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InitiallyGood N t t� C D c I 15211 SW 100"' Avenue i AELECTRICAL ERMT CITY Y OF ! 1!„A '� D RL TRI TEDPEN RIGY DEVELOPMENT SERVICES PERMIT#: ELR2001-00195 13.125 SW Hall Blvd.. Tigard. OR 97223 (503) 639-4171 DATE ISSUED: 700/011 SITE ADDRESS: 15211 SW 100TH AVE PARCEL: 2S111CB-05460 SUBDIVISION: LONDBERG MLP2000-00008 ZONING: R-3.5 BLOCK: LOT: 001 JURISDICTION: TIG Proiect Description: A. RESIDENTIAL __ _ B.COMMERCIAL _ AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING: BL RGLAR ALARM. X BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: ALL ENCOMP X NVAG: PROTECTIVE SIGNAL: INSTRUMENTATION:. OTHEr: TOTAL # OF SYSTEMS: Owner: Contractor: RUSSELL& LANGBEHN OWNER 14220 SW 100TH AVE TIGARD, OR 97224 Phone: 502-620-5441 Phone: Reg #: FEES _Required Inspections Type By Date Amount Receipt Ceiling Cover PRMT CTR 7/20/01 $75.00 2720010000 Wall Cover 5PCT CTE? 7/20/01 $6.00 2720010000 Ele:;t'I Final Total $81.00 This Permit is issued subject to the regulations contained in the Tiy:jrd 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 nil �s are set f firth 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 OWNER INSTALLATION ONLY The Installation is being made on property I own which is not Intended for sale. lease, or rent. X OWNER'S SIGNATURE: C��utit.l G. �Ec �1 G� DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N _ DATE: LICENSE NO: Cali 6394178 by 7:00 P.M. for an Inspection needed the next business day _ Electrical Permit Application � -� City 04Cigard Dater_ e,e'_ived; L—LPermit no.: /_Ovp Pro ect/a I.no.: City fTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 J pp Bxpiredate: Phone: (503) 639-4171 Date issued: By: Receipt no.: Fax: (503)598-1960Case file no.: Payment type: Land use approval: 1 U I &2 family dwelling or accessory U Commercial/industrial U Multi-familyt New construction .,]Tenant improvement U Addition/,Alter ition/replaccmcnt U Other: U Partial 11 Job address: Blo ( L.J (p v�� Lot: [Block: Bldg. nu.: Suite no.: Tax map/tax lot/account no.: ck: Subdivision: Project name: Description and location of work on premises: -`—� - Estimated date of cuntl,l.'li m/ins eclion: - -_- - 1 1 Job no: Mat Business nameFee Descri lion (Ny. (ca.) Totalt no.Insp Address: New rmidenlial-single or multi-family per City: dwelling unll.Incudes attached garage. Stale: D. Ser�iceIncluded: I Phone: Fax: E-mail: I(xx)sy,it.or less --_ - — a CCB no.: Elec.bus. Ile.n:r Each additional 500 s .ft.or onion thereof Ci(y/metro lie.no.: Limited energy,residential Limited energy,non-residential - - i Lati _ _ Each mmmfaclured home or modular dwelling - Si not ol'su rvising ele inn(re uired) - Dote Service and/or feeder Sup.elect.name(print): License no: Serylcesorfee lers-Installatlon, _ - 1OWNIKIIINalteration or relocation: 2W amps or less 2 Name(print): l�u.,^.sc>(( r 5 t u� i w_ 201 amps to 400 amps - z Mailing address: K z�t� S �)t' 401 amps to 600 amps 2 State: 601 amps to I0(xl an Z - r Q r f,(' l:1':�t )�2 t Over IIx10 amps or volts Phnnc:6N C,10 `;4(I/I Fax: Email: keconnectonl —` 2 owns installation:The installation is being made on property I ownTem n Po rymrvfcesorfeeders- 1 . which Is net intended for sale,lease,rent,ur change according to InataItalian,a:'-raIon,orrelocaion: ORS 44%,455,4 .6 701 201)an stir las owner's si nature: ` 1 201 amps to 400,,ops 2 -- Date: 4(11 lar 6(N)am s Bunch clrcuhr.-new,alteration., z Name: ar etlensiun per panel: Address: A, Pee for branch circuits with purchase n1 _ service or feeder fee,each branch circus ` City: Slate: ZIP: B. Fee for hranch circuits without purchase Phone: Fa r: F-nail: of service or feeder fee,first branch circus , Each additional branch circuit - Misc.(.Service or feeder not Inclndcd►: U Service over 225 amps-c(im;;;,.,1.11 J Iiealnr care 6n tilt) Bach pump or irngauun circle U Service over 320 amps-ruling of 1 Net U IlarMous to ation Each signor outline Ii�htin family dwellings U Building over 10,000 sywue feet four or Signal circuit(s))or a limited energy panel. U System over 600 volas nominal more residential units in one structum alteration,or rxtenswn• U Buildin overthmestories 2 R U Frrdent,41K1 amps tip more * _ U Occupant load over 4v persons U Manufactured structures or kv park ch titin: _— U I.gresvlighting plan U I ni.'f Fwh additional ImpeMloe overt allowable In any of the above: Submit_111M of plats Mth any of the above.�— InIn vesteg1ill lion fee coon -- --�c— ----�---T— W The above are not applicable to lempon,ry construction service. Other Not all Jurisdictions arcepr credit cards,please call Iunsdicti-fa more inGxrnntlmePermit fee..............• .....$ U Visa U Mastercard iVotice:This permit application _ Credit card number. expires if a permit is not obtained Plan review(at _ 9i) $ _ s ilhin 180 days after it has been State surcharge(896) S isplrcs -- Name of c n r as awn nn cFjh car - accepted as comptoic. TOTAI, ..... $ trromt 4404611 I(vfx1K'OMI CITY OF TIGARD 13125 S,W,. BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE CRAFTWORK PLUMBING INC 7736 SXN NIMBUS AVE BEAVERTON, OR 97008 Plumoing Signatur: Form Permit tt: MST2001 -00065 Date Issued: 419101 Parcel: 2S111 CB-05400 Site Address: 15211 SW 100TH AVE Subdivision: LONDBERGOOMLP2000-00008 Block: ,Jurisdiction: TIG z-oning: R-3.5 new single family detached residence. Path Remarks: Construction of has been indicated as the plumbing contractor for the permit r company above.dicated gn ben order for the Your company plumbing permit to be valid, please har to iriethe statpofrthe1wtorkindividual the address above, ATTN: Building Dept. this Plu!-ibing Signature Form pr No plumbing inspections will be aut[iorized until this completed form is received PLUMBING CONTP,ACTOR: OWNS R CRAFTWORK PLUMBING INC RUSSELL & LANGBEHN 7736 SW NIMBUS AVE 14220 SW 100TH AVE BEAVERTON, OR 97008 TIGARD, OR 97224 prj()jjn #: 502-67.0-5441 Phone #: 644-86913 Reg #: ir. 79666 PI M 20-148PB AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of At orized Plumber If you have any quec-tions, please call 639-4171 , ext. # 310 ELECTRICAL PERMIT FEES: LIP"ITED ENERGY PERMIT FEES: FEach plefe Fee Schedule Below: — TYPE OF WORK INVOLVED -RESIDENTIAL ONLY --- _�_ Number of Inspections per permit allowed Restricted F_nergy Fee........................... —'�-- (FOR ALL SYSTEMS) $75.03 ce included: Items Cost Total ntial-ver unit Check Type of Work Involved: 8 or less $145.1.) q ❑ ditional 500 sq ft or — -- - Audio and Stereo Systems' n thereof $33.40 1 Energy $75.00 Burglar Alarm nufd Home or Modularing Seivico or Feeder $90�� L, Garage Door Opener' Services or Feeders Installation,alteration,or relocation ❑ Heating,Ventilation and Air Conditioning System' 200 amps or less $8030 2 201 amps to 400 amps $106.85 2 �'�Vacuum Systems' 401 amps to 600 amps $160.60 2 n� 601 amps to 1000 amps _ $454 60 2 Other _ ---C ,r✓"/ v_ Over nett amps or volts _ $454 65_ 2 Reconnect only $6.'85 �— 2 ' Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL 'ONLY Installation,alteration,or relocation Fee for each system................................... 200 amps ur less $66.85 2 I - -- $75.00 201 amps to 4C3 amps $100.30 _ - (SEE OAR 918-260-260) 2 401 amps to 600 amps $133.75 2 Check hype of Work Involved: Over 600 amps l0 1000 volts, - I see"b"above. ❑ Audio and Stereo Systems Branch Circuits New alteration or extension per panel ❑ Boller Controls a)The fee for branch circuits with purchase of service or feeder fee. ❑ Clock Systems Each branch circuit $665 2 b)The foe for branch circuits - ❑ Data Telecnmmunication Installation without purchase of service or feeder fee. ❑ Fire Alarm Installation First branch circuit $46.85 Each additional branch circuit _ $6.65 ❑ HVAC Pllscellaneous (Srrvir•,e or feeder not Included) ❑ Instrumentation Each pump or irrigation circle _ $53.40_ Each or outline lighting $53.40 ❑ Intercom and Paging Systems Signall cir circult(s)or a limited energy panel,alteration or extension $7500 Minor Labels(10) $125.00 ❑ Landscape Irrigation Control' _ Each additional Inspection over ❑ Medical the allowable In any of the above Par inspeciu.n _ $62.50 ❑ Nurse Calls Per hour $62.50 In Plant $73.75 ❑ Outdoor Landscape Lighting' Fees: ❑ Protective Signaling Enter total n(Ahove fees $ ❑ 8%State SuOtherrcharge 25%Plan Review For ---__Number of Systems See"flan Revif!w,se.lrun on $ Na licenses are required Licenses are required for all other installations front of appli':atkm Total Balance Due Fees: ❑ Trust Account Enter total of above fees $ 81,:State Surcharge $ total Balance Due $ i:\dsts\fomas\elc-fees.doc 06/07/01 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGA.RD, OR 97223 IMPORTANT PERMIT NOTICE CR:AFTWORK PLUMBING INC 7736 SW NIMBUS AVE BEAVERTON, OR 97008 Plumbing Signature Form Permit tf: MST?001 -99065 Date Issued: 419101 Pa-cel: 2S111 CB-05400 Site Address: 15211 SW 100TH AVE Subdivision: LONDBERG MLP2000-00008 Block: Lot: 001 Jurisdiction: TIG Zoning: R-3.5 Remarks: Coostr►action of new single family detached residence. Path 1 Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be \, ilid, please have the appropriate individual from your company sign below and return this Plumbing Signature Corm prior to the start of the work to the address above, ATTN Building Dept. No plumbing inspections will be authorized until this completed form is received OWNER: Pl-UM13ING OONTRACTOR RUSSELL & LANGBEHN CR.A.rTWORK PLUMBING INC 14220 SW 100TH AVE 7-36 S,,V NIMBUS AVE TIGArRD, OR 97 224 BEAVERTON, OR 97,J08 Phone #: 502-620-5441 Phone #. 644-8698 Reg # 1(' 79666 PI M 20-148PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X 1^ Signr-,ture of ALAcirized Plumber If you hava any questions, please call (5n3) 639-4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ALAN FITCH ELECTRIC 25973 S NIOEHNKE BEAVERCREEK, OR 97004 Electrical Signature Form Permit#t: NIST2001-00065 Date Issued: 419101 Parcel: 25111 CB-054 ) Site Address: 15211 SW 100TH AVE Subdivision: LONDBERG MLP2000-00008 Block: tot: 001 Jurisdiction: TIG Zoning: R••3.5 Remarks: Construction of new single family detached residence. Path 1 Your company has been indicated as the electrical contractor forpermit irequired.Iindicated abov have the r for the electrical permit to be valid, the signature of the supervising electrician appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No electrical inspections will be authorized until tlhis completed form is received oVVNFR ELECTRI;;AL CONTRACTOR: ALAN FITCH ELECTRIC RUSSELL 8 I._ANGB[=HN 25973 S MOEHNKE 14220 SW 100TH AVE TIGARD, OR 97224 bEAVERCREEK, OR 97004 Phone #: 502-620-5441 Phone #: 503-313-0761 LIC 00196872 Req #: ELE 3-187C SUP 37215 AN INK SIGNA URE IS REQUIRED ON THIS FORM x Signature of Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF T I GLi�® _______MASTER PERMIT PERMIT#: MST2001-00065 DEVELOPMENT SERVICES DATE ISSUED: 4/9/01 13125 SW Hall Bivd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 15211 SW 100TH AVE PARCEL: 2S1 11 CB-05400 '9DIVISION: LONDBERG MLP2000-00008 ZONING: R-3.5 BLOCK: LUT: 001 JURISDICTION: TIG REMARKS: Construction of new single family detached residence. Path 1 BUILDING _ REISSUE STORIES2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 25 FIRST: 964 of BASEMENT: of LEFT: 14 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,181 of GARAGE: 910 of FRONT: 35 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: i FINBSMENT: of RIGHT: 5 VALUE: S 210,101.00 OCCUPANCY GRP: R3 BDRM: 3 RATH: 3 TOTAL: 2.16500 of REAR: 47 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRA.S: RAIN DRAIN: 1C J •PS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUBISHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES. 100 BCKF-W PREVNTR: i GREmbE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN 1K: SOIUCMP c AHP: VENT FANS: 4 CLOTHES DRYER: 1 OTH FURN>•100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVFS: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: I PUMPIIRRIGATION: PER INSPECTION: EA ADWL 5008F: 5 201 400 amp: 201 •400 amp: tat WIO SVCIFDR: 0 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 60n amp: 401 •600 amp: EA ADDI.OR CIR: SIGNALIPANEL: IN PLANT: MANU HMISVCIFDW 601 • 1000 amp: 601+ampf•1000v: MINOR LABEL: 1000♦anlplvoll: PLAN REVIEW SECTION Reconnect only: >e4 RHES UNITS: SVCIFDR>425 A.: >600 V NOMINAL: CLS AREAISPC OCC: ELECTRICAL•RESTRICTED ENERGY A.Sr RESIDENTIAL B.COMMERCIAL _ AUDIO&STEREO: VACUUM SYSTEM: AUDIO d STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNUSC LT: BURGLAR ALARM OTE. BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATAITELE COMM: NURSE CALLS: TOTAL a SYSTEMS: TOTAL FEES: $ 6,744.75 Owner: Contractor: This permit is subject to the regulations contained In the RUSSELL& LANGBEHN OWNER Tigard Municipal Code,State of OR Specialty Codes and 14220 SW 100TH AVE all other applicable laws 411 work will be done in TIGARD,OR 97224 accordance with approved plans This permit will expire H work is not started within 160 days of Issuaire,or if the work is suspended for more than 160 days. ATTENTION. Phone: Phone Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Rana forth in OAR 952.001-0010 through 952-001-0060 You may obtain copies of these rules of direct questions to OUNC by calling(503)246-1987 REQUIRED INSPECTIONS Erosion Control Insp 8, Underfloor Insulation Electrical Service Low Voltage Appr/Sdwlk Insp Final Inspection Sewer Inspection Crawl Drain/Backwater Electrical Rough In ties Line Insp Misc. Inspection Building Final Footing Insp Footing/Foundation Dr; Framing Insp Insulation Insp Electrical Final Foundation Insp PLM/Underfloor Shear Wall Insp Rain drain Insp Mechanical Final l`ost/Beam Structural Plumb Top Out Exterior Sheathing Incl Watel Line Insp Plumb Final Issued By : Permittep Signature :� W Call (56) 639-4175 by 7:00 P.M. for an inspection needed the ne�l busines day r. CITYOF TI GA R® SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2001-00037 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639-4171 DATE ISSUED: 4/9/01 SITE ADDRESS; 15211 SW 100TH AVE PARCEL: 2S111CB-05400 SUBDIVISION: LONDBER G MLP2000-00008 ZONING: R-3.5 BLOCK: LOT: 001 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: L.TPSWR IMPERV SURFACE: Owner: Remarks: Sewer connection permit for new single family residence. RUSSELL& LANGEEHN FEES 14220 SW 100TH AVE Type By Date Amount Receipt TIGARD, OR 97224 PRMT CTR 4/9/01 $4300.00 27200100000 iNSP CTR 4/9/01 $35.00 27200100000 Phone: 502.620-5441 = _ Total $2,335.00 Contractor: Phone: Reg#: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires '80 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer lateralo. If the sewer is rot located at the measurement given, the installer shall prospect 3 feet in all directions fmm the distance given. if not so located, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth ir;OAR 952-001-0010 through O P 952-001-0080 `'ou may obtain copies of these rules or direct questions to OU14C by galling( 246-19 Issued by: � Permittoe Signature. Call (5 6) 6394175 by 7:00 P.M. for an iris ection needed p the next uslnes day • Building Perm:! Application City of 'Tigard ----- �Dat!ere�ceivcd: �A�/ ell Permilno,: Proiect/a I.no.: Expire date: J Address: 13125 SW Hall Blvd,Tigard.OR 97221 PP p r City ofTigarel Phone: (503) 6394171 Date issued: By: Receipt no.: Fax: (503)598-1960 Case file no.: Payment type: f, Land use app'oV81: 1 ' •�(/r'Cn"�n �" I&2 family:Simple Complex: TYW-4 PERMIT W &2 family dwelling or accessory 11 Commercial/industrial U Multi-family k.,Ncw construction U Demolition U Addition/alteration/replacement U Tenant improvement ❑Fire sprinkler/alann O Other: It-,VlrE INF(AMATION Job address: s,2\� (� \ �� Bldg.no.: Suite no.: Lot: t I I Block: Subdivision: C�%J k$Q _ Tax map/tax lot/account no.: Project name: Description and location of work on premisedshecial conditions: Name: V�=�Cl1r Vy - 1. N E. ' Mailing address: *:7,L,3 \� 1 & 2 family d„elling: City:' RA State:Gr ZIP: Valuation of work................I....................... $ PhoncSt Q-S ax: -_ IE-mail: No.ofbedrooms/baths.... ............................ J� -Owner's _ d representative: number of floors................................. Phone: Fax: E-mail: New dwelling area(sq.ft.) ... ... Gamge/carport area(sq.R.)......................... Name: Covered porch area(sq.ft.) _ Mailing addrt•ss: Deck arca(sq.ft.) ....................................... _ City: _ v State: L,II' — Other structure arcus ft. _ ( ) Phone: I rrx: E-mail: ('ommercf>tl/induetrlal/multi-ftlmlly: Valuntion of work........................................ $ - - 7Phon namc:'�� A- ��O J Existing bldg.area(sq.ft.) .......................... New bldg.arca(sq,ft.)........................I....... -- Number of stories........... ...........................Slruc: 7.11':— Type of construction.. .................................Fax: E-mail: Occupancy group(s): Existing: CCB no,: - New: City/metro lie.n,.: 7Notlre: ll contractors and subcontractors are required to be ith the Oregon Construction Contractors Board under Name: S IaTEEIDESIG� of ORS 701 and may be required to he licensed in the Address: 7(&S -S(.) 1 40 P SU,1 Z (Oy jurisdiction where work is being performed. ll'the applicant is city: TI CWD JSta(e:1QVQZll1: exempt from licensing,the following reason applies: ” �_ Contact ncrson: �M 1 flan no.: \\ 1 k,01Q _- PhoneSCiIS- -QS tx' E-mail: _ _ Name:F ,WL Cut itact person: Fees due upon application ........................... $ Address: W '�) Date received: City: IF t ,L�r .A State: Z111:917 Amount received ........................................ Phone,5o?-_S;& , 111 E-mail: Please rel'er to fee schedule. —_ I hereby certify I I ave rend card e) mined this application and the Nal dl Juri%dicticwis accept cmtit card«,Pleur call luliwh,tt(ar fin more Infnrmmtnn attached checklist All provis ons of'I ws an rdinances governing this UVisa U MasterCard t'redii cmd numhm work will be cumtJi with, w c c rein or not _—______ --4 sp�_ Authorized signature: _ _ e: � Now of c,rdfia�r s.r,own on cmdif card _ S Print name. �}r _ -- — ('ardhnldrr NRnature Amnuni Notice:11tis permit application expir:s ira permit is not obtain d within 1110 days n0cr it has been accepted as complete. "14M 1 WNWOM) One-and Two-Family Dwelling z' Z Building Permit Application Checklist 7Referenceno.:r__3WM __ — ed permits: City of Tigard City of Tigard U Electrical U Plumbing U Mechanical Address: 13125 SW HallBlvd,'rigard,OR 97223 UOther: _JI Phone: (503) 639-4171 Fax: (503) 598-1960 vlllu1 �w 1 1 1 I Land use actions completed.S„a jurisdiction criteria for concurrent reviews. _ 2 'Coning.Flood plain,solar balance points,seismic soils designation,historic district,etc. 3 Verification of apr-oved plat/lot. - 4 Fire district_ -approval required. - -- 5 Septic system permit or authorization for remodel.Existing system capacity_ _- 6 Sewer permit. 7 Water district approval. -- - ti Soils report.Must carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U permit requital.Include drainage-way protection,silt fence i.esign and location of cutch-basin protection,CO.. — 10 _ Complete sets of legible pians. Must be drawn to scale,showing conformance to applicable loci!and state building codes.Lateral design details and connections must be incorporatzd into the plans ac on a separate full-size Shed dttached to the plans with cross referenccs betw-en plan location and details.Plan nevi(w cannot be completed if cop right violations exist. _ -- — I 1 Sltelplot plan drawn to scale.The plan must show lot and Wilding setback dimensions;prop:rty comer elevations(if there is mon:that/a 4-11.elevation differential,plan must show contour lines at 2-ft.intervpSs);location of casements and driveway;footprint ol'structure(including decks);location of wells/seotc systems;uUty locations;direction indicator;lot ansa-,building coverage area;percentage of coverage;impervious area;existing Faucturs on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent sire r.nd location. 13 Floor plans.Show all dimet,sions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans, lumbin fixtures,balconies end decks"10 inches afxhvc grade,etc. _ 14 Crom section(s)and details.Show all framing-member sizes ar•S spacing such as floor beams,headers,joists,s-ib-floor, wall construction,roofconstruction.More than one ctoss sectior,m-iy be required to clearly portray construction.Show details of all wall and mol'sheathing,roofing,roof slope,ceilin1 height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. —--- - -- 15 Elevation views.Provide elevations for new construction minimum of two elevations for additions and rmodels. Exterior elevations must reflect the actual grade if the ch ttige in grade is greater than four foot at building envelope. Full-size shect addcndums showing foundation elevation•with cross references are acceptable. _— 16 Wall bracing(prescriptive path)and/or lateral anslys is plans.Must indicate details and locati.ms;for nun- rescriptivc path analysis provide specifications and calculations to engineering standards. 17 H7oorlroof framing.Provide plans for all floorshoof assemblies,indicating member sizing,spacing,and bearing locations Show attic ventilation. 18 Basement and retaining walls.Provide cross sections and details showing placement of rebar.For engineered systems ace item 22,"Engineer's calculations." 19 Beam calculation-r.Provide two sets of calculations using current code design values for all beams and multiple joists over 10 feet long and/or any heatn/joist carrying a non-uniform lord. 20 Manufactured floorlroof true de+lgn d_etrlls. — 21 Vnergy Code compliance.Identify the pmccriptive 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,ro.rf truss)shall be stamped by an engineer or architect licensed in Oregon and shall be shown to 1w apl,li(-obie h)the proyecl under review 23 hive(5)site plans are required for Item I I alxrvc 24 ---- 25 -- — 26 -- 27 - - — - 28 Checklist must be complete:/ before plan review .tart date. Minor changes or notes oil submitted plulu relay be In blue 0i black ink. Red ink is reserved for derartment use only. 440 .6141r.RrAXIM) Electrical Perinit Application Datereceived: ; t" Permit no.: =GGi G0� City of Tigard Project/appl.no.: Expire date: Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Recei tno.: Phone: (503) 639-4171 — y P -- Fax: (503) 598-1960 Case file no.: Payment typt,: Land use approval: _ 2X 1 &2 family dwelling or accessory 0 Commercial/industrial U Multi-family U Tenant improvement �3 Ncw construction 13 Additic,n/alteratiolt/replacement ❑Other. U Partial JOB NFULIN FORMATION Job address: 15.Z t( 5W T1 ARA Q Bldg.no.: I Suite no.: ITax map/tax lot/account no Lot: Buck: Subdivision: AWt:PJlEto) _ -- Project name: I Description and location of work on premises: Estimated date of completion/inspection: Job no:V6t 4-F4T% 1--6t t _ t ntnr Business name: IT:.k4, E.t._CUrrLj LIk•,cripli�,n Qty. Ira.) 'luta) no.insp - New residential-shtgk•or milts-:amity per Address: —� _ dwellingunit.Inclurlrssttache•Agarage. City: SlatC:Q ZIP: Servicelswiudrd: Phone'S036 y. Fax: E-mail: iWK)sq.ft or less q CCB no.: ? TEICC.bus.Ile.no: Farch additional 500 sq.ft.or portion thereof Limited energy,residential 2 City/metro lie.no.: i Limited energy,non-residential 2 Each manufactured home or modular dwelling Signature of supervising electrician l Date Service an(Vor feeder 2 sup.elect.namc(priuu L.icenseno: Services or feeders-Installation, alteration or relocation: PROPERTY1 200 amps or Iebs 2 K) 201 amps to 400 antes T 2 401 amps to 6110 amps 2 Mailing address:(14S(>-) ��. _ 601 strips101(xxlntnps 2 — Clty:'T� Stater -LIP: 70verlW0antpsnrvnits 2 - P110111•� ,- E-mail: Recnuntcct only -- -- - I O%vncr installation:The installation is being made on property I own Temporary services. orfeeders- which is not intended for sale,lease,rent,or exchange according to installation,alteration.orrelocatiou: ORS 447,455,479,670,701. 21%1 amps or less 2 201 nntps to 4(%I amps 2 (lwncr's signature: I kite: 011 to 6(x)ams 2 Ranch circuli%-new,alteration, or extension per panel: Name: A Fee for branch circuits with purchase of Address: service or feeder fee,each lranch circuit 2 City: State: ZIP: N. Fee for hranch circuits without purchase of service or feeder fee,first brunch circuit: 2 I'htttu: fax: f mail. Lach additional branch circuit: Misc.(Service or feeder not Included): U Service ovet 225:uups cutnowncial U It-:ddt-care Iadllly Bach pump nr lrrigatimm circle 2 U Service over 320 amps-rating of 1&2 U lWard,lus Iocaaon Each sigh Ur outline lighting - -- - familydwellings U Building over 10.000 square feet four or Signal cocuitU)or a limited energy panel, U System over 6(x)volts nominal inure residential units in one structure alteration,ore%tension• 2 U Building over three stones U Feeders.41x1 amps or atom 00escri tion U Occupant load over 99 persons U Manufactured structures or It V park ra.m..adillonat Inspection over the allowable In an)of the above: U Pgrranniahthtgplau U Other. Llpve., pcd •Submit %etc ofpians with nnv ofthe aimne. gationfe-, theabove arc not appiksole toIrmporary c•unoructionservice. -- - _ — — Permit fee............. .......E Wi all juriulicurms acagr oola cords,please:nll pm„6,tnni 1,,i mmr mbnm.tion. Notice:This permit application U visa U Mastert'nut expires if a permit is not obtained Plan review(at _ %) $ t redit card notnbe: --�..-- within 18(1 days atter 4 has been State surcharge(8%).. .$ I cpimt ---- accepted as a,mpb• TOTAL AL ................. $ ante eelrsr-3ia,l3eris�su,wnnncrcdll-curd -- •••••• S CardbUttletldKmnare 4.uium 44046M60 'Wi Electrical Permit Fees: Limited Energy Fees: -- TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Restricted Energy Fee................................... Complete Fee �cN ember o Number rmit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work involved: Residential-per unit $145 1 n El Audio and Stereo Systems 1000 sq it,or less ---- — Each additional 500 sq it or $33,40 t Burglar Alarm portion thereof $75 00 - — Limited Energy -- - El Door Opener' Each Manufd Home or Modular $90 9 Dwelling Service or Feeder ❑ Heating,Ventilation and Air Conditioning System' Services or Feeders Installation,alteration, relocation $80.30 J 2 Vacuum Systems' 200 amps or less $10685 2 201 amps to 400 amps $160.60 2 Other— _ ----- 401 amps to 600 amps -- $240.60 2 601 aTps to 1000 Amps $454.65 Over 1000 amps or lolls _ 2, $66 85 Reconnect only TYPE OF WORK INVOLVED -COMMERCIAL ONLY Temporary Services or Feeders Fee for each system.......................................................... $75.00 Installation,alleratiou,or relocation $66.85 2 (SEE JAR 918-`260-260) — 200 amps or less $10030 2 201 amps to 400 amps Check Type of Work Involved. _ 401 amps to 600 am $133 75ps Over 600 amps to 1000 volts, LJ Audio and Stereo Systems see"b"above. r B l� Boiler Controls Branch Circuits New,alteration or extension per panel Clock Systems a)The fee for branch circuits with purchase of service or feeder fee. $h re`s Data Telecommunication Instaliation Each branch circuit — -- b)l he fee for branch circuits Fire Alarm Instaliation without purchase of service or feeder,fee. $46 K) _ __ HVAC First branch circuit ---- $6 6, Each additional branch circuit -- --- ❑ Instrumentation Miscellaneous (Snrvix or feeder not Included) $53.40 Intercom and Paging Systems Each pump or irrigation circle $53.40__ _____ Ea7h sign or outline lighting _ 5Ignal circuits)or a limited energy Landscape Irrigation Control' __ penal,alteration or extension $75.00.00-- $125 _ ❑ Minor Labels(10) Medical Ei dditlonal Inspection over Nurse Calls the allowable In any of the above $62.50 Per Inspectlo r $62.50 _ _ Outdoor Landscape Lighting' Per hour $73.75 In Plant Prolective Signaling Fees: Other Fater total cf above Ices - — $ Number of Systems H% 8%.Stals Surcharge - Plan Review Fee No licenses are required Licenses are required for all other Installations f;ee"Plan Review"seellon on $ -- Lont of application — Fees: TofalBalance Due — Enter tot„l of above fees $- N _ 9%State Surcharge El Trust Account $----”-- __ - Total Balance Due $ f klsts\futmsklc fees doc 101090) Plumbing Permit Application City of Tigard 1 Date received:� 1<1101 Permit no.:Nl'rew/-eet*. Address: 13125 SW all Blvd,Tigard,OR 97223 Sewer permit no.: Building permit no.: CiryofTigard Phone: (503)639-4171 ProjccUappi.no.: Expire date: Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: - - - Case file no.: Payment type: IKJ &2 family dwellin r or acccssory U Commercial/111(' nal ❑Multi-family ❑Tenant improvednertl h$New construction Ll Addition/allcrition/rcplace.mcnl J I-ood service ❑Other: t r Job address: (S 5w ltd-, kvc Description Qtv. Fee(ea.) I Total Bldg.no.: I Suite no.: New 1-and 2-family dwellings only: Tax map/lax lot/account no.: (includes 100 p.for each utility connection) SFR(1)bath Lot: Block: I Subdivision: SFR(2)bath ---- — — Project name__ SFk(3)bath — City/county: I ZIP: Each additional bath/kitchen Description and location of work on premises: Skeuteitles: Catch basin/area drain Est.date of completion/inspection: Drywells/leach linehrench drain -- Footing dra'n no.lin.ft.) Manulactureu home utilities Business name: - (,�� PUA IN Manholes Address: Rain drain connector Cily: -aeAklpc..RT'bo Stutr,:6 ZIP: Sanitary sewer(no.lin.ft.) - —-- Phone'Sp 4 %9 �ax: E-mail: Stone sewer(no.lin.ft.) -- CCB no.: Plumb,bus.n g.no: Water service(no.lin,ft.) - City/metro lic.no.: — Fixture or Item: Contractor's representative signature: Absorption valve Back flow reventer Print name: "��'�' Backwater valve Basins/lavatory — Name: Clothes washer --- Dishwasher Address: _ Drinking founlain(s) - City: - -AState: 1711' --- Ejectors/sump I'horte------ I,t,: I. nt,til Expansion tank —Fixture/sewer cap -- Name(print): � 5 E e Flair drains/floor sinks/hub AN fa iN►J Garbage disposal Mailing address:('4�'3p SW ( il_� Vet —Hose. bibb City: M%N_R>a —-- St1111 ((� ZIP: Ice maker — 1'hone Email: Interceptor/grease trap Owner installalion/residential maintenance only: The actual installation Primer(s) - will he made by me or the maintenance and repair made by my regular Roof drain(commercial) _ — employee on the property 1 own as per ORS Chapter 447. Sink(s),hasin(s), ays(s) Owner's signature: Date: I Sum _ — Tubs/shower/shower pan Nance: Urinal ---- -----— Water closet Address: Water cater City: State: IT_IP: Other: Phone: [,'ax: I E-mail: 1,01111 Nue fill Judsactlons acceln credit cards,pleas.call Jurisdiction for mom Inrcmnati(m Minimum fee................$ Nottc. "is permit application , Uvisfi UMasterCard Ilan review(al _ %) $ e•rcdit raid number: expires if a perrnit is not obtained -- - within 180 days aflcr it has hecn State surcharge(8%)....$ --� — accepted as complete. TOTAL .......................$ Nnme of cardholder u shown an credit cud P P --- S Cardholder signature Amount — PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: jT FIXTURES individual) QTY ea AMOUNT (includes all plumbing fixtures In1660 the dwelling and the first100 ft. ALJNT1660 for eachutilify connectionTub or Tub/Shower Comb Gne_( bath ___16.60 Two�bath _ -- Shower Only �._ 16.60 Three(3)bath --�- -Water Closet _ 16.60 __ Urinal _ 16.60 SUBTOTAL Dishwasher _8%STATE SURCHARGE 16.60 PLAN REVIEW 25%O_F SUBTOTAL Garbage Disposal 1 1660 TOTAL Laundry Tray —_ 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" -. 16.60 16.60 PLEASE COMPLETE: 4" -- 16.60 Water Heater O comrersion O like kind 1660 Quant! b Work Performed Gas piping requires a separate mechanical [Fixture Type: New Moved Replaced Removeermit.MFG Home New Water Service 46.40 Ca ed _FG Home New SaMStomt Sewer 46 40 — ry _ - Hase Bibs 16.60 Tub or Tub/Shower — — — Roof Drains — — Combination 16.('0 Shower Onl -- Drinking Fountain 16.60 Water Closet — -- Other Fixtures(Specify) 16 6 Urinal - Dishwasher -- - — Garbage Disposal ..Laundry Room Tra _ - Washing Machine Sewer-1st 100' 55 00 Floor Drain/Sink: 2" — Sowor-each additional 100' — 3" 46A0 4„ -- --- Walor Seryice- tst 100' 55.00 Water Heater — — Water Service-each additional 200' — 46.40 Other Fixtures — Storm d Rain Draln , 5�00-1st loo' ---- ASpecify _ — Stonn—&Rain Drain-each additional 100' 46.40 -- Commercial Back FloW_PTWv_enI_ion Device 46.40 _ Residential Backflow Prevention Devito' - 27.55 — Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 — — Reg_uested Inspections __ erthr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65,25 --- Grease Traps 16.60 — �— QUANTITY TOTAL — Isometric ar riser diagram Is required If ,— z ---- Oumr Total Is a 9 ---�--- -- "SUBTOTAL --- ---- ---- 8%STATE SURCHARGE --- - — — — — "PLAN REVIEW 25%OF SUBTOTALRequired only If fixture qty total Is>9 TOTAL 5— — "-- �Minimum penult roe h>;72 5o•996 state surcharge,except Residential Backflow Prevention t'evice,which IB$36 25•996 slate surcharge All New Commercial Buildings require pians with Isonmtnc or riser diagram and plan review i\dsts\forms\plm-fees.doc 10/10/00 Mechanical Permit Application Date received: ,� / �t Permit no.: City of Tigard Project/appl.no.: Expire date: CityofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: I Receipt no.: Phone: (503) 639-4171 Payment type: Fax: (503) 598-1960 Case file no.: Y YP Building permit no.: Land use approval: _ ,lt&4 &2 family dwelling or accessory U Commercial/industrial J Mniti-family J"I rnant Itlipf•,l'Cilll`nf Aq New construction U Addition/alteration/replacement Job address: S.Z l 1 S U�1 �,Suite Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: value of all mechanical materials,equipment,labor,overhead, profit.Value$ Tax map/tax lot/account no.: 'See checklist for important application information and Lot: t-3 Block: Subdivision: \ jurisdiction's fee schedule liar residential permil fee. Project name: City/county:Tf ;. ZIP: Description and location of work on premises: Fee(ea.) Total Est.date of completion/inspection: Ikscripdon qty. Res.only Res.only Tenant improvement or change of use: Air handling unil CFM Is existing space heated or conditioned?U Yes U No it conditioning(site p an require ) — Is existing space insulated?U Yes U No Alteration of existing HVAC system Boiler/compressors State boiler permit no.: Business name: _ HP Tons BTU/11 c uct smoke stertors Address: it smo a amper State: 'LIP: eat pump(sue p an require ) City: urnac urner BTU/11 Phone: 7,111—x: L marl' - Including ductwork/vent liner U Yes U No CCB no.: _ nsto rep ac•re-orate seaters-suspended, City/metro lie.no.: _ wall,or floor mounted _ ens fur a iauce other than furnace i Name(please print): a gest Absorpti,.n unite_- -._-- BTII/H -- -- -- Chillers -- - HP Name: -- Com,res•,ors_ Address: nv ronmenta ex ust an vent at on: City: Slate: ZIP: Appliance vent Phone: _-- I I I )rycrexhaust uo s,I'ypc 11 lurcs.kitchmAnziliat hood fire suppression system — Natne: Exhaust fan with single duct(bath fans) ix aunts stem a Sart from heating or At- Mailing CMailing address:t O 15;\0 1 d ��- ue p p ng on vt ut on(up to -outlets) City: '( \ -- State: 7.IP:Q\ fYIX I.1'(; _, NO (til Phone%03' 0- ax; I iu;lil uc ,i in each a uiona over rocessout Cts _R 10 XtL piping ng(schcusaticrcywre ) — Number of outlets — Name: t ,rr d app ante or equ pmen1: Address: Decorative tueplace State: ZIP: Insert-type -- City: — o, stov pe et stove _ Phone: Fax: I E-mail. Other: — Applicant's signature: Date: -Other: —_-- Name (print): - Permit fee.....................$Not sill p,riWica,me Oivetn c,nfh csinls,plrn•r call iurlxlk,h,n(r.near ndonnN,°n Notice: This permit application Minimum fee............... $ U Visa U Mmrtcrt'ard expires if a pcnnit is not obtained Plan review(at _. %) $ - c'mdu cmd nu,nheo ___ - L-1- within Igo days after it has been t•..�nr. State surcharge(8%)....$ Nimr - accepted as complete. cual,n�kr.,shown on rrrau�,r TUTAL ......................•$ -- ----- ('ardhai,�er�IEnature s Amount ")4617(Nil IA,,M, MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: Price Total _ Description: Oty (Ea) Amt TOTAL VALUATION: FEE: _ - Table 1A Mechanical Code $1.00 to_$5,000.00 Minimum fee$72..50 - ,) Furnace to 100,000 BTU 1400 $5,001.00 to$10,000.00 $72.50 for the first 85,000.(0 and includin ducts&vents - $1.52 for each additional$ 00.00 or 2) Furnace 100,000 BT 1740 fraction thereo,to and incl iding including ducts&vents _ $10,000.00_ 3) Floor Furnace 1400 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and includin_g-vent $1.54 for each additional$100.00 or 4) suspended heater,wall heater fraction thereot,to and including 14.10bor floor mounted heater _ $25,000.00. 5) Vent not included in appliance permit 6 CO $25,001.00 to$50,000.00 $379.50 for the first$25,000.(10 and _- $'.45 for each additional$100.00 or 6) Repair units 12 15 fraLrion thereof,to and including _ $50 L+00.00. - Check all that apply: Boiler Heat Air $50,001.00 and up $742.OU for the first$50,000.00 and $1.20 for each additional$10(.00 oror I For Items 7-11,see or Pump Cond -- fraction thereof. footnotes uelow. ----- '- 1)<3HP;absorb unit 14.00 to 100K BTU — - ASSUMED VALUATIONS PER APPL C 8)3-15 HP;absorb _ 25.60 Value Total unit 100k to 500k BTU - Descrl tion: at Ea Amount _ 9)15-30 HP;absorb _ 35.00 Furnace to 100,000 BTU,Including 955 unit.5-1 mil BTU- ducts&vents 10)30-50 HP;absorb 52.20 Furnace>100,000 BTU Including 1,170 unit 1-1.75 mit BTI/ r __ - 11)>50HP absorb 87.20 ducts&vents _ Floor furnace inciudln vent 955 _ unit>1.75 mil BTU Suspended heater,wall heater or 955 12)Air handling unitit l 10,000 CFM 10.00 floor mounted healer 445 13 Air handling j - 110,000 CFM+ Vent not included In applicance ) 17.20 - iermit — 805 _. Repair__ unfits_ 14)Non-portable evaporate cooler 1000 <3 hp;absorb.unit, 955 to 100k BTU ----- - 15)Vent fan connected to a single duct _6 80 3 15 hp;absorb.unit, 1,700 1011k to 500k BTLI --- 16)Ventilation system not Included In 1000 15-30 hp;absorb.unit,501k to 1 2.310 appliance pPrmil mil.BTU 17)Hood ed by mechanical exhaust 1000 30.50 hp;absorb.trait, 3,400 -- 1-1,75 mil.BTU - 18)Domestic incinerators 17 40 -, >50 hp;absorb.unit, 5,725 - - > 0 h mil.BTU 19)Commercial or industrial type Incinerator 6995 Alr handling unit.to 10,000 cfm 656 - Alr handlln unit>10,000 cfm 1.170 2010 ther units,Including wood stoves 1000 -9_��-- 656 _ - - Non- ortable evaporate—cooler 448 Vent(an connected to a single duct -- 21)0.15 piPing one to four altlets 540 — Vent system not included In 658 _ ap Ifance ermlt - 22)NF than 4-Per outlet(each) 1.00 - Hood served by mechanical exhaust 656 Domestic incinerator 1 170 Minimum Permit Fee$12.50 SUBTOTAL: $ Commercial or industrial Incinerator 4 590 - Surcharge Other unit,including wood stoves, 656 8%State Inserts,etc. - 360 25%Plan Review Fee(of subtotal) _Gas piping 1-4 outlets 83 Required for ALL commercial permits only Each additional outlet - -- b--- TOTA COL MMERCIAL s TOTAL RESIDEN A RMIT FEE: VALUATION: --'--"-- -- 01her stwctions and Feed: 1 Inspections outside of normal bas,;iess hours(minimum chat go.4*0 hours) $72 50 per hour 2 Inspections for which no i;a is specifically Indicated (minimum charge-half hour) $72 50 per hour 3 Additional plan review required by changes,additions or revisions to plans(minimun chargeone-half hour)$72 50 per hour `Slate Contractor Boller Certification required 1nr units 3,200k BTU. "Residential A/C requires site plan showing pisc.ment of unit. I dsts\formsumech•fees.doc 10/11/00 Permit #: oma.: Address: f✓02//__ .�GC� �G O f1'l/� — Issued by: Date: 18.39 L. -- - Statement: Information Notice to Property Owners About Construction Responsibilities :'vote: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration corder ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Dill in the appropriate blanks and initial boxes I and 2, and either box 3A or 38: 1. 1 own, reside in, or will reside in the completed structure. 2. 1 understand that I must register as a construction contractor if the structure is sold or offered for salr before or upon completion. (� 3A. My general contractor is _ ---———— l_-1 (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby cer•til's that I he above' ►formation is correct.Incl Ili-it I have read and do understand the Information Notice ► operty w yrs a U Co str -tion hest►on%ibilities on the reverse side of this form. (Sign re of permi applicant) (Date) (White c olm to issuing agencl permit file, link copy to applicaw CITYOF TIGARD ELECTRICAL PERMIT PERMIT#: 1-LC2001-00240 DEVELOPMENT SERI 'CES DATE ISSUED: 5/9/01 13125 SW Hall Blvd.. Tigard. OR 97123 (503) 639-4171 PARCEL: 2S111CB-05400 SITE ADDRESS: 15211 SW 100T1-1 AVE SUBDIVISION: LONDBERG MLP2000-00008 ZONING: R-3 5 BLOCK: LOT : 001 JURISDICTION: TIG Prosect Description: Temporary Service RESIDENT;AL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS _ 1000 SF OR LESS: 0 - 200 amp: �1 PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 arnp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 60C amp: SIGNAL/PANEL.: MANF HM/SVC/ FUR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS_ ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 2.01 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp. to ADD'L BRNCH CIRC: IN PLANT: G01 - 1000 amp: _ _ PLAN REVIEW SE_CTIUN _ _ _ 1000+ arrip/volt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect onIT._ SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: RUSSELL & LANGBEHN OWNER 14220 SW 100TH AVE TIGARD, OR 97224 Phone: 502-620-5441 Phone: Reg #: _ FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT CTR 5/9/01 $66.85 2720010000( Elect'I Final 5PCT CTR 5/9/01 $5.35 2720010000( Total ,72,20 J 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 OA 95 1-0080. You may obtain copies of these rules ordirect questions to OUNC at(5U3) 246.6699 or 1-800-3 344 Permit Signature: Issued By: 1 OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNAL URE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: LICENSE NO: Call 639-4175 by 7:00pm for an Inspection the next business day Electrical Permit Application — — � Date received: .. _p Perttlitno.: a04l-00.2 City of Tigard Project/appl.no.: Expire date: �- City ofTigard Address: 13125 SW Hall Blvd,"Tigard,OR 97223 Dateisrued: By: Receiptno.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: U I &.2 family dwelling or accessory U Commercial/industrial _) Muhl Lanlnly U Tenant improvement New construction U Addition/alteratioil/replacement U Partial 1 1 Job address: S ( ( =''W ( I C Bldg.no.: Suite nc Tax map/tax lot/account no.: Lot; I Block: Subdivision: Project name: Description and location of work on premises: Estimated date of com letion/ins action: 1 1 Fcr M11ax Job no: A _- -'-' Ikwcriptiom vty. teal Ictal no.insP BU51 mess name: New mideiiiial-single or multi-family per Address: dwellium unit.locludm anaclred{aragr. City: State: ZIP: Servicein(lud,", M)"I u s 4 PhOI1G: Fax: E-mail: Each additional 500 sq,ft.or portion thereof CCB no.: Elec.bus.tic.no: _ Lintttedencrgy,residential 2 City/metro Ilc.no.: _ _ Limited energy,non-residential 2 Each manufactured home or modular dwelling Signature of supervising electrician(requite I i U:uc ___ Service and/or feeder 2 I.icenseno: %ervicesorfeedem-Installation, Sup elect.name(piing: ahenllun or relucwrluu: PROPERTY OWNER 2(x)amps or less 2 ` l 7 201 amps to 4(x)amps 2 Name(print): �.;a�(_L `� 401-amps to 600 amps 2 Mailing address: 1 4:;,,k2, 0 u l 601 amps to 1000 amps 2 City; T ) Slate:Vl ZIP: over 1000 amps or volts 2 Phonc!,j ' lam- E-mail: Reconneirlonly I (Avner installation:The installation is being mad( on property I own Temporary wrvicm or feeders- InNallail(til,alirration,urrrluexnou: which is not intended for sale,lease, •n t exchange according to 200 amps or less 2 ORS 447,455,4n67(.7( 201 snips to 400 amps - —_- 2 Owner's si nature: Date. 401 to 600 unifiR - -- '- Rraaeh clrc•ults•new,alteration, or extension per panel: Name: A. Fee for branch circuits with Purchase of Address: scrvice or feeder fee,each branch circum - City. State, ZIP: B Fee for branch circuits without purchase of scrvice or feeder fee,first brach circuit 2 Ph(nnr" Fax: I: Illall Bach-additional branch citcuil - Mise.(Service or feeder not Included): UService over 225amps-conunercial UHcahh-caefalu� _Eacum oIrr ❑uou crcic 2 - — 2 U Service over 120attps-rating of I&2 U liatardouskuatb,n Each sign or oulline lighting _ family dwellings UBuilding over l0,INN)square feet four(it Signalcircuit(s)urulinriiedenergypanel. U System over(0)volts nominal nage residential units to one structure alteralio n,or extenston• 2 U Building over three slones U Feedcrs,4(IOamps tit Knre •Iksol tion U(kcupanl load over 99 Ilersons U Manufactured structures or RV park 1 ash additional lnspecilnn over the alloHable in anv of the above: U F4lress/IightinPPlmn U r)thcr -._-- __- -_-- Pei its Iic_i till submit-___acts of pian+with any of the above. Investiillat�ion lee _ lite above are not applicable to temporary construction service. Other _ Not all)urisdictbra aneta cmlin cane,Pleavr call lod"diCtion(IM mtxe NMI on.' NOIICC: Illi t permit appllcalltln Permit fee.....................$ _ Plan review(at , 9G) U visa U MasiciVard expires il'a permit is not obtained S Credit cord number within 180 days alley it has been State surcharge(8%) ....$ accepted as complete. 'CO'i'Al. .......................$sane a o r a s awn nn crric� _ S card d uurc Amount 44()4611 I vtJlyt'()M) Electrical Permit Fees: Limited Energy Fees: -- -- TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee.................................................... $75.00 Number of I_nspecoons per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved' Residential-per unit 1000 sq it or less $14515 4 ❑ Audi,,and Stereo Systems f.ach addi'tonal 500 sq it or portion'hereof $33 40 1 ❑ Burglar Alarm I imiled Eneigy _ $75.00 Each Manuf d Home or Modular ❑ Garage Door Opener' Dwelling Service or Feeder __ $9090 2 Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 2 Vacuum Systems' 201 amps to 400 amps $106.85 7 401 amps to 600 amps $160.60_ 2 ❑ 601 amps to 1000 amps $240.60 r Other _ Over 1000 amps or volts $45465 Reconnect only $66..15 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation Fee for each system......................................................... $75.00 200 amps or less $66.85 It G � 2 (SEE OAR 918-260.260) 201 amps to 400 amps _ $100.30 401 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 C� Boller Controls New,alteration or extension per panel a)The foe for branch circuits with purchase of service or Clock Systems feeder fee. Each branch circuit $665 _ _ Data Telecommunication Installation b)The fee for branch circuits wlfhour purchase of service ❑ Fire Alarm Installation or feeder lee. First branch circuit _ $4685 — �] HVAC Each additional branch circuit Y �^ $6.65.-- Miscellaneous 6.65 _Miscellaneous ❑ Instrumentation (Service or feeder not Included) Fach pump or irrigation circle $53.40 ❑ intercom and Paging Systems Fach sign or outline lighting $5340 Signal circuit(s)or a limited energy panel,alteration or extension $7500 ❑ Landscape Irrigation Control Minor Labels(10) $125.00 ❑ Medical Each additional Inspection over the allowable In any of the above ❑ Nurse Calls Per wspoclion $6250 I'er hour $6.2 50 _ In Plant $73 75 _ ❑ Outdoor Landscape Lighting' Fees: ❑ Prolective Signaling Enter total of above fees a _` ❑ Other,______.,__ __ 8%State Surcharge $ _sZ_�� Number of Systems 25%Plan Review Fee See"Plan Review"section on $ No licensee are required Licenses are required for all other installations front of application ---� -- Fees: .,tat Balance Due $ �-z.: 2 Enter total of above fees $ __ ❑ Trust Accot.mt 0 8%State Surcharge = total Balance flue = 0drits\fornu\elc•I'ecs drw 10/090) CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 / BUP — Received _____ —_Date Requested ( �5 AM----- PPA - _ -__ BUP _ Location - _.__-. ( �� G' '{'`' _ __ ...... Suite MEC Contact Person -_._____�. ___.__.-_ �'- - Ph (_--___-; 6 ky -C q�(3 PLM Contractor-- --- - -- -- Ph (- --) _ SWR - - - ---- BUILDING Tenant/Owner _ ELC Footing ELC Foundation Access: Ftg Drain ELF! Crawl Drain _ Slab Insoection Notes: SIT Post& Beam _ ------- ------- --- Shear Anchors - - Ext Sheath/Shear Int Sheath/Shear Framing -- - Insulation Drywall Nailing Firewall Fire Sprinklor - - --- Fire Alarm Susp'd Ceiling - - - - Root Other: - - -- -- Kill MM&Bi PARTFALL ING Post& Beam Under Slab _ Rough-In Water Service Sanitary Sewer Rain Drains - - Catch Basin/ Aanh( Storm Drain -- Shower Pan Other. Final PASS PART FAIL _ MECHANICAL Post 8 Beam _--- Rough-In --- - - -- - --- - --- ------- _...._—_ Gas Line Smoke Dampers - -- - -- Final PASS PART FAIL - - ELECTRICAL Service — -- Rough-In UG/SlabLow Voltage ----- Fire Alarm Final Reinspection fee of$— required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ^—_ _ Please call for reinspection RE: __.___.__ __. E] Unable to inspect- no access Fire Supply Line ADA Approach/Sidcwalk Date► Gc Gnspector __ _ _Ext Other: Final DO NOT REMOVE this hispection record from the Job site, PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST "Iva/ 66o�vs INSPECTION DIVISION Business Line: (503)639-4171 BLIP Received - Date Re uestod 'Z AM— -- PM - -- _ BUP -- ----- q �� /tLl SUIt9_ MEC -- Location - LLD' -� PLM Contact Person Ph( ) — -�� SWR Con'xactor -- ---____ __ Ph( ) - — ELC rFig ILDING Tenant/Owner __ --_- ELCotingundation Access: ELR Drain �c� Crawl Drain SIT - -- - Slab I pection Nates: .G�'� ? =C -- – - -- - Post&Beam -—— -- _ --- Shear Anchors Ext Sheath/Shear " Int Sheath/Shear �u / F✓►r- C7---, /i.cc L- �'h+ Framing Insulation L774 -1��r v• hra/N - - -- ----- -- — Drywall rdailing Firewall — --- Fire Sprinkler — Fire Alarm - Susp'd Ceiling Roof - -— Other------ - -- Final PASS PART FAIL - PLUMBING Post 8 Beam - -- Under Slab Rough-In Water Service — Sanitary Sewer ---- Rain Drains Catch Basin/Manhole Storm Drain Shower Pan Other: PART FAIL Post 8 Beam Rough-In ------------ ---- Gas Line J—` ---- ---- Smoke Dampers -- ---— --__. Final PASS PART_ FAIL ELECTRICAL - -- -- --------- -- ---- ---- Service --- Rough-In - ------ - - UG/Slab I /• L S'"i= - ------ LowVoltage _- Fire Alarm --required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Final 0 Reinspection lee of$--- PASS PART FAIL— Please cell for reinspection RE: Unable to inspect-no access SITE — r� ----- ----- Fire Supply LineExt ADA ��_ L Inspector Approach/Sidewalk Other: DO NOT REMOVE this Inspection record from the job site. Final PASS PART FAIL CITY OF TIGARD 24-Flour BUILDING Insper.ion Line: (503)639-4175 ',SCG / G'GUCo� INSPECTION DIVISION Business Line: (503) 639-4171 MST BUP -- Received —Date Requested r r Z Z AM PM_—..__ BUP — ---_— t-ocation Suite MEC Contact Person -- �--�L%?.lL)_ -- Ph( ) —d PLM -- Contractor — ---- --- , Ph SWR -- - BUILDING Tenant/Owner ELC __- Footing - -- - —-- ELC _ Foundation Access: Ftg Drain ELF! Crawl Drain Slab Inspection Notes: SIT Post& Beam Shear Anchors - Ext Sheath/Sh• ar ----..-- Int Sheath/Shear Framing - - Insulation Drywall Nailing - - — Firewall Fire Sprinkler ^— Fire Alarm Susp'd Ceiling - Root Other- Final _ PASS PART FAIL — PLUMBI'O'.4 Post$ 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 G Low Voltage Fir-Alarm- ,+¢�S RT FAIL El Reinspection tee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. $) l l Please call for reinspection RE:__- n Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Dab Other- Final therFinal DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL vq a � S ''7 cr a C? r 1 � O a O O O � l n 0 �C