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WALT_ AREA: 448 sq. ft. WALL FACE (DIRECTION): NE SIGN HEIGHT: 15 ft. PROJECTION FROM WALL: 2 in. ILLUMINATION: NON DESCRIPTION OF SIGN: Installing a 16 sq. ft. permanent well sign. MATERIALS: FOAM EXISTING SIGNS: 1 ELECTRICAL PERMIT REQUIRED: Y BUILDING PERMIT REQUIRED: Y ADMINISTRATIVE EXCEPTIONS: TOTAL PERMIT FEES: $ 50.00 0 D This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable taws. All work will be done in accordance with approved plans A sign permit shall expire 90 days from approval date A temporary sign shall expire 30 days from approval date. A balloon sign Ghall expire 10 rlavc frnm annrnval riatP �n APPROVED BY: PERMITTEE IIAA,_-ll ` — 1'ERMITTEE SIGNATURE: ��—�-�---€� DATE: 03/09/2000 ELECTRICAL PERMIT- CITY OF TI GARD RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT#: ELR2000-00020 13125 SW Hall Blvd.,Tiqard, OR 97223 (503) 639-4171 DATE ISSUED: 01/20/2000 SITE ADDRESS: 1455 SW 68TH AVE PARCEL: 2S101AA-08200 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT: 029 JURISDICTION: TIG Proiect Description: Installation of a date telecommunication system. 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: Contractor: J - . ROTH, JR DIVERSE COMMUNICATIONS 12600 SW 72ND 544 N 14TH ST' SUITE 200 ST HELENS, OR 97051 TIGARD, OR 97223 Phone: Phone: 503-366-1131 Reg #: LIC 135996 ELE 5-46CLE FEES Required Inspections Type By Date Amount Receipt Low Voltage Inspection PRMT GFO 01/20/200( $60.00 00-321276 Elect'I Final 5PCT GF_O 01/20/200C $4.80 00-321276 Total $64.80 ORIGINAL This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and a!I 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 issuanc,, 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 fofth in OAR 952-001-0010 through OAR 2-001-0080. You may obtain copies of these rules or direct questions to O7 -, t(503) R 246-1987 ( 1 Issued by L � G Permittee Signature OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale. lease, or rent. m LO OWNER'S SIGNATURE: DATE: J CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N ,� Zw- _ _ DATE: LICENSE NO: Call 639-41'i 5 by 7:00 P.M. for an inspu�tiurr needed the next business day CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by: 13125 SOV HALL BLVD Date Recd: TIGARD OR 97223 PRINT OR TYPE V - 503-639-4171 X304 Permit#:kq� `C'003Z6 F - 503-598-1960 INCOMPLETE OR ILLEGIBLE APPLICATIONS Cust.Cail'd:_ _ WILL NOT BE ACCEPTED Name of Development Project TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Restricted Energy Fee........................................ $60.00 (FOR ALL SYSTEMS) ,JOB Street Address Ste# _ Check Type of Work Involved: ADDRESS % � �_� '7(fJ �Jee City/StateZi Phone# ❑ Audio and Stereo Systems Name ❑ Burglar Alarm / EE ❑ Garage Door Opener' OWNER Mailing Address Ciate Zip Phone #rHaating,Ventilation and Air Conditioning System' 11 D JC Z?i 7.2 / / ❑ Vacuum Systems' Name 1.�/i2�25 (anr��,rJr[��,oA1S ��ie,uy ❑ Other CONTRACTOR Mailing Address 5 10 �'� S�. TYPE OF WORK INVOLVED -COMMERCIAL ONLY (Prior to issuance a City/Slate Zi Phone# Fee for each system............................................. $60.00 copy of all licenses S/: 14.!:ICF,.)-( ; 70 57/ 6 I J?I (SEE OAR 918-260-260) are required if Oregon Contr.Bird Lic.# Exp.Date J�[ expired in C.O.T. /35-1176 o7-O •p i Check Type of Work Involved: data base) Electrical CnMr.Lic.# Exp.Datc. S•- < /o-01•va Audio and Stereo Systems C.O.T.or Metro Lic.# Exp.Date /5?;2 /.2-31-40 a ❑ Boiler Controls Owner's Name clod<Systems OWNER - Maili ig Address APPLICANT [Z Data Telecommunication Installation City/State Zip Phone# Fi,a Alarm Installation This permit Is issued under CAE 918-320-370.This applicant agrees to make only restricted energy installations(100 volt amps or less)under this ❑ HVAC permit and to do the following: ❑ Instrumentation 1 Only use electric3l;1ccnsed pera)ns to do installations where required. Certain residential and other transactions are exempt from licensing. ❑ intercom and Paging Systems These have asterisks('). All others need licensing; 2. Call for inspections when installation under this permit are ready for F-1 Landscape Irrigation Control" inspection at 503,639-4176,- ❑ Medical 3 Purchase separate permits for all installations that are not ready for an �❑ Nurse Cells inspection when the Inspector is out to inspect under this permit; 4. Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting' inspector ere done.and; � ❑ Protective Signaling 11 5 Assume responsibility for calling for a final inspection when all of the r� L11 corrections are completed. u Other �- Permits are non-transferable and non-refundable and expire if work is not started within 180 days of Issuance or if work Is suspended for 180 days. Numher of Systems m The person si g for this permit mint be the 8ppli nt or a person No licenses are required Licenses are required for all other installations Q0 authorized nd the applica FEES: ignature- - _ ENT FEES if SURCHARGE(45 X TOTAL ABOVE) S Authority It other than Applicant TOTAL f i WsWformsvesele doc 3/00 CELECTRICAL PERMIT CITY O� T I�A R D PERMIT#: ELC2000-00022 DEVELOPMENT SERVICES DATE ISSUED: 01/13/2000 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S101AA-08200 SITE ADDRESS: 12455 SW 68TH AVE SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT : 029 JURISDICTION: TIG Proiect Description: Install 20 branch circuits in existing commercial building. RESIDENTIAL UNIT _ TEMP SRVCIFEEDERS _ MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMI 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 SRVC OR FDR: 1 PER HOUR: 401 - 600 amp EA ADD'L BRNCH CIRC: 19 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION _ 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL: RAconnect only: _ SVC/FDR >=225 AMPS: _ CLASS AREA/SPEC UCC: Owner: Contractor: MCGEE WILSONVILLE ELECTRIC INC 12455 SW 68TH PO BOX 845 TIGARD, OR 97223 WILSONVIL.LE., OR 97070 Phone: Phone: 638-5353 Reg #• SUP 38545 ORIGINAL LIC 00075752 FLE 3-3037C FEES _ Required Inspections Type By Date Amount Receipt Elect'I Service PRIVET KJP 01/13/200C $139.15 00-32.1124 Elect'I Final 5PCT KJP 01/13/200C $11.13 00.321124 Total $150.28 This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR Specialty Codes and all other applicable la4vs. All work will be done in accordance with approved plans This permit will expire if work is no'started within 180 days of issuance,or if work is suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adop:ed 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 ord,ec.t questions to OUNC at(503) ;., 246-1987 n. PERMITTEE'S SIGNATURE ISSUED BY: a— OWNER INSTALLATION ONLY J The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _ _ DATE: J —_ CONTRACTOR INSTALLATION SIGNATURE OF SUPR ELEC'N: c'r� `"N7a^� � �- DATE: / 3 C LICENSE NO: .5PyY s ---------- Call 639-4175 by 7:OOpm for an inspection the next business day C*Y OF TIGARD Electrical Permit Application Plan Check# 13125 SW HALL BLVD. Recd By TIGARD OR 97223 Date Recd Date to P.E. Phone(503)639-4171, x304 Date to DST_ Inspection (503)639-4175 Print of Type Permit# ELS ' 0 OUxi Fax(503) 598-1960 Incomplete or illegible will not be accepted Called _ 1. Job Address: 4. Complete Fee Schedule Below: Name of Development _ _� Number of Inspections per permit allowed Name(or name of business) C1 SDEN,,�e�,�J,,w� Service includes): Items Cost Sum Address /OZ q-S`,j- 3:a s-d 4a. Resi6ential-per unit 1000 sq.ft.or less $ 117,75 4 City/State/Zip `T/ C. 1� (7� Each additional 500 sq.ft.or ponion thereof $ 2.6.75 1 Commercial Residential ❑ Limited Energy _ $ 60.00 Each Manufd Home or Modular 2a. Contractor installation Only: Dwelling Service or Feeder $ 7:..75 rPrior to pennit issuance,applicants must provide contractor license 4b.Services or Feeders information for COT data base). Installation,alteration,or relocation Electrical Contractor t '1 t +,.3J a! =ter 200 amps or less $ 64.25 Address S-S 201 amps to 400 amps $ 85.50 401 amps to 600 amps $ 128.50 City 1<<ra.�_•_. .Mate- V ZI 1 Q")D 601 amps to 1000 amps $ 192.50 Phone No. G y 4 Over 1000 amps or volts $ 36375 - t Job No. Reconnect only _ $ 53.50 Elec. Cant. Lice. No. Exp.Da 4c.Temporary services or Feeders OR State CCB Reg. No..'7 Exp ate R Installation,alteration,or relocation COT Business Tax or Metra N Ex . ate C 200 amps or less $ 53.50 /r- 201 amps to 400 amps $ 80.25 401 amps to 600 amps $ 100.00 2 Signature of Sup Elec' - Over 600 amps to 1000 volts, see"b"above, License No. Exp.Date �� 4d.Branch Circuits Phone No. -3 J 3 New,alteration or extension per panel a)The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Print Owner's Name Each branch circuit $ 5.35 _ 2 Address b)The fee for blanch circuits without purchase of.Rervice City_ State_ Zip or feeder fee. Phone No. First branch circuit $ 37.50 Each additional branch circuit $ 5.35 The installation is being made on property I own which is not 4o.Miscellaneous intended fcr sale, lease or rent. (Service or feeder not Included) Each pump or Irrigation circle $ 42.75 Owner's Signature Each sign or outline lighting $ 42.75 Signal circult(s)or a limited energy if required):* panel,alteration or extension $ 60.00 3. Plan Review section Minor Labels(10) E 100.00 �a Please check appropriate item and enter fee in sectic-, 5B. 4f.Each additional Inspection over CL _ _4 or more residential units in one structure the allowable In any of the above Ln Service and feeder 225 amps or more Per inspection $ 50.00 ` --- - Per hour $ 50.00 _ > __System over 600 volts nominal In Plant $ 5900 Classified area or structure containing special occupancy as described in N E C Chapter 5 5. Fees: 02 5a.Enter total of above fees $ /3-1 /S Submit 2 sets of plans with application where any of the above apply. 8%Surcharge(.08 X total fees) $ J-4t1! Not required for temporary construction services. Subtotal $ 6b.Enter 2546 of line 6a for NOTICE Plan Review if required(Sec 3) PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtr $ 15 NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ T1ust Account# AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ ;F I:\dsts\forms\electric doc CITYOF T I G A R D CERTIFICATE OF OCCUPANCY DEVELOPMENT SERVICES PERMIT#: BUP2000-00003 DATE ISSUED: 01/05/2000 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S1 C'1 AA- AA-08200 ZONING: MUE JURISDICTION: TIG SITE ADDRESS: 12455 SW 68TH AVE FILE SUBDIVISION: WEST PORTLAND HEIGHTS BLOCK: LOT:029 CLASS OF WORK: ALT TYPE OF USE: COM TYPE OF CONSTR: 5N OCCUPANCY GRP: B OCCUPANCY LOAD: 39 TENANT NAME: MCGEE FINANCIAL STRATEGIES REMARKS: Commercial TI - Final Building Inspection and Certificate of Occupancy Approved 2/28/00 by Tom Plescher, Building Inspector Owner: J.T. ROTrI 12600 SW 72ND AVE #200 TIGARD, OR 97223 Phone: Contractor: _ TIMOTHY JOHN HAYFORD DBE, HAYFORD CONSRUCTION 7320 SW FROG POND LANE WIAgw.V 3jPd%2V8070-6726 Reg#: LIC '132505 q Ln J This Certificate 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 Specia!ty,Codes for a roup, occupancy, and use and r which the eferenced permit was issu�dd / ((�l / GL �UV(�C BUILDING INSPECTOR BUILDING -FICIAL POST IN CONSPICUOUS PLACE CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 � — BUPilrl�C"�-Cl1CY� Da!e RequestedAM, PM —� BLD Location ( ,� J S l C� 7`'` �. _ Suite MICLCO ''JGG- Contact Person :1_i ✓�� Ph �� (� - ��d _ CLM)'2f-jb0 -()0(-)1 Contrc:,tor Ph SWR IUILDI G Tenant/Owner ELC Retaining W& MLR _ Footing Access: Foundation =PS Fig Drain 5GN Crawl Drain Inspection Notes:Slab SIT Post&Beam , Ext Sheath/Shear Int Shea (g /Shear Framinmin Insulation Drywall Nailinq Firewall Fire Sprinkler _ Fire Alarm Susp'd Ceiling _. Roof Misc fin PART FAIL - -- —_-_ B , PostSB&m -Under Slab Slab Top Out Water Service Sanitary Sewer -V- - — Rain Drains FAIL Post& Beam - - -- -- -- Rough In Gas Line - - ------ — Smoke Dampers 16%, PART FAIL 'fMTRICAI. --------- -- -- -- - — - Service Rough In -- UG/Slab a Low Voltage Q; Fire Alarm > Final PASS PART FAIL SITE Backfill/Grading L' 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 [ J Please call for reinspection RE: _ _ __ __ [ ] Unable to inspect no access ADA -Z J - Approach/Sidewalk nate 7 Inspector `_ Ext Other - --- - ----- Final PASS PARI FAIL J DO NOT REMOVE this Inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour I,:ispection Line: 639-4175 Business Line: 639-4171 BLIP _ Date Requested_ )_AM PM SLD Location_ Suite MEC Contact Person Ph " C PLM Contractor IIS I1 %C=� Ph ��-�� d _ SNR BUILDING Tenant/Owner _ ��E Retaining Wall R' Footing Access: Foundation ,�J�-se_ err,+,..,_, , FPS Ftg Drain Z I c4-c,i-i,,e,J ,- SGN Crawl Drain Inspectior. `totes: , ,� Slab IT Post&Beam rr)) Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall _ �J Fire Sprinkler �� l�l� UG'O ZC� Fire Alarm Susp'd Ceiling Rovf Misc: Final PASS PART FAIL PLUMBING �— �� -- - Post 8 Beam Under Slab Top Out - - - Water Service -- ' ------ ---- Sanitary Sewer - Rain Drains Final ------ ---.—�. PASS PART FAIL MECHANICAL - --------- -- -- Post& BeamRough In In Gas Line - ------ --- Smoke Dampers Final - --- ----- PASS PART FAIL Service Puugh In a UG/Slab 2 Low Voltage Fire Alarm > Fir _AS PART FAIL Itn Boc',fill/Grading — LLr Sanitary S,awer -� Storm Drain [ Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Please call for reinspection RE: Fire Supply Line [ p _; _ J[ J Unable to Inspect-no access ADA - �-L Approach/Sidewalk Date �102-rV1-00-0 _ Other Inspector — , — — — Ext sinal PASS PART FAIL DO NOT REMOVE this inspection record from the job site. 1' ELECTRICAL PERMIT- CITY OF T I G A R D \ RESTRICTED ENERGY "\\\ DEVELOPMENT SERVICES PERMIT#: ELR2000-00037 13125 SW Hall Blvd.,Tiqard, OR 97223 (503) 639-4171 DATE ISSUED: 2./16/00 SITE ADDRESS: 12455 SW 68TH AVE PARCEL: 2S101AA-08200 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT: 029 JURISDICTION: TIG Proiect Description:Add protective signaling. A.RESIDENTIAL B.COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GAkAG OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS- VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: HVAC: PROTECTIVE SIGNAL.: X INSTRUMENTATION: OTHER: _ _TOTAL#OF SYSTEMS: 1 Owner: Contractor: CHUCK MCGEE FIRST RESPONSE SYSTEMS GROUP 12455 SW 68TH AVE 4647 SW HUBER ST TIGARD, OR 97223 PORTLAND, OR 97219 Phone: Phone: 244-5996 Reg#: LIC 001'1713 ELE 26-956CL _ FEES Required Inspections Type By Date _ Amount Receipt Low Voltage inspection FRMT GEO 2/16/00 $60.00 00 321743 Elect'I Final 5PCT GEO 2/16/00 $4.80 00-321743 Total $64.80 ORIGINAL 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 th5ough OAR 952-0?)-0080. You may obtain copies of these rules ar direct questions to OUNC at (503) a 246-1987. E� rL Issted Ny % ' �� Permittee Signature N j ( ` OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale. lease, or rent. m OWNER'S SIGNATURE: _ DATE: LL7 CONTRACTOR INSTALLATION ONLY _ SIGNATURE OF SUPR. ELEC'N _ ---1�� rt DATE: p2 LICENSE NO: Call 619-4175 by 7:00 P.M. for an inspection needed the next business day 02, 113. 00 N'ED 11:01 FAX 503 244 9076 FIRST REPONSE PDX01002 CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLI EETW VED Recd by: 13125 SWIHALL BLVD Date Rec'd: TIG.L�RD OR 97223 PRINT OR—, YPE FEB 16 Paan -- V - 503-6394171 X304 Permit 4:5�9Rc w ' -3 F - 503-684-7297 INCOMPLETI'. OR ILLEGIBLE APPLiWMSW60E'.'ELOPMENtust.Call'd:_ W111-1-NOT BE ACCEPTED Name of Dev,;Iopmt;nt Protect TYPE OF WORK INVOLVED -RESIDENTIAL ONLY —� (FORRestricted LL SYSTEnergy Fee................. ^Y ...................... $4o.0o (FOR ALL SYSTEMS) ,JOB Stn:el Address Ste# ADDRESS S" �,f 6B�ti � Check Type of Work Involved � Z� L3.(/ tate Phone a Audio and Stereo Systems _ � NN U. l/ ❑ Burglar Alarm ( ❑ Garage Door Opener" OWNE=R Mailinc i,ddres& { =--- ❑ City/State Zip Heating.Ventilation and Air Conditioning System' Phone# Namo ❑ Vacuum Systems` ►.I L. J r�.1 �/�� LiOther allin Add CONTRACTORMS TYPE OF WORK INVOLVED-COMMERCIAL ONLY (P-ioi to issuance a Phone# Fee for each system.............................................. $40.00 copy of all licenses (SEE OAR 918-250-260) are required if Oregon Coalr, Pr,;Llc.# Exp. Date expired in C.0 1. ?r IS,A5—G Check Type of Work'nvolv;d: data base) J ctrtC�I Cootr ic.,� Exp. Date ,K-ci7 — �� /O--d/- ❑ Audio and Stereo Systems CA°E 1r Metra I-1- c'#— Exp Dlite Boil--r Controls C#riot's Name _ Clock Systems OWNER - Mailing Address APPLICANT ❑ Data Telecommunication Installation City/State Zip Phone# L_, lJ Fira Alarm Installation This permit is 155LJed under OAE 918-320-370 This sppl rant agrees to ^ make arly restricted energy installations(100 volt amps less)under this HVAC permit and to do the following: ❑ Instnumentalinn 1 Only use eler_trical licensed persons to do installations where required- Certain residential anc other transactions are exempt from licensing. ❑ Intercom and Paging Systems �\ These have asterisi:•r("). All others need licensing; ❑ Landscape Irrigation Control* 2 Call for Inspections v l)en installation under this permit are ready for inspection at 503-A1,4175; ❑ Medical 3. Purchase separate permits for all installations that are not ready for an Nurse Cells unspectOn When the inspector is out to inspect under lhls permit; 4. Assume responslhillty fnr asst ring that all corrections required by the ❑ Outdoor Landscape Lighting' inspector are,done, and; Protective Signaling 5 Assume responsibility for calling for a final;ndpection when all of the — cunections are completed Q Other Permits are non transferable and non-refundable and expire if work Is not Marled within 1 R0 dav'of issua a or if work Is suspended for 180 days. _ Number cf Systems J The person signlnq for th's ermit ust be the applicant or a person No tlrrnses are required. Licenses are required for all othor, inatallaLune authorize to bind the appl' nt. �— J w�_�'� FE'S gnature ENTER FEESci S 5";, SURCHARGE(.05 X T01 AL ABOVE) 5 v O Auth ity if other tharf Applicant TOTAL S Zoel FfO ims:avesele.doc 7197 CITYOF TIGARD _ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2000-00017 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 01/27/2000 SITE ADDRESS: 12455 SW 68TH AVE PARCEL: 2S101AA-08200 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT: 029 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 3 OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing for tenant improvements. Instail new water heater, laundry box, & one (1) new lay. Relocate two (1) existing lays. No change to current EDU count. SWR2000-00016) Owner: — - Type By Date FEESAmount Receipt JUDITH MCGF_E PRMT KJP 01/27/200C $57.50 00-321446 4900 SVS! MEADOWS RD 5PCT KJP 01/27/2000 $4.60 00-321446 LAKE OSWEGO, OR 97223 _ Total $62.10 Phone 1: 503-697-42.00 Conti actor: ELITE PLUMBING INC 6023 SE NEHALEN STREET PORTLAND, OR 97206 REQUIRr:D INSPECTIONS Phone 1: 503-788-4746 Rough-in Insp Reg #: LIC 135077 Misc. Inspection PLM 26-673PB Final Inspection ORIGINAL This permit is issued subject to the regulations contained in the 1 igard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved pans. This permit will expire if work is not started within 180 days of issuance, or if WoiK Is suspended for more than 180 days. ATTENTION Oregon law requires you tc follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain co ie of these rules or direct questions to OUNC by calling (503)l 246-1987. Issued By h,- _ M. Permittee Signature. Call (503) 639-4175 by 7.00 1 .M for an inspection n de a nex slness day o►, 'Vu on TllF 09:05 FAX 503 598 1960 c_ I'I'1 OF TIGARD r000l ITY OF TIGARD Plumbing Permit Application Plan Checks 3125 SW HALL BLVD. C.ornmercial and Residential Recd By_,Q IGARD, OR 97223 Date Recd 5039 639-4171 Date to P E. _ Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit# �n►ao�— � Related SWR ir,�Qm-ew_4 Called /-a _—_ AXE c�•l) //:.?�A•f Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job ��/1 �;,� �,�,,� S� Sink 11.50 Address Stivet ddress �t.� Suite _— Lavatory 3 11.50 / Tub or Tub/Shower Comb. 11.50 Bldg# Cr 1Stale Lpc `Z j Shower Only 11.50 _ _ n OR >7 --- - - -. Piame�` Water Closel 11.50 Urinal -- -1150 Owner . al Ing Address yy1I (� Sults. Dishwasher T 11 5U QQ SaJ McGt,L�;e C) Garbage Disposal -- 11 50 I State O Zipti CI 7 Phone Laundry Trey 11.50 /12 --- - arae Washing Marh!nelLaundry Tray I 1150 S _ Floor Drain/Floor Sink 2' 11 50 Occupant Mailing Address Suite 3- � 11.50 CHyl5tale Zip e - 4' --- 1150 Phon Water Heater O conversion C i'an kind ( 11 50 --- — Gasi ing roquires a separate mech,nical permit Name .._ - -- C I1 Lv /fir N L MFG Home New Waler:iervlce_--- - 32.00 t4alling Address i1rEr MFG Horne New San/Storm Sewer 32.00 Contractor a: Hose Bibs 11.50 AL3 SE /JCI��{'•�1` Prior to permitIIy/S le //1 Do Ph �< or� Roof Drains _-- 11.50 Issuance.a copy �� T 1c_ E 7 IL (v 78 L' —1— rklnklny Fountain 11.50 of aP licenses am Oregon Const.Cont.Board Lic.# F p Dale -- required If .3,5 o 7 7 �J . _U I Other Fixtures(Specify) 15.00 expired in COT Plumbing L is# Exp.Dale database �)-14, 7 P -- Name - - - Architect Sewer- 1st 100' 38.00 Or (•lalling Address Suite —_ Sewer-nodi additional 100' 3200 1x1 - Engineer City/Slate Zip Phone Water Service-1st 100' 38._ Water Servirr-each additional 200' 32 00 5nscribe work to be done: - Storm 6 Rain Drain-+st 100' 38.00 New O Repair O Replace with like kind Yes O Nu O Storm R Rain Drain-each additional 100' 3200 Resiriential O Commercial ---- - Commercial Back Flow Prevention Device 32.00 Additional description of work Residential Bar,Mllow,Prevention Device' 19,00 Catrh Rasin 11.50 Are you capping,trying or replacing any fixtures? Insp.of Existing Plumbing w Specially Requested 5000 - Yes \ No O Inspections _ —per/hr If yes,see back of form to Indicate word. performed by Rain Dram,single family lwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps it 50 — WORK COULD RESULT IN INCREASED SEWER FEES. --- QUANTITY TOTAL v t hereby o0nowledgn that I have read[his application that the informalton g,ven is correct.that I am the owner or authorized agent of the owner,and I Isooricrk or neer diagram Is required It ouanlily Total Is ,s 'SUBTOTAL that plans su ed are In compliance with Oregon Stato Laws. Sig ra61O nerlAgentDate t><7ylr r+rn�f t S _ 8%SURCHARGE — ta t Pers n N --� Phone C q L Ik�' "PLAN REVIEW 25%OF SUBTOTAL BAHOUSE=178.00 Required only N GKtureet 1o1a1 is-9 — i TOTAL — `�Bre HOUSE 12150.00 SA TN HOUSE$288,00 --- r?lrls fee Includes all plumbing RxlurtM�1R ttla tfind� I -Minimum permit fee is 150 ax surcharge,"cept Residential Parhlk+w Prevention - 60 My sanFEa swat storm atsW�t•i`� Jil1i -.:Sl'-'.. '1gftt9Y .,.. .. r�I'�... .. r�;',rJ l:-vlrY whvir h 125#0'f�sirchsrpe —All Now Commercial Buildings rim-ft mane with lswneirk or riser diagram and plsn re new ►tdusVo.mr *+ar+r+da 1111119199 01 Zo, uo THU 09:06 FAX Sus 598 1960 c.ITI OF TIGARD Z out P�.EASE COMPLETE: Fixture 'Type Quantity by :Nark Performed ' - Now Movod Replaced Removed/Capped Sink _ Lavatory _ 2- Tub or Tub/Shower Combination _ Shower Only Water Closet _ Urinal _ Dishwasher _ Garbage Disposal _ T Laundry Room Tray Washing Machine _ Floor Drain/Floor Sink 2" 411 Water Heater _ Other Fixtures (Specify) _ COMMENTS REGARDING ABOVE: /y 0 t j 6 (1 3� CS I I " /f� `d I�,�C'h) L�tv�i p12� 0)e ---- L'N r. c0 Li) J l�r�lunww•a.e»nwo Accumulative Sewer Tally Tenant Name:Lll-i�EEai /!N{- This SWR#o'0M -00" Add,ess: /;ZYf-Y SCJ G __ This PLM# 000 — (5QQ1? Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New # Value Capped oft value added# edded #s to!al Court off#s count valt!e values Baptistry/Font 4 Bath -Tub/Shower 4 _ -Jacuzzi/Whirlpool _ Car Wash- Each Stall 6 - Drive Through16 _ CuspidoNWater Aspirator 1 _ _Dishwasher-Commercial _4 _ Domestic 2 Drinking Fountain 1 Eyt Wash 1 _Floor Drain/sink-2 inch 2 3 inch _ 5 4 inch 6 -Car Wash Drn 6 Garbage Disposal 16 - Domestic(to 3/4 HP) _ -Commercial(to 5 HP) 32 -Industrial (over 5 HP) 48 _.• _ _ Ice Machine/Refrigerator Drains 1 _Oil Sep(Gas Station) 6 Re(..Vehicle Dump Station_ 16 Shower- Gang (Per Head) 1 -Stall 2 Sink -Bar/Lavatory 2 Bradley 5 Commercial 3 Servi.;e 3 Swimming Pool Filter 1 Washer- Clothes 6 _Water Extractor _ 6 _ Water Closet -Toilet 6 _ Urinal 6 TOTALS i -- Total fixture values: /` _ divided by 16 L / EDU F B r Crd (t u e41I.-,,Q �IlA17 . HISTORY' PLM #_! EDU#_/ SWR# PLM# EDU_# SWR# PLM# EDU# SWR# PLM# _ EDU# SWR# _ EDU# ~SWR# PLM# EDU# SWR#� PLM# EDU# SWR# PLM# EDU# SWR# r\dststswrtaly doc CITYOF T I GA R D MECHANICAL PERMIT z' DEVELOPMENT SERVICES PERMIT#: MEC2000-00027 DATE ISSUED: 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2 2S101 AA-SI01AA- 08200 SITE ADDRESS: 12455 SW 68TH AVE .;UBDIVISION: WEST PJRTLAND HEIGHTS ZONING: MILE BLOCK: LOT: 029 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: _FUEL TYPES 0 - 3 HP: DOMES. INCIN: 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 -50 HF': WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: _ AIR HANDLING UNITS OTHER UNITS: 1 FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Install gas insert and gas piping Owner: FEES _ JUDITH MCGEE Type By Date Amount Receipt 4900 SW MEADOWS RD PRMT KJP 01/24/20( $,',J.00 00-321340 LAKE OSWEGO, OR 97223 5PCT KJP 01/24/20( $4.00 00-321340 Phone:503-697-4200 Total $54.00 — Contractor: JAY'S G 4S PIPING 11525 GkV CANYON BEAVE R ON, OR 97005 REQUIRED INSPECTIONS Gas Line Insp Phone:626-4652 Mechanical Insp Reg #:LIC 0119836 Final Inspection ORIGNAL R" F- N H �w This permit is issued subject to the regulations contained in the Tigard Munir•inE;i Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended J for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obta' o ie� of these rules or direct questions to OUNC by„calling (5Q 46 189. Issue By: Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for inspections need d t e n x business day Plan Check# CITY OF TIGARD Mechanical Permit Application Recd By _ 13125 SW HALL BLVD. Commercial and Residential Date Recd TIGARD, OR 97223 Date to P.E. — (503) 639-4171, x304 ��t ��"1� Date to DST__ Print or Type Permit#/ll (- 2"S-0c017 Incomplete or illegible applications will not be accepted Called Name of Development/Project Description Table 1A Mechanical Code Qty Price Amt Job Street Address Suite# A) Permit Fee `;= '<. 16.00 Address 2 yS"S�S�✓ �Q8 1) Furnace to cis& 0 BTU _ including ducts 8 vents see footnote 1,2 9.65 Bldg# City/State Zip 2) Furnace 100,000 BTU+ On including ducts&vents see footnote 1,2 12.00 Name(or name of business) 3) Floor Furnace Ownerly,a� includin vent see footnote 1,2 9.65 M.m 161ailing Address 4) Suspended heater,wall heater or flour mounted heater see footnote 1,2 9.65 _ ?D 9"IA4 5) Vent not included in appliance permit 4.75 City/Stale Zip Phone Check all that apply: 'Boiler Heat Air Lio-t J 9 4-f7 412, For Items 6-10,see or Pump Cond Qty Price Amt Nalme(or name of business) footnotes 1,2 Comp 6)e3HP;absorb unit to _ 100K BTU _ 9.65 Occupant Mailing Address 7)3-15 HP,absorb unit 100k to 500k BTU _ 1765 City/Stale Zip Phone 8) 15-30 HP,absorb ' unit.5-1 mil BTU 24.15 9)30-50 HP;absorb Contractor dfne 19 unit 1-1.75 mil BTU 3600 f-� 10)>5TP,absorb unit Prior to permit Mailing Address j, "> .3(r 'S"i (L 1 > 60.15 issuance,a copy 1 Z0 �� `+J O�1or Air handling unit to 10,000 CFN, of all licenses City/Slate Zip ??Phone 7.00 are required if U/l/-- d) �s24y 12)Air handling unit 10,000 CFM+ expires in COT Oregon Const Cont Board Lic# Fitp-9ate _ 11.85 database__ _-� D.� `�y - 2 13)Non portable evaporate cooler Architect Name // 1-2,q. u I _ 700 14)Vent fan connected to a single duct ---- or Mailing Addr cs - -- -- 15)Ventilation system not included In 4,75 appliance permit _ 7.00 Engineer City/State Zip Phone 16)Hood served by mechanical exhaust _ 7.00 Describe work to be done 17)Domestic incinerators _ 1200. New? Repair O Replace with like kind Yes O No O 18)Commercial or industrial type incinerator Resid4ntial O Commercial 48.25 19)Repair units Additional information or description of work _" _ 8.40 7.0)Nood stove/gas FP/other units/clothe dryer/etc. 7.00 NOTE: For Commercial projects only,Units over-'•00 lbs require 21)Gas piping one to four outlets structural gas talcs See footnote 1 _ _ I 3.75 7. Type of fuel oil O natural gas OD LPG O electric O 22)More than 4-per outlet(each) 75 Minimum Permit Fee$50.00 SUBTOTAL I hereby acknowledge that I have read this application,that the information 8%SURCHARGE V) - given is correct,that I am the owner or authorized agent of PLAN REVIEW 25%OF SUBTOTAL the owner,that;dans submitted are in compliance with Oregon State laws Required for ALL commercial permits onl J TOTAL c� Siynature of Owner/Agent Datc - --- -- — - Other Inspections and Fees: i 1 Inspections outside of normal business hours(mininum charge-two Contact Pe Nam Phone — hours) $50.00 per hour 2. Inspections for whit h no fee Is specifically Indicated (minimum 7 g U charge-half hour) $50.00 per hour t~ note fdr commercial projects only: �— 3. Additional plan review required by changes,additions or revisions to /1 Provide full schematic of existing and proposed gas line an pressure plans(minimum charge-one-half hour)$50.00 per hour 2 Provide drawings to scale showing existing and proposed mechanical units ..Residential Contractor Boiler Certification required — -- - "Residential A/C requires site plan showing placement of unit 1 lmechperm doc rev 7/1999 -- BUILDING PERMIT CITY OF TICARD PERMIT#: BUP2000-00003 DEVELOPMENT SERVICES DATE ISSUED: 01/05/2000 13125 SW !-fall Blvd.,Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S101AA-08200 SITE ADDRESS: 12455 SW 68TH AVE SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MITE BLOCK: LOT: 029 JURISDICTION: TIG REISSUE: _ FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ALT FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf _ PROJECT OPENINGS? TYPE OF CONST: 5N 4,500 sf N: S: E: W: OCCUPANCY GRP: B TOTAL AREA: sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 39 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: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 10,500.00 Remarks: Commercial TI Owner: Contractor: JUDITH MCCEE TIMOTHY JOHN HAYFORD CHUCK DEFOE P13A ,dAYFDRD CONSRUCrION 499000 SWMEADOWS gRD STE100 7320 SW F��R�OFG POND LANE Pl�oneS 5 t�J7�42007223 W on V503 :� 5ZJ8070�726 ORIGINAL Reg#: LIC 132505 FEES REQUIRED INSPECTIONS Type By Date Amount Receipt Framing Insp PRMT KJP 01/05/200C $133.25 00-320931 Gyp Board Insp Susp Ceiing Insp PLCK KJP 01/05/200C $86.61 00-320931 Final Inspection 5PCT KJP 01/05/200C $10.66 00-320931 FIRE KJP 01/05/2000 $53.30 00-320931 Total $283.82 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. n_ 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 952-001-19f37. You may obtain a copy of these rules or direct qL -stions to OUNC by calling (503) 246-1987. J Pe rm itee -� Signature: Issued By: Call 639-4175 by 7 p.m, for an inspection the next business day Ct T Y OP TIGARD C c)mmercial Building Permit Application Plan Check# 13125 SW HALL BLVD. New Construction and Additions Recd By Date Recd_ TIGARD, OR 97223 Date to P.E. (5103) 639-4171 Date to DS� -7 Print or Type Permit# %,42ow- Lvav„3 Incomplete or illegible applicaticns will not be accepters Related SWR#__�_ Called Name of Deve(opment/Project Job 11 f' , l e Existing Building New Building Address Street Address Suite ;)Ll 5. S W U'116' Building Bldg# City/State zip Data Existing Use of Building or Property: Name �u Jen en a,t D Property �' �� c 11 Proposed Use of Buildin r rooert Owner Mailing Address Suite ro P 9 / _ y 51tyle �Ptleod 67 &e' City/State zip Phone No. Of Stories: D uJT�1-y Z Occupant Name Sq. Ft. Of Project.- Name roject:Name Q Occupancy Class(es) Contractor 1 -/"2-j/�llcJ/a/� F c;r•� F� - 3cn� i Prior to permit Mailing Address suite Type(s)of Construction issuance,a copy /13�p Sul j�6 PdN of all licenses L/j �— are required if City/State zip Phone ST)� Wili this project have a Fire Suppression Sy tem? expired!-,C.O.T. yt/fISLti✓t1k y la i�' S�9 Yes [) No database 3i 9- — Americans with Disabilities Act(ADA) —� J Oregon Const.Cont.Board Lic.# Exp.Date � i3��J-• ��, /F-.0 Valuation X 25% = $. Participation �� Complete Accessi ility Form_ _ l,Q Namc Project $ 4r� Architect Valuation Jr�, Melling Address Suite Plans Required: See Matrix for number of sets to submit City/Slate. --- till Phone on back LL Engineer NameI hereby acknowledge that I have read this application,that the information given is correct,tht.t I am the o•Hner or authorized agent of the owner,and Mailmq ,�luir ss Suite that plans submitted are in compliance with Oregon State Laws Signature of Owner/Agent Date City/State Zr) Phone Contact Person Nams Fri mm---- Indicate type of work. New O Addition O Demolition �/ L Accessory Stricture O Foundation Only O Alteration 6l/ Repair o other o FOR OFFICE USE ONLY Descrlpt{on of work: fJ�mOv� p,n .5 ftW rE [4,A�f klap/TL# ~� Land Use. r�eW40rulsf, .c/ter Rei Ppf .M a -� wa,lin d- A-14► PILia Notes! Parks: Est!mated 0 of 5mployeas Ti{- If the above figure is not supplied at the time of application,the city will calculate the lee based upon the number of parking Note: Site Work Permit Application must precede or accompany Building i'ermlt Application I\dstsUormstcomnew doc 5/10199 COMMERCIAL. PLAN SUBMITTAL REQUIREMENT MATRIX Plan Review 1s dependent upon submittal of BOTH plans AND a COMPLETED application. For an electrical submittal, the application must contain the signature of the supervising electriJan before plan review will be conducted. After plan review approval, Plans Examiner will contact the applicant to request additional plan sets for distribution purposes. (Copy for Contractor, City, Washington County, Tualatin Valley -ire & Rescue) Total # of TYPE OF SUBMITTAL Plans KEY: Submitted S (Private) 1 S = Site Work B (New or Add) 1 B = Building F (New or Add or Alt) 3 F = Fire Protection System M (New or Add or Alt) 1 M = Mechanical B & M (New or Add) 1 P = Plumbing P (New, Add, or Alt) 2 E = Electrical B & M & P (New or Add) 2 New = New Building —E--(Ne—w,-Add, or Alt) 2 Add = Addition B & F & M & P & E 3 Alt - Alternation to Existing (New , Add) _ _ Building *13 or B & M (Alt) 1 "B & M & P (Alt) 3 .B & MRP & E(Alt) 3W *�3 & M & P & E & F(Alt) —3� G. i' NOTES: "Shaded areas designate ALT submittals only. 1Adsts\forms\matrxcom doc 10130/98 SUBJECT: ACCESSIBILITY BARRIER REMOVAL IMPROVEMENT PLAN REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241. (1) Every project for renovation,alteration or modification to affected buildings and related facilities shall be made to insure that the path of travel to the altered area and the restrooni, telephones end drinking fountains are readily accessible to individuals witi,disabilities unless such alterations are disproportionate to the overall alterations in terms of cost and scope. (2) Alterations made to the path of travel to an altered area may be deemed disproportionate to the overall alteration when the cost exceeds twenty-five per-cent(25%). VALUATION of all renovation, alteration or modification being done excluding painting, wallpapering. (1]$ /QFsDU multiply: 25% Barrier removal requirement. .25 BUDGET FOR BARRIER REMOVAL [2]$ (41 oG In choosing which accessible elements to provide under this section, priority shall be given to those elements that will provide the greatest access. Elements shall be provided in the following order: (a) Parking $ — (b) An accessible entrance: $ — (c) An accessible mute to the altered area: $ lr (d) At least one accessible restroom for $ each sex or a single unisex restroom: (e) Accessible telephones: $ (f) Accessible drinking fountains: and $ _ V) (g) When possible, additional accessible elements such as storage and alarms $ — 111 TOTAL: Shall equal line_2 of Value Computation_ $_ i\dsls\forms\access doc OVER-THE-COUNTER (OTC) PERMIT PLAN REVIEW COMMERCIAL (STRUCTURAL) BUILDING PERMIT CHECKLIST DESCRIPTION OF PROJECT: CLASS OF WORK: I K f FLOOR AREAS: A EXTERIOR WALL CONSTRUCTION TYPE OF��SE: FIRST SQ. FT. N: E: W; TYPE OF CONSTR: � SECOND SQ. FT. PROTECT OPENINGS?. OCCUPANCY GRP:_ THIRD SQ. FT. N: S: E: W:___ OCCUPANCY LOAD: -� TOTAL SQ. FT. ROOF CONSTR: FIRE RET: STOR: HT: FT: BSMNT. SQ. F,r. AREA SEP. RATED: BSMNT?. MEZZ?: GARAGE SQ. FT. OCCU.SEP.RATED: FIRE FIRE SMOKE HANDICAP SPRINKLER: ALARM: _ DETECTOR: ACCESS: COMMERCIAL INSPECTION ACTIONS FEE MENU —� Foot/Found Post/Beam $ Permit Fee Masonry r m n� $ gE l_ Plan Review Insulation Shear Wall $ /C 6,16 8% State Surcharge Firewall _Gyp 80=_ $_w�� FLS Plan Review __(Suspended Ceilime Sprinkler Rough-in $ Add'I Perm'.i Fee 1 Sprinkler Final Fire Alarm $_ Add'I FLE Pln N Smoke Detector Approach/Sidewalk $ inspection Miscellaneous Final $ _MIS Fee -' FOR OFFICE USE ONLY: TYPE OS USE OPTIONS(COM=commercial; CMS-=commemial mi'LI actured structure) CLASS OF WORK OPTIONS FOR ALL PERMITS(NEW=new• Add=addition;ALT=alteration;ACS=accessory;FND-koundation; OTR=other,DEM=demolition; REP=repair; FPS-fire p otruion system, NOTE: USE OTR FOR FENCES, RETAINING WALLS, DETACHED DECKS, SIGNS, AWN'NGS, CANOPIES) I\ovrcntr2 doc (DST) 9/99 L C qj V)O T> N-2 C O 7 C O C O Q 2 N O N C C N O 0 � 0mE Ef° m- N O O O d cb V) ; T m 0,0-0 C a C Z 2 O O O N a N - m 7 d QNLn LO i C)i 00)) 0) m m Q) QOi OOi 0) cp QOi Qui m OOi N a s a s am inN a (D U N a o o CN CN CN N a a a a N « T LL LL LL Q a Cn a a a a a a a a a 10 T- _ _ J W J I J J J m C> J J J 1 G F �_ d O >y =J r � fn V) (n n a V) m a V) fn V) (n (n W fn V) V) fn w O. 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N N a ro U � a O 10 C N N •� O V d ro O 1 X n J a 8 Ll N J n .a q uN F U a - '0 m co y a C o U O 00 o o Ln 00 N Q 'C v 0 0 0 3 N O N C O O_ N N N N r a O Z � U) ccDD uo Ln N (1 QOi Q� �2 S cn N Ca l� r N C a y a s T i am o a �d o d =J ti Oa w 0 w w 0 O ^ m a a a a a O cn a a d- 0 a a a N � � O m w LLLo a 0 a o m M Co C0 0 �C a"en p) U a o d a "' a �«- o a a a� N V Q _ 61 A Q R �-r J � O OC N N O_ m O Na Q C N N C � y u LL VI C f9 N N Q a (A LL LL C.1 O O O O1 O C, O d d h 00 O 0:) N s Q m m Q Q m t h t t t: IV Q (f) N V7 N in N N d O Z ED LO 0 QI M Com') M Q m 61 0S7 a a 10 T Cr) LLCL D vd o � =J r Q a En U) V) /) V) A N Q Q Q Q I a s a a a a In T L!1 Co a o a 0 cn `' m °' v *k c o - � NF o N a �, v mLo � 0 a L (D N N •� 0 V Q � N n_ v; - > c —r LL ap Ly C O NN G_ Q U U U T N O 11 G) N 4Ni n c ; 10 m V) r.� ,nn (n a LL LL C) 0 0_0 co ao (V 6 0 o a o fr Ir of Of a � V) V) o.v (r— Com,✓�� CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Lir,.j: 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL: Foundation Water Line Ceiling umb Post/Beam Mach. Shear/Sheath Framing Feh Plbg.Und/Flr/Slab Plbg. TLp Out Insulation Post/Beam Struct. Mech. Rcugh-in Gyp. Bd. an. Sewer Gas Jne Appr/Sdwlk r Reins. Other: Date: _ A.M,_P.M. Entry: Address: K '*i� Tenant:_ _ Ste: MST: BU Con/Own: !- 'D �T— MEC: PLM: ELC: _ THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: v J Inspector: Date: ��DISAPPROVED/CALL FOR REINSP. CF CO CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL: Foundation Water Line Ceiling -Plumb. Post/Beam Mech. Shear/Sheath Framing -Mech. Plbg.Und/Fir/Slab Plbg. Top Out Insulation �. Post/Beam Struct, Ivtech. Rough-in Gyp. Bd. -Bldg. San. Sewer Gas Line Appr/Sdwlk Other: _ Date: _ l U G_� A.M. P.M. Entry: Address: S 5 Tenant: Ste: MST: _ 2 e BUP: �n/Owr� _L�-�-C�2� MEC: PLM: ELC: THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: ` I —r rJ Inspector. ( c �r _I � Date: '�U 2 APPROVEI��E�ISAPPROVED/CALL FOR REINSP. C / Co Z CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4176 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL: Foundation Water Line Ceiling -Plumb. Post/Bearn Mech. Shear/Sheath Framing -Meeh. Plbg.Und/Flr/Slab Plbg. Top Out Insulation -Elect. Post/Beam Struct. Mech. Rough-in Gyp. Bd. Bldg. San, Sewer Gas Line Appr/Sdwlk Reins. Other- — -- -- --- --- bate: ._ G A.M. P.M. Ent Address: �_— Tenant: -- —_ --- __ Ste: _ MST: BUP. -_ — Con/Own: . — _ _ MEC: PLM: ELC: THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR L/7 J Ci f . LL' Inspector: . — Deter _ AP ED —DISAPPROVED/CALL FOR REINSP. CF CO CITY OF TIGARD DEVELOPMENT SERVICES 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 CERT If=ICATE OF OCCUPANCY PERMIT )t. . . . . . . : BUP950401 DATE Ici5UED: 06/ t1)/96 PFMCEL: 21;1q11Af1--08200 ITE ADDR17-ca-) 1i''455 SW F_.CATH AVE UBDIVISION. WEST PORTLAND HEIGHTS ?ONINGoC-P kj_OCK. . . . . . . . . . s LOI.. . . . . . . . . . . . . 429 I_ASS OF WORD. :NEW YPE OF USD:. . . :COM YPF OF CONS I Rt 5V 1 'CUr C DANCY GRP. r BE !CCUIPANCY U)Ar.s 1-NONT mmr.. . . pom or'F710E BUILDING ,;,marks : New 48,20 sq. ft. siviqle ztary buildinq �,mers -,*-,.------------------ ------ -------------.- -----.- RUTH JR i'I9 SW CHARLESTON 14ARD UR 97224 ione tt : 590-0139 011tractov.-I ' . 1. ROTH CONE:TRUCTIDN INC ....540 SW 68TIA PARKWAY I I 60RD OR 17223 1:11one 0 - 639-2639 keg 081-4970 1his Certificate prantb. uccupanc•y of thp Ahnve referenced bi.qi1ding or portion thereof and (zonfirms that the building ho-n bpen inspected fat- rompljAnce with oe SI a* e of Orclon Spe"Ity I:odv - for thp group, �ccIrrparncy, mv,d Lisp under Ilich this reference iv'Ait was issued. _L61XF F I C.I AL M:J IN CONSP (61JOLIF PLACE' LL� ELECTRICAL F,ERislIT DTI S :cCITY OF TIGARD AE ISUD02/22/9 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,Oregon 97223.8199 1503)830-4171 PARCEL: 2 S 101 AA-0821["1111 I'iL°L'i•.1._a-. . . . i--,-�, -vV L'•i.. I Ii HSC !JI'D I V I S I ON. . . . : WEST F,ORT•LAND HEIGHTS ZONING-C--P, _UirK. . . . . . . . . . . . L.0 T. . . . . . . . . . . . . : =3 00,ject Descr-iption: Install one service or- 1 eecier, to 4001 amps and 40 branch .it .:LAits. RESIDENTIAL UNIT--.--.__ .._..__-TE W SRVC:/1=CEDERS.__.._.._ ----- 11I5CELLANE EUS - 000 SF OR LESS. . . . : 0 0 - 200 ramp. . . . . . . : 0 F'UMF'/IRRIGATION. . . . : 141 :iLH AUDI L '_J00SF. . . : 0 2'01 '— 400 amp. . . . . . . : 0 SIGN/OUT LINE: LTG. . : 0 iI„iITE:D ENERGY'. . . . . : 0 401 — 6110 amp. . . . . . . : 0 SIGNAL/FIANE:L. . . . . . . : 1b i�;\ % HII/ ,QVC/FDR. . : 0 b01 - amps-•11201Z1 volts. : 0 il:INOit LABEL ( 10) . . . a 0 _—SERVICE:/FE`zE:DER—.____ ------BRANCH CIRCUITS—••----- ---_.ADD' L INSF,E_CTIONS_._. -- 200 ;,imp. . . » ., 0 W/i',ERVICE OR FEI=DGR: 40 PIER INSPECTION. . . . . : 0 .il -- 4001 amp. . . . . . . 1 1st W/0 5RVC OR FDR. : 0 PIER HOUR. . . . . . . . . . . . 0 i; C,00 amp. . . . . . . 0 EA ADDI I_ BRNC14 CIRC : 41 IN P,I_ANT. . . . . . . . . . .. : 1i1 111 — 1000 amp. . . . . : 0 RLViEW SLGTICiN•--- 'Ii+Il.1� amp/vol'.. . . . . : V, ) 4 RLS UNITS. . . . . . . . : > 600 VOLT NO11INAL... . t econnect only. . . . . : 0 SVC/FDR > = 225 AIhF,S. . : CLASS AREA/SK,EC: OCC. : IC HAEL DE=NTON type amount by date r-ecpt 3 0 X 1790 PRMT 11 ,e130, 00 CJS 02/1;22/916, 96•--27619 PLCK $ 7121. 00 CJS 0.2/x!2/96 96-•-,E7619� t= ('5WE:60 0R ) 70,35 5PICT $ 14. 00 G.J:� IcN2 L/9G 1)6-2'79191, ane #: AR [-.L E CT R I C 4 364. 00 TOTAL J BOX 389 .3085 BUTT•EVJLLE RD NC _- _ -- REQUIRED INSF'ECT:IONS - - .— )Ni1LD OR 4x7020 Ceiling Cover Llec':' 1 Service lulie #; Wall t:over^ Elrct' 1 Final cl ,is permit is iss;,ea subject tc the regulations contained in the Tigard Municipal Code. State of Ore. Specialty Codes and all other E'1erm i t t p e Si.gnat .Ire applicable laws. All work will be dine it accordance with approved plans. This permit will expire if work is not started 160 days 0 issuance, or if work is suspended for more ti,an LEl6days. Issued BV ___.._.. I N STALL-IST I ON 0NI_`f”._.-.._..._.__ .1 he irista:l lat ion is being made on property :I own which is not intended For o :;ales i.ease, ar rEznL. R. �WI�IErFt' S IUNATUHL: _ _ _ _. UE47E: __. .. .._.... . .. .... CONTWILTUR INSTALLOTION :_ EJNAT UF4E OF SU; P. C.L_l C:' N: /.n4l jc�cs/ __.. DATE: 2.- 2 2 m NSL NCI: Call far, inspection -- 639--4175 Community Development ELECTRICAL PERMIT APPLICATION 13125 SVV Hall Blvd Tigard, OR 97223 Permit # &696-00/3 _ Date Issued Phone (503) 639-4171 CITY OF TIGARD FAX (503) 684-7297 TDD No. (503) 684-2772 Inspection (503) 639-4175 1. .yob Address: 4. Complete Fee Schedule Below: Name of Development MCK/ UFF/1-E bl-R& • — Number of Inspections per permit allowed Address_/ Z Y5,5 W A09 VE. Service included Items Cost(ea) Sum r:ity/State/7_ip_rL&,d/V,, 0A_ 9I2Z-L 4a. Residential -per unit 1000 sq. ft.or less $11000 Name (or name of business) .7T R°Trt (..Ont 5-• _ Each additional 500 sci ft or portion thereof $2500 _ Commercial Residential C� IlmtedEnergy -_- $2500 _ 1 Each Manurd Home or Modular Dwelling Service or Feeder $6000 2 2a. Contractor installation on1w: 4b. Services or Feeders Installation,alteration,or relocation Electrical Contractor_H61 C-I r/liC? ZA2G• 200 amps or less $6000 2 Address__ P. BoX 201 amps to 400 amps �_ $8000 v,r,v 2 ._ a �D State D R Zi 70 2 401 amps to 600 amps $120 00 2 City.-—per p� 0-- 601 amps to 1000 amps $160.00 2 Phone Nc.__&lf-/3 SS Over 1000 amps or volts $34000 _ 2 Job NO Reconnect only $5000 2 contractor's license NO._ 2�/ -/07� — 4c. Temporary Services or Feeders Contractor's Board Reg No. x.09/2 Installation,alteration,or relocation Signature of Supr Elec'n X /-'1.r n --s y r. r�G — 200 amps or less V License No. /6�5 _ _ Phone No. lo7B"i3 SS _ 201 amps to 400 amps $5000 a 401 amps to 300 amps $7500 Over 600 amps to 1000 volts $10000 — — 2b. For owner installations: see"b"above . 4d. Branch Circuits Print Owner's Name_ _ New,alteration or extension per pane Address a)The fee for branch circuits with Cit State Zi purchase or service or Nader 1104.y� 2 City --- p Each branch circuit $5 U0 �U. p Phone No. b)The fee for branch circuits without The installation is being made on property I own which is purchase of service or feeder fee.F.rs1 not intended for sale, lease or rent. Each branch nalcirbr $$500 5 00 Each additional bran�.h circuit SS 00 Owner's Signature_ 4e. Miscellaneous (Service or feeder not included) I 3. Plan Review section (if required): Each pump or irrigation circle ,_ $40 00 _ 2 Each sign or outline lighting $4000 Signal circud(s)or a limited energy 2 Plerlse check appropriate (tern and enter fee in section 5B. panel,alteration or extension __ $40 00 4 or ;pore residential units In one structure Minor labels(10) _ $10000 Service and feeder 225 amps or more System over 600 volts nominal 4f. Each additional Inspection over Classified area or structure containing special occupancy the allowable In any of the above F— Per inspection $3500 v: as described in N.E.C. Chapter 5 Por t,n„r $5500 .. in plant $5500 Submit 2 sets of plans with application where any of the above _ apply. Not rertuired for temporary construction services. 5. Fees: 5a. Enter total of above fees $ NOTICE 5%Surcharge (05 X total fees) $ PERMITS BECOME VOIn !r WORK OR CONSTRUCTION Subtotal $ AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter evi of line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec 3) $ 7� do A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ o� COMMENCED. Trust Account 0 X M^xGe Balance Due $ -3 y. a WURK CITY OF TIGARD . ERMI f F�ERI�f I T #. . . . . . . SI T95--•004-; COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 1;R/10/95 13125 SW Hall Blvd.Tigard,Dragon 07223.8190 (503)838-4171 PARCEL: 2'S 101 AA-08200 WDDRL;=S. . . . 1L-_'455 SW 68TH AVE: 3UPD I V I S I ON. . . . : WEST V'ORTLAND HE I GHTS ZONING: C-P (3LOCFI. . . . . . . . . . LOT. . . . . . . . . . . . . :c TYPE OF WORK: NEW (=SAV I NG?. . . . . . . . . : Y RESO. NO. GXCV VOLUME: 171 cv GRADING?. . . . . . . . : Y VALUE. . . L : 49300 PILL VOLUME: 171 Cy LANDS(--AF'1 I\IG'?. . . . : Y LNG FILL?. . . . . . . N SITE PREF'?. . . . . . s Y 30IL.S RPT PEOD) .- hi STORM DRAINS?. . . : Y IMPERV SURFACE: 1283j' sf emarl�s : new 41320 sq. ft. SinPle Stor-y hi.lildinrl site w()r^k 1wner,: -_._.___.____._-_._.___._._.______ f=EES J ROTIi JR tyre aino1_(nh, by date i-ecPt 1 ,::3779 SW CHARLESTON SWM $ 486. 00 JSD 12/15/95 95-273978 SWM $ 874. 80 JSD 12/15/95 95-2:7,:397a I(IARD OR 972iR4 F'FtM'T $ 283- 00 JSD 12/15/95 95--273978 htlne #: 590•-0139 13F'CT 1, 14. 15 JSD 12'/1 5/95 9`3--2.7:3()713 PL..CK $ 183. 95 JSD I2'/15/95 95-2739-178 ?nti-actor: -_ _ ___._._ __ __.____---____-.-.CROS 4 130. 00 JSD 1 '/15/95 95--2:739711 J. T. ROTH CONSTRUCTION INC ERPC $ 26. 00 JSD 12/15/95 95-273976 r--:RPS; 1 2:0. 00 JSD 1?/15/(35 93--2.73971" 1��';a4O 5W 013TH PARKWAY T.I.GARD OR 972:23 ['1-i on e #: 621'926,31') $ 1973. 90 TOTAL_ 3,1700 ---- --- REQUIRED INSPECTIONS This peroit is issued subject to the regulations rontainen in the Erasion Control T:oard Municipal Code. State of Ore. Specialty Codes and all other e ,r,adinq InsP _ aml:. .31e laws. All work will be done in accordance with St rm Drain I n s p approved plans. This pewit will expire if work is not started Reinfor-ced cnnc,r � � �-- within 100 days of issuance, or if work is suspended for more Final. InsFec_ticin than 181, days. --- — - i:r•m 1 t t e e -- Call for ins;.rection - 639--4175 M' Ln J .-w cm C� I1) —j Commercial Building Permit Application City.of Tigard 13125 SW Hall Blvd. V Tigard, OR 97223 r (503) 639-4171 Jobsite Address: Tenant: Suite# Office Use Only Valuation: GI d Planck/Rec # Permit # C i d Owner: _=j J / — — Map & TL #�- Address: Approvals Required - Planning F lone Engineering — Other Contractor: Address: _ �,,,(1 _ 7- 2-- Type of const: ' Occupancy class: _ Phone: Sprinklered? Yes No Contractor's License # _ (attach copy of current Oregon license) Sq. ft. of project: Contact name & phone. — Story (1st, 2nd, etc.) Proposed use. Architect/Engineer: Previous use: _ Address Note Plumbing & mechanical r,ians must be submitted at tine of building permit applicat un. N Phone. -J JOB DESCRIPTION o� J Applicant Signature & Phone number Received by — Date Received: Permit# Account Description Amount Amt. Pd. Bal. Due+ Bldg. Permit (BUILD) ) Plumb. Permit (PLUMB) Mech. Permit (MECH) State Tax (TAX) i Bldg: Plumb: Mech: Plan Check (PLANCK) Bldg: Plumb: Mech: Sewer Connection (SWUSA) Sewer Inspection (SW'NSP) _ Parks Dev Charge (PKSDC) Residential TIF (TIF-R) Mass Transit TIF (TIF-MT) _ Commercial TIF (TIF-C) _ Industrial TIF (TIF-1) _ Institutional TIF (TIF-IS) Office TIF (TIF-0) pv ✓ Water Quality (WQUAL) _ !�_` V Water Quantity (WQUANT) 11 i Fire Life Safety (FLS) Erosion Cntrl Permit (ERPRMT) J Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN) C L TOTALS: / BUILDING PIERM(71' T #. . . . . . : DUP1 CITY OF TIGARD DAJEIDERMIISSUED: . 12/1zJ/9595-0401 COMMUNITY DEVELOPMENT DEPARTMENT IDARCEL: 2S101AA0B200 13125 SW Hall Blvd.I lgard,Oregon 9722398199 (503)539-4171 68TH F4VF. ZONING:C—P ,UDDIVISION. . . . WF ST PORTLAND HEIGHTS '.LOCK-. LOT'. . . . . . . . . . . :29 REISSUE: FLOOR EXT'ERIOR WALL CONSTRUCTION 4820 sf N; E: W: ,LASS OF WORK. :NEW FIRST. . . . . YPE OF USE. . . :COM S1.C 0 N D. . . ID S F FROTECT OPENINGS? 0 sf N: S: E: W: P, PE OF CONST. :5N ROOF CONST- FIRE RET? : 1CCUPnNCY GRP. nB2 TO TAA-- 4 8,::Q, s'F JCCUPANCY LOAD: 5 BASEMENT, : 0 s f AREA S)EP. Pr)TED: -�TOR. : 0 1 iT: 0 ft GARAGE=. . . : 0 s f OCCU SEP. RATED: iISMT'' .-N MEZZ" :N FREUD SETBACKS-------'--- :'LOOR LOAD. . . . : 0 1-,)s f LEFT: 0 ft RGHT: 0 ft F I R SPKL..1\1 SMOV, DCT. . :N DWELLING UNI'-S: it I-Fj N11 : 0 ft REAR: 0 ft FIR 0LRM:N HNDICP ACC*I:y 0F.-DR11S. 0 _2 PIRO rORR:N PARKING: lzi PATHS: 0 IMP, SURFACE`: 12 3 32 VAI-UE. $ : 2.19E+32 f4p `0 story mark s : new 48a sq. (t. single stoy . building Dwner- EES F J ROTH JR type aMOUnt by date recpt 13,779 '133W CHARLESTON $ x=93. :='0 JSD 10/02/95 95--270632 ` FIRE $ 476. 45 JSD 10/02/95 95-270632 I-IGARD OR 97224 1-,1 R MT $ 7 33. 00 JSD 12115/')3 955-273977 l::Ihclne 5 PC T $ 36. 65 JSD 12/15/95' 95-273977 EROS $ 8800 , jc;-D 1;7..,/15/9!75 95-2732)7'7 I ("'cintractor: E RPC $ 28. 60 JSD 12/15/95 95-$273977 J. T'. ROTH C.",ONSTRUCTION JNC ERPC $ 8. 60 ,J!-:jT) 1.2/15/95 95-273977 ti`540 SW 60-ri-A PARKWAY VIGAND OR 97223 16f..14. 50 TOTAL I.-_"hone 4*: #. . : 31700 REDUIRED INSPECTIONS Ilervit is issued subject to the regulations contained in the post/Beam Insp 7ioard Minicioal Code, State of Ore. Specialty Codes and all other jyjasoT-jry Insp applicable laws. All work will be done in accor.l.mce with Framing Insrj aoDroyed olans. This perpit will txpire if work is nog started Insl_klaticm Insp within IN days of issuance, or if 000rk s s,isoended for tort Shear Wall. Insp Van IN days. Gyp Board Insp .______-- sp Ceilnq Insp Appr-,';;dwll( Insp Misr. Insner-tion i'ermitteeFinal Inspection rL, I F,S I.A e d b Y e TI _j Call for inspection _. 639 -4175 LO ELECTRICAL PERMIT CITY OF T I OARD PERMIT #: ELC95--0651 'COMMUNITY DEVELOPMENT DEPARTMENT DATE" ISSUED: 12/22/95 13125 SW Hall Blvd,T'nord,Or*gan 97223*8igg (503)630-4171 '3ITIL' 124'Lj'_':)' SW 68TH AYFE. 3LJBLj I Y I Q I ON. . . . : WEST PORTLAND HEIGHTS ZONING:C--p DLOCK. . . . . . . . . . : LOT, . . . . . . . . . . . . 29 Llt,oject Descv-3.ption: Tempoi-ar-y service - - RESIDENTIAL UNIT----- ----TEMP SRVC/FEEDERS----- -------MISCELLANEOUS-------- , 000 Sr OR LF,737). . . . : 0 0 - 200 .-_-kmp. . . . . . . : 1 PUMP/TPRIGATION. . . V, "ACH ADD' f_ 500SF. . . : 0 201 - 400 amp. . . . . . . : 0 S I GN/C'JIT L I NE L.TG. 0 LIMITED ENERGY. . . . . : it! 401 -- 600 amp. . . . . . . : 0 9 1 G N r4 L/PA N E L.. . . . . . . .. 0 YIANF. HM/ SVC/FDR. . : 0 &01+amps.--112100 volts. : 0 MINOR LABEL ( 10) . . . : 0 S E R V I C E/F E E D E R CIRCUITS---- ---- -ADL)' L I1qGr'ECTIONS---- Lti - 20171 amp. . . . . . 0 W/SERVICE OR FEEDER: 0 PER TNSPECTION. . . . . - 0 17.11 400 ,amp. . . . . . . 0 1st 1410 spc or PDR. : 0 PI-R HOUR. . . . . . . . . . . . Vj 04)1 GOO amp. . . . . . .. 0 EA ADD' L BRNCH CIRC- 0 IN PLANT. . . . . . . . . . . . 0 10 1 1000 amc). . . . . . 0 REVIEW SECTION--• ----..._.--------.-.-__ 101710+ ECTION----------------- 101710+ alllp/volt. . . . . : 0 ) =4 RE'S UNITS. . . . . . . . . ) 600 VOLT NOMINAL. . ; i2e(7onnect on] v. . . . . : 0 SVC/FDR > = 225 AMPS. . : CLASS AREA/SPEC OCC. : (*Jwnev-- FEE,. r BOTH JR t,/D(a a m()I.t n t by date recpt '71779 SW CHARLEEJON 17ORMT 50. 00 JSD 12/22/95 95-274222 SPICT 3 50 Y'31) 12/G:,?/95 95-274222.' I CARD 0 R :17,::.='4 !-,hone 4: 590--0:139 f�'ont�-autor-: }EAR ELECTRIC $ 52. 50 TOTAL. . ,Lj BOX 389 REOUI RED INSPECTIONS I)ONALE, (DR 970c-.,0 Elvc:t9 I Sei—ic.-e 'hone C .- Flect, I Final 'his oervit is issued subiect to the regula�ions contained in the -illard Municipal Code, State of Ore. Specialty Codes and all Sthpr 4� t t eteii E4t1atLtr,e 'oDlicable laws. All work will be done in accordance with 4oaroved plans. This permit gill Exoire if work is rat started ,,ithin 180 days of issLance, or if wol' is susnended fir more ,han .180 days. I�, .� I.,�:d P y _._..___.._..__._____._.______..__.__OWNER I N5TOLLAT I ON ONLY.-----, he installation is being made on proper-ty I own vihich is not intended for ale, leasp, of rent. IWNEP? S SIGNATURE: DnTF : TNS)TAL1.nTTON I GNATURE OF SUPR. Fl_EC1 N DATE: ICENGE NO: U) Call for inspection 639--.4175 Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. Tigard, OR 97223 Planck/Rec. # _ Permit # C= — D / Phone (503) 639-4171 Date Issued c CITY OF TIGARD FAX (503) 684-7297 Issued by TDD No. (503) 684-2772 Inspection (503) 639-4175 1. Job Address: ,'// 4. Complete Fee Schedule Below: Name of Development Al"W 016KI 6UU-Pliy6 Number of Inspections per permit allowed Address 12 q5 5- 54,v l g f1'✓E _ _ Service included. Items Cost(ea) Sum City/State/Zip -r/Lsi!`t4 elzc&,N 91223 4a. Residential-per unit 4 �/ 1000 sq II or lean $11000 - Name (or name of business) /4_ T"N -"n/ rcu",IV Each additional 500 sq II or 1 portion thereof $2500 Commercial Residential ❑ Limited Energy $2500 Each Manurd Home or Modular 2 Dwelling Service or Feeder $88 00 2a. Contractor installation only: 4b.Services or Feeders Electrical Contractor—�E �l-F�t/l r G �/1/ — nat00all"aon,or letwn,or relocation 2 / �"' 200 amps or lees $80 00 �/ t7 201 amps to 400 amps $8000 2 Address I ,d OX V/ 401 amps to 800 amps $12000 2 City DONALD Stato O _ Zlp_�O� 801 amps to 1000 amps $18000 2 Phone No. 61 7b,—/SSS Over 1000 amps or volts $34000 2 � Contractor's License Nr,.__ ,? /U'G Reconnect only $5000 Contractor's Board Reg. No.. 4c.Temporary Services or Feeders Installation,alteration,or relocation 2 Signature of Supr. Elec' 200 amps or lass _L $50 00 $o,Oy 2 License No. Z 7 7 5 Phon o. 201 amps to 400 amps $7500 2 401 amps to 800 amps $10000 Over 800 amps to 1n0o volts 2b. For owner installations: see W above 4d. Branch Circuits Print Owner's Name New,alleralion or extension per panel Address a)The lea for branch cirruds with purchase of asrvke or leader Pre. 2 City State Zip Each branch circuit $500 Phone No. b)The fee for branch circuits without The installation is being made on property I own which is purchase of son ke or leader lee. 2 not intended for sale, lease or rent. Vint branch circuit $1500 2 Each additional branch circuit $500 Owner's Signature — 4e. Miscellaneous (:.'grvice or feeder not included) 2 3. Plan Review section (if required). Each pump or Irrigation circle S40 00 _ 2 Each sign or outline lighting $4000 Signal cucu'(s)or a hmded energy 2 Please check appropriate item and enter fee in section 5B. panel after ttron or eutension $e0 00 _ 4 or more residential units in one structure Minor;.abate('0) $10000 Service anJ feedar 225 amps or mo-o System over 600 vnits nominal 4f. Each additional inspection over Classified area or structure containing special occupancy the allowable in any of the above as described in N E C Chapter 5 rias "'nn $3500 _ F tier holo -_ $55 00 V1^I'la'�l $55 00 Submit 2 sets of plane with application where any of the above —' j apply. Not required for temporary construction services. 5. Fees: J NOTICE 5a. Enter total of above fees $ 50, 01) E9 5%Surcharge(05 X total fees) $ .Z. 3-0 PERMITS BECOME VOID IF WORK OR CONSTRUCTION Su $ 2, p t-� AUTHORIZED IS NOT COMMENCED W'THIN 180 DAYS, OR IF Sb. Enteeroral r 25/0 line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Fleview if squired(Sec 3) $ X A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ COMMENCED ❑ Trust Account 1M $ X Balance Due s 45). 3-0 Commercial Building Permit Application df Tigard ,w( 13125-SW Hall Blvd, Tn to 2A1( Tigard, OR 97223 (503) 539-4171 Jobsite Address: �`- V>-?C_S 5&;t� Office Use Only Tenant: Suite# Valuation: oZJ j 1 Planck/Rec # Permit# S n Owner: / Map & TL t' _ Address: �3�i f i/✓ �� f�r�-. �j/t� Approvals Required /� Planning �7 Phone: )V �%�I – Engineering `7 95 _ Other 011 Contractor: Address: Type of const:4✓0W),1q?X 1Y Occupancy class: Phone: 3//�v Sprinklered? Yes 5 Contractor's License # //v _ (attach copy of current Oregon license) Sq. ft. of project: LO j,- Contact name & phone: � �^ —1. 7 Story (f st, 2nd, etc.) � Proposed use: � Arch ltectlEng1ne9r: W,� ► L ,,t� Previous use: d.9�... ►1' _ Address 3 r , 2 _ Note: Plumbing & mechanical plans must be submitted at time of building permit application. Phone: 7— JOB JOB DESCRIPTION: ��✓� C- ��1rl� n(��_ `_ LO Applicant"Sqynature & Phone number Received by: - Date Received: l Permit # Account Description Amount Amt. Pd. Bal. Due Af5eVcBldg. Permit (BUILD) ;" > 3 _ :2 Plumb. Permit (PLUMB) Mech. Permit (MECH) _ State Tax (TAX) i_= Bldg: Plumb: Mech: Plan Check (PLANCK) Bldg: Plumb: Mec h: c'' J� �� ✓�'�� Sewer Connection (SWUSA) ^r z 2L D Sewer Inspection (SWINSP) 1 _ Lj�I Parks Dev Charge (PKSDC) _ Residential TIF (TIF-R) Mass Transit TIF (TIF-MT) Commercial TIF (TIF-C) Industrial TIF (TIF-1) % Institutional TIF (TIF-IS) 1 Office TIF (TIF-0) Water Quality (WOUAL) _ Water Quantity (WOUANT) 2 Fire Life Safety (FLS) y Erosion Cntrl Permit (ERPRMT) � p a Gv ✓ Erosion Planc!:"JSA (ERPLAN) 0z J Erosion Planck/COT (EROSN) -74(o°� �� TOTALS: r'ENt PERM 1 P"7T #. CITY OF TICARD DATEWIIST-)UE* D* ": " "It'2/15/9 5 95-041 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639.4171 PARCEL.: 25101AA-08ZO0 il- i-IDWRE6: o)— iL'4'1jr5 '.-?W 6,61H I*WE SUBDIVISION. . . . WEST PORTLAND HEIGHTS ZONING: C-P IAI-OCK. . . . . . . . . . L-OT. . . . . . . . . . . . . 219 TENANT NAME:. . . . . : ROTH OFFICE BUIL-DING USA NLS. . . . . . . . . . . FIXTURE UNITS. . . . 17 CLASS OF WOR1-1,. . . :NEW DWF.'L,I-I NG UN I TS. . I ryF-,E OF' USE. . . . . .COM NO. OF BUILDINGS: 0 TI\113"[*Al-..L TYPE.:,. . . . :13USWR IMr-"F-I?V SURFACE: 14 f Remarks : New 48211 sq. ft. office building Owner- FEES J ROTH JR type amount by date reept 1-3779 SW CHARLESTON PRMT t `100. 00 J S D 12/15'/()15 9 a-1'7,3977 T NqP $ 45. 00 JSD 12/15/95 95--273977 1 1 OARD OR 9722,� Phone #: 590-0139 Contractor: CONTRACTOR 1\101' ON rIf-E Phone #: f 2,1145. 00 TOTAL. Reg -------- REQUIRED INSPLILTIONS This Applicant agrees to casolv with all the rules and regulations Sewer Inspectinn of the Unified Sewage Agency. The nersit exioires 180 days from the date issued. The total amount paid wall be forfeited if the jermit exoires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the oeastirement civen, the installer shall Prosoect 3 feet in all directions ft-cm the distance given. If not so located, the installer shall purchase .i "Tao and Side Serer" Permit and the Aaencv will install a lateral. ! lei-mittee Si ec �__ _ - /i -� -__�___ _ ____._ ___ ___ __._ _--. D y for" ti specl,t i on 6.-.'i9-'4175 Lr' CITY OF TIGARD MECHANICAL P I:':-R M I'I- COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : MEC95-0337 I 13125 SW Hall Blvd.Tigard,Or*gon 9722398199 (503)639-4171 DATE ISSUED: 1,-/15/975 PARCEL : 25101 AA-08200 SITE ADDRESS— : 1P455 SW 68TH AVE F)UBD.L V I S I 01\1. . . . : WEST PORTLOND HEIGHTS ZONING: C-P . . . . . . . . . . : Lo-r. . . . . . . . . . . . . ...c) CLASS OF WORK. . :NEW FLOOR FURN. . . . : 0 EVAP COOLERS: 0 TYPE OF USE. . . . :COM UNIT HEATERS. . : 0 VE14T FANS. . . : 2 OCCUPANCY GRP. . :132 VENT5 W/O APDL_.: 0 VENT SYSTEMS: 0 STORIES. . . . . . . . : .1 BOILEFRS/COMPRESSORE� H017ID5. . . . . . . . 0 FIJEL TYPES---------------- 0-3 HP. . . . - '23 DOMES. INCIN: t",) : ,/GAS/ 3-15 HP. . . . : 0 COMML. INC IN: 0 MAX INPUT: is LAT U 153 Q) HP. . . . : 0 REPAIR UNITS: 0 P .1 RE DAMPERS?. . : N 30-50 HP. . : 0 WOODS"I'OVES. . : 0 GAS PRESSURE...: In 50+ HP. . . . : 171 CLO DRYERS— : 0 NO. OF UNITS----------- AIR HANDLING UNITS OTHER UNITS. : 0 FURN ( 100K BTU: 13 (= 10000 cfin : 171 GAS OUTI ET5. : I FURN )=100K BTU: 0 > IIZIO041 efrit : 0 Rern,arks : (_ qrier-: FEES J ROTH JR type --A M 0 1.1 n t by dAi,p t-ecpt 13779 SW CHARLESTON PRMT $ 54. 00 JSD 12/15/95 95-273977 PILCI-11 $ 13. 550 0 ,T(-:)D 1 /15/`5 `?5_-2_7397/ T IGARD OR 97224 5PICT $ 2. 70 JSD 12/15/95 95--27397-1, Phone #: 7590-01139 Colltractor-.. TRI COUNTY TC*MP CONTrRoL 13651 BE AMBLER RD CLACKAMAS OR 97015 Phone 777.-3874 OR '70. 20 TOTAL REQUIRED INSPECTIONS This pe�,mit is issued subiect to the reculations contained in }he Gi-, Line Iisp Ticard Municipal Code, State of Ore. Specialty Codes and all other Meehan ic7al Ins;r) applicable laws. All work will be done in accordance with Heating Unt IT-isp auoroved plans. This oermit wi 4oire if oor;, is not started Cooling Unt Irisp within IN days rf istuance, or work is susop0ed for more Dl,tc-t Inspertieri 180 days. Misc. lrispectiuti Final Irispecticin V) . 4 .1 S s 1.1 e(j BV Call fc)v- inspection 639-4175 INK Gity of Tigard MECHANICAL PERMIT Planck/Rec. 13125 SW Hall Blvd. APPL_ICATI i < Permit # 141C c -0-33 i Tigard, OR 97223 (503) 639-4171 l` ) ^» estopion Table 3A Mechanical Code CITY PRICE AMT ,lob «• / � � �_ 1) Permit Fee -0- -0- 10.00 Address •• 2) Supplemental Permit 3.00 � •«�" urnace to 100,000 BTUJ ��n•'f j Jf! 1) incl. ducts &vents 6.00 f ••� Furnace 100,000 BTU + Owner �>%/%• 5�/ (�`1 "4l T 2) incl. ducts &vents T •t% Floor Furnance 3) incl. vent 6.00 m•Im n•m•• «•I Suspended heater, wail heater 4) or floor mounted heater 6.00 • • ••• om;. Vent not incl. In Occupant 5) appliance permit 3.00 •• ZIP Repair of heating, re ng. 6) cooling, absorption unit 6.00 offer or comp, heat pump, air cond, 7) to 3 HP; absorp unit to 100K BTU f 6.00 ' /761 .. •• of er or comp, ,eat pump, air con . 8) 3-15 HP; absorp unit to 500K BTU 11.00 Contractor o Railer or comp, heat pump, air con . 9) 15-30 HP; absorp unit .5-1 mil BTU 15.00 ••R.Ow• Boiler or comp, eat pump, air cond. //.?ham ,�'_ 10) 30.50 HP; absorp unit 1-1.75 mil BTU 22.50 hereby ar. now e g� that I have read this application, that the Boiler or comp, heat pump, air cond. information given is cor ert, that I am the owner or authorized 11) > 50 HP; absorp unit 1.75 mil BTU 37.50 agent of the owner, l;-at pians submitted are in compliance with Air handling unit to State laws, that I am -egistered wi h the Construction Contractor's 12) 10,000 CFM 4.50 Board, that the numbs: given ,s -orrect. (If exempt from State Air handling unit registration, Flease gree reason below.) 13) 10,000 CTM + _ — `�- on portable 14) evaporate cooler 4.50 Vent fan connected 15) to a single duct 3.00 -j / Ventilation system not 16) included in appliance permit 4.50 Rood serve y ' 17) mechanical exhaust 450 Describe work new addition j aeration repair U Commercial or industrial Io be done residential Q non-residentiai 18) type incinerator 30.00 Existing use o�— uther i.e.. woo stove. water budding or property ilf'' 19) heater, solar, clothes dryers, etc 450 Proposed use of n�-Y-� 20) Gas piping one to four outlets 2.00 �- building ur property n= 21) More than 4-per outlet (each) 2.00 N Type of fuel -oil U natural gas t LPG O electric 0 --Mr, — � Minimum Fee 525,00 SUBTOTAL c. PERMITS 9ECOME VOID IF WORK OR CONSTRUCTION 'L0 AUTHORIZED IS NOT CUMh1ENCED WITHIN 180 DAYS. OR 5 SURCHARGE Z f ii: IF CONSTRUCTION CR WORK IS SUSPENDED OR J ABANDONED FOR A PERIOD OF 180 LAYS AT,ANY TIME PLAN REVIEW 25% OF SUBTOTAL 7 S r> AFTER 'WORK IS COMMENCED. O TOTAL �7 7 Special Conditions Date Issued by M1Lo61Mt)1T9,4EGW4T PLUIABING PERMIT • PERIAIT : CITY OF T I CARD DTE ISS#UED: .12/19/95 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard.Oregon 9722301199 (503)639-4171 PARCEL: I—S1.01AA-063200 E i=01, SUBDIVISION. . . . ., WEST PORTLAND HEIGHTS ZONING: C—P BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . .29 CLASS OF WORK,. . :11JE-W GARPA(]?1-_ D l`:,PDSALS. : 0 110SILE HOME SPACEQ� TYPE OF USE. . . . :COry: WArHING MACH. . . . . . 3 0 BACKFLO'14 PREVNTRS. . 0 OCCUPANCY GRP. . :B1. FLOOR DRAINS. . . . . . : Q'I TROPS. . . . . . . . . . . . . . .. 0 STORIES. . . . lb WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 121 LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASF TRAPS. . . . . . . . 0 LAVATORIES. . . . . : 2 CiTHER FIXTURES. . . . 4 TuB/SHOWERS. . . . : 0 SEWER LINE (ft ) . . . 100 wr)TER CLOSETS. .. : 2 WATFP I..INr--. (ft ) . . . 1,17,0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . 0 Rpmav-14s : New 48810 sq. ft. office bt-kilding Owner-: F•EES J ROTH JR type amoltnt by date eept 13779 SW CHARLESTON PRMT $ 127. 00 JSD 12/15/95 95-273977 PI—CI-1, $ —1. 75 JSD 12/15/95 r)!5-273977 FICARD OR 97224 5VICT $ 6. 35 JSD 12/15/95 95—.277q77 ID[ionc #.- 590 0139 Contractor: ------- ACl/AIR CONTROL, INC:,. 12300 SW 69TH AVE riGARi) OR 97223 PI-ione #- 165. 10 TOTAL.. Req #. . : 68338 REQUIRED INSPECTIONS This permit is issued s� iect to the reo-ilations contained in the Final 1115 C'Ct i 0 n Tiolard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done it accordance with auv;ved clans. This permit will expire if work is not started within 160 days of issuance, or if work is suspended for more than IFO days. i t is e L I L"~x` 9/2 , (/ `~4 V-1 Call for insoe--tion 639-4175 „ity of and �Ti ' I" 5 g � � PLUMBING PERMIT APPLICATION Planck/Rec. # 13125 SW Hall Blvd. 100 Lis Permit # /'_011 ,+1 Tigard, CR 97223 (503) 639.-4171 ' MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE ••r •• New Single Family Residences Only �+•+ ❑ 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE$195.00 Job ?.L4 15> LAW tot 1r ntlP ❑ 3 BATH HOUSE$225.00 Address array. all Fee includes all plumbing fixtures in the dwelling and the first 100 feet t "17 ' of water service, sanitary !ewer and storm sewer. See fees below. +^•,a^•"• p�"•••r FIXTURES QTY PRICE AMT Sink 9.00 Y.rq AOfM P`• Lavatory 9.00 , Owner /J x/ n l Tub o,TubiShower Comb. 9.00 �+�•�• e► Shower Only 9.00 I;rlhi+� all, Water Closet 9.00 N.-ja n. .r Mon...) Dishwasher 9.00 Garbage DLaposal 9.00 Occupant Y.&I,,a,w ewe. Washing Machine 9.00 Floor Drain 9.00 ar+ ro Water Heater 9.00 Laundry Ro•)m Tray 9.00 �^• Unrim 9.00 /�(� r Zvi +r�:•OC Other Fixtures (Specify) 9,00 ,'ContraY.Ma Ad*- � P�ww Pfd_ ♦Cr /ri S 9.JO rY i �, ' /;!&)o i :ft i 9.00 e k,�n ,,,. Oil 9.00 Pi1lL.'J Sewer 1st 100' 30.00 sm.Rep*""N& r ar am Tr N& Sewer-ea. i 'it. 100' 25.00 , Water Servic i st 100' 30.00 I hereby acknowledge that I have read this applic Atlon, that the Water Service ea. Addft. 200' 25.00 information gioen is correct, that I am the owner or authorized agent of the owner, that plans submitted are in compliance with State laws, that Storm 8 Rain Drain 1st 100' 30.00 I am registered with the Construction Contractor's Board, that the Store &Rain Drain Addit. 100' 25.00 number given is correct. (If exempt from State registration, please give reason below.) Mobile Home Space 25.00 Back Flow Prevention Device or Anti-Pollutlon Device 9.00 �o�••• •�•• d• / bo. Any Trap or Waste Not Connected to a Fixture 9.00 Describe work new addition v alteration repair Q Catch Basin 9.00 to be done residential Q non-residential Insp. of Exist. Plumbing 40.00ihr Specially Requested Inspections 40.001hr Existing use of huildinq or property l/�� ,. Rain Drain, single family dwelling 30.00 Residential backflow prevention devices 15.00 Proposed use of v; budding or propertyy' / -• •(6rcepf residential bacMfow prevention devices) NOTICE 'Minimum Fee $25.00 SUBTOTAL r' r] ra �,/ PERMITS BECOME VOID IF WORK OR CONSTRUCTION / -S AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5°: SURCHARGE CONSTRUCTION OR WORK IS SUSPENDED )R ABANDONED -- - � FOR A PERIOD OF 180 DAYS AT ANY TIME i FTER NORK IS j 7 S COMMENCED PL.\N REVIEW 25"o OF SUP,TOTAL �- TOTAL Special Conditions Date issued by �� ]� LIc,_ n�/� y Accumulative Sewer Tally A-ddress: AA c.%`B cn r� This PLM#: / C- [Baptistry/Font ixture Value Previous Previous Credits Capped Fixtures Fixtures New New # Value Capped off value added # addcd total Its total Count off #s count value values 4 Bath - Tub/Shower 4 Jacuz/Whpl 4 Cuspidor/Water Asp 1 _ Dishwasher - Commer 4 Jowest 2 DrinKing Fountain 1 Floor Drain 2 inch 2 3 inch 5 4 inch 6 Garbage Disposal 16 Dom Ito 3/4 NPI _ _Comm Ito 5 HPI 32 �I d lover 5 HP' 48 Oil Sep (Gas Sta) 6 Shower Gang 1 Stall 7_ Sink Bar 2 Bradley 5 Commercia 3 Service 3 _ Washer, Clothes 6 Water Ext 6 Water Closet 6 Urinal 6 TOTALS Total fixture values: divided by 16 = EDU J r-y HISTORY PLM# EDU# SWR# PI-M# EDU# SJJR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# • SWR# PLM# EDU# _ SWR# PLM# EDU# SWR# PLM# EDU# SWR# COUNTYWIDE CITY OF TIGARD TRAFFIC IMPACT FEE OREGON PAYMENT OPTION FORM Date Site Address q— Project Name r Plan Check # I realize that I must make a decision on payment of the Traffic Impact Fee (TIF) at this time. Therefore, I request the following (choose whichever option or options are applicable): ❑ Cash or Check ❑ Credit Voucher Bancroft or Installment Payments and/or The Ordinar•ce allows for deferral of payment' of the TI.: until issuance of the occupancy permit if the TIF is greater than $5,000. If the TIF meets this requirement, I also request this option. I understand the TIF must be paid prior to issuance of an occupancy permit. I also understand that the TIF will be recalculated based on the prevailing rates at the time of payment. Please be advised that TIF rates may increase up to six percent each July 1 st This rate increase is not subject to appeal. I n_ I— v; OWNER/A ICANT OWNER/APPLICANT c: Building Permit File Payment Option Nr.ebook h''MinWswidaub 13125 SW Nail Blvd„ Tigard, OR 97223 (503) 639-4171 TDD (50:3) 684-2772 ' e DATE: PLANS CHECK NO- T9C PROJECT TITLE- COUNTYWIDE ITLE:COUNT WIDE TRAFFIC IIWACT FEE, APPIlCANT. `�T 1�V O RKS�1.EET -"4v i --T,T, (10; .Sr (FOR NMII. ON-SINGLE F.� Y TJSES) MAILING ADDRESS: CITY/ZJP/PHONE: �— RATE PER �! _ f !,- 9 ,-7- z t/ LAND U§E CATEGQRY TRIP TAX MAP NO.: RESIDENTIAL $159.00 E?S l c r A11 -CS Zot BUSINESS AND COMMERCIAL X0.00 SITUS NO.ADDRESS: $146,00-1 '"fC� Int �r•ter...., .+r�( INDUSTRIAL $15:3.00 INSTITUTIONAL $66.00 PAYMENT METHOT'_ rAqH/CHFCK CREDIT INSTTTU rnONAL ONLY: 8ANCROFT(PROMISSORY NOM L WO USE CATEGORY rESCAJP'nON OF USE EKOAY AVG TR 7"UAWFEKENODAVE TRIP RAT DEFER TO OCCUPANCY I I GP.� oFi -clscl` /(r /I BASIS: nC "L c7 n I �/�)(�C�c�c' �, �.0,",Ji f�.0 i,z', G+� c7 CALCULATIQNS: / r.¢, /'`�Cc/T�,' - l `��; PIIOJ GT Till/QElIW1TION: ADDITIONAL NO ES: FOR AM"'UNTING PURPOSES ONLY: -TSF N`T =� 'T�iP> _ 48,crt� I Rw.O AMT.: TZ� r T-Tf v 9S ie�, 3o,cru C� TRANSIT AMT.:/ C71-,L` �L .HT 9`�` ,U-G D BY: -12=- I CC: WASHINrTON COUNTY TIF NOTEBOOK lDfTT10