11045 SW COTTONWOOD LANE M
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11045 SW COTTONWOOD LANE
IMIMI"
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: 1639-4171 MST
�-�- ' / BUP _
Received �� !l. ✓�' Date Requested_�'��` AM_ PM— BUP
Location � uite_ _ MEC —_
Contact Person Ph( :574 ) �� �7 PLM —
Contractor _ —�— Ph( ) _ SWR _
BUILDING Tenant/Owner -- _ E C �Z_—00l 3 to
Footing
Foundation Access: ELC — --
Ftg Drain ELR _
Crawl Chain
Slab Inspection Notes: SiT
Post&Beam
Shear Anchors - ------ ,
Ext Sheath/Shcar
Int Sheath/Shear
Framing
Insulation
D
Drywall Nailing
Firewall
Fire Sprinkler ,,,( � (—•
Fire Alarm _ \ �
Susp'd Ceiling
Root
Other:
Final I -- 'A
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 -i— - �~—
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL -- -- ---- - - -
-ELECTRICAL I _
UG/Slab
Low Voltage
Fire Alarm
CaD
SS PART FAIL Reinspection fee of$ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd.
SITE Please call for reinspection RE:. E] Unable to inspect-no access
Fire Supply Line
ADA �;��
Approach/Sidewalk '= --- Ina A �'�'' Ext
Other:_
Final DO NOT REMOVE this Inspection mord from the Job e-
PASS PART FAIL
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 E I-E:C,T R.I C A 1 . PERMIT —
REG'TRICTEO F-NERGY
Pf=9M I T #:
DATE I,SUET' : 03/07/97
PAPCEI._ : 1 c-,1 40C--•O26�37
TE (1hI)F�F"G'i. ,. . , 1. 1045 93WCO1�T(�NWOC'f:' 110
'BD I V I S I ON. . . . : ENGLEWOOD NO. 3 7 Ohl I NSi: R-•4. C
ocK. . . . . ,• . . . . LOT. . .. . . . .
o,j ect Description: TNGTL SURGL AR 11LARM
RES IDENT TAt. ________.._ B.
nUDIfl 8 S-rF,RF.o. . . : AU1]1(? F :1"rEREO. . : INTERCOM R PAGiNO. .
BURGLAR ALr1RM. . . . aX POT LF'R. . . ,. . . . . . . : LANDSCAPE/TRRIGAT. .
OnRflor nr'rl,,E:R. . . . . C'LOCI% . . . . . . . . . . . MED Tr,nl.
HVnC. . . . . . . . . . . . . s DATO/TEeLE COMM. . . NURSE- CALLS. . . . . . . . .
VA(.'!_!I.1M CYSTF'M. , . , FIRC (1l ARM. . . — OUTnnflr I...ANDE)C 1. .Tf r
OTHER: : t HVAC. . . . . . . . . . . . : PROTECTIVE SIGNAL_.
I N9TRI 1MF"P,TnT'T ON, r nTHF:P. . ;
TOTAL # OF' SY STEMr:
type
mFEES
�_t
JAMES+Rf]ON.5 r_ry .p
e aont by
date reg t
1104 aW .nT ',1!IlJgn17 I hl PRMT 1 4.0 00 1AT i7 X7/97 ?7
PCT t E% 00 TAT 03/07/97 97-291.41
"aARD 0R '.77;:'
one #
contrartor:
!1 R I NE!, HOME '._if:R'L1R I TY $ 4;',. 00 TOTAI.,.
B059 SW CIRRos DR
- - _ --- REnU I RED I NSPFCT I ONr
SEAVERTON 11F' ❑ 711108 1"e i 1 i ng Cover E- 1 pct' 1 Ser v is e
Phone #: V--641--0574 Wall Cover Flec:t' 1 F"irial
'ley #•• . � tTiT���1��4
his permit is issued subject to the regulations captained in the
Tigard Municipal Code, State of Ore. Specialty Cnd*s and all otherPe+^m i.t i gnat I.Av,
applicable laws. All work will be done it accordance with J
approved pla*s. 'his permit will empire if work is not started /
" 16@ days of issuance, at' if work is suspended for mere
JA
a. '9@ days. Issued 1?y
_.. (1W1\ICF T N!3Tral-_l_A'T I ON ONLY-_._.._._ .. _.
'he installaticrn is being made on property I own which is not ir,ts,n 'ed for
l.e-.ase, rat• r-ent,,
"1WNF-R' S T GNAT(IRS': DATE a
- - r:ONTRACTOR T!dr-TAI 1 .0TION QN11_Y.
TCS"J/�TI_IRE"
nF 7UPR. E(_.EC' N: _ DATE_:
Call for inspect. ion - 6:39--4175
. .
Community Development RESTRICTED FNERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd.
Tigard,OR 97223 PERMIT#_ w
*....-� Phone(503)639-4171
FAX(503)684-7297 DATE ISSUED---
TDD
SSUED_TDD No. (503)684-2772 f
CITY OF TIGA,RD Inspection (503)639-4175 ISSUED BY
PLEASE COMPLETE ALL SECTIONS
1. LOC 'ION OF INSTALLATION 4. TYPE OF WORK
A /• / � rtf_SIDENTIAL--Restricted
OR LL YS NMS)
ee . 140.00
Cil; Sta a Zip Chfsk Type of Work Involved:
PERMITS ARE NON-TRANSFERABLE%ND NON-REFUNDABLE AND EXPIRC IF WORK ❑ Audio and Stereo Systems
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR � _`
180 DAYS, burglar Alarm
2. CONTRACTOR APPLICATIOIy,�� ❑ Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
ContraEto °� 'Type Vacuum Systems*
Address L9 a Cyt �� . �r�ZC f-d �' • El Other -- -
Date _ COMMERCIAL—Fee for a uh system . . . . . . . . . $40.00
�i� (SEE OAK 918-260-260)
Property Owner -� �'►`-'�' Check Tine of Work Involy�;
Contractor's Board Reg.No. 7 Y 1(.( ❑ Audio and Stereo Systems
I � V d ❑ Boiler Controls
Phone# lL `( ('' S 7�/ ❑ Clock Systems
3. OWNER APPLICATION Cl Data Telecommunication Installations
❑ Fire Alarm Installation
❑ HVAC
Print Owner's Name Phone No ❑ Instrumentation
Address ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
City State ti, ❑ Medical
This permit Is Issued under OAR 918.920.21M This applicant agrees to make only ❑ Nurse Calls
restricted energy Installations(1 00 volt amps or less)under this permit and to do the ❑ Outdoor Landscape Lighting*
following.
1. Only use electrical licensed persons to do Installations where required.(Certain ❑ Protective Signaling
residential and other transactions are exempt from licensing These have ❑ Other —,
asterisks(*).All others need licensing).
7.. Call for an inspection when all of the installations under this permit are ready
for in,per3ion at 503.639-4175. ❑ Number of Systems
1. Purchase separate permits for all Installations that are not ready for Inspection
when the inspector is out to inspect under this permit •No licenses are required. Licenses am required for all other Insfallatlons.
4. Assume responsihility for assuring that all corrections required by the Inspector --------are done,and
5. Assume responsibility for calling for a final inspection when all of the S. FEES
corrections are completed. 7�
The person signing for this permit must be the applicant or a person a. Enter Fees $ _
authorized to hind the applicant. -1
b. 596 Surcharge(OS x total above) $ O�
Signature __JX TOTAL $
Authority if other than applicant
- ------
ENFRGAP.CHP
CITY OF T I C A R D ELECTRICAL PERMIT
DEVELOPMENT SERVICESPERMIT#: ELC2004-00136
13125 SW Hall Blvd., Ticiard. OR 97223 (503) 639-4171 DATE ISSUED; 3/22/04
SITE ADDRESS: 11045 3W COTTONWOOD LNPARCEL: 1 S134AC-02637
SUBDIVISION: ENGLEWOOD NOA ZONING: R-4.5
BLOCK: LOT : 194 JURISDICTION: TIG
Project Description: Circuit, recepticle and light in gazebo
RESIDENTIAL UNIT TEMP SRVC/FEEDERS -----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).
y� SERVICE/FEEDER - __ BRANCH ;IRCUITS 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 arnp: 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 APAPS: _ CLASS AREA/SPEC OCC:
Owner: Contractor: `
ROOKS, JAMES A+ RITA R CO-TRS OWNER
11045 SW COTTONWOOD LN
TIGARD,OR 97223
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
(h.LPk�4"f� IiCt'[let-11111 { 11 n.1 $46.85 ----
[TAX 18",,State Surcharge s 2222 W $3.75 Elecl'I Service
—. Elect'I Final
Total $50.60
L
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 wil!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 requin;s 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 ordirect questions to OUNC at(503)
246-6699 or 1.800-332-2344 i
Issued By: /, ; Permit Signature:
OWNER INSTALLATION ONLY
Tlie 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: _ _ TATE:
LICENSE NO
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Appa. �V
Citi' of Tigard Received
DataB : Permit rJa D���/.�%3
13125 SW Hall Blvd.,Tigard,OR 97223 t �1 004 Plan Review 1�Y /
Phone: 503.639.4171 Fax: 503.598.1960 MAR r Date/By: - Other Permit
Inspection Line: 503.639.4175 Date Ready/By: lwu 0 See Page 2 for
Internet: www ci tigard.or.us Y o) - I IUA Notifced/Method _- — Supplemental Infurm.. n
PLAN REVIEW
El
New construction ❑ Addition/alteration/replacement Please check all that apply:
�] Demolition t_]Other ❑Service over 215 amps,comm'! []Hazardous location
_ -_- _--, ❑Service over 320 amps-rating ❑Buildng over 10,00t'sq.ft.,
CATEGORY OF CONSTRUM. ON* of 1-and 2-family dwellings 4 or more new residential
[] I..and 2-fancily dwelling, ❑Commercial/industrial ❑Accessory building ❑System over 600 volts nominal units:h one structure
❑ Multi-family ❑_Mbuilder aster ❑Other ❑Building over three stories 07eeders,400 amps or more
[]Occupant load over 99 persons []Manufactured structures or
JOB 5 INFORMATION AND LOCATION -— ❑Egress/lighting plan RV park
--`-— Health-care facility ❑Other:
Job no.: job site address: �� fG,S iV el, j l"i"t11i'cziSubmit,L sets of plans with any of the above.
City/State/ZIP: 77 4'-4/L n U t2 (772- 2--3 The above are not applicable to temporary construction service
C K GA F.EE" SrHEDULE
Suite/bldg./apt.no.: Project name: --
_ �r Description Qty. Fee. Total
Cross street/directions to job site: New residential single-or multi-family dwelling unit.
-_-- _ Includes attached garage. _
1,000 sq.R.or less 145.15 4
Subdivision: Lot no.: Pa.add'I 500 sq.ft.or portion 33.40 1
-- -- - Limited energy residential 75.00 2
Tax map/parcel no _ Limited energy,non-residential 75.00 2
FWb
RKRI O ' Each manufactured or modular
----` %
� dwelling,service and/or feeder 90.90 2
RV;r '91V ,C,tilt'fid/r/}4—/�6-ut r W i AJ Services or feeders installation,alteration,and/or relocation t
f 7' r A � 200 amto ps less - 80.30 2
- ° ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amp., 160.60 2
Name: J-'q tyVis' A r l ay K S 601 amps to 1,000 amps 240.60 2
Address: % O f is✓� L7pTla'� W Otau A.Al, Over 1,000 amps or volts 454.65 2
Reconnect only 1_66.8., _ 2
City/State/ZlP: / 6-440, 04 1 Z y Z� / Temporary services or feeders Installation,alt.�ration.and/or
relocPhone:( y't3 ) SSo-o s"7b Fax:(Sy3) Z--`� - st 4-0 200 action _ _
_J .� mps or less 66.85 I
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,r t,or exchange,accord to ORS 447,449,670,and 701 401 amps to 600 amps 13 3.7 5 2
Owner simiaturr- `. '_ Date:'36-" Branch circuits-new,alteration,or extension,per panel
❑ LIrAN r ❑ CONTAre 1 ERSON A.Fee for branch circuits with
-.--------- ----- ------ service or feeder fee,each
6.65 2
Business name: branch circuit
-- -- - -- -- - --------- B Fee for branch circuits
Contact name: without service or feeder fee, ' 46,85 2
- - - - each branch circuit
Address: Each add'I branch circuit 6.65 1 2
City/State/ZIP: Miscellaneous(service or feeder not Included)
-- - Pump or irrigation circle 53.40 2
Phone:( ) 1 ax ( Sign or outline lighting 53.40 _ I
-
E-mail: —
Signal circuit(s)or limited-
--- ^r - - ---- - -- energy panel,alteration,or
- extension.Describe Page 2 2
HU1ihCSB 11at1'�: � ,
Address: -gyp f Each additional inspection over allowable In any of the above
---- - .- - Per inspection 62.50 I
City/State/ZIP: Investigation per hour(t hr ttun) 62.50
Phone:( ) Fax:( 1 Industrial plant per hour 7175
ELECTRICAL PEMIT •
CCB Lic.: Electrical Lic. Suprv.Lic.: _ Sub,,tal L `
Suprv.Electrician signature,required: II Plan review(25%of permit fee)
F State surcharge(11%cfpermit feel 4P.. Z
Print name: Date:
_ TOTAL.PERMIT FEE
Authorized signature: rhis permit application expires if a permit It not obtained within 160
days after It has been accepted as complete
Print pante: Date: Fee methodology set by Tri-County Building Industry Service Board
-- Number of inspections per permit allowed.
i\BuildinitTermiWEL.C•Fertna,vpdoe 1710) 440•461ST(1(W21COWWES
i
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WOV K ONLY: —
Fee for all re-idential .ivstems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door O?ener*
❑ Heating, Venti ation and Air Conditioning
System*
❑ Vacuurr Systems*
❑ Other:
COMMERCIAL WORK ONLY: '
Fee for each commercial system....................... $75.00
(SEE OAR 918-200-260)
Check Tvae of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fir; 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
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