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9200 SW®AK ST
ITT-OF T'IGARD ELECTRICAL PERMIT
PERMIT#: ELC2004-00147
`
DEVELOPMENT SERVICES DATE ISSUED: 3123/04
13125 SW Hall Blvd..Tigard, OR 972.23 (503)639-4171 PARCEL: 1S135AC-03800
SITE ADDRESS: 09200 SW OAK ST
ZONING: R-4.5
SUBDIVISION: ASHBROOK FARM
BLOCK: LOT: 018 JURISDICTION: TIG
Project Description: Remove unsafe wiring ,connect 2 GFCI cin -Rceptacles.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGNIOUT LINE LTG:
LIMITED ENERGY: 401 . 600 amp: SIGNAUPANEL:
MANF HM/SVC/FOR: 6014 amps-1000 volts: MINL,R LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS AI)D'L INSPECTIOo:Z
0 200 amp: 1 W/SERVICE OR FEEDER: 2 PER INSPECTION: '
201 - 400 amp: 1st W/O SRVC' - FOR: PER HOUR:
401 - 600 amp: EA ADn'L BRNCH CIRC: IN PL.1NT:
601 - 1000 amp: _ _PL_A_N_REb1EW_SECTION
1000+amp/volt: > 4 RES UNITS: 4nn o-OLT NOMINAL:
Reconnect only: SVC/FDR>-225 AMPS: _CLA aS.AREA/SPEC OCC:
Owner: Contractor:
FOREIGN MISSION FOUNDATION ROBERTS ELECTRIC INC
9200 SW OAK ST 5759 SW 48TH
TIGARD,OR 97223 PORTLAND,OR 97213
Phone: 503-244-7754 Phone: F-244-0560
Reg 0: V*44-77548865
--- — LTC 9388
FEES F,LF 34-23C
Desrdptlon Date Amount Required Inspections
[FI_PRM'Tj FLC Permit 3/2''04 $93.60
["TAX]8%State Surcharge 3/23/04 $7.4.4 Rough Service
Rough-in
Total $101.09 Elect'I Final
This Permit!v Issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialty Codes 31x1 all other applicable laws. An
work will be done in accordanoe with approved plans. This permit will expire if wick is not started within 180 days of issuance,or 9 work Is suspended
for mere t ays. ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Cantor. Those rules are set
forth I AR 952-Oo1-oo10 ch ugh OAR 001-0100. You may obtain copies of these tiles or direct questions to OUNC at(503)246.6899 or
1.8 332-2344.
n' Iss d By: _ Permit Si nature:
CO) OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, !ease, or rent.
J
m OWNER'S SIGNATURE: DATE:_
i9
LU CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: �' _ DATE: _
LICENSE NO: 5 _
Cali 639-4175 by 7:00pm for an inspection the next businass day
Electrical VerwitAR29Rgion
City Of Ti%ard ReceivedaPermit No:
13125 SW Hall Blvd.,Tigard,OR 97123 Men Review —
_ &mss-"�
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Otlkr Permit.
Inspection Line: 503.639.4175 Dap ReadyBy., Iy► ' 0 See Pagr.2 for
Internet: www.ci.tigard.or.us Noomwmetlpll: s- > (t C' Supplemental Information
PLAN PEN1111011
❑New cotW[uction ❑Addidoal/NDeration/replaoement . P1esse check all that apply
Demolidw 110dw. 5W&Y%CA_ C]Swvice over 225 snips,comm'1 ❑liazardous location
❑Service over.320 amps-rating ❑Buildng over 10,000 sq.A.,
of 1-and 2-family dwellings 4 or more new residential
I-and 2-fhmily dwelling Commeteial/industrial KAcce&WybVdft []System over 600 volts nominal units in one structure
L3 Multi-famil Mager builder L3 G:ha ❑Building over three stories [:]Feeders,400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
❑Egress lighting plan RV park
Job no.: Job site address: c� w ❑Health-care facility QOthet--- --
1?-Co Sw Ott W_ 5T Sul mit•_sets of plans with any of the above.
City/State/ZIP: T%b w,qD p m_ 9 ZZ 3 The above are not applicable to temporary construction service
Suite/bldg./apt.no.: Project name: tx.3r 9*jI LL(%(ee Vote.r*twm Qb. Pee. Tetal ••
Cross street/directions to job site: ZyP6l�oL_v_S EAST- <:li.4 New residential single-or multi-family dwelling unit.
Includes attached garage. _
C-�6 61�► a�X f:� c'P-d 1,000 sq.ft.or less 145.15 4
Subdivision: Lot no.: - Fx.add']500 sq.ft or portion 33.40 1
Tax reap/parcel no.: Limited energy,residential 75.00 2
Limited energy,non-residential 75.00 2
Each manufactured or modu',ar
dwelling,service and/or t�eder 90.90 2
IZt-el"1 O V� l'Jn1 SAt=E (�t�hP�✓t(o C oh F'\F-�T Z Services or feeders Installation,alteration,andror relocation
GFLZ GtQC-%-)ir rL c-e.JT_V"'-CA-ES 200 amps or less ( 90.30 �7• 2
Wj 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: t=as E t C.yy Mh S s i or-1 ;=akY-,t_AT,w A _ 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts _ 454.65 2
Address: l O$ E) W $q 7%-% �rT t2.�6 TReconnect only 66.85 2
City/State/ZIP: Tp o a-0 On--- Temporary services or feeders Instsiletion,alteration,and/or
Phone: S(.7 ( 3) 9 4 .cA-3 t relocation _
(So3 ) 2u b• S Fax: So' - 200 amps or less _ 66.85 _ I
Owner Installation:This installation is being made on property that I own which is not 201 amps to 400 arms _ 100.30 T 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 arras to 600 amps 133.75 2
Owner sigtiature: Date: Branch circuits-new,alteration,or extenslo_n,per panel
A.Fee for branch circuits wit.5
service or feeder fee,each 6.65 �.Sv 2
Business name: branch circuit
— --� B.Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
each branch circuit
h Address: _ Each add'I branch circuit 6.65 2
ICity/State/ZIP: Miscellaneous(service or feeder•not Included)
IL Phone:( ) Fax: :( ) Pump or irrigation circle 53.40 2
r _ Sign or outline lighting 53.40 2
N E-mail: Signal circuits)or limited-
energy panel,alteration,or
} — — - extension.Describe: Page 2 2
5 Business name: j��� �s ,�
m Address: C12-1 5� s a Each additional Inspection over allowable In any of the above
Per inspection _ _62.50
WCity/State/ZIP: '7�T L�uD �� <31,:t ZZ InvestigL on per hour(t hr train) 62.50
J Phone:(5o3) Z y q 1->)S Fax:(goz,) 2-LA-4 b_S(o O Industrial lent hour 73.75
CCB Lic.: `13$$ Electrical Lic.: Suprv.Lic.: 3g8�5 subtotal 9 0
Suprv. Electrician signature,required: {�„4 Plan review(25%of permit fee) -
-E� State surcharge(8%of permit fee) 7.Y
Print name: ZeDate: 3• Z,'3-p Li --
-• TOTAL PERMIT FirE
Authorized signature: This permit applicntlon expires If a permit Is not obtained within Iso
days after It has twee accepted o complete
Print name: Date: **
Fee methodology set by Tri-Cminty Building Industry Service Board
Number of inspections per permit allowed.
i%n.ilding\Permn ikELC,PermftApp doc 12/07 440-4615T�INOVCOWWEa
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined....,,... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Doc pener*
❑ Heating,Ventilation and Air Conditioning
System*
❑ Vacuum`iystems*
❑ Other\
Fee for each commerliql system................ ..... 575.00
(SEE OAR 918-260-2 /
i
Check Type of WorK Involves:
❑ Audio and Stereo Systems
❑ Bailer Controls
❑ Clock Systems
❑ Data Telecommunication stallation
F] Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging S stems
d
❑ Landscape Irrigation ontrol*
N
❑ Medical
❑ Nu:se Calls
W ❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systams:
*No license,are required. Licenses are required
for all other installations
i\Buildin`\P-rn is\BLC-PenitApp doe 04103
CITY OF TIGARD 24-Hour
WILDING ® Inspection Llne:,,W, )639-4175 ►
INSPECTION DIVISION V Business trine: (603)639-4171 MST
Received �� ____ Date Requested AM _Phi __ BLIP --
Location _ _ez:: ...-- _ Sufte - MEC - -----��_-_
Contact Person A-�_� N OKt, - Ph(—) 3 3 PLM
Contractor -__—_ �.___.. Ph(____.-_) _ _ SWR /
BUILDING � Tenant/Owner LC 7`'
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: �// / SIT
Post&Beam _ U�1 UMIL-4a.,
Shear Anchors IV - - -- -- ----
Ext Sheath/Shear
Int Sheath/Shear -
Framing
Insulation
Drywall Nailing — ---•
Firewall
Fire Sprinkler - --
Fire Alarm
Susp'd Ceiling - --- - - ---
Roof
Other: ------
Final
PASS PART FAIL -- --� `
PLUMBING
Past&Beam -
Under Slab �-
Rough-In
Water Service ----- --- --- _
t�,..nitary Sewer
Rain Drains - -----
Catch Basin/Manhole
Storm Drain -- —
Shower Pan
Other: r------ - - ---
Final
PASS PART FAIL — - — -`-
MECHANICAL
Post&Beam
Rough-In -
A. Gas Line - - -
Smoke Dampers
Final
PASS PART FAIL --- - - -- --
ELEC ICAL
t Service -
m Rough-In
_j Low Voltage
J
larm W
Q Reinspection fee of$ required before next;nspection. Pay at City Mall, 11125 SW N$aii Rlvri.
PART FAIL
___-- F] Please call for reinspection RE:- Unable to inspect- no acress
Fire Supply Line
ADA
Dalt
Approach/Sidewalk
Other:
Final - DD NOT EMOVE this Inspection record hem the job silt.
PASS RT FAIL
-- SITE WORM. �
C11YOFF T11FARD PERMIT
CITY PERMIT M. . . . . . . : SIT90�-0024
COMMUNITY DEVELOPMENT DEPAR'TMIENT aaars� PRIM. PERMIT If. : SIT90- 0024
1 S12d 8Yl Hall 6Md P.O.Baa 7�lD7,T�paid,Onpon O TJ)+.1. i�.� \._ DATF ISSUE-Da n'7✓1 /V0
SITE ADDRESS. . . : 9200 SW OAK ST PARCEL.: 1S135AC--03800
SUBDIVISION. . . . : ASHHROOK FARM ICININGa R-4. 5
BL.O(,K. . . . . . . . . . a LOT. . . . . . . . . . . . . .. 16
------------------------
TYPE-C'F WORK:ADD PAVING?. . . . . . . . . aN RESO. NO. :
F--XCV VOLUME. : cy GRADING?. . . . . . . . :N VALUE— $: 0
FILL VOL_U11L'. : 100 cy LANDSCAPING?. . . . :N
ENG FILL?. . . . . . :N SITE PREP?. . . . . . :N
SOILS RPT READ'?:N STORM DRAINS'?. . . :N
IMF>ERV SURFACE. . : sf
I eniarks: Add approx. 100 c.-y fill. to level lot tit corner.
Owner.- ________..... ___.__.____.�_______. _____ _.-_-__..,___-_--__ FEES
.TATA CORPORATION type amoaAnt by date •reept;
4485 NW WALL_OWA COURT PAYN $ 38.63 JLH 07/19/90
PRMT $ 22. !)'0 / ✓
PORTLAND OR 97229 PLCK $ 15.00
Phone i1: 645-4438 !.)PCT $ 1. 13
Contriacto•r a
CONTRACTOR NOT ON FILE
Phone H: $ 38.63 TOTAL
Rei fit. .
- ----- REQUIRED INSPECTIO14S
This permit is issued subject to the regulations contained in the Erosion Contra'!
Tigard Municipal Code, State of Ore. Specialty Codes and all ether Final Ins per..t i r,n
Applicable laws. All work will be done in accordance with ___•�___,__ _ ___ ___ �_
approved plans. This permit will expire if work is not started
within 189 days of issuance, or if work is suspended for more
than 189 days.
1:1erniittee Si.q»ature:
I,F>SLted Ry:
L;all for inspection 639--4175
i
SW 1/'4 NE I/4 SECTION 35 T I S R I WM.
SEE MAP WASHINGTON COUNTY OREG01
IS I 35AB Z-
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SC.ILE I (00'W. T OAK S T R
C.R. NO- 023
400 01. 04 73.30 t0 7t.t�N
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C. 3300 i 3400 35n0 3700 � 3800 3900 � 4000
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conditionally Approo� . t
For only the worke� ibe In:
(73
PERMIT NO. 1Z :(L' ,
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OMMUNITY DEVELOPMENT DEPARTMENT DATE 7ssUED
JOB ADMESS., _ _11L� `3 t') ��c�/ TAX MAP/10r-1 ssA
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---
M :
PERMIT f ACCT I OE9CR>3?TIION AMMM AM3[Nr PD. BU,- EM
10--432 00 Building PeWmit Ftmm -
10-431 00 Plumbing Pexmit FkMM --
10-431 Ol Mechanical Permit Psi
10-23001 State Bailding Tax (50 -1---��- - -----
Bui'.ding
Plumbim
Mach
a 10-433 00.. Plans Che& Flee �
Building i 5.00
L.
plumbing --
y Mac#n
30-202 00 Sewer 0MV00tiOn -
-� 30-444 00 Sewer .TnsPectian —
m 51.--448 00 Street SYstem Dew Ctk-WW (SD--)
w 52-449 00 Parrs SysttAm Dev Chax9e (EDC)
--------
31-45000 St.Orlu Drctinage Syst Dev C1n9 (SSDq -- ---
10-230 06 Fire
RDC if
Received By: Date Re0elved:
P_f/3587P-WPF