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IMAGE IS NOT AS CLEAR AS THIS NOTICE_ 1 2 3 I 4
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ITIS DUE TO THE QUALITY OF THE — ` ------ � •„�.��..� �._ '
No.36
ORIGINAL DOCUMENT 0V
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10970 SW North Dakota St
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST •'
INSPECTION 91VISION Business Line: (503)639-4171 BUIP
Receivedy� Date Requested - AM_______. PM BUP
Location .___.__- Z69e70 4AtJ_ ti- — e__ MEC
Contact Person -_ Ph(. ) -'� PLM - -- --
Contractor _ _. Ph( ) — _—_ _ SWR
BUILDING Tenant/Owner _- ___— —______ — ELC _
-- -----------
Footing ELC
Foundation Access:
Ftg Drain ELR ---
Crawl Drain -
,lab Inspection Notes. dcl SIT
Post&Beamer
`hear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing ------ — ------- -- --
Insulation
Drywall Nailing �c l C —J_ c/t L.. k 'c > —
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling -- --- -- ------ -- -
Roof
Other: —
F
ASS PART FAIL - -- ----—
PLUMBING -
Post& Beam --_
Under Slab - -- -- - - _
Rough-In
Water Service
Sanitary Sewer
Rain Drains _--
Catch Basin/Manhole
Storm Drain ---
Shower Pan
Other:
Final -
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 -
Final Reinspection fee of$_ -.___ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE - F] Please call for reinspection RF: ----, Unable to inspect-no access
Fire Supply Line -
ADA
Approach/Sidewalk Date -�=5-- hnapwrt�► Ext
Other: _
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY O F T I G A R D __ MASTER PERMIT
PERMIT #: MST2.001-00531
DEVELOPMENT SERVICES DATE ISSUED: 10x'26/01
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 6139-4171
SITE ADDRESS: 10970 SW NORTH DAKOTA ST PARCEL: 1S134DB-03500
SUBDIVISION: ZONING. R-4.5
BLOCK: LOT: JURISDICTION: TIG
REMARKS: Garage addition. 1600 sq.ft. (pole barn construction.)
BUILDING
REISSUE, STORIES. t FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: L•. FIRST, of BASEMENT: or LEFT SMOKE DETECTORS.
TYPE OF USE: SF FLOOR LOAD: SECOND: of GARAGE: 1,600 of FRONT PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT sl RIGHT.
OCCUPANCY GRP: kJ BDRM: BATH: TOTAL br VALUE: S 38,080.00 ROAR,
PLUMBING
SINKS: WATER CLOSETS. WASHING MACH: I' •NDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: _. cR LINES! SF RAIN DRAINS: 1 CATCH BASINS:
TUB/SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES BCKFLW PREVNTR. GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN<100K: BOIL/CMP<311P VENT FANS: CLOTHES DRYER:
FURN-100K. UNIT HEATERS. HOODS: OTHER UNITS:
MAX INP. btu FLOOR FURNANCES: VENTS. WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT _ _SERVICE FEEDER TEMP SRVC/rEEDERS BRANCH CIRCUITS MISCELLANEOUS ADU'L INSPECTIONS
1000 SF OR LESS'. 1 0 200 amp. 1 0 - 200 amp. W/SVC OR FDR: I PUMP/IRRIGATION: PER INSPEC TION:
EA ADD'L 500SF: 201 400 amp. 201 400 amp. tat W/O SVCIFOR: SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp 401 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HWSVC/FDR: 601 - 1000 amp. 601•8mpl-1000v: MINOR LABEL:
1000.amp/volt
PLAN REVIEW SECTION
Raconner.l only -4 RES UNITS. SVC/FDR> 225 A.: >600 V NOMINAL: CLS AREAISPC OCC:
ELECTRICAL•RESTRICTED ENERGY _
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO, VACUUM SYSTEM AUDIO 8 STEREO: FIRE ALARM- INTERCOMIPAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH, BOILER: HVAC LANOSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER CLOCK: INSTRUMENTATION: MEDICAL OTHR:
HVAC DATAlTELF COMM. NURSE-'ALES TOTAL ff SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 1,148.59
886
This permit is subbed to the regulations contained In the
10970 SW NORTH DAKOTA PO BOX 8
JABS,WILLIAM M EUE3AN CONSTRUCTION Tigard Municipal Code,State of OR. Specialty Codes,and
Tl(-,ARD.OR 97223 BEAVEf2CREEK,OR 97004 all other applicable laws. All work will be done in
acoordanre with approved plans. This permit will expire if
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days. ATTENTION:
phone: Poona: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Censer. Those rules are set
Raga II(- 5.1961`, forth In OAR 952-001.0010 through 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
LIC, 0144 REQUIRED INSPECTIONS
Erosion Control Insp Rain drain Insp vY J
Footing Insp Electrical Final
Electrical Service Plumb Final
Electrical Rough In Final inspection
Framing Insp
Issued By '�Qt,,LL�<<�- i/G/� Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
G rlo --
Building Permit Application
City of Tigard
.� Date received: Permit no.: ' r -'/
- ,
City a/Trgard
Address: 13125 SW Hall Blvd,'fi 1.d,OR 972 Project/appl.no.: Expire date:
Phone: (503) 639-4171 i 11 / Date issued: By:rF-' Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: I&2 family:Simple Complex:
Ilea
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family XNew construction U Demolition
U Addition/alteration/replacement U Tenant iniprovement U Fire tiprinkler/alarm ❑Other: 1
Joh address: /C' U 5•r , ,/l �a� C c � Bldg.no.: Suite no.: v "
I.ot: I Block: Subdivision: �ax map/tax lot/account no.:
Project name: C7 CA ODI -rl0 T'
Description and location of work on premises/special conditions::14
OWNER FOR Sill-AIAL INFORMATION, USE CIIIIECKLISM
Name: (1--loodplain,septic capacity,solar,etc.)
Mailing address: It'! Ci / p�� !� , 0MAVA S,4. 1 &2 family dwelling;: �
City: t C -1 r' 1 1 State:d,- ZIP: e ZZ,? ' Valuation of work........................................ $
Phone: ' 1( ' Fax: ' E-mail
I No.of txdrexrms/paths.................................
Owner's representative: �,t n- G Total number of floors.................................
Phone: Fax: E:-mail: New dwelling area(sq. ft.) .......I..................
Garage/carport area(sq.ft.)......A CJS...
Name: ''�"CAA4 tfw Covered porch area(sq,ft.) .........................
Mailing address: Deck area(sq.ft.) ........................................
--- —
City: 1 lI Other structure area(sq. ft.).........................
Starr
Phone: I;ix (I �I ---- — ('ommercial/industrial/multi-fomily:
1 1 ' Valuation of work........................................ $
Business name: < < ��itr'S T/�G'L /(.�il.l
Existing bldg.area(sq.ft.) ..........................
L G'i3i i .
� New bldg.area(sq.ft.)................................
Address: f'�'' e-k r,0(- Number of stories _
City c 1,e State• ,c ZIP: g Zeoel Type.of construction.............•......................
Phone: & �Z-C '3 Fax_ - E-mail: (kcupancy group(s): Existh.g:
CCB no.: ,57,1-��(�6,
-- — New:
City/metro lir nn Notice:All contractors and subcontractors are required to he
I
with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: —-- - jurisdiction where work is being performed.If the applicant is
__ -_ _ exempt from licensing,the following reason applies:
Cit State—j7.IP:
Contact person: flan no.: ---' '—
Phone: Fax E-mail.
Name: t!OirS ' Cn t contact person:kt,# -- i e Fees due upon application ........................... $ —
Address: >Jr ��,r V ni c i' /� _ Date received:
City: ro, lh, e-fState:Qr ZIP: i l Amount received ......................................... $-- —
Phone: ' •J• /J j6' F9x;J¢6-- E-mail: Please refer to fee schedule.
1 hereby certify I have read and examined this application and the Not all jurisdictions accept credit code,please call jurisdiction for more intorunation
attached checklist.All provisions of laws and ordinances governing this U Visa U Mastercard
work will be complied witlte4hethcr speci(leti he in or not. Credit card rwmba: —_— _--- re%
GRpiree
Authorized signature i t ? 'DAle: Name of Artaroldef as shown on credal card
Print name: 11114,/r 1 i 4` S - cadboide,aiputtrne — s Amonmr
Nolice:•ibis permit application expires if a permit is not obtained within 190 days aver it has been accepted as complete,, 410-4613(60000M)
One-and"I'wo-Family Dwelling
\ ) Reference no
Building Permit Application Checklist
Cirv4lTigurd Associated permits:
1�3 Of Tigard J Electrical U Plumbing U Mechanical
Address: 13125 SW liall Bivd,Tigard,OR 9722.4 J Other: _
Phone: (503) 639-4171
Fax- (501) .599-1960
TIIF FOLLOWING ITEMS ARE REQI IRED FOR PLAN REVIEW Ves No N/A
1 Land use action.completed.See jurisdiction crud i,t 1,,i �,III III i:•nt reviews. (/
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic distnct,etc.
3 Verification of approved platllot.
4 hire district approval required.
5 Septic system permit or authorization for remodel. isxisting system capacity
6 Sewer permit. —
7 Water district approval.
8 Soils report.Must carry original applicable stamp and signature on file or with application.
9 Erosion control Ian U permit required.Include drainage-way protection,silt fence design and location of
catch-basin prow6tion,etc._
I Oi 3 Complete sets of legible plans. Must he drawn to scale,showing conformance to applicable local and state
building codes. Lateral design details and connections must he incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plum location and details. Plan review cannot be completed
if co ri!,ht violations exist.
I I Sitt/plot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(it'
there is more than a 441.elevation differential,plan must show contour lines at 24t.intervals);location of easements and
driveway;lix)tprint of stroclute(including decks);location of wells/septic systems;utility locations;direction indicator,lot
area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage.
12 Foundation plan.Show dimensions,anchor hobs,any hold-downs and reinforcing pads,connection details,vent
sire and location.
13 Floor plans.Show all dimensions,room identification,window size,location ol'srnoke detectors,water heater,
furnace,ventilation Gans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor,
wall construction,roof construction. More than one cross section may he required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four fool at building envelope.
Full-size sheet addendums shoeing foundation elevations with cross references arc acceptable.
I O Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysis provide sp cilicuuuns and calculations to engineering standards. —
17 11oorlroof framing.Pro,.ode ph-s for all Iloors/roof assemblies,indicating member sizing,spacing,and fearing
locations.Show,attic%ewilatior
18 Basement and retaining wall_ P -)vide cross sections and details showing placement of rebar.For engineered
systems,see item 22,"Engineer s calculations."
V) Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam./joist carrying a non-uniform load.
20 Manufactured floorlroof truss design details.
21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required
for flour or nturr appliances.
22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss)shall he stamped by an engineer or
;uchnect licensed in()Ieron and shall he shown to he applicable t„the project under review
M 11MMUM 11121"1 bum
23 Five(5)site plans are required for Item I I above. Site plots must he K 1/2" x I I"or I I"x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 above.
25 Building plans shall not contain red lines or tape-ons.
26 No rolled,reversed or mirrored building plans will be accepted.
27 — — -- — —
28 —_--
Checklist must he completed before plan review start date. Minor changes or notes on submitted plans mai he in blue or black ink.
Red ink is reserved for department use only. 440-4614(rraa T t.n
Electrical Permit Application
Date received: Permit noj,
City of Tigard Project/appl.no.: Expiredale:
City ofTigard Address: 13125 SW Ilall Blvd,Tigard,OR 97223 bate issued: By: Receipt no.:
Phone: (503) 6394171 -
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
1 r
r
ly dwelling or accessory U Commercial/indutiurtl U Multi-family U Tenant improvement
ruction U Addition/alteration/replacement U Other: _ U Partial
JORS111 INFORNIAHON
Job address: /Or'/ I 15. . c.-/7t Z)4,kAS1.j Bldg.no.: - - `.uu no.: ITax map/tax lotiaccount no.:
Lot: Block: Subdivision:
Project namc: ✓RPS Description and location of work on premises: _—
Estimated date of cnmpletionhns -ction:
Job no: \aJ IVB fee Mas
Business name. Description v. (ea.) I ofal I no.Insp
--- - --— New rrsidenlial-singleor multi-family per
Address: dwelling unit.Inchok-%allacberl garage.
City: State: ZIP: Service included:
Phone: Fax: I E-mail: Ilxx)sq.ft.or less / 4
Each addillonal 500 sq.ft.or portion thereof
CCB no.: Elec.c.bus.tic.no: Limited energy,residential 2
City/metro lic.no.: Limited energy,non-residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician(required) Date Service and/or feeder 2
Sup.elect.name(print): License no: Services or feeders-installation.
aheratlun or relocation:
21N)amps or less 2
Name(print): SLC /111 PS 201 amps to 400 amps --- 2
401 amps to 600 amps 2
Mailing address: 0 p S,r t r, r O 601 stops to I(xH)ramps _
2
Cit _ State: ZIP:c'
Y� f t �' LIK 1 11 5' Over 1000 amps or volt.,_ -- 2
Phone: �� Drax:" E-mail: Reconnect only I
Owner installation:The installation is being made on property I own Temporary servkes or feeders-
which is not intended for sale,lease,rent,or exchange according to butallation,alteration,orrelocation:
ORS 447,455,479,670, )1. 21x)amps or less
t / r� � 201 amps►0 4W amps 2
rs
Oncr's si mature: 7_) ' 44— Dale: _ /E e., 401 to 6(N)ams 2
Branch circuits-new,alteration,
or extension per panel:
Name: A Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City: stdtc. ZIP: B. Fee for branch circuits without purchase
---
Phony.: of service or feeder fee,first branch circuit. 2
I E-mail:;tt ch additional branch circuit
Mise.(Service or feeder not Included):
U Service over 225 wraps-commercial U Health-care t.-flit) Fisch pump or irrigation circle _ 2
U Service over 320 amps-rating of 1 Ret U Hazardous location Each sign or outline lighting 2
familydwetlings UBuilding over l0,(Xx)squwefeet too,(it Signal circuit(s)orahoutedenergypanel.
U System over 600 volts nominal mote residential units in one s moure alteration_or extension' L — -'
U Building river three stories U Feeders.400 amps or more •Uescn sum _ __ __ _
U Occupant load over 99 persons U Manufactured structures or R\'park Fneh additional Inspection o,er the allowable In am of the above:
U F.gres4lightingplwt U Other _ _—_._ Pcrinspecuon
Submit__sets of pians with any of the above. Investigation fee
The above are not applicable to temporary cotnetrudlon serrdce. Other
Na all jurisdiclirms weer credit cants,please call jurisdiction for more in(rxmation. Notice:This permit application Permit fee.....................
U visa U Mastercard impires if a permit is not retained Plan review(at _,. %) $ _
Credit card number: - _-_�.� _ -_ within 180 da,,s after it has been State surcharge(8%)....$
xpire+ _
__ occepted as complete. TOTAL .......................$
Name of cat�tolyder u rwn on credit cid
_ S
Ct*Wdet signature Amours 4404615(6M OM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
_TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
Schedule omp eta Fee e oW: Restricted Energy Fee................ ..................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential-per unit _
1000 sq ft.or less __ $145 15 _ 4 [-� Audio and Stereo Systems'
Each additional 500 sq it or
portion thereof $33.40 _ h LJ Burglar Alarm
Limited Energy $75.00
_--
Each Ma wfd Home or Modular
Dwelling Service or Feeder $9090 2 ❑ Garage Door Opener'
Services or Feeders ❑ Healing,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less _ $8030 2
201 amps to 400 amps $10685 _ 2 ❑ Vacuum Systems'
401 amps to 600 amps _ $16060 2
601 amps to 1000 amps _ $240.60 2 ❑ Other
Over 1000 amps or volts $45465 2
Reconnect only $66.85 2
Temporary Services or Feedei-s TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each system...................................................... ... $75.00
200 amps or less $66.85 2 (SEE OAR 918.260.260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133 75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts.
see"b"above. ❑ Audio and Stereo Systems
Branch Circuits ❑
Now,alteration or extension per panel Boiler Controls
a)The fee for branch circuits
with purchase of service or Clock Systems
feeder fee.
Each branch circuit $665 _ 2 ❑ Data l telecommunication Installation
b)The fee for branch circuits
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
F irst branch circuit $46.85
Each additional branch circuit $665 n HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑
Each sign or outline lighting — $5340 — Intercom and Paying Systems
Signal circuit(s)or a limited energy
panel,alteration or extension $7500 ❑ Landscape Irrigation Control'
Minor Labels(10) $12500
Each additional Inspection over F] Medical
the allowable In any of the above
Per inspection _ $62.50 �� Nurse Calls
Per hour $6250
In Plant $73 75 ^ _ U Outdoor Landscape Lighting"
Fees: Protective Signaling
Enter total of above fees $ — [-1 Other
9%State Surcharge $
Number of Systems
25%Plan Review Fee
See"Plan Review"sertion on 5 N licenses are required Licenses are required for all ottrrr in,tallations
front of application ---
Fees:
Total Balance Due $
_---- Enter total of above fees •ri
❑ Trust Account# I B•,e Stnte Surcharge $
Total Balance Due
i:\dsts\formt\elc-lees doc W07/01
SEE 35MM
ROLL # 20
FOR
OVERSIZED
DOCUMENT
ERMIT
CITY OF TIGARD ELECTRICALPERMIT
EP02-00
PERMIT#: 7/26/002-00352
DEVELOPMENT SERVICES DATE ISSUED: 7126/02
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639-4171 PARCEL: 1S134DB-03500
SITE ADDRESS: 10970 SW NORTH DAKOTA ST
SUBDIVISION: ZONING: R-4.5
BLOCK: 1 OT : JURISDICTION: TIG
Proiect Description: Shop building
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS _
1000 SF OR LESS: 0 - 200 amp: PLO' o/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGNtOUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS _ ADD'L INSPECTIONS___
0 - 200 amp: 1 W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
60'1 - 1000 amp: _ PLAN REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only — SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JABS,WILLIAM M RURAL ELECTRIC INC
10970 SW NORTH DAKOTA 5285 NE ELAM YOUNG PKWY
TIGARD, OR 97223 SUITE A900
HILLSBORO, OR 97124
Phone: Phone: 503-648-6696
Reg#: LIC 00047478
SUP 4062S
ELE 34-82C
FEES Required Inspections _
Type By Date Amount Receipt Elect'I Service
PRMT CTR 7126102 $80.30 2720020000( Elect'I Final
5PCT CTR 7/26/02 $6.42 272.0020000(
-- Total $86.72 F.XP, q F n
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 OAR 952-001-0080 You may obtain copies of these rules or direct questions to
Permit Signature: L � ,�7, f � Issued By: /, ,
_ _OWNER INSTALLATION ONLY _
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: �_ -- DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SIJPR. ELEC'N: _-- DATE-----.
LICENSE
ATE: —_.LICENSE NO: —
Call 639-4175 by 7:00pm for an Inspection the next business day
JUL 25 2002 11 : 00AM RURAL ELECTRIC INC 5036406004 p.
Electrical Permit Application
-- Uatereceived: Permit ova-6 j35
City of Tigard Ptojerxlappl.nu.: Exp ire date:
CiryofT'igard Address; 13125 SW Hall Olvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 6394171 --- `— --
Fax: (503) 598-1960 rate file no.: Payment We:
Land use approval:
XXkI &2 family dwelling or utxessory U Commercial/industrial U Multi-family U T'r.nant improvement
❑New construction U Add itiuit/alteration/replacement _J Other: U Partial
Job address: 10970 SW North_Dakota Billy mr. i Suite no.: lTiLx map/tax lWaccount no.
Lol: _ Block_ Subdivision: _ ---i
Pnrject name: Bill Jabs —�Des�riptiun and lucaliun of work un promises; shop bullftng feledet _
F,stimated date of completion/inspection: -
Job no: r.� tax
Business name: – -- Dur fiat Qt OIL) '1.4x1 it ins
Address: y�.., Nrt+rrsMeatLt-tirtgk ortnnln lartdly�cr
-5�� nM Yom MgM_ duelling unit.lnchitkm stlad"rsar2".
City: Hi]LCt) nSlate:. ZIP: krrlcrhiclu"
Phone:50 648-66 Fax:C90.{004 E-mail; 1000 sq.ft.or less - - 4
Fachadditional 500s ft.or tortinn!liens,(
CCA oro.: 47478 _ Llec.bus.tic.no: 34-82Cg' l --------- -- - _
limited energy,residential 2
C 11y/me lie.no.: 5787 Undtedrnu ,non-residurtiel 2
7/25/02 trach manufactured home or modulo d;WI_1 nR
Signature of supervisink electrician(required) Date - Service niuvar feeder 2
Sup.elect.naune(print): Pat.11 A.. Villa License no. 4052–x: S,rviersorreedera–isstallstiun,
after ttlon or relocation:
200 amps or less 2
Name(print): Bi 11 Jabs 201 amps to 400 amp' 2
Mailing tuWress: 10970 FM Sk_ h 5W0ta' -- 401 amps to 6W amps - 2
601 un s to 1000 ampr; 2
City: Ti lard Slate: OF( ?.IP: 97223 Over RM amps or volts - - --- - -- 2
Phone: I Fax: I R-mail: ltft-onrr.clard '- -- —
Owner installation:The installation is being trade on property I own TersporiryW., orfeedera-
which is not intended for sale,lease,rent,or exchange according to Imtsitall nt''dtrridilorrelacane"
ORS 447,455,479,670,701. 200amps or lns 2
201 amps to 4(tnampc 2
Owner's si nature: Date: 40iuo6wam.s-� - - - - - 2
Branch drealts-new,alteratlort,
ortatrrteloa per prnek
Name' _— _ A Fee for bruncb ctrruits with purehnse of
Address: service of ferder tee,each bratictr circuit 2
City: State:— ZIP: 8 Fm for branch circuits withoutpurchase
of sen tee o.finder Pee,first branch circuit 2
Phone: Fax: I'. Mail Ivchadditional brarwhcircuit:
Mlles.(Service or feeder not laeladed):
0 Service over22S*mpg mmme-mal J Ilcsith carrta.:ley Each pump oritagationcircleY 2
❑ServiteaverA20amps-ratingnf 1&2 J Ilarrrdoruk,caunn Each sip ororth
tnelighting 2
family dwellings J Rulldingnver 10, N)agtraretretfuutor Signal circuit(s)orslimitedenerRypnitel.
*Systnnover 600volts norninal rneternsidentialunitelrtonestructurr alleradmurentarion• 2
J nuildinguverthreestories J Feeders.400 amps lit murc "Wwription
❑Occupant lain over 99 persons ❑Mrmafxltrced atruexaroe at RV park Each additional inspeeilon n ver the allowable in any of the above:
0 kgre"Aightingplan 0(*wr _ Per inspection
9etiask_eels of plains with any of the above. Investi anon tee
'Ilse above are not applkable to tanporery constractlim seryke. Met — - -
-;ot an)uriWktioaa weal credit carr.gcax calt:arha-tiva fa more udvmstlon. Notice. Ittis permit application Permit fee.....................$8 30----
U Visa J MasterCard expires if a permit is not obtained Plan review(at _ %) S
credit cud number: — ___-__ _._.-L__/ - within IRO days anter it has been State surcharge(9%)....S 6-42
- - -----
neccptodmcomplctc 10TAL .......................$86.74
Name of eardlnldrr n sitoevn mcreat card
S
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