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11400 SW NORTH DAKOTA STREET lie) 500- 709 62 9- 10" r10wV5' SIGN GROUP SW Gwnb n Rd A 4 Tq,rd Onpon 97223 503-6246398 63.33' N00003' 1 5"W 160.67' 30' CCD4R En -ta (31 I ti N titi ti �' tv C� 1 t..3 1 JRII/EWA Y � •' MAN DECIDUOUS _` v — -- �~ �--� ` I 0°/1' UNKNO Z I I ■ I I _`1 CEDAR 11 r)MDUOUs 1'�1 I ■ 16" UN &-ft N I CO 11 / nfc>oreUs o I N Q F` I r- -4 '� 1 Z \ ' m r 12' UNKN ON 8' BIRCHES OiCIDWUS I 1 8' BIRCH 225 18" FIR IIB" FIRS Ui 76 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - --- - - - - --- - - SOO*03' 15" E SI'D'E PLAN= SCAIE: 1" =20' 11400 S.W. NORTH DAKOTA STREET TIGARD, OR. LA""V N M!CW GIS M CttON 34 M M 04.C"Q"um, W4M�IrRY�!UOtM1',OII14,711 NOTICE: IF THE PRINT OR TYPE ON ANY -�(-�- Ilr SII III 111 III II1 � 11r III Ill tIt ILr tlt .r� t _ . �� lir II � IIII Int III III 111 1 111 1111111 � Illtll 111 -lri 7� 11 1 � 1 I�� 1�1 1_�r 1- r� I i l1I � I1 I I I Jill � 1 I I � 1 I IMAGE.IS NOT AS CLEAR AS THIS NOTICE, 1 z 4 5 6 7 $ �� — — -- — -- -- __ 11 IT IS DUE TO THE QUALITY OF THE No.36 ORIGINAL DOCUMENT E- 6Z � 8Z LZ 8Z sZ EZ Z iZ OZ 6 L 8 (IIIILfIIIiIIIIIIIIIIIIIIIIIIIillillllllliLLI11.� .IIll�11lIIIILIII .IIIILIi 111111� 1111111iiIIIIIIIiIIIIIiIIIiIIIIIIIII :IIIIIIiIIIIIIIiIIIiIIIIIIIIIIiIIIIIILIuII .111111111 IIIILIIILIIILUI ll �IIiI11�11� 't A Ab 0 0 cn Z O w O 11400 SW North Dakota Street BUILDING PERMIT CITY OF TIGARD PERMIT#: BUP2001-00032 DEVELOPMENT SERVICES DATE ISSUED: 1/24/01 13125 SW Hall Blvd..Tigard, OR 97223 (503) 639-4171 PARCEL: 1S134DB-02300 SITE ADDRESS: 11400 SW NORTH DAKOTA ST ZONING: R-4,5 SUBDIVISION: BLOCK: LOT: JURISDICTION: TIG REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: DEM FIRST: sf N: S: E: W: TYPE OF USE: SF SECOND: sf PROJECT OPENINGS? — TYPE OF CONST: sf N: S: E: W: OCCUPANCY GRP: R3 TOTAL AREA: 000 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MF_ZZ?: REQD SETBACKSREQUIRED FLOOR LOAD: psf LEFT: ft RGHT_ ft FIR SPKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: Remarks: Demolition permit for removal of existing house, garage, deck & pump house, approximately 1400 square feet All demolition debris must be removed from the site. The sewer line must be capped and inspected. New Owner: Contractor: FERREL, DORIS M LIFE ESTATE OWNER WERNER, STACEY L. 11400 SW NORTH DAKOTA ST IUARD OR 97223 Phone: 579-9125 one'. Reg#: _ FEES REQUIRED INSPECTIONS _ Type By Date Amount Receipt Cap Sewer Line Insp PFtMT CTR 1/24/01 $62.50 27200100000 Final Inspection 5PCT CTR 1/24/01 $5.00 27200100000 EROS CTR 1/24/01 $26.00 27200100000 ERPC CTR 1/24/01 $8.45 27200100000 (additional Fees not listed here) Total _ $110.40 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-1987. Pe rm itee f Signature: r`U�✓ ---! ��')i 44� Issued By: amu- Call 639-4175 by 7 p.m. for an inspection the next business day Building Permit Application rDatcreccivcd: /�� -O/ Permitno.: City of 'Tigard Address: 13125 SW!call Blvd,Tigard,OR 11722.3 ProjecUappl.no.: Expire date: City of Tigard phone: (503) 6394171 Date issued: By: Receipt no.: Fax: (503) 598-1960 Case,file no.: Payment type: Land use approval: _ 1&2 family:Simple Complex: TYPE OF PERNI IT U I &2 family dwelling ar accessory U Cornmercial/industrial U Multi-family U New umstrrclion Demolition U Addition/alteration/replacement U Tenant improvement U I'ire sprinklcdalartn U Other: _ �.— i ! SITE INFORMATION Job address: I� p1i ,5�.. lkrpl Oq+ic, �ti- . F31dg.no.: Suite nt, Lot: — E31ock: Subdivision: x map/ atax lot/account no.: -- - - 1 Project name: - -- -- _- De�dption and location of work on premises/special conditions: L� 14 F F(CcY / L'C' x": OWNER 1INFORMATION, / Name: 57ACr r M�1�2 t L We r E f-- solar, Mailing address: 4L .Sts R J)&!5 .S _ 11 &2 family dwelling: City: T1 State:d 7.11' 2 2. Valuation of work........................................ S; Phone: .*1 -6 p Fax: E-mail: No.of bedrlxims/baths................................. �C Owner's t cprcscnt_ative: Total number of floors................................. ----- - Phone: Fax: Email: New dwelli area(sq.ft. Garagelcarport area(sq.ft.)......................... ---------------- Name: , Covered porch areh.(sq.ft.) ....................... . Mailing address: Deck arca(sq.ft.).............................I.......... -- `- Other structure area(sq. ft.)......................... City: State: ZIP: -- 1 - J— -- — -- _- Commercial/industria!/multi-family: Phone: I ax. F.-mail: 1 Valuation of work........................................ v, NTRACFOR Existing bldg.arca(sq.ft.) ......................... Business name:_" t �P'U L ''a t1J � Address: � I 1 ttG'G � b�4 -�z '37- Ncw bldg.arra(sq.ft.)................................ Nur fiber of stories........................................ — -- City: '71 State:0P, ZIP: g7Z*n - — Type of construction.................................... Phvnc: - p -f Fax: E-mail: �— Occupancy group(s): Existing: _ ----- `� CCB no.: Z _--- New: City/metro lic.no.: Notice All contractors and subcontractors are required to be ` ARC11 1111TH71DESIGNtRlicensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may be required to be licensed in die Address: "- jurisdiction where work is being performed. If the applicant is r City: State: Z,II'. exempt from licensing,the following reason applies: Contact person: Phone: Fax: -- E-mail: _ -- vi Name: __Contact person: Fees due upon application ........................... S Address: Date received: .,t City: State: ZIP: Amount received ..................... ................... $ Phone: _ Fax: — Email: Please refer to fee schedule. I hereby certify I have read and examined this application and the Nor all jurisdictions accept credit cards.please call jurisdiction for mor information attached checklist. All provisions of laws and ordinances governing this U Visa U MasterCard work will he complied r wh her slxcrfred herein or not. Credit card number _- / l C!WZLtiaplrea Authori7cd signature: �- — Date: f ' CC — None of cardholder as shown on credit card 1 , $ _ Print name:_��� Q _— —CarAlsolder signature — Amount Notice:This permit applicati n expires if a permit is not obtained wi;41n 180 days alter it haq been accepted as complete 44",13(&"WOM) os/�T f -5 IS ETBACK TA STREET S W N)RT H DAKO t NORTH C[WW'C ARC KVO GV CRY Y TrAW BOOMW NO 234 - +' Lh 1 SE40 AU.OrAnD IN IW x SII WIRM CW'alA 57RC17. - — — nrmwjv-7,19.75 fmum.mm 19,f 1118-20,�� 0 D' R-320. < 225— �I 4► ��. ti Im 'v 2 -- 1 8 LYNMRw O o ?24 . FFKt o r. c �- ?mss" 223 r- R FENC I / [AbmCMCAM co � 11 M EXISTING RESIDENCE --- r cmc taw GAS E Q ry .I ry I EAlM\ M DECK \ cesmc IyY�q 6C N b 2 ?fi I SILT PENCE iV 220 1 1 I I RLYR RCiARRAG wv.l ' ?le i 19 1 I A� I I ------.. ---- 211 M215--- M vi l0 214 DEMOLITION $ITE PLAN LCrATEP M T4 5EV4 CP BECTirM 54, 7.16,It W.WM.,CITY OF TIGARD o" WA6NINOTON COLNTY,OREGCN SWAY UMRt Pt MOIEMNCE +.c«•. w.. io.„.. �JlilT 1146,"4,^ 3U1 NORTH DAKOTA $T DATE �EIrT�! �„^�r; Cofom HimDaMO 9585 S w 89t, (sa�; <., e�7� p�flonC, (P 97.2` I Cx TIGARD,OR 9'223 FILE:UVPMTlDUC! •. .::w �. (5403;639-69fLL FAY (sou M3--5025 eame.004 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 SENTIFIN NO 08 2001 IMPORTANT PERMIT NOTICE RECD M NOV 0 8 2001 ROBERTS ELECTRIC INC 57 59 SW 48TH PORTLAND, OR 97213 Electrical Signature Form Permit #: MST2001-00524 Gale issued. Parcel: 1 S134DB-02300 Site Address: 11400 SW NORTH DAKOTA ST Subdivision: Block: Lot: Jurisdiction: TIG Zoning: R-4.5 Remarks: Construction of new single family detached residence. SDC credits to apply once BUP2001-00032 (demo permit) has been finaled.path 1 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 below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: STACEY WERNER ROBERTS ELECTRIC INC 11400 SW NORTH DAKOTA ST 5759 SW 48TH TIGARD, OR 97223 PORTI__oNn, oR 97211 Phone #: 503-639-6909 Phone #: V-244-7754 Req #: LIC 93ees ELE 34-23C 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 MASTER PERMIT I 001-00524 DEVELOPMENT SERVICES DATE ISSUED: MS520 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 11400 SW NORTH DAKOTA ST PARCEL: 1S134DB-02300 SUBDIVISION: ZONING: R-4.5 BLOCK: LOT: JURISDICTION: TIG REMARKS: Construction of new single family detached residence. SDC credits to apply once BUP2001-00032 (demo permit) has been finaled.path 1 BUILDING REISSUE: STORIES: 2 _ FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 23 FIRST: 1 o5: of BASEMENT, Son 00 of LEFT: SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: 40 SECOND: ?.::35 of GARAGE: 858 of FRONT: 5; PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: I FINSSMENT: of RIGHT: 31 VALUE: $485.39020 OCCUPANCY GRP: R3 BDRM: 3 BATH: 4 TOTAL: .I Iy701' if REAR: 70 PLUMBING SINKS I WA TER CLOSETS: 4 WASHING MACH LAUNDRY TRAYS. I RAIN DRAIN- 100 TRAPS: LAVATORIES: 5 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: ton SF RAIN DRAINS: I CATCH BASINS - TUBISHOWERS: 4 GARBAGE DISP: I WATER HEATERS. 1 WATER LINES: 108 BCKFLW PREVNTR. GREASE TRAPS. OTHER FIXTURES. MECHANICAL FUEL TYPES FURN<10OK: BOILICMP<3HP. VENT FANS: 7 CLOTHES DRYER. 2 r;n5i FURN—100K: I UNIT HEATERS: HOODS: I OTHER UNITS 2 MAX INP. blu FLOOR FURNANCES: VENTS. I WOODSTOVES GAS OUTLET I ELECTRICAL RESIDENTIAL UNIT _ SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 sr OR LESS: 1 0 200 amp. 0 200 amp W/SVC OR FOR 1 PUMP/IRRIGATION PER INSPECTION. EA ADD'L 500SF: 10 201 400 amp: 201 400 amp: 1st WIO SVC/FDR 01j SIGN/OUT LIN LT: PER HOUR. LIMITED ENERGY. 401 - 600 amp 401 - 600 amp: FA ADDL BP CIR: SIGNALIPANEL: IN PLANT MANU HWSVCIFDR. 601 1000 amp: 601-amps-1000v: MINOR LABEL - 1non.amp/vorl PLAN REVIEW SECTION Reconnect only —4 RES UNITS. SVC/FDR>=225 A. >600 V NOMINAL: CLS AREA/SPC OCC ELECTRICAL-RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO: X VACUUM SYSTEM: x AUDIO d STEREO'. FIRE ALARM- INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: X OTH: BOILER: HVAC: LANDSCAPE/IRRIG PROTECTIVE SIGNL- GARAGE OPENER: X CLOCK: INSTRUMENTATION- MEDICAL OTHR: HVAC' X DATA/TELE COMM: NURSE CALLS TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 6,061.78 This permit is subject to the regulations contained in the STACEY WERNER OWNER Tigard Municipal Code.State of OR. Specialty Codes and 11400 SW NORTH DAKOTA ST all other applicable laws. All work will be done in TIGARD,OR 97223 accordance 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: Phone Oregon law requires you to follow rules adopted by the AOregon Utility Notification Center. Those rules are set '11Reg Ir: forth in OAR 952-001-0010 through 952-001-0080. You mai obtain copies of these rules or direct questions to �1U CLINIC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Slab Insp Crawl Drain/Backwater Mechanical Insp Shear Wall Insp Insulation Insp Grading Inspection WIT Proofing Bsm't Wa Footing/Foundation Dr; Plumb Top Out Exterior Sheathing Ins► Gyp Board Insp Sewer Inspection Post/Beam Structural Plm/undslab Insp Electrical Service Low Voltage Rain drain Insp Footing Insp Post/Beam Mechanica PLM/Underfloor Electrical Rough In Gas Line Insp Water Line Insp Foundation Insp Underfloor insulation Fing Drain Bsm't Wally Framing Insp Gas Fireplace Appr/Sdwlk Insp Issued By r y_ _, _ � ,y. L ./- Permittee Signature Call (503) 639-4175 by 7:00 p.m. for an Inspection needed the nt3 business day CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2001-00076 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 11/5/01 SITE ADDRESS; 11400 S'qV NORTH DAKOTA ST PARCEL: 1S134DB-02300 SUBDIVISION: ZONING: R-4.5 BLOCK: LOT: JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF'AIORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection permit for new single family detached residence. Sewer connection credits to apply upon final approval of demolition permit. Owner: FEES STACEY WERNER — 1140013W NORTH DAKOTA ST Type By Date Amount Receipt TIGARD, OR 97223 INSP CTR 11/5/01 $35.00 27200100000 Phone: 503-639-6909 Total $35.00- Contractor: Phone: Reg#: Required Inspections 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 purl iqse a "Tap and Side Sewer' Perm Issued by: �. L Permittee Signature: j"'-=- -- Call (503) 639-4175 by 7:00 P.M. for an inspection needed the ►r - business day A17 Building Permit Hcation City Of Tigard Datereceived• /p�(o.p/ Pernitno. Project/9-11.no.: Expire date: 1 Ciryn(Cigard Address: 1312.5 SW Hall 3lvd,Tigar 7223 Phone: (503) 639-4171 Date issued: By:. Receipt no.: Fax: (503) 598-1900 Pao �O r'OQO` '.1- Case file no.: Payment type: 'R Land use approval: Iat�t" _— - t&.2 family:simple Cow lex 1 U I & 2 family dwelling or acressury U('ununcrcial/in(hrstnal U Multi-familycw construction U Demolition U A(I(lition/.perillion/replacement U TC11amt improvement U Fire sprinkler/alarm U Other: INFORMATION40D SITE Job address: 11 4M M c"i AhrWC• .>T, Bldg_n�a.: Suite no.: Lot: I Block: Subdivision: — - Tau map/tax lot;account no.: Project name: R - Description and location of work on premises/special conditions: C=p (FI OWNER FOR SPL(iffJNFORMATION, USE. CHECKLIST Name: .'STZ' 6� (,t A'n4 VReI t Mailing address: %I kjcp St,,1 rioR 1 &2 family dwelli79.�� City: 'Z1(�y2sj Stater 7.IP: a(�tZ Valuation of work.. .......... 2.��.... $ ,�� %% Phone -L_ Fax: 4-Lf E-maiL•Tr nrr reE ' No.of hedrooms/baths................................. -.-- Owner's representative: _ 4cL.foo" Total nr mber of floors................................. 5;h-On,--: 11-ax: E-mail: New dwellin area(sq.ft.) ..... APPLICANT Garage/carport area(sq.ft.)......................... Nat e: CQ w� Covered porch area(sq. ft.) ......................... J Deck area(sq.ft.) _ 4�, Mailingaddress: 11 t1�'t .Sk. ,r-,7.., .............. .................. City: 't1 State:e) 7.1 P:Q7` Z, - Other structure arca(rq. Phon :V'1 7C Fax: 4-Ltl4 F mail: Commerclal/industriallmulil-family: Valuation of work............................... ....... $ Business name: CtJY� l�u F)p °S Existing bldg.arca(sq.ft.)\....... t { - New bldg.arca(sq.ft.)..... .............. Address: _ ('tly. Number of stories................. ................. - -- --- Type of construction............ ......... ............ Phon 5t1 V- -oJ rax: --- E-mail: -- Occupancy group(s): Fxi. ' g: CCB no.: City/metro lie.no.: Notice:All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board under Name_'1� _�5� - _ provisions of ORS 701 and may be required to be licensed in the Address: ) j -jam G `f=`- �'f jurisdiction where work is being perforrcd. If the applicant is City: — State:O 71P: q )21 exempt from licensing,the following reason applies: Contact person: 'T-t)VX Planno.: �- Phon � 24S—g91 Fax: - -- E-mail: ---- - _ Name: Contact person: Fees due upon application ........................... $ Address: Date received: City: State: ZIP: Amount received . ........... ........................... $ Phone: Fax: E-mail: Please refer to fee schedule. j I hemhy cerlify I have read and examined this application and the Not all jurisdictions accept credit cards.please call jurisdiction for nuirr inf.nation attached checklist. All provisions of laws and ordinances governing(his U Visa U Mmlei-Card work will Iv complied 'th, 1-11 then specified herein or not. Crr<tit card nurnhet -_._-._-..__-_. __-__ 1—!__ expires Authorized signature: _ Date: _ j IC Nine of cardholder u.Hawn a, a c.rd -- Print name:_— CQ CLt_�r1GlC' - -_- cardnntdei�IEnuare- Notice:This permit application expires if a permit is not obtained within ISO days alter it has been accepted as complete. 44OA611(~'OM) Electrical Permit Application Daiciecerved is-/G-a/ Permit no.: tysrsQp/-006,2 City Of Tigard Project/appl.no.: Expiredate: —_ r avo.fTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503)598-1960 Calc file no.: Payment type: Land use approval: 1 ' U I &2 family dwelling or accessory U Commercial/industri-! U Multi-family U Tenant improvement New construction U Addition/alteration/replacement U(hher: _ U Partial JOB SITE INFORMATION Job address: 114 VQj lil17 net.: 71tc [III : Tax map/lax lothiccount no.. Lot: Block: Subdivision: Project name: -- �Desctiption and Icwation of work on premise. Estimated date of Coll ifile(ion/inspectioll: CONIRACtOR �PPLIUATION FEE SCHEDULE Job no: 711) ata% Business name: r t Ueuriplion total uo.imp 4 a �pzc- New residential-single or multi family per Address: - dwellingunit.Inclurtr•sallachedgarage. City: Slatc:0V 'LII': 9721Service Included: 1000 sq.ft or less Phone: Zy -1�5 Fax: Email: __ _ 4 Each additional 500 sq,ft.or ponwn thereof CCB no.:61AP 3 Elec.bus.Ilc.no: -0-3- Limited O3Limited energy,residential pU 1/r' 2 City/metro lic.no.: Limited energy.n m-residential 2 c— _Vy Each manufactured home or modular dwelling Si nature of supervising electrician(required) pate Service and/or feeder 2 Sup.elect,name(prino License nn Services or feeders-histallallon, alteration or relocation: PROPERTY OWNER 200 amps or less 2 Name(print) STrlat. s^ .v� 201 amps to 4W amps 2 1 401 amps to 600 amps 2 Mailing addres11"I 0A k'L fti ST- 601 snips to 1000 amps 2 City: T) SIatC Zlp: �Z?L� Over 1000 amps or volts 2 F'hone:•2C - �— Fax: E-mail: Reconnectonly I owner installation:The.installation is tieing made on property I own Temporary services orfeeders- which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation: 2amps or less 2 URS 447,4.55,479,670,701. 20011 - _ -amps to 40)amps 2 Owner's signature: Dale: 401 to 600 ams — - 2 Branch circuits-new,alteration, or extension per panel: 7P11on—e A. Fee for branch circuits with purchase of service or feeder fee,each branch circuit 2 Sate: ZIP: B. Fee for branch circuits without purchase of service or feeder fee,first branch circuit: 2 Fax: E-mail: I?achadditionalhranchctrcun I'l %N REVIEW(Please check rill that appi Misc.(Service or feeder not Included): U Service over 225 angn t mint nal LJ l Italth-care facility Each pum or irrigation circle 2 U Service over 320 amps-rating of 1&2 U Ilaimclouslocation Each sign or outline lighting 2 fmnily dwellings U Building over 10,0(M)square feet four or Signal circuits)or a limited energy panel. U System over 600 volts nominal more residential units in one structure alterauon,or extension' I 1 2 U Building over Three glories U Feeders.41M1 amps or mote •I)escri tion: U O^cupam load over 99 persons U Manufactured structures or RV park Poch addIflonal Inspection over the allowable In any of the above: U Egresx/lighungpinri U Other. ______________—__- per inspection Submit__sets of plans with any of the above. Investigation fee ILe alcove are not applicable to temporary cotulruclion service. Other elan all juristuctiotn accept credit cant,please call jurisdiction fa more information Notice:'(itis permit application Permit fee.....................$ _ U Visa U Mastercard expires it a pennit is not oblained Plan review(at _ %) $ Credit cad mlaber _ _ —1—L.— within I RO days after it has b"n Slate surcharge(8%).... l xplrcs accepted as complete. TOTAL $ Now of cardholder o shown on arch cad'-- Cardholder signature — J Amount 4404615(610aR•'OM) Plumbing Permit Application 7'�t d: 1p_//e-ol Permitno.! �`1Sr�� �,oSr3 City of Tigard - _ Address: 13125 SW Hall lilvd,Tigard,OR 97221 no.: _ Buildingperinnuo.: Phone: ($03) 639-4171 no.: Ezpiredate:Fax: ($03) $98-1960 By: Receipt no.. Land use approval: - - case Elle no.: Payment type: - -��blumelou jam U I &2 fancily dwelling or U Columrrcial/industrial U Multi-family U Tenant improvement New construction U Addition/alteration/replacement U Food sen i(I. U Othcr 1 r � Job address: ( 4 S6j Qty. Fee(ea.) •lolal Bldg.no.: Suite no.: NeH 1-and 2-family dnellings only: Tax map/tax lot/account no.: --�- (includes 100 ft.for each u(tlkyconnection) L --� SIR(1)bath ot: Block: Subdivision: SFR(2)bath-- Project FR(2)bath—Project name: -- City/county: 7.IP: Each additional bath/kitch<m - Description and location of work on premises Siteutilitles: _ Catch basin/area drain Est.date of completion/inspection: llrywclls/leach line/trench drain_ Footing drain(no.lin. ft.) -1 W 11111 K Voll Business name: / Manufactured home utilities -- 'M ! Manholes Address: Rain drain connector - - -- City: ) Slate c 7,IP: It)ZZ Sanitary sewer(no,lin.ft.) - -- Phone: r Fax: C-mail: Storm sewer(no.lin. ft.) - CCB no.: Plumb,bus.reg,no: Water service(no.lin.ft.) — City/metro lic,no.: - - Fixture or item: Contractor's re resentative signature: Absorption valve Print name: e - Dalc: 1 .; Back flow preventerNow U Iiackwater valve Basins/lavatory Name: S TAC 0fh Clothes washer Address: 11 041<64at br. --- Dishwasher - Cit Drinking fountain(s) --- -- _y: 7l< Stater err: q �z 3 _ — — --�-- Ejectors/snmp (hone �j a0 •E Fax: I?-mail: Expansiontank - - Fixture/sewer cap Name(print): ifFloor drains/floor sinks/Imb - -� -- - Garbage alis sl -- -`- -- - Mailing address: - g Imo•a - ------- _ City: Stater ZIP: Hose bibb _ Ice maker �--- Phone: - __--- - Falx: 11•: mail: Intcrt�cptor/grease trap - - Own,!r installation/residential maintenance only: The actual installation Prirner(s) will he made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) - --- - Ownces signature: Date: - Sump Tubs/shower/showerpan -- _Name: Urinal ---- --- Water closet Address: W _ Water Cit y: State: ZIP: __ Phone: — Fax_- E-mail: Total NM all Juriwlictions accept cn%hl cnida,pleas call Judxficoon fol tMxe infnrmatlm. Minimum fee................$ _ Notice: I)ns pernut application ----- U visa U MaslerCard expires if a permit is not obtained Plan review(al "/C) $ Credit card number _. _ _ - a tea- within 190 days after it has been State surcharge(8%) ....$ --'— Name of cardholder as shown ar credit card accepted as complete. TOTAI. .......................$ Cardholder sisrutum Aniouol 4101616(6M COM) Mechanical Permit Application bate received: 0-4,01 Permit no.:I`'S(_dac,i-cc 5aW h4 City of Tigard Project/appl.no.-. Expire date: CiryujTigurd Address: 13125 SW Hall Ijlvd.Ti}yard,()k 9722 t Phone: (503) 6394171 bate isaued: By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: _ - Building permit no.: U I k 2 family dwelling or accc!,sory U Conunercial/industrial U Mule Gamily U Tenant jmpruvcnlent New construction U Addition/alteratiotl/replacenlent U()tlwr INFORMATION3011 S1-1 1: 1VALUATION / Job address: 11400 5,jt-11 Q R -T Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ Lot: Block: I Subdivision: 'See checklist for important application information and Project name: jurisdiction's fee schedule fur residenlial perYnit fee. City/county: ZIP: Description and location of work on premises: Fer(ea.) Total Est.date of completion/inspection: Description "y. Res.only Res.only Tenant improvement or change of use: Air handling unit Is existing space heated or conditioned?U Yes U No CIM trcon itioning(si(site p an rcquir'cd)- Is existing space insulated?U Yes U No Alteration of existing HVAC system 1 jof cr/compressors 7 State boiler permit no.: — Business mrmc: i U t HP Tons BTU/] Address: cjSaf, 5„ :Sr- Fir smo a damper,/duct smoke detectors City: 7StatceM, I ZIP: Z&3 Heal pump(site plan require ) Phone: '91Q-0)q Fax: E-mail: - nsta I rep ace furnacc/burner_—. 3 / Including ductwork/vent liner U Yes U No CCB no.: )9 _ _ nstaII/rep ace/rc ocatc heaters-suspended, City/metro lic.no.: wall,or floor mounted Name(please print): rna ent fora iance other than furnace �--- --- Refrigeration: Absorption units-----___^_____ BTU/II Name. (,, ►-��V- Chillers _ I#P — - -_�_ _ _ _--- - Compressors _ IIP - - Address: _ _ Air ronmenta exhaust and ventilation: City: --- - Lte: ZIP: _ Appliance vent Phone: )rycrexhaust Hoods,Type I/res,kitchen/hazmat hood fire suppression system — Name:_�' . by�� Exhaust fan with single duct(bath fans) Mailing address: '(1�t� .S.J 'Ql�-< ST- -.xhausl system a art Pruni lcatin or C' Cit State: 7.IP: Fuelpiping andistribution(i SEE 35MM ROLL # 20 FOR OVERSIZED DOCUMENT y• z7 � CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Four Inspection Line: 639-4175 Business Line: 639-4171 - -- - BUP _ Date Requested�L�— AM PM — _ BLD — Li)cation G 0 5 lee, Suite — MEC Contact Person — _ Ph _2_,o'g_s�- G g PLM Contractor Ph _ SWR BUILDING Tenant/Owner ELC 2t o1- 0 U 3 Y U Retaining Wall ELR Footing Access: — — Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: --- -- ---- Slab _ ---- --- ---- --- SIT Post& Beam ----- Fxt Sheath/Shear Int Sheath/Shear — Framing Insulation Drywall Nailing Firewall Fire Sprinkler _ Fire Alarm --- ----- Susp'd Ceiling -- ----_-----. -- ---- _-.— _� Roof Misc Final ---- - — -- ----- ---- ---- ----__ PASS PART FAIL _-_— PLUMBING Post& Bea,1 ---- -- Under Slab — — L, LL, j! Y ; t/Q Top Out Water Service Sanitary Sewe, -- ---- ------- ---------- - Rain Drains Final ----------- - - PASS PART FAIL MECHANICAL Post BBeam - -------- ----------- --T- — Rough In Gas Line - - - — -- — - Smoke Dampers Final -- -- ---- — PA PART FAIL Service - Rough In UG/Slab _ -� - ---—--- ---- — — _ -- I ow Voltage FireAlarm --- ---------- —-.--__4— --- --------- Fwa — PASS -PART FAIL ------__---------__-- SITE 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 i ]Please call for reinspection RE: -- -. [ )Unable to inspect no access ADA /� Approach/Sidewalk Date Z_ �" Other � /-- Inspector � � ��7�11� Ext Final PASS PART FAIL DO HOT REMOVE this inspection record from the job site. CITYOF TIGAR D ELECTRICAL PERMIT PERMIT#: ELC2001-00340 DEVELOPMENT SERVICES DATE ISSUED: 6/29/01 13125 SW Hall Blvd.,Tigard,OR 97223 (503) 639-4171 PARCEL: 1 S134DB-02300 SITE ADDRESS: 11400 SW NORTH DAKOTA ST SUBDIVISION: ZONING: R-4.5 BLOCK: LOT : JURISDICTION: TIG Prosect Description: Temporary service. RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT 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: 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: 601 - 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: STACEY WERNER ROBERTS ELECTRIC INC 11400 SW NORTH DAKOTA ST 5759 SW 48TH TIGARD, OR 97223 PORTLAND, OR 972.13 Phone: 503-639-6909 Phone: V-244-7754 Reg #: SUP 3886S LIC 9388 ELE 34-23C _ FEES Required Inspections Type By Date Amount Receipt Elect'I Service PRMT CTR 6/29/01 $66.85 2720010000( Elect'I Final 5PCT CTR 6/29/01 $5.35 2720010000( Total $72,20 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laves All work will be done in accordance with approved plans 1 his 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 '(ou may obtain oopies of these rules ordirect questions to OUNC at(503) 2466699 or 1.800-332-2344. Permit Signature: _— 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 SUPR. ELEC'N: —� _--- DATE:__ LICENSE NO: — Call 6394175 by 7:00pm for an Inspection the next business day Electrical Permit Application uatereceived:&&,?1QPermitno.:424too/10 City of Tigard Project/appl.no.: Expire date: Citygffigard Address: 13125 SW Ilall Blvd,Tigard,OR 97223 Date issued: (3 Receiptno.: Phone: (503) 639-4171 — Pax: (503) 598-1960 Case file no.: Payment type: Land use approval: _ &2 family dwelling or accessory U Commercial/industrial J N1u111 fanny U'fenant intproveou•nt ` New construction U Addition/alteration/replacemeni U Other: U Partial I Joh address: 114 ` ,,: Tj Bldg. no.: I Suite no.: 'Tux map/tax IoUaccount no.: l.cll: I Block: Subdivision: - Project name:WL--*,r0l1! �'�l� Description and location of work on premises: Estimated date of completion/inspection: - - - Job no: Fee Max Business name: L ��_ii`I c_ - -- - -- - Uescriplion cry. (ea.) Tolal no.Insp New residential singe or mulll-family per Address: Z -�Iy� �f8 /Fila dweIling onIf.Inelodesaltachedgarage. City: Slate: "LIP_q z-Z tieniceincluded: Phone: Z I'ax: E-mail: — — I(xxlsq.ft.orless — a -- Each additioual 51x1 sq.ft.or portion thereof CCB no.: Elec.bus,tic.no: �i;� Limited energy,residential C'it /metro lic.no.: 4 1h of n _ - 2 Y I t Li teach manufaco—d home or modular dwelling Signature ot'supervising clectriciar.(i,•,mwd) bafe Service and/or feeder _ — Sup elect.name(pnnu Re Ser-Ocesorfeedem-Installation, alleralion or relocation: 2(x)amps or less _ I Name(print): `)i air 1 ,.vN� 201 amps to 400 amps 2 Mailing address: C , �, z 401 amps to amps - — —, — z-- .__ '� ` 601an,pstoI(xlllantps City: T1 u ) State: ZIP: 7 2 Over 1000 amps or volts _-- _ 2 Phone: Fax: — E-mail: Reconnect ml t Owner installation:The installation is being made on property I own Temporary wrvlce%or feeders- which is not intended for sale,lease,rent,or exchange according to Intl allation,alleralIon,orrelocal Intl: ORS 447,455,479,670_7 I. 200 amps or less _ G 201 amps to 40U amps 2 Owner's si mature: 1 —7152mr� — '� I 401 to 600 urn s --- -- 2 Irmo Branch circuhs-new.■Iterallon, or extension per panel: Name: a Fee for branch circuits with purchast f Address: service or feeder fee,each branch circuit 2 City: Stale` 'LIP: B Fee for branch circuits without purchase of service or feeder fee,first branch circuit: 2 Phone: Fax: i-mail: Each additional branch circuit: Mist.(.Service or far er not Included): U Service over 225 amps-conunercial U Health-care facility Each pulop or irrigation circle _ _ 2 U Service over 320arips-ratingof 1&2 U Hazardous location F.achsign oroutline lighting 2 family dwellings U Building over 10,000 square feel four or Signal circuit(s)or a limited energy panel. U System over 61x1 volts nominal more residential units in one structure alteration,or extension* _ -- 2 U Building over three stories U Feeders.4(10 amps or more 'Description. U Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over the allowable In any of the above: U Fgress/lightingpirm U Other --_--- ---- --- Verinspecuo Submit—sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. other Permit fee.....................$ Not all jurisdictions accept credit rnntx,please cell jurisdiction fir mixe inrnn,uuon. Notice,This permit application U Visa U MasterCard expires if a permit is not obtained Plan review(at __ %) (-redo card numhe, _—_ __—___ L...1 within 189 days atter it has heel) State surcharge(8%)....$ FRpires accented as complete. TOTAL .......................$ Name of mrdhnlder as Chown on credit card —�--- Ctrdhnlder ctgnedure -- -Anount 440-4461s tevOUK'0M1 ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee...................................................... $75.00 Number of Inspections 22r ennit allowed (FOR ALL SYSTEMS) ) Service included: Items Cost Total `�' Check Type of Work Involved: Residential-per unit 1000 sq fl.or less _ $145 15 4 Audio and Stereo Systems' Each additional 500 sq ft of portion thereof _�,. $33.40 1 ❑ Burglar Alarm Limited Energy _ $75.00 Each Manufd Home or Modular Garage floor Opener' Dwelling Service or Feeder - $9090 2 Services or seeders L J Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 2 Vacuum Systems' 201 amps to 400 amps _ $10685 y 2 401 amps to 600 amps $160.60 2 601 amps to 1000 amps _ $24060 2 Other___ Over 1000 amps or volts $45465 2 Reconnect only $66.85 _ 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteration,or relocation , Fee for each system........................ ..... .. ........................ $75.00 200 amps or less ! $66.85 _ _ 2 ISEE OAR 918-260-260) 201 amps to 400 amps $10030 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 ❑ Boiler Controls New,alteration or extension per panel a)The leo for branch circuits with purchase of service or Clock Systems louder fee. Each branch circuit $665 2 ❑ Data Telecommunication Installation b)The fee for branch r.,ucuits without purchase of selvlce ❑ Fire Alarm Installation or feeder lee. First branch circuit $4685 �� HVAC Each additional branch circuit $665 _ Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or Irrigation circle _ $53.40 _ ❑ Intercom and Paging Systems Each sign or outline lighting $5340 Signal circuit(s)or a limited energy panel,alteration or extension _ $7500 Landscape Irrigation Control' Minor Labels(10) _ $125,00 _ Each additional Inspection over E] Medical the allowable in any of the aboveNurse Calls Per inspection $6250 ❑ Per hour _ $6250 In Plant $73 75 _ Outdoor Landscape Lighting' Fees: r/ _ �� Protective Signaling Enter total of above fees $ Other _ --- 8%State Surcharge $ _ � Number of Systems 25%Plan Review Fee ' No licenses are required Licenses are required for all other installations See"Plan Review"ser.tion on front of applicdtion — Fees: Total Balance Due $ Enter total of above fees $_ --- ❑ Trust Account# _ 8%State Surcharge $_ ----.-- ----�--� ----_ �___—�_ Total Balance Due $ - i\fists\forrru\cic-fees dee 06/07/01 C TY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 �- BUP a601 L) D,3 -Z- Date Requested /c, - / d AM PM BLD Location // `�� < �i L� = t � e Suite MEC . Contact Person Ph PLM Contractor Ph SWR — BUILDING Tenant/Owner ELC __— Retaining Wall ELR _ Footing Access Foundation FPS Fig Drain SGN Crawl Drain Inspection Notes, --- - - Slab _ —.--__.-_.__._------ —_ SIT Post&Beam --- --- Ext Sheath/Shear Int Sheath/Shear — �- Framing --^— -- ----- — -- Insulation (� ^� Drywall Nailing `��!> >r's Q1601A6 l I�J�� ►�-_S(2 Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling ------------------—— ------- ---- ---------- _-- Roof Misc: J � n -- _. . _ ---------------------- ----- --- -- (� T FAIL ------------- — — - --PLUMBING Dost8 Beam —-------.._--...------- -- --------- ------- Under Slab TSN Out -- ----------- --------- Water Service Sanitary Sewer �� ------------------ __-.—_. Rain Drains Final - PASS PART FAIL MECHANICAL [lost& Beam Rough In GasLine - - --- - -- ---- ------------- --- Smoke Dampers Final — --- ----- -- -- — ---- _--- _ -. -- -- PASS PART FAIL ELECTRICAL Seivice -------------------- _..—..._.—__—_._.._-- - ----- --- Rough In UG/Slab Low Voltage Fire Alarm -- - -- ----- ----- -------- --- Final PASS PART FX 1. ------ —__.—�— --- — --_—_--- -- SlTE Backfill/Grading - —-- ------- -------- ------— ---- --- Sanitary Sewer Storm Drain [ ] Reinspection fee of$ _ _required before next inspection Pay at City Hall, 13125 SW Hall Bl id Catch Basin [ J Please call for reinspection RE —_ [ J Unable to inspect - no access- Fire Supply Line ADA Approach/Sidewalk "^ Other Date — __--Inspector-- , _ Ext — Final PASS PART FAIL DO NOT REMOVE this Inspection record from the job site. — ELECTRICAL PERMIT- CITY O F T I G A R D RESTRICTED ENERGY DEVELOPMENT SERVICES PERMIT#: ELR2002-00052 13125 SW Hall Blvd..Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/28/02 PARCEL: 1 S134DB-02300 SITE ADDRESS: 11400 SW NORTH DAKOTA ST ZONING: R-4.5 SUBDIVISION: BLOCK: LOT: JURISDICTION: TIG Prolect Description: Low voltage: all encompassing A. RESIDENTIAL B.COMMERCIAL — AUDIO & STEREO: X AUDIO& STEREO: INTERCOM & PAGING: BURGLAR ALARM: X 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: STACEY WERNER SMART CONNECTION 11400 SW NORTH DAKOTA ST 524 SE ASH ST. TIGARD, OR 97223 PORTLAND, OR 97214 Phone: 503-639-6909 Phone: 503-255-8900 Reg #: LIC 1507.58 ELE 3618JLE _ FEES Required Inspections Type By Date Amount Receipt Low Voltage Inspection PRMT CTR 3/28/02 $75.00 2720020000 Elect'I Final 5PCT CTR 3/28/02 $6.00 2720020000 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 clone 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 OUNC at (503) 2461987. -L Issued by Permittee Signature _ OWNER INSTALLATION ONLY The installation Is being made on property I uwn which is not intended for sale. lease, or rent. OWNER'S SIG' TURE: _ DATE: — CONTRACTO;. INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N _..-_____ --. DATE:___.____ " LICENSE NO: _ _ L,-�, Lt --------- Call '39-4175 by 7:00 P.M.for an inspection needed the next business day 03.28;2002 II :58 FAX 5075981960 CITY OF TIGARD It 002 Electrical Permit Application --- - - Devi \ e : Peri0 ( -a f6xpitcdate:City of Tigard .a ,5m �s y CiryojTrfard Address' 13125 SW Nall Rlud,Tigard,OR 91223 \ f)eteianued: By' Receiptno.: Phone: (503) 639-0171 Case file no.. Payment type- Land(5,03) 598 1960 land use approval ` t & 1 family tlwrllir,;of occeanl y U Commercial/indusulal Q Mdlll-family U Tenant lmprovemcnt 0 New cormit,ction U AdditloN■Itetationlreplaccmrni U Othcr 1 lob address. j C�c.- hr 5wte no Tax map/tax lot/occount no. Lot. _-- Pro'ect name Deacri tion and location of workonp Ettimal�i date of complcthon/ins don 1 Job sof Fee HUDesrnptien (ty t fort no.hip Busineasname: ✓��� •r i _ wnslMiwtid eir`iearat■hllriadhPr - Addre r > dweUials+a Includes atu alfOrape. City: State:e- ZIP:'1 Serrtaeuei■du! Fit '' _ ti �; E man I OOO sq n.a.Ieee 4 Phone . r t. `'1�- --- Each additional 500 sq h.or portion 1creot CCB no.: BJtc bus.Lc.no: L / --__ --�- l Loins rd encs y.maidenual z - Ci /atletr0lic.n0.: _� ,_�f, Umlteetenerjy,nan residential 1 -�- 0 y ch manufartated home or modular ill; • )>` 2 i of n-Llaetnnan( road r- Date � 5ervtcx utNnr lecder _ $r rriN3 M ke4er+ i M, ��- .ehcl.name( nt). n 1 Lit ansa no rNcr atitsa or refec�uo+. 1111 amps or Itss1 fttc(pfiat)' � -n f lot unpi to 600 arrive - - r_ 2 i nOdstu' 7 , � -_ 601 amps l0 1000 anw+ : ) -- SI>,te ZIP: Ch1+1000 as+tpa m vnlu --- - 2 Photos' __ F■xF.mail: f- aecanwool -- or owner insmilatlon.The installili as being made of properly I()-n'n tsep�Mna/law l fret« rden- )psl■Ita6 +i a ,aitrratka,or rrlacatioa winch it;not intended for sale,lease rent,or CXChanq';IIA01ding to 100 amps(srlei t 1 OR 5 447,455,479.670,1OI. aMos io X00 gimps —_ _-- - 1 Owner's si ature- Date., _ 401 to 600 am-Ilft1 nch ckvw u-view,■lferatiaa, or e v sonata+per pew) Name: A Gee larAtsnchtlKunaWnhpurchster( Address: U +ervtor or feadw fr,eecA brand:ctrcu' 1 St'' lIl': 8 Far fm branch circuiu wiVhmn pursue (rift'-- --. -` -_. -._.. ----- --- ---.---...- of iervxe of fccdn fee,first branch nuuis 1.. I111DT1C. fa* F.-mall. Faehadditional branch circuit . Seesfe�w fae4er vias bcteMadF. Fach pomp ainn tarOn ciRk _ USoniteever125snapsmuln2n.Ial UHcalth-axefarday F�cbY or IMIilhtln O Servioeewr 1711amps raltnsut W 0 HarudnUSWItIn'l -.ting fanalydmelhng+ O RuiRbnt err I0.W,%qutur fete fua w Silnaieircu.t(+)or a limn+denergy psad, U System over 600 volt+nominal irtom re+idrar d units in one+lntturt Wrtratioe,a extension" 0 Building ovrr throe stone CJ Feeders.400 amps or nnrc •Description' - U pct:uponr hied ovrr 99 peoori U Mrutu(actused+raUarer rw R V pert atll adw1iN01 oswitmi a o-or the alhwabk M any of five aYora:--- U frresVhlhnnr).,an O Chher ---�'_-...__. _-----__-- Ver fns euro .vision seu of plats"i say of Ube above. Imeougauon etc Ilse above are net agtpikabje,to tomparary eost■tractiva sar.iee. r - - -- .. - S s Permit flee...,.... N p..,drroeer aremt udn raw,per-rdt plm&ace Itim lam Wolvaailaa Notice.This p-rmn application Plan fevlew(ae Cl thexpires if a permit is not obtained Staff.sttrehet (1)116)....S cr+.rt orae rwatber_ within 180 dav�otic it hies Aeon � �. senepted as ctmiplete TOTAL............ Nein a�rai o+ri oa ee.mi tea s -------•------ -- - -- --�ian;,e-- NC-.61!l'QA4tcoht) CELECTRICAL PERMIT CITY OF TIGARD PERMIT#: ELC2002-03110 DEVELOPMENT SERVICES DATE ISSUED: 3/15/02 13125 SW Hall Blvd.. Tiqard. OR 97223 (503) 639-4171 PARCEL: 1S134DB-02300 SITE ADDRESS: 11400 SW NORTH DAKOTA ST SUBDIVISION: ZONING: R-4.5 BLOCK: LOT : JURISDICTION: TIG Project Description: Installation of(1)200 amp service to out building. RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE_ LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAI-!PANEL: MANF HMI SVC/FDR: 601+amps - -1000 volts: MINOR LAPEL (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: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC/FDR >= 225 AMPS_ _ CLASS AREA/SPEC O;C: Owner: Contractor: STACEY WERNER OWNER 11400 SW NORTH DAKOTA ST TIGARD, OR 97223 Phone: 503-639-6909 Phone: Reg#: FEES Req sired Inspections Type By Date Amount Receipt Elect'I Service PRMT C1R 3/15/02 $80.30 2720020000( Elect'I Final 5PCT CTR 3/15/02 $6.42 2720020000( Total $86.72 This Permit is issiied 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: _ Issued By: t OWNER INSTALLATION ONLY 1 he installation is being made on property I own which is not intended for sale, lease, or rent. l OWNER'S SIGNATURE: — — -- -- DATE: _ CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: _ — — Call 639-4175 by 7:00pm for an inspection the next business day electrical Permit Application Date received: Permit no�:aenoFv R7.) City Of 'Tigard Project/appl.no.: Expiredate: C'ityuf1-igarA Address: 13125 SW Ilall Blvd,Tigard,OR 97223 batcissued: By: Receiptno,: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: 7 1 b'c 2 faintly dwcllinp or accessory U Commercial/industrial J Multi-family J,renant improvement J New consuucli�nl U A(I(litinn/alteration/replacement J(nlict _- J Partial JOB SITE INFORMATION Joh ad(Ireas: t i DD . DAK• S-1 Bldg.nu.. Suite no.: Tax map/tax lal4tccuunt no.: Lot: Block: Subdivision: - - Project name: Description and location of work on premises: � _�f Estimated dale of completion/inspe ` ction: I '`-' CONTRAVI OR APPLICATION 111-11 SCHEDULE' Job no: 1 m Mat r� ✓K°sr----- - 1)escriptlon Qty. (ea Business name: ) lural nu.insp -- - - --- Nen esidenlial-singleor muhi-fandh per Address: or., ` Ho �V� r _ dNelllnl;rmir.IncludesallaclredQarage. City: -1IState:Cp. 7.IP: q-)Zz 3 Serviceincluded: Phone: 631-4, p Fax: I Email: l(x)Osq ft.orless _ a Fach additional 500 sq,[1.01"portion thereof CCB no,: Elec.bus.lic.no: Limited energy,residentinl 2 City/metro lic.no.: Limiledeneigy,non-residennal I Each manufactured home or modular dwelling Signature of supervising electrician(reyuiredi Irate Service and/or feeder Sup,elect nente(prun) _ I.iccnscnr. Services orfeeden-Installation, III[W 1110'kill miff 111,11101 1!4 alteration or relocation: 1 l',- 20O amps or less Name(print): �T21C�n� glamps ta400amps -_ z Mailing address: 11 5w hl vn►I yk rCc to 6(l0 amps 2 to I(xx)ampsClly: ' ( State: ZIP: l�2 Z 3 amps or volts A 2 1 Phone: E-mailReconnect only �— l Owner installation:The installation is being made on property 1 own Temporaryservices or feeders which is not intended for sale,lease,rent,or exchange according to lnslallation,altemiloa,orrelocalion: ORS 447,455,479,67Q,701. 2(x)amps or less _ 2 201 amps to 4(XI amps 2 Owner's signature: Date: 15 ) Z 401 to 60(1 ams -- 2 Branch circuits-new,aiterallon, or extension per panel: Name: A Fee for branch circuits with purchase of i Address: service or feeder fee,each branch circuit 2 I City: Slate: ZIP: N Fee for branch circuits without purchase --�-—-- of service or feeder fee,first branch circuit: 2 Phone: Fax Email: A . Each additional branch circuit. I Misc.(Service or feeder not included): U Service over 225 amps-commercial U Health-care facility Each pump or intgation circle U Service over 320 amps-rating of 1&2 U Hazardous loc•atiun Each sign or outline lighting 2 family dwellings J Building over 10,(101)square feet four or Signal circuit(s)or a limited energy panel. U System over 6W volts nominal more residential units in one slructt,te alteration,or extension' 2 U Building aver three stories U Feeders,4(IU amps or more •lkscnption U Occupant load over 99 persons U Manufactured structures or RV park Fich additional Inspection over the allowable In any of the above: U F.girss/lightingplan U(tiller 11erinspecuon Submit_,._sets of plans with any of the above. Investigation fee The above are not applicable to temporary con,tructlen service. (Ahrr -- Permit fee..................... NO all)rniklic(ian&:+till ordit cords,please call junsiicucsr far mmr inromurion. Notice:This permit applicallon J visa U Mastercard expires if a permit is not obtained flan review(at ___ %) $ l irdo crud number: _ L_J- within 180 days after it has been Stale surcharge(817c) ....$ Name of cardholder u shown on credit card accepted as complete. TOTAL . _ S _ -' Cardholder siSnature Amount 4101615(6011COM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Complete Fee Schedule Below: 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 $3340 1 Burglar Alarm Limited Energy _ $75.00 _ Each Manu"d Home or Modular ❑ Dwelling Service or Feeder $9090 _ _ 2 Garage Door Opener' Services or Feeders Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $8030 2 r—� 201 amps to 400 amps _ $10685 — 2 EJ Vacuum Systems' 401 amps to 600 amps __ $160 60 _ 2 O amps to 1000 amps $240 601 .60 _ 2 Other _ Over 1000 amps or volts — _ $45465 — _ 2 Reconnect only $66.85 2 TYPE OF WORK INVOLVED -COMMERCIAL ONLY Temporary Services or Feeders Installation,alteration,of relocation Fee for each system.......................................................... $7500 200 amps or less _ $66.85 2 (SEE OAR 918-260-260) 201 amps tc ;u0 amps _ $10030 _ 2 401 amps to 600 amps $133.75 _ _ 2 Check Type of Work Involved: Over 600 amps to 1000 ills, E] see"b"above. Audio and Stereo Systems Branch Circuits New,alteration or extension per panel ©oiler Controls a)Tho fee for branch circuits with purchase of service or Clock Systems feeder foe. Each branch circuit $6(35 _ 2 Data Telecommunication Installation b)The fee for branch circuits without purchase of service n Fire Alarm Installation or feeder fee. First branch circuit _ $4685 _ Each additional branch circuit — $665 _ HVAC Miscellaneous Instrumentation (Service or feeder riot included) Each pump or Irrigation circle $53.40 Intercom and Paging Systems Each sign or outline lighting — $53.40 ❑ Signal circull(s)or a limited energy panel,alteration or extension _ $7500 F1 Landscape Irrigation Control' Minor Labels(10) _ $125.00_ Medical Each additional Inspection over the allowable In any of the above Per inspection $62 50 Nurse Calls Per hour $62 50 In Plant — $73.75_ Outdoor Landscape Lighting' Fees: U Protective Signaling Enter total of above fees $ _—�_- Fj Other 8%State Surcharge $ _ _ Number of Systems 25%Plan Review Fee See"Plan Review"section on $ No licenses are required licenses are required for all other installations front of application -- Fees: Total Balance Due $ — Enter total of above fees ❑ Trust Account#_,_._, 8%State Surcharge $ Total Balance Due $All Now Commercial Buildings require 2 sets of plans. i ldsts\fonnaklc-fces.doc 08/30/01 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BLIP --- -.�_-- Received Date Requgsted_--_ uO AM _-_ PM - BLIP Location � �' ti-�` Suite _G - MEC _ Contact Person _ Ph(—) ' - PLM Contractor ------- ---- - - ------ -- Ph(- ) --- SWR - --- BUILDING Tenant/Owner - _ -_ ELC __ Footing Foundation ELC _---_--- _ Access: Fig Drain ELR Crawl Drain Slab Inspection Notes: -, SIT Post& Beam Shear Anchors �, -- -- -- - Ex:Sheath/Shear Int Sheath/Shear Framing _ - --- - Insulation Drywall Nailing --- --- - --- ------------------------------- Firewall T4F�/Fire Sprinkler -- -Fire Alarm Alarm Susp'd Ceiling — Roof Other. Final -- - --- r-� � PASS PART FAIL -- PLUMBING_---- Post& Beam -- Under Slab --- 1 -- - �7� _ _-__ `'--Q Hough-In Water S3rvice Sanitary SewerCZ Rain Drains -- -5--�'�t� �'f - Catch Basin/Manhole Storm Drain ----- ------ ------ �.__-.-_.__ Shower Pan Other. r <",C7 Final PASS _PART FAIL - -- MECHANICAL _ Post& Beam - Rough-In Gas Line Smoke Dampers -- - ------ - -- - - Final PASS PART FAIL --- -- ------------ -- - --- ELECTItICAL Service - - -- --- -----------------_-__--__ Rough.In UG/Slab - - ---------- ----- ----- -.... Low Voltage Fire Alarm ins] [-_] Reinspection fee of$-_ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE:_--- _ �� Unable to inspect--no access F=ire Supply Line ADA Approach/Sidewaik Date C Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP --__—T_ Received .-------_______ Date Requested Q_ AMPM- ---.. BUP — ._--- Location _�1� 0 C�_JAG t L -Tl �' � -- -Suite-------.-- - MEC Contact Person _. Ph( ) — — PLM __- Contractor _ �1S� S� _ Ph SWR _------— BUILDING Tenant/Owner -- ELC Footing-----�-- ELC Foundation - ----- -- Ftg Drain ACCESS: ELR Crawl Drain Slab Inspection Notes: —' SIT __— Post 6 Beam Shear Anchors — --- A Ext Sheath/Shear I Int Sheath/Shear -- �- �- Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling -- - --- ---- — ---- ---- Roof Other- Final therFinal SS PART_ FAIL PLUMBING Post& Beam -- Under Slab Hough-In Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain --- Shower Pan Other: --- _ - Final - ASS PART FAIL MECHANICAL Post& Beam Rough-In - .---------------------- Gas Line Smoke Dampers Final PA PART FAIL - - - -- ------- - ------ --- ECTRIC SerVtCV Rough-In UG/Slab _.___---------._..--.---_-- <tt1W'�fOft�ge Fire arm PART FAIL Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE l Please call for reinspection RE -- Unable to inspect-no access Fire Supply Line -- - ---- --�-- ADA Approach/Sidewalk Dab Insp�cta � `- 1Z/ - ��!_G' _`"-`' Ext Other: --_ - �-- - Final DO NOT REMOVE this Inspection record from the jbb site. PASS PART FAIL ry n G `" o 0 s a c a A p, N n r. 7 ry w t., n f n ` ..., 5 0 71 mom � � s ° O Z r' o r. � CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 — ((// BLIP Received ---__._------ Date Requested -�`�_d _ AM PM_ ___. BLIP Location cl.�,ke, 4 5 r Suite_—____ —- MEC Contact Person __- _ �ph Z°1 ` 0 __-_-- PLM Contractor ___ _—__— �1�_ ) - P _---- -- - SWR TenanUOwner _ fes -�__C u'�� " ELC Footing 4"( +I l -A.-- FLC Foundation Access: Ftg Drain ELR Crawl Drain Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors �— — Ext Sheath/Shear Int Sheath/Shear Framing -------- - - - Insulation Drywall Nailing -- -- - - --- Firewall Fire Sprinkler _-- Fire Alarm Susp'dCeiling _. - -- --- ----- ----- Roof Other - --in ASS PART FAIL BIN_G [lost& Beam ^ T Under Slab __—_. -- - --_--_ --- - ---- Rough-In Water Service - - - Sanitary Sewer Hain 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 Bough-In ------- UG/Slab ---- -Low Voltage Voltage - Fire Alarm Final L-, ReinsP ion fee of$ re uired before next inspection. Pay _at Ci ryHall. 1315 SW Hall Blvd. PASS PART FAIL SITE -- Please call for reinspection I IP -___ -_-_ Unable to inspect-- no access Fire Supply Line ADA ' Approach/Sidewalk Dat*- _�y 1_� �' -- Inspoctor_ _ ------------ --Ext- _-- Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BLIP Received ____ __ data Requested 1/' BLIP Location 'In L26% k�_C�-- - --- --Suite .—-_---.--__ ._ MEC Contact Person _—__—.-------------------__- Ph3----) PLM ------- Contractor-_---- - -— - -- ----- Ph(------) - - - — - -- SWR --- ---- —. BUILDING Tenant/Owner --- - --- - --------- -- --- ---- - ELC --- ---- ---- Footinq ---- ELC ------ Foundation Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT _— Post& Bcam _.. -_--.----__-- Shear Anchors - Ext Shoath/Shear -------__�__ Int Sheath/Shear Framing - - _ - -- --- _ Insulation Drywall Nailing -- — - - -- --- -. - - - --- -- - - -- Firewall Fire Sprin"ler - ...----- - - - _-- - --- - - — --- _ - Fire Alarm Susp'd Ceiling _ --- -- -- - - --- -- - - --- -r.a_ ------- Root Other: ------- - -- - - ---- - _ - - ---- - --_ ------- --- - _. - -- Final PASS PART_ FAIL LUMB --------- _ Post&Beam - Under Slab ------ -- ------- - ... Rough-In Water Service -_--- -- - --- -- -—_-r _---- - -------- Sanitary Sewer Rain Drains - - _ - - --- - _ — ---- -- — Catch Basin/Manhole Storm Drain - Shower Pass Other: - --- - - --- F � PA PART FAIL- MEC_HANICAL -- - - - -_ Post& Beam - - - Rough-In - -- - - -- Gaas Line Smoke Dampers - - -- Final PASS_PART FAIL - ELECTRICAL Service, Ronnh-In UG/Slab Low voltage Fire Alarm Final Reinspection fee of$__ --_- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE } Please call for reinspection RE:__ - -_- —_ �� Unable to inspect-nn access Fire Supply Line � � C� ADA Date _ Inspector- / / Ext— Approach/Sidewalk - - -� Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour 1 BUILDING Inspection Line: (503)639-4175 MST 1 Gv 5✓Z INSPECTION DIVISION Business Line: (503)639-4171 BUP — Received __ Date R este' AM_� __ PM BLIP _ Location .—_--j D c; -1--=�-- ' �_ Suite MEC Contact Person Ph(_—�) D�f -Cv 9G PLM Contractor Ph(--) SWR _BUILDING TenariUuwner ELC Footing ELC Foundation Access: _ Ftg Drain ELR Crawl Drain slab Inspection Notes: , SIT Post& Beam ---- -- - r - Shear Anchors /J� ----- Ext Sheath/Shear Int Sheath/Shear -- - -- -- Framing - - - -------- --- -- - -- - ---- - - Insulation Drywall Nailing - --- - - -- --- --- --- ---- - - - -Firewall f ire Sprinkler Fire Alarm Susp'd Ceiling - --- -- -- Roof Other: Final _- PASS PART FAIL PLUMBINGI - --^--- Under Slab Rough-In \ \'�� 10�v Water Service - Sanitary Sewer Rain Drains o V� - Tl /� Catch Basin/Manhole Storm Drain - - --. Shower Pan Other: Final - -- PASS PART_ FAIL MEC_HANIC_A_L -� Post 8 Beam Rough-In Gas Line - - Smoke Dampers - _ --- - -- -- - - - Final PASS PART_ FAIL - - - ------- ------ - - - ELECTRICAL Service - - Rough-hi UG/Slab --- - - ---------------- ----____------ -- Low Voltage F=ire Alarm - - - -- -- _---.-�-___---_ PAS PART FAIL I--� Reinspection fee of$_ --_ _ required before next inspection. Pay at City Hall, 1;,125 S'VV Hall Blvd ---- Please call t r reinsp cticn RF L Unable to inspect -no access Fire Supply Line— �S Approach/Sidewalk Dstt /�'�` f Inspect r ' ��. / Ext Other: __ _ _ Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL