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11780 SW 91ST AVENUE-1 0 0 to D 3 C (D 11780 SW 91'' Avenue _ ELECTRICAL. PERMIT _ CITYOF TIGARD PERMIT#: ELC2002-00038 DEVELOPMENT SERVICES DATE ISSUED: 2/6102 13125 SW Hall Blvd., Ticiard, OR 97223 (`031 639-4171 PARCEL: 1 S135DC-01600 SITE ADDRESS: 11700 SW 91ST AVE ZONING: R-4,5 SUEDIVISION: TIGARDVILLE PARK LOT : 009 JURISDICTION: TIG BLOCK: Proiect Descrip. ion: Electrical service and (3) branch circuits. RESIDENTIAL UNIT TEMP SRVC/FEFOERS MISCELLANEOUS _ -1000 SF OR LESS: 0 • 200 a' PUMP/IRRIGATION: EACH ADL'L 500SF: 201 - 400 atop: SIGN/CUT LINE LTG: 401 - 600 amn: SIGNAL/PANEL: LIMITED ENERGY: MINOR LABEL (101: MANF HMI SVC/ FDR 601+amps 1000 volts: _ SERVICE/FEEDER BRANCH CIRCUITSADD'L INSPECTONS W/SERV!CE OR FEEDER: 3 PER INSPECTION: - 0 200 amp: 1 PER HOUR: 201 - 400 amp: 1st W/O SRVC OR FCR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: PLAN REVIEW SECTION E01 - 1000 arnp: >=4 RES UNITS > 600 VOLT NOMINAL: 1000+ amp/volt: CLASS AREA/SPEC OCC: Reconnect only: SVCIFDR >= 225 AMPS: -- Contractor: Owner: DAVID CHANDLER ELFCTRIC LAURA CRUICKSHANK PO BOX 80696 11780 SW 91ST PORTLAND, OR 97260 TIGARD, OR 97223 Phone: 503-245-7774 Phone: Rey #: LIC 94908 ELE 26-1081 C SUP 688S FEES — Required Inspections Type By Date Amount Receipt Rough-in _ Elect'I Service PRMT CTR 2/6/02 $100.25 2720020000( Elect'I Final 5PCT CTR 216102 $8.02 2720020000( Total. $108.27 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 K 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: i - OWNER INSTALLATION ONLY _ The installation is being made on property I own which is not intended for sale, lease, or rent. DATE . — OWNER'S SIGNATURE: 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 Per Ideation W Date received: ;2 G D Permit no.: � , Ai City of igar Project/appl.no.: Expire date: Cityof"Pigard Address: 13125 SW HaIJ Blvo,Tigard,OR 9Z!/,/6/i Phone: (503) 639-4191 ' Date issued: B Receipt no.: Fax: (503) 598-�Y lUf' j j4jA W Case file no.: Payment type: Land use a#AP1 10 DMS10N tot 8. 2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/replacement U Other:— U Partial 1 1 Joh address: i� h1dp.no.: suite no.: 1-ax map/tax lot/account no.. Lot: Block: subdivision: Project name: I Description and location of work on premises: eA-,� VL ♦ 3 C ij," S Estimated date of completion/inspection: _ AC7OR APPLICAll 10 N IFEE SCHEDULE Joh no: I"- eta. Business name: (-t C YMuriplion Ul). (ea.) Total nu.imp Nets midenlial-single or multi-famih per Address: .L-) G o:5. d"ellingunil.I ncludes attacIm-figaragil. City: PT&V Slate:0 kj ZIP:q 7Z C) til•nicrincludru: Phone:L S- 7 Fax: y E-mail: I0U0sq.II or less _ 4 CCB no.: Q Y lElec.busAic.no: 0 Hach additional 5(x)sq.It mportion thereof � L I.nnncdenrrgy,restdcntial 2 City/metro tic.no.: I ' l!) DI Lonitedenergy,non nrresidential 2 —Q L. Erich manufactured horne or modular dwelling Signature of su rvising electrician(requited) _ bate 11 Service and/or leder 2 Sup.elect.name(prion: d L, LU C:(nU t,e� .icense no: Services or feeders-installaltor, alteration or relocallon: 21n0 amps or less 2 Name(print): (�t��-[� r_t, s G ';71A.64, 201 amps to 4(N)amps 2 M.liling address: (� , 601 amps to 1000 annps 2 Clly: 1 Q r Slrile: ZIP: �� Z Z quer I(N)0 amps of volts —--- 2 Phone: V E-mail: Reconnect only — I owner installation:The installation is being made on property I own Temporary services or ferden- which is nor intended for stile,lease,tell(,or exchange according to Installation,alteration,or relocation: ORS 447,455,479,670,7()1. 200 amps or less 2 201 amps to 4(xl amps 2 Owner's signature Date: 401 to W)ams -- XMI Branch clrculls-nen,alteration, or eslension per panel: Name: _ A. Fee for branch cirruils with purchase of Address: service or seeder fee,each branch circuit 2 City: State: ZIP: R. Fee for branch circuits without purchase -- -- -- of service or feeder fee,first branch circuit 2 Phone: 1�ax: 1:-mail: Each additional branch circuit PLAN RMEW(119lenie check all that apply) Mise.(Service or feeder not Included): U Service over 2-1.iamps cununcrclal J Health-carelncnhty I%chpurn o otignnoncoLle 2 _ UService over 320amps-rating of 1&2 UHazardous location Fah sign or outline lighting 2_ fumilytlwellings UBuilding over l0,01H)squateleet[out n Signal ctrcuo(s)onalimited encrgypanel, U System over 600 voles nominal Inure residential units in one structure oneration,or esti-imoo 2 U Building over three stories U Feeders.4(tonrnpsormorc •Ikscripuon U Occupant load over 99 persons U Manufactured structures or RV park tat 11 addillollal Impertion reser thr pllaN ahlc III alts(it the alcove: U ligtess/Iightlngplan U tither' _- I'er mspcown I - Submit _-nets of plavis with any of the above. investigation fes fhe above are not applicable to temporary construction service. Other - - NM all 111ristlictions accept rtedil cmd+,pirax call paisAlcuoa for more inf ninanon Notice:This permit application Per-11111 lee. .............�I U Visa U MasterCard expires if a permit is not obtained Plan review tat __ 76) $ _ _- credit card number / / within .80 bays alter it has been Stale surcharge(8%,)....$ Expires accepted as complete. 'TOTAL . $ Name ca Irks ea--shown on credit rat ---- _ _ S C older si(lnalure Amount JJl l 4615 i MM N('r)A11 ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES: Complete Fee Schedule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY p Rest.icted 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' Eaca additional 500 sq n or portion thereof _ $33.40 1 Limited Energy $75.00 ❑ Burglar Alarm Each Manufd Home or Modular Dwelling Service or Feeder _ $90.90� 2 ❑ Garage Door Opener' Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less _ $80.30 V. 2 201 amps to 400 amps $10685 _ 2 ElVacuum Systems* 401 amps to 600 amps _ $160.60 _ 2 601 amps to 1000 amps $240,60 2 ❑ Other Over 1000 amps or volts $454.65 2 Reconnect only $66.05 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 (SEE OAR 918-260-260) 201 amps to 400 amps $100.30 _ 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 at fps to 1000 volts, see"b"ubove. ❑ Audio and Stereo Systems Branch Cir.:uits New,alteration or extension per panel ❑ Boiler Gc -rols a)Thr,fee for branch circuits with purchase of service or ❑ Clock Systems feed,r fee. Each t ranch circuit _3 _ $6.65 1!,Y 5i 2 ❑ Data Telecommunication Installation b)The fr a for branch circuits without purchase of service r or feeder toe. Fire Alarm Installation First branch circuit $4685 Each additional branch circuit 56.65 ❑ HVAC Miscellaneous ❑ (Service w feeder not Included) instrumentation Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 ❑ Interr .and Paging Systems Signal circult(s)or a limited energy panel,alteration or extension —_ $75.00 ❑ Landscape irrigation Control' Minor Labels(10) $125.00 Each additional Inspection over ❑ Medical the allowable In any of the above Per inspection _ $67 50 _ ❑ Nurse Calls Per hour _ $6250 In Plant _ $73 75 _ _ ❑ Outdoor Landscape Lighting' Fees: 0 , / e ,3 , ❑ Protective Signaling Enter total of above fees d %S ❑ Other 8%State Surcharge $,(}Ll $A.� � a _Number of Systems 25%Plan Review Fee p ^ See"Plan Review"section on Q r f% $ " No licenses are required Licenses are required for all other installations front of application Fees: Total Balance Due 1$ / � Enter total of above fees $ El Trust Trust Account 0—I _ 8%State Surcharge $____ All New Commercial Buildings require 2 stats of plans. Total Balance Due $— i Wsts\fbrms\cic•f'ces.doc OW30 OI CITY �1 9 I�� MECHANI�ALPEr�M1T DEVELOPMENT SERVICES PERMIT #: MEC2002 00056 2 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1513 PARCEL: 1 S135DC-01600 SITE ADDRESS: 11780 SW 91ST AVE 31)BDIVISION: TIGAROVILLE PARK ZONING- R-4.5 BLOCK: Lar: UU9 JURISDICTION: TIG CLASS OF WORK: Al.T� FLOOR TURN: EVAP COOLERS: TYPE OF USE: SF ;'NIT HEATrR:i: VENT FANS: OCCUPANCY GRP: R3 VENTS WIO AF,PL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: f FUEL TYPES 0 3 HP: DOMES. INCIN: I_PG A 3 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HI-: CLO DRYERS: FURN < 100K BTU: 1 _ AIR HANDLING UNITS OTHER UNITS: FURN -100K BTU: <= 11,000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Replace existing gas flour furnace with forced air and addition of a/c. A/C cannot be placed within the required setbacks. Owner: _ FEES LAURA CRUICKSHANK Type By Date Amount Receipt 11780 SW 91ST PRMT CTR 2/11/02 $72.50 272002000C TIGARD, OR 97223 5PCT CTR 2/11/02 $5.80 272002000C Total $78.30 Phone: Contractor. ARROW MECHANICAL 10330 SW TUALATIN RD TUALATIN, OR 97062 _REQUIRED INSPECTIONS Gas Line Insp Phone:692-1565 Mechanical Insp Req #: LIC 5193 Duct Inspection Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-Pl0 through OAR 952.001-0080. You ma.v obtain copies of these rules or direct yuestf6 s to O by calling rtin�`ldF_g1��' �i 1 Issue By: ,� ,l�'c C t Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day Mechanical Perluit Application -- �� Datereceived: Permit no.: 1 C,(, City of Tir,ard Project/appl.no.: Expire date: City uJTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Phone: (503) 639-4171 Date i. aed: By: Receipt no.: Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: / Building permit no.: rPERMIT family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement O New cons rvction U Addition/alteration/replacement U Other: .1011 SI I E t ' tVALUATION Job address: t,', J?A 30 (` Frv� Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead. Tax map/tax lot/account no.: profit. Value$ Lot: I Block: ISTbdivision. *See checklist for important application information and Project name: .jurisdiction's fee schedule for residential permit fee. City/cov:d f' 1 N r1,Y ZIP: ( L 4 6 W101 I I:It 1111i F 211111111111111 Descriptiqn and locatir o work on premises: ft�nlas IrY„ 7rcon 71-7 IYp„tnr Iihl'K ndt l" lee(ra.) luial 1?si.dateofcompletion/inspection: I _ plion (ley. Rec.onl Res.only Tenant improvement or change of use: _CFMIs existing space heated or conditioned?(!-Yes U No ionmg e p an reywre ) Is existing space insulatcd�'ta Yes U No tr:ration o existiijt C system - t of er compressors State boiler permit no.: Business name: r zrr HP __'tons BTU/14 Address: V"'l Q F,i (Z -Fire/smoke dampereduct sato a detectors —� City: -F,), ?, v Stale: &I ZIP: 17/Cl(p L eat pump(1 site plan require ) - - Phone: ( T Fax: 67 JW E-mail: nstal rcplacefurnacc/burner CCB no,: ; 17 Including ductwork/vent liner U Yes U No nsta replac re ocate heaters-suspended, City/n:atro tic.no.: _ _ wall,or floor mounted Name(please'In int I Vent orappliance other t t—f a�nace - t e gest on: Absorption units_ BTU/11 Name: Chillers __ HP Address: Cum ressors Environmental ex laud and Int un: City: Stas 71P: Appliance vent - Phone: t I uI )ryerex exhaust T -- foods,Type res. Ile c azmat hood fire suppression system Name; Exhaust fan with single duct(bath fans) Mailing address: iX laust S stem apart rom heating or AC � 'ue piping andistribution(up to outlets) City: state: 71I: ___ Iylx: 1,11; _ NG Oil Phone: I-ax: T." III III I-ItTii,III I'each add iuunn over uul els process piping(sc lemaiicrequre ) Name: Number of uullets Other llsli4l appliance or equipment: Address: Decorative fireplace City: State: ZIP: nsert-ty e Phone: Flt : E-mail; oa stov pe et stove Applicant's signature: t ! , I Date: - I 0 "l1 Otler er: Name (print): ,Ak — — - Nat all)udedicriortr accept credit crudx,please coil)uNedictlon for more Infarmatiun. Permit fee.....................$ LJ Visa U MasterCard expNotice:ifn permit application Minimum fee................$ credit crud nundKr:_—_ / within il'a permit a not obtained plan review(at — %,) $ _ within IRO days eller it has been State surcharge(8%) ....$ N— arK o�ca�r i—ioTder u shown on credit— - --� accepted as cnmpletr. j _ TOTAL, cardholder d`nemre '� ��mnum"— 440-.k,17(WDCOM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: _ - - - Description: - Price Total TOTAL VALUATION: FEE_: __ - - Table 1A Mechanical Code Qty (Ea) Amt $1.00 to$5,000.00 Minimum fee$7250 1) Furnace to 100,000 BTU $5,001.00 to$10,000.00 $1 52 for each_72.50 for theaddit b,666,60 and $100.00 or includingst ducts&vents 14.00 2) Furnace 100,000 BTU+ 17 40 fraction thereof,to and including includingducts&vents $10,000_00. 3) Floor Furnace $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and includin vent 14.Ou $1.54 for each additional$100.00 or 4) Suspended heater,wall heater fraction thereof,to and including or floor mounted heater 1400 _ $25000-00. 5) Vent not Included in appliance permit $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and _ 6.80 $1.45 for each additional$100.00 or 6) Repair units fraction thereof,to and including 17..15 $50,000.00. I Boiler Heat A.. $50,001.00 and up $742.00 for the first$50,000.00 and Check all that appy: $1.20 for each additional$100.00 or I For items 7-11,see or Pump I Cond fraction thereof. J footnotes below. Comp* M 7)<3HP;abl�nrb unit 14.00 to 100K BTU [!Description.,. SSUMED VALUATIONS PER APPLIANCE: 8)3-15 HP;absorb 25.60 Value total rn to 500k BTU t'.1ty. Ea Amount HP;absorb35.00Furnace to 100,000 BTU,including 955 mil BTUducts&vents HP;absorb 52 20 Furnace>100,000 BTU including 1,170 5 mil BTUducts&vents P:absorb 87.20 Floor furnace lncluding vent 5 mil BTU _ Suspended heater,wall hester jr 955 12)Air handling unit to 10,000 CFM 10.00 floor mourted heater Vent not Included in 445 applicance 13)Air handling unit 10,000 CFM+ 17.20 emtit --- 805 Repair units 14)Non-portable evaporate cooler 10.00 <3 hp;resorb.unit, 955 to 100r BTU ----- 15)Vent fan connected to a single duct 6.80 3-15 hp;absorb.unit, 1,700 - 101k to 500k BTU - 16)Ventilatlon system not Include]in 10.00 15 30 hp;absorb,unit,501k to 1 2,310 applianco LL•mil mil.BTU _ 17)Hood served by mechaniral exhaust 10.00 30-50 hp;absorb.unit, 3,400 - 1-1.75 mil.BtU 5 725 18)Domestic Incinerators 17.40 >50 hp:absorb.unit, >1.75 mil.BTU 656 19)Commercial or Industrial type incinerator 69.95 AIr handling unit to 10,000 cfm - 1 170 ---- -Air handling unit>10,000 cfm 658 20)Other units,i-tcluding wood stoves _ 10.00 Non- ortabie e��orate cooler - - 446 Vent fan connected to a sln 8 duct 21)Gas piping one to four outlets 5.40 Vent system nol included In 858 appliancepermit 22)More than 4-per outlet(each) 1.00 Hood served hYmechanical exhaust 656 Domestic Incinerator4 170 Minimum Permit Fee$72.50 SUBTOTAL: $ m - comercial or Industrial Indnre etor _ Other unit,Including wood stoves, 858 8%State Surcharge $ Inserts,etc. - - ng 1-4 o 380 Gas 1piutlets 25•/.Plan Review Fee(of subtotal) Each eddllloual olitlot 63 Required for ALL commercial permits only TOTAL COMMERCIAL TOTAL RESIDENTIAL I�ERMIT FEE: S VALUATIONS -- - Olhsr In eactlons and Fsea: 1 Inspections outside of normal business hours(minimum charge-two hours) $72 50 per hour 2 Inspections for which no fee is specifically indicated (minimum charge half hour) $72 50 per hour 3 Additional plan review required by changes,additions or revisions to plans(minimum charge-one•half hour)$72 50 per hoar 'state contractor Boller Certification required for units 3-200k BTU. "Residential AIC requires site plan showing placement of unit. I:Wsts\forn.sVnech-fees.dor 10/11/00 { A C c O-- C N 1; IF, ., Q a° r� � � N .L �1 CP -- — W id s c G ' 1 S� CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)539-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP Received _ _Date Requested - (( AM—___PM BUP Location 7 Suite MEC ContaclP�rson _ _ _ —._ Ph(--) 7.9 3 ?33 - PLM Contractor. _ Ph( _) _ SWR BUILDING _A Tenant/Owner __ ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors A --- Ext Shealh/Shear Int Sheath/Shear Framing Insulation ' r' Drywall Nailing ----- ---- - - - --�-- Firewall Fire Sprinkler - - --- Fire Alarm Susp'd Ceiling - ----- -- Roof r Uther: ---- -- Final PASS PART PART_-FAIL - - - -� —"--- PLUMBING Post&Beam Under Slab -- Rough-In Water Service Sanitary Sewer Rain Drains -- - - -- -- Catch Basin/Manhole Storm Drain - - ----- -- - - Shower Pan Other: -- Final --- -------- PASS_ PART_FAIL - MECHAN_ICAL _ Post&Beam — Rough-In -----�_ -- Gas Line Smoke Dampers -- Final PASS PART FAIL --------- - -- --- --- -- — ------ ELECTRICAL - -_ ------- ---- ------ u lm /Slab Low Voltage F re Alarm -- �'in`�I ' ❑ Reinspection fes of$__ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd. PASS PART FAIL SITE _ 0 Please call for reinspection RE: _ F-] Unable to inspect-no access Fire Supply Line ADA " Approach/Sidewalk Data �/� _- Inspectof� �r9e� � Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL A ELECTRICAL PE 7MIT CQTY OF 1 I G A R D PERMIT#: ELC200,'-00046 DEVELOPMENT SERVICES DATE ISSUED: 2/11/02 13125 SW Hall Blvd.. Tiqard. OR 97223 (503) 639-4171 PARCEL: 1S135DC-01600 SITE ADDRESS: 11780 SW 91ST AVE ZONING: R-4.5 SUBDIVISION: TIGARDVILLE PARK LOT : OOS) JURISDICTION: TIGBLOCK: Proiect Description: Lcw voltage for thermostat install to furnace. RESIDENTIAL UNIT _ TEMP SRVCiFEEDERS _ MISCELLANEOUS 1000 SF OR LESS: 0 200 amp: PUMPIIRRIGATION: EACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 1 401 - 600 amp: SIGNAL/PANEL: MANF HMI 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 imp: 1st W/O SRVC OR FDR: PER HOUR: - 401 600 amp: EA ADD'L BRNCH CIRC' IN PLANT: 601 - 1000 amu: PLAN REVIEW SEC110N _ 1300+ an.-)/volt: >=4 RES UNITS: > 600 VOLT NOMINAL: _ Reconnect only: �__ SVC/FDR — 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: LAURA CRUICKSHANK ARROW MECHANICAL 11780 SW 91ST 10330 SW TUALATIN RD TIGARD, OR 97223 TUALATIN, OR 97062 Phone: Phone: Reg #: LIQ• 00005193 ELE 34-47CLE _ FEES Required Inspections--___ Type By Date Amount Receipt `Nall Cover PRMT CTR 2/11/02 $75.00 27200200001 Elect'I Final 5PCT CTR 2/11/02 $6.00 27200200001 Total $81.00 J 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 ff work is not started within 180 da,,i f 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 AR 952.001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to /' .�1 Permit Signature: - Issued By: f`� � eL� OWNER INSTALLATION ONLY _ -The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: Cf1NTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: ,_! :_,r�' DA I E. LICENSE NO: ___ i r'� _- Call 639-4175 by 7:00pm for an inspection the next business day Electrical Permit Application — Date received:;' r t Oo Permit City of Tigard Project/appl.no.: D.pirc date: City ojTigard Address: 13125 SW Hall Blvd,Tigard,% Date issued: By: Receipt no.. /� ) - Phone: (503) 639-4171 I Fax: (503)598-1960 Case file no.: Payment type: Land use approval: _ t "1 & ly dwelling or accessory U Commercial/i ❑Muhi family U Tenant im,:rovement uctionAddit' altcration/rc})Wccmenl U Other: U Partial Job address: \k_78b �..I �It f Aum Bldg. no.: Suite no.: Tax map/tax lot/account no.: Lot: Filock: Subdivision: �\\�F� Project name: Lawn. Ciru't AAo^k- Description wid location of work on premises: l.e.., ve °8` _ Estimated date of completion/inspection: k-"i t t ,Cl t �t l,Y• 1t:r. .lob no: fle-wripllon r,i,_-t!a.) To!al no.fns BUSInCSS name: f �d IVVIU AIVvr New m%ldential-single or multi-family 1Kr dwelling wdt.I nclurles nttaclred garage. Address: O t State: tat :6 C- Serviceincluded: Cit : U a I E.mail: 1(X10 sy n orlm — - Phone: (�Q2-rSb Fax: �9t- _ Each additional 5(t)sq.ft.or portion thereof CCB no.: 3 Bice.bus.lie-no: -q I CLE Limited energy,residential 2 — Limited non-residential 2 City/nictrlie.no.: 1/ /3 �' -(. energy. Foch manufactured home or modular dwelling service onrUur frrdrr 2 +gimturc�_ Cryng—efectnrian reyuvcd) _ I)alc Services or reeders--installation, Sill, elect nanrc(print): Ltccnseno: 244 1 alteration or relocation: o amps or Irss 2 201 amps to 400 strips 2 Name(print): 40l anlPs to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: 5lale: ZIP: Over 1000 amps or volts T___ _ 2 Reconnectonly Phone: Fax: E-mail: -- - Owner installation:The installation is being made on property 1 own Temporary service:+or feedersInstollatlon,alterrdlon,orrelocatlor+: which is not intended Ibr sale,lease,rent,or exchange according to 2W amps or Irss __— 2 ORS 447,455,479,670,701. 201 amps to 4W amps — 2 Owner's signature: Date: 401 to 600 ams 2 VIM Branch circuits-ocw,alteration, or extension per panel: Name: A Ire rut branch circuits wnh purchase of service or feeder fee,each branch circuit 2__ Address: _ _ — State- _ Z111: Y ll. Fee for branch circuits without purchase City: of service tit feeder fee,first branch circuit Phone �,� 1'a�, I I mail. Each additional branch circuit: Mise.(Service or feeder not Included): FACIIVunrPorinignuancnrli — - -- 2 UService over 225auyrsam dental U1lralrhiareta,lilt I:aclrsignoruurinrrlrghung ? U Service over 32O nnrps-ral:ng of Ik 2 U Iltowdous imatio r signal circuiUx)or o limited energy panel, famlivdwell(ngs Ulluddurgovet100Hrsywurlectluurur g I U System over 600 volts nominal nxrre residential unto in one structwr alterstiti of extension' 2 _ ),, U Building over Ihrex storiesU Feeders,400 amps or more *Description L_wd-_- i• - ' i U Occupant load over 99 persons U Manuf acture l structures(ir NV park loch additional Inspection over the allowable In an)of the above: U Egterts/Iightingplan U Other -- -- Per ins cthm Submit_sets of pians with sm of Ilse afore. Inveslitiation fee Ilse above are not applicable to temporari r onstruction service. other Permit fee..................... _.. �— No1 elt jur+sdicuam accela credit cardr,pieare call)unsdicnon fir nvure rniailwilo r Notice 'rhis permit application Plan review(at _ % S ._ — � f O'redtt card numberU Visa U MasterCard e"pires it a permit is not obtained ;5 within 180 days after it tins been State surcharge(8%) ....S ' -- -- -- — --. - -+tspnc' accepted as rx)apiete TOTAI. .......................S ��irrre d o o r u t own un r It car ar 0 ral`notum — S Amount 41tra,IsthRdoRUM) C CITY JF TIGARD 24-Hour 3U!LDING Inspection Line: (503) 639-4175 MST INSPI 'TION DIVISION Business Line: (503) 639-4171 BUP Received _ Date Requested_ -- ! Z- AM PM _ BUP — Locatian _ &/._ —Suite----- MEC "vZG O U 03 Contact Person ___ ' f _—_ Ph (— ) 2 3PLM Contractor _ _—___--_ Ph ( ) _ SWR BUILDING Tenant/Owner Footing— — EL C - - Foundation Access: Ftg Drain L:LR --------- — Crawl 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'd Ceiling - - -- --- Roof Other: - ---.--- -- Final PASS PART FAIL — - — PLUMBING _T_,__—_-- - -- �I. Post&Beam _ Under Slab --- Rough-In Water Service ----------- - ---— — -- ---- Sanitary Sewer Rain Drains —.---- Catch Basin/Manhole Storm Drain —------- - — Shower Pan Other: -- ----- -- ------ Final PAS8---P*RT, FAIL 'MSCHAKMAL--� Post& — o 1- Smoke Smoke Dampers --- -- - ----- - ------ P_AAT� FAIL J_—— ___.—..------- ------- --- - --__- IC ___ L L Iry _- _ �------------_-__ Rough-In ---- — -------- - - - UG/Slab Low Voltage' Fire Alarm JFinal Reinspection fee of� __— required bofore next inspection. Pay at City Hell, 13125 SW Hall Blvd. PASS ART FAIL Please call for reinspection RE:_ _ _-- Unable to inspect-no access Fire Supply Line ADA Date .. ` Approach/Sidewalk —1 1 Z Q Z'" Inspector-- ---- - --- ---.-- --Ext ------- Other: -- Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL