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'- RrINRAV 14MIFT MS 99T?T
A CITY CF TIGARD
DEVELOPMENT SERVICES ELECTRICAL PERMIT
PERM:!T #: El_C97-0`.7.4
r. 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 04/16/`37
PARCEL.: c:S103BB-02300
SITE ADDRESS. . . : 12165 SW 124TH AVE
SUBDIVISION. . . . :BROOKWAY ZOIV I NG: R--4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :'_ )URISDICTION: TIG
Pro j .tet Desc,r-iI ion: INSTL 2 ORKH CIRCUITS///JOB N 2059-59
---------------- ---------------------
_RFS I.DENT 1 AL UNIT-•-.-_.- ----TEMP SRVC/FEEDERS----- _----_.-M l Si;ELLANEOUS-----...
IOOLA 5F OR LESS. . . . : 0 0 - 200 amp*.;. . . . . . : 0 PUMP/I kRIGATION. . . . :
L ACH ADD' L.. 500SF. . . : 0 `31 - 400 amp. . . . . . . : 0 SIGN/DL)T LINE ►_TG. . 0
LIMITED k. NERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 S I GNAL., PANEL. � . . . .. . : 0
IIANF. HM/ SVC/FDk. . : 0 501+amps-1000 volts. : 0 MINOR LABEL. ( 10) . . . 0
----•-SERV 1 CF/FEEDER----- -_--BRANCF I C T RCU I TS------ ----ADC' L I NSPE:C1 I UN,---- _
0 - '00 amp. . . . . _ ; LSI W/SERVICE OR FEEDER: 0 PIER INSPECTION. . . . . : 0 DA:I - 400 amp. ., . . . . : 0 1st W/O SRVC OR FDR. : 1 PEr HOUR. . . . . . . . . . .. . 0
401. - F,00 amp. . . . . . : 171 EA ADD' L BRN(_;H C:T.RC: 1 IN PLANT. . . . . . . . . . . : 0
601 - 1 000 amp. . . . . : il' -------PLAN REVIEW SECT ION----- ---- ---_.__-_
1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . . ) 600 VOLT NOWTNAL. .
Reconnect on 1 y. . . . . : 0 SVC/FDR > = 25 AMPS. . : CLAS"- APEA/SPEC OCC:. :
Owner. --___.__.__.___________.__._._._.____________._._..__.______________.. FEE
'SHELLY WALKER type amount by date recpt
12169, SW i F14TH F'RMT $ 40. 00 TA7 04/1.6/97 97-293304
T IGARD OR 97223 5F'CT E ='. 00 ,:IT 04/16/97 9•/- -93304
[,hone 0:
Cont.-,,ctor. ---•---_____.____.-----______--•_---
PHOENIX EL.E=CTRIC CO $ 4'.[.'. 00 TOTAL.
7x79 F7W TECH CENTER DR
- - --- REDU T RED INSPECTIONS
T TGARD OR 97223 Ce i I ing Cover Under^gr-oijnd Cove
("hone #: 503-684-3600 Wall Cover Elect' 1 Service
This pilru t is issued subjec;- to the regulations contained to the —.__.�
1 igard Municipal Code, State of pre. Specialty Codes and all other Permittee 'Si gf.at[ar1►�
applic.:le laws. All wore will be done in accordance with
approved plans. This rrreit will expire if work is not started
within IN days of •,s;uance, or if work is suspended for sore
tha,j IN days. Tssut-Ad By
--OWNER INSTALLATION ONL_Y--___.--.�!_________________.____...
The inetall.Ati.o.-i is bei.ng made on property I own which is not intended f°nr-
gaIe, 1PaSP, Or` r Pnt.
OWNER' S SIGNATURE: _ DATE-
--------------------------cnNTRAc
ATE:----_-------------------.-CONTRAC TOR I NSTALLAT i ON ON1..Y ------ -- ---- --- --- ___.__
S T GN'1TURF OF SUPR. F_L EC' N: -�Jrl- , i � DATE
LICENSE NO:
Cell for inspection - 639-4175
APR-15-97 TUE 11 :27 AM PHOENIX ELEC'T'RIC FAX N0, 503 684 3611 02/02
clTv OF T1tGARD Electrical Permit Application Plan Cho"
,311.5 SW HALL BLVD.
Recd�
Date Recd
T10ARD OR 97223 Date to P.E.
Phone(503)639-4171, x304 Date to DST
nspec,lon (503) 639-4175 Incomplete
or hype Permit 0
T?t
Fax (503) 664-7297 Incomplete ole illegible will not be accepted Called
11. Job Address: 4. Complete Fee Schedule Below:
Name of Development � Number of Inspuctlons pw permit allowed
Name(or names of business - ,\ �iI \j Service included: Items Cost Sum
Address k�'-Ut�?�'� 4a. Residential-per unit
1000 sq,ft.or less $110.00
_ 4
City;State/Zp` �'a _ Each additional 500 sq.h,or
portion thereof $25.00 t
clminercial Residential 1�r Limited Energy Mu 125.00
Each Mng f'dSo Roma or Modular
Dwelling S6rviea or Feeder S6Fl.00 _ 2
2a. Contractor installation only:
(Attach copy y�,all current licenses) In Servicers or Feeders
Elec?flcal Contrado �lr_„_�c 'n ��� Installation,alteration,or rvk=don
20C amps or lessSW 00 2
201 amps to 400 amps 5N0.00 2
h Gmte Zip ��-__ 4n1 amps to 6o0 amts � $120.40 2
I hon I'74 _ 601 amps to 1000 amps S:80.00 2
� _ Over 1000 amps or volts 5W-00 _ _ 2
Job No
FJec Cont. Lice. o. ��_._Exp-Date tqlwawo
Rec�nnecc only -- f50.00 2
OR State CCB Reg. No —°��_Exp.Date! 4:.Temporary Services or Fenders
COT Busioess Tax or Metto No.�? S7(,u6cp.U�i � Installation,alteration. K rebcarren
200 amts or less J 550.00 2
Signature of Supr FJ^c'n� 201 amps t0 400 unps _ 575.00 _ 2
401 amps to 800 amps ,;100.Oo 2
Over 600 amps to 1000 voles,
Ucense-No. /41'45 Exp.Date %m"b'above.
Phone No ----
- art.Branch Circuits
New,altefakon or efaenswn per penal
2b. For owner installations: a)The fee for branch circum with
purchaQe of seroks,or
!Tint Ownyf, Name � feeder roe.
Earn branch circuit _ S5.00 2
Address____ _ b)The fee for branch citcurtrr,
City-_-- — State _ Zp-_-_ without pureftane of
Phone Noservice or made?twr.
Fief branch rimuit 1 sm.o0
T11e installaton is beinq made on property I own which is not Each additional branch circuit
intended for sale,lease or rent 4e.Miscnuaneous
(Service or fow*r rel included)
Owner's Signature.__ _ Each pump+x imgation carne „� •� --- 2
Each sign or outline lighting W,00 2
3. Plan Review section (if required):* Signal circuit(s)or a Iirnhad energy sat `
panel,aheratlon or vrionsion
Maar Labels(10) 5iC10•00
Pl"ase check appropriate item and enter fee in section 58.
_ 4 or more resid«ntfalal urnrs in ane striMto 41.Each additional inspectlon over
Service and feeder 225 amps a more. the allowable in anv of the above
System ever 600 wits nonnnal Pet mspertion '635.00 _
- Classified arna Or structure c:orataming special orcupnncy Per hour 555.00
as desrhbmd in N F C.Chapter 5 In Plant 11155,00
' Submit 2 sets of pans with application where any of th•abcwe apply. 5. Fees:
Not requirod for temporary construction serviaat 5a.Enter Intal of abo,�w Iris $
5%Surc large(OS x toEtl lei) S
NOTICE Subtotal S
5b.Enter 25%of lin"Sa for
PERMITS RECOMF VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if r V.Mg(Seca) s ---
NOT COMMENCE')WI1HIN leo DAYS,OR IF CONSTRI1CTION GR WORK subrefel
IS SUSPENDED C.,1 AS/,NDONED FOR A PERIOD OF ase DAYS AT ANY
TIME AF-rE n WOFK I.';rJMMENCFD, IQ'Trial Account
S
Total balance Due
CITY OF TIGARD MECHANICAL_
DEVELOPMENT SERVICESPERMIT
PERM I-f #. . . . . . . : MEC.'37-01.N3
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 04/24/97
PARCEL- - E'" O3HB-023OO
SITE:. ADDRr SI-,. . . : 12165 5W 1.24TH AVE
SUBDIVISION. . . . : BROOKWAY ZONING: R-4. 5
PL_OCK. . . . . . . . . . .. LOT. . . . . . . . . . . . . .27, JURISDICTION: TIG
CLASS OF= WORK. . :ADD FLOOR TURN. . . . : 0 FVAP COOLERS: 0
TYPE= OF USE. . . . :SF LINT T HEATERS. . : iT VENT FANS. . . : 0
OCCUPANCY GRP.. . :H2 VENTS W/O APPL-: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOIL..ERS/COMPRESSORS HOODr).. . . . . . . : 0
FUEL- TYPES-----.-_--__--- 0-3 HP. . . . : 1 DOMES. I NC I N: 0
.,GAS -15 HP. . . . : CnMML. T NC I N: 0
MAX I'JPUT: BTU 15-30 HP. . . . : 0 REPAIR IAN T TS: 0
FIRE DAMPFRS?. . : 30---50 H.P. . , . : 171 WOODSTOVES. . : 0
GAS PRESSURE. . . : 50+ Hf ,. . : 0 0._1) DRYERS. . : 0
NO. OF' UNITS--- ------ AIR HANDL..I NG UNITS OTHER UNITS. : 0
FURN < 10171K PTU: 1 (- 10000 r_f m: 0 GAS OUTI-..ETS. : 0
F'URN > =1O0K BTU: 0 > 1.0000 cfm: 0
Remarks : instl 1 furnance +ducts vents, 1 boiler/heat puap
Owner.: _.___._______.__.__.__-_----.---_----_-.-.- __-- FEES _
HFLA-Y WAI-.KFR type amol_tnt by date recpt
12165 SW 1214TH AVC PRMT $ 225. 00 TAT 04/24/97 97--293690
T T(.inRD UR 1:3722'3 5PCT $ 1. 25 TAT 04/24/97 97-293690
Phone #.-
CI...IMATF.. CnNTROL. HEATING
3315 MW -'F,TH AVE
F'ORTI ANI) OR 97210 -----------------._-___-----_____----_--
Ph o n w #- 223-4:393 $ r?6. 225 TnTAI_.
OOOOOF,
-- ----- RECL I T RED I NSPECT T ONS - - -
This permit is issued subject to +he ,-egulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical 1 n s p
applicable laws All wo••k will be oono in accordance with Misc. Inspection
approved plans. This pewit will eMpire if work is not started Final Inspection
oithin IN days of issuance, or if work is suspended for sore
than 189 days.
F e r m i t:t e e 5 i R n a tr e s ✓� f __-_____ �._...__ _ __ __ ._.____� _.
T s s i..t e d R y:
Ca(. for inspection — 6.39-4175
Plan Check a
CITY OF TIGARD Mechanical Permit Application Recd By
Oate Recd
131?5 SoVii HALL BLVD. Commercial and Residential Date to P E.
TIGARD, OR 97223 Date to DST Y�
(503) 639-4171, x304 Permit rt
Print or Type Called
Incompiete or illegible applications will not be accepted
d Descnpoon --- I OTY PRICE AMT
\v Table to Mechanical Code
IT
I ee A) Pemut Fra - u -0- 10.00
Jol� 1 "�
I Address �__ �C�I" I l --
Bayr estate zip B) Supplemental Permit 3 _
1.) Furnace to 100,000 IiTU 600
lar d OusmesAl _
`vj�v' ind.ducts 8 vents
t)w ter
1 2.) Fumacn 100,000 BTUIrg 7.50
__md duds&vents
ewsuee _i tae
3.) Floor Fumaar 6.00
!reit.vent -
4.) Suspended heater,wad treater 6.00
o r floor mounted heate,•- +
5.) Vant rot rnd.N 3.00
Occupant ma"Adam" appliance permit_ _ _
11
r ervsur
Nlrona 6) BoIN comp,heat purrg.air rend. � 6 00 a
der
,o 3 H_P:_abs.orp unit to 100K BTU
4C()Tvss
7) Boder or comp,heat pump,air C;xZ 1'1.00
3-15 HP:ahsap unit to 500K 8TU -�--
w 9.) Bader or Dump.heat pump.air pond. 15.00
Contractor /d n /2-( O `� �_ 1 S 30 HP absorp and mil BTUl- 9.) Borer or comp,heat pump.air tend. 2250Atiach SPY of aI� �) � 30-5011P-absorp unit 1-1.75 mu BTUCurrent Litxnsea 3750
nt. tronatart .0 10) Baler a comp,heat Pump.air cnnd.C:� >50 HP',absorp unrt_1.75 and BTUONA 11.) Av hanohng unit to4.Tat or MAO f -
' C tO.OW CFM
} 12) Air handling unit 7.50
Architect 1/ef1e 10,000 CTM
Ma"orexia•. 13) Non portable 4.50
or evaporate cooler
pr,p„e 1 i) veru fan connected 3
00
Engineer n sem" zio� -to a sir le dues _ —
�r-- t 5) Venolabon system not a 50
Desatbe work New C� Addition O AMntwn O Repair O - �y in appliaaix Permit +_
to be dr a Resrdenhal Non oEsdential O
Additional Doscnpbon of work 16) Hood mechanical
by 450
nKchanical exhaust -
III 17) Domestic uranerators 7.50
-- - `- I s.) ComI nermal or rrrdustrril 30 0(1
Existing Lie of �' �� type vrcinerator -
ttuidding or Property 19.) Clothes dryers.etC. x.50
Proposed use of
20) Other units -.--- I ---- 450
building or Property
! —` 200
Type of fuel-or O natural gas LPG O e*ctm O - 211 Gas piping one to four outlets -
- - 22) More that,aper outlet (each) 50
I hereby acknowl&lge that I have read this applrcatron,that the
I ntorrnstbon given a crortecl,that I am the owner or authortzed agent of --- — t2Ty.SUBTOTAL
the - C
owner,that plans subMAW are in complia"ce with Oregon State
Laws. — 'SUBTOTAL
Signature of owniWAgent Date 2 y
,' 5K SURCFWRGE
r Contact Pe n me �hof1e PLAN REVIEW 25%^F SUBTOTAL
a TOTAL
isftradtpmt.doc Minimum prrrmrt 4es is S25 5%surcharge --U a-
ev 7196 ll.•
RECEIVED
APR 2 4 199Y
CDMMUNITY DEVELOPMENT
Home Layout 0
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A. Win�oGis Windows Doors Walls Roof Floors