12780 SW 121ST AVENUE 190190 tsw
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i:\rcoords\micro(Irn\targels\building.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
` 24-Hour Inspection Line: 539-4175 �y Business Line: 6.39-4171 -
BILIP
Bate Requested �1 7_ / - 0 AM % _PM — BLD
Location-42 /OV �_G r/�/'dj az,-e,, Suite MEC
-7�
Contact Person ��' C���. �✓'L Phfg / PLM _
Contractor _ 2Q,�1./.P1� ��.0 Ph - SWR G7
BUILD114G Tena;adOwner -
Retaining Wall ELR
Footing
Foundatio�� r',r,CeSs:
FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: —
Slab
---- SIT
Post&Beam —
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing --
Firewall
Fire Sprinkler _.� ------- --- --- ------- --... ---- ----- -
Fire Alarm
Susp'd Ceiling -- ----- - — --. _-_. _--.--.--_- _ -
Roof
Final ----~--^-
PASS FART FA1'. - - - —- — --- --- - ---- -
PLUMStNG
Post&Beam - -- -_ ^-- - ------ ,--`- --- - ----- --
Under Slab
TopOut -------------- ---___—_-- _ _------ - -- - - --
Water Ser.-ice
Sanitary Sewer
Rain Drains
Fina! -
PASS PART FAIL
MECHANICAL
Post&Beam - ---- ----- -- - ---
Rough In
Gas Line ----- ----
Smoke Dampers
Final -
PA FAIL,AU
ECTRICA -- -- ----�_— — _ _—�
Service T
Rough In -- _------- - -- - - �—,.
n UG/Slab
Low Vollagu
v~i F' arm
jFm
PART FAIL --------- -- -- — --- -
:-' SITE:
L Backnll/Grading - -----
w Sanitary Sewer
-' Storm Drain [ )Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ j Please call for reinspection RE: [ ]Unable to inspect-no access
Fire Supply Line -----
ADA
Approach/Sidewalk Date Inspector_ Ext
Other
Final
PASS —PART FAIL 00 NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD ELECTRICAL PERMIT
DER #:
DEVELOPMENT SERVICES DATE MIT ISSELCUED: 11 /298-0700
5/98
LaWft 13125 SW Hall Blvd., Tigard,0R."722i(503)639-4171
PARCEL: 25103,BD-03000
SITE ADDRESS. 1 :'780 SW 121ST AVE
SUBDIVISION. . . . :CAL;MEI 1 PARK ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . 00 1 JURTSDICTION- URB
Pr-oject Description- Electrical alteration to reconnect service for residence.
Job No. 56799
--------------------------
----RE_13 I DENT IAL UNIT--.- --.-- -----TEMP SRVC/FEEL)ERS--.--- I SCELLPNEOUS------
1000 SF OR LESS. . . . : 0 0 — 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADD' L. 500SF. . . . 0 201. — 400 amp. . . . . . . : 0 SIGN/0117 LINE L.T,:',. . 0
LIMITED ENERGY. . . . . : 0 401 — 600 amp. . . . . . . : 0 SIGNAL/PANEL...., . . . . 0
MANE. HM/ SVC/FDR. . : 0 601+amps---.1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
------SER'VICE/FEEDER---- —___BRANCH CIRCUITS------- -- -ADDIL INSPECTIONS—-
0 — 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PE", INSPECIION. . . . . : 0
201 — 400 amp. . . . . . : 0 1 st W/O SRVC; OR FDR. : 0 PER HOUR. . . . . . . . . . . : 0
1401 — 600 amp. . . . . . . 0 EA ADD' I BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
601 — 1.000 amp. . . . . : 0 REVIEW SEC'TION-----------------
1000+ amp/volt. . . . . : 0 ) 4 RES UNITE). . . . . . . . : ) 600 VOLT NOMINAL. . ;
Reconnect only. . . . . . I SVC/FDR ) = 225 AMPS. . : CLASS AREA/SPEC OCC. :
Owner-: FEES
DARLA ROFFS tyre iimol.qnt )y date rerpt
12780 SW 121ST PRMT $ 50. 00 DLH 11/23/98 98-3, 1099
TIGARD OR 97223 5PCT $ 2. 50 DL.H 11/25/98 98-311099
Phone #:
Contr,artot ------------- ----
FIRAHLER ELFCTRIC CO $ 52. 50 TOTAL
1. 1860 SW GREENBURG RD
REQUIRED INSPECTIONS
TIGARD OR 97223 Elpl-tl 1. Set-vice
Phone #: 639-4627 Eli?ct' l Final
Reg 000374
This permit is issued subject to fne regulations contained in '.he Tigard Municipal Code, State of Oregon Specialty Codes and all other
applicable laws. All work will be done in Pxordance with approved plans. This permit will expire if work is not started within 180
days of issuance, or if wnrk is suspended for sore than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Nolification Cinter. Those rules are set forth in OAR 952-001-0010 through OAR 3552-001-1987. You may obtain d copl,
of these rules or direst questions to W by calling 1503)246-1987.
e r,m i t t 9 e S i g n a t i-i r e : dA/19�0,"z.1(!�CIA// Issl.led By :_
.._---------------------------OWNER INSTAI.LATION ONL.Y------------------------------
T'ie installation is being made on property I own which is not intended for
sale, lease, or rent.
(IWI\JFRI S SIGNATURE: DATE:
INSTALLATION ON1,Y-----------------------------
R)IGNATURF OF SUPR. ELEC9N: _ 0A1 —-----— DATE:
L.ICENSE NO:
4,+4-+4-+++4-+++j ++++-+-++4 ..........4..........4.+4.+++4-++++4-++4-++-1-+4-++++-+++4-+-#.......
Call. 639-4175 by 7-00 p. m. for- an inspection needed the next bi.isiness day
++++++4.................#-+4..................................................4-+++-++
ii/24/98 14:29 FRAHLER ELECTRIC 3 INSPECT TIGARD NO. 167 P001
CITY of Tie-,&12 �qq� Electrical Permit Application Plan d B -Z L�
13125 SW HALL BLVD 7 �,�� I �j Date ay
TIGAR ��r-W / Z �� Date Recd
Date to P.E.
Phone(503)639-4171, x304 �L /Date to DST
Print or Type U /
Inspection(503)639-4175 Permir ft
Fax (503)684-7297 Incomplete or illegible will not be., acceptid celled
1. Job Address; 4. Complete Fee Schedule Below.
Name of DevelopmentNumber of In,pectlons per permit alloyed --�
Name(or name of business) u V bfS Service Included: Items Cost Sum
Address / 2-7
So �S&j Z/ 4a. Residential-per unit
CI istate2l 17
��]Fl7r�/ �-� t�sq.n or fess $110.00 4
ry pEach adc5llonal 5Co sq.tt,or
rwmfl portion thersof $25.00 1
Commercial
(erResidential
�- � ,Q� Limited Energy $25.00
�-�W -4t7T'?'i
Each tling f'dSe Homo F Modular ----
Dwelling S@NKB or Feeder $68.00 _ 2
2a. Conti ctor Installation only; ��[•4�icJ�
(Artaeh copy of all cuaant Ilcsn ) G' ` 4b.Services or Feeders
Electrical Contractor 6411 12{L ca
Installation,alteration,or relocation
Address/ 6y L1� 7fjj�- 200 amps or loss $60.00 2
201 amps to 400 amps $80.00 2
Ciry_
State tip is 401 amps to 6n0 amps $120.00 2
Phone No. 601 amps to 1000 amps � $180.0(
Job No.,_S� __ Over 1000 amps or volts 5340.00 2
Elea Cont.Lice. No, -L Et Date_16 f y Reconnect only L s50.00
- 2
_. P
OR State CCB Reg. .Vo.374i,,o Exp.Date„_ 4c.TemporarySarlllcns er Feedors
COT Business Tax or Metro No. Exp.Date Installation,alteration,or relocation
200 amps or less $50.00 2
Si ��,� 201 amps to 400 amps r $15.00 2
olgnature of Supr. Elec'n .'1� 401 amps to 600 arnps $100.00 _ 2
Over 000 amps to 1000 volts,
License No. -Exp Date o see"b"above.
Phone No _
4d.Branch Circuits
New,alteration or extension per pang)
2b. For owner installations: a)The fee fer branch circuits with
purchase of earvlca or
Print Owners Name_ _ _ _ Avder fee
Address Fath branch circuit $5.00 2
h)The fee for branch circuits
City- State Zip wirhour purchase of
Phone. No. _ service or feeder fee.
C.� Fust branch circuit $35.00 2
Ea-:h additional branch circuit 55.00
The installation is being made on pr t ----- --- `
Intended for sale,lease or rent. f/ 41 5'V 4e.Miscellaneous
(Service or fewler not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting -� 540.00 2
rz 3. Plan Review section (it required):' Signal arcuit(s)or a limited energy
panel,alteration cr extension2
h Minor Labels(10) SI00,00
Please check appropriate item and enter fee In section 58.
�- d or more resld-jMlat units in one structure 4f.Each additions:inspection over
Service and frandw.r 225 amps or mora the allowable in any of the above
-r System over 600 volts nominal Per inspection $35.00
L Classified area or structure containing special occupancy Per hour $55.00 _
C-0I as dascribed in N E C Cha;.w 5 In riant $5`r
w
J Submit 2 sates of plans with application wh-rp any of the above apply. Jr. Fees:
Not required for temporary construction services. 5o.Enter Intal of above toes $
59:Surcharge(.05 X total fees) S - t4
NOTIC subtotal S ---
1,b.Fnter 2514 of line Sa for
PERh411 5 BECOME VOID IF Wi- 4K OR CONSTRUCTION AUTHORIZED IS Plan ReviAw if_ragiti r:4(Secs) $ -NOT COMMENCED WITHIN ISO DAYS,OR Ir CONSTRUCTION OR WORK Suyhrral S
IS SUSPENDED OR eBANDONED FOR A PERIOD OF 180 DAYS AT ANY ❑ N_ .' �1/111/L1
TIME AFTER WORK 15 COMMENCED, trust A�r°unf ' C� s
Total balance Due