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/ CITY OF TIGARD ELECTRICAL PERMIT
�.^,.
DEVELOPMENT SERVICES PERMIT #: EL-C98--0402 13125 SW Hall Blvd., Tigard,GA 97222 (503)639.4171 DATE ISSUED: 07/20/98
SITE ADDRESS. . . :09830 SW K I MPEIRI....Y DR PARCEL: 2S 1 1 1 CD-09600
SURDIV1STQN. . . . :KERWOOD ESTATES ZONING;R-4. 5
BLOCK.. . . . . . . . . . I_.O-1.. . . . . . . . . . . . . :030 JURISDICTION: TIG
Pr•o jest Desr_r-i pt i on: Alterations to residence. Job No. 618-010.
---RESIDENTIAL.
-------------------------------------
UNIT—- ---TEMP SRVC/FEEDERS-- --- ------M I SCELLANEOUS----- -
1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADD' L... 500SF. . . : 0 201 - 400 amp. . . . . . . 0 SIGN/OUT LINE LTC,. . : 0
L.IOITED ENE . . . 0 401 - 600 amp. . . . . . . : 0 SIGNAT_/PANEL_. . . . . . . : 0
MANE. HM/ JR. . : 0 601+amps-10Q,0 volts. : 0 MINOR LAPEL ( 10) . . . : 0
___-SERVIC,_/r SER.---- -- BRAVA:H CTR(-,l.)I'TS--- -- ... .-- -ADO' L INSPECTIONS--
0 - ''00 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPE(.:TIOIV. . . . . 0
201 400 amp. . . . . . : 0 1st; W/O SRVC OR FDR. : 1. PER HOUR. . . . . . . . . . . : 0
401 - 600 am;i. . . . . . : 0 EA ADD' L BRNCH CIRC.- 1 IN PLAN? . . . . . . . . . . . 0
601 - 1000 amp. . . . . : 0 ____._.__._.__.__--__--_-F'I._AN REVIEW SECTION----_-------_.-._...
1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR > 225 AMP'S. . : CLASS AREA/SPEC OCC. :
Owner: ---- -__ _______________________--__----____.__-_-_.__ -- FEES
BOSTWICK type amo,.int by date recpt
989P' SW KIM!'ERL Y DR PRMT $ 40. 00 DL.H 07/20/98 98-307460
TIGARD OR '+7,t ':; )PCT, $ 2. 00 DLH 07/20/98 98-307460
Phone #:
WEST SIDE ELECTRIC CO I1\IC $ 42. 00 TOTAL.
1.834 SE 8TH 1VENIAE
REQUIRED INSPECTIONS
PORTLAND OR 97214 Poi_igh-- in Elect' l Final
Phone #: '31-1548 Elect' 1 Service
Reg #. ., : 0001.33
This pewit is issued subjkct to the regulations contained in the Tigard Municipal Code, Siate of Oreqon Specialty Culus and all other
applicable laws. All wPri will be lone in accordance with approved plans. This permit will Expire if work is nit staribO. within 180
days of ;ssuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules 0.1-.;.!ed ty
the Oregon Utility Notification Center. Those rules are set forth in DAR 952-001-0010 through OAR 952-001- 987. You may obtain a copy
of these rules or direct questions to DIM by calling 1503)246-1987.
Permittee Signatl_ire : �lC _ lssiled By :
---_-_--.•--•---- .______ _-._-_---OWNER INSTALLATION
The installation is being made on property I own whish is not intended for
'ale, lease, or rent.
(-IWNF R' S S 1 C;NA 11)RE: - _ ___ DATE:
'CONTRACTOR 1NSTFILA.A- ION
� r
I UNA TI IRE OF SIJP'R. ELEC N: m►J �71a�'L� %/�*T/_.��._
DATE:
`'
I_.ICE.NSE:. NCj, ?`
+ + 1-++4+++++++.L+-++++4,4+++++++++++++i•+++++i+++++++++++++•H i..........i•++++++++++++
Call 639-4175 by 7:00 p. m. for, an inspection needed the next bi.isiness day
+4+++++++++++++++++++-F++++++++++++++++++++++++++-F++........4-++-+-4.............4-++4
CITY OF TIGARD Electrical Permit Application Plan Check#
1.'125 SW HALL BLVD. Recd By,
TIGARD OR X7223 Date Recd Ae `?�_
Date to P.E.
Rhone (503) 039-4171, x304 Print or Type Data to DST
Inspection (503) 639-4175 Incomplete or illegible will not be accepted Permit#_E4 C
Fax (503) 684-7297 Called
1. Job Address: 4, Complete Fee Schedule Below:+�
Name of Development_ Number of Inspections per uermit allowed
Name(or name of business)_ CC c/ ._ w Service included: I!ems Cost Sum
Address �( � �� 6 4a. Resldr,ntlal-par unit
Ci /State/Zi / 1000 sq ft.or loss $110 00 4
City/State/zip p Each additional 500 sq.It.or
portion there,)f $25.00 1
Commercial Residential E I trailed Energy $25.00
Each Manuf'd Hoin.a or Modular
Dwelling Service or Feeder ___ $68.00 ____ 2
2a. Contractor Installation only:
(Attach copy of all current Ice res D 4b.Services or Feeders
Electrical Cp actor �/�( /C /� Installatioo,alteration,or relocation
AddreS ✓ 200 amps or less $60.00 2
c 201 amps to 400 amps r $80.00 2
City Ur C-z State Zips 401 amps to 0`00 amps $120.002
Phone No. 2 - /S� 601 amps to 1000 amps $180.00 _ _ 7
Job No. :FT _0 Over 1000 amps or volts �- $340.00 _ 2
Elec.Cont. Lice. No. -IJ S-C EXp.Date lolo i-ieconnect only $50.00 _ 2
OR State CCB Reg. No. 11306 Exp.Date 3 4c.Temporary Services or Feeders i
COT Business Tax or Metro No, Exp.Date Installation,alteration,or relocation
200 amps or less $50.(,0 2
Signature of Supr. Elec'n 201 amps to 4f O amps $75.00 2
401 amps to 600 amps $100.(0 2
�
License Nt, , Over 600 amps to 1000 volts,. S Exp.Date�1 i c__ see"b^above,
Phone N ,d.Drana4 Circi;its
Now,alteration or extension per panel
2b. For owner installations: a)The len for branch circuits w/fh
purchase or service or
Print Owner's Name _ feeder foe,
Address Each branch circuit $5.00 _ 2
b)The lee for branch circuits
City _ State Zip _ without purcha.ta of
Phone No. service or feeder lea. '
- First branch circuit / 635.00 } -'
The Installation is being made on property I own which is not Each additional branch circuli ( $5.00 2
intended for sale,lease or rent. 4e.Miscellaneous
(Service or feeder not included)
Owner's Signature _ Each pump or Irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required): Signal circuil(s)or a limited energy
panel,alteration or extension $40.00 2
Please check appropriate item and enter fee in section::H. Minor Labels(10) $100.00�-
___�__4 or more residential units In one strucwre 41.Each additional Inspection over
Service and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal Per Inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00 -_
as described In N.E.0 Chapter 5 In Plant $55.00
Submit 2 sets of piens with application where any or'he above apply. 5. Fees: 1,/C)
Not requited for temporary construction services. 5a.Enter tctai of above fees $
5%5u change(.05 X total fees) $ - --
NQTICE Subtotal $
Sb.Enter 25%of line 5s for
FERMI TS BECOME VOID IF WORK OR CONSTRUCTION.AUTI4DRIZED IS Plan Review jf require (Ser,.3) $
NOT COMMFNCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Su'ltotal $ -
IS SUSPENDED OR ABP,NDONED FOR A PERIOD OF 180 DAYS AT ANY L� ? 3 0 � y
TIME AFTER WOjpK IS COMMENCED, True!Account# /
Total balance Due
'�1 V
CITY OF TELECTRICAL_ PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC98-0344
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 06/25/98
PARCEL: 2Si. 1 1 CD-O96V)0
SITE ADDRESS— :09891b SW KIMBERLY DR
SUBDIVISION. . . . :KERWOOD ESTATES Z(JN I NA: R,-4. 5
BLOCK. . . . . . . . .. LOT. . . . . . . . . . . . . :O3O .JURISDICTION: TIG
ProJect Description: Bostwick
---RESIDENTIAL IJNIT.---- ---TEMP SRVC/FEEDERS---- _----^fISCELLANEGUS--- --
1000 SF OR LESS. . . . : 0 Q1 - 200 amp. . . . . . . : .n PUMP/IRRIGATION. . . . 0
EACH ADA' L 5O0SF. . . : 0 201. - 400 amp. . . . . . . .. 0 SIGN/OUT LINE LTG. . : 0
LIMITED E19E'RBY. . . . . : 0 401. - 600 amp. . . . . . . : 0 SIGNAL./PANEL. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 601+amps-1000 Volts. : 0 MINOR LABEL (10) . . . : 0
----SERVICE/FEEDER---- -----BRANCH CIRCUITS-._._.--- ---ADP.' L INSPECTIONS----
0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
201 _ 400 amp. . . . . . : 0 1st W/O SRIC OR FDR. : i PFR HOUR. . . . . . . . . . . . 0
401 - EOO amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . . 0
c;O1 - 1.000 amp. . . . . . 0 -.- -__-___ __--_.__��LAN REVIEW SECTION---
i.00@+ amp/volt. . . . . : 0 > -4 RES UNITS. . . . . . . . : > 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR AMPS_ : CLASS AREA/SPEC OCC. :
Owner: --______.____.___.______-_________.__._____._._____.__._ _._..____.____ FEES
PHIL_ BOSTWICK type amount by date rpcpt
9890 SW K'MBERLY DR PRMI 11 35. 00 JSD O5/23/98 98-3O6n3i:'
TIGARD OR 97224 SPCT $ 1. 75 JSD 06/25/98 98-305831''
Rhone #:
Contractor: ---------__._._—__..—_---_----__—
W'ESTS I DE F_LECTR t C CO INC $ 36. 7`: TOTAL.
1.834 SE STH AVENUE'
------- REQUIRED INSPECTIONS
--
PORTLAND OR 97214 f OUgh—in Elect' 1 Final
Phone #: 231 -15148 .1ect91 Service
Reg #. . : 0001.33
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work will be done in accordance wits pproved plans, This permit will expire if work is not ftarted within 180
days of issuance, or if work is suspended for more than ', days. TENTION: Oregon law requires you to follow Ve rules adopted by
the Oregon Utility Notification Center. Those rules *P s t fart i.A OAR 952-001-0010 through OAR 952-MI-71987. -you may obtain a copy
ar these rules or direct questions to 'bf ,Call ng (5031 - /
Pormittee Si.gnwttdr¢: Issf-ted By:.._..
L
INSTALLATION
'Che installation is being made on property I own which is not intended for
sale, lease, or rent.
OWNER' S SIGNATURE: — _.�. _. DATE -
---------------------------CONTRACTOR
ATE :__---_-___.------.---_--__CONTRACTOR INSTALLATION
IGNATURE OF SUPR. ELf=C' Nt DATE:
I-I CENSE NO:
++++++++++-F+++++++++++++++++++++++++++++++++++++++++++++++++++++++++•4-+++++++++
Call 539-4175 by 7:00 p. m. for an inspection needed the nerd bi-isinAss day
+++++++++++++4.+++++++.t++++++++++++++++++++++++++-1-+++++++++++++-F+++++•44........t
CITY OF TIGARD Electrical Permit Application ran chebk# r
13125 SW HALL BLVD. Recd 6y
TIGARD OR 97223 JUN 2 Date Recd( '-' 7`(, y'�S
Date to P.E.
Phone (503)639-,'.171, x304 'NITY DEveLUPtr�ENT Date to DST
Inspection 503 639-4175 Print or Type '
P ( ) Porrnit ft_ CLC
Fax (503) 684-7297 Incomplete or illegible will not be accepted called_
1. Job Address: 14. Complete Fee Schedule Below:
Name of Development_ A Number of Inspections per permit allowed
Name(or name of business)_ Tui,LV-, Service included: Items Cost Sum
Address, '1�,!9 0�r fL
SVJ I:��rt'1 LN 0(1- 4a. Residential-per unit
City/State/Zip- 1..1-1)t.►E b CA. c �. Each $110 tic
additional 500 sq.ft.or
Commercial ❑ Residential portion thereof $25 0u
Limited Energy - $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder - $68.00
2a. Contractor installation only: -�
(Attach copy of all current licenses) 4b Services or Feedors
Electrical Contractor ',kIV L _;Jj,L_ (y Installation,alteration,or relocation
Address it�y _`Y N� 200 amps or less $60.00
201 amps to 400 amps $80.00 __ 2
City_ 4l- Stat Zip 1 L14 401 amps to 600 amps $120.00 •1
Phone No. 2- L - 1S-tY3 _ 601 amps to 1000 amps $180.00 2
Job No. �10VL(i Over 1000 amps or volts :340.00 2
Elec.Cont. Lice. No.� i:� -13;L Exp.Datev Reconnect only y $50,00 2-
OR State CCB Reg. No._ i 33v(o Exp.Date 4c.Temporary Services or Feeders
COT Business Tax or Metro No, Exp.Date Installation,alteration,or relocation
200 amps or less $50.00 2
Signature of Supr. Elec'n -___ 201 amps to 400 amps -_ $75A0 _v 2
401 amps to 600 amps $100.00 - 2
7� G Over 600 amps to 1000 volts,
License Nr` f L1 Exp.Date_ _ see"b"nbove.
Phone N Z 3► I SRS __- 4d.Branch circuits
Now,alteration or extension per panel
2b. For--caner Installations: a)The fee for branch clrcultr with
purchase of service or
Print Owner's Name _ _ feeder fee.
Address - Each branch circuit $5.00
--- -- - b)The fee for branch circuits
City State Zip ____ without purchase of
Phone. No, _ ___ service or feeder!ee.
First branch circuit $35.00 3 7. 2
The installation is being made on property I own which is not Bach additional branch circuit $5.00 2
intended for sale,lease or rent. 4e.Miscellaneous
Owner's Si nature (Service or feeder not Included)
g _�. Each pump or irrigation circle $40.00 - -- 2
Each sign or outline lighting $40.00 - 2
3. Plan Review section (if required):* Sign.'circuits)c a limited energyi
panel,alteration or extension $40.00
Please check appropriate Itemand enter fee in section 5B. Minor Labels(10) $100.00-
4 or more residential units in one structure 4f.Each ndditional Inspection over
Service and feeder 225 amps or more the allowable in any of the above
_i System over 600 volts nominal Per Inspection $35 rr0 --
^_Classified area or structure con,!aiAng special occupancy Per hour $55.00
as described In N.E.C.Chapter 5 In Plant $5`-)0r' ------.
Submit 2 sets of plans with application whera any of the nbove apply. S. Fees:
Not required for temporary construction services. 5a.Enter total of above fees $
5%Surcharge(.05 X total fees) $ - -'
-w-DU DU Subtotal $ --
5b.Enter 25%of line 5a for
PERMITS BECOME VOID IF WOFiK OR CONSTRUCTION AUTHORIZED IS Plan Review if required(Ser,.3) $
NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ ----
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED. ❑ Tru;t An nunt k-_
$
Total balance nue
I�VSMELC96 APP nev WN
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
'ITY OF TIGARD Plumbing Application Recd By /1,4
•3125 SW HALL BLVD. Commercial and Residential Dale Rec'(if
'GARD, OR 97223 Dan to PE.
503) 639-4171 Dare DST_
Permitt r �%.'_,9,f''
Print or Type Related SWR 4-
Incomplete or illegible applications ?gill not be acceptRd card
Na_rhe of 0-,P""menvProllpK1 .FIX RES;(Indlv!awl) ;' 1 Q7 + E +wMj
Job sink 9.00
Address Street Address Strte Lavatory 9.00
1/j %O-51' /ill ' 4 rub or Tub/SAawr Comb. A lip
Bkfq r CAt f/stat Xlp Shower Only g 00
e-1 Cl i
9.00
i
owft"her 9.00
to Wn e r MarYkh9 Addrstrrt L !uft `Garbep.04 Dosat 9.00
f )I bot ii, )/' :Vashfnq It's,ftw 9.00
g4mitele
Phone Flow Grain Y 9.00
" c;) -!, J", 3• 9.00
Plante �
e- 4- 9.00
Occupanth9 Addnsa WOWS theater 9.00
Lauri"Room Troy _ 9.00
ClryfState 21p unnar
9.00
--
Nam j wr OtlFixdrrss(Specrfy) - 9.90
_. __
���� 1 (J Alt1C b.W
ont-actor maili'9 A"- Suft 9.00
i j:)( 3 ) — 2
ca
'riot to issuance ----- --
appllrant rnuat (�ky/Staa p 7 Phone '70 9.00-
provide a3 OnIgIch ConelL(1 pt.Board ur-t Exp.Date900
contractor iJ V. -q 9.00—
nogbili Lic,it Exp.Date Sewer-t at 10( 30.00
information - 5 I- Sewer--each additlonal 100' - 25.00
for COT COT,Buskless Tax or Metra r Exp.Data - - --
database)_ e- - � )1 _ f�1- _L Water Servitor-1st 100' - 30.00 -
LL-
Narm rJ-- Water Service-each additional 200' 2500
Architect Storm 6 Ran Drain- 1st 100' --- ;10.00
or ►lainq Address Suets Sto m&Rain Oran-each oWitfahal 100' 25.00
Mobile Ham Space 25.00
Engineer Gcyrsmte Zip Pheim (;orhrrwrhxal Bad[Flortr Prsve+non Device or Anti- 25.00 -
_-__- L- !'oltttiorh vice _
asrsbr wrxhc New O Addition O Alteration G!" Repair O Residential Backflow PmvenriA�Oi vice' 15.00
r done: Resrfertl�l.d Non resrdentlal O — Any Trap or Waste Not Corrected to a Fixture 9.00
i(minnai desrnption of wort[ Catch aasui -- - 9,00
,'� r"' ��✓(. - l(/r;" 71- X H T7`W_ ins,,.of Exntlny Plumh`«iq 40.00
!T f, C, o9 _ per/hr -
ling use of Specialty Reques,td Inspections 40.00
_ peithr
ling or property ____ __ Rain CAaw,single family(7w.i!!'^n 30.00
nosed use of Grease Traps _ -- - --- - 9.00
*10i;or property^ --
_ QUANTITY TOTAL
,Tyou cap[n9, moving or replacing any itxtures? Yes p �No p iii",,is roqus+d d CusrhsY raw is >9 ��.:;w.- ;-►
If yes see bock of form) 'SUBTOTAL t
Hereby 3clu-,wledge that I have read this application.that the infmrna—twn
,ven,s axreck Owt I am the owner or authorized agent of the owner,and I 5%s SURCHARGE
at oians ed ire in o6mpliance with_Oregon State Laws.
PLAN REVIEW 25% OF SUBTOTAL
gnaturt- nagelt Dab -
1\ 1 �� Requrrid anh A fa us iter !cm is*9
TOTAL
t3btNii6n Nares __ S
c �I�/�r'1'� I//'.,�I 'Minimum permit fee u S2-•5`A surcharge.exnlpt RCSrdential Baddtow,
LLW)I U1�^0/I' _ I, - Pnwention Device,which is s1S+ 5%surcharge
I:\plmapp.doc 121'96 (dst)
-� � LAS APPROPRIATE TO PRQ J r 1:
Fixtures to be capped, moved or replaced Qty .
Sink
Lavatory
Tub or Tub/shower Combination
Shower Only
Water ^,loset
Dishwashe�i
Garbage Disposal
Washing Ma shine
Floor Drain 2"
3"
4"
Water Heater —
Laundry Room Tray
Urinal
Other Fixtures (Specify)
'OMMEI TS REGARDING ABOVE:
L , etc s
I:\p1mapp.doc 12/96 (dst)
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Olvd., f lgard,OR 97223 (50C)639.4171
I
Plan
CITY OFTIGARD Mechanical PermitpP Rec'd lication Rec'dBeck�
By_
13125 SW HALL BLVD. Commercial and Residential Date Recd ' Z 7-/9P
TIGARD, OR 97223 Date to P.E. _
(503) 639-4171, x304 Date to DST_
Print cr Type Permit#QFC 9 -elv
Incomplete or illegible applications will not be accepted called
me
Naof Development/Pro)ed
Description
t Table 1P.Mect apical Code OTY PRICE MT
Job Street Address Suite# A) Permit Fee 0- 0- 1000
Address '� , -- �� //J1 'l, U' _
Bldg# rCity/State Zip _ 1.) F tmaceto 100,000 BT11 �- E,00
including ducts&vents _ 1U
Name for name of business! 2.) Furnace 160,000 BTU+ i 7 50
Owner �jr,7 including ducts&vents
Mailing Address
3.) Floor Furnace 6.00
J411" <`,�� r/1l ' L? including vent
ah 151tate Zip phone 4.) Suspends i heater,wall heater 6,00- / �� -711 lC" or floor mounted heater
Name(or name of busiriess) 5.) Vent not included in appliance permit 3.00 i
OCLupant Mailing Address 6.) Boiler or comp,heat pu ,air ccnd 6,00
t,3 HP:absorb unit to 10
Crtyistate Zip phone 7.) Sutler or comp,heat rump,ai, Gond. 11.00
_ _ 3-15 HP.absorb unit to 500K BTU" _
Contractor n 8) Boiler of con. heat pump,air Gond.
/� P� P. 15.00
15-30 HP,absorb unit 5-1 mil BTU"
Prior to permit Mailing Address 91 Boiler or comp,heat pump,air gond. 22,50 -
issuance,a copy 30-501 1P.absoib unit 1-1 7Pmil BTU"
of all licenses eltyJstate Zip Phone 10) Boiler or comp,heat pump air Gond. �37 50
are required if (( Zr�q >50 HP,absorb unit 1 75 mil BTU"
expired in COT or on const.Cont.Board L.i.# Exp,Date 11.) Air handling unit to 10.000 CFM 4.50
database /� cL__ W, .� _
Architect Name 13) Non-port&ble evaporate cooler 4.50
or Mailing Adtlrai 14) Vent fan connected to a sinyle dud 3.00
Engineer CitylState Zip Phone -
15J Ventilation system not included in 4 50
_ appliance permit _ _
Describe work New O Addition O Alteration 0- Repair O 16) Hood served by mechanical exhaust 4 50
to be done Residential-0 Non-residential O
Additional Description of work. 17) Domestic incinerators i 50
18) Commercial or industrial type _In 00
Incinerator
Exrshng use of 19) Repair units �' 4 50
building or property _
20) Wood stove
Proposed use of 21 ) Clcthes dryer,etc. 450
buildmq or property
-�-- 22.) Other units 4 50
Type of fuel-oil O natural gas(n SPG U eiedric O 2?.) Cas piping one to four outlets - 200
I Tereby acknow; dge that I have,read this application,that the -
24 1 More than i-per outlets(each) 50
information given is correct,that I am the owner or authorized agent of
the owner,that plans submitted are in compliance with Oregon State OTY.SUBTOTAL-
_ _ _ "1�gu
Signa of Qwne sept i ,Date V� 'SUBTOTAL �`
5%SURCHARGE �-
Co` t Pill me Phone PLAN REVIEW 25%OF SUBTOTAL
2-Li)lIt
iid ''G1t::
mechpmt.doc (rev 8Win4mum permit fee is$25+5%surrharge
"Residential AJC requires site plan showing placement of unit.
•
HEATING & COOLING, INC.
P.O. Box 230397 Tigard, OR 97281-0397
(503) 624-2704
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CITY OF TIGARD BUILDING INSPE(_ i IC3iV DIVISION
24-Hour Inspection Line: 639-4175 Busine3s Line: 639-4171 MST
BILIP
_i �5L_I Date Requested ��� J �J �jAM 1C PM BLD
Location _I"�-cCi( . . Suite _ pr
Contact Person Ph i: �jt C��/-
:Ei —7 PLM
Contra,tor__ u,ry�, � U� Ph SWR_
BUILDING Tenant/Owner
Retaining Wall ELR
Footing _
Foundation Access: FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab
Post& Ream SIT
Ext Sheath/Shear
Int Sheath/Shear
Framing
insulatiun --- -_—___
Drywall Mailing
Firewall - — ---- - —
Fire Sprinkler
Fire Alarm
Susp'd Ceiling �/U 5 ✓�C: ` c����
Roof -_
Misc:
Final ---
PASS PART FAIL
PLUMBINGf� 5LC'
Post& Beam _ ----
Under Slab
I op Out "- — -----
Water Service
Sanitary Sewer -- ----- ---
Rain Drains
final ----- ---- — ----•-- - - --_��_
PAeS F FAIL _
MECHANICAL) _ - - _---
s na at - --- - -- ----- -
R
f�ampers
P T FAIL _
r,-TP.ICAU_ —_ --_— —_ _ --- —
Low Voltage - ----'- ----. __._-----_--
Fire Alai in
Final----, _------------�_�--------------_--_.�__ -- -------
f34SS PART FAIL -___--- —_ �_-____- -----_-__-- --- --
Backfill/Grading - ---- ----- —
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$---_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( ] Please call for reinspection RE:--- _-_ [ ]Unable to inspect-no access
ADA
Approach/Sidewalt-
other ---_-- Date -- Inspector _--_— Ext
Final
PASS _PART - FAIL- DO NOT REMOVE this, inspection recovd from the job site.