11720 SW HAZELWOOD LOOP-1 J
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11720 SW HAZELWOOD LP
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CITY OF T I G A R MASTER PERMIT
PERMIT#: MST2003-00469
DEVELOPMENT SERVICES DATE ISSUED: 9/16/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171
SITE ADDRESS: 11 720 SW HAZELWOOD LP PARCEL: 1S134BD-04200
SUBDIVISION: ENGLEWOOD NO.2 ZONING: R-4.5
BLOCK: LOT: 130 JURISDICTION: TIG
REMARKS: Fire restoration. Adding (1)service panel & an additional (9)branch circuits to the original (3)br
circuits that were taken out by the general contractor.11-13/03 ADD (2)wood burning fireplaces.
BUILDING
REISSUE STORIES: F,.00R AREAS REQUIRED SETBACKS i REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: of BASEMENT: of LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: of GARAGE: Sf FRONT: PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: 1 rHRO of RIGHT:
VALUE: 75,000 00
OCCUPANCY GRP: RJ BORM: BATH: TOTAL: 0 sl REAR:
PLUMBING
SINKS: 1 WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES 2 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUBISHOWERS: GARBAGE DISP: WATER HEATERS: I WATER LINES: SCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
_ FUEL TYPES FURN c 100K: BOIL/CMP<JHP: VENT FANS: I CLOTHES DRYER: _
FURN—10014: UNIT HEATERS: HOODS: OTHER UNITS: 2 1
MAX INP btu FLOOR FURNANCES VENTS. WOODSTOVES: GAS OUTLETS
ELECTRI.:AL
RESIDEN I IAI_UNIT SERVICE FEEDER _ TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCI LLANEOU3 A00'L INSPECTIONS
1000 SF OR LESS 0 -200 amp t 0 -200 amp WISVC OR FDR: PUMPIIRI'IGATION: PER INSPECTION:
EA ADD'L 500SF: 701 400 amp: 201 - 400 amp tat WIO SVC 7F OR: Oa SI, )UT LIN LT: PER HOUR:
LIMITED ENERGY: .101 600 amp: 401 600 mnp EAADDL SR CIR'. 200 SIGNALIPANEL IN PLANT:
MANUHMISVCIFDR- 601 1000 amp: 601-amps-1000V MINOR LABEL:
10004 anlplvolt
PLAN REVIEW SECTION
Reconnect onlV:
ra4 RES UNITS SVGFOR>=225 A. >600 Y NOMINAL: CLS AREAISPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO R STEREO: VACUUM SYSTEM. AUDIO 6 STEREO: FIRE ALARM: INTERCOW6PACING. OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA7TELF.COMM: NURSE CALLS TOTAL a SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 1,559.90
ACHUGBUE.MOLLY LORENTZ BRUUN CO INC This permit is subject to the regulations contained ut the
ACHU B E.M HAZELWOOD LP 3636 SE 20TH AVE Tigard Municipal Code,State of OR. Specialty t odas and
TIGARD.OR 97223 PORTLAND,OR 97242 all other applicable laws. All work will bp done it
accordance with approved plans. This permit will expire M
work is not started within 180 days of Issuance,or if the
work Is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: Phone: 212.7106 Oregon Utility Notification Center. Those rules are set
forth in OAR 952-001-0010 through 952-001-0080 You
Reg a: LIC Z 1 may obtain copies of these rules or direct questions to
OUNC by calling(503)246.1987.
REQUIRED INSPECTIONS
Mechanical Insp Framing Insp Electrical Final
Plumb Top Out Low Voltage Mechanical Final
Plumb Top Out Insulation Insp Final inspection
Electrical Service Rain drain Insp
Electrical Rough In Misc. Inspection
i
Issued By 11,1 _ _ r'L��_-_ Permittee Sig»cure : v'
Call (503) 639-4175 by 7:00 p.rn. for an inspection needed the next business day
YO
�:lec tical Peri int alp I atiou R= e,ectrioc �...��• ,
Planning Appmvtl Sign
City of Tigard Test �'�Oli'mr�■rem t(N .
13125 SW Ha11 Blvd. Plan FAVIew then
Tigard,Orejon 97223 Dated y: I'MitNopost-play . —
Pbone; !03.639.4171 Fax: 503.598•:460 DetwIy: lira ea
Du
Internet. www•cLtigard,or:us f unuct )VHS.: Lj Sea Page.t for
24-hour Inspection Request: 503-639-4175 Nr nrJty othod:- 9u cineol rnforrastion.
14ih
TYPEOF WORK -- �.PLi�I•�i VIEW' l-' 't>a{ 6111that a
New construction Demolition Sere oe over 22S amps Health-cm facribly
iron/alteration/replacement lacement Other: `on111°ovl Htlsardow et I0,n
Add iro
Scmoe over 320 tamp.-nttthrg of �utldfig over 0,000 stlwre flet.
RV 1F'GON$TRUCM 0M,-AML,K dl 1 dr 2 thndly dwelling, four or we rex Wtial ur:its in
1 &2 l attul dWtllin CcmmerciaUIndugtrial ❑system over 000 volts nominal one 11IM to
Building aver three ttonn Feeders.400 imp or natre
Acee3sory Building Mule-Famil 8 Occupant load over 99 ptrtont Manufact2w etricturef or RV pu•k
Master Bu)lder Other: ❑Egrusli jbBng plan I C3Other_
_ _JOB SITE LNFORMAFION and LOCATION submit otic blptana with any of tba actirm
The above art not—sets t�tUaablo W gmltprary con>»rucdc n forvice. I
Job site address: t) 0 �' - RLL►•SC. Ut,ILL' -"'J1
Suite $lel ./A tA- Number of Inn aotloilt portnit a► 'w
Project Name: , c Dascri don _ _ Fa es Tout �-
NOW rt:taonna►atngte or m.nHr•�nnY p.r
Cross street/Directions to jOV site: nk InctudW attachod hrr3ile.
$trt'tea lntttldad� I I�
1000 rg R w _ _I t4 _ 4
_ q FVl3ryllli!l34L. TT ^-
talt�a
Llma d enc, recidentlal ' •00
S� ubdi ,ision: LOt#: yY L,nnhodonirray.non mildtKial —— 73-00
Tax l Fach manuhchued home or noduli: ++": ;
'Li'kSC fP�10N F,W.I�RK tanict and'or leader _ 0
-- Servlecy or seeder-Itaallsabn,
alttim mo or r•Noeatloa:
200 am orlat 1030
n a ;X13
401 ami 00 ro . — i 60.60
PPOPERTVOWKnTfihlu'v"T ' —4a-
tr 1000 amw or v,iu 4l4,6,5
Name _ _ Munnogtonly 66.15
Addrt s; Temporary services or fecdcrs•Inatalladea,
_ elttr&Wrk:or rclocatlon: —
I City/StatedZip: — -T_ — 200 amDe oris __--- 66.1S
Phone: Fax: I a�+Q/Marn_ct_-- toa,a1 2
? APpLICAfiT .moi r. CO?VTACIT P pN 601 m 60o atr
Branch eltnwla-new,Alteration,or
Name: extension per pansh �a
�.fce for brach chults with purchase of
AdIkess: ecrviec or feeder fc ach wteh c: it 6 65 2
Ca,Stat eli : Y Fos for branch Orcuiv without putchw of 2
Phone: rax: say a ur f@Wtt Ip,funbruuh cisco►
Each WHonal branch ci-mdt _ d.6!
E-mail, Misc(Samea or feeder not included):
COUMORaw or IT111dan cne;a J'40
' Each e. n or o,thna S3 40 2
Job
ISO: c.. L ( gni draoMa?w a hound enerr pawl,
• 1s.
Business Name: &�LIsU Lk,i'- ) s ; nnn
121
Address: ► _f
Cl ,$tAtG Zl : ry ) O add) orW Inspection ever the atiowlible In o the above:
P i hour•muthour)
I _
Phone: L z Lj I I .Mn
CCB Lic. a:
;FJacMa1'Pir•tek ------;**-ti�M•rM•r-��
15upervisingelectrician
I ig ature:re uired: i' � �— Pin Review(23%of Permit Fee S
LPrint Name: y Lia#s: 3rna 9tuaFtarje,�K of P.cmit ee)
TOTAL PEItMTi FRE 1 S 1 AY
Atttttorlxed (- 1 Notice: This permit application eaplrna 1f a permit Is net sbtaiato within
Slinature. Hate: 1 �� 190 der afar It has been aeesptad to earopiets.
•Fee tattbodoloe sat by Tri-County building industry Seeviro Beard.
I print none)
100(pJ QtIV9fI d0 3IIa oee19PSC0C XV3 t111 toot-9Z 8o
40
BuilAhig; Fixtures
Tiumbina Permit Appl<<atian Received
DatefB
Lit of Ti I1lC(� Planning Approval Sewer �—
y g Date/By: Rcrmit No
13125 SW Hall Blvd. Plan Review Other ---�
Tigard,Oregon 97223 Date/By! Krmit No
Phone- 503-639-4171 Far: 503-598-1960 Post-Review Lind Use
DateiB : __ Case No
Internet: www.ci.ttgard.or.us Contact Jurs See Page 2 for
24-hour Inspection Request: 503-6.19-4175 Name Method; _ Aupplemental Information.
TYPE OF WORK _ FEE*SCHEDULE(for special Information use checklist
,11 New constriction Demolition Description Q! FceteaJ Total
ddition/alteratlon/replacement ther: New I-&2-family dwellings
CATEGORY OF CONSTRUCTION Includes 100 ft.for each u'lllty connection
'ZIT, 2-Fames dwelling Commercial/Industrial SPR t bath _ 249.20
SFR(2)bath 350.00
Access�Building Multi-Family _ SFR 3 bath _ 39900 _
Master Builder [ Other: Each additional bath/kitchen _ 45.00
JOB SITE INFORMATION and LOCATION Firesprinkler-sq. R.: Pae 2
Job site address: U720 tALct ,� J Site Utilities
Suite #: _ Bid .;Ate.#: -�_ Catch basin/area drain 16.60
Dr elVleach line/trench drain __ 16.60
Pro est Name: Footing drain(no. linear R ) _ Page 2
Cross street/Directions to job site: Manufactured home utilities_ 110.00
neI`''o�d P4'. Manho'es _ ' 16.60
L Rain drain connector —r 16.60
Sanitary sewer no. linear tt.l Page 2
Subdivision: Lot#: Storm sewer(no. linear fl.) _ Pae 2
Tax mapiparcr I #: -- Water service(no. linear ft) Pare 2
DESCRIPTION OF WORK�- Absorption Fixture or Item, hon valve _IG hO
:.�C�.::��'� '� toi. _ e(►�1;�� Backflow pievcnter Pae 2
Z A �/ T S, Backwater valve 16.60
-rte— Clothes washer 16.60
Dishwasher D _ 16.60
--- Drinking fountain 16.60
PROPERTY OWNER __ TENANT Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/Gip: _ Floor dram.floor sink/hub 16.60 .�
---- Garbage disposal 16.60
Phone: Fax: Hose bib 1(.60
APPLICANT I Ll CONTACT PERSON Ice maker 16.50
_Name: Interce tor/ tease trap 16.60
Address: Medical gas-value: S Pae 2
City/State/zip: _ Primer 16.60
Roof drain(commercial) 16.60
Phone: Fax: Sinkibasin/lavato 16.60 !..
E-mail: Tubishowershowcr pan 6) 2 16.60
CONTRACTOR Urinal 16.60
Business Name: (, Water closet 16.60 2 v
(N iiti-. Water heater 16.60
(Oi
Address: 16, o��*'� 2 Diner
City/State/Zip; _06,,t ,.,,-t_C(2— J-10(ce Other
Phone: 1� j Fax: (� —..7�3a Plumbin Permit Fees*
Subtotal S l 13
CCB Lic. #: Plumb. I ic.#: '51 C) !Minimum Permit Fee S"SU S
Authorized --,._ 1 Residential Backflow Nfminwm Fee$36.25
Signature: 1 Date_�`� 1�3 Plan Review(25",o of Permit Fee) S
`l� ' _ State Surchar a(8°o of Permit heel S
(Pleas print name) TOTAL PERMIT FEE J S (� %
Notice: This permit application expires If a permit Is not obtained within All new commercial buildings require 2 sets of plans with Isometric or
Igo days after it has been accepted as complete. riser diagram for plan review.
'Fee methodology set by Tri-County Building Industry Service Hoard.
, Usts Permit FormsTiml ermitApp doc 01 03
3-�q3 r C
Plutnbin�i'ermit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su ression Systems:
Site Utilities Qty- Fee(ea) Total S uare Footage: _ Permit Fee:
Footing drain- I" I ow 55.00 0 to 2,000 $I 15,00
Footing drain-each additional 100' 46.40 2,001 to 3,600 S 160 00
3,601 to 7,200 $220.00
Sc«cr- I st 100' 55.00 7,201 and eater $309 00
Sewer-each additional 100' 46.40
Water Service- Ist 100' 55,00 Medical Cas Svstems'
Water Service-each additional 100' 46.40 Valuation: Permit Fee'
Storm&Rain Drain- Ist Ifi0' _ 55.00 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001 00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each
Fixture or Item Qty. Fee(es) Total additional$100.00 or fraction thereof,to and
including$IO,00(:.00,.
Commercial back Flow Preverdion Device 46.40 $10,001.00 to$25,000 00 $149.50 for the first$10.000.00 and$1 54 for
Residential backflow Prevention Device each additional$100.00 or fraction thereof,to
(minimum permit fee$36.25) 27 55 and including$25,000.00.
Rain Drain,single family dwelling 65.25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
Inspection of existing plumbing or each additional$100.00 or fraction thereof,to
spccially requested inspections-per hour 72.50 and including$50,000.00.
Subtotal: $50,00100 and up $742.00 tor the first$50,000.00 and$1.20 for
each additional$100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"Yes",please indicate work performed by fixture. Failure to
accurateh•report fixtures could result in increased sewer fees*.
r- uantity by Fixture Work Performed Conunenis regarding fixture work:
Fixture Type: Replsee
New Moved Existing Capped
red -------- ____
BaptistiFont
Bath -Tub/Shower — ---- ----
-Jacuzzi/Whirlool
Car Wash -Each Stall _` -
-Drive Thru _
Cus idonWater Aspirator
Dishwasher -Commercial
_-Llomestic
Drinking Fountain
Eye Wash
Flour Draimsink .2"
-3" —
4"
Car Wash Chain
Garbage -Domestic _ — *Note: If the fixture work under tills permit results in an
Disposal -Commercial — increase of sewer F.DUs,a sewer permit is-ill be issued and
-Industrial — fees assessed for the sewer increase must he paid before the
Ice Mach,Refri .trains plumbing permit can he Issued.
Oil Separator liar Station)
Rec Vehicle Dump Station
Shower -t sang
-Stall _
Sink -Bar/Lavatory
-Bradley — _--
-Commercial
-Sen ice
Swimming Pool hiller_
Washer-Clothes _
Water Extractor
Water Closet-Toilet --
Urinal —
Other Fixtures
i:\Dsts',Permit Fonms`,PlmPemutAppPg2doc 01 03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 IMST�.
INSPECTION DIVISION Business Line: (503) 639-4171
BUP - -- _
Received 2._.._.1b.-2 7 Date" r3 Req sled AM ... L-21- 11- 15M __-___ BUP -_
Location i l ZC� Suite MEC -_-
Contact Person Ph(,� ��'- � PLM
Contractor — _— Ph SWR
BUILDING Tenant/Owner _ ELC
Footing ELC
Foundation Access: _
Ftg Drain ,1C�{'p GyeGL�j _c--L:ovz_ ELR -
Crawl Drain SIT
Slab Inspection Notes: i - -
Post&Beam C�� I
Shear Anchors
Ext Sheath/Shear ---
Int Sheath/Shear
Framing ---
Insulation — —
Drywall Nailing ---
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling — — -
Root _
Final
S ART FAIL -
PLUMBING ----
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
Smglr�Qampers
FQ PART FAIL
ELECITIMAL_
Service
Rough-In
UG/Slab
Low Voltage --
Fire Alarm
Final Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAVI.
SITE [� Pleaso call for reinspection RE:__- —__ [� Unable to inspect-no access
Fire SupplyLine ADA
Approach/Sidewalk Date—` - ----� � Inspector_ F"
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)6,39-4171
BUP
Received �z Z -'?'i 1_q NData Req ested �.2J5—041AM _ PM_.. BUP
Location _ /Z z Z [` u,� l�airnl Suite ___ MEC _�—
Contact Person Ph( -5 0--' ) 7- PLM
Contractor Ph( ) _ SWR
BUILDING Tenant/Owner �_
__ ELC ---___----
Footing
Foundation Access: c ELC
Ftg Drain c� �l1 '� CQ L- ELF!
Crawl Drain J
Slab Inspection Nolet . SIT
Post&Beam
Shear Anchors
Ext Sheath/Sheat
Int Sheath/Shear
Framing - --
Insulation
Drywall Nailing
Firewall
Fire Sprinkler --— -
Fire Alarm
Susp'd Ceiling
Hoof
Other —
Final
I
PASS T FAIL �- -
MBI
Poslyaeam
Under SlabRough-In
Water Service -- — —_ ►'
Sanitary Sewer
Rain Drains — --
Catch Basin/Manhole
Storm Drain ----
Shower Pan
O
S PART FAIL —'- --
NICAL_
- __ --- _ ------- - ------------_--___---
Post&Beam
Rough-In --
Gas Line
Smoke Dampers -____--
Final
ASS PART FAIL -- ----- - -- --- - - -- -- ---- —-
E:LECTRIAL-,
Service � _ —
Rough-In
UG/Slab
Low Volta,fe -
4U'
FI Reinspection fee of$__- __required before next inspection. Pay at City Hall, 13125 SW Hell Blvd.
"PART FAIL
!'_j Please call for reinspection RE: _ Unable to inspect-no access
Fire SLOaply Line
Anp, �
DAt� LInspector
Approach/Sidewalk -_—� --
Other:
Final _ DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL