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11933 SW ELEMAR CT �,
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Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, CR 97223 Planck/Rec. #
Permit # ,E")c YS- 0 35b'
Phone (503) 639-4171 Date Issued _ .2 32Z!5
CITY OF TIGARD FAX (503) 684-7297 Issued LY _ �
TDD No. (503) 684-2772
Inspection (503) 639- 175
1. Job Address: i 4. Complete Fee Schedule Below:
Name of Development _ , —`_ Number of Inspections per permit alit- ad —
h;UfeSS !/933 I�FL /I17iS4� C�• SHrvlc,e inc;lu;.,J lt�ms Cost(ea) Sum I
Clfy/State/lip_ 77 G-4a,7b 2 4a. Residential- per unit` 4
1000 FA It or lose _L $110 0
Name (or nanip of business) Each additional 500 so It or ,
(��'�� portion thereof $25 00 �
f Omr118fClai ❑ Residential 1_'.f Limited EnofN $2500
Each Manufd Homo or Modular
Cwplhny Service or Feeder $Bel 00
2a. Contractor installation only:
4b.Services or Feeders
(` 77�� Imlallahon.arlpiation or rotocation 2
Electrical Contractor �—CIV ) ��� �r /'f 200 amps or 1066 $s0 OQ 2
Address -sV t- c1G 201 amps to 400 amp6 $8000 2
— 401 amps to 600 amps $12000 2
City State Zip _ 601 amps m 1000 amps $10000 i 2
Phone No. -7-3-r- 703-- Over 1000 amps or Voll, ^_ $34000 2
rontractor's License No. -? 5� — ( 9 S`a Reconnect only E5000
1,ontractor'S Board Reg. No. G7 2/7_ _ ! Ac Temporary services or Feeders
r Installation nheraoor or relocation 2
Signature of Supr. Elec'n �j re>r ( 200 amps or less $5000 2
License No.�!
'91!L, _ Phone No. ; 5� 5�72'�S I 201 amps to 400 amps $7500 _
.r— 401 nmpa to POO amps $10000
VVer,—-rips f0 1000 Vohs --�
2b. For owner installations: sef •b•ntxwo
4d. Branch Circuits
Print 0WnQr s NdrTlf` J� New aheralion oi extension per panel
Address a)The fee for branch assets with
City State Zip_ pumhass of amlhe
ce or ader M..
Each branch arced $5 00
Phone No. _ _ b)The rep for branch circuits wfthour
The installation is being made on property I o::r Which IS purchase of service or Moder Ms.
_
not intended for sale, lease or rent. Ernst branch circuit $35 00
Farh add4loral bunch grant $5 00
Owner's Signature _ ` 4e. Miscellaneous
(Service or leader not included) 2
3. Plan RAview section (if required): Each pump or irrigation dude t40 0
Each sign or outline Inghbng $40 on
Signal arcuh(r)or o limned energy 7
Please check appropriate item and enter fee in sec.:on 5B. panel.airvaton or extent on $4000
4 or more residential units in one structure Minor Labals(10) $100 00 —_
Service and feeder 225 amps or more
_System over 600 volts nominal I 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 E'er Inspe 1.0" $3500Per hour -- M5 00
In Plant $S500
Submit 2 sets of plans with application where any of the above --
apply. Not required for temporary construction services. 5. Fees:
NOTICE 5a. Enter total of above tees 3 —,
---- 5%Surcharge(05 X total fees)
PERMITS BECOME VOID IF WOE, 'OR CONSTRUCTION I Subtotal
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Entpr 25%of fine A for
CONSTRUCTION OR WORK IS SUSPENDEC OR ABANDONED FOR Plan Review if required(Sec.1) $
A PERIOD OF 180 DAYS AT ANY TIME AFT:R WORK IS Subtotal $
COMMENCED. ❑ Trust Account 0
�alanre Dtfe $
.Mrc.exwwwc vT�o
MASTER PERMIT
PERMIT #. . . . . . . . MST940406
CITY' OF TIGARD DATE ISSUED: 04/10/95
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)630.4171 PARCEL:
.)DIIRL.55.
1_a).L ,vISION. . . . . ASPEN RIDGL. ZONING: R-4. 5
OCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .004
DUILDING ---
3SUE.- DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 s f
ASS OF WORK. %NEW BEDRMS:3 BATHS:.?, GAROGE. . . . . . . . . . :0 Sf
IPE. OF UILA'. . . :SF r1_0nR riREAt3 - - - RE(7U I RED
'PE OF CONST. : FIRST. . . . :290-3 5f LEFT. 33 ft RIGHT. :: ft
CUPANC ORP, :R3 : EXOND. . . : 1 19b s FRONT. '33 ft REAR. . :0 ft
DRIES. . . . . . . .2 r I NBSMENT:1,� S f REQU I RED--
I GHT. . . 1'7 ft TOTAL 100 5 f r3MOKr DETECTORS.
OOR LOAD_ . -.40 Fra f VALUE. PARK 1N SPACES. . :0
,mAr%ks - PATH I
r'L.UMBTNG
N V,�.... . . . . . . . . . 1 41 FLOOR !,RAINS. . . . :0 BACVrLCW PR17VNTRS. . I
)VATORIEE,. . . . . -5 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
SY1r7,WER5. . . . .4 LAUNDRY TRAY'?. . . - 1 COTCH Bi7jaINO. . . . . . . :0
WATER CLOEiETS. . :3 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
T73HWA7j11ER!.5. . . . : 1 W(�TEA i_INE (ft ) , :0 OTHER FIXTURES. . . . . :0
)(4BAGE DIS3P. . . el RAIN DRAIN (ft ) . :0
7H ING, MArl-J. . . 1. 5F RAIN DRAINS. . :0
MCCHANICni_ FFES
P-1— TYPErUNIT 14TRS. . :0 type Amount by date v-ecpt
AS/ VENTS I . . . . . :0 T I F* f 1`50. 00 JD 04/10/95 95--264013
,X INPUT 021 BTU VENT I—ANS. . :7 5 P r,T t 3£36'.1. '10 JD 04/10/')5 9 5 401:
I RN ( 1001-1, :0 F1 C)0 D S. . . . . . : I SPL(- $ 33 JP 10/21/94 94-258048
JRN ' 100K . . sl WOODSTOVES tO n 15)P(- f 44. 0? JD 4')4/1.0/9~ ^'' 4177i !
`80. 00 J D 1x4/1271 '95 9 40 !
DOR FURN. . . . 30 CLO DP'(r-Rq. . I SSDC f, I
]IL/(.:MP ( '31-41^'..0 on-;ER UNITS: I [DARKS $ 500. 410 JD 041101"5 97 6 If.013
GAS OUTLETS; l MPRT $ 48. 00 JD 04/10/95
-MPI.._c $ 12,. 01;1 JP 04/10/15 95- i='( 40
ORGE SAYLOR M5PC $ 2. 40 JD 04/10/95 95--.2&401
`333 ISW 11. 7TH AVE 3STIA t 00 JD Q14/10/95 95-264013
PriPc $ 11. 25 JD 04/1271/95 95--2 44_'113
NCOVr_R WA .J'03-I'3700000 Eric- $ 05. 00 JD 04/10/95 95-264011
long #. ERPC $ 28. 60 JD 04/10/95 9.5-26412113
nti-z,r.to,-: E,RPC S, 61T. JD 0,4/10/95 95' 264017
CIFTC NW HOUSING
IST NE 717T1 I
,NCOVEr WA 98684
one 206 - 144 -1092
70 " 1,2
4i72,70. -71 TOTPI..
s rervit is issdel subject to the reg-jiations contairind in the R17'QUIRED INSTIEC'TIONE7
Bard Municipal Cede, State of Ore. Specialty Codes and all other root /found Insp Fit-eplace Ins
•Iicablv laws, 01" work will be dole in acre dance with approved Rost/neam struc:t Gas Line Insp
ms. .ims pareit will expire ifw:,,,,di,fnot started within IN Post /seam Plechan Insulation Ins
p
is ;aspen t'a- 180 days, Gyp Poar-d Insp
s of issuance, or if v�, Plm/uridslab Ins[
1--ILM/Undei-f I oar, Pain drain Insp
I i :a I T 11 S f,
Q r- L i n e 1 1)
Appr/';dwlk Insp
Pli-imb Top Out
ly
rt*aivinu Tti-,p FiT)al
Call fot- insppction 6:y9-4175
CITY OF TIGARD SEWER CONNECTION
PERMIT
PERMIT #. . . . . . . : SWR94-0359
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 04/10/0--
1312F,SW Hall Blvd.Tlgard,Oregon 072230199 (503)639.4171
PARCEL: 2S1IO19D-03900
TTE ADDREI-14-- : 11933 SW ELEMAR C1
� JBD I V I S I ON. . . . : riSPEN RIDGE ZONING: R-4. !-:.
. . . . . . . . s LOT. — . . . . . . . . . :00+4
TENr(NT NAME.
;5A NO. . . . FIXTURE UNITS. . .
1-ASS,33 Or' WORK. NC-*W DWELLING UN1TS. . : 1
7Yr-',E OF USE. . . . . ..SF NO. OF 19UILDINGS: 1
11\13TA1_L TYPE, . . . -SUSWR 111PERV (73URFACE. S f
RemE.ir-ks : PATE' I
FEES
-ORGE SAYLOR ty,Pe am()ikrt toy (j At e 1-fvc=pt
1933 SW 117TH AVE PRMT $ 2200. 00 JD 04/10/95 95-26401
IN13P $ 35. 00 JD 04!10/95 95 2C,40
'iNCOIIER WA 50'". -`09-000
,nrie #:
?NT RAI::TOR NOT ON FILE
4: $ 222235. 00 TOTAL
Re t, 0.
REDUIRED INSr,ECTIONS
This 4Dplicart agrees to roeplf with all the rules and regulations Sewer Iits fiec:tiran
of the Unified Sewage Agency. 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 p,irrhase
a "Tap and Side Sewer" Permit and the erc
wild
install a later 1.
I i t; t e
c11 f*ni- inspec:-t iori 639-4175
Residential Building Permit Application c 1. cl,
City of Tigard
13125 SW Hall Blvd. CG.,GCQ
Tigard, OR 97223
(503) 6394171
Jubsite Address: pqr `�� G In,911 a K-
Subdivision: 4-a2a RAA- Lot 0 Office use OnY 1
Valuation: Pemiit#&5t5q- 04
#
Corner Lot? Y
Reissue of
Flag Lot? Y �
Map & -i-L# �'�_ ]�(� ��,p
Owner: ��� U auprovals Required
Address: ---- Planning fr. -
---- Engineering
Phone: Other
Contractor: //4C/F-/L. L'CJ 'U Items Required
Address: l OF // ) T/, Au e, SUbccntractors
i
� Ute/1 C., "A 2 r6
T(USS Details
Phone: �U ? � $."-� �r � 1� .�
\ \ �1 Other
Contractors License # 1 � ?
(a 1,opy of current Oregon license)
Contact Name & Phone: 116 u,�,, -D?01/ 12,
Subcontractors: Arch itect/EngIneer: 5!6<�
Plumbing:
4-7'120 1 (� Address:
Mechanical: ,Tyu/2 -ASQ r
(attach copy of current OR Contractor's License) �--�2- )
Phone: � -� ` 3 e �
JOB DESCRIPTION:
1
_ L
Applic int'-sidnature & Pho umber
Received b, _ Date Received:
Permit # Account Description Amount Amt. Pd. Bal. Cae
U U6 Bldg. Permit (BUILD)
Plumb. Permit (PLUMB) Z25
Mech. Permit (MECH) LILY,00
State Tax (TAX) 57(,,K Ll 5 •G+
Bldg: 44.u S
Piumh:
Mech:
Plan Check (PL�NCK) Sir 3 3 } u 3 3`1•-33 ✓ u
Bldg:
Plumb:
Mech: _ 1�2• L j
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP) 3 ,"
Parks Dev Charge (PKSDC)
Storm Drainage Chg (SDSDC) - =
Residential TIF (TIF-R) 1,4 / 3
Mass Transit TIF (TIF-MT) ,I -r 1_.y____
Commercial TIF (TIF.-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-O)
Water Quality (WQUAL)
Water Ouantity (WQUANT) �c�i _ /So
Fire Life Safety (FLS) Z 6)C)
Erosion Cntrl Permit (ERPRMT) ,Yk
Erosion Planck/USA (ERPLAN) )tr-,°
Erosion Planck/COT (EROSN) ?b 0 31T Go
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TOTALS: G'S"v i.7 , � � �' � lSS. )(/"
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CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Nall Blvd., Tigard,OR 9727.3 (503)639.4171
CERTIF=ICATE OF
OCCUPANCY
PLRMI T ii. . . . . . . r MST94-•0406
DATE ISSUED: 04/04/97
FIARCELf 2Si1goBJ)-•03900
SITE NDDRESS. . . s 11933 ,W ELEMAR CT
SUBDIVISION. . . . s ASPEN RIDGE ZONING 1 R --4.
BLOCK. . . . . . . . . . 1 LOT. . . . . . . . . . . . . 1004 JIJRIFDICTIONeTIQ
CLASS OF WORK. t NEW .,.._.�_.___..._.._...._...__... _.
TYPE OF USE. . . 1 SF
TYPE OF CONSTRI!jN
OLCUPANCY GRP. s R3
OCCUPANCY L.OAD12
Remarks s PATH I
Owners
GEORGE SAYLOR
11933 SW 117TH AVE
VANCOVE R WA 503--300000
Phone #s
Contractors - ___.__..,�_..._.___.__..._.. ._.. �._.__.__..._..__. .....
PACIFIC NW HOUSING
121ST NE 117TH
VANCOVER WA 98684
Phoirp #r 206•-944--10W
Bey #— :
1 702 1
It—.Js Certificate grairt s occ'upancy of the above referenced bui ldinq or port i Dn
thereof and confirms ttiat ths building has been inspected for compliance with
the State of Oregon Specialty Codes for the groL occup ncy, and use under
which the r'•eferenced permit was issued.
i
'.
_ Y,,, & _. ..._...._... .---
PU T-D I NEa NSPEC T OR i1 Lb I NO OFFICIAL
.4
POST IN CONSPICUOUS PL.AC�
i
ELECTRICAL rERM1T
C11Y OF TIGARD RESTRICTED 1�`_'NCRGY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: ELRib-0231
13125 SW Hr 11 Blvd. 7,igaro,Oregon 97223*8199 (!,03)839-4171 DATE ISSUED: 1,1/11/955
PPRCEL: 2S110i-AD-03900
is TIZ ADDRLSS. . . : 119.3-7 W ELEMAR CT
JBDIVISION. . . . . (;SPEN RIDGE ZONING:R--4. 5
_OCK. . . . . . . . . . : LOT. . . . . . . . . . . . . .004
)-olect Description :
RESIDENT B. COMMERCIAL-
I')UDIO & STEREO. . . : AUDIO & STEREO. . : INTERCOM & PAGING. .
.6URGLAR ALARM. X BOIl._ER. . . . . . . . . . : LAND SCAPE/IRRIGAT. .
GARAGE OPENER. X CLOCK. . . . . . . . . . . .. MEDICAL. . . . . . . . . . . .
IYAC. . . . . . . . . . . . . . DATA/TELE COMM. . i NURSE CALLS. . . . . . . .
)ACUUM f3YS3TFM. . : FIRE ALARM. . . . . . : OUTDOOR LANDSC LITE:
)THEE.- 3 F I IVAC. . . . . . . . .. . . . : PROTECTIVE SIGNAL— :
INSTRUMENTATI ON. 3 OTHER. . :
TOTAL # OF SYSTEMS: 0
FEES
ELECTRIC type amount; by date rec:pt
424 1\1 MICHIGAN AVE PRMT s 40. 00 CJS 12/11/95 95--27374'..1
5PCT 00 CJS 12/11 /95 95-27374u
fIRTLAND OR 97217
cont, #: 503-71-:55-47051
.)ntrActor:
13NITRACTOR NOT ON FILE 40. 910 'TOTf-il-
REQUIRED INSPECTIONS
C,e j. I i n q Cover Elec-t, I Gervic:f?
Wal I cover Fleet ' I Final
. is oermit is issued sub)ect to the regulations contained in the
!tgard Municipal Code. State of Ore. Specialty Codes and all other Flermitee5iqrlatL1re
avolicable iaws. All work sill be done in accordance with
Mroyed plans. This pprgIt "III expire if wnrk is not started
within 180 days of issuance. or if work is suspended for sore
than 180 days. 15sk.ted Sv
INSTAI-LATION
The installation is being made on property I own which is not intended foi-
sa I e, lease. or rent.
014NER1 S b I 6NATURE DATE:
L AT I ON ONLY
It GNATURE (IF SUVIR. ELECT N DATE
I.CENSE NO%
Ca I I for insE)Pc,t ion 6,3,941 _75
Community Development RESTRICTED ENERGY ELECTRPCAL APPLICATION
"13125 SW Hall Blvd.
Tigard,OR 97223 PERMIT#alc)9S 0231 _
Phone(503)639-4171
FAX(503)684-7297 DATE ISSUED / -// - 9$
TDD No. (503)684-2772
CITY OF TIOARD Inspection (503)639-4175 ISSUED BY C/Sa�/cit Sc�.y►PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTZLTION 4. TYPE OF WORK
W,0� C�_
Address s-_'� 1 RESIDENTIAL—Restricted Energy Fee . . . . . . . . . 140.00�� � , _ (FOR ALL SYSTEMS)
City V 9tale Zip Check Type of Work Involved:
PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK E3 Audio and Stereo Systems
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR y
180 DAYS. ❑ Burglar Alarm
2. CONTRACTOR APP I ATI N Garage Door Opener*
Ze —•T/2�C19 �Heating,Ventilation and Air Conditioning System*
Contracto&2M &—e4 Type — — ❑ Vacuum Systems*
❑ Other
Address 1l
(
Date / Z" 3 " 91-57 COMMERCIAL—Fee for each system . . . . . . . . . 14,0.00
/�� (SEE OAR 918-260-260)
Properly Owner P � `---�____ Check I pe of Work Involved:
Contractor's Board Reg. No._� Z/'L ❑ Audio and Stereo Systems
�- ❑ Boiler Controls
Phone# �3��Z�� ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
_ ❑ HVAC
Print Owner's Name Phone No
❑ Instrumentation
Address ❑ Intercom and Paging Systems
❑ Landscape Irrigation Contrcl*
City State Zip _ ❑ Medical
This permit is Issued under OAR 918.320.370.This applicant agrees to make only ❑ Nurse Calls
restricted energy Installations(too 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 El Protective Signaling
residential and other transactions are exempt from licensing.l hese have ❑ Other
asterisks(*).All others need licensing).
2. Call for an inspection when all of the installations tinder this permit are ready
for inspection 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 are required for all other Indmllatiora.
4 Assume responsibility for assuring that all corrections required by the inspector
are done,and
S. Assume responsibility for calling for a final inspection when all of the 5. FEES
corrections are completed.
The person signing for this permit must he the applicant or a person a. Enter Fees $
authorized to bin 'i app)cant.
b. 5% Surcharge(.05 x total above) $_
Signature TOTAL $
Authority if other than applicant
ENERGARCHP