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Permit ' � Ali: CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00346 -11L X111 DEVELOPMENT , SERVICES 9-171 DATE ISSUED: 12/8/2004 13125 SW SITE ADDRESS: 12873 SW RIDGEFIELD LN PARCEL: 2S104DD -02600 SUBDIVISION: MOUNTAIN HIGHLANDS NO. 2 ZONING: R - 4.5 BLOCK: LOT: 023 JURISDICTION: TIG REMARKS: Conversion of existing crawl space to bonus rm & bath. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: 550 sf BASEMENT: 550 sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF • FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THROE sf RIGHT: VALUE: 25,000.00 OCCUPANCY GRP: R3 BDRM: BATH: 1 TOTAL: 550 sf REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB/SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 1 CLOTHES DRYER: GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W/SVC OR FDR: PUMP/IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 • 400 amp: 201 - 400 amp: 1st W/O SVOFDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 1.00 SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000. amp /volt : PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL • RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATARELE COMM: NURSE CALLS: TOTAL If SYSTEMS: Owner: Contractor: TOTAL FEES: $ 704.49 RODGERS, JEFFREY + CINDY L SCOTTCO BLDG + DESIGN This permit is subject to the regulations contained in the 10889 SW DOVER CT 11640 SW 135TH AVE Tigard Municipal Code, State of OR. Specialty Codes TIGARD, OR 97224 TIGARD, OR 97223 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 the work is suspended for more than 180 days. Phone: Phone: 503 - 524 - 6777 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg IV: LIC 00049670 rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Plumb Top Out Insulation Insp Post/Beam Structural Electrical Rough In Electrical Final Underfloor insulation Framing Insp Mechanical Final PLM /Underfloor Gas Line Insp Plumb Final Mechanical Insp Gas Fireplace Final inspection Issued By : _,. Permittee Signature : 4 1 7� Call (503) 639 -4175 by 7:00 p.m. for an inspection neede a ex busin - s day �� \� � Permit A ,� . ttit on FOR OFFICE USE ONLY City of Tigard ,� ; ,? �' �� Dat eived ii —C l O 4/ , Permit No. S1:7 "." *6 13125 SW Hall Blvd., Tigard, OR 9722 , A, v- Plan Review 6 C �'l A_ .°1 / Phone: 503.639.4171 Fax: 503.598.1260v � \� ,.. -„�CC` �"sF= 1 � Date Ready/By: Date/By: //! 9 - O� /1KR1t/ Other Permit: Inspection Line: 503.639.4175 �t �t � �, ( / /4V �� /� : �� 65 See Attached Checklist for Internet: www.ci.tigard.or.us ` O \' �' Notifie. ethod: ! -1••• iA/ Su lemental Information - ti ' .�.t'J 4 _ '!7; ' �..� f..t` ..or • / f„� (1 2_ `..��f - , p ; ' i - n 1• } - A: "�,tr' r,.� lr' �•'• • if S :' r' t EL �i W •r s� i'r ; 1` :: E. OF,FWORK` °��i ' -: f' RE`.QU DA'TA:y'1LAr D''2` -F-AM DW �I IN ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the ': ' .'',i `" 1 f s ' C,+_ a;� 3. a y'a + F' 'r w ork indicated on this application. �:3 - Vii~- tif.,.. tl"<<e' ", 1` PP ; ' ^ .;,= 1 ^ De h; -; . g� :. c, , CAST> J : GO Et '.i l '��O - P' 4G0 C TI Q � I k F' r _ , ° a; .�="; l " N•l= 1- and 2-family / dwelling Valuation: $ Z l 000 y g ❑ Commercial/industrial ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: / 5.- °' :!, x ' '' , '4'' '":17:7: 7 " "' Total number of floors: ;�:`",..,oa,''" ,,:S,IOB SI1ti dNFb I9. OC I ly Job site address: / 2, Y 3 ,s'.6.4.) 44 �/ Labe,' New dwelling area: 5 square feet City/State/ZIP: .yavtT f OR- 0I1--Zz ? Garage/carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet • Other structure area: square feet :;;41 -T.QUf 'D+DAtCA ` O.IVINIE ( EI.4 ® ► ''':. Subdivision: iI •I{l/ri(t //`j � AA 14 ire 15 It Z Lot no.: �? Permit fees* are based on the value of the work performed. Tax map /parcel no.: Zs/ D2�� / �Z� s � � �. equipment, the value (rounded labor, to the nearest and dollar) of all b4- J equipment, materials, labor, overhead, and the profit for the ia; ^' °` }; ',_: • ., ., ' , ; ,� � �F' --�:+; �bES.C� I�IPiLrON O�'V1?OR 4 _ - work indicated on this application. / /iII 5 l c , / 5/wee Valuation: $ '7 � Existing building area: square feet New building area: square feet q: y , , . � ..? ,: y „ . , ,•�:u, - ±.„ - „ � ti ... . . , ; . ittikEII ; WNER d t ; � .; ' , 't. :. ' `❑ - 'GE I ANT , �s - - : v Number of stories: • �r Name: J12.c,Ce, , ,--Od j e r5 Type of construction: Address: 2 S ,6o re to ( Occupancy groups: t�'?i� City/State/ZIP: 7 oe 7A)/ Existing: Phone: 0!) 5 -Gd V44,5 Fax: ( ) New: , :r ,. t'v ^v '� l.ri . ;. '' .it _id �' ..�uZ.'.y,. ��. .:-w - rd,� -.,. - ," . Y , F� - : ; - w �%� " . � ® ° Y �:r � � ¢ : q - s Q y Gb�'1'�C't, PE1tSON y � �, � - .». ' - . Y - � -. ; : ' Ft � � IOtfi }�C��i."�`- �°' - - ' - _ d'�+- .,.:_; ��wSSaA.�.alt[Gths.F t�.:f' �a✓f�n.r.. " Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City/State/ZIP: .� / applicant is exempt from licensing, the following reasons Phone: ( 59..c.1 --L 7 7 7 I Fax: : ( ) apply: E -mail: . • 1�v.., e ;,t . 1� 'r V : ��1;� 4�_ ^�4�. `, � 1 - 'y r"'Y -. sC,a'_ ;�� , ,:,,i . 71., . ' Y; j x ' " fi" t + _: ' ar. fu,Oly. �C --;,.'..17, � .' t 4: z. 'a`' : ' , , Business name: �6F!! / C-0 A / i di/ 7 T j'�710'1. J� -.. p 5 ,. �d zei r>e, :r��.,� „_�.,,:!..'-:,•.. .. . • Address: /! 640 5 t) , 33- / � - rncr. +if:$ I?IJ�G#PD1CtIV1' `�E1�ES'' r y > .;. -.:ti i ;.. .,. Please refer to fee schedule. City/State/ZIP: 1 y /ZZZ 3 / "` 443-4-7 d Fees due upon application • Phone:93) 574 Fax: ) 5Zei -.5 ` F 4o1 6 ••:/,...0 Amount received CCB lic.: Date received: Authorized signature: ,, -� . This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: / 5409 C tiv Date: / / ,{ _of • Fee methodology set by Tri County Building Industry ` Service Board. i:\ Building \Pennits\BUP -PemutApp.doc 12/03 440.4613T(11/02/COM/WEB) • Mechanical Permit Application FOR OFFICE USE ONLY City. -of Tigard Received ST Permit No./�/� S [ cro � _ I f 6 13125 SW Hall Blvd., Tigard, OR 972 : C `� L V , Date/By: !! -- -- Plan Review //d Phone: 503.639.4171 Fax: 503.598.1 60 - �, -, '� ;\ Date/By: Other Permit: Inspection Line: 503.639.4175 a y,. a : )1 I Date ReadyB luris: H See Page 2 for Internet: www.ci.tigard.or.us ' y 7 4 V 0 / ��'t Not d: Supplemental Information ;k'�� Y ''.. 74, - :;. - 1.. : . •;,:t't. - w:4 .:;kL -P , 1:i :e•tr.; •.:ti -<.N ".'_.j :„ _ iyr %:o ; ,x.. _ �, ': _ r s L d O .n a- c e. ! l,__ €h'a a, `: ?,, i .. .r' _ c`�� ' '' , ;t w r , 'CO1vM'E�� ' A�' - ; '`:t SE HED . : I E ^ ksaciclNrs�r . Mechanical permit fees* are based on the value of the work ❑ New construction [' Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. 4,'' ;', , +. ..' # " L, " t:y _;2 w v ;. , .r „p - . ., g. . :4,4.:;.t;"^•,„; ,1r,.:, ?'.f 4 :e . : 4- 1 tt. , a Value•$ ., V1' h� ,- , 4 , ';':7 4 !. GI� lV , � dR:Vay � ' �1 C ,T# O 4; : ' a� ,>4 Ib t,...- i=.Y'J.'s4+.... X ._ "5`':...... ?:fk .ls.- , !, L'- .��'_.6bL..s ..: .•.LUr_.i.b3 ? iG�+ vF " 1..'.+'S'+If `- i �,.i,..;�� "i 1 = ' ";RF;S )� Ir a Q MENT /? YSTEIVISMFEES ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building t ❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist. Description I Qty. I Ea. I Total .r ., ' , s ;)rbB 5P_ I+E �U$lYl �?'IQ 'A - ' ` *' -' -" ,' ' tu' Heatinp/cooling Job site address: n Air conditioning or heat pump i i.• ei 3 S K/ E, dl e -F I e t d L (requires site plan showing placement) 14.00 City/State/ZIP: 'Ti 4,7g tad (1 q ZZ. Furnace 100,000 BTU (ducts/vents) 14.00 Suite/bldg. /apt. no.: l Project name: Furnace 100,000+ BTU (ducts/vents) 17.90 Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 • Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: p'J 4') / J fg6 /L lZ I Lot no.: Z ?�. Flue/vent for any of above 10.00 �x '�� ^ S 4.,5-13 Other: 10.00 _ Tax map /parcel no.: 25)04 OZbOQ 1ZO � ,5-b Other fuel appliances . fl '"iq 1 +. -.:. , vx� :. f' z r �. Water heater 10.00 t: 3� a q,., -> s [uPSr i '�' e� .. . - .,. -es ` 3 -'b Gas fireplace / 10.00 "( / S arc 0 ra tO / 5/?CC Flue vent for water heater or gas fireplace • _ 10.00 • Log lighter (gas) 10.00 _ Wood /pellet stove 10.00 Wood fireplace /insert 10.00 • =, ,r, w M _, . r y �: Chimney/liner /flue/vent 10.00 • A s :;, 1 R '- ` y ' d,'S! �s.� ,g � J€ ^x ='.L® j. `, : :.; ,» 'w Y..�,. E 21L. aS Name: ,Ja.g r ` j /2,d0 Environmental exhaust and ventilation - other: 10.00 �� / /� ��,.! Range hood /other kitchen Address: (/ G' i 47 ea q ,� equipment 10.00 City/State/ZIP: g 49 e. 7 o / Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) ) - 9 Fax: ( ) toilet compartments, utility rooms) / 6.80 .- or• -s y_ar Y . zj' 7 ' - t - ee : .. x ` , n 7A ®_ ' . ?. ,, P P_& ,l, r !9' -'4,1'.;.,:-.'` ` ®C F13C P SO .i 7 t - ;, . , Attic /crawlspace fans 10.00 Other: 10.00 Business name: �G© 0 x t W � q t f ' b Fuel piping Contact name: S Ue S'o -f ' ' $5.40 for first four; $1.00 for each additional Address: //44.0 ..) Furnace, etc. Gas heat pump City/ State/ZIP: / ' 9 1/ OR Z S Wall/suspended/unit heater • Phone: ( 3) ' � ' 2 � . Fax: T (�"� .,2 ) 5ZL, i / Water heater 7 Fireplace I E -mail: 1:11.,.;'; „`� `i' � _ fr 4 i o , a� .. �irsrG�°.w .- ., :. •• Range j .,,r- 's�: ;5 4 0 �” R .. : # ..� s �:. - � *.�.t+ .r..ar...� ^� -a3 �";i s' ,,...„9.7:,.;.„ r�.�r�:f`ty Barbecue Business name: �dp e0 Q l i d n . p 2 f5 I + Ai Clothes dryer (gas) AP ) Gam`" °� Other: Address: See l�� ' , r i .. -•.,' t;;:,;,t: City/ State/ZIP: Subtotal Phone: ( ) Fax ( ) Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: ` J / � Yl " State surcharge (8% of permit fee) Frs TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: I Date: • Fee methodology set by Tri- County Building Industry Service Board i:\ Buildin ¢\Pemits \MEC-PennitAoo.doc I2/03 • 44£1 - 46 I7T /II /n7Jf./1M/WRRI Building Fixtures . Itlumbing Permit AsrairtetiWill FOR OFFICE USE ONLY S tl--- City of Tigard , a'\ / ( 44 A Received Date/By: Pennit Nx/l Grgoe) 1.1-cr034 c 13125 SW Hall Blvd., Tigard, OR 97223 ,?((-'); , .; Plan Review Phone: 503.639.4171 Fax: 503.598.196G\ ''' - r p, NT--`,\ A_ 1 ,'!' 1 .411iAlli Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 ,--. Or ` _R_Ij ell I' Date Ready/By: kris: Eil See Page 2 for Internet: www.ci.tigard.or.us " OMS'Z" --.. Notified/Method: Supplemental Information .:. :*: 1..." .1 '; . :' , Itiiii 14 0F.VoRk . , • .-'*: X ' .".":2: :I" ,,..:q .,',, .: ,. ''''.-- - 1. ';; 1 : . kg*:-SCIMP,T‘IiM"::. 0 New construction I 0 Demolition For special information use checklist. Description I Qty. I Ea. I Total X Addition/alteration/replacement 0 Other: New 1 - 2-family dwellings (includes 100 ft. for each utility connection) 0'8iiq 4:00tiVii00K. ,..:..: ,.,. SFR (I) bath 249.20 and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00 SFR (3) bath 399.00 0 Accessory building 0 Multi-family Each additional bath/kitchen 45.00 . El Master builder I 0 Other: . Fire sprinkler ( sq. ft.) Page 2 .,-' ' mit*Ani&v.1,4*If - ii;An , 1fiOrg • 7 .'.,•%:;`). . sr c.'' . ' ' 7 'i`■ ' ',:.' " - ..,:! 1 Site utilities Job site address: / 2,e4 5 Eldle-ri Leff Catch basin or area drain 16.60 City/State/ZIP: 7701 4 4 r 4e 7/143 Drywell, leach line, or trench drain 16.60 Footing drain (no. linear ft.: ) Page 2 Suite/bldg./apt. no.: f Project name: Manufactured home utilities 110.00 Cross street/directions to job site: • Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: /YY 1,1 m i ds ik z, . • 1 Lot no.: 2 . 3 • Fixture or item Tax map/parcel no.: 2.5 /04 0210 . gZa54 656 Absorption valve 16.60 '..';- ''',";: :". ...t • '1 ,, TIO I O "4DESCRPN AV •• '..; 'A' '''''''".', . ' - '''..' 15 , ' ' --- ' ' ' ; . •,-. ,.., ..- , ■,... .,._ :•,... - :.:' - .-, .,..,„.. : - ,, Backflow preventer Page 2 l'intckt c•-( Crawl 51odqe-to Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain • . 16.60 krlidfiktfik ,,, _ di 1-., '.. . , t - 14!'jiNA14i' . .'"'-'.; .' .. .. : 1( ; ''' J i!' ,, t ' . :"..- ' ' • o ' '' '''' '' ' ' ' ''''''''' '''-- ''''' ' ' '' . - ' ' '• - • A: Ejectors/sump 16.60 Name: Rig- re w Acalevs Expansion tank 16.60 ■ ./ Address: Z..t:71, g . i g a r t iakt 4 1. K Fixture/sewer cap 16.60 City/State/ZIP: ,;,„,„/ 0 € 9770/ Floor drain/floor sink/hub 16.60 i Garbage disposal 16.60 Phone: 911 ) 395- eiPk,‘ Fax: ( ) _ , '7`'.' - k • ...ci ir' :' .1•-.;„,:•.,;:e ‘• .., ■ : , ,,,, ;-.! ;,t Hose bib 16.60 1 ql,„ : ' -:. . ?::': '.`: •,, ''-'. ::97T*TACT P ERS ON ' .`..1' Ice ma 16.60 Business name: Interceptor/grease trap 16.60 Contact name: Medical gas (value: $ ) .. Page 2 . Address: Primer • 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Sink/basin/lavatory t 16.60 Phone: ( ) Fax: : ( ) Tub/shower/shower pan I 16.60 E-mail: Urinal 16.60 - :' ,4W.:4!-41,...:44 ,,',' l' r.,' ::,,..: ..,.... 4 , .,". .:, :!,..:' • , ' 1:-=','.V. Yk!'' :',.!!;'...`. ' I? A ,.;.,' ..,;,, . - , Water closet f 16.60 Business name: Theri„,tt Tyt,,,,pibiv Water heater 16.60 Address: '?OT' 5 4 0, /) 11,4 Other: Subtotal . City/State/ZIP: fiat tee - km O 17cob Minimum permit fee: $72.50 Phone: ($03) 4,45 44.13 -...... Fax: ( ) 43.7 5311 Residential backflow minimum permit fee: $36.25 CCB Lic.: /044 51,-. / Pluthbing Lic. no.: .?4-2-'? / M Plan review (25% of permit fee) State surcharge (8% of permit fee) Authorized signature: c r... .00.. , 4 . C / / ,, 0 ( - Op TOTAL PERMIT FEE Print name: - ,1--g . ,1/4/ / , Date: If - 3 ..... 0 4 - This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. B.BuildinePermils NYLMF-PcnnilApp.dot 12/03 440-4616T(i WM/COM/WEB) Nov 04 04 09:41a Nestor 503.982.0926 • p.1 11 /tlq /Ltlt34 titf:'L'e , btl Z • SLUI 1UU &Db. & Utb. PAL*. 151/171 EIVE • Electrical PC>r>utlit App C FOlt OFFICE I;SF ONLY • City of Tigard Received Permit No �t S i -d r) 3 `I Ce • :3:25 SW Hall Blvd., Tigard. OR 97223 NOV 0 d elm Review 1 none: 503.639.4171 Fax: 503.598.1960 ! t t elm Othei Perna: OF Ti Inspection Line: 503.639.4175 CITY p - 4- '_ / pan Rudy/81: ►'fl: el See Pate 2 for Internet: www.ci.tigard.ocus . it Notified/Melhod: Supplamenteltlrrermse&ola TYPE OF W iUISIE PLAN REVIEW • 0 New construction 'Additiodalteration/raplaoement Please cheek aU that apply: Demolition ❑Other: " ❑Service over 225 amps, eomtn'I ❑Hazardous location • ❑Secvtce over 320 amps - ca ❑Buildng ove:10,000 sq. ft, • CATEGORY OF CONSTRUCTION of 1- and 2-family dwellings 4 or more new residential • Igr I- and 2- family dwelling ❑ Commerciallundustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi-family p Master builder [] Other. ❑Bugdingover three erotica ❑Fecdere, 400 amps or more JOB SIZE INFORMATION AND LOCATION ❑Occupant load over 99 paeans ❑M ctured immures or ❑Easfl R igbiing plan park ; : l Job no.: I Job Site address: f Ze73 �,1) e1 Pld 14,,E :Wealth-care facility ❑Other. Submit a setts of pleas with any of the above. { City/State/ZIP: / x The a are not applicable to • F T� pp temporary construction service. • Suite/bldg. /apt. no.: Project name: FEE` SCHEDULE Percripiva I Ob. I • Pea I tent I . ' Cross 91 to job Bite: New residential tingle or matIti 1amJl y dwelling unit jj Includes attached garage. 1,006 s sq. ft Of IC 1 il 4 Subdivision: / r / / K� Lot no.: Ea. add'I 500 eq. ft. or portion 1 /'/ 7� ,���` 5 �� Limited energy, residential 75.00 2 Tax map/parcel no.:Z. 3 d14 -PO () d 4 se , Limited eat edgy, non-residential 76.00 33.4 2 b)ESCRIPTION OF WORK Each manufactured or modular - ' r / '7 dwelling service and/or feeds 90.90 _ 2 n1 5 ► e� w Q J" 7 7�� Services or feeders fa auWtioa, alteraU On, and /or relocation • - 200 amps or less _ 80.30 2 • 0 PROPEitXY OWNER ❑ TENANT 201 arcps to 400 amps 106.85 2 401 amps to"600 amps 160.60 2 - Name: .,�ec�► 400. # `s 601 amps to 1.000 amps 240.60 - 2 Address: Z d'`Qs JgO I 'd i* t L )( Ovat 1,000 amps or volts 454,65 , 2 ar Reconnect only 66.25 2 City/State/ZIP: $ () -/ Temporary services or feeders tastalladon, alteration, and/or / relocation Mile: ( /) 1 4,,05 ^ 16,4 5 I F ax; ( ) 200 amps or less 66:85 1 Owner installation: This installation is being made an property that i own which is not 201 amps to 400 amps 100.30 . 2 intended for sate, lease, rest, or exchange, according to OILS 447, 449, 670, and 701. 401 empa to 600 amps ( 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per pawl 0 APPLICANT I ❑ CONTACT hE3tSON • A. Fee for branch circuits with . service or feeder feed f ee, e ach 2 6.65 2 • Business name: branch circuit • . B. Fee for branch circuits Contact name: without service or feeder fee. 46.85 2 - Address: V each branch circuit Each add I branch circuit 6.65 _ _ 2 City/State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 I 2 Phone: (d _ + - I Fax:: ' • Sign or outline lighting 53.40 2 E-mail: Signal circuit(a) or limited- • CONTRACTOR . energy penal, alteration, or • Business name: C - / VL Elect-xi C L , • extension. Detente: Page 2 2 Address: 50 ( 5. e // f D I Z 6 ;) n Each additional inspection over allowable In any of the above insg City /State/ZIP: (� pd!Juje." D 11°4 Inv estigatti ion k a 62.50 Q invon per bout (1 hr min) 62.50 . Phone: (503 ) (03 '6)45 I Fax: (563 ) ,3(/ --.2111-$14 Indusaial plant per hour 73 -75 cal Lie.: /.2976 / • .. I Electrical Lic.: c, I Suprv- Lic.: 5 46 ) 5 ELECTRICAL PERMIT FEES' t Subtotal Suprv. Electrician signature, required: 1,) / /O� �p 7 Plan review (25% of permit fee) J Print name: Ry4 g 6 tf' 7� f"7 r/ I Date: (/ d f/ .. .. t, Suite surcharge (8% of permit fee) TOTAL PERMIT PEE _ Authorized signature: } This permit appitutlea eapiras if a permit le at obssioa4 •.isain 580 : days after it bas beets aeceptad as complete ?tint Ky� gen JoJ6 H- I Date: 1/ - o.y- ( 'J L/ • Fee methedclogy set by' M ara •CoueryButldiaalndamServiceBo r " Number of inspections per permit allowed. 6'9■: 17101 •eo.ael,R IOWYCOfNwea • • CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639 -4175 MST 64-0 d 34, INSPECTION DIVISION Business Line: ( ) 639 - 4171 BUP Received Date Requested 3- 3 > AM PM BUP Location fa-0 i° di � /• �� Suite MEC Contact Person ( ) PLM Contractor, •h ( ) SWR UILDING Tenant/Owner , / ELC , 6 P � � �� ELC Foundation Access: ` Ftg Drain ELR Crawl Drain Slab Inspection Note : �/Z SIT Post & Beam Shear Anchors -LVLel. Ext Sheath/Shear -P Int Sheath/Shear Framing Insulation Drywall Nailing or < Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling o Other: cr) CD ART FAIL • ■ = ING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer I LA. /6 Rain Drains Catch Basin / Manhole � 1 '/ I , Storm Drain Shower Pan Other: LY=, ' PART FAIL M CHANICAL Post & Beam Rough -In • Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA /-1 Approach/Sidewalk Day / Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (- 3) 639 -4175 MST 2 06), 3 C A 6 INSPECTION DIVISION ' ' Business Line: - 03) 639 -4171 BUP Received Date Requested 3 � - AM PM BUP Location _ . : � - w Suite MEC Contact Person P ( ) PLM Contractor •h ( ) SWR BUILDING — Tenant/ le ei0-7 e -7 ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear C • FramingL -� �► ' /fit i Insulation Drywall Nailing Firewall Fire Sprinkler b Fire Alarm Susp'd Ceiling Roof ' - l / t k o llrq-C__ Ot , = 4ggr i Ts1 PASS PART FAIL PLUMBING Post & Beam Under Slab • ar • 'Er"' C L= _ 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 Ft ' Gas Line 3, Smoke Dampers PART FAIL ECTRICAL — Service Rough -In UG /Slab Low Voltage Fire Alarm / 1 PART FAIL Reinspection fee of $ required before ne ' :ctio . Pay at City Hall, 13125 SW Hall Blvd. El Please call for reinspection RE: ❑ Unable to inspect - no access ADA Fire Supply Line -1111111111111111111° Approach/Sidewalk fiats °s'sMs� MI/ arif Ext Other: Final DO NOT REMOVE this inspection record ro the job site. PASS PART FAIL