9385 SW 70TH AVENUE ADDRESS :
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i \records\micretlm\target,3\building.doc
CITY Or TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: �),;9-4175 Business Line: 639-4171
BIJP l�
Date4?sgtrgMed -_AM I��__PM BL.D
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Location- 7 `� Q T� Suite MEC
ContactPerson _ Ph PLM
Contractor _ — — Ph SWR
B G Tenant/OwnerEL%
etaining Wa ELR
Fooi Access. FPS
Foundation - - -.- --
Ftg Drain — SGN
Crawl Drain Inspection Notes: -
Slab _- ----------_—_�_ — __r.__..._.. SIT
Post&Beam _
Ext Sheath/Shear
Int Sheath/Shear
Framing —
Insulation
Drywall Nailing `�-
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ----
Roof
Misr.: ---
Final
PASS PART -AIL - ---
PLUMBING 1 _ LK
Post& Beam
Under Slab _ \",..Y
Top Out
Water Service —
Sanitary Sewer
Rain Drains _
Final
PASS PART FAI'_
MECHANICAL
Post& Beam
Hough In
Gas Line ----� vv ----
Smoke Dampers
Final �—
PASS P, RT FAIL
ELECTRICAL
Service
Rough In
UG/Slab -
a Low Voltage
Fire Alarm -
N Final
PASS PART FAIL
SITE
Backfill/Gradingcc
_
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
' Catch Basin [ ]Please call for reinspection RF. [ ]Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Datev Inspt3CtOr, y` -`�/ EXt/
Other _ —
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Phone:639-4171
// p pp
Date Requested: 3 6, ! O A.M. P.M. MST:
Location: .y�i(� �(� GL'yt� _ BUR
Tenant:_ Suite- Bldg: MEC:
Contractor: / �lfoe�u� �,�� dZ v� PLM:
Owner: t��=ie/C S A_/ 1'honc: ELC:
-7 616 <7--ELR•
SfT:
BUILDING BLDG(con't) PLUMBING MECHANICAL '" ELECTRICA_L , SITE
Site Post/Beam Post/Beam Post/Beam over iie Sewer/Storm
Footing Roof UndFl/Slab Rough-In Ceiling Water Line
Slab Framing Top 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 Drain A/C UG Slab
Shear/Sheath Fire Spklr/Alm CrawUFound Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
FAppr/.'S;dwlk Not Approved Not Approved Not Approved owovcd Not Approved
FINAL FINAL FINAL FINAL- > FINAL
12 GFCy nI4 A+.1,0 )wj"i I _
Ce If CD r C/ k p l� 1�o eXt^e t a/ c3G �� ♦.►�
Lam,
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F-
❑Call for reinspection inspection fee of S_.- ?_required before next inspection C]Unable to inspect
Inspector: Date Page _of
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 6394171
Date Requested: 3'6- F? A.M. P.M. MST: Q 7 /
Location: �.� .� 5W 70/�'u BUP:
Tenant:_ Suite: Bldg: NEC:
Contractor:_-1 , G one: PLM:
Owner: Phone: ELC:
((y�//n�eL tr ��..5 ti:
—T•�1 �.�Zr]L- T^ie — ELR:
SIT: _
BUILDING LDG on't) PLUMBING CHANCAL ELECTRICAL SITE
Site —P6iityf3cam % - Cover/Service Sewer/Storm
Footing Roof Un Fl 'lab Rou h-ln Ceiling Water Line
Slab Framing �' s Rough-In UG Sprinkler
Foundation Insulation Sewer ood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling '1AWn—D Mn 1- A/C UG Slab
Shear/Sheath Fire S klr/Alm Cra d Dr Beat Pump Low Volt
roved Approve Approved Approved Approved
Appr/Sdv Ik roved roved o ppraved Not Approved Not Approved
INAIr INA: FINAL FINAL
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0 Call for rein ti C3 Rcinspectiop fee of S uired before next inspection O Unable to inspect
Inspector: _ �___ late: T _ Page of
CITY ® F' TIGARD ELECTRICAL PERMIT
PERMIT it: ELC97-.0S23
DEVELOPMENT SERVICES Dur ISSUED: 07/29/97
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171
PARCFL. 2SJ.03nC-0i7j1_03
71-17- ADDRESS. . . : St.,
!-JBDIVIGION. . . . ZONING: P 4. 5
!-,;_OCK. . . . . . . . . . .I L_o T. JURISDICTION: URD
'floject Description : Add two (2) branch circuits.
-
------RESIDENTIPL UNIT-------- - -FEMP SRVC/FE 11DERS------
1000 SF OR LESS. . . . : 0 0 E'00 amp. . . . . . . : 0 PUMP/1RLQ TGnTION. _ . : 0
EACH ADDIL 500SF. . . : 0 201 /too rain p. . . . . . . : 0 13!GN/OUT I...TNE LTG . . V,
LIMITED ENERGY. . . . . : 0 401 GOO amp. . . . . . . : 0 SIGNnt_/PANEL. . . . . . . 0
MANE'. HM/ SVC/FDR. . : 0 6014-amps- 1000 volts. : 0 MINOR LADEL ( 10) . . . 0
--------SERVICE/FEEDFR---- CIRCUITS-------- ---ADD' L INSPECTIONS——
0 '2,00 .amp. . . . . . : 0 W/SF7RVICE OR FEEDER: 0 PER INSPECTION. . . . . : TO
201 400 amp. . . . . . : 0 Ist W/O SPVC OR FDR. : I PER HOUR. . . . . . . . . . . : 0
401 C,00 amp. . . . . . : 0 EA r-IDD' L DRNCH' CIRC: I 1N r'1_nN1.. . . . . . . . . . . . 0
601 1000 amp. . . . . : 0 REVIEW SECT I ------------
1000-4- amp/volt. . . . . : 0 > =/1 RE,17 UNITS. . . . . . „ „ ) 600 VOI-T N01ITNAI.— . :
Reconnect only. . . . : 0 SVC/FDR > = 225 CLASS AREA/SPEC OCC. :
OV411el. . - F1''7E!7)
JIM HOPE 1.) a m 0 1.t 11 t by date t-eept
93135 3W 70TH AVFNI 40. 00 G E.0 07122,0—97 97-2977 12
Orr, "-�'2'LL.7, 5PCT 2. 00 CEO 07/29/97 97-2297712
17,1-ione # _
ont ract or-:
",110r.NIX ELI CTR TC CO $ A-2. 00 TC)TnL
',-;,79 SW TECH CENTER DR.
REOUIRED INSPECTIONS
TIGARD OR 97223 Elect' l Set-vice
Phone ff ,., G8zi-3G. 00 Undecgt-ol.tnd Cove Eloctll Final
Reg 0. . : 000522"
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable law;. All wc� will be done in accordance with apprcved plans. This permit will expire if work is not started within 182
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 DAR through OAP 952-001 1361. You may obtain a copp�'
of these rules or direct questions to OUNC by calling f )246-19PI.
Z",r-mittee r3iwnatl.lt-e :
------OWNER INSTALLATION
ir)St,_1lI.ati0T1 is beiny made on property I okqn Which is not intended fol
leas'ej or, r-ent.
"jIGNATURC.- r DATE:
I NST01...1 r)T T nr4 mit-y-
GNATURE Or SUPP. ELECIN: DATE: V
LTCEh,SE Nr
e711 1/0
4A+4-+++4 + i-A-4-+ Vi F-I +-f-+4,++-+A-+++-44-+4-4-++++44-++-I-++4-+-+-+4-+4-+-4-+-I-+++++ F-V-I-+-f++4+4-++�L+-+-+++4
Call 63;9-4175 by 6:00 p. m. for an inspection needed the next bl.tsinesit day
+++4...................4-4,4-++++-I-+++4-++++-++-++4-4-++-f-+-•-1-++-++4+++4.......1-1-4 4-4-+-1 +i+-f++
•JUL-7.9-97 TUE 10:57 AM PHOENIX ELECTRIC FAX NO, 503 684 3611 1" 02; 02
circ of 11GARD Electrical Permit Application Plan Check
Recd By
13125 SW HALL BLVD. Date Heed _
TIGARD OR 97223 Date to P.E.
Phone (503) 639-4171, x304 Finnt or Type Date to DST_
Inspection (503) 639-4175 PermitOF-e- 7
Fax (503)684-7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below.
Name of Development — __ Numner of Inspectons par permit allowed
Name(or namrt of busines y-1 r'_ Service included: Items Cosi Sum
Address l 1.�_ 4�t• Residential-per unit
$110.00 d
City/State/71p Each additional 500 aq,n_or
i� portion therof $25.00 1
Commercial ❑ Residential ICs. �mitel Energy S25 00
Each Manurd Home or Modular
pweffing Service or FL-W;w T_— 568.00 -
2a. Contractor installation only: 4b.Semcss or Feedom
(Attach copy 1 curyern Ilcnn:uV
Installation,aftera:ien,or rghr30en
FI@etnedi%Ontrdet0r4 200 amps or less $6000 2
Add r 5 - ,— 201 amps to 4W amps S80 ou 2
city _StatE'. —Z - 401 amps to 600 amps
$190.00 2
Phon., No. �` -Q ;' _ - T i +� 601 amps to loco amps $340.00 2
r 1 Over inec amps or volts S�•0 2
Job No. �,t -- Rrconnect only $50.Co 2
Elec. Cont. LJce. No r to
OR State CCB Reg. No. c Exp.Dah-) 4c.Temporary Servicirm or Feeders
COT Business Tax or Metro N v Fxp.Date_ _ Installation,alteration,or reloc-a Wn
200 amps Of lec s 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec'n,_� � —• 401 amps to COO amn!% $100 UO 2
Over 600 amps to 1000 vorG.
License No 1L1 CSS -_Exp Dalo -t1'above.
Phone NO. _. _ id.gran.-In Circulr_S
Now,anerat on or exten:;rm per Dame
i 2b. For owner installations: a)Thr+1w for branch armirh wiM
purcliam of service or
Print Owner's Name _ acri r nch _
— - Each branch um��t 55.00 _ _ 2
4ddresS__ bi The fen for branch r,rcuRs
CiN State L.p _ _ w,rnoof purcnaoe or
Phone Now service or feedar rr:
F,rsl branch urcuit
9 $35.00 2
The installation is being made on properly I own which is not Fact?additional branch circuit S� Ss oo � 2
intended for sale,lease or rent. 4e.Miswitsnsous
(Semcii or teeder net included) 44n 00
Owner's Sianatura_ _ _ _._ Each pump or Irrigation cirrsn Soo 00 - __ 2
Each sign or ouUmn lighting
Signal orwlt(s)or a limited anergy
3. Plan Review secr;on (if required):' panel,alteration or enons ion _ $40.00 2
� Miner IIs(10) $100.00
Please crisck appropriate item and enter fee In s._-tion 58.
In 4 or more residentiel units.n one structure 4f.Each additional Inspectlan over
Vn Service.and feedor 225 amps or more the allowable in any of the Above
> Sysirm over 600 volth nominal Per in�oeeticn --
f- Classified area or structure containing 5001 Ocxupanay Per hour
r
-- .00
as described in N,E.C.Chapter 5 In Plant $1'
n�
Submit 2 sets of plana with application when any of the above apply. 5. Fees:
LL Not required for temporary construction servicers. 5a.Entar total of above fees S
S?:,Surcharge(.05 X total fees) S r
NOTICE sunrotal $
5b.Enter 25%of lire Sri for
PERMITS BECOME VOIn IF WORK OR CONSTRUCTION AUTHORIZED IS Plan gwiew if mQuired(SOCA) $
NOT COMMENCED WITHIN 180 DAYS.OR IF CONSTRUCTION OR WORK bfofar S
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY eTrust Armunt a
TIME AFTER WORK IS COMMENCED. f iCa.z�
Total balance Due
e
CITY O TIGARD MASTE R F'E RM I T
DEVELOPMENT SERVICES F'ERMII" #. . . . . . . : MS, 7—¢r41
13125 SW Hall Blvd., Tigard.OR 97223 (503)63.9-4171 DATE ISSUED: 10/01 /97
F"'ARCEL: 1 S 125DB-00100
SITE ADDRESS. . . :O9385 SW 70TH AVE
SUBDIVISION. . . . :SHADY DELL ZONING: R-4. 5
BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . :001 JURISDICTION: TIG
Remarks: Fire damage repair ELECTRICAL PERMIT TO BE TAKEN OUT BY ELECTRICAL CONTRACTOR WHEN HE IS RALE TO SEE WHAT NEEDS TO BE DONE
--------------------------------------------------------------- BUILDING ---------------------
PEISSUE: STORIES.......: 0 FLOOR AREAS----------- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED-------------
CLASS OF WORK.:REP HEIGHT........: 0 FIRST....: 0 sf GARAGE.....: 0 sf LEFT..........: 0 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 0 sf FRONT.........: 0 PARKING SPACES: 0
TYPE OF CONST.:SN DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 0
OCCUPANCY GRP.:R3 BDRM: 0 BATH: 0 TOTAL------: 0 sf VALUE..1: 35000 REAR..........: 6
-----------------------------------------•------------------------ FL UMBING ---------------
SINKS.........: 0 M,TER CLOSETS.: 0 WASHING MACH..: 9 LNUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATuRIES....: 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: I CATCH BASINS..: 0
TUB/SHOWERS...: 0 GARBAGE DI5P..: 0 WATER HEATERS.: 1 WATER LINE ft: 0 3CKFLW PREVNTR: 0 GREASE TRAPS..: 0
O'iHER FIXTURES: 0
-------------------------------------------------------------- MECHANICAL -------------------
FUEL TYPES--------- FURN ( 100K ..; 0 BOIL/CMD ( 3HP: 0 VENT FANS.....: 0 CLOTHES DRYERS: I
GAS FURN )=100K ..: 1 UNIT HEATERS..: 0 HOODS.........: 0 OTHER LINI13...: 1
MAX INF-.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...: 1
----------------------•----------------------•-------------------- ELECTRICAL ---------------------------
—RESIDENTIAL UNIT--- ---SERVICE/FEEDER----- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ---- --ADD'L INSPECTIONS—
1009 SF OR LESS: 0 0 - 220 amp..- 0 0 - 200 amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 201 - 400 amp..: 0 201 - 400 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 F'ER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 amp... 0 401 - 600 amp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT......: 0
MANF HM/SVC/FDR: 0 601 - 1000 amp.: 0 601+amps--1 N@ v: 0 MINOR LABEL -10: 0
1000+ alp/volt.- 0 ------------------------------------ PLAN REVIEW SECTION ----------------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
-------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ----------------------------------------------------
A. SF RESIDENTIAL-------------------------- B. COMMERCIAL---------------------------------------------------------------•---------------
AUD,^ 8 STEREO. : VACUUM SYSTEM..: AUDIO b STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAk ALARM—: 0TH: :: BOILER.........: HVAC... ........: LANDSCAPE/IRRIG: PROTECTIVE S1GNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR:
I1VAC...........: DATA/TELE COMM.: NURSE CALLb....: TOTAL I SYSTEMS: 0
Owner: -----------------------------------Contractor: ------------------------------ TOTAL. FEES:$ 437.24
KELLIE D ERICKSON HORIZON RESTORATIONS This permit is subject to the regulations contained in the
9.385 SW 70TH AVE 16176 SW 72ND AVE Tigard Municipal Code, State of Ore. Specialty Codes and all
TIGARD OR 97223 TIGARD OR 97224 other applicable laws. All work will be done in accordance
with approved plans. This permit will expire if work is
Phone 1: 452-1684 Phone N: 620-2215 not started within 180 days of issuance, or if the work is
Reg C.: 004608 suspended for more than 188 Jays. ATTENTION: Oregon law
requires you to follow rules adopted l:y the Oregon Utility
N Notification Center. Those rules are set forth in DAR 952-801-P810 through OAR 952-001-8880. You may obtain copies of these rules or
direct questions to OINdC h,, calling 15031246-1987.
--------------------------------------------------------- REQUIRED INSPECTIONS -----------------------------------------------------------
Mechanical Insp Byp Zlwd !nsp
r� Plumb Top Out Rain drain Insp _
LLFraming Insp Mechanical Final
-� Gas Line Insp Plumb Final _
Insulation Insp Final inspe ti
Issr-red By :-�� _ Permittee Signat LWe:
++++++++++4.+++++++++++ ++++-TT-r+++++++4-+++++++++f-1. +++++++++++++++++i-+++
Call 639--4175 by 6:00 p. m. for an inspection needed the next br"rsiness day
.�
Plan Check
CITY OF TIGARD Residential Building Permit Application Recd By _
1312'; SW HALL BLVD. New Construction Additions or Alterations Date Recd
T IGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E./r) I
V 503-639-4171 Date to DST /G 'f 'C
F 503.684-7297 Permit#
Print or Type
Incomplete or illegible applications will not be accepted
— Name of FIroject Name
Job 'i Architect Mailing Addres
Address Site Address
9 3 g r S K1 7O-rH —
Nam City/State Zip Phone
� c/6- tJ. G/� .SO/0 Name
Owner Mailing Address
t- ads Sw {�
City/State Zi Phone Engineer Mailing Addie s
X6,4 �/� �7LL 'Yl
General Name
City/State Zip Phone
Contractor &IQ/z Uv -LAD Describe work New O Addition O Alteration O Repair
Mailing Address to be done:
Prior to permit 730� 5k(/ i}(3L�� �� Ad itional Description of Work:
issuance, a copy CAqState Zip Phone ✓ 'P+ Ag%�A' -!12 S
of all licenses doCT, 6-R
are required if Oregon Const. Cont. Board I Exp. Date PROJECT dCj
expired in COT Lic# �6O / y VALUATION
database _
Mechanical Name NEW CONSTRUCTION ONLY
Sub- Sq. Ft. House: Sq. Ft. Garage
Contractor Marling Address
Prior to permit / 3 ?'0( Corner Lot YES NO Flag Lot YES NO
issuance, a copy y/State Phone (check one) (check one)
of all licenses d i.4 i1 ix Restricted Audio/Stereo Burglar
are required if Oregon Const. Cont. Board Exp.Date Energy System Alarm
expired
database Li .#,.; Installation Garage Door HVAC
Plumbing Name Q Opener Systems
Sub- (check all that Other:
Mailing Address
apply)
Contractor g Will the electrical subcontractor wire for all YES NO
_ _ restricted energy installations? _
Prior to permit City/State zip Phone
issuance, a copy Has the Subdivision Plat recorded? N/A YES NO
of all licenses are Oregon Const.Cont Board Exp Date
required n Lc.# Reissue of MST#: Salar Compliance
expired in COT 11770 /
(Calculation Attached) _
database Plumbing Lic # Exp Date I hearby acknowledge that I have read this application, that the
t NPo-SSA� Z �O3 J� inform tion given is correct, that I am the owner or authorized
N me age o the owner, and that plans submitted are in compliance
wo Or gon hT4W laws.
Electrical i of er/A ent T D:ie
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Contractor �/Z- N� ��(/�Y � `% n1t�aj;t Person Name--, Phone#
City/State Zip/ Phone i C_K Oct ?1�rZZl
Prior to permitJ� r FOR OFFICE USE ONLY: _
ssuance, a copy VQe� t/�( Plat#: Map(rL#:
of all licenses are Oregon Const Cont Board Exp Date C�
required if Lic# / I—
expired in COT 3S _ fir) Setb,�cks: Zone: - , Solar/
database Electrical Lic # Exp. Gate (\
3 O / En fining Approval: Planning�proval: TIF-
I SFREM DOC (DST) 4197,
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CONSTRUCTION
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I .NGINEER. —��~ DALE:F-22-97 SHT / OF 3
JOB NO.: ERESTOR47110N SYSTEMS _SCALA=_ ro f
y3 c9 C5..W, DWG NUMBER:
7 301 5 W Kible la 100•Portland OR 97224
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.9 T��3 15031 P20 2215•FAX(503)624.0523
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ENGINEER: _ _ DATE: ?-�2-97SHT 2 OF
JOB NO.: E' S RESTORATION SYSTEMS
T3 8 S,4J. 70 DW^ NUMBER:
7301 S W Kable Ln M 100•Portland,OR 97221
AI, L� Q/�. 9722 (503)620.2215•FAX(503)621.0523
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DATE 02-97SHT 3 OF 3
ENGINEER. - H-20RIZON
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7301 S W Kable Ln *t00•Portland.OR 97224 DWG NUMBER:
(5031 620 221E•FAX(503)624-0523
CITY OF TIGARD EL._ECTRICAL F'ERMTT
DEVELOPMENT SERVICES F,ERMIT #: EL_C07- 0E78
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: 10/ 11: /97
FIARCE1_: 1 S 1 cCDLA--00100
SITE ADDRESS. . . :093B5 SW 70'fl-1 AVi_.
CUBD I V I S I ON. . . . :SHADY DEL-I._. 7.ON I NG: R--4. "
BLOCK. . . . . . . . . . . I_OT. . . . . . . . . . . . . :001. JURISDICTION: TIG
p'ro j ect De scr-i pt i on : Fire damage repair residential - per unit 1,000 sq ft or
less.
____REST DENT IAL_ UNIT..----._ ----TEMPI SRVC/FEEDERS----- .-----MISCEL.LANEOLJS
10Q10 SF OR LESS. . . . : 1 0 — c200 amp. . . . . . . : 0 F'Uh1F'/IRRIGAT ION. . . . : 0
EACH ADD' [- 500SF. . . : 0 201 - 400 Amp. . . . . . . : 0 STGI\I/OUT LTNE LTG. . : 0
1 IMTTED ENERGY. . . . . : 0 401 - (500 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
1y1nNF. HM/ SVC/FDR. . : 0 601.+amps-1000 volts. : 0 MINOR L_.APEL ( 10) . . . : 0
__--_SERVICE/FEEDER------- ------BRANCH CIRCUITS-------- ----ADD' L. INSF,ECTTOI\IS-_.--
0 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PIER INSPECTION. . . . . : 0
201 - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 0 PIER HOUR. . . . . . . . . . . : 0
401 - ('00 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 171 TN PL..AIVT. . . . . . . . . . . rlr
601 1000 amp. . . . . : 0 ______.__._________._.--- F'L.AN REVIEW SECT I
1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) C,00 V01_.T NOIrIINAI_.. . :
Reconnect only. . . . . : 0 SVC/F'DR > 225 AMPS. . : CLASS AREA/SFIEC O('C. :
Owner; _.______._____.____... .._. ._--.__._..____.__........ ......._______.__------------•-_._-- FEES
KEL-LIE D ERICKSON type amoi.int by date r-ecpt
9385SW 70TH P'RMT $ 110. 00 GED .1.0/1.4/97 97-3000,1.1
TIGARD OR 97223 OI-ICT 2 0. 50 GEO 1.0/14/97 97-300041
Phone #:
Contr-actor:
ROSE CITY ELECTRIC CO INC $ 1. 1.5. 50 TOTAL-
4012 NE CI_Ii._L_Y BLVD
REQUIRED INSPECTIONS
PORTLAND OR 97c13 Rol_tgh--in Elect' 1 Ser,v it c
Plione #- 287- 61.64 Undergroi_rnd Cove Elect' 1 Final
R v g #. . : 000035
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 the rules adopted by
the Oregon Utility Notification Center. Those ruses 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.
F'flcmittee Signati_rrla : jam _ Tssi_ied By :
Ln _.___OWNER INSTALLATION
The installation is being made on property I own which is not intended for-
C.Ole, lease, or r^ent.
c� nWNER' S SIGNATURE: _ DATE: —
W
_-__..___._..__.`--------CONTRnCTOR TNSTALT
L.AIOIJ
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S T GNATIJRE OF SUF'R. ELEC' N: SW-3 DATE:
I._I CFNSE NO:
++++++++++++Ah++++•}++++,+4-h++i.+++++++4•+++++++++4.4++++++++++•t+4•.....+++4•+++++-h+4 4
Cal 1 639--4175 by 7eOO 12, m. f ov- AL inspection need
+++4 +++++++-+++++++-1-+4++++++++++++++4+++++++++++.4 ++++++++++++++++++++++++++++-E 1-+
Community Development ELECTRICAL PERMIT APPLICATION
1 SW Hall Blvd. FGeog7_ 6V,7�
Tigard, OR 97223 Permit # l
Date Issued
Phone (503) 639-4171
CITY OF TIOARD FAX (503) 684-7297
TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development 7 Number of Inspections per permit allowed
Address_ 7 tom_ fk, Service included Items Cost(ea) Sum
City/State/Zip 4a. Residential -per unit ' )��i
h 1000 sq. ft. or less __ $11000 .1 °
Name (or name of business) / /G//-'s 0/1 Each additional 500 sq ft or $25 00
(Q� portion thereof
Commercial ❑ Residential IJV Limited Energy $2500 1
T Each Manuf d Home or Modular
Dwelling Service or Feeder $66 00 2
2a. Contractor installation only:
4b. Services or Feeders
1
Installation,alteration,or relocation
Electrical Contractor I � i C-,/ 200 amps or less $6000 2
Address 1p L • •� 201 amps to 400 amps $8000 z
_ State' �K Zip L 401 amps to 600 amps $120 00
City- P �:.— -- $18000 2
601 amps to 1000 amps
Phone No. r4k- -1 t _.— Over 1000 amps or volts $340 00 2
Job NO.�,_3 Reconnect only $5000 2
contractor's license N 4c. Temporary Services or Fseders
Contractor's Board Reg. No. r Installation,alteration,or relocation
Signature of Supr. Elec'n, r-1A- 200 amps or less ----- 2
201 amps to 400 amps $50 00 2
License No Q)/,a 7 C P One NO _ 401 amps to 600 amps $7500 2
Over 600 amps to 1000 volts sloo'no
2b. For owner installations: see"b"above.
4d. Branch Circuits
Print Owner's Name-- _--- Now,alteration or extension per pane
Address a)The fee for branch circuits with
Cit State ZI purchase of service or feeder fee.
City - P— -- Each branch circuit $5.00
Phone No. b)The fee for branch circuits without
The installation is being made on property I own which is purchase of servlcc or feeder fee. 2
First branch circuit $3500
not intended for sale, lease or rent. Each additional branch circuit $500
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if rpquired): Each pump or litigation circle $4000 !_
Each sign or oulllne lighting $40.00
Signal circult($)or a limited energy
Please check appropriate item and enter fee in section 5B. panel,alteration or extension $4000
_ 4 or more residential units in one structure Minor Labels(10) $10000
Service and feeder 225 amps or more
4f. Each additional inspection over
System over 600 volts nominal
Classified area or structure containing spa lal occupancy the allowable in any of the above
�� uisp�rfirn $3500
V) as described in N E.0 Chapter 5 --- $511 00 _
In '�rel _ $5500
'— Submit 2 sets of plans with application where any of the above
apply. Not required for temporary ryconstruction services.
5. Fees:
5a I nL r total of above fees $ Q Gt
NOTICE 5 Surcharge 105 X total fees)LD $
LL1 Subtotal
PERMITS BECOME VOID IF WORK OR CONSTRUCTION $ T
5b. Enter 25"/" of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Flan Review if required (Sec.3) $ _
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $ 'T
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS --
*"me�rsu �_� Trust Account #
COMMENCED.
Balance Due $ 1�
F-
RECEIVED
OCT 13 1997
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COMMUNITY DEVELOPMENT