11350 SW FONNER STREET In
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11.350 sta FONNLR 9TRNRT . .,
CITY OF TIGARD qS-lER IDERMIT
DEVELOPMENT M
SERVICES r,ER111T #� . . . . . .. ..
13125 SW Hall Blvd.,Tigard,OR 97223 (503)63q.4171 DATE ISSUED: 12/26/96
r1r4RCEL_, S 10�2,'n C—12)62.2.0LA
131 TE (-)DDRESS. . 11350 13W FONNER ST
StJBD I V T S T Ohl. . . . ML-P99-001 9 ZrJN I hIC,
r1r�,. . . . . . . . . . .. L01 . . . . . . . . . . . . ..
marks: Path I
-------------------------------------------------- -------— BUILDING -------------------------------------------------------------------
REISSUE: STORIES.......: 2 FLOOR AREAS----------- BASEMENT.. : 0 sf REOUIRED SETBACKS---- RENIRED-------------
CLASS OF WORK,:NEW HEIGHT'........; 30 FIRST....: 1037 sf GARASE......: 764 sf LEFT..........: 14 SMOKE DETECTR9: Y
TYPL OF USE...-SF FLOOR LOAD—.- 40 SEC9ND... 1090 sf FRONT.........: 2e PARKING SPACES: 1
TYPE OF CONST.:5N DWELLING UNITS: I FINBRENT- I sf RIGHT.........: 5
OCCUPANCY GRP.: 2 BDRM: 4 BAT14- 37 TOTAL------: 2121 Ff VALUE..1: '.54743 REAR..........: 25
----------- ---------------- ------------- ----------------------- PLUMBING --——------------— —-------------------------------
SIW,S......... I WATER CLOSETS.. 3 WASHING MACH.. : 1 LAUNDRY TRAYS.: 0 RAIN DRAIN ft! 0 TRAPS.........: 0
LAVATORIES....: 5 DISHWASHERS...: I FLOOR DRAINS-: 0 SEWER LINE ft: 0 SF RAIN DRAIN18- t CATCH BASINS.,: 0
TUB/SHOWERS...: 3 GARBAGE DISP..: I WATER 4EATERS.: I WATER LINE ft: 1@0 BCYFLW PV.VNTR: I GREASE TRAPS..: 0
OTHER FIXTURES: 0
---------------------------------------------------------------- MECHANICk -----------------------------------------------------------
FUEL TYPES------- FURN ! 100K 0 BOIL/CMP ( 3HP- 0 VENT FANS.....; 4 CLOTHES DRYERS: I
/GAS/ I / FURN1,=Ilff, I UNIT HEATERS- : e HOODS.........: I OTHER UNITS... : I
MAX INP.: 0 BTU FLOOR FURNACES: I VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...- I
-----------------------------,---------------------------------- ELECTRICAL ----------------------------------------------------------------
_RESIDENTIAL UKIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEDFRS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS--
1000
NSPECTIONS—1000 Sr OR LESS: 1 @ - 21@ alp-: 0 0 - 200 alp..: 0 W/SVE OR FDP..- 0 PUMPlIRRIGATION: @ PEP INSPECTION; 0
EA ADD'L 5q0SF.: 4 211 4n@ amp.. ? 201 - 4@@ amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 GN asp..: 401 - 600 amp. 0 EA ADDL BR CIRs 0 SIGNAL/PANEL...: e IN PLr,%g......: 0
MW HM/SVC/FDR: 0 01 lee@ alp.: e 6@lfasps-I000 0 MINOR LABEL -10: 0
1000+ amp/volt.: @ ---------------------_------- PLAN REVIEW S[CTION -----------------------------------.
Reconnect only.: 0 1=4 RES UNITS..- SVC/FDR)=L�5 A.: ) 610 V NOM?NA).: CLS P'IEA/SPC OCC:
------------ ------------------------- ELECTRICAl. - RESTRICTED ENERGY --------------------------------------------------
N. SF
-----------------------------------------------SF RESIDINTTAL------------------ ------- B. COMMERCIAL--------------------------—-------------------------------------------
NDIr, I STEREG.: VACUUM SYSTEM.. AUDIO & STEREO.; FIRE ALARM...... INTERCOM/PAGING! PUTDOOR LNDSC LT:
BURGLAR ALARM.., 0TH: X BOILER.........: HVAC...........: LANDSM/IRRIG: PROTECTTVF S19t-
GARAGE OPENER., CLDCII I I I..I.: INSTRUMENTATION: MEDICAL......... ]THP:
HVAI..1... DATA/TELE CIMM. NURSE CALLS._- TOTAL 0 SYSTEMS:
Owr er: ------------------ TOTAL FEE9:$ 46?0-`1
FOUR D CONSTRUCTION FOUR 0 CMTjUCT:ON
PO BOX 1577 PC BOX 1577
BEAVERTON OR 97075 BEqVERTY, OR 97075
Phone It: 590-0605 :!hone 590-O805
Reg #..: 71037
This pet-sit is issued s1ject to the regulatiu,, contained in the Tigard Aunicipal Code, State of Ore. Specialty Codes and all other
applicable laws. Al? , ,-I. will be done in accor,,ncp with approved plans. This permit will expi,,e if work is not started within 180
days of issuance, or if work is suspended for, tore '-4p iN days.
---------I------------------------------------------------- RrGUIRED INSPECTIONS ------
Erosinn Contol Post/Beal Mechan PI,X/Underfloor rraling Insp Gyp Bnart Insp Electrica! Final
Footing lisp Underfloor insul 'Mechanical Insp Shear Wall Insp Rain drain Insp Mechanical Final
Foundation Insp Crawl Drain .1ust: Top Out Low Voltage Water Line Insp Plumb Final
Pest/Beim Struct Pis/,.indslab Insp Elpctjcal Sprvi Gas Li,.,@ Insp er Service In B!iilding Final
Post/Beal Mechan PLM/Underfloor Electrical Rough Insulat;on InspPppr. 1'+ I n esp
nq i I.t I
C
C_a I I i-ot- j.Tispec.t ion E.39 4175
CITY OF TIGARD SEWER CONNECTION
PE RM T
DEVELOPMENT SERVICES PERMIT ft. . . . I. . . : SWR96-0436
Aa!20vjm 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: 12/26/96
PARCEL : PS103AC-06200
ITE ADDRESS. . . - 11 13�50 SW f---U111qL H '5'1'
SL)SDIVISTON. . . . : MLP95-00J9 ZONING:
FLOCIJ. . . . . . . . . . . L.OT. . . . . . . . . . . . . :OOL
I ENONT NAME. . . . .
USA NO. . . . . . . . . . . FIXTLIRE UNITS. . . : 0
CLASS OF WORT'.. . . :NEW D W E L I... 1.N r3 Ll N I TS. . I
TYPE OF LJS7. . . . . ..9F NO. OF BUILDINGS: I
INSTAL[. TYPE. . . SLJSWP IMPERI) �;tjRFACE: 0 r f
Remark-' :
Owner-: FEES
r*OOR D CONSTPLICTTON type amouni-, 1:)"! d,.k L e V-ecpL
PO F30X 1.7,717 PRMT 2200. 00 URA 12'/26/96 96-2881.70
I VIF-P ;?2. 00 DR(), 1.2/26/96 96...;881.70
rV:AVERTON OR q'701 -1
Phone #: S90-0805
Cont riirtat—
CONTRnCTOR NO-T' ON FILE
Phone E 2:39.. 1?10 TOTAL
Rey #. . , PEOVIRED INSPECTTONS
This Applicant agrees to cosply with all the rules and reg,0&tiom Sewer Tnspecion
of the Unified Semaq? Agency. %t pt-jit expires 180 days frov
the ,late issued. The total &votipt paid w;ll be torfeiti?d if t1e
pewit expires. The Agen,,j does not guarantee the accurety of the
side sewer laterals. If the sewer is not locatea -A the veasurevent
glypil, the installer shall prospect 3 feet in all directiors fro:
the distance given. ' not !,o located, tha installer 03, 11 purchase
a "Tap and Side Sewer" permit and the Age W!'. ins j lateral.
"t'm0Jr7)1 t rare4.4
i e
C-ill Fot, i,ispect ion 639-4175
Plan Check#
"ITY OF TIGARD Residential Building Permit Application R4cd By
i 25 SAN HAI.L BLVD. New Construction Additions or Alterations Date Recd -olb
71GARD, OR 9 7223 Single Family Detached or Attached Date:o P E.
(503) 639-4-'71 Date to DST
# �
Print or Type Permd - 4' �
Called
Incomplete or illegible applications will not be accepted ,j,�,��1`
r ;-v E e+1 l W P 1 1 50 S.W. FON&I K
Name of Subdivision L ty., Narne
M1asCo A.C�
Job II(Ax !_OT 25 I O 3 �1 L Architect Mailin gAddress
Address Site Addrrss
CdyiState Zip Phone
Names S NS C N _ i cr ALID ry'- lV ZZs 6vl
r—. Nameme
Owner Mailing Addres% FP y no rJ 'RU W£'L L-
--"5 C� Engineer Mailing Andress
City/State c p Phone g y 3 ',E It-)v`'f AYE
CityrS:alr: - Zip Phone
Name }, alp oy, q 7�1 ZSr-/-hZ9L
General Fc-,C{t2 D C C)M s n 2,u C-T I o N Describe work r1eWX addition O alteration O repair O
Contracto.' Mailing Address to be done
�• BOX I Additional Description of work:
City/State Z:o Phone
Etc:wcr rolioo701 570-0Sn1
Oregon Const. Cont. Board Lie.# Exp. Date ^(�
Attach Copy of 07103? _ 1-:7-- 7 8' Project Q _ �
Current CGT Business Tax or Metro# Exp. Date Valuation `P - r /5 /�
Licenses ew Ll 1� 11w NEW CONSTRUCTION ONLY:
-- --- Name ..
MechanicalSgTt. House Sq.Ft.Garage:
eC I L_I �)F_ -S 1 6 `2 1 2_7
Sub- Mailing Address `— *14C /
Contractor952_ s. --- I.
, ,T.
� Corner Lit Yes No, Flag Lot Yes I
r�R , _
city/state Zip Phone (check one) (check one)_-:
(a R 09 97Z?-3 6ZO-S'-64 3 Rei, rioted Audio/Sterec; Burglar
Oregon Const.Cont.Board Lc.# Exp.Date Energy System Alarm
Attar hCopy of (,,fps7 p es--il- - 0�
C,urent COT Business Tax or Metro# Exp.Date Installation Garage Door HVAC
Opener X Systems
Licenses UO�O (C"91L �
Name (check all that Olher.
t, g ;
Plumbing Pj ALU M /�1 apply) t' lw t. in
Will the electrical subcont actor wire for all Ye No r
Sub- Mailing Address � r
Contractors f restricted enerny Installations?
5 y�. 5• s 1 Has the-6 *eieft-P+st recorded? N/A Yes Nq
C ty/State Zip EPhone MI Nr L A N p PAK7 tCIuFJ ✓ 'I
F4zseoxo o 2-�Oregon Const Reissue of MS�7TP Solar Compliance
Attach Copy of / 2Jo 7 97 '76 " G'd z (Calculation Attached)
Current PlumbiL c # Exp. Date I hereby acKnowlecge that I have read this application, that the
Licenses I y-- y y eo _3o-177 information givens correct, that I am the ovmer or authorized agent of
COT Business Tax or Metro# Exp Date the owner, and the, submitted are in compliance with Oregon
DOC)C)ZO I77 1.-1-9-7 State laws _
Name Sigryt y0yyr�e fiery Date
Electrical r5 `LECrte C_ � — -
Contact on Narne �/ Phone
Sul)- Mailing Address L�E.F I h1 R�' j)q i- $ Q-0 _�
Contractor 5 7 S 7 5,C- • 41 NV4 FOR OFFICE U,-,E ONLY:
Gtylstate Ziphone Plat# rnf,.r'CIS_--JL'r� g / Map�TL# -
i �'orttL�wu old '�LeKIS forAclA�oS 1 0,3/ C
Oregon Const Cont BoIrTM# Exp Date
Attach -opy of Setbacks Zone Solar:
C.:r ent Electrical t.ic # Exp.Date �-
L,censes ?
COT B"Business Tax or Metro# F..xp. Date Engineering Approval. Plann.ng Approval: T'IF:_
ists'mstapp dos
r
Permit # A�t�gunt_ rriu Ami Amt. Pd. Qal. Dye
MST. Permit (BUILD) 1. u ,yz 7L'. .sy
Plumb. Permit (PLUMB)
Mech. Permit (MECH) U
ELC/ELR Permit (ELPRMT) ,/ S v _ 04 SU
State 'Fax (TAX)
Bldg: /C 3
Plumb: /
Mech
ELC/ELR
Plan Check
MST: (BUPPLN) -220 �� { �5�; vo �.Ge 3
Plumb (PLMPLN)
Mech: (MECPLN) �', _ z
CDC Review (LANDUS)
Sewer Connection (SWUSA) C
Sewer Inspection (SWINSP) _3
Parks Dev Charge (PKSDC) v,-4L) 0 1c) S c,
Residential TIF (-FIF-R)
Mass Transit TIF (TIF-MT) _
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT)
Erosion Planck/UoA (ERPLAN) i-�>c�v �4 _
Erosion Planck/COT (EROSN) ;Lv ti
Fire Life Safety (FL-0)
TOTALS:
i ldsts\mstapp doc
7"/ //
Rev 7/96
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
ROBERTS ELECTRIC TNC
5759 SW 48TH
PORTLAND OR 97213
Electrical Signature Form
Permit # . . . . . MST96-0421
Date Issued. : 12/26/96
Parcel . . . . . . : 2S103AC-06200
Site Address . 11350 SW FONNER ST
Subdivision . : MLP95-0019
Block . . . . . . . . 1 t 002
Zoning. . . . . .
Remarks :
Path I
Your company has been indicated as the electrical contractor for the permit indicated above. In
order for the electrical permit to be valid, the signature of the supervising electrician
is required.
Please have the appropriate individual from your company sign below and return this Electrical
Signature Form prior to the start of work. No electrical inspections will he authorized until
this completed form is received.
AN INK SIGNATURE: IS REQUIRED ON THIS FORM
)WNRP : ELECTRICAL CON'T'RACTOR:
FOUR D CONSTRUCTION ROBERTS ELECTRIC INC
PO BOX 1577 5759 SW 48TH
BEAVERTON OR 97075 PORTLAND OR 97213
Tlh,:n- if : 590-0805 Phone # : F-244-0560
Reg # . . : 000093
1
X � <
�igna ure o Supervising—€ ec rirician
Please return this completed form to the address above.
A T'T-N: Building Dept.
If you have any questions, please call 639-4171 , ext. #310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
G & B PLUMBING
1592 SE 51ST
HILLSBORO OR 97123
Plumbing Signature Form
Permit # • MST96-0421
Date Issued. : 12/26/96
Parcel . . . . . . : 2S103AC-06200
Site Address : 11350 SW FONNER ST
Subdivision . : MLP95-0019
Block . . . . . . . : Lot : 002
Zoning. . . . . .
Remarks :
Path I
Your company has been indicated as the plumbing contractor for the permit indicated above. In order
for the plumbing permit to be valid, please have the appropriate individual from your company sign
below and return this Plumbing Signature Form prior to the start of work. No plumbing inspections
will be authorized until this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
' WN1'N : PLUMBING CONTRACTOR:
FOUR D CONSTRUCTION G & B PLUMBING
PO BOX 1577 1592 SE 51ST
BEAVERTON OR 97075 HILLSBORO OR 97123
# : 590 -0805 Phone It : .J
Reg # . . : 019907
Signature of Authorized Plumber
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639-4171 , ext. #310
r —
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171
CERTIFICATE OF
OCCUPANCY
pERMl•I' i1. . . . . . . : MST96 -04c i
DATE ISSUED: 07/23/97
PARCEL: 2S103AC:-06-200
1TF ADDRESS. . . : 11350 SW FONNER a ZONING:
UBUIVISION. . . . : hILP95 -0019 JURISDICTIONP TICS
13LOCK. . . . . . . : LOT. . . . . . . . . . . . . :00
CLASS, OF '40RK. :NEW
TYPE OF USE. . . i GF
TYPE. OF CONSTR:5N
OCCUPANCY CARP. : R3
OCCUPANCY LOAD:1'
Itwmai 1(i : Path I
FOUR U CONSTRULTION
FSO DOX 1577
BEAVERTON OR 91075
Phone #& 590•-41805
ontractor: _- _-
J1UR D CON FTRUC T I ON
'I EaC1X 1577
'EAVERTOIJ OR 97075
h u n e #: 59111-08051
a g IF. . : 0x1+0710
Iii s Cert i f i.c,xt :: grants rGt_upanr.y of thethr;ve referenr-e!d bui lcJing or' pox t in��
hereof and c:_onfirms that the builciing has been insp ,ted for- camPliance ith
he Fit;.ate of Or
c>pecialty COdPs for the pt-OLTP, ef! upanc.y, and use under•.
,hich the rPfelreneed Permit was issued.
,
. . BUILDI
iUILDIr-16 ,-.-,,FECTOR OFFI�T
v,OS7 IN C:ONSP I CUO05 PL GICF.
CITY OF TIGARU BUILDING INSPECTION DIVISION
24-Hour lnspcaion Linc. 639-4175 Business Phone: 639-4171
Date Requested: fl �" _----.-- A.M. P.M. MST (7Z/
Location: ._._ � � )Lt(I �.AJ �� �-- BUP:
Suite; Bldg: NEC:
Contractor y ' D L[3/1�t11 Phone: _7.Z0 '7C� �J _ PLM:
Owner: Lc Phone: ELC:
k_� TU Ffzp�h- aa0 JO 121 CT147- C4-7 1)0012- I IQ ELR:
F-000DAT70t1i 1/k>� Srr:
BUILDING G c9n't) IG MECHANICAL 4LEC `Alm SITE
Site cam Post/Beam Post/Beam c ver Mice Sewer/Storm
Footing Roof UndFVSlab Rough-in Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In C�+LI� UG Sprinkler
Foundation Insulation`fkb) Sewer I lapd/Duct Reconnect Vault
lismt Damp Drywall Sloan Furnace Temp Service MIStC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear/Sheath lire Spklr/Alm Crawl/lound Dr I leat Pump Low Volt
1'liro Approved Approved pprove Approved
Appr/Sdwlk r o roved Not Approved Not Approved o - Fovea Not Approved
FINAL FINAL FINAL FI1V FINAL
C7 Call for reinspection CI Reinspection fee of Srequired berorc next inspection 0 Unable to inspect
Inspectot:�- _ -- Date:_ �' 7 Page___—of_----
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection line: 639-4175 Business Line: 639-4171
BUP
Date Requested �i7 � - AM PM BLD
Location C� ��/Yl u'`- — Suite MEC U /
Contact Person �„ Zu- Ph (F' �U �� �-� PLM
Contractor Ph OZ - 1(le -Y, SWR
BUILDING Tenant/Owner _
ELc
Retaining Wall ELR
Footing ACCP,SS: +r� �e /''�/) Qt -FPS
Foundation ------ --
Fig Dain SGN
Ciawl Drain !nspection Notes: -
Slab _ '� _� ..�---- --- SIT
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -
Fire Alarm
-
Susp'd Ceiling — - -- -- - -- - -C--�t�-l�
Roof
Mise -
Fina) - .------- -
PASS PART FAIL ------ --- _-___ __- -------
PLUMBING
Post&Eeam ----
Under Slab
Top Out
Water Service
Sanitary Gewer
Rain Digins
Final
FAIL
�El ANICALAiLies --
n �'�. a - - - ----------------
Gas me
Smoke Dampers
T FAIL
4kiUfR I C A L - - ----- - ---- —
Rough In J_ ---------- - - -
UG/Slab -_ --.-_ -- --
Low Voltage
Fire Alarm —
F
A' RT FAIL
Backfill/Grading — -
Sanitary Sewer
Storm Drain [ j RelnsNb�;tlon fee of$-_^ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ Please call for einspection RE: __ Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk �, fJ,� h _- -� •:xt
Other date his actor
Final
PASS PART FAIL J O 4-4OT REMOVE this inspeclJon record from the jvb site. i
�
CITYOF TIGARD __MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2000-00149
13125 F:W Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 04/25/2000
PARCEL: 2S103AC-06200
SITE ADDRESS: 11350 SW FONNER ST
SUBDIVISION: PP1996-063 ZONING: R-4.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VE-.NT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
_FUEL TYPES_ 0 3 HP: ? DOMES. INCIN:
3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
OTHER UNITS:
FURN -100K BTU: <= 10000 cfm'
> GAS OUTLETS:
.1n000 cfm:
Remarks: Install an air conditioning unit. A/C units cannot be placed within the required setback areae.
Owner:_ _ _ FEES ~ _
JIM BURGESS Type By Date Amount Receipt
11350 SW FONNER PRMT GEO 04/25120( $50.00 1001670
TIGARD, OR 97223 5PCT GEO 04/25120( $4.00 0001670
Phone:503-620-1387 Total $54.00
Contractor:
SPECIALTY HEATING + FABRICATIO
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Cooling Unt Insp
Phone:620-5643 Final Inspection
Reg #:SUP 257ORET
LIC 006657
ELE 34-341 CR
rpA
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. ATTEN i ION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952.001-0080.
You may obtain�opies�f these les or direct questions to OUNC by calling (503)246-9189.
Issue By: // //// �' _— Permittee Signature:
Call (501) 639-4175 by 7:00 P.M. for inspections needed the iiext business day
Check
CITY OF TIGARD Mechanical Permit Application Plan Ch
Recd By
h
1312.5 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223D p0/`a0 — Date
to DST
(503) 639-4171, x304 a
Print or Type ( Permit#MPe;zV0V von
Incomplete or illegible applications will not be accepted Called _
Name or CevelupmenUProiect Description
Table 1A Mechanical Code City Price Amt
Job Street Addiess Suitett A) Permit Fee 4;°,W •f NJOP;*' 16 00
Address 1/35o 5 W iciwv 1) Furnace to 100,000 BTU
including ducts&vents see footnote 1,2 9.65
eidga ctystate Zip 2) Furnace 100,000 BTU+
G� r! including ducts&vents see footnote 1,2 12.00
Na (or name of business) 3) Floor Furnace _
Owner ��� including vent see footnote 1,2 965
4) Suspended heater,wall heater
ailing Address
or floor mounted heater see footnote 1,2 965
/ .3! 2 S Int/ n 5) Vent not included in appliance permit 4 75 _
to Zip phone Chick all that apply. 'Boiler Heat Air T
For items 6.10,see or Pump Cond city Price Ant
Nor (or name of business( footnotes 1,2 Comp
6) <3HP;absorb unit to
_ 100K BTU _ 965
Occupant timing Address 7)3-15 HP,absorb unit
100k to 500k BTU "j _ 1755
Crtyrstare Zip Phone 8) 15-30 HP, absorb
unit 5-1 mil BTL' 24 1 s
Name 9)30-50 HP,absorb
Contractor ucit 1-1.75 mil BTU 36 00
10)>50HP, absorb unit
Prior to permit Ma..ng Address >1,75 ml BTU 60 15
issuance,a copy / 11 Air handling unit to 10.000 CFM
of all licenses State Zip Phone 700
are required if / g!e--e oe Q;01�3 G m S-4�f-s 12)Air handling unit 10,000 CFM+
expired in COT 0//of�g•:n co st Co l 5oard,.c x Exp D to _ 11.85
database iP �7� 5��/ 13)Non-portable evaporate cooler
Architect Name 700
14)Vent fan connected to a single duct
or Mailing Address 415
5
15)Ventilation system not included in
_ appliance permit 7.00
Engineer CAyrState Z,p n~one 16)Hood served by mechanical exhaust
7.00 _
Describe work to be done 17)Domestic incinerators
12.00
New® Repair 0 Replace with like kind Yes O No 0 18)Cor ia1 or industrial type incinerator
Residential Commercial 0 _ 48 25
19)Repair units
Additional information or(escription of work: 8.40
f n6t , / 1� I _ 20)Wood stove/gas FP/other units/clothe dryerletc. 700
NOTE: For Commercial projects only,Units over 400 lbs.require 21)Gas piping one to four outlets
structural gas talcs See footnote 1 375
Type of rue! oil 0 natural gas O LPG O electric 22)More!han 4-per outlet(each) 75
Minimum Permit Fee$50.00 SUBTOTAL •>pt00
I hereby acknowledge that I have read this application.that the information 8%SURCHARGE '
given is correct,that I am the owner or authorized agent of PLAN REVIEW 25%OF SUBTOTAL
the owner.that plans submitted are in compliance with Oregon State laws Required for ALL commercial permits only
TOTAL r �(
Signature f Owner/Agent Date —
Other Inspections and Fees:
1, Inspections outside of normal business hours(mininum charge-two
Contact Pen Name Phone hours; $50.00 pe,hour
2. Inspections for which no fee is specifically indicated (minimum
charge-half hour, $50.00 per hour
Foones for commercial project only: 3. Additional plan review required by changes,additions or revisions to
e
1 Provide full schematic of existing and proposed gas line and pressure. plans(minin um charge-one-half hour)S50.00 per hour
Provide drawings to scale showing existing and proposed mechanical
units. 'State Contractor Boiler Certification required
"Residential A/C requires site plan showing placement of unit
I Umechperm doc rp.:7/19/99
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ELECTRICAL PERMIT
CITY OF T I G A R D
PERMIT#: ELC2000-00200
DEVELOPMENT SERVICES DATE ISSUED: 04/25/2000
13125 SW Hall Blvd.,Tigard. OR 97223 (503) 639-4171 PARCEL: 28103AC-06200
SITE ADDRESS: 11350 SW FONNER ST
SUBDIVISION: PP1996-063 ZONING: R-4.5
BLOCK: LOT : 002 JUR►.,DICTION: TIG
Proiect Description: Add a first branch circuit.
_ RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS MISCELLANEOUS _
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRICATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGNIOUT LINE LTG:
LIMITED ENERGY: 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: WlSERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st WIO SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC- IN PLANT:
601 - 1000 amp: _ PLAN REVIEW SECTION
1000+ amp/volt: >=4 PES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVCIFDR >=225 AMP:': CLASS AREA/SPEC OCC:
Owner: Contractor:
JIM BURGESS ShARNE ELECTRIC INC
11350 SW FONNER 226125 SW RIGG
TIGARD, OR 97223 BEAVERTnN, OR 97007
Phone: Phone: 642-7937
Reg#: LIC 600815
SUP 3344S
ELE 34-2170
FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRiv1T GEO 04/25/200C $37.50 0001670~ Elect'I Final
5PCT GEO 04/25/200C $3.00 0001670
Total $40.50
I
1 his 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 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 by the Oregon Utility Notification Center Those
rules are set forth in OW!952-001-0010 through OAR 952-001-0090 '(ou may obtain copies of these rules or direct questions to OUNC at(503)
246-1987 -�
PERMITTEE'S SIGNATURE �;,�/ �� ISSUED BY:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, o rent.
OWNER'S SIGNATURE: DATE:-
CONTRACTOR
ATE:CONTRACTOR INSTALLATION ONLY_
SIG14ATURE OF SUPR. ELEC'N: DATE:_._����d
LICENSE NO: _ ____ _ 3 3yo
Call 639-4175 by 7:00pm for an inspection the next business day
CITY OF 'TIGARD Electrical Permit Application Plan Check#_
13125 SW HALL BLVD. Recd By
_
TIGARD OR 97223 Date RecdDate to P E
Phone (503)639-4171, x304 Date to DST
Inspection (503) 639-4175 Print of Type Permit# aRcd
f ax (503) 598-1960 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name(or name of business)__j:j W� fe-S 5 _ Service included: Items Cost Sum
Address ! 5 0 5 _ 4a. Residential-per unit
City/State/Zip � g/ ��� loco sq R o.less $ 117.75 _ a
Each additional 500 sq It or
portion thereof $ 2675 _ 1
Commercial ❑ Residential Limited Energy $ 60.00 ^�
Each Man-jt'd Home or Modular
2a. Contractor installation only: Dwelling Service or Feeder _ _ $ 72.75 2
(Prior to permit issuance,applicants must provide contractor license 4b.Services or Feeders
Information for COT data bas ► Installation,alteration,or relocation
Electrical Contractor r. _' < _k!lc _ 200 amps or less $ 64.25 2
Address ` ! 201 amps to 400 amps $ 85 50 2
1 --� '— j 401 amps to 600 amps _ $ 128 50 2
City _��_:4 rtel-" State Zip 1 IC,dn -7 _ 601 amps to 1000 amps $ 192 50 2
Phone No. J _�i y.�- 7Y 3 7 Over 1000 amps or volts $ 363 75 2
Job No S e�O _ — Reconnect only Y $ 53.50 2
Elec. Cont. Lice. No. Exp.Date dr,.Temporary Services or Feeders
OR State CCB Reg No �iS� Exp.Date !�A le Installation,alteration,or relocation
COT Business Tax or Metro No 24 4, L_Exp.Date 200 amps or less _ $ 53 50 — --
201 amps to 400 amps $ 8025 2
Signature of Supr Elec'n _C,,)�`rr���,,�, 401 om! � _ nveramps to 600 a npsOamps to 000 volts, $ 10000 2
License No ���_Exp.Date b 0
see"b°above.
4d.Branch Circuits
Phone No __$ 11 2!2 7G -____, New,alteration or extension per panel
a)The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5;15
Address b)T he fee for branch circuits
-- - - ------ without purchase of service
City `date Zip_ __ or feeder fee.
Phone No. First branch circuit I $ 37.50 3 "�
Each additional branch circuit $ 5.35
The installation is being made on property I own which is not 4e.Miscellaneous
Intended for sale, lease or rent. (Service or feeder not included)
Each pump or irrigation circle $ 4275
Owner's Signature _ Each sign or outline lighting $ 42.75
Signal circuits)or a limited energy
panel,alteration or extension _ $ 60.00
3. Plan Review section (if required):* Mi
_
nor Labels(10) $ 100.00
Please check appropriate item and enter fee In sviation 5B. 4f.Each additional inspection over
4 or more res,,iential units in one structure the allowable in any of the above
–'-- — Per Inspection $ 5000
_Service and fader 225 amps or more Per hour $ 5000
_System over 600 volts nominal In Plant $ 59.00
---Classified area or structure contair ing special occupancy as
described in N E.0 Chapter 5 5. Fees:
5a.Enter total of above fees $ 3 -5"
Submit 2 sets r+plans with application where any of the above apply. 8%Surcharge(.08 X total fees) $
Not required for temporary construction services. Subtotal $
5b.Enter 25%of line ba for
NOTICE PI-n Review if required(Sec 3) $
PERMITS BECOME VOID IF WCRK OR CONSTRUCTION'AUTHORIZED Subtotal $
IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR
WORK IS SUSPENDED OR hPANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account#
AT ANY TIME AFTi:R WORK IS COMMENCED Total balance Due $ U. J C/
i d,rti form,electric doc