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SCALE DRAYNG LOT 56 ERICKSON HEIGHTS
S.E. 4 SEC. 100 T.2S., R.1 W.0 W.M.
Cl TY OF TIGARD
WASHINGTON COUNTY, OREGON
MAY 22. 2000 Center-line Concepts Inc.
DRAWN BY: MSG CHECKED 8Y; INGDIiI
SCALE 1"m-20' ACCOUNT # 115 640 82nd Drive Gladstone, Oregon 97027
M: \MU\L56ERICK 503 650-0188 fax 503 65 -0189
J
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10859 SW KABLE ST
CITY OF TIGARD BUILDING INSPECTION DIVISION MST . -66 17(
24-Hour Inspection Line: 639-4176 Business Line: 639-4171
� �
,,_Date Requested__ AM PM BIPBLD
Location5� S w �c,G%✓ Suite MEC _
Contact Person _ Ph �� �' _ PLM
Contractor Ph _ _ SWR
BUILDING Tenant/Ow,ier ELC
Retaining Wall ELR
Footing Access:
Foundation FPS _
Ftg Drain SGN
Crawl Drain Inspection Notes: -- —
Slab —e_ SIT
Post& Beam
Ext` oeath/Shear
Int Sheath/Shear --
Framing
Insulation
Drywall Nailing - S L'„I� F'C fi" _r _ /<//[ s'S�r�/g!5— _
Firewall �T
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: ----_�.. __-_---_ — -- --- --- ----- ---
Final ------ ------
PASS PART FAIL - ------------- --
PLUMBING
Post& Beam __._.-..______.�_....__-__. �i✓A�>� -
TopUnder Slab Z, - 00
Top Out --------------------
Water Service
Sanitary Sewer - -
Rain Drains
Final --- --------- ----___�.-_ _
PASS PART FAIL
MECHANICAL
Po,,t& Beam ----------------------..._ ..__.._--__-�
Rough in
Gas Line
Smoke Dampers
Final ---- -------- - . ------------ - ._... - - ---
PAj PART FAIL
Servire
Rough In ---- --.�_
UG/Slab
Low Voltage - ----_ - _ __-
Fire Alarm
S PART FAIT_
Backfill/Grading
Sanitary Sewer
Storm Drain ( Reinspection fee of$_ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( ] Please call for reinspection RE _ i Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk /2-
Other Date -s Inspector _ _ /�? C" _Ext
Final ~` — �-
PASS PART FAIL DO NOT REMOVE this inspection recond from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST Gl(il/�Gv�7
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested-) 2-,>� AM _PM BLD
Location J Q R S-q S�.' `G�`� Suite MEC _
Contact Person Ph PLM
Contractor _ Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: FPS
Foundation --
Ftg Drain SGN
Crawl Drain Inspection Notes:
bias, _-_—_-- _- SIT _
Post& Beam
Ext Sheath/SheGc - ----
Int Sheath/Shear
Framing - - -- ----- - - --
Insulation
Drywall Nailirni __-_.--- --- - --- ----- - --
Firewall
FireSprinkler ----..----------.._--- ------ __.._._.--- __._ - -------..._. �__ ._
Fire Alarm
Susp'd Ceiling - - --....-------- --— --..�__--___. ------- ------ --- --..... - -
Roof
Misc: __ -- ------.._.- --- - -- -- - - -
Final -
PASS PART FAIL - - ------ -----
UM
Post&Beam -- ---- ----- --
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
PA, PART FAIL --
ANICAL
Post&Beam
Rough In
Gas Line _ _ -------------- - - -
Smoke Dampers
Fnnl
PASS PART FAIL _
ELECTRICAL
Service --- - --
Rough In -------
UG/Slab ---_.-----.___ -- _ -- - -- —
Low Voltage
Fire Alarm - -- - - — - --
Final
PASS PART FAIL -- - ---- —-- -- �- -----SITE
Backfill/Grading —
Sanitary Sewer
Storm Drain ( I R mspection fee of$ _-_-required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Unable to inspect-no access
Fire Supply Line I l Please call for reinspection RE:--- _ _ _ _ � � P
ADA
Approach;Sidewalk pate / -� InspIrc,tor _ Ext
Other ----- ----
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION blftlnlV MST
'174-hour Inspection Line: 639-4175 Business Line: 639-4171
BUP _
Date Requested_,/y�—j -�I `:A�IIPM BLD
Location L' Sw � J _ Suite MEC
Contact Person Jb % Ph Z/ PLM
Contractor „•,,// Ph SWR
- Tenant/Owner A&5, �Gt� ELC —
Retaining Wall ELR
Footing /-,ccess: / ,
Foundation LCL- /' ,4” 0,r"/ i) �'� FPS -
Fig Drain L 0 /
Crawl Drain Inspection Notes: / Ir N
IG
SIT
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing _
Insulation '
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm �� o l 7G v < <P
Susp'd Ceilinp �G"�` /
Ll
Roof -
Misc: - -- - — ---
m -
PART FAIL --- ----- -- ----
PL BING
F'ost& Beam -- -�- -
Undcr Slab
Top Out -- --------------- --- - -----
Water Service
Sanitary Sewer -- -
Rain Drains
Finai
PASS PART FAIL --
MECHANICAL
Post& Beam -- -- --- ---- - ---
Rough In
Gas Line
Smoke Dampers
Final ----- -- - -- -
PASS PART FAIL
ELECTRICAL ----_---- _ -�--- - --- - -_
Service -- - --------------- _-------- -
Rough In
UG/Slab ------
Low Voltage
Fire Alarm -
f=inal
PASS FART FAIL -- �_---__. _--- - --SITE
Hackfill/Grading I ----- — --- -----
Sanitary Sewer
Storm Drai i [ J Reinspection fee of$ required before next inspection Pay at City Hall, 1315 SW Hall Blvd
Catch Basin [ j Please call for reinspection RE -_-__ [ Unable to inspect- no access
Fire Supply Line
,ADA
Approach/Sidewalk Date 1 2I C Ext
Other --
F inal
PASS PART FAIL 00 NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD
13125 S.W. HALL BLVD. _
TIGARD, OR 97223 �.f
IMPORTANT PERMIT NOTICE
GAGE ENTERPRISES INC
PO BOX 1429
CLACKAMAS, OR 97015-1429
Electrical Signature Form
Permit #: MST2000-00171 i
Date Issued: 07/06/2000
Parcel: 2S110DA-I=1-1056
SitF; Address: 10859 SW KABLE ST
Subdivision: ERICKSON HEIGHTS
Block: Lot: 056
Jurisdiction: TIG
Zoning: R-3.5
Remarks: S/F PATH I
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 beiuv ind return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authr,r-. 9d untie :;-is completed form is received
OWNER: ELECTRICAL CONTRACTOR:
GAGE ENTERPRISES INC
PO BOX 1429
CLACKAMAS, OR 97015-1429
Phone #: Phone #: 503-657-0142
Req #. CP 34544
ELE 3-128C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Supervising Electrician
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD
13126 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICEFR
h;��'-1 Fp
CRAFTWORK PLUMBING INC JUL 2 4 2000
7736 SW NIMBUS AVE 13Y:_
BEAVERTON, OR 97008 -J
Plumbing Signature Form
Permit #: MST2000-00171
Date Issued: 07/06/2000
Parcel: 2S110DA-EH056
Site Address: 10859 SW KABLE ST
Subdivision: ERICKSON HEIGHTS
Block: Lot: 056
Jurisdiction: TIG
Zoning: R-3.5
Remarks: S/F PATH I
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN.- Building Dept.
No plumbing inspections will be authorized until th-s completed form is received
OWNER: PLUMBING CONTRACTOR:
CRAFTWORK PLUMBING INC
7736 SW NIMBUS AVE
BEAVERTON, OR 97008
Phone #: Phone #: 644-8698
Reg #: I Ir 79656
PI M 20-1481313
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X �^ 2IL�-//—
Signature of Authorized Plumber
If you have any questions, please call (503) 639-4171, ext. # 310
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PL/15/20 -00308
13125 SWHall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 08/15/2001
PARCEL: 2S1 1 ODA-09500
SITE ADrRF-SS: 10859 SW KABLE ST
SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.G
BLOCK: LOT: 056 JURISDICTION: TIG _
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING h,ACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Irrigation backflow prevention device. _
FEES
Owner:
— Type By Date Amount Receipt
PRMT CTR 08/15/2001 $36.25 27200100000
5PCT CTR 08/15/2001 $2.90 2720010000C
Total $39.15
Phone 1:
Contractor:
MOODY ENTERPRISES INC
PO BOX 713
ESTACADA, OR 97023 REQUIRED INSPECTIONS
Phone 1: 503-630-5532 Final Inspection
Reg #: LIC 5973
PI-M 11717
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
'',pE:cialty 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 suspended for more
than 180 days. ATTENTION: Oregon law requne5 you to follow rules adopted by the Oregon Utility
Notification Center Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to O'ONC by calling (503) 246--1987.
Issued By:
Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
�-fsTe=odo -�0/7/
Plumbing Permit Application
Datereceived: e• 2 0/ Permit no f JtJ-200/-063,6,f'
City of Tigard
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 97223
City of Tigard phone: (503) 639-4171 Project/eppl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By� Receipt no,;
Land use approval: _ _ Case file no.: Payment type:
L�I &2 family dwelling or accessory U Commercial/industrial U Mulli-family U Tenant improvement
�j New construction U Adtlitinr!alteration/replaceinent U Food service U Other:
—Description Fee ca. I oral
Bldg,no.: Suite no.: New I-and Z-family dwellings only:
Tax Wrap/tax lot/account no.: (includes 100 ft.for each utility connection)
Lot: SFR(1)bath
5" ; Block: Subdivision: SFR(2)bath
Project name: L 2 f.t�'ti I,! SFR(3)bath --
City/county: ZIP: Z Z'' Each additional bath ki chen
Description and location of work on premises: r 4- Siteutilities:
_ Catch basin/area drain
Est.date of completion/inspection: Drywells/leach line/trench drain
Footing drain(no.iir+. ft.)
Manufactured home utilities
Business name: —
G !7= Manholes
Address:PC,fir 7/3 Rain drain connector
City: ZIP: 7C 2-3 Sanitarysewer•(no. lin. ft.)
Phone: dj,6- c S'J�'z Fax:fy.rtC E-mail: Storm sewer(no.lin.ft.)
CCB no.: //7j / Plumb.bus.reg.no: J`/•"3 Water service(no.lin. ft.)
City/metro lic.no.: -- Fixture or Item:
Contractor's representative signature: i ,,, Absorption valve
Print name: n Date: Back flow reventer ]- -
i Backwater valve
Basins/lavatory
rName:r, ,;�, j �,�, % Clothes was er
Address c 7/YDishwasher
City:
Drinking fountain(s) -�
-SY .tc«�, ii__ StateC•% ZIP: �'ZJ Ejectors/sum
Phone: c3, r`o'c X17 Fax: rte; ! <� E-snail
Expansion tank
Fixture/sewer cap
Name(print): , Floor drains/floor sinks/hub
Mailing address: 6/ - Garbage disposal
_City: State: Z1P:
• Hose bibb
_ - --- -- - Ice maker
Phone. Fax: E-mail: In
_ -- -
tcrccptor/grease trap
(honer installation/residential maintenance only: The actual ins allation Primer(s) -
will be made by me�intenir made by my mgula+ Roof drain(commercial)
employee on the ppter 447. Sink(s), asin(s), ays(s)
Owner's si nature. Date: _� 1 p Sump
Tubs/shower/shower pan
Name: Urinal _ "-
-- ---- Water closet
Address: '—__ Water heater _
City
_- State: Z.IP: Other, --
Phone: Fax: �-mail: �! Total
NM all Jurisdictions seep credit cards,please call Jurisdiction ror more information. Minimum fee................$ 2` ,
Notice:This permit application ._U vise ❑MasterCard expires if a ptrntit is not obtained Plan review(at ._ %) $
Credo cud number! 4. .� Expires
� it/ _ Within 180 dnys after it has been State surcharge(8%) ....$ .2 -90
p
Name of rardholck—r eTh—own' rre itnl— accepted as complete.
TOTAL . ..........$ 9
-
Cardholder signaturr Amarum --
- -- 440.4616(WWOM)
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ERM
` CITY OF T I G A R D ORIGINM MASTER MIT#:MST 000- 00171
DEVELOPMENT SERVICES DATE ISSUED: 07/06/2000
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 10859 SIN KABLE ST PARCEL: 2S110DA-EEH056
SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5
BLOCK: LOT:056 JURISDICTION: TIG
REMARKS: S/F PATH I
BUILDING
REISSUE: STORIES: 2 _ FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1,167 of 9ASEMENT: of LEFT: 4 SMOKE DETECTORS: Y
TYPE OF USE: Sr FLOOR LOAD: 40 SECOND: 1.156 of GARAGE: 674 of FRONT: 20 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: of RIGHT: 5
VALUE: $241.326 63
OCCUPANCY GRP R3 DORM: 3 BATH: 3 TOTAL 292300 of REAR: 99
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TPAYS: 1 RAIN DRAIN: 100 TRAPS'
LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS 1 CATCH BASIN::
IUDISHOWERS. ) GARBAGE DISP: t WATER HEATERS: 1 WATER LINER; 100 BCKFLW PREVNTR: I GkEASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN i 100K: BOIL/CMP<3HP: VENT FANS: 5 CLOTHES DRYER: 1
ns FURN>=100K I UNIT HEATERS: HOODS: I OTHER UNITS: 2
MAX INP: Ito FLOOR FURNANC'& VENTS: 1 WOOUSTOVES. GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEE.DERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp 0 200 amp: WISVC OR FDR: I PUMP/IRRIGATION, PER INSPECTION:
EA ADD'L 500aF: 6 201 400 amp: 201 400 amp: tat WIO SVCIFDR. On SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL OR CIR- SIGNALIPANEL: IN PLANT.
MANU HMISVCIFDR: 601 • 1000 amp: 601♦ampo•1000v: MINOR LABEL
1000-amp/volt:
PLAN REVIEW SECTION
Roconnect only:
—4 RES UNITS SVC/FDR-225 A.: >600 V NOMINAL: CLS ARFA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO&STEREO. .CUUM SYSTEM: AUDIO&STEREO: FIRE ALARM INTERCOMIPAGING: OUTDOOR LNDSC LT
BURGLAR ALARM: OTH BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DA1Art ELF COMM: NURSE CALLS. TOTAL M SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 6,308.77
RENAISSANCE DEVELOPMENT This permit is sub)ect to the regulations contained in the
1672 IS WILLAMETTE FAILS T Tigard Municipal Code,State Of OR Specialty Codes and
WEST WI OR WILLAMETTE
all other applicable laws All work will be done in
accordance with approved plans. This permit will expire d
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION
Phone: Phone: Oregon law requires YOU to follow rules adopted by the
Oregon Utility Notification Center Those rules are set
Rea 0: 111, 49956 forth in OAR 952-001-0010 through 952-001-0030 You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Erosion 844-8444 Underfloor insulation Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final
Footing Insp Crawl Drain/Backwater Plumb Top Out Low Voltage Rain drain Insp Plumb Final
Foundation Insp Footing/Foundation Dr; Electrical Service Fireplace Insp Water Line Insp Final inspection
Post/Ream Structural PLMIIJnderfloor Electrical Rough In Gas Line Insp Appr/Sdwlk Insp Building Final
Post/Pgam Mechanica Mechanical Insp Framing Insp Gas Fireplace Electrical Final
Issued By IllyE;__ Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
CITY OF TIGARDORIGINAtRMIT WER CONNECTION PERMIT
SERVICES #: SWR2000-00133
DEVELOPMENTDATE ISSUED: 07/06/2000
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S110DA-EH056
SITE ADDRESS; 10859 SW KABL.E ST ZONING: R-3.5
SUBDIVISION: ERICKSON HEIGHTS JURISDICTION: TIG
BLOCK: LOT: 056
TENANT NAME:
FIXTURE UNIT'S:
USA NO:
CLASS OF WORK: NEIN DWELLIN3 UNITS: 1
'TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: S/F PATH I
Owner: FEES
[INSP
ype By Date Amount Receipt
RMT PLN 07/06/7.000 $2,300.00 0003518
PLN 07/06/2000 $35.00 0003518
Phone. �� Total 52,335.00
Contractor:
Phone:
Reg#:
Required Inspections
Sewer Inspection
This Applicant agrees to comply with all the rules and regulations 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 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 952-001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Permittee Signature:
Issued by: 1 ----_ — --
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
i
CITY OF TIGARD RE �� n� )plication Plan Check#_
13125 SW HALL BLVD. Recd By --�
Date Recd
TIGA,RD, OR 97223 Date to P E
V 503-639-4171 I Date to DST
F 503-684-7297 Permit# .%)15 of (wy -00_)7!
Print or Type
Incomplete or illegible applications will not be accepted
Name of Project — Names _
Job i
�-L���lk}�`" ���s �° -� Architect M IingAddress `
d re ,` /,
Address Site�� � ���f �C% S,/,v / 1,-
Cid/State Zip I Phone
QYQ
Owner Mailing Address Name! �
/6Z2 ��til�flys'//S 7 ' n Ad 4
Engineer Mail� Address
v'�/
City/State ._ ip Phone g
/5T'riv5.r, E
City/St to Zip Phone
General Name C�� �/�it
Contractor >��� Describe work New 4 Addition O Alteration O Repair O
Mailing Address - to be done
Prior to permit Additional Description of Work:
issuance,a copy City/State Zip Phone _ --
of all licenses
are required if Oregon Const.Cont Board Exp Date PROJECT
expired in COT Lic# �" VALUATION
database_ _ i� _ � i%��
I echanicr,l Name.//. NEW CONSTRUCTION ONLY:
Sub-
( !�/ //�'�t/ f� !c 7 y Sq. Ft. Housr, �, / Sq. Ft. Gjarage 1
_ _ /-
Contractor Mailing AddressIcrestricted
ndiate the restrid cteenergy installation by the electrical —
Prior to pc mit �C�Zlr`' ��/�!/�'!ti/ /.Jr� � � jl
issuance,^copy City/tate Zi Phone subcontractor in the followingareas
of all licenses �,�;� /C' �y 7/,7.j -- Restricted T Audio/Stereo
are requ red if Orer�on Const` Cont. Board Fxp. Dale Energy ESystem _ __Alarms
.
expired in COT Lica; G Iristallations Vacuum Irrigation
_ database _ ___ Systern _ System
Plumbing Name I (check all teat Other:
Sub- L ri��l�tz ��' /�1�/,_1/�� _appy) _
Contractor Mailing Address Number of Units in Building I'iit Number Designation
Has the Subdi�•ision Plat recorded? N/A l= NO
Prior to permit Cil /State I hone
issuance,a copyt i'l�!�✓ CC'! _ -- —of all licenses are Oregon Const. Cont Board Exp Date
required If Lic.# — ���� (C/�
expired in COT --
database Plumbing Lic.# Exp. Date I hearby acknowledge that I have read this application,that the
n information given is correct, that I am the owner or authorized agent
of the owner, and t plans submitted are in compliance with
Namg. -Oregon Stat
Electrical (:% � �_/L'f, Sign 2 ne/Agnt Dat
Sub- Mailing Address
Contact Person Name Phone#
Contractor 2'�L`u2 9 — _ !S'!-6,(,t S
ity/Sl to Zip Phone l/
Prior to permit
issuance,a copyS-___ _..— FOR OFFICE USE ONLY: _
all licenses are Oregon Const Cont Board Exp Date —--
Plat#: Map/TL#:
required if Lic#
expired in COT `
database Electrical tic # Fxp Date__ Setbacks: _ Zone:
Electrical Supervisor Lic # Exp Date Engineering Approval: Planning Approval: TIF:
i Asts\+.nms\sfd-new doc 11/20/98
i
ELECTRICAL -
CITY OF TIGARD RESTRIC EDPEN RICKY
DEVELOPMENT SERVICES PERMIT ELR2001-00084
13125 SW Hall R.',/d.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/27/01
SITE ADDRESS: 10859 SW KABLE ST PARCEL: 2S110DA-095(,9
SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5
BLOCK: LOT: 056 ;URISDICTION: TIG
Proiect Description:
A.RESIDENTIAL B.COMMERCIAL
AUDIO& STEREO: AUDIO&STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
-- TOTAL#OF SYSTEMS:
Owner: Contractor:
GREENLINE INC
PO BOX 230755
TIGARD, OR 97223
Phone: Phone: 968-1978
Reg#: LIC 103033
ELE 34-397CL `
_ FEES Required Inspections
Type By Date Amount Receipt _ ,r
PRMT CTR 3/27/01 $75.00 2720010000 [.r
5PCT CTR 3/27/01 $6.00 2720010000
Total $81.00
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 suspended for more than 180 days 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 OAK 952-001-0080. You may obtain copies of these rules or direct questio,is to OUNC at (503)
7.46-1987.
Issued by Permittee Signature
i -
^_- OWNER INSTALLATION ONLY _
The installation is being rn o roperty I own which is not intended for sale. lease, or rent.
OWNER'S SIGNATURE: '""'�"" DATE:_ Z
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639-4175 by 7:00 P.M. for an inspection needed the next business day _
Electrical Permit Application
Date received: "� p( Permitno.: 1 Lm e e
City Of Tigard Pmject/appl.no.: Expire date:
City(If 7'igard Address: 13125 SW Nall Blvd,Tigard,OR 97223 pate issued: By: Receipt no.:
-
Phone: (503) 639-417!
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
JYPE OF-PERM]
I &2.family dwelling or accessory' U Commercial/industrial U Multi-family U Tenant improvement
New construction U Addition/alleratinn/replaccmcnt U Other: U Partial
1101111 1
Job address (,�, tj Bldg. no.: Suite no: Tax map/tax IoUaccount no.:
Lot: Block: Subdivision:
Project name: Description and location of work on premises:
Estimated date of completion/ins ,cellon: -- -
1
Job no: Fee Max
Business name: �" F,�_ IOescrtpunn Qty. (ea) Total no.ins
New rasidenllal-.single of nnilti-famlly per
Address: r 0V 11110 FJ- dwelling unit.Includes attachedgarage.
City: State: ZIP: Servireincluded:
Phone. f Fa '-mail: 1000 Ski nor less -- _ --4
Fach additional 500 sq,ft.or portion thereof
CCB no.: Q' ii& Limited energy,residential 2
City/ CtM tic.no' Limited energy,non-residential _ 2
Foch munufnctured home or modular dwellinp
Signature of supervising electrician(required) hnce Service imdAsr feeder
Sup,elect.name(print): ,,.,,W O,, V r Services or feeders-Installation,
PROPERTY OWNER alteration or relocatlon:
200 amps or less
Name(print): ' V7 (J 201 amps to 400 amps T -- - -- 2
-- 401 amps to 600 amps 2
Mailing addrrss�01,
1- �.� �' 601 amps l0 10(Nl amps 2
City: Stale' ZIP: Over 1(00 amps or volts � 2
Phone: Fax: E-mail: Recnnnectonly - I
Owner installation:The installation is being made on property I own Temporary servlcesorfeeders-
which is not intended for sale, lease,rent,or exchange according to in4allatlon,olterrilon,
21x1amps or less 2 s,rn•Incaflon:
ORS 447,455,47), r) 7 ! 201 amps to 400 amps - 2
Owner's s! nature: _ I):tut: m l n,r;oo an, s z
OEM 1111111Rrnnch cfrenfts•mew,alteration,
or extension per panel:
L. V ^_- A. Fee for branch circuits with purchase t,f
Address: service or feeder fee,each branch circuit 2
- -------- — - —
City: Stale: _ ZIP: B. Fee for branch circuits without purchase
- -�
Of service or feeder fee,first branch circuit 2
Phone.: Fax F-mail: -. ---
Ruch additional branch circuit:
Misc.(Service or feeder not Included):
U Service over 225 amps-commercial J I(ecdth carefacifity Bach pump or irrigation circle 2
U Service over 320 amps-raring of 1&2 U Hazardous location Fach Lign or outline light) 2
ramilydwellings U Building over 10,000 square feel four or Signal circuit(s)or a limited energy panel, 1
U System over 500 volts nominal more residential units in one structure alteration.or extension* ?
U Building over Three stories U Feeders,400 amps or more •Ikscri,tion --
U occupant load nve,119 persons U Manufactured structures nr RV park Fach additional inspection over the allowable In any of the above'.
U Egressfllghtingplan U(Wirt perinspection
Submit , sets of plans wills anv of 1hP s!n)ve. Investigetionfee
Fhe a1mve are not applicable lu temporary construction service. Other
-- Permit fee............ $
Nor all Juris,lictions trcept credo,art1s,please call)udsr.lclioo f:x rnrne intnrrwtinn. tvhrtice: 11115 permit application """"' -
Ubisa U MasterCard expires if a permit is not obtained Plan review(at ` %) $
Ctedu card numb^: - �../ within IRO days aper it has been Stale surcharge(946) ....$ Vol 1
F"p1fr, accepted As complete. TOTAL . $
Name of ca�+��f--aa shown on crc It ca v —
S
CaMholder rignalure _ Amor,,,
-- 4404615(&MCOM)
CITY OF TIOARD
Residential Certificate of occupancy
Permit No.:/V-6/ ,o7( 0- Q U/;?/ Address: &
Owner/Contractor: ,� Q SSG/�✓�,�
Date of Final Inspection: Inspector:
This structure has been found to be in substantial compliance with the provisions of the State of Oregon One& Two Family Dwelling
Specialty Code and is hereby approved for occupancy.