9075 SW NORTH DAKOTA STREET 1S d1O)ida HIHON MS 5106
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9075 SW NORTH DAKOTA ST
CITY
O� TIGARD
����� ELECTRICAL PERMIT
PERMIT#: ELC2000-00270
DEVELOPMENT SERVICES DATE ISSUED: 05/24/2000
13125 SW Hall Blvd.,Tigard. OR 97223 (503) 6394171 PARCEL: 1S135DA-04500
SITE ADDRESS: 09075 SW NORTH DAKOTA ST
SUBDIVISION: PP1997-057 ZONING: R-4.5
BLOCK: LOT : 002 JURISDICTION: TIG
Proiect Description: Install 1 branch circuit in single family dwelling.
RESIDENTIAL UNIT _ _TEMP SRVC/FEEDERS MISCELLANEOUS_
1000 SF OR LESS: i 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF FIM/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: 1 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:
KERRY WILSON PORTLAND STATE ELECTRIC
9075 SW NORTH DAKOTA PO BOX 2.30933
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 233-8030 ORIGINAL
Reg#: L!C 96644
SUP 41259
ELE 26-854C
FEES _ _ Required Inspections
Type By Date Amount Receipt Elect'I Service
PRMT KJP 05/24/200( $37.50 0002426 Elect'I Final
5PCT K.IP 05/24/200( $3.00 0002426
Total $40.50
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. ATI-ENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those
N rules are set forth in OAR 952-001-0010 through O 952 001-0080. u may obtain copies of these rules or irect questions to OUNC at(503)
246-1987.
.j PERMITTEE'S SIGNATURE ,Q� ISSUED BY:
C7 _ OWNERIN5TA CATION ONLY
W� 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' �\ G-7�'�- DATE:
� _
LICENSE NO: _�__ `� 25-5
Call 639-4175 by 7:00pm for an Inspection the next businsas day
CITY OF TIGARD Electrical Permit Application Plan Check M
13125 SW HALL. BLVD. Recd By
TIGARD OR 97223 Date Recd_ -
Date to r'E
Phone(503)639-4171, x304 Date to DST
Inspection (503)639-4175 Print of Type Permit N
Fax(503) 598-1960 Incomplete or illegible will not be accepted Called
?. Job Address: 4. Complete Fee Schedule Below:
Name of vevelopment
Number of Inspections r rmit allowed
_ __._ _ ------- --
Name(or name of business)� 6 Lt-SoA/ Service included: items Cost Sum
Address_ 0 7.`5r--5 ,W-_ Ago 7rr 4a. Residential-per unit �.
CI /State/ZI 1000 sq ft or less $ 117 75 4
ry p - - -- Each additional 500 sq R or
portion thereof f 26.75 1
Commercial ❑ Residential Limited Energy $ 60.00 _
Each Manufd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2
(Prior to permit iesuance,applicants must provide contractor license 4b.Services or Feeders
Information for GOT da ase). -CoInstallation,alteration,or relocation
Electrical ntractor -� LSC. C 200 amps or less _ $ 64.25 2
Address 201 amps to 400 amps $ 85.50 2
401 amps to 600 amps $ 128.50 2
City_ State Zip 601 amps to 1000 amps _ $ 192.50 2
Phone No. 1z Over 1000 amos or volts S 363.75 2
Job No. /0R connect only ^� $ 53.50 2
Elec.Cont. Lice.No. G.Exi to -/ 0 Q 4c.Temporary Services or Feeders
OR State CCB Reg. No. ��Exp.Date -0� Installation,alteration,or relo.Ption
COT Business Tax or Metro No. ,- /�O Exp.Date '1-� " 200 amps or less - S 53.50 � 2
n ,1��(1 201 amps to 100 amps $ 80.25 _ 2
Signature of SUgr. Elec'n e 401 amps to 800 amps $ 100.00 2
g - Over 600 amps to 1000 volts,
License No. Z.57__'S Exp.Date /10-01-01 see"b"above.
2►. -3 -3 O 4d.Branch Circuits
Phone No.
New,alteration or extension per panel
a)The fee for branch circuits
2b. For owner installations: with purchase ofsery►re or
feeder fee.
Print Owner's Name Each branch circuit _ S 5.35 -
Address b)The fee tot branch circuits
without purchase of service
City State Zip or feeder fee.
Phone No. First branch circuit _ $ 37.50 jj__
Each additional branch circuit $ 535
The installation is being made on property I own which is not 4e.Miscellaneous
intended for sale,lease or rent. (Service or feeder not induded)
Each pump or irrigation circle S 42.75 _
Owner's Signature _ Each sign or outline lighting J $ 42.75 _
Signal circuit(s)or a limited energy
3. Plan Review section if required):* panel,alteration or extension _ $ 80.00
CL �rMinor Labels(10) _ $ 100.00
Please check appropriate item and enter fee In section 58. 4f.Each additional inspection over
N 4 or more residential units In one structure the allowable In any of the above
Service and feeder 225 amps or more Per inspection -�_ $ 50.00
Per hour $ 50.00
System over 600 volts nominal In Plant S 5900
m __Classified area or structure containing special occupancy as
(� described in N E.C.Chapter 5 5. Fees: ?�y
tU So.Enter total of above fees 4,�•r l.'
Submit 2 sets of plans with application where any of the above apply. 8%Surcharge(.08 X total fees) E -�
Not required for temporary construction services. Subtotal
5b.Enter 25%of fine 6s for
NOTICE Plan Review 0 required(Sec.3) E _
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS lJ Trust Account 0
AT ANY TIME AFTER WORK IS COMMENCED Total balance Due ^� $4d^'
is\dsts\forms\clectric.doc _-
CITY OF TIGARD --
MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2000-00172
13125 SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 05/08/2000
PARCEL: 1 S135DA-04500
SITE ADDRESS: 09075 SW NORTH DAKOTA ST
SUBDIVISION: PP1997-057 ZONING: R-4.5
BLOCK: LOT:002 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
_ FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 -50 HP: WOODSTOVES:
GAS PRESSURE: 50+ HP. CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: install 1 air conditioning unit,<3HP;absorb unit to 100K BTU. A/C units cannot be placed within the iequired
setback area.
Owner: _ _ _ FEES
WILLSON, KERRY T + VICKIE A Type By Date Amount Receipt
9075 SW NORTH DAKOTA ST PRMT KJP 05/08/20( $50.00 0001999
TIGARD, OR 97223 5PCT KJP 05/08/20( $4.00 0001999
Phone:
Total $54.00
- — -
Contractor:
COST PLUS HEATING 4 AIR
7132 N FESSENDEN ST
PORTLAND,OR 97203 REQUIRED INSPECTIONS
Cooling Unt Insp
Phone:286-2009 Final Inspection
Reg#:LIC 000479
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ORIGINAL
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III rhis permit is issued subject to the regulations contained in the Tigard Municipal Code, State of �:)re.
Specialty Codas 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 in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001 •0010 through OAR 952-001-0080.
You may obtain copi these rules or direct questions to OUNC by calling (503)246-9189.
Issue By: Permittee Signature:1k 4 f tc"'4-A a�s�
Call (503)639.4175 by 7:00 P.M.for Inspections needed the next business day
Check 4
�-
CITY OF TIGARD Mechanical Permit Application Recd Flan Chh
By
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E. -
(503) 639-4171, x304 Date to DST-
Print or Type Permit s-_----—_-_
_ Incomplete or Illegible.a plications will not be accepted _ called
Nemo M OevabpmenUPro)ect Description --
Table 1A Mechanical Code Price Amt
Job Sireell Address SUNSA A) Permit Fee
Address %C` 7.5-3A- .JC/K balms 1) Furnace to 100,000 BTU
Bklo rey/sute zip - including c-icts 6 vents 9.65 -
2) Furnace 100,000 BTU+
47t2- 3 _ including ducts d,vents 12.00
Name(or name M business) 3) Floor Furnace
Owner %er"O'll LL.-t 4c,,J __including vent ^ 9.65
Mailing Address 4) Suspended heater,wall heater
or floor mounted heater 0.65
5) Vent not included in appliance miit 4.75
cltylstate zip Phone Check Ail that a 'Boiler Heat Air
�(o iD C 3 PPly e
r 5,'h-J v, ° For Items 6-10,see or Pump Cond Qty Prix Amt
Name(or name or business) footnotes 1,2 Com ~ __
6)Repair units
Occupant Mailing Address 7)<3HP;sbsorb unit to 8.40
100K BTU A 9.65_
CNylStaie Zip Phone 8)3-15 HP,absorb unit
I 00k to 500k BTU 17.65
Contractor Nam ' 9)15-30 HP;absorb
s, o4f, a q,;2 unit.5-1 mil BTU v 24.15
10)30-50 HP;absorb
Prior to permit Mailing Address �+ unit 1-1.75 mil BTU 36.00----
issuance,
8.00 _issuance,a copy 713'L f-) i�SSrrt�Pn �11)>50HP;absorb unit>1.75 trill BTU
of all licensesExp.Dale tate zip Phone
are required if r�Ft.J q�au� S6-Z407 80.15
expired in COT Oregon Const.Cont.hard Lie* Exp.
Air handling unit to 10,000 CFM
_ _ 7.00
database _ y 7Q'7J' -/z�) 13)Air handling unit 10,000 CFM+
Architect Nam- 11.85_
14)Non-portable evaporate cooler
or Mailing Address 7.00
15)Vent.fan connected to a single duct
_ 4.75
Engineer cN'tstate tip P11" 16)Ventilation system not Included in
appliance permit 7700
Describe work to be done: 17)Hood served by mechanical exhaust
7.00
Now O Repair O Replace with like kind Yes O No n 18)Domestic Incinerators
Residential O Commercial O Modification 0 $`ii-ICAC 1(71 12.00
��_ �_ 19)Commercial or industrial type incinerator
Additional Information or description of work. 48.25
Add R I/L- "(('N P 20) Other units,including wood stoves
a _-- 7.00
NOTE: For Commercial projects only;Units over 400 lbs,located on the 21)Gas piping one to four outlets
r roof,require structural calcs.prepared by licensed engineer. 3.75
N Type of fuel: oil O natural ga$M LPG O electric O 22)More than 4-per outlet(each) .75
1 hereby acknowledge that I have read this application,that the information Minimum Permit Fee$50.00 SUBTOTAL
-f given is correct,that I am the owner or authorized agent of 8%SURCHARGE
m the owner,that lens submitted are In compliance with O PLAN REVIEW 25%OF SUBTOTAL
pOregon State laws Required for ALL commercial permits only
Sig ture of r/Agent 00% TOTALU L {
1 P..r�_
Af-'T 17A t' Other Inspectinns and Fees
Contact Person Name Phone
f 1. Inspections outside kA normal business hours(minlnx,m charge-two hairs) $50 00 per hour
.0 ? Inspections for which no fee Is spxMcally IndicatM (rninirnum charge-hate Ixrn)
$50.Foonotes for commercial pnigwts only: Additional
o al Ola r
1. Provide full schernAtic of exists and s Addlr e-o plan hole)required per
hour s,additions or mvlskxes to plans(minimum
n9 proposed gas line and pressure. charge-one-half hour)$SO.00 per haK
2. Provide drawings to scale showing existiny and proposed mechanical *State Contractor Boller Cstlilks6on rsgtrltsd
units. ~Residential A/C regtdM Nle plan sllosih fosnient of unit
1:lrnechperm.doc rev 11/1/99
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Lino: 639-4175 Business Line: 539-4171 -
BUP
Date Requested Q0 AM PM _ BLD _
Location �� �( Suite _ MEC
Contact Person Ph PLM _
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS _
Ftg Drain SGN
Crawl Drain Inspection Notes: - ---
Slab SIT
Post&Beam —
Ext Sheath/Shear _.
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall /�
Fire Sprinkler -�Az� Q —
Fire Alarm
Susp'd Ceiling -- — — ----------
Roof
Misc: -
Final
PASS PART FAIL.-
PLUMBING
AILPLUMBING
Post 6 Beam ------------- ---. -_—.�_- -. --
Under Slab
Top Out .--- -- --- —.— _ .—
Water Service
Sanitary Sewer _.—__—___._-- _ — ------------.--- ------ —
Rain Drains
Final
PASS PART FAIL -----,------.� --— --- _.__. _---
MECHANICAL
Post 6 Beam -----------
Rough In
Gas Line
Smoke Dampers
Final -- _ — — - -- -- --- — —
PASS PART FAIL
IL EL LT.TRIC � ---- -------- - ---- - - -.r
pX TeWry j rre
N Rough In
U) UG/Slab
Low Voltage
J Fire Alarm ----- ------- -- ---- -
m Fin
5 S ART FAIL
W
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Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ _-- required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE: _ _ [ J Unable to inspect no access
ADA
Approach/Sidewalk Date Inspector Ext
Other _ --
Final
PASS PART FAIL D /NOT 14EMOVE this inspection record from the Job site,
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-41TS Business Line: 639.4171
BUP
Date Requested5 � OD AM PM BLD
Location a�� � � Suite MEC ;)4
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC —
Retaining Wall M ELR
Footing Access:
Foundation FPS
Ftg Drain ,SGN
Crawl Drain Inspection Notes:
Slab SIT
Post&Beam r
Ext Sheath/Shear
Int Sheath/Shear --
Framing ---- - - ----__ - -_-
Insulation
Drywall Nailing
Firewall 7,, ' • J�''
Fire Sprinkler -�• -..-
Fire Alarm
Susp'd Ceiling - ---.-_�
Roof
Final -�
PASS PART FAIL ------_------_-_ _
PLUMBING -- -------- -- —�._�—. — -----
Post& Beam
Under Slab
Top Out --
Water Service
--- ---------------- ---------------
Sanitary Sewer
Pain Drains
Final _--_----- `.-- - -- ---------.-_A-.-___
PA PART FAIL -
ECHAN
Rough In
Gas Line --- - ------------ ------ - --
Smoke Dampers
Final -
PASS PART FAIL
ELECTRICAL ------------------------ -------------- -----
d Service
Rough In -
UG/Slab ------------ ----- -------------- - ---- -- - --
Low Voltage ------- ---------__- _ ----- ----- -
t=ire Alarm
J Fi
to A ART FAIL -__----__..--.------_ ._- _ --- -_---
tiTir
JBackfill/Grading -- --- --_"--- -- - ---J_ --
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ _-__--required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ]Please call for rQinspection RF _ [ ]Unable to inspect -no access
Fire Supply Line
ADA
Approach/Sidewalk
Other Gate Inspector - Ext
Final
PASS PART FAIL O NOT-14EMOVE this inspection record from the job site.
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APPROVED FCh 'STRUCTICN
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Linc: 639-4175 Business Phone: 639-4171
Date Requested: �',/�J �7— A.M. — P.M. �s
-� MST: � /
I,ocation: / BUR
Tenant: _ i Suite. Bldg: _ — MEC:
Contractor: - Phone -- -- -- PLM'
Owncr: -- Pbone. ---- EW:
ELR:
srr:
BUILDING BIDG(con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Bcam Post/Besm Post/Beam Cover/Service Sewer torm
Footing Roof UndFVSlab Rough-In Ceiling
ffffler Lim
Slab Framing T [l�C Out Gas Line Rough-In t er
Foundation Insulation flood/Duct Reconnect Vault
Bsmt Damp Drywall Furnace Temp Service MISC.
Masonry Ceiling am sin A/C UG Slab /�
Shear/Sheath Fire Spklr/Alm uid Dr Fleat[lump Low Volt .14)R
Approvedved Approved Approved Approved
Appr/Sdwlk Not Approved c Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
,Lek9 .<PdAIJ-t- — —--- ----
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2-71
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Unable to inect
Inspector:_ __ Date'- _��� PW
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7 r✓ CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Bub:xss Phone: 639-4171
Date Requested: _ c/,-,o '�•' A.M. P.M.__ MST:
Jwation: dVN� _�— BUP:_
Tenant:_ _ Suite: Bldg: _ MEC:— —
Contractor: CU &� a2-0 _Phone: 5 1,60_"_ 30 SV PLM: —
(hvner (J/ A^ PPhho�ne ELC:
—3�L— _ i ELR: -----——
_ _ SIT: _
BUILDING BLDG(con'() PLUMBING MECHANICAL LECTRICAL sin
Site Post/Beam Post/Beam Pod/Beam Sewer/Storm
Footing Roof UndFVSlab Rough-In Ceiling Water Line
Slab Framing Top Out Onix Line Rough-In UO Sprinkler
Foundation Insulation Sewer 1{ood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service misc.
Masonry Ceiling Rain Thain A/C iJG Slab A�F /�AA�
Shear/Sheath Fire Spklr/Alrn Crawl/Found lh I lest Pump Low Volt �./ "'6
Approved Approved Approved A � Approved
Appr/Sdwlk Not Approved Not Approved Not Approved Roo-K-ppproved Not Approved
FINAL FINAL FINAL FINAL FINAL
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C3 Call for reinspection O einspection fee of S _required before next inspection ❑linable to inspect
Inspector: _-- -- Date:-- 9�__-- Page— __ of
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUIP
/
C/ 9 S/
(7 Date Requested1-2^ ` 0 AM _ _PM BLD
LocationMEC
Contact Person PhiV41.,l PLM — —
Contractor_— Z �� �y b v L— _ Ph — N���c SWR
BUILDING -:;+481[Yew t —
Retaining Wall ELIR _
Footing Access: --
Foundation FP's
Ftg Drain ------- 3GN _
Crawl Drain Inspe(lion Notes: --
Slab _ _ — __— SIT
Past&Bearn
Ext 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&Beam
Under
----
Under Slab _
Top Out — —
Water Service
Sanitary Sewer -
Rain Drains
Final
PASS PART FAIL _
MECHANICAL
Post&Beam
Rough
---- ---- —
Rough In
Gas Line — --- ---
Smoke Dampers
Final --- --
P ART FAIL
--
IL Service --- -- -- - - — ---- --------_
Rough In
f' UG/Slab
N Low Voltage - — —
M , ASS PART FAIL
0
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 [ J Please call for reinspection P,c: [ )Unable to inspect -no access
ADA s
Approach/Sidewalk Date t/ �.•Z ' 9 Inspector Ext
Other —
Final
PASS PART FAIL DO NOT REMOVE this inspection Record from the job site.