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Permit
CIT OF T SEWER CONNECTION PERMIT " DEVELOPMENT SERVICES PERMIT #: SWR2003 -00272 DATE ISSUED: 8/5/2004 "�-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS; 10960 SW HUNTINGTON AVE PARCEL: IS133AC -13100 SUBDIVISION: HAWK'S BEARD TOWNHOMES ZONING: R - 25 BLOCK: LOT: 049 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SFA NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SFA dwelling. Owner: FEES AUTUMN PARK TOWNHOMES, LLC Description Date Amount 4949 SW MEADOWS RD SUITE 400 LAKE OSWEGO, OR 97035 [SWINSP] Swr Inspect 8/5/2004 $35.00 [SWINSP] Swr Inspect 8/5/2004 $0.00 Phone: 503 233 - 0075 [SWUSA] Swr Connectic 8/5/2004 $2,500.00 [SWUSA] Swr Connecti( 8/5/2004 $0.00 Contractor: Total $2,535.00 Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 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 laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from 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 in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699. Issued by: j), r /e Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day } CITY OF T I GAR D ELECTRICAL PERMIT PERMIT #: ELC2005 -00086 �1 6 DEVELOPMENT SERVICES DATE ISSUED: 2/14/2005 1 ' � 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 - 4171 PARCEL: 1S133AC-13100 SITE ADDRESS: 10960 SW HUNTINGTON AVE SUBDIVISION: HAWK'S BEARD TOWNHOMES ZONING: R-25 BLOCK: LOT : 049 JURISDICTION: TIG Project Description: Temporary electrical service for job shack. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 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: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: DEREK L BROWN & ASSOC ELECTRUM INC 4949 SW MEADOWS RD DBA SPECTRUM ELECTRIC LAKE OSWEGO, OR 97035 2050 VISTA AVE #100 SALEM, OR 97302 Phone: 503 - 866 -4897 Phone: 503 - 361 -1256 FEES Reg #: LIC 116453 SUP 2223S Description Date Amount ELE 24 - 353C [ELPRMT] ELC Permit 2/14/2005 $66.85 [TAX] 8% State Surcharge 2/14/2005 $5.35 REQUIRED ITEMS AND REPORTS Total $72.20 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 susp - • - • or - • - • -n 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those r - s are set forth in OAR °, 2- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) • 66699 or 1 -80 - 332 -2344. I - ued By: 4 /4 �� Permit Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:OOpm for an inspection the next business day • • • Ele t Electrical Permit Application ,. FOR OFFICE USE ONLY City Of Tigard Received � ��a PermitNo.: g 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ' ff ; 4l tip DateB : Other Permit: Inspection Line: 503.639.4175 � •I Date Ready/By: P' s: El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: I a Supplemental Information , -.0,. _s�•48 - - 4 -,' ?g , ,, a y. �•' ! 3 'C" .S. f 10: h G.e K'„ J Z Vi i'44- x Y, v ti v � l J i ' .P {� E nF WORD 4.- 1,- '"'" i + �s. y '40 - r fi r ''' } t,eve i c � . 3 63 P,t�r'4' ?', ` ..r� e ` ,,` °" + E . e. 1 ".... _ _. .. t'-"1 '. x�3.' " "•'" ..- .. + %f V +.iii .,t. ., Mm4.,- :Qi.': c7h ... _.,. _ ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ['Service over 225 amps, comm'l ['Hazardous location ❑ Demolition ❑ Other ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., o 4- 1 T` , ' CA EG•0A2 C1F'�CO . ON, '` g4 €•_ t:' { ; ; -; �•;," :-133- � ,. ,..M.,k :t4 ` ._s .. _. .s s .. - . ...4-%;, is._, . r i4g,,I.J " ' of 1 -and 2- family dwellings 4 or more new residential e ❑ 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Master builder ['Building over three stories ❑Feeders, 400 amps or more ❑ Multi - family ❑ Other: ❑Occupant load over 99 persons ['Manufactured structures or re`,. T s" f ` r tf , k" .K# §,44 I4:0RVIAT1.ON p 4D LOCATION awA y , 1 u > . ❑Egress/lighting plan RV park Job no.: ' Job site address: 1a9 ( cSUJ Hu 1.)-rim GT) k] Ac v ['Health-care facility ['Other: Submit 2 sets of plans with any of the above. City/State /ZIP: T‘ GAe.D (47 2 z '3 The above are not applicable to temporary construction service. V- catilt, - rllvSCHEDtiffkiX Project f" AtoKs [ A � P y,� �...__, Suite/bldg./apt. no.: 'Pro ect n ame: � ` • � , Description I Qty. I Fee. I Total I ' Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: w r F 4 r , Limited energy, non - residential 75.00 • 2 :s' rct, ,, Y. % ' :. 4D SCRIPTI . ,;1 . ) ';WORKt. {± ty v `..:, -5'L,l Each manufactured or modular � -p dwelling, service and /or feeder 90.90 2 C © OSTe.t)CT )Oi'. I I"AI LEE- -r r. pe co W E. Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 S " p4.: r ®: ,{YOP$RTY " �', * ..- �.v T E N T y , fi t, rr 201 amps to 400 amps 106.85 2 - - _ 4- - . T.. -. ." - _ - -, -`' . -• ", 401 amps to 600 amps 160.60 2 Name: , L. WROvoiJ 4, A SS ®C . 601 amps to 1,000 amps 240.60 2 Address: 49 49 S .(4), µs4ppWg t.j. - Over 1,000 amps or volts 454.65 2 Reconnect only • 66.85 2 City/State /ZIP: (_A 4 E. OSWS 60 j ® 9 7 03) Temporary services or feeders installation, alteration, and/or Phone: 6D3) ' I$ -4(617 ( Fax: rr5V� ,{ relocation VV� ) Sa � ' Q p `1' �S 200 amps or less 66.85 01 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel t r. t ' p r � "}`�'.' ",' .. 1 A. Fee for branch circuits with 96, 4 .; r* `r` �wf T. +I !t > `.. ,. '°R ' . -,W b;, . . 4 , y ? Qr ',.-- Z* l , ln`� fS te.: :. i _e.. ;:. service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'l branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2 • Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - s ;. :t: " ,> -r . _ c r r 'O1 Y R.ACTOR , 4 •' 2'. } • . �., 1 �_- :�'h ` ' . :.:. ,.." rk. k s.` s energy Panel, alteration, or extension. Describe: Page 2 2 Business name: s ?EC Te V /vl E(.ECT(z 1 C Address: 3 10 U I S 1 AV Each additional inspection over allowable in any of the above ( Per inspection 62.50 City /State/ZIP: SA I.XK I © -(') 3 0� Investigation per hour (1 hr min) 62.50 Phone: (!.92)' - g6,1 - 12,5 Fax: ( ) Industrial plant per hour 73.75 ., ? .,,T �+5ELEkTWffi "PERIV1ITs iI EE 'a ∎ -M3. 7 yr t CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal 6 6 , g S • Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) 5. 3 S TOTAL PERMIT FEE 7 • 9..0 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. i:\ Building \Pemuts\ELC- PemdtApp.doc 12/03 440- 4615T(10 /02/COMJWEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information • LIMITED ENERGY PERMIT FEES: ; RES DE. t: _,. OI . "O:i51 a " :P .. Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ A udio and Stereo Systems* ❑ Burglar Alarm ❑ G arage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: r CQIVI I .x ..tiK U ' 3 M t WHfar - . Fee for each commercial system $75.00 . • (SEE OAR 918 260 - 260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other . Total number of commercial systems: *No licenses are required. Licenses are required for all other installations ilBuilding \Pemtits\ELC- PetmitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested ( -5 AM PM BUP Location D &v. ■ _,ii Suite MEC Contact Person r�?.�.l.f -? / Ph ( ) IX��O 4661/ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC OU x ' 0 8 1 /" Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final C__ PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL ugh n ,.�ii i �l QC Slab Low Voltage ( Fire Alarm : 11g34 3 ART FAIL Reinspection fee of ,$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE ❑ Plea a call f reinspection RE: Unable to inspect — no access Fire Supply Line ADA D of Inspector Ext Approach/Sidewalk p Other: Final • DO NOT REMOVE this Inspection record from th ob site. PASS PART FAIL Feb 14 05 03:38p Bruce Cone 503- 521 -8465 p.l 02/1Al2905 16:26 5033618810 SPECTRUM ELECTRIC PAGE 01 Feb 14 05 03:23p 9ruce Cone 503 -521 -9465 P• CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 f -r ; PEP r- IMPORTANT PERMIT NOTICE ELECTRUM INC DBA SPECTRUM ELECTRIC 2050 VISTA AVE #100 • SALEM, OR 97302 Electrical Signature Form Permit #: ELC2005 -00086 Date Issued: 2/14/2005 Parcel: 1 S133AC -13100 Site Address: 10960 SW HUNTINGTON AVE Subdivision: HAWK'S BEARD TOWNHOMES Block: Lot: 049 Jurisdiction: TIG • Zoning: R -25 Remarks: Temporary electrical service for job shack. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the 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 Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: DEREK L BROWN & ASSOC ELECTRUM INC 4949 SW MEADOWS RD DBA SPECTRUM ELECTRIC LAKE OSWEGO, OR 97035 2050 VISTA AVE #100 SALEM, OR 97302 Phone #: 503. 866.4897 Phone #: 503- 361 -1256 Reg #: LIC I t 6453 SUP 2223S ELE 24 -353C AN INK SIGNATURE IS REQUIRED ON THIS FORM );p6rSW2w. Si of Supervising Electrician If you have any questions, please call 503.718.2433. �O S-5 "' t -ry