12321 SW 132ND COURT 12321 SW 132"" Court
CIT
'A OF TIG /� R� ELECIi ICALFERMiT
1�J r 1 /y PERMIT#: El_C2003•J0036
DEVELOPMENT SERVICES D rE ISSJED: 1/28/03
13125 SW Hall Blvd., Tiqard, OR 87223 (503) 639-4171 PARCEL: 2S104AB-10400
SITE ADDRESS: 12321 SW 132ND CT
SUBDIVISION. MORNING HILL NO 6 ZONING: R-4.5
BLOCK: LOT : 13:3 JURISDICTION: TIG
Project Description: Install 2 blanch circuits to living room floor.
_ _RESIDENTIAL UNIT 'EMP SRVC/FEEDERS_ _ MISCELLANEOUS
1000 SF OR LESS: 0 kdo amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - F00 amp: SIGNAL/PANEL:
MANF HM/SVC/FDR: 601+a,rr,- - 1000 volts: MINOR LABEL (10):
SERVICEIFEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
7.01 - 400 amp: 1st W/O SRVC OR FDC;: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: I IN PLANT:
601 - 1000 amp: _ _ PLAN REVIEW SECTION
1000+ ampl;nit: —4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: -SVCIFDR—225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
RON NELSON OWNER
12321 SW 132ND CT
TIGARD,OR 97223
Phone: 503-590-0862 Phone:
Reg #:
_ FEES
Description Date Ain xmt
Requirod Inspections
II I I'12M1'� I.I �' I'crnut 1/28/04 $53.50
I Xj 8%Slaw I.i\ 1/28113 $4.7.8 W311 Cover
-- Elecl'I Final
Total $57.78
This Permit is issued subject to the regulations contained In the Tigard Municipal Cude.State of OR Specialty Codes and all other applicable laws.
All work*11 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 requin';s you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 957.-001-0100 You may obtain copies of these r es or direct questio to OUNC at(503)
246-6699 or 1-800:P2-2344 � �
Issued By: �.I1E1 1 — Per nit Signature,
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
ATE: ---CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 4LA ti LC `L= DATE:_ _
LICENSE N0' ------ -- — -- --_ — -- --
Call 639-4175 by . .00pm for an inspection the next business day
NLY
l"lectricl Permit Applica>aican ' ' ' '
Received l5a Electrical
Date/L : I _J _' Permit No.
Planning Approval Sign
City Of Tigard Date/By: Permit No.: _
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.: _
Phone: 503-639-4171 Fax: 503-.598-1960 Post-Review Land Use
DateB : _ Case No.:
Internet: www,ci.tigard.or.us Contact Juris.: See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Mcthod: __ — Supplemental Inforntatlon.
TYPE OF WORK PLAN REVIEW Please check all that apply)
New construction Demolition Service over 225 amps- U Health-care facility
commercial ❑Hazardous location
Addition/alteration/rt-placement I rT6—th—er: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1&2 family dwellings four or more residential units in
1 &2-Family dwelling Commercial/Industrial ❑System over 600 vults nominal one structure
❑Building over three stories ❑Feeders,400 amps or more
Accessory Building Multi-Family_ — ❑Occupant load over 99 persons ❑Manufactured structures or RV park
Master Builder Other: ❑EgressAighting plan ❑Other: __ _
JOB SITE INFORMATION and LOCATION Submit—sets of plans with any-of he above.
-- - The above are not applicable to temporary construction service.
Job site address: I i iz t S It7_I 3I- irt. �t c�u vr- _ FEE*SCHFIDULE
Suite#: Bld ./A to Number of inspections per permit allowed
Project Name: Description I Qty Fee(ea,) Total
New reside ntin l-slnRlc or multi-family per
Cross stre VDirections to job site: dwelling unit.Inrlodes attached garage.
'All� �� I, •.� ��U� Service Included:
I
I(M sq R or less 1 145.15 1 4
13 2- Each additional 500 sq.a.or portion thereof 33.40 1
---— Limited energy,residential 75.00 2
Subdivision: _—__ �Ot# Limited energy,non residential 75,00 2
Tax map/parcel #: Each manufactured home or modular dwelling
DESCRIP iON OF W RK service and/or feedet 90.90 2
Services or feeders-Installation,
i C i l 1�i`� D-� t �� Q-R�v I t o alteration or relocation:
200 amps or less 80.30 2
i_1t���19sL 'JLIN-4'_ L J' '�'1s- _� '� 201 nm .to 400 amps — 106.85 2
k-tLt,�,-1-�V(2L_6?��tt11.1 R 1 1b e tc. Aa v.S 0� 401 amps to 600 amps ------ --- 160.60 2
ROPERTY OWNER _ TENA'tT 601 amps to 1000 amps _ 240A 2
-- — Over 1000 amps or volts _ 454.65 2
Name: Sp Vim,—�p�.—/--y_ _ Reconnect only _ 66.85 2
Addrer-1- 1-2-3-z 1 S ltl I y L \ Temporary tervices or feeders-Installation,
alteration,or relocation.
City/State/Zip: �y�v� 0 °1 LZ 2011 amps or less 66.85 - 1
Phone:;D e.-S1 8 6 z -9w r D&-y' sa s -219-7 Y12n amps to 400 amp` __ 100.30
APPLICANT CONTACT PERSON 401 to 600 amps — 133.75 2
Branch circuity-ncw.alteration,nr
Name: extension per panel:
----- - - A,Fee for branch circuits with purchase of
_Address: _ _ service or(ceder fee,each branch circuit 6.65 2
City/State/Zii•. 1 ^_ B.Fee for branch circuits without purchase of
--- r service or feeder fee,first branch circuit 46.85 ¢ 2
Phone: , }'AX: --- _ Fisch adlif,nal branch circuit 665 2
E-mail: —� Misc(F.rvice or feeder not included)
Each,rump or irrigation circle 53.40 _ 2
^,_—_ CONTRACTOR— Fv_n dgtr or outline lighting _ 53.40 2
(.
Jolt No: l.,,.ii. /_h_ l_, _-_ '.Ignal circuit(s)or a limited energy panel.
- ----- "` - Iteration,or extension _ —pas 2 2
Busi'iess Name:-- nescription
Address:
Pooch additional Inspection over the allowable In an of the above:
City/Jtatk'/Zip: _-- Pcr inspection per hour(min. 1 hour) _ — —62.50
Phone: Fax: Invcsugation fee: --
CCB Lie. #: _ E_�_Jl.ie. #:__— Electrical Perrolt��ees*
;supervising electricign _--_ _ Subtotal S
sibnature required: Plan Review2( 5%of Permit Fee) S _
� -' —� State Surcharge 8%of Pcrmit Feel S _
1 rtnt Name: Lic. #: —_ .�5---
_ ___TO_TAL PERMIT FEE S
Authotize t� Notice: Thlt permlt application expares If a permit Is not obtained within
Signature:g�"'' = Date:-'/ 6 S 180 days after It has been accer ca at complete.
` --
"Fee methodology set by Trl-( Building Industry Service Board.
(Please print name)
i\Dsts\Permll FormsMeficrmitApp.doc 01103
Electrical Permit Application -City of Tigard
Page 1. Supplemental Information
LIMITED ENERGY' PERMIT FEES:
RESIDEN'T'IAL WORK ONLY:
Feefor all systems............................................................ $75.0^
Check'Type of Wot k 111vol%0:
DAudio and Stcrcn tiystcros*
Burglar Alarm
Garage Door Opener*
I leating,Ventilation and Air Conditioning System*
Vacuum Systems*
L] Other_.—--- ---— --- —
w.OMMERCIA.L WORK ONLY:
Feefor each system......................................................... $75.00
(SI-1:.0Alt 919-260-260)
('heck Type of Work Involved:
Audio and stereo systems
Boiler Controls
UClock systems
n Dela Telecommunication Installation
Fire Alarm Installation
L� IIVA(
Instrumentation
�j Intercom and Paging systems
DI andscupe Irrigation Control*
Medical
�] Is .dr Calle
C� Outdoor landscape Lighting*
Protective Signaling
Other
Number of Systems
* No licenses site retyuired. Licenses are re(luire,.1 for all
other installations ,
1:`.bs#eV'ermit Forms\FlcI,crmitAppPg2.doc 01103
arY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00029
13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/28/03
SITE ADDRESS: 12321 SW 132ND CT PARCEL: 2S104AB-10400
SUBDIVISION: MORNING HILL NO 6 ZONING: R-4.5
BLOCK: LOT: 133 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WAS"-R HEATERS: 1 CATCH BASINS:
FIXTURES_ LAUNDRY TRAYS- SF RAM DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace gas water with same
-- --- FEES
Owner: _ - -- --
Description Date Amount
RON NELSON
12321 SW 132ND CT IPLl�MI31 Permit Fee 1i28/03 $72.50
TIGARD, OR 97223 ITAXI Ml,State Tax 1/28/03 $5.80
Total $78.30
Phone : 503-5()0.08(12
Contrartor.
OWNI_I1
REQUIRED INSPECTIONS
Phone : Final Inspection
Reg#:
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 dune in accordance with approved plans.
This permit will expire if work Is not started within 180 days of issuan;e, 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 952-0001-0010 through OAR 952-0001-0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6699.
Issued ey: ,tzj:,� ,LJ�, (�,� Permittee Slgnatura:
Call (503)639-4175 by 7:00 P.M. for an inspection needed the next business day
Plumb-ing Permit Application 7Revicw
5s Plumbing r-
-- ---- Permit No.: ' JDA
l Sewer
City of Tigard Permit No.:
13125 SW Hall Blvd. Other
Date/B Permit No.:
Tigard,Oregon 97223 Post-Rcvicw Land Use
Phone: 503-639-4171 Fax: 503-598-1960 Datc/B : Case No.:
Internet: www.ci.tigard.or.us Contact Juns, see Page z for
24-hour Inspection Request: 503-639-417-1 Name/Method: Supplemental Information.
_ TYPE OF WORK _ FEE"SCHEDULE(for special information use checklist
FE�l •'ten Demolition Description Qty. Fec(ca.) Total
New COristrr~:.:_ . New 1-&2-family dwellings
Addition/alteration/re lacement Other: includes loo ft.for each u 111ty connection
CATEGORY OF CONSTRUCTION SFR I bath 249.20 _
I &2-N_ �amily dwellin _Cominercial/Industrial SFR 2 bath 350.00
accessory Buildin Multi-1'al ily_ SFR 3 bath 399.00
Master Builder Other: Each additional bath/kitcLcn 45.00
JOB SITE IN and LOCATION Firesprinkler- . ft.: Pu c 2
3 �. U Site Utilities
Job site audress: Iz 5•z Qt- Catch basin/arca drain 16.60
Suite#: Bldg./Apt.#: p ell/leach line/trench drain 16.60
Project Name: Footing drain(no,linear ft. Pae 2
Cross street/Dircetions to job site: IManufactured home utilities 110.00 —
C+ Manholes _ 16.60
Rain drain connector 16.60 1 _
Sanitary sewer ino. linear Il_._t _ Pa c 2
-- Storm sewer(no.linear tt. Pa c 2
Subdivision: _ _ Lot#: , pa,c 2
Water service Ino.linear Il.
Tax ma / arcel#: _ _ Fixture or Item
DESCRIPTION OF WORK Absorption valve i�.60
R c d Backflow preventcr Pa c2
�U-E fit✓ ,+!r Backwater valve 16.60
-�- Clothes washer 16.60
- ---- --- — Dishwasher 16.611
_
Drinking fountain 16.60
PROPERTY OWNER TENANT E cctors/sum 16.60
Name: t%m, t- Q\n — Expansion tank 16.60
Fixture/sewer cap 16.60
Address: L L 1 vil �'� —
---�—�-- - Floor drain/floor sink/Itub 16.60
Clt /State/ZIl1: (1 `�� �t 3 Garbage disposal I6.60
Phone:3t, r– 10--t7R6 L_ cr -03--2-I`L 7,17,1 [lose bib 16.60
APPLICANT ON ACT PERSON Ice maker I6.60
Interce tor/ rcasc trap 16.60
Name: �,... �u w��_ _
Address: Medical a5 �'UIUC: $ Page 2
— - Primer 16.60
Cit /Stale/Zip: _ Y Roof drain commercial 1x,.60
Phone: Sink/basin/lavatory 16.60
----- Tub/shower.shower pan 16. 0
E-mail:
� Urinal 16.60
_ CONTRACTOR
Water uset 16.60 17
Business Name: n��Q ___ -Wa 16.60
Address: _ _ Other:
Cit /State/Zip: Other: _Y
_ Fax: Plumbing I'crml[Fees*
Phone: _ _ _ Subtotal $
CC_B LiC. #: Plumb. LIC.h. Minimum Pcmiit Fee$72.50 5
AuthoNxe Residential Backflow Minimum Fee$36.25 / 1 S�
Signature: Date: 1 �� 0 Plan Review 25%of Permit Fee 5
(� State Surcharge 8%of Pcrmit Fee
T S _
IFS :-
(I'lesse print namel TOTAL PERMEE
Notice: This permlt application expires if a permit Is not obtained wlthtn All new commercial buildings require.'sets of planawl�t Iwmetrlc, ry
Igo days after It has been accepted as complete. riser diagram for plan review. ]�
*Fee methodology set by Tri-County Building Industry Service Board.
1\Dx1a\Pem1j1 Forms\111mi'ermitApp.doc 01103
Plu L nt?Permit Application -City of Tigard
Page 2-Supplemental Information
Fee Schedule: Residential Fire Suppression S st
Qtv. Fee(ea) em__— s_
FTotal S uare Foota e: Per
Timit Fee`__--
te Utilities 0 to 2,000 $115.00 —
Footing vin.1' 100' 55.00 2 001 to 3,000 $160.00
Footing drain-each additional 100' 46.40 3,001 to 7,200 $220.00
55.00 7,201 and realer
Sewer-lst IU0' $309.00
Sewer-each additional 100' 46.40
Water Service-1st 100' 55.00 Medical G S Stems:
er Service-each additional IOU' 46.40 Valuation: Permit Fee:
Wat
55.00 5I_oo to SS, 0. Minimum fee$72.50
Storm&Rain Drain-I sl 100 $5,001.00 to$1 O,fA.')00 $72.10 for the first 55,000.00 and$1.52 for each
Storm&Rain Drain-each additional 100' 46.40 additional$100.00 or faction';tereof,to and
Fixture or Item Qty. Fee(es) Total including$10 000.00.
Commercial Back Flow Prevention Device 4G.4C — $10,001.0010 52 5,000.00 each additional$100.00 or fractticn hereof,to
Residential Backflow Prevention Device and includin $25,000.00. _
(minimum crtnil fee$36.25) 27.55 25 $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and SI AS for
65.
Rain Drain,single family dwelling each additional 5100.00 or fraction thereof,to
_ and includin $SO,OW.00.
Inspection of existing plumbing or 72 50
s eciell re uested ins ��tions- er hour -- 550,001.0(1 and up $742.00 for the first 55(1,000.00 and$1.20 for
Subtotal: each additional$100 M or fraction thereof
Fixture Work:
Are you capping,moving or replacing existing fixtures" If
"yes",please indicate work performed by fixture. Failure to
accurately reop rl fixtures could result in increased sewer fees*. Comments regarding fixture��ork:
(�uanlit ti Fixture Work Performed —_
Fixture Type: Rephce
Ncw Moved Existln Cawed _
Ba list /font
Bath -'I ub/Shower
.Jacuzzi/Whirl ool —
Car Wash -Fach
"Drive 1'hru
C"us idor/Water As iratar -
Dishwasher -Commercial
-Domestic
Drinkin Fountain _
F' a Wash
Fluor Drain/sink 2" _
.4" _
Car Wash Drain *Note: If ti-e fixture work under tills permit results In an
Clarbage -Domestic - Increase of sewer EDt.ls,a sewer permit will be issued and
Disposal -Commercial fees assessed for the sewer increase must he paid before the
-Industrial plumbing permit can he issued.
Ice M /Rcfri .Drains
Oil Sc orator Cies Station
Rec.Vehicle hum Station
Shower (sang ---
-Stall --
Sink -Bar/Lavatory
-Brodie)-
-Commercial
Bradley•C'ommercial _
-Service
Swimmin Prxvl l tller _—
Washer-Clothes
Water Extractor -
Water Closet-Toilet _—
Urinal
other Fixtures:
i\I)sWermtl FottnsU'hnPcrmitAppPg2 duc 0 1/0 1
r
CITY OFTIGARD 24-Hour
BUILDL, ", Inspection Line: (503)639-4175 MST -
INSPECTION I N?SION Business Line (503)639-4171 BUP —
Received __- _ ____—Gatc Requested//,, S- _J�_t' AM — P�"- BUP _
c;__2� �J� �-----Suite_ -- --- _- MEC — q
Location _
PLM
Contact Person ___—___ �=— — Ph(---) - -3
Contractor — ---
Ph(.J_—) -r__� �"J SWR ------ ----
�EIrJILDIMG Tenant/Owner ._ _--_ ELC —_ —_-__,---
ELC
Footing —
IFoundation Access: ELR
Ftg Drain
Crawi Drain SIT - -
Slab Inspection wNotes.
Post&Beam � --_--
,'hear Anchors
E>t Sheath/Shear -
Irt Cheath/Shear
Framing -
Insulation -
Drywall Nailing -
Firewall -----
Fire Sprinkler -- - -
Fire Alarm - - - -
Susp'd Ceiling -
Roof _ ----- -
Other: --
Final - --- - -- ---
PASS T FAIL -
Post&Beam _ _--_----- ------
Under Slah --------
Pough-In --- - - - --- -
Water Service - -----
Sanitary Sewer -- - - --
Rain Drains -
Catch Basin/Manhole -
Storm Drain -
Show1Pan - - -
__ ASS PART FAIL
_ML_C_RANICAL - -— -
Post& Beam - - - _--_.-_-
Rough-In ' -
Gas Line _-.--
Smoke Dampers - -
Final — -
PASS - PART FAIL ---
LECTRICAL __._ -- ----- ------�--
c, P.ough-In
Low Voltage -__ -- --
Fire Alarm
it r I R jinspection fee of$__ __. required before next inspection. Pay a1 City Hall, 13125 SW Hall Blvd,
SS PART - FAIL --
SITE - �_ ' "'ease call for reinspection RE: �A Unable to inspect-no access
Fire Supply Line
ADA ;'' �- G7Inspector
Approach/Sidewalk
�.(��- `�'�.•
Other: __--
Final DO NOT REMOVE this Inspection record from the job site-
PASS PANT FAIL
CITY OF TIGARD 24-1iour -
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST —
BLIP
Received — .—Date Requested_ S AM — PM BLIP
Location � MEC
Suite _
--,I��i2��i-L��r__------
Contact Person _— -- ----- --- - Ph( — 1 = j --Q�'(p� PLMPh SWR
---
Contractor
--------- ---
BU'LDING Tenant/Owner
Footing - -- __ — — _. ELC �v —
Foundation ELC
Ftg Drain Access:
Crawl Drain __ ELR
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors - - --- --.__----_-`
Ext Sheath/Shear -- -- -- - -- _
Int Sheath/Shear
Framing - -- --
Insulation
Drywall Nailing
- ----- --
Firewall --- - --- ---.-__
Fire Sprinkler
Fire Alarm --
Susp'd Ceiling ----
RoofOther: ------ -
Final
PASS PART FA!L ---- - -- - L- - - --PLUMBING --- -- --
Post 8 Beam - -
Under Slab
Rough-In - - -
Water Service
Sanitary Sewer - —_- -- ----
Rain Drains
Catch Basin/Manhole -- -- __-. ---- -- ---.
Storm Drain -
Shower Pan -
Other:
Final - - ---- --- ------
PASS PART FAIL
MECHANICAL
Post 8 Beam -
Rough-In -
Gas Line
Smoke Dampers
Final
PASS�p�_ FAIL
ECTRI
Servica -
o - -
UG/Slab
Low Voltage - —
ire Alarm _ ---------
S�PART FAIL Reinspection tee of a _-! required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
SI --_ Please c.311 for reinspection RE:_-
Fire Supply Line �- --- --- E] Unable to inspect- no ac:ess
ADA
Approoch/Sidewaih �_ -
Date _ _ ._ Inspector I -
Other:
Final PO NOT REMOV(s this Inspection recor from a Job site.
PASS PAP'r FAIL