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�C�1 CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Phone: 639-4171
6 7
Date Requested: — `O - � 7 M. ) P.M. MST: (/ S V /O
1
Location:— � C- — -- BUR _.
Tenant: Suite: Bldg: _ MEC:
Contractor:_—ISf& a4JLJ Phone: _ PLM: _
Owner: Phone: ELC:
_ CIt 4�k SIT:
BUILDING / LDG t) PLUMBING MECHANICAL ELECTRICAL SITE
Site s ram Post/Beam Post/Beam Cover/Service Sewer/Storm
Footing Roof UndFI/Slab Rough-In Ceiling Water bine
Slab Framing Top Out Gas Line Rough-in TIG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace 'femp Service MISC.
Masotuy Ceiling Rain Drain A/C UG Slab
Shear/Sheath Fire MY`♦hn Crawl,found Dr Heat Pump Low Volt
Approved Approved Approved Approved
Appr/Sdwlk 1Jot vcd Not Approved 'riot Approved Not Approved Not Approved
IN A1, FINAL FINAL FINAL FINAL
c>:
rn - ---
os
C7
Lil
D Call for reinspection 4 Reinspet tion fee of S— required before next inspection D Unable to inspect
Inspector:_ — Date: d �' P e_ of
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639A 175 Business Phone: 6394171 j A
Date Requested: / ! ' ^11 / A.M. P.M. MST: l�'
Location:— �� {,(J BUP:
Tenant: _ Suite: Bldg: NEC:
Contractor: Phone:Phone: PL _
- �- W
Owner: Phone: WWW
E
BUILDING BLDG(don't) PLUMBING MECHANICALEI,ECTF.ICAI,. SITE
Site Post/Beam Post/Beam Post/Beam r/3rrVk Sewer/Storm
Footing Roof UndFI/Slah Rough-In Ceiling Water Line
Slab Framing 'fop Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain brain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Foumd Dr _Heat Pump Low Volt _
Approved Approved Approved Approved Approved
Appr/Sdwlk Not Approved Not Approved Not Approved N: 4pproved Not Approved
FINAL !FINAL FINAL IANALI FINAL
n�
LLJ _
J
0 Call Cor reinspection 0 Reinspection fee of S required before next inspection O Unable to inspect
Inspector: Date: - pageL of
�–
A
ELECTRICAL PERMIT
CITY OF TIGARD P 1�-R M I T #-. E L C 17)6--0 41)4 '�
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 07/29/96
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171
P A R C rH L: .1 -7 2,JC1A-1Z1.L l V111
SITE ADDRESS. . . : 0')040 SW 691-1-A AVI:-;'.
GJBDIVISION. . . . KINSS VIEW Z ON I NG: R-4. 5
BL-130.... . . . . . . . . . L-01.. . . . . . . . . . . . . : 1
Pr-oJ ect Description: ADD 17 1 ON PATH I
UNIT------ -----T'EMP 9R VC/FEEDERS-----• -----MISCELLANEOUC3------
1000 OR L11"GS, 1 0 - 2_'00 amp. . . . . . . : 0 P U M P/I R R.1 0 A T1 0 N. . 'it
EACH ADD' L. 5005F. . . : 1 01 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . -, V,
LIMITED 1__"1\1E7RGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 1/1
11ANF. HM/ C;VC/FDR. . : 0 61711+amp5 1000 volts. : 121 MINOR LABEL ( 10) . . . : 0
-------S E R V I C E/FE:.E'"Ll E R- CIRCUITS------------ INSPECTIONS—
0 C2,00 amp. . . . . . : I W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
201 400 amp. . . .. . . : 0 1st W/O SRVC OR FDR. : 0 PER HOUR. . . . . . . . . . . : 0
401 60171 amp. . . . . .. -, V) EA ADDL BRNCH CIRC: 0 1 N Pl ANT. . . . . . . . . . . . 0
61711 1000 amp. . . . . 0 REVIEW SECTION----_._.__.__.__.__..._._._
1000+
ECTION--
1000+ amp/volt. . . . .. : 0 ) =4 RE5 UNITS. . . . . . . . : ) 600 VOLT NOMINAL.
Reconnect only. : 0 SYC/FDRR 1 = J"2 ' AMPS. . CLASS) ARL'A/SPEC OCC.
Owner,. FEES
MICHAE-L. DECKFIAM type amol-tnt by (:late t-ecpt
9040 SW 69TH p'RMT $ 195. 00 E*% 07/29/96 96--
5 ID C T $ 75 8 07/C`3/9C, 96,...28. 21
T16ARD OR 97223
F"hone #: _93-6288
L o n t r,a c t o
OWNER 0.04. 75 TOTAL
REQUTRED INSPECTIONS
Ceiling Cover Elect, .1. se.-vice
1:1,hotie SITE ABOVE Wall Covet, Elect' l Final
R I
eq
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all ocher 011rn1t.teF Signat Lkt,e
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 onre
than 180 days. Isstted Bv
...... INS)TALLATION
The installation is being mrd an tv I own which is not intencled for-
sale, ) ease, or- rent.
OWNER' S SIGNAT URE: DATE-
CONTRACTOR INSTALLATION
,31GNAIURE DF SUPH. ELECIN: D A TE
i.-ICENSE NO:
Call for inspection — 639 -4175
• Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. M r�-�� c1
Tigard, OR 97223 Permit # -!�7 �,t
Date Issued
Phone (503) 639-4171
CITY OF TIvARt? FAX (503) 684-7297
TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of ins;iections p•rr permit allowed
Address Service Included: Iter", Cost(ea) Sura
City/State/Zip o,q Q 122 3 4a. Residential -per unit ,
1000 sq. ft, or less _ St to'&
Name (or name of business) Each aduitional 500 sq.h.or 1
portion thereof 12500 l
Cot ilercial Residential Limited Energy _ - $2500 _r
Each Manur'd Home or Modular
Owe(ling Service or Feeder ssn oA _
2a. Contractor installation only:
_4b. Services or Feeders
Installation,alteration.of rotooltton
Electrics ontractor_ _ 200 amp!or less % $6000 2
Addr ss -T� 201 amps to 400 amps $8000 2
city—
State---'r:- Zip 491 amps to 600 amps $120.00
y-- ,��— p— 601 amps to 1000 amps $18000
Phone No. Over 1000 amps or volts $340.00 2 ,
Job NO. Reconnecl only sen 0o 2
contractor's licen O. 4c. Temp Services or Feeders
Contractor' and Reg. No.
Installation,elterauon,n
Sign of Supr Elec'n_ ^Y 200 amps or less C"` l 2
1.cense No. Phone No. 201 amps to 400 amps = 2
--- 401 amps to 600 $75,00
Over a o 1000 voile $10000
2b. For owner installations: s a„b„above
4d. Branch Circuits
Print Owner's Name -C_�° m __ New,alteration or extension per pane
Address a)The fee for branch circuits with
City State Zip i purchase or fervlce or feeder fee. 2
Each branch circuit $5.00
Phone No. b)Thu fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee.
not intended for sal , IenSe r f First branch circuit $35 00 _f
// Each additional branch circuli $5 00
Owner's Signature/ ✓ ✓ 4e. 1111119,ellaneous
(Service gr feeder not included) -
3. Plan Review section (if required): LSIgnsl
pump or dine fighting
o:oo
sign or outline lfgheMg 540 00
circuits)or a energy 2
Please check appropriate item and enter fee in section W. el n or extension 540 00 1
__1t-or�^^�� •��i al units in one structum, abels(10) $100.00
Service and feed71-27TVMP4,0r mo•e
System over 600 volt nominal 41. Each additional Inspection over
C'assified ar structure containing lal oc�upency the allection many of the above
abed in N E C Chapter 5 � - Per Inspection $35.00 _
_ Per hour
I n Fie
$5500
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5, Fees:
NOTICE
ga. Enter total of above fees
5%Surcharge (05 X total fees)
1
PERMITS BECOME VOID IF WORK OR CONSTRUCTION gbEnterof alt%of Ilne/�Mf a �~
AUTHORIZED IS NOT COMMENCED WITHIN 180 O .AYS, OR IF Plan R �. ,nuked (Sec 3)
CONSTRUCTION OR V;ORK IS SUSPENDED OR ABANDONED FOR ofal $
l
A PERIOD OF 180 DF YS AT At 1Y TIME AFTER WORK IS S
COMMENCED. Trust Accou:to - $
w m.no
Balance Due
CITY OF TIGARD MASTER PERMIT
COMMUNI rY DEVELOPMENT DEPARTMENT !"Ir.'rmli' 1t. . . . . :
13125 SW Hall Blvd.Tigard,Oregon 97223*6199 (503)639.4171 DA"C Tr 7,UITD- 06/01/9!7
PARCEL: ',S-11-:5DA ID11- Ov,,
2,JT;.7 ADDRES�7— --- f7l")TH AVE
ZONING. R-4,. 'S�
LAUTI-r ..,iG
%nSS OF WORK. AU PEDRMt-:4 13ARAGE. . . . . . . .
YT"' 7,f- U'S;7' �Ir- -LOOR (1t" r"Nj I RED ELI" i"T!f)crV:
'FIE OF CDNIST. aSM FIRST. . . . c1006 sf UEFT. . .30 ft RI:HT. 0 f t
Ir i" 77 r r-C 0 1, -0 40 F I RC r.r(. 0
r 7"
.0GR LOAD. . :40 Vt')LUE. . . 8 7 7 PiARV:NG SPAC�,rj. . I
ADD 17"1 01\1 PATH I
W A T r" I i E'A 71"'R r",. -0 TRAPS. . . . . . . . . . . . . . ..0
1,.4
10 61 r- !'"p L(1-1(j!*1 n R Y T r"'r,Y . . . . . .
CPT
f 7),"'7.01 r t" L I N 47 r'6' ) 0 C)R E A T . . . . .. . .
17.R c"L 0 S C T 7)'.
per L.INE I'!. r 'ITHrr' r:" , I f
IQbACIIE rrYtlrll. 0 RAIN DRAIN ( ft ) . .0
1111C C"HAN,z CAL
U11 IT .0 11,,
VfENTS . . . r11',r T .'7). 00 JD 0!� IS/9 S
.11'•111 111 1141, 1 46. r Jr) 0~/1.r"
HU'ID".3. . I ':X'c LCI. r! JI) 0, C 1, 1)5
F'USN "1 -.1 0,' J T� 0 /*17 1 '9!75
/I a f),
r"(-OCIR 7URN. . . 0 -0 RE, 0 MPLC 10. U1 JD 0,
S
^. I t' 'T I'll,
FUTLI:: 9u. 00 JD 0 1
4. C,
e C-
13.
LO
.yrs
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
obsite Ad:iress:
7,X ,� V e-I.J Office Use Only
Subdivision: r Lot#_
Valuation: V�—, - Contact Date / r Initials
Result �
1 �._ f\
Plarck/Rec #
fe l New Construction Only: (Square Footage) Permi! # 1";>I U-U-AzU
iI` House: /O'S� Garage: /e o F:eissue of
Map d TL
Zone
Corner Lot? Y N Flag Lot? Y N Plat #
Owner: — Approvals Req aired
�—fk Plannino Setbacks _ Solar
Address: S 6Engineering
' 0 2 Other
r Items Reeguired
Phone. � ) �9 3: _
Subcontractors
Contractor:
S�t � Truss Details _
Address: Other
Notes
Phone: ( )
Contractor's License #
(attach copy of current Oregon license)
Contact Name: �{ti i ���
Contact Phone:
Subc `Tactors: Architect/Engineer;
Plun..j:ng: Address
Mechr nical•
(attach copy of currant OR Contractor's License)
Phony:
JOB DSS 1 IPTIOON: i0 _ J;� n��.1' 3� L-TZ3 �LZ7. L►vlra�
Ap licant Signature Applicant Phone number
CC-
Received by: ��- -- I _ Date Received: �
H'bpnlafVNigO "
Permit# Account Description Amount Amt. Pd. Bal. Due
i
`,VX/6 Bldg. Permit (BUILD) 143.��
Plumb. Permit (PLUMB) ,_
Mech. Permit (MECH)
State Tax (TAX) �� 1`�
Bldg:
Plumb:
Mech: U
Pian Check (PLANCK) u � y�•o
Bldg:
Plumb:
Mech: /D S
Sewer Connection (SWUSA)
Sewer inspe, ",)n (O'WINSP) -
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TEF (TIF-MT)
Commercial TIF (TIF-C) _
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-0) _
Nater Quality (WQUAL)
Water Quantity (WQUANT)
' Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT) C _L_
Erosion Planck/USA (ERPLAN) __
Erosion Planck/COT (EROSN)
TOTALS:
Permit #: _
Address: —
e: w
9
Issued by: Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
foi residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt,from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
0—1. 1 own, reside in, or will reside in the completed structure.
n 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
—� before or upon completion.
(� 3A. My general contractor is —————
I� (Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
313. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Burd. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners abou Construction Responsibilities on the reverse side of this form.
a A.
(Signature of permit applicant) Date
(White copy to issuing agency permit file,
pink copy to applicant)
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