12973 SW 116TH PLACE 12973 SW 116 Place
Jan-30. 2002 1 :51PM Ranier Pacific Electric No-0342 P. 6
CITY OF TIGARD r/
13125 S.W.HALL BLVD. c�
TIGARD, OR ,47'223
IMPORTANT PERMIT NOTICE
RAINIER PACIFIC ELECTRIC INC
8916 NE 90TH AVE
PO BOX 823070
VANCOUVER, WA 98682
Electrical Signature Form
Permit#: l41ST2001-40470
Date Issued: 1011/:2001
Parrc.1: 25103BD-09500
Site Address: 12973 $W 11OTH RI..
Subdivision: HUNTER'S WOODLAND
Block: i.0: 007
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Construction of now SF reesidence.Path 1
Your company has been inditatcd as the electrical cant rautor for the permit indicated above In orderfor
ttitp electrical permit to be valid, the signature of the supervising electmian is inquired. Please have the
appropriate individual from your company sign below and return this Clectncal Sigrraturo:Form prior to the
start of the work to the address above, ATTN.- building Oept
No electrical inspertioi is will be authorized until th s cornpleted form is received
OWNER: FI ECTRICAL CON I RACTOR
RIVERSIDE HOMES RAINIER PACIFIC EI.ECTRIC INC
154115 NW GREENBRIER PKY. 140 891B NE 90TH Al/E a
BE.AVERTON, OR 97006 DO 13OX 873070
VANCOUVER,WA 29682
Phone#: 503.645-0986 hone ft: 360-898-2AS1
Reg#- I Ic 1494§9
n F 57-SSC
4U�' 1fi�R9
AN INK SIGNATURE IS REQUIRED ON THIS FORMA
x 2'40'A11 _
Signa u�rr of Su�sing lectric on
If you have any queshons, please call (303)639-1171, ext. # 310
U'd hT6h26804LT Ol NIDCNI - aNUE111 dO ALL) WONd WWVi60 ?OW-B2-10
CITY OF TIG�►RD ___ MASTER PERMIT
I PERMIT#: IvIST2001-00470
DEVELOPMENT SERVICES DATE ISSUED: 10/1!01
13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12973 SW 116TH PL PARCEL: 2S103BD-09500
SUBDIVISION: HUNTER'S WOODLAND ZONI" R-4.5
BLOCK: LOT:007 JURISDICTION: TIG
REMARKS. Construction of new SF residence.Path 1
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1.22U at BASEMENT: of LEFT: 5 SMOKE nETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,202 of GARAGE. 497 of FRONT: 20 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS: 1 FINSSMENT: of RIGHT: 5
VALUE: $233,087.40
OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 2,422.00 of REAR: 33
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WAS14ING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOUR DRAINS: SEWER LINES: 100 5F RAIN DRAINS: I CATCH BASINS:
TUBISHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: I WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS:
OTHER FIXTURES-
MECHANICAL
FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS, 5 CLOTHES DRYER: 1
GAS FURN s.100K: 1 UNIT HEATEI S: HOODS. 1 OTHER UNITS: 1
MAX INP: blu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER 'EMP SRVCIFEEDERS _BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FOR: 1 PUMPIIRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 400 amp. 201 •400 amp: lot W/O SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR::
LIMITED ENERGY: 401 800 amp: 401 - 800 amp: EA ADDL OR CIR: SIGNALIPANEL: IN PLANT:
MANU HWSVCIFDR: 801 1000 amp: 801+ampo•1000v: MINOR LABEL:
1000+amp/volt:
PLAN REVIEW SECTION
Reconnect only:
1.0"_o UNITS: SVCIFDR>m225 A.: %600 V NOMINAL, CLS AREA/SPC OCC:
ELECTRICAL-RESTRICTED ENERGY
_ A.OF RESIDENTIAL B.COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOWPAr-':;u. OUTDOOR LN"C LT':
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSC;PE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLC"K: INSTRUMENTATION MEDICAL: OTHR:
HVAC: DAT A/TELE COMM: NURSE CALLS. TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,110.00
This permit is subject to the regulations :ontained in the
RIVERSIDE HOMES RIVERSIDE HOMES Tigard MunlQipal Code,State of OR. Specialty Codes and
15455 NW GREENBRIER PKY, 140 15455 NW GREENBRIER PKWY all other applicable laws. All work will be done in
BEAVERTON,OR 97006 SUI E 140 accordance with approved plans. This pormit will expire H
BEAVERTON,OR 97006-2115 work Is not started within 100 days of Issuance,or if the
work is suspended for more than 180 days. ATTENTION:
Phone: Phone* Oregon law requires you to follow rules adopted by the
Oregon Lltility'Jotification Center. Those rules are set
Reg 0: LIC 10085 forth in OAR si52-001-0010 through 952-001-0080. 1)u
may obtain poples of these rules or direc'questions to
OUNC by calling(503)246-1967.
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post/Beam Structural PLM/Underfloor Frarning Insp Gas Fireplace Electrical Final
Grading Inspection Post/Beam Mechanlca Mechanical Insp Shear Wali Insp Insulation Insp Mechanical Final
Sewer Inspection Underfloor Insulation Plumb Top Out Exterior Sheathing Inst Rain drain Insp Plumb Final
Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Line Insp Final inspection
Foundation Insp Footing/Foundation Dr; Electrical Rough In Gas line Insp Appr/Sdwlk Insp
Issued By : _.� `" Permittee Signature :__�� '✓ —
JL,-�• L
'� Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next busine.s day
CITYOF TSG /�, R� SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: b 1-00243
13125 SW H311 Blvd., Tigard, OR 9729' (503) G39-417'
DE;TE ISSUED: 16//1/011/01
PARCEL: 2S 103BD-09500
SITE ADDRESS; 12973 SW 116TH PL
SUBDIVISION: HUNTER'S WOODLAI':'7 ZONING: -�-4.5
BLOCK: LOT: 007 _ JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NFW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: i
INSTALL TYPE: LTPS',NR IMPER" SURFACE:
Remarks: Sewei connection permit for new SF residence.
Owner: —�FEES
RIVERSIDE HOMES 'type By Date Amount Receipt
15455 NW GREENBRIER PKY. 140 — - - -
BEAVERTON, OR 97006 PRMT CTR 1011/01 $2,300.00 27200100000
INSP CTR 10/1/01 $35.,10 27200100000
Phone: 503-645-0986 Total $2,335.00
Contractor:
Phone:
Reg#
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located,the installer stall purchase a"Tap and Side Sewer" Perm
,�,
Issued by:I_ LPermittee Signature_:
Call (503) 639-4175 by 7:00 P.M.for an Inspection needed the next bushiess dray
16w2. .--00a 3
Building Permit Application
City of Tigard Date received: Permit no. rdp0
Address: 131255W Hall Blvd,Tig OR Project/appl.no': Expire date:
City of Tigard 11;nt B Receipt no.: n
Phone: (503) 639-4171 _Issued: Y� ) 4 ,
Fax: (503) 598-1960 (;Ise file no.: paytncnitype:
Land use approval: 1&2 family:Simple Complex:
f�
TYPE'OF PERMIT
• I &2 family dwelling or accessory U Commercial/industrial U Multi-family Mtlew construction U Demolition
U A(f(litioii/alter ition/replacement U Tenant improvement U Fire sprinkler/alarrn U Other: ._
Job address: 10Z�- Bldg.no.: Suite nu,:
Lot: "� Blcxk: Subdivision: ' I -� Tax map/tux lot/account nu.: /038b�d
Project nalnr: t ' S /13A- �� -- --- ------
Description and location of work on premises/special conditions:
1 1
Name:
Mail in address: r"C 5: (' p - /t 1 &2 family dwelling: W
Cit Slate 7.1 P: T Valuation of work..... ..................... ....
y. J
Phone: - 21 E'-mail: No.til'bedrooms/halhs.................................
Owner's rcpn•srntative:'%f t-_� L.:•t Total numhcrol'Iloun.................
---—
Phone:— II . I nt ill Newdwellin area(sq.11.) .�... Zr. . ....
C3araga/car ori arca(sq.ft).......y.f I....... - Al
--
Name: L c /`< Covered porch arca(sq.R.) .........................
Mailing address: '—�(���-�- Deck arca(sq.11.) ........................................ -
City: State: 7.11': Other sit uclure area(sq. ft.).........................
Phone: hex I ('ommercial/industriallmulti-fanilly:
Valuation of work........................... ............ _---�
Business Warne: v 1z(�-fit(� Existing hidg.area(sq. ft.) ... I...........
�1 -- - New bldg.arca(sq.fl.).......... - - --
Address:
-- - Number of stories
City: Slate: ZIP: ............
Type of construction..................... .....
Phunr; I ax: I: (nail: Occupancy gmup(s): lixislinh
C CIJ
City/metro lic.no --_ - -- Notlse:All contractors;and suhcontrac(I s are required to he
a licensed with the Oregon ConslRkli011 Contractors Board under
Name: provisions of OILS 701 and may be ftaluired to hr licensed in the
Addres — -- juNsdiction where work is being performed. If elle applitant Is
City: ----- - State: l.II': - exempt from licensing,the following reason applies:
('ol lacl prr�tnr Hall n : —'------ --- —' —
Nanac; ('onlact pelma: lies due ulxm application ........................... $_-
Address: Uatc received: ---
City: tiLu( 1/II Antounl mcrivr(I .........................................
Please rcfr to Ice schedule.
I lit r'ehy certily I have read and examined thi•,applik,iol l and Illy JI I'mulloilm%wcepl mode cauk,plew call Imisrlioinn for inorr Infnnnarlrm
atlachcd checklist. All provisions of laws and IndlnancrN pt,truunt tin•, j s U Mastrt('ard
1 ^, d helt•Itl rel Ilnt, rJu card numl,cr _.___... _.__ .--L-1--
L
.—.1_1.� —
work will Ix runtphrd wish, whether epic for ,�('
AlllhltrlZt`J si�turrw��,„_,.- < �� t. �� I�.IIt: _f Namrnfcnrdht tki tz+brim m n lu vl
Print name: CiudholdertiaRnaune— Amounl
Nolice Ibis pennit application e%pires if a permil is not obtained within I No days alter it has been accepted as complete, 44OA611(fnxftt•ONI)
Mechanical Permit .Application
- -- bare received: Permit no.:Il1e�"'r /.
City of Tigardop
Ci(p of Tigard
Address: 13125 SW Hall Blvd,'rigard,OR 97221 Project/appl.no.: Expire date:
Phone: (503) 639-4171 I)rue issued: By: Receipt no.:
Fax: (503) 598-1960 Cpse file no.: Payment typ.
Land use approval: _ - Building permit no.:
1
Ll I &1..family dwelling or accessory U Commercial/industrial >Multi-family
New construction U Additiun/alteration/replacement U Oder: U Tenant improvement '
I �
address:
Job
� _%L - Indicate equipment quantities in luxes leluw. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/lax I ruaccount no.: profit.Value$
'.otc Block: 'See --
_ rS LtJl ( Sec checklist For important application information and
Project name: jurisdiction's frc schc(Iu1r fur rr.:i(Icnlialc
n emit Ice
city/courtly: , ,t�•Q zIP- q 7 z z3 ,
Description and location of work on premises:....1 ..fit t , t
QUID
_ -• � at t
Est.date of completioNinspection: t''''t''"•1 I..I:d j
(jl . Itis.onl
Tenant improvement or change of use: C: De.wription Res.only-
Is existing space heated or conditioned'''J Yes U No Air handfing unit CFM
Is existing space iluulaled?U Yrs UN,, A1rcIndilioomn( (slle. 11111111 require ) —
',li(rationo cxisong Csystem
CONTRACTORMECHANICAL it.1;1compressors
Businr. j Stale holler permit no.:
Mr-
Address: 11T— NP Tons B'fU/H
�i�a/ f'�G,, t[� __ IIfC51110 C(IIn1pC(x IIC19n1U C electors
City: o r /wh Shur: t ll': Z I Z I I�.at pump(snr p an require )
F(torte: —
+S03 O�Fax: yfj./`3 E-ttlail; Ins1a repla'cefurnacr/,u-Trncr`—jI'fjjjl�
_CCB no.: y(p�(�z, Including ductwork/vent liner U Ye.x U No
City/►netro lic.no.: -- - nsta rep ac rc ocale,caters-suspen e(,
----- - --- wall,or floor mounted
Nnnle(please pri 1111 ��r1i7, (( IrCLL-4-j— evil lora, iancc of ler i lin furnace
—
Co e gest nn:
Ahsorptiununits_ _ BTU/H
Name: --
Address: ChillchilleC' rs
ress"'s _ III' -
City: - �-i I I;------ nv ronme ma ex aunt sa vent at nn:
Alrpllance vent
I .1 x: I?-mrlil )ryerex ausil -- --
uol s, 'ype res, itrhen/,azl-I- n;n'-'
Name: hood fire suppression system
- _ _ Exhaust fan with single duct(hath fans) —
Mailing address: - _ �- —-- :x laltern n earl rom ealin'orTC-
City' — Slnlr: 7_Ih: - ue p p ng an fit rut on(up 10 out els)
Phone: Fax: fyPe -_-Llai NG
L'-mail: l ue ,i in.each 1111711
una (ever Wallets
rnceisp p ng(sc tcnlnficrequired)
Name: N1.111cUrof uuticis
Address: -Diller qtr app ancenrequ pmenl: '—
_ _ Uecorativefireplace
City: �fa
-- State: ZIP: hlscrt -type �-- --
Phone: I: 111411: 11uc stout pe rt alive
Applicant's signature: Date: UtTier:
Namc (print): ----_--_---
__s�_
01 all imi+dirllnne rrsrrpl rrrd(1 cn,ds,please rnll pulunclinn far Durr udonnauun
N((tice:'I'llispern,it applicalloll I anal Ire.....................$
U Vlsn U Mnslr,t'nrrl �linintum frc.............. .$
('rrd11 cmd nunlrrr _. �'\tlhes Ira pet,nit is 11111 Whlainerl + ---------
-- _. __-_- -_- (,chin Ili((dais alter it has leen
I'll"review(:u •-_.- ' ,) $ _-- -
Narx of au hulr r a++1-inwn nn cm`rlit em�i ,u cepaed as(11111p1cte, State surcharge(It9t•) $
TOTAI. .......................$
Cnrdh.d+ki ei nn1Wr-- Arnuun( -- —_-
- -- 441)4,11 1(u,>'vc•oM)
04/20.101 12:59 IM 1 3110 254 7106 FARWES1' 14Lh:C7721t:. INC, W..)oul
Electrical permit Application
�v "� __ __ __-------.-____ Ua►errcuverf Permit no,? �'��
CitOf 71garu 1ka) �~ Gxpircdatc: _
Ciryq/1'ig�rd Address: 1312,5 SW flail Blvd,Tigrd,pR crt/appLne.:97223
Phone; (503)639A 1*11 Uult istnled✓ By: Receipt no.;
Fnx: (503)598.1960 Case filo no.: Payment type-
Land use approval: .____,
t
U 1 rQt 2 family dwelling or accessory U Comrnert ial/indusuial U Multi.family 0�' lent improvement
K'New construction U AdditioNaiteiation/trplacementi U CNhcr:____,___ 13 Partial
Job address: -7.3 1t� [ $_idg,no: Suite no.; Tax map/trx lot/account no.:
Lot: _ Dlock: rubdivisio�" (,r✓";_ �
Project name: Description and location of work(inremises:
Estimated date ofcom letion/inspection: ""--�-�- p
iob ao,, _
We IM4st
Business name F e r w 12 1.t l; ee C t r l t F T it .. Ik�crlprian lea.) Total iso.I
Address: 7 4 2N 10th Ave orr**ul-b,evy law
AwelprrF unN-)nclurkra4atehedperaAe.
City: 'Sue n c o u v e r State: 7Jl.. Ser ter h,rin,t«r
Plwne �riJ— ax;�L - I -mail: a
t:^qty n otirrr
CC:R nob 33 5 U __ Elec.bus.lie.no: 3 7-__1277 C Fin ado^. 'ri situ ry_nor j`wrtion thgeof
City/metro lie.no. LIMIItdtYtNE resiJumtl p
.--.� .r l.indtedener ,ntr1•rrutknual �
Nach mmmfaeloted home or moalulrr dwelllna
bignnutt o[ u ela:nkian(r Iran) pate Servieo AnNot feeder
Sop,ekm ramie(ptlaiji;A K K war B ' UeeM�ao:1, rvlrn or ter rt-imuUlr t on,
eherenoa er sYlocetMm
001 mps or las
Name(print) tui.mpr 2
Mldlingaddress: y - -- 4olarrtps1060t1arnps
Cit �.___ 601 arms to 1000 u_npt _ 2
Y' _ Slate ZIP f��eIIWUstn for volt+ 2
Fax: limail: ��_ Itceonnectnnry 1
Owner installation:'tTe installndon it being made on property I own lempormyaenleftWfeeden-
which is not intended I(K"Ir,iease,rent,or exchange according to Mtatahelien,auerNlsKr,srrelocetltmc
ORS 441,455,479,670, /01. 2(x1 amps os Feat 2
201 amps to 400 artpR 2
Owner's signature: Date.
rtMt clrc�ht new,aheret r, -`
Name: or eatenskm per renal:
Alldrets: "-� ---- - A. rte fm branch chrelu with purchase of
service or reciter W.each bramb clm"il
$tate: ZIP: p. fns bt�neh ohc�in rvithoal pwrhase
one ---�� Fit X: �. I&mail, T�of servke of loader ler,fent bench elm,Il; 1
ffir tLr.h eddluorMi tMMeh eireult: - -
MrW(strrkeor rFuel Wt da ); -
U Service over 223 aryMetr*raxcial U Hearth-tarefaetlity Czech rump or Inigetlon circle 1
O SRrvltrt nver 320 amps stiffs of IA.2 U HttrTloul krcatitrl (aeh d n ue Wtlina�u�,�itlt -^��� 1
(omilyr wellirrgs U pmWing over 10.000 quare feet four te Signal dict"'tit)two Umited warty panel. -
U System over 6W volts nawniml rrorr rrsidential*nits in one suncu,te shirt lion,or eatentiont _2
Unundlnpin-"shrrwth,rier U ..adrfs.400Mrrrpttit rtenT •Pettit don:
U(kxupant load over 99 pennm p ManurRoutnl suectu lit(W P V park
addh
li
U N rcr✓li Alla last nt bul hsa'ea9Ma ever the allewe►la M My d 11Fe eMrr.
a g gp U 011M..
Feb of phot with sty of the abo re. Invests •tion fee -
The rove are teat rgs}tlestsk to feMM:tflry rosutltnctltw etttHce._ Ulher �""
tsPermit fee.....................S
NM.n)eiFsacrloas rrrp adM Miss.plebs rail tuHMraen rte ate, taw.
tnonr Notice•This pennil application
t t Vita U MasterCard raplret If a permit it not obtained flan review(wt -. fir) s �_,,. .•_.
t
'"11.cord Hamar: within 100 days Act it has been State surcharge(1114) s
__ ...
'" ie' acrtpftd Fn e TOTAL Ren .....................
Plumbing Permit Applicant
�— Date received: Permit no.: / L'
City of Tigard Sewerermit no.: Building
Nddiess: 13125SWIfall Blvd,Tigard,OR 97223 P gpermitno.:
79
City q/i•, Mrd phone: (503) 639-4171 ProjectLp fil.no.: Expire date:
Fax: (503)598-1960 Date issued: By: Receipt no.:
Land use approval: —_ _ ease file no,: Payment type:
TYPE OF PERM IT.
U I &2 family dwelling of accessory U CominerciaPindustrial iJ Multi larmily U Tenant improvement
JXNew construction U Addilion/alt ,i ion/replacement U Food service J Otlivr:
1 1 i
Job address: 1,2-J9 3 SCI-1 � Descriptlon I Ql%.1 Ftr(ca;) 'fotai
Bldg.no.: Suite no.: New I-and 2-family dwellings only:
(includes 10011.for each utility connrction)
Tax maprtax lot/account no.: SFR(1)bath
Lot: �1Block: Subdivision/ ,, SFR(2)bath _. - -- - ---
Project name: — SFR(3)bath
City/county: T F, ,C y- ZIP: q ?2% Each additional hath/kitchen
Description and location of work on premises: SiteutflNies:
Catch hasin/arca drain
Est.date of completion/insp•,(; n): Drywclls/Ieech Ii_eL trench drain --
1 t Footing drain(no.lin.ft.)
�/ Manufactured home utilities
Business name: - 74)Dpl ? r1/Y(21_1c,rte, Ill Manholes -- --
Address: v Y _ Rain drain connector
City:67"Y,a_�/t Ci _ State: 0 7.1 P: �p 'Sanitary sewer(no.lin. 11.) -- `
Phone:!'0 (v3Z Fax: o32- E-mail: �;� p Stornt sewer(ur.lin. ft.)
CCB no �Plumb. hus.reg.no: Water:icrvice(no.lin.ft.)
City/melro lie.no.: (.# Z
`-_" - 3 Mixture or Item:
Contractor's n resentative signature: Absorption valve -
Back flow reventer
Print name: ( .�� Da c: Backwater valve _
t Basins/lavatory
Name: C of ics washer -- ---
Address:
- - ria inggfountain(s) - —`
City: - -- SlateZIP: _ ''ectors/swnp - -
Phone: 111x: I: mail: Expansion tank
•ixlu.e/sewcrcap
Name : Fllx
(print) tr diains%floor sinks/Hub --- —�
Mailing address: - Garbage ddispnsa
City: Y - Statc:� /II' Hose hibbb _
--- _- I ----_ _ Te maker
Phone: Fax: I. 111,111 Inlcrce for/grease trap -
Owner installation/residential maintenance o11!.. The actual installation rimers)
will he made by lite or the maintenance and repan made by my regular Root'drain(commercial)
employee on the pioltcriy I own as per ORS Ch;ipier 447. Sink(,r sin(s), -
Owner's signature: -- - I L I tiUnl —
A&M 10111 I'uhs/showcr/shower pan
Name: IIrinal -
-- Water closet
Address: - — -- --.-----_--
-- - -ta Wafer-_- icater
City: 1Slatr I I -- --- ---
_-____ 1 rihcr:
Phone: �I'ax�� I n;iil: --- L I'ofa —`
Not all piN uticllonn accept reedit cads,plrau call puiWllcllmt Ge marc inrurnmti„n Minlnlum fee................s
Mnlicc 1'h1s pennll.qq+lil auln
U Visa U MaslrWard CXIMU.it a pcnl II 1,not uI'lailled Plan inview(ret
�ctlhin 18U d;l s alter it has been Stale surcharge(8%).....ri
- --—
_-_ _ -_ - ___-- ____— aece ted ns coin lete.
Name lir ear ,ndekr a�nwn on credo cwd r r
.—.— - -—-- .S..—_—_-_-.
t'anlhn dot eixnnuue Ammml
4111 4616 1(AWCf/M)
RIVERSIDE HOMES. INC. =
15055 N.W. GREENBRIER PARKWAY
>u — SUITE #140 r.
BEAVERTON. OREGON 97006
SCALE: 1" — 7.0' (503)Go'5 -_
Lot -1 ( I n-n ? 10 I Urn )
1;,297-3 -5w //� ' ��, S 00'45'17" W G8.89_ Z3 — — ------�
56
` v
U4 \ \
W
C4 ,
00 \
' Ir
1
167-1.1
HUNTER'S WOODLAND HA 11
RIVERSIDE HOMES wS1"LAKE �
' ' I I `r'I'S mr.
L 0 F 1711 - 116TIl PLACFE _ 1NGINtAItINI; • SIII?ITYINc • ►'I„+r�
of JI,n Irl', N'INC
(1I n171 �A^t_5,90) tr'r 1 PA(Iflt tnlilt)111 llt
I IIIACI< Alit ) lr> 1 I 11 t)n SiI N tfli r elp ilf Igfl t',tt'll nnl 11f1S7l
ELECTRICAL PERMIT-
CITYO F T I G A R D RESTRICTED ENERGY -_
DEVELOPMENT SERVICES PERMIT#: ELR2001-002136
13125 SW Hall Blvd., Tiaard. OR 97223 (503) 639-4171 DATE ISSUED:
90
PARCEL: 2S 0
36D Oy500
SITE ADDRESS: 12973 SW 116TH PL ZONING: R-4.5
SUBDIVISION: HUNTER'S WOODLAND JURISDICTION: TIG
BLOCK: LOT: 007
Proiect Description: Low Voltage al! encomp.
A. RESIDENTIAL B.COMMERCIAL____
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: L 4WDSCAPEIIRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP X HVAC: PROTF_CTiVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL#OF SYSTEMS: _ 1
_ J Contractor:
Owner:
RIVERSIDE HOMES GREENLINE INC
15455 NW GREENBRIER PKY. 140 PO BOX 230755
BEAVERTON, OR 97006 TIGARD, OR 97223
Phone: 503-645-0986 Phone: 968-1978
Reg#: LIC 103033
ELE 34-397CL
SUP 3?45JLE
�+ FEES Required Inspections
Type By. Date Amount Receipt Low Voltage inspection
_ Elect'/ Final
PRMT CTR 11/9/01 $75.00 2 t 20010000
5PCT CTR 11/9,01 $6.00 2.720010000
Total $81.00
This Permit is Issued subject to the regulations contained in the Tigard Muniapal CcrJe,State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to fnllow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 ti ough OAR 952-001-0080. You may obtain copies of these rules or direct questions to O t(503)
246-1987. _� l� f Permittee Signature
Issued b
OWNER INSTALLATION ONLY _
The installation is being made on property I own which Is not Intended for sale. lease, or rent.
OWNER'S SIGNATURE ____ DATE:—
CONTRACTOR INSTALLATION
SIGNATURE OF SI1PR. ELEC'N
LICENSE NO: S'� 1 S a �. — ----- ----__—�_� -----
Cali 639-4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
pate received:1 i Permit no.:
•�� _ --- I
City of 'Tigard Project/appl.no.: P.xpiredate:
irpu/Tigard Address: 13125 SW Nall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: By:6,� I Receipt no.:
Fax: (503)598-1960 Case file no.: Payment type:
Land use approval: - —
t '
Zd I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
New construction U Addition/alteration/replacement U Other: U Partial
1
Job address: i cl T3 SW I Iif'TN Bldg,no.: Suite no.: Tax snap/tax lot/account no.:
Lot: 1 Block: Subdivision: NuN1Cn$ W o�D(.'9�D
Project name: - Description and location of work on premises: �,,v vu� ;,v
Estimated date(,I rompletion/inspection: ✓
e 1
Job leo: MINE UNK-Tilimiff-I
I-ce Max
Busilless(lame: G (LF C ni V t rJ C INC- Ikscri[it ion (,11y. (ea.) Iblal no.insp
Address: � 34,_- 2 2� � New rr%idential-sin k ur muhi-famill per
�-�'J- dwellioR unit.Includrw altaclmd�aru�c.
City: r'l- State: Ort ZIP: '9l g 1 Service included;
Phone: Fax: c 6 2 t.s s E-mail: 1000 sq.It.or less 4
CCB no,: z, y " Elec.bus.lic.no: -� Each additional 500 sy.ft ur portion thoreof
City/metro tic.no.: t.imited,ner y,residential I 2
Umitedenerp.y,non-residential - 2
r $ C.= I L'ach manufactured home or nlndular dwelling
Signature u supervising electrialon(required) pate Service and/or feeder 2
Sup (lect.name(print), J q_ : 7rL( A License no: }' y5 tt Serrlrrsorfeeders-installation,
alteration or relocation:
200 amps or less 2
Name(print): 201 amps to 4t10 amps 2
Mailing address: -� — 4011 mps to 6th)amps
City: 601 Amps to 10(x1 amps V 2
State: 7.IP: _ over 10(x)amps or volts
Phone: Fax: — 2
E-mail: Reconnect ant 1
Owner installation:The installation is being made on property I own Temporary services or feeders-
which is not intended for sale, lease,rent,or exchange according to w+rtall'llon.Wirral ion,orrelocation:
ORS 447,455,479,670,701 2txl amps or less 2
Owners si mature: amps to 400 snips 2
_ Date: 201401 In are)ands 2
Branch circutls-new,alter vtion.
Name: or extenric 1 per panel:
Address:
- A. Fee for branch circuits with ,se of
-- - - __• service or feeder fee,each I 1 circuit 2
City: Stale: ZIP; 11 Fee G,r branch circuits with ,,purchase
Phone: ntail`A- —�— of service(it feeder fee,first branch circuit: 2
Bach additional branch circuitIMMUGEMMITIMMITH ,
Mlie.(Service or feeder not Inc•luded).-
U Service over 2_'•:nap.vumnMrcial U tlralth-care facility Each im"Ift of irrigation-o-cle 2
U Service over 320 amps-rating of 1&2 U llacardous locate nl trach signor outline lighting Z
familydwellinrs U Building over 10,000 squmr legit four o• Signal Lit, lilts)or a limited energy panel, -
U System over60(1 volts nominal more residential units in onestructure a11.--•n m extension•
----- 2U Building over thrremories U Fuxera,4t )amps or
ulclrr
U(kc uparu fond over 99 persons U Manufactured structures or R v hark
U V12tess/lighting plan U Other Each additional Inspection over the allowable M any of the alcove:
Submit rets of plans with any of the above. Investigation fee � -
The above are not applicable to temporary construction service. Other -
Nd nil prialU iwu Ma rapt ctrdil;mals,please call Imis`h"""n roc nese inGamatitat Notice:I I permit application Permit fee.......•......•......
U visa U Mestrrc'ard expires if a permit i-not obtained Plan review(at _ %) $ .T
within ISO days atler it has been State surcharge(8%) $ �
---�----- f cpircc ,
accepted
Nome nr cardho c r u shown ane a ttr -' as complete. �Y TA II. ........ .............$ I . Ct{„L•_
t' dV1 sixnattre s _ Allt011nl---
440 4615 1 MXYt'r)M)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: - -- -- ----
p Restricted Energy Fee...................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type rf Work Involved:
Residential-per unit
1000 sq fl or less $14`j 15 1 ❑ Audio ane Stereo Systems`
Each additional 500 sq.ft.or
portion thereof $33.40 `, 1 ❑ Burglar Alarm
Limited Energy - -- $75.00 —__-�_-
Each Manufd Home or Modular
Dwelling Service or Feeder $9090 _ 2 ❑ Garage Door Opr ner'
Services or Feeders u Heating,Ventilation and Air Conditioning System'
installation,alteration,or relocation
200 amps or less $80.30 2
201 amps to 400 amps — $106.85_ 2 ❑ Vacuum Systems'
401 amps to 600 amps _ $160.60 2
601 amps to 1000 amps $240.60 _ 2 ❑ Other -
Over 1000 amps or volts u_ $454,65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each system.......................................................... $75.00
200 amps nr less $66.85 2 (SEE OAR 918-260-260)
201 amps to 400 amps _ _ $100.30 2
401 amps to L00 amps —�� $133.75 2 Check Type of Work Involved:
Ove';600 amps to 1000 volts,
see"b"abo%e. ❑ Audio and Stereo Systems
Branch Circuits
New,afteralion or e)tension per panel Boiler Controls
a)The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit —,� $6 65 _ - ❑ Data TPiocommunication Installation
b)The fee for branch circuits
without purchase o/service ❑
or feeder fee. Fire Alarm Installation
First branch circuit �— $4685
Each additional branch circuit $6.65 u HVAC
Miscellaneous ❑
(Service or feeder not Included) Instrumentation
Each pump or Irrigation circle _ $53.40_
Each sign or outline lighting $53.40 ❑ Intercom and Paging Systems
Signal circuit(s)or a limited energy
panel,alteration or extension _ $7500 ❑ Landscape Irrigation Control'
Minor Labels(10) $12`i 00
Each additional Inspection over J ❑ Medical
the allowable in any of the above
Per inspection _ $62 50 ❑ Nurse Calls
Per hour _ $6250
In Plant $73.7L ❑ Outdoor Landscape Lighting'
Fees: [] Protective signaling
Enter total of above fees $ __ _ ❑ Other
11%State Surcharge $ _Number of Systems
2F a Plan Review Fee
See'Plan Review"section on $ No Ycenses are required Licenses are required for all other installations
front of application
-- _ - Fees:
Total Balance Due $
----- Enter total of above fees f
Trust Account M
8'/.State Surcharge = __
S
All New Commercial Buildings require 2 sets of plans. Total Balance Due
i.41s1s11igms.clr lees dot: 0130A)l
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BLIP _
Date Requested "" —AM PM — BLU
Location / '-4- 113 Suite MEC
Contact Person /� �� � Ph 'vt 9 PLM
Contractcr Ph SWR
BUILDING Tenant/OwnerELC _---
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
Di ywall Nailing
Firewall
Fire Sprinkler
Fire Alarm -
Susp'd Ceiling
Roof
Misc; ----- ——--
t!n)S PART FAIL
PLUMBING
Post&Beam
Under Slab
TopOut - _— __--- -- ------- -- __------- --.. _.._-------- ---
Water Service
Sanitary Sewer
Rain Drains
Fiwil
PASS PART FAIL
MECHANICAL
Post& Beam
Rough In
Gas Line —
Smoke Dampers
ma -- -- —
PART FAIL
RICAL
Service
RoughIn -------_—_—---------- ------- �_� —.._.._— _
UG/Slab
Low Voltage
Fire Alarm —
Final
PASS PART FAIL _--
SITE
Backfill/Grading '—�'—
Sanitary Sewer
Storm Drain ( J Reinspection fee of$._ _—required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fare S apply line ( 1 Please ca!;for reinspection RE._ ( ]Unable to inspect-no access
ADA 1 �-+
Opheoach/sidewalk DBte Inspector �{L'�h• ,Ext
Final
PASS PART FAIL DO NOT REMOVE this Inst t-tion record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISIO' MST
24-Hour Inspection Line: 63 175
Business Line: 639-41/1 BUP
PM .- BLD
Date Requested_ ��-AM - _-- --
_- '-- Suite - MEC - --
Location-!__ (L�j- - 1-�-
Ph s-7-L y 7 PLM _
Contact Person - -- SWR
_ Fh _ - - -
Contractor -- --- ELC _
BUILDING— Tenant/owner `-_ ----- ---- ELR
Retairnng Wall �.._
Footing Access. FPS _-----
Foundation _ SGIN
Ftg Drain
Crawl Drain Inspection Notes SIT
Slab
Post&Beam -
Ext Sheath/Shear
Int Sheath/Shear ----
Framing -
Insulation - - —
Drywall Nailing --� --
Firewall d (�j� ✓�.v —
Fire Spnnkler
Fire Aiarm � r- l/ � h •� � �"�` _ /"yf M �—_�
Susp'd Ceiling
Roof I _ �V_!��___ /` �'Cr!(�•-•-- — 4 -
Mise -
Final X71 s _� ---------- --- --
PASS PART FAIL /
PL.UMBING _ d1�
Po:.t&Beam ---
Under Slab _-_ X z —_--
Top Out — —_---
Water Service
Sanitary Sewer --
lRough
Dains ---
in
ART( F
HANICAL
eam —�
neDampers PART FAIL - - --- —
ELECTRICAL _
Service ---
Rough In _
UG/Slab
Low Voltage -_
Fire Alarm
Final --
PASS PART FAIL
SITE
Backfill/Grading — —
Sanitary Sewer required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Storm Drain [ ]Reinspe Aion fee of$ _.._
Catch Beain �, II for reinspection RE' ]Unable to inspect no access
Fire Supply Line
[ )Pleas ca
ADA Ext
Approach/Sidewalk Date Inspector
� .r _
Other
Final Dip NOT REMOVE this i.1spection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 MST :�*f OEI l f 70
!NSPECTION DIVISION Business Line: (503) 639-4171 BUP
Received _ Datt Requested --_ -+- -3( AM -- -- _ PM BUP
Location ,-C 73 ----- Suite - - MEI: _
Contact Person �Y1/ - �- - Ph(—) ?t _� �' G PLM
Contractor _ _ Ph( ) -- — SWR
BUILDING Ten<<nt/Owner ____ _. ELC -- -_ ---
Footing ELC - -- -
Foundation ACCESS:
Ftg Drain
ELF! -- -- -._
Crawl Drain -- - SIT
Slab Inspection Notes. - - -
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
Post&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&Beam
Rough-In ----- _ -- --------- —
Gas Line _
Smoke Dampers -__--
Final
PASS PART FAIL -- --___
_ELECTRICAL ---
Service
Rough-In
UG/Slab
Low Voltage -- --
Fire Alarm
!�
PART FAIL Reinspection fee of$___ __required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
8S -- L' Please call for reinsriction RE:—_ _ Unable to inspect-no access
Fire Supply Line
ADA Date /� r� Inspector _._. - -- s Ext --
Approach/Sidewalk f+`
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL