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Community Development ELECTRICAL PERMIT APPLICATION
3125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 99- A 89G3r
Permit # / - C"T 0A,�_
Phone (5G3) 639-4171 Date Issued =7 9,s-
FAX (1;13) 684-7297
CITY OF TIGARD TDD No. (503) 684,277" Issued by /���-!�r SCS,►.c.,/t _
Inspecticn (503) 639-4175
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1. Job Address: 4. Complete Fee Schedulo Below: �
Name of Development Number of Inspections per permit allowed
Address_%3,1z) 1 f, k 11 Service included: Items Cost(ea) Sum
City/State/Zip 4a. Residential-per unit +
1000 sq It o;Mas $11000
1 Name (or name of business) Fach additional 500 eq It or
3 - Portion thereof $2600 _ 1
Commercial ElResidenti'L Limned Energy 92500
Y' Each Manu1'd Home or Mudd r 2
y Dwelling Sarvaa)or Feeder 988.00
2a. Contractor installation only: 4b.Services or Feeders
_ Installation,alteration,or relocation 2
Electrical Contractures. �'�, S 1`G ECE G,1� f 200 amps or leas $150 00 2
Addre ScW k]GA � V 201 arr,ps to 400 amoF $8000 2
City-- ( _ Statesr;' Z_iOKHE 401 amps to 800 amps $12000 2
601 amps l0 1000 amps $180 00 2
Phone No. ��5 -
��,Yj� Over 1000 amps or volts $34000 2
Contractor's License No. (,j- i _ Reconnect only $5000
Contractor's Board Reg. No._ - 4c.Temporary Services or Feeders
i K lallation,afteretion or relocalion 2 i
Signature cf Supr. Elec'n_ jA A, y�� ' 200 amps or less _^ $5000 _ _ 0 j
7-- - ,.,� 201 amps to 400 scope $7500 2 t
License No. PI o e No.j) r�- fX i� 401 amps to eoo amps -- $10(300 �-
Over Wo amps 10 1000 volts
2b. For owner instattatlohs: see-h•above
i 4d. Branch Circuits
Print Owner's Name New,alroravon or extenoion per panel
Address a)The lea for branch circuits with
City State Zip psrchass of eerviee or Aeedc-Ars. 2
Each branch circuit $500
Phone, No._ b)The tea for branch circuits without
The Installation is being made on property I own which is purchase of service or Iveder fes. . 2
First branch circuit $3500 2 i
not intended for sale, lease or rent. Each additional branch circuit $500 r
„ Ovner's Signature _ _ 4e. Miscellaneous )
(Service or feeder not included) 2
3. Plan Review section (if required): Ench pump or Irrigation circle $4000 2
Each sign or outline lighting $40 00
Signal circuit(s)or a limited energy 2
Please check appropriate item and enter fee in section 5B. Panel,alteration or extension $4000 r
t 4 or more residential units in one struciure Minor I-abets(10) $10000
Service and feeder 225 amps or more I
System over 600 volts nominal 4f. Each additional inspection over
Classified area or stricture containing spar:ial occupancy the allowable in any of the above
^s described in N.E.0 Chapter 5 Per inspection -_- $3500 —_
Per hour $5500
9
Submit 2 sets of plane with application where any of the above In Plant !"r 00
apply. Not required for temporary construction services. 5. Fees:
NOTICE 5s. Eater total of above fees $ f
--- 5%Si:charge(.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Entr,r 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED ❑ Trust Account 0 $
Balance Due $ 1 r'
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CITY OF TICARD — RF7CE'TPT OF PAYMENT N.E:CETf.,T NO. :95—•c6896
CHECK AMOUNT s 36. 75 ■
NAME 7 WE:r3T SIDE: ELECTRIC CO. INC C(4%4 AMOUNT C 0. 00
AC)I:)llE 3 S. W. MAC.AIIAM AVE. PAYMENT DATE 08/07/95
PORTLAND, OR. SURD I V I S I ON s
9'7219 -
PURPOSE OP PAYME14T AMOUNT FSA I D PURPOSE OF PAYMENT AMOUNT FSA 11) �
ELIwCTRIC,AL.i',ERkIIT� -...._. 115. 00 ST. —BUILD P�ER._.... .._,_.. ._._ 1.. 75
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11620 S. W. GAL.LO
TOTAL AMOUNT PAIL) _ __ ...) 36. 75
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspe;tion Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:.
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk '
Fourdr.tion Plbg. Underslab Mech. Rough-in Fireplace ■
PosVBeam Struct. Plbg. Top Out Elec. Rough-in FINAL: '
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Frlbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation e
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested — _[ ;�w Time: AM PM
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Address:
►�-+� '`
Builder: ,� _Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
A/
I�L��- C'I 2�.•l 7� �(=---��rL �•�17�-rr�,,f7on.J�:T i`.
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Inspector: / Date:
—APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
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!zxry Olt TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection*. , ^
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation F';og. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San, Sewer Gas Line -Bldg. ?�
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: Time: AM PM
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Address:_LL(,(2 f)-.,c j _7 C- IL
Builder: � � f• Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED.
2
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f Inspector: c Date j,—L—,=
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APPROVED — —
DISAPPROVED APPROVED SUBJECT T7 ABOVE
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_Call For Reinsp. �
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CITY OF TIGARD PERMIT #. . . . . . ME C95•--�7+"'`
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 03/04/95 i
13125 SW Hall Blvd.Tigard,Orapon 97223.8199 (503)839-4171
PARCEL: 13134DC:-08300
SITE �+D1�REGa. . . : 11L�20 SW GOLLO AVE:
SUBDIVISION. . . . : GALLOS VINEYARD ZONING. R-4. 5
CLOCK. . . . . . . . . . . LOT. . . . . . . •. . . . . . : 14
�� ......_w.___.._«.,•......_._..._..-.___.v_�..._.._._._.._....._.__._._._.._.__.r..._:.._�__..__.._..._-....__....._...._««a..-.._......_._._"a
CLA S OF WORK. . :ALT FLOOR FURN. „ C--VnP COOLER
-f YPE OF U.SE. . . . :f3F UNIT HEATERS. . VENT' FANS. . .
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0CC,UP(4NCY GRP. . :R3 VENTS W/O Af=PL: VF_N'1- SYSTEMS:
STORIES. . . . . . . . : BOILERS/CO(1PRESSORS HOODS'. . . . . . . ..
FUEL TYPES_._....._. .._......_...._ _ 0. 14P. . . . : 1 D0I,1IES. INCIkl:
3_15 HG. . . . . COMML. INCIN:
MAX INPUT: BTU 15•--..:0 HP. . . . : REPAIF'; UNITS:
FIRE DAMPERS?. . : :30-50 HP. . . . : WOODST'OVES. . :
GAL; PrkEGSURE.. . . : 5141- i IF'. . . . : CLO DRYERS. . . �
NO. OF UNITS._-----•---•--_._.__._ AIR HANDLING UNITS OTHER UNITS. :
p FURN ( 10014, 137U: (= 10000 '— fill . GA i OUTLETS. :
{' F•U RN ) =10W!. BTU: > 10000 c f m :
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Remarks : Install air conditioner~
Owner. --_._.___._..____.___._.___.__ __.._.____._._________�___. _...._..._.____ FEES __.._---..___•..._.__._.._.
14IEHLBAUCH type amount by date recpl.
1166'0 ESW GALLO AVE: PRMT 1, 25. 00 JD 08/04/95 95--2669,_
`PC"T t 1. 25 JD 081/04/95 95--26E31:1—:-,
1"IGARD OR '"-2-'']
phone #:
:.ont rac:t ar e
'01 0EN AND SONS HEATING
:.300 SE 7TIA AVE
'. 0. COX 141)b7
-'ORT'LAND OR 97214
-.1ione R.- .2353 -558-41 L ;:-:'G. 25 TOTAL
'-Zeg 001884
---- REUU 1 RED INSPECTIONS
,is permit is issued subject to the regulations contained in the Mectlanic_ai. Irisp
'igara Municipal lode, State of Ore. Specialty Codes a-d all oth"• Ficial I n<,pec t .ion
applicable laws. All work will be done in actor-dance with
approved Flans. This permit will expire if work is not started
hithin 100 days of issuance, o- if wort; ended for es
x
ar, i0t days.
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Call fior inspection 639-4175
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City of Tigard MECHANICAL PERMIT Planck/Rec. #
13125 SW Hall Blvd. APPLICATION Permit #gic.c. '07;7
Tigard, OR 97223
(503) 639-4171
Doscription
dq Table 3A Mechanical Code QTY PRICE AMT
Job1) Permit Fee -0- -0- 10.00 ,
Qo
Address � zw --" -
2) Supplemental Permit 3.00 °
`--Fumaco to 100.000
1) incl.ducts A vents
1.00
�"�• umace 100,000 BTUT
Owner � ���A 2) incl.duds A vents 7.50 —
+ unance )
3) incl. vent 6.00
SuspII heater,wall heater
4) or floor mounted hoator 6.00
Vent not Ind.in 1
Occupant 5) appliance permit 3.00
`✓"' 4 Repair o. oabng,refng.
6) cooling,absorption unit 6.00
i er or comp,heat pump,ar cond.
- 7) to 3 HP absorp unit to 100K BTU 6.00
,"/ adrx w comp, at pun p,air con
Contractor T � 6) 3-15 HP absorp unit to 500K BTU 11.00
i + —Molloi or comp,heat pump,aiirond-
9) 15.30 HP absorp unit.5.1 mil BTU 15.00
• ••"" "+ ••"°
Boiler or comp,heat pump,au coed.
10) 30-50 HP absorp unit 1-1.75 mil BTU 22-SO
y a- ow ge that I have read this app ication.that i a or comp,heat pump,arc cond. 6
inlomintion given is correct,that I am die owner or authorized agent 11) >50 HP absorp unit 1.75 mil BTU 31.50
of tlne owner,that plans submitted are in compliance with State Air handling unrt to —
laws,that I am rogistured with the Construction Contractors Board, 12) 10,000 CFM 4.50
that die number given is correct (If exempt from S4-mte registration, r ami
please give reason below.) 13) 10,000 CTM. 7.50
-�- Non portabka --
14) evaporate cooler 4.50
--- Vent tan ccxum-„tt --
" — 15) to a single dud _ 3.00
Ventilation system not
16) included in appliance permit 4.50
,,.... .,«., _ .. Hood Fp�
1-1) mechanical exhaust 4.50
scnbe work now aJditwa 0 alteration 0 repair Commercial or indusubl
rim to be done residential U non-residential Q 18) type incinerator 30.00
xisbng use o — mer i.e., stove,water --. --
building or prnperty-- 19) heater,aolar,clothes dryers,etc. 4.50
Proposed use of 20) Gas piping one to lar outlets 2.00
buildiing o'property - -—
21) More than 4-per outlet :
Type of hrel -oil natural gas Q LPG 0elodric rl -
- rioTtcn-_— - --- ';
PERMITS BFCMinimum Fee=25.00 SUBTOTAL cc,
VOID IF WORK OR CONSTRUCTION --
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,On 5%SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR -'�—
ABANDONED FOR A PERIOD OF 160 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL t
AFTFR WORK IS COMMI7.1I
Date issued --- --
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CITY OF TIk3ARA R_.C:F'IPT OF PAYMENT RECEIPT NO. a9.., •c.f.���...� !
CHECK AMOUNT s e.G. 25 t y
NAME s ROI.;HEN & SONS HEAT I NA, CASH AMOUNT a 0. 00 f
ADDRCSS a ItJC PAYMENT DATE: a 0H/04/9--f
2R14 SE STIR SUBDIVISION
PCIRTLAND OR 97E114•--
PURPOSE OF PAYMENT AMOUNT PC.)II) PURPOSE: OF AMOUNT PAID
MECHANICAL PF' I4EC"�3—tAcj°59 �''S. 00 tiT. kZlill_D PER 1. :.,'5
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1 162 A SW GALLO AVE I .
f iJTAI.. AMOUNT PAID 26. 25
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C1M!' b'1 ro•.IA..y ti::.L. t. f r >at; ;j.rn Y .�r5r5",•It`H3'1. '";F{a, 1+ 4' ,'" r.'Mto-j�iwN "
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08-03-95 03:39PM FROM PEST SIDE ELECTRIC P01
' NEST SIDE ELECTRIC CO.,
INC. N.
MCTMCAL COMMAMOK
FAX COVER SHEET
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ATTN i
FROMs '' ■
DATE
N1mER OF PAOES, INCLUDING COVER SRIETs
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VOL I
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IF TRAMMUTTAL IS NOT CLEAR, PTEA CALL
AND WE WILL RE-TRMENIT.
PHONE (503) 245-3965
FAX (503) 245-6571
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1518 S.W. MACADAM AyENUE• PORTLAND OREGON 97219• PHONE (503) 245-33" • FAX # 245-8571�
U-03-95 03:39PM GpOM WEST SIDE ELECTRIC P02
Community Dsvefopment ELECTRICAL PERMIT APPLICATION e
13125 SW Hall Blvd.
Tigard, OR 67223 Planck/Hoc. #
Permit # —
PW,It°t (503) 639-4171 Date Issued
;
FAX (503) 684-7297 Issued by
CITY OM TIOiRD TDD No. (503) 684-2772
inspection (503)639-4175
1, Job Address: 4. Complete P" Schedule Below:
Name of Development Number of Inspsmlone Par permit ollowod —
Address-11 k'S�l -b, Service Included: Items Goatee) sum -
City/StaterZlp 'II[ A*-)Qs 41L R"Womilod•►w unit
t Doo p.h or Ism Y t t a.aa
Is*ar/Ibrd{as e0•N.of t
Name (or name of business) pwrtionfhoreal Us 00
Commercial 13 Ryidenh led,hlrnuw Horne or Mwdvw
Drreinry 5sfvlas or Feeder 5$1.00 _
2a. Contractor Installation only. 4b.111arvices or Faedsre
InraNdlrn,ahsrmle["or rvtossllnn 2
ElectricalContractor_.W % stag Im Work"AddflaoDo
trot amps to 400 amps aeo.00 =
city5 t Stat zip97.r� �al.mpsto9on.ma itR�
b eot.m fotsoosmpw /tse.00 s
P)rt7ne No, over toxo ams err rale 1040,00 l
1lwoennwd Dilly ilio as
contractor's License No.
Contra^.tor's Board Reg. No.__a?(4W Tempora or re"We
Irehll4bn,ab ny. .', cation l
Signature of Supe Elec'n— l0°ar'tp'or ---
Rai amp to t d r,ipr 1t'e.00 l
Ucense No._9,ffe!f2___ Pho a No. - 401 Wpm M e- wpm II1100 oo
Over Wo Drips It IM v0s i
2b. For owner lnsts a: '• �'"`°'
44.$rensh Clroulle
Print Owner's Name,_ Now.shandion or ewMndsn Per pend
Address_—_—.. e)Ile fee Iw bre oh dra*A silo ;
Clty — __ State_ w Zip pwou"N a'r`ia."'seeder be
Esch bm+eh DINO 111.00
Phone No. b)The taw for brsnoh dmfs
The Installa0cin is tieing made on properly I own which is owthou'04".1118a or h odor Am
not Intended for sale, lease or rent. Fast trench drarl LL sla
F+sh rddAlorrl branch dram law
Omnq 's ftnatura 40.MiseNrilansow
(Seryop or feeder not included) •
3. Plan Review section (IC required): Kuh pump m WQarl"n ids 840.00 l
Each syn or Vein WN aaa•fra �O
ayn.f oinam(s)or•Meewd of ropy
Maass chock appreprlete Item end enter tee M esetlon ES. "I.sttendion u werrrriwn
4 r mon residential units In one stniatun hWwr Iatelw(tc} itoDOo
�–3"-7o and leader 225 amps or mon
41.ieoh additional
System over 1100 who nominal
additional inspection ever
VaGaMed area or structure ca.tsininp special occupancy the allowable In any of lite above
an described in N.E.L.Chapter r hr vupwdon Ui.00
Per hour rsi,oe
In Phnl
Submit!sets,of plans with applIestlon whereon)of the above
apply. Not nillulred for temporary consvuetlon*"me. I S. Foes: S
5s.Enter total of above fees f
NOTICE Etc sureharye(.os x tow leas)
PERMIT$9ECOME VOID IF WORK OR CONSTRUCTION War 26 One A for
1 _
AUTHORVIO Is NOT COMMENCED WITHIN 150 DAYS,OR IF Eb.Ener
CONSTRUCTION OR WORK 19 SUSPENDED OR ABANDONED FOR "tar Review
If required lt3ee.J)
A PERIOD OF too DAYS AT ANY TIME AFTER WORK 16 ppeoar
--i`�� s _
COMMENCED. L.f Trust Aocount M !
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offence ave S -
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IrJr/�reMlYle}•�� 77
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