __ _ - ELC -
Footing ELC
Foundation Access.
Ftg Drain ELR
Crawl Drain _
Slab Inspection Notes: SIT _—.._--
Post& Beam --- _.-_- _--- ----- - __
Shear Anchors _
Ext Sheath/Shear -
Int Sheath/Shear i
Framing r�r.� t1'c' h• � l7=C'�"JO n/ /.�5T "iJf,T , 2__��Z-43
Insulation
Drywall Nailing --- ---- —
Firewall
Fire Sprinkler -_--._--
Firt Alarm —
Susp'd Ceiling
Root
Other:
in /
S PART FAIL.
P BING ------
Post& Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drdins
Catch Basin/Manhole
Storm Drain
Shower Pan
Other: -
Final
PASS PART FAIL --_------_--------
--L
MECHANICAL ___ -
Post&Beam
Rough-In - - - --- - ---- __ - -- -----_._._ - ----------
Gas Line
Smoke Dampers ----- ------ -- ---.__._.
Final
PASS PART FAIL --------__-.---
ELECTRICAL -
Service
Rough-In
UG/Slab f-
Low Voltage ___- — -------- - ---- -- -- _.-_--
Fire Alarm
Final Reinspection fee of required before next In pection Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE - L]-- - � Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA Daft
Approach/Sidewalk =� Inspector- _ - ---I ---
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Morar --7
BUILDING Inspection Line: (503)639-4175 MSTl-
INF-PEC',ION DIVISION Business Line: (503)639-4171
BLIP -
Received _____-_ -____Date Requested !r_ 3 AM_ PM - BUP
I-ocation �_ 1 a-D ti. >- I -a _�Suite ,! - MEC -- -
Contact PersonE'- _ Ph( ) ��� 'L�3 7 PLM _--------
Contractor ___�---- ---- -- --- - Ph( - ) SWR --
BUILDING Tenant/Owner - ELC --
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain - - - - SIT -
Slab Inspection Notes -- - -
Post&Beam - -- -- - - _
Shear Anchors
Ext Sheath/Shear -- -
Int Sheath/Shear
Framing --
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other. _
Final
PASS PART FAIL
PLUMBING --
Post&Beam
Under Slab
Rough-in
Water Service ---- - - -- —
Sanitary Sewer _
Rain Drains
Catch Basin/Manhole
Storm Drain ---- ----- - - - - _
Shower Pan
Other: _--- --- -_ -- -
PAS_ PART _FAIL
HANICAL_ -
Post&Beam
Rough-In -- -- -
Gas Line --
Smoke Dampers - -
Final
PASS_ PART FAIL - -
ELECTRICAL - - -
Service
Rough-In T -- --- --
UG/Slab
Low Voltage ___�_---- ----- -- ----- - -- - — ------ ----
Fire Alarm
Final Reinspection fee of$ _--_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PAR? FAIL
SITE �� Please call for reinspection RE: _-_-___ Unable to inspect- no access
— .1
Fire Supply Line
ADA Date�/ / 7 -- Inspector / Ext ----
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the Joh site.
PASS PART FAIL
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 -j
INSPECTION DIVISION Business Line: (503) 639-4171 MST -3
BUP
Received ______/ / .Date Requested l r �- AM _. PM _ __—__. BUP —_
Location .-.__.- ! `7 l<<- Sults MEC
Contact Person _ X11 h(_) PLM _
Contractor ,-- _ — Ph(—) SWR
_B_UILDING Tenant/Owner —_—_ ELC --__
Footing --
Foundation Access: ��--�� ELC
Ftg Drain ELR
Crawi Drain --- --
Slab Inspection Notes- _ SIT _
Post& Beam
Shear Anchors ----
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling --
Root
Other:
Final
PASS PART FAIL --
PI_UMBIN4
Post&Beam - -
Under Slab -
Rough-In -----
Water Service _
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain - _-
Shower Pan
Other: - --- -
F inal
PASS PART FAIL -- - ---- - - - --- ---
MECHA
NICAL
--_ — - - - -
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL -- ----- -
ELECTRICAL
Service --- -—
Rough-In
ow Voltage
Firs fttm
Final I 1 Reinspection fee of$ required before next inspection Pay at City Hell, 13125 SW Hall Blvd.
h 9) PART FAIL
SITE 1 Please call for reinspection RE: _ �_ Unable to inspect-no access
Fire Supply Line 1 17
ADA — -
Approach/Sidewalk Date -- `O► - 111spectur -¢- Ext
Other:- --
Final DO NOT REMOVE this inspection record rom tki job site
PASS PART FAIT_
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 175 MST --
INSPECTION DIVISION Business Line: (503) 1 BUP
Received -------Date Requested__.-�-r 1�-- AM- — PM ___. BUP
Location —_�� y - Suite -- MEC —_-
Contact Person I'h(- ) — PLM
Contractor_ Ph (_.- -- ) ---- ----—--- SWR —.._— --
BUILDING Tenant/Owner ELC —_-- -
F00.;Ig ELC - - _ -------
Foundation Access:
Ftg Drain ELF! _ --
Cfawl Drain ---- — --- -- -' SIT -,-----
Slab Inspection Notes:
Post&Beam -- -
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear r-
Framing
Insulation --_---_.--.__- --------__.—__--
Drywall Nailing - -
Firewall - --- ----------- _
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - - -- ----- --
Roof
Other:
Final
PASS PART FAIL --
PLUMBI —
--N__G—
-_ _ _ ---,*------ - - -
Post&Beam -
Under Slab - - - _-- —
Rough-In
Water Service ----
Sanitary Sewer _
Rain Drains -
Catch Basin/Manhole 04
Storm Drain
Shower Fan
Otha :_—�G� —
S AR FAIL
Post&Beam -
Rough-In -- _—_ - --- -- ----
Gas Line
Smoke Dampers - --
Final
PASS PART FAIL
-----
Service
Rough-In -
UG/Slab
Low Voltage ----
Fire Alarm
Final ❑ Reinspection fee of$— _ required before next inspection. Pay at City Hall, 13125 SW lail Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line /� /�� `�
ADA Dusts_ - _- ( ln�peetor _ _Ext
Approach/Sidewalk
Other: ---___-
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL