13665 SW 130TH PLACE ADDRESS:
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Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION
13125 SW Hall Blvd. — Ct G� q _ty f
Tigard, OR 97223 PERMIT# � G —f� _
Phone(503)639-4171
FAX (503)684-7297 D1A'!E ISr'..ED
TDD No. (503) 684-7.772
CITY OF TIGARD Inspection (503)639-4175 ISSUED BY Iv IAI.e tnQglfl---
PLEASE COMPLETE ALL SECTIONS
1. LOCATION OF INSTALLATION 4. TYPE OF WORK
gddreS�� U� jpRESIDENTIAL—Restricted Energy Fee . . . . . . . . . $40.00
r (FOR ALL SYSTEMS)
Cite State Zia ;, �� ck TT•ne of Work Involved:
PERMITS ARE NON-TRAV5FERABLE AND NON-REFUNDABLE AND EXPIR4 IF WORK Audio and Stereo Systems*
IS NOT SrARTF0 WITHRJ 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR
18u DAYS. Burglar Alarm
Gauge Door Opener*
2. CCidTRAC FOR APPLICATION ) Heating,Ventilation and Air Conditioning System*
Contractor Type_ _ Vacuum Systems*
❑ Other
AddresF
Date COMMERCIAL—Fee for each system . . . . . . . 540.00
--- (SEE OAR 918-260-260)
Propert,,Owner Check Tyne of Work Involved,
Contractor's Board Reg. No. - ❑ Audio and Stereo Systems*
❑ Boiler Controls
Phone# — _ _ ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
��/� r El Fire Alarm Installation
�UUI� CQ't"t�dJ2- ❑ HVAC
Print Owner's Name I Phone No El Instrumentation
�a `!' V 10. 7h �.41 C F-1 Intercom and Paging System
Address
Fj WOGe-- C) p lic j ❑ Landscape Irrigation Control*
City State Zip ❑ Medical
This permit is Issued under OAR 918-320.370.This applicant agrees to make only ❑ Nurse Calls
restricted energy installations(100 vv', ,mps or less)under this permit and in do the ❑ Outdoor Landscape Lighting*
following:
1. Only use electrical licensed persons to do installations where required.(Certain ❑ Protective Signaling
residential and other transactions are exempt from licensing.These have ❑ Other
asterisks(*).All others need licensing).
2. Call for an Inspection when all of the installations under this permit are ready
i for inspection at 503-639-4175. ❑ _ Number of Systems
3. Purchase separate permits for all Installations that are not ready(or inspection
f when the Inspector Is out to Inspect under this permit. •No licenses are required. Hrenses are required for all other Installations.
4 Assume responsibility for assuring that all corrections required by the Inspector
are done,and
5. Assume responsibility for calling for a final Inspection when all of the corrections 5. FEES
are completed.
the person signing for his permit must the applicant or a person a. Enter Fees $ �•00
Lj authorized to hind I .applicant.
b. 5% Surcharge(.05 x total above)
Signature
TOTAL $ � DU
Authority if other than applicant
ENERGARCHP
t-
R Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Phone (503) 639-4171 6,�y tied $—h —y�
CITY OF TIGARD FAX (503) 684-7297 Is�t �i 1.1 �Iz �--
TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development N 1Ut t trm4�yt/� 4'1:)I I(44�� Number of Inspections per permit allowed
Address �?yC�oS"f5yy �(� 1►I now e.,-, Service included Items Cost(ea) Sum
City/State/Zip_ IC Yc"z U F—� its. Residential- per unit / $11000
ft Orissa
Name (or name of business) LJti 12_ L('(/I If7: Fach additional 500 aq It or C' t
pohion thereof $25 00
Commercial El Residential. Limited Energy $75 00
Each Manul'd Home or Modular 2
Dwelling Service or Feeder $be 00 _-
2a. Contractor installation only: 4b.Services or Feeders
Installation,atterabon.or relocation 2
Electrical Contractor _ 200 amps or less Ali` $60 jo 2
Address 201 amps to 400 amps $8000 2
CI State Li 401 amps to 600 amps $12000 2
7__.. p 601 amps to 1000 amps _ $18000 2
Phone N0. v Over 1000 amps or volts $34000 2
Contractor's License No. _ _ Reconnect only $5000
Contractor's Board Reg. N0. 4c. Temporary Services or Feeders
Inslallalron,alteration,or relocation 2
Signature of Supr. Elec'n 200 nmpe or less $50 on 2
License No. Phone i to. 201 amps to 400 amps $1500 _ 2
-- --- 401 ampe to 660 amps $10000 _
Over 600 amps to 1000 volts
2b. For owner installations: see•b•above
L_6U IF,— 4d. Branch Circuits
Print Owner's Name New,alteration or extension per panel
Addr 9 7 0 ce, n)The lee for branch circuits with
Cit, States Zip 6(lop purchase of servke or Meller W. 2
Each branch circuit $500
Phone No. b)The fee for branch circuits without
The installation Is being m de on property I own which is purchese of service or Moder fee. 2
First branch drcuit $35 00 _ 2
not intended for sale, le a Of 'ant. Each additional branch circuit $500
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review se (lf required): Each pump or irrigation circle $4000 2
Each sign or oullina lighting S4000
Signal vicuit(s)or a limited energy
Please check appropriate item and enter fee in section 58. panel,alteration or extension $40 o0
4 or more residential units in one structure Minor Labels(I C) _ $10000
Service and feeder 225 amps or more
System ova(600 volts nominal 41. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N.E C. Chapter 5 Per inspect-on $3500
Per hour $5500
N
Submit 2 sets of plans with application where any of the above In Plant $6500
apply. Not required for lemporsry construction services.
3. Fees:
i 5s. Enter total of above fees $ �l�
NOTICE 5%Surcharge(.05 X total fees) $ S
cD PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
W 5b.Enter 25%of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF plan Review if requirod(Sec.3) $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Sitbrotel $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. ❑ Trust Account x $
Balance nue $
• C11Y CSF TIGARD MASTER PE=RMIT �7
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT *1. . . . . . . : MST95--0.::29
13125 SW Hall Blvd.Tiperd,Onpon 97223.8199 (503)839-4171 DATES ISSUED: 06/30/95
���/ P,'IRCEL: i-'S 104DD---00700
SITL i-iDDRLS;:i. . . : i3&L�5 SW i;:01'1-i PL
SUBDIVISION. . . . : MOUNTAIN HIGHLANDS i' ZONING: R-4. 5 PD
BLOCK. . . . . . . . . . . L.0-1. . . . . . . . . . . . . :006
BUIL.DING
RE I S�1UE: D14ELI_I NG UNITS: 1 BASEMENT. . . . . . . . :4137 5f
-LASS OF WORK. ;NEW BEDRMD:4 P;"rHS:5 GARAGE . . . . . . . . . . :094 s f
"YrE or, USE. . . : F FLOOR AREAE.-- -_.---.--- REQUIRED SETBACKS -
7 YPE OF CONST. :5N FIRST. . . . : .1989 sf LEFT. . : 11 ft RIGHT. : 10 ft
)CCUPANCY GRP. : R3 SECOND. . . -. 1349 _f FRONT. :20 ft REAR. . :33 ft.
:;TORIES. . . . . . . .2 FINDSMENT: 105 sf
T:IGIIT. . . . . . . . :C0 ft "TOTAL - ;• :44., 5f SMOKE DETECTORS. :Y
LOOP LOAD. . . . :40 psf VALUE . . . . . ? : 244864 PARF;:IJG SPACES. . : 1
^em,::,rks : PATH 1
PLUMBING
IN 1-1,5. . . . . . . . . . ..2 rl_00'7 DRAINS. . . . :0 BACKFLOW PRE'VNTRS. . : 1.
AVATORICS. . . . . :6 WATER WEATE-RS. . . : 1 CRAPS. . . . . . . . . . . . . . :0
7UB/SHOWCR5. . . . :5 LAUK,DRY TRAYS. . . : 1 CATCH DASINS. . . . . . . :0
.DATER CLOSETS. . .5 SEW'-7R LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
.)v7jiAwn3HERG. . . . ; 1 WATER _INC ( ft ) . . 1r*Z0 OTHER FIXTURES. . . . . :0
'ARBAGE DI`;P. . . : 1 rAIN DRAIN (ft) . :0
•JASH I NG MACH. . . : 1 o1 r?AIN DRA I NG. . : 1
MECHANICAL_ ________.___..____._.._-_._.____._._..______--__--- FEES _...._._____.__....
"UCL TYPES- _._._..._..__.._.._..._ UNIT hITRa. . :0 type 'amol.uti: by (date v-er_pt
,,GAS/ / / VFINT5 . . . . . :0 TIF $ 1550. 00 P 106/30/93 -
1AX INPLJT.O BTU VENT f ANS. . :C, r2WM $ 100. 00 D 06/w0/'35
-URN ( 100K . . :0 HOODS. . . . . . : 1 aWM 100. 00 8 06/30/95 -
"URN ) =100+' . . '. 1 WOOC)'5TOVE S. :0 BF RT 795. 50 1' 06/30/93
"LOOR TURN. . . :0 CLO DRYERS. 1 SPLC 51"7. 09 JD 05/30/95 95-266016
101L/CMP ; I ;P:O OTHER UNITS: 1 B5PC 1i 313. 70 S 0G/'0!95 --
GA5 OUTLETS: I PARE; $ 500. 00 B 06/30/9:;
Jwner : _ ...__ _______._..___._ _..___ _._._.._._-_____._...----.-- MG"RT $ 51. 00 S 06/30/9"S
HENRY LOUIE nNNn LE=UNG MPLC $ 12. 75 B 00,/30/95 -
7-ClOO 5W 16711H PL M5PC $ .2. 55 D 06/3e/95
PPRT $ 276. 00 D 06/30/95 -
ILOHA OR 97007 P51"i_ k 15. 1.30 D 06/30/15
5
-hones #: S03-l549--9052 EROS L 803. 00 B 06/30/95 -
:ontr-act ur- : _..___._._____.___.__ __. _.. ___._.______...__EBBE g 28. 60 13 06/30/95
'RISTIAN PLUMBING ERPC 28. 60 B 00/30/95 -
`201') 5W STAT`FORD RD
'_U,�LLAT I t4 OR 97062
CL r1hone It: 636 8231
�r Reg #. . : 42071
v~r, I $ 41.83. 60 TOTAL
"his permit is Lsueo sibjert to the regulations contained in the - - - REQUIRED INSPECTIONG
J -igard Municipal Code, State of Ore. Specialty Codes and all other Footing Insp Pl,_Imb Top Oi.Ii
applicable laws. All work will be done in accorda%e with approved F o l.tn d a t i o n Insp Ft-arn i n g Insp
_� liras. This permit will expire if work is not stilted oi:hir 18x2 Post/Beam Str'l.ILt Fit-eplace Insp
w iy: of issuance, or if work is suspended for ore than i days, Rost /Beam Mec_han Oas Line Insp
Ci-awl Drain Insulat iun Ing;
I m1LLeePlm/r.indslab Insp Gyp Dua.rrj Insp
� � 3LlI' .-... PLM/Underfloor Pain drain Insp
I itet� L'
_ y : L 'Y 1*41echaniLal Insp Water Line Inst.
C,-r11 {or• inspection - 0,74-4175
SEWER CONNECTION
CITYCSF
PERMITIGARD PERMIT
: ISWR95-0221
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/30/95
13125 SW Hall Blvd.Tigard,Orogon 97223*6199 (503,630.4171
PARCEL: 2,S104DD--00700
i T!_-_ ADD RE5 13665 SW 130TIA I- L
SUBDIVISION. . . . : MOUNTAIN HIGHLANDS ZONING: R-4. 5 FID
BLOCK. . . . . . . . . . , i-OT. . . . . . . . . . . . . :00G
TENANT NAME.. . . . . :
USANO. . . . . . . . . . : FIXTURE UNITS. . . .'
CLi')SS OF WORK. . . :NEW DWELL I NO UNI TS. . . 1
TYF,E OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSTALL TYPE. . . . ;BUSWR IMPEPV SURFACE. . :
Remar-ks. PATH I
Owner-: FEES
[rJEj'4RY LOUIE a ANNA LEUNG type amount by date 11"ecpt
7400 SW 167TH PL PRMT $ i_200. 00 B 06/30/95
-
INSP $ 35. 00 0 06/30/95
ALOHA OR 97007
Phone #: 503-649-9052
Contr-actor —--———————————
CONTRACTOR NOY ON FILE
Phone 203::x. 00 TOTAL
R e 9
REQUIRED) INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer- Ins pert j on
of the Unified Sewage Agency. The permit expires 180 days from
the date issued. The total amount paid will be fc,-feited if the
permit expires. -he Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not locatea at the measurement
given, the installer shall prospect feet in all directions from
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer" Permit and the Agen y. will ins .1 a lateral.
Per. mit: Lee .may
Lis e d By : *t4MJ
Call rov- inspect ion b39-4173
r�
A?k ,/ ' x,6\1)
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 CI
(503) 639-4171 /, J3 o S `7 w 1-30
' \
Jobsite Address:
Subdivision:
MOUN'T'AIN HIGHUNDS Lot # 6 Office Use Only
Contact Date / / Initials
Valuation: `�"fig_ _ — Result _
Planck/Rec #
New Construction Only: (Square Footage) Pcrmit # tns I `r.S 2
House: ii*7 Garage: 1f*jr, Reissue of
Map & TL # 5 tct nD- oc�
Zone
Corner Lot? Y 0` Flag Lot? Y Plat #
Owner: Henry Louie & Anna Leung AUr,,dls Required
Planning Setbacks _ � Solar
Address: 700 SW 167th Place Engineering _
Aloha, OR 97007 Other
Phone: ( 503 ) 649-9052 Items Required
Subcontractors
Contractor: OWNER CONTRACTOR Truss Details _
-same- Other
Address: rr
Notes � Pur M tic"Vt A,6i ;meye, -5 5,, jq
cats ,
Phone: �_ )
Contractor's License # _
(attach copy of current Oregon license)
Contact Name:
Contact Phone: L
Subcontractors: N4, AeLv\- (�LL �,,�chitect/Engineer: ALAiv MASCORD DESIGN
_ Plumbing: —>� ' - "`111 Address: 1305 NW 18TH AVE.
Mechanical: ;-)jLjy off_ _ PORTLAND, OR 97209
(attach copy of rijr : Contractor's License) Phone: ( 503 ) 2259161
JOB DESCR{PTION: 'TWO STORIES RESIDENTIAL HOME
Applicant Signal6re t '.�� Applicant Phone number
-----��- o 5S
Received by: _, _ Date Received:
Permit # Account Description Amount Amt. Pd. Bal. Due ` -
�13 a 2-`1 Bldg. Permit (BUILD) ,Ss
Plumb. Permit (PLUMB) �
Mech. Permit (MECH)
State Tax (TAX) 51615— S�
Bldg: 3V 78
Plumb:
Mech:
Plan Check (PLANCK)
aidg:
Plumb:
Mech:
4� t t Sewer Connection (SWUSA)
Scwer Inspection (SWINSP)
Parks Dev Charge (PKSDC) G'u
i
Residential TIF (TIF-R) / C
Mass Transit TIF (TIF-MT) _ l idy
Commercial TIF (TIF-C) —
Industrial TIF (TIF-1)
Insti',jtionai I-IF (TIF-IS)
Office TIF (TIF-0) _
Water Quality (WQUAL) _
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT) LL i
Erosion Planck/USA (ERPLAN) r
Erosion PlanckiCOT (EROSN) o2�-Ge
i
TOTALS: jig"
1
Permit#:
Address: 13 /'a 6 ,.5 57Q
<,: w --
Issued by: 1' d�lt"-- Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a Building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under URS 701.010(7),
need not submit this statement. This.statement will be filfd with the permit.
Fill in the appropriate blanks and ir�:tial bones I and 2. and either box 3A or 313:
�(L 1. I own, reside in, or will reside in the completed structure.
to 2. 1 understand that I must register as a construction contractor if the structure is sold or offered for sale
IFi�1 before or upon completion.
LJ 3A. My general contractor is
L_1 (Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
4 3B. I will be my own general contractor.
If i hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the abov information is correct and t hat 1 have read and do vrider.sland the 1 nformation
Notice to Property Owners bout Const ction Responsibilities on the reverse side of this form.
(Sig aturepe nut 4 plicant) ( ate)
White copy to issuing agency permit file,
pink copy to applicant)
2340i
aY :
THS LOUIE RESIDENCE
CITY -F TIGARD '
S W GREENFIELD DRIVE MOUNTAIN HIGHLANDS �
LOT 6 1
p I
8,550 S0. FT. '
410
I
_ 1 1
I 1
1 28'-10 1/2"
1 0'-1'1/2
1' 1/2" —
1 \ .........'MAIN PLOOR.
ID EL.:403.Q' c
\ r
•10'-10
'
GARAGE. ..... -�
I K.-39310'
"o
...... ...... 15. 5 1%2" _
...... ... n,......���.� � ... Q.Q. .... _... . I A I
13'4 2"
4" CCNC
DRIVEWAY
�! io
13500 PSI) o
N
I
S lb' 08 E _ 77-_
387' ,,12 390'
- X31 onl r-ow-ro L_
t) 114vi 171.AIr1 �9
0131GINlAL
r
S W 130TH PLACE
J I
ALAN MASCOPD DESICN ASSOCIATES WILL 4''?R
NOT BE HELD LIABLE FOP ACCURACY OF
w TCPOGPAPHY INFOP'AATION IT IS 1,' SOLE
LLJ RESPONSIBILITY OF INE BUILDER TO VCPIFY
J ALL SITE CONDITI(NS KLUDING ANY FILL 1
PLACED ON THE S TE AND TO INFORM OWNERS
OF ANY POTENTIAL FIELD MODIFICATIONS
NOT SPECIFIED ON THE PLANS
AlAfl flA1CORD DFlldn AI 0 TCI
1305 NV: 17TH AVENUE. PORTLAND, OREGON 97109 15031 225-9161 S C A L E I 0 0