13749 SW FERN STREET n
APO I .�
JAY MILL B 1t 1JUJIMER, INC. 110 IJUX 23201 I'MAIWI Vit 97281
I'll: 00 -'IG4J 1,' RX., 604-0671s ML_
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LO Ta_ S1U1)D1V1SI011i L_
ADDRESS: q f��
Sctuc: 1 /8" = 1' Nolcs: Down6pouts and crawlepacc draln to Strcet.
51devvidits and drive-way approach to city code.
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NOT"CE: IF THE PRINT OR TYPE ON ANY
C1 i 1 t1I ! ili t1 ]T .T [T Trlr ii-r Ii ;
IMAGE IS NOT AS CLEAR AS THIS NOTICE, 2 3 I12
I I DUE TO THE QUALITY OF THE -
No.36
ORIGINAL DOCUMENT ----�__-- -- ______-- - -_---___-_ -- ___-- ____-- _-
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'� 13749 SW FERN ST "'
CERTIFICATE OF OCCUPANCY
CITY OF T I GA R D
PERMIT#: MST95-00007
DEVELOPMENT SERVICES DATE ISSUED: 02/03/1995
.13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S10413D-04300
ZONING: R-7
.JURISDICTION: TIG
SITE ADDRESS: 13749 SN! FERN ST FILE
�
SUBDIVISION: ROSE MEADOWS
PY
BLOCK: LOT:002
CLASS OF WORK: NEW
TYPE OF USE: SF
TYPE OF CONSTR: 5N
OCCUPANCY GRP: R3
TENANT NAME:
REMARKS: PATH I - Final Building Inspection and Certificate of Occupancy
Approved 7/1/95 by Ken Schriendl, Building Inspector
Owner:
Phone:
Contractor:
KEN WATTS CONSTRUCTION INC
PO BOX 230925
TIGARD, OR 97281
Phone: 684-4431
Reg#:
This Certificate grants occupancy of the above referenced building or portion thereof and
confirms that the building has been inspected for compliance %.,ith the State of Oregon
Specialty Codes for the group, occupancy, and use under w!tich the referenced permit was
issued. i J
BUILDI O INSPECTOR BUILIING OFFICIAL
POST IN CONSPICUOUS PLACE.
5-z 8
CITY OF TIGARD BUILDING INSPECTION DIVISION
G24-Hour Inspection Line: 639-4175 Businm Phone: 6394171
Date Requested: '/ —QA A.M. P.M. MST:
Location BUR Ig
Tema: _ — _ Suite:___Bldg: MEC:
Contractor:_ „_ - --_. Phone: _ _L.7 P1.M:
—_ —,
090
Owner:------------- Phone: �� �?�� t:L,C: --
---- ELR�— — —
__ SI-I':
BUILDIN ��BLDconi) PLUMBING �MECH4NICAL ELECTRICAL SITE
Site t'os Akmn y`—�- PosUBemn Post/Beam Cov:-r/Service Sewcr/Stone
Roof UndFI/Slab Rough-In Ceiling Water Line
Slab ramm -I'op Out Gas Line Rough-In UG Sprinkler
Toundalion Insulation Sewer Il(exm)uct Reconnect Vault
Iismt Damp Drywall Stoml Fnmace 'Temp Service MISC.
Masan-y Ceiling Rain Drain A/C UG Slab
Shear/Sheath I'irc Spklr/Alm CrewUl'ound Dr I lent Pump Low Vola (�
Arove( �, Approved Approved Approved Approved
Appr/Sdwlk >)roved Not Approved Not Approved Not Approved Not Approved
FINA FINAL FINAL FINAL FINAL
---- -- � 3t3� /} l /�.r�2- S'.�G�S G=•!�. i='1�� ST , i�t `rC�/1 1 C_ —
D7 Call for reins O Reinspection fee of S - __required before next inspection D t Innble to inspect
Date Inspect— D _ /
--- -- Page----- of
CITY OF TIGARD
DUTI D11\113
DEVELOPMENT SERVICES
93-214M 13125 S W Hall Blvd.,Tigard,OR 97223 (503)6394171 1 T�iGUFA):-
J::,()RCA*.]...,-
1.3749 SW 1::'1::.RH 5 1
ROW.- Ml--:0DC)W(:; R
:002 JUR 1,C)1)1 C'T 1CA-1-0,1C.-�
DL.C)C,'K.
............................................................................
RI: I SUE F1 OOR 1:::XTER*1*.()R W01 I C-*,C)H�-)TR(J(`,'T...011-
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I - *T*0 I()I........................
(AW). -R.3
OCCUF.,A1"1C"*y 1 0 1,1ASE ITIERT. N 0 Sf 0RE::0 SEP. R011:1)n
S*TOR. C FIT:: 9 f 11 CY)RAG1:71. .. 0 RA'TEDt
14SM"I 111:17z'? RE(A) St.."T 11 ACIK S
9110K DIHA'"
F."I OOR LOAD. . . .. n 60 f-t-, 0 f t F--*I:R
@ 8 -ft 1::*,E R ()I Rlvl:: HNDI(*,[.:, A( C',
DWE.A.LING UN11,1:3-- 0 3 0
BEDRMS s 0 1-*1(-)J*1--113,- 0 TITIP 0 (',('.)RR.- PARK 1:N(
VOL11E.$n :1.0 i.?4
Rern,A-rk.s o Addition of deck to single family residence.
Dwrie-r I ......... F-F.F:.G
ROL-*41:::R*T ROISENPI 0011 t,y p V. -Allicn.trit by 1-�A-(-;e -rec,pt
?' 3p)/98 98---,301:5394
1.3749 (:,)W F41M STRF*,*.E1* DEf.4 04/,
'11CIORD OR 97'(223 1'.)RITIT ii P.5.00 DI-1-4 05/21/911 98 3095929
1.25 DIA-1 0 r-5 ro?1. 8 98""305 9('?'--*�
phc)viv� Oc
C'oiit-(-,xetc)-r. ................................................................................................
PE."YTON PROPERT1179)
3CA-IN MOR11N r:'F.*.:Y'I*(:)N
SW 6TYTH AVE 01-04
LOKE (:)1,*.-)WF:(3O OR 9*10135 $ 4r`-�.50 rOT01-
Phorie Oc 635 25 9 9
Reil 1:1.2070
AC-TTONS)
..........
This permit is issued subject to the reqttlations contained in the ITISP
Tiga,-d Municipal Code, �,tate of (bT. Specialty Codes aix] all other .....................................
applicable laws. All wo* will be done in acrordance with ....... ........................................................
approved plans. This permit will expirp if WDT+.. is not Started .............................................................
within IN days of issuance, or if wo* is suspended for more ...... ............................................................
than 180 days. AlTFNTION: Oregon law requires you to follow the ................ ........................
rulp,; adopted by thp Oregon Utility Notification Center. Those ........ ..............................................................
rtilp,; are set forth in W through OAR 952-WIRW. ................................................................
Ynt, many obtain a copy of these rules Or direct questions to OLW, ....................
bf ;,;Ilinq (503)246--1987. ........—--------------............... .........................I.................
.............................
................................ ................................................................
Pe-rniit,tee SignAtU'ret" ii-,�.t e d D ..........................
L
�f.++4-+++4-++4-+4-4-+4-+ +4-+-#....... 4-++4-+++++4--+-4-++++-f-+4--+-4-,#- ........f.+++++4-++4-4+f-
C'A 1.3. 639 4175 by 7--.00 P-M- fc)-r iaii i.1-1spec-ti.c.vi iieeded the riext bt.tsi.i-iess (:IAy
4-4-++++4-+4-4-+++++++4-+4-++++++4.............4-4...........�-++++++++++++4-++.4........ +
L
n1 20 RS uu\ I.1 : 0 I'k\ 30:► 598 19iu ► l'I'I OI.' 'I'IG.WD p 002
Plan Check p
CITY OF TIGARD Residential Building Permit Application Recd By _
13125 SW HALL BLVD. New Construction Additions or Alterations Date Recd r
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P.E. s ' -Y
V 503-639-4171 Date to DST:'y:'''
F 503-684-7297 j Permit a .:p'D/9
Print or Type Called 5-14115b.
Incomplete or illegible applications will not be accepted
Name of Projectame
I .�
Job vn��-L/)&,W Y-4:1—yL Architect Mailin ddress
Addvess S to Address �
City/State Phone
It,6S�itklire . Name
Owner Mailing Address /
/�,'c
�1UY/Slata Zip 1,Phone Engineer Mailing Ad as
CI tate Zip Phone
General N A"L
Contractor 7Uw�'�:� / r � �f41e Describe work New o Addition 0 Alteratlon 0 Repair O
Mailing Address to be done:
Prior to permit 4,1 K A '5 r Additional Description of Work:
issuance,a appyity Slat Zip/� Phone
of all licenses u rv1C �S ►.���
are required if Oregon Const'Cofht.Board Exp.Dale PROJECT
expired in COT Lic.K / (�� __ _ VALUATION $
database __
Mechanical Name /y�.r,Z,� rMy I _NEW CONSTRUCTION ONLY: _
Sub- t.Ft. House: Sq. Ft. Garage
Contractor Mailing rens p ,9y'Ii
Prior to permit _ _ _ Corn of YES NO Flag Lot S NO
Issuance,a copy City/State i Phone L(check on _ check _
of all licenses Restricted Audio/Stere Burglar
are required if Oregon nsl Coni Board E,,p. Date Energy S stem Alarm
expired in COT Lic_
databaseInstallation _ea'Ke a Door HVAC
Plumbing Ner e i I er Systems
Sub- (check all that Othe ,
Contractor Mailing Ad s apply)
Will the electri subcontractor wire11 11 YES NO
restricted a rgy installations? 7_ _
Prior to permit CityrState Phone Hast bdivision Plat recorded? N/A �ES NO
issuance a copy
of all licenses are Oregon Const Board Exp.Date
required if Lac a S r Compliance
expired in COTCalculation Attached)
database Pj ing tic x _ I_xp ate I hearby acknowledge that I have react this application,that the
Information given Is correct,that 1 am the owner or authorized
Naiire agent of the owner, and that plans submitted are in compliance
with Oregon_SWte laws. __
Electrical _ _ Si nate► w erlA 'Y Date
Sub- fAadin ddress _ ,y g
Contractor irsonPOfihone t*
CilyrState <,,,
Phone
Prior to permit FOR OFFICE USE ONLY:
issuance,a copy _ _ ___ Plat#: Map/TLi�: ,
of all licenses are Oregon Cons ont Exp Date <�
required it l is N Setbacks _ Zone: Solar:
expired in COT ---
database Ele cal Llc ax "x\ Date Engin ring Approval. Plannin t pproval: TIF:
LSFREM.DOC (DST) 4197
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CITY OF TIGARD PLUMBING PERM11
COMMUNITY DEVELOPMENT DEPARTMENT PERmi V #
13125 SW Hall Blvd.Tigard,Oregon 97223*6199 (503)a39-071 DAIL ISSUED: Oe/03/95
PARCLL; 25104BL)--RM00L
i� ] L ADDRL-73G.. . . : 1'_'� /49 SW PERN s'r
�.11301 V 15 1 ON. . . . : ROSE MEADOWS ZONING: R-7
-OCK. . . . . . . . . . .. I-01... . . . . . . . . . . . . 00,71
-ASS 01" WORK. . :NEW GARVAGE' DISPOSALS— - 1
"'WE OF USE. . . . :SF WASHING MACH. . . . . . . : 1 BACK�FLOW PRLVN'('RS. . -. 1
..CUPANL'Y GPP. . :R3 F"L 0 0 R L'R k 114 S. . . . . . . :0 RkPS. . . . . . . . . . . . . . .16
Lj H i E�tj. . . . . . . . 12 WATER HEATERS. . . . . . il C ATL H B A 5 1 NS. . . . . . . 10
.1 X TU RES LkUNDRY TRAYS. . . . . . : 1 SF RPIN PRA11\1S. . . . . : 1
(04KS. . . . . . . . . . : 1 GREASE TRAPS. . . . . . . :0
i4VATORIF.5. . . . . .4 OTHER F I X TURES. . . . . :0
JB/SHOWr_RS. . . . - SEWER LINE ( ft) . . . . :0
4TER CLUSLIS. . : 3 WATEF,' LINE (f t 1014)
-SHWASHERS. . . . : 1 RAIN DRAIN (ft ) . . . . :0
�:,marksp PAIH I
,4Y MILLER T 1 F- $ 1`550. 00 J F 02/03/95
0 BOX 23291 5WM $ 180. 00 JF 02/03/95
SWIVI $ 100. 11111A 2T 0 a/I'll 3/95
Izi R D 0 R' BPRI $ 49B. 111121 J 1" 02/03/95 ...
684-7543 BPLC $ 50. 00 KAR 12/29/94
0115VIL 11 2 4. ')it) J�- 111,t/1113/95
mbiuq -------- Pnplj� -1, 51110. 00 JF 111,�/03/95
MPRT 43. 50 J F 02/03/95
KEN WATTS CONSTRUCTION INC MPLC 1i 10. 819 J F 0,--'/0 3
M5;-:'C $ 2. 18 JF 02/03/95
t A t-a .30 1 H $ L.-",25. 00 JF 0 LA 9'5
p ! V'5PL $ 11. eb JF LAC-,/0.6 9 b
Additional fees not Shown here. . . . . .
HLUUIREU iNSPLL, I IONS
11s permit is Assued subject to the reg
,,Ations contained in the 'rigard MunicipAl Foot/foi.tnd Irisp Rain drain Insp
rjde, State of Ore. Specialty Codes and all Posl'/Be'�Am �3truct Wiater Line Insp
1.ner applicablp laws. All Wor'k will be done Post/Beam Mechan Appy,/Sdwlk Insp
PlIm/undslab In,:p Mechanical �:inal
accordance witli Approved plans. fhis
or-mit will expire ,, f work is not started VILM/Underf loor Plumb Final
ithin 180 day% of issuance, ar if work is Mechani(:al Insp LAu i I d i n 9 1- j.Ti a I
.ispended for more -than 180 days. Plumb Top Out Erosion Control
Fv-aminq lnsp Wtr Proofing Rsm
Fi�-evlace Insp Crawl Drain
bas Line Insp Ftg Drain Bsm'
Insulation Insp
-d
Gyp Doar I n s p
t u t,i z e d t- .i 1 Q n L;k t u r e
Call for inspection 639-417',-j
)ritrar-tor I\Iute5 -.
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT MASTER PERMIT
13'.26 SW Hall Blvd.Tigard,Oregon 97223*61,99 (503)639-4171 PIH-RMIT #. . . . . . . : MST95-001,A/
DATE ISSUED: OE/03/95
PARCEL:
TL ADDRESS. . . SW FLRN �JT
.jBDIVISION. . . . . ROESE MEADOWS ZONING: R-7
OCV. . . . . .. . . . . LOT. . . . . . . . . . . . . ..00,2-
BUILDING
i._IGSUL.,M9T-9b--00lZA6 DWELLING UNIT5 : 1 BASEMENT. . . . . . . . :0 5f
.ASS OF; WORK. iNEW BEDRMS:3 BATHS:3 GARAGE. . . . . . . . . . ..400 5f
4�111` OF U53L. . . :SF FLOOR AREAS-- ---- REQUIRED SETBACKS------
(PL O� LUN51 . :bN F I R61 . . . . :970 6 f LEFT. . :9 ft RIGHT. :6 ft
.'C,UP( . L_ -
INE'Y GRP. :R3 SECOND. . . .-B64 5f FRONT. : --"0 ft REAR. . : -;6 f!
iORlLS. . . . . . . :a FINBSMEN7':O Sf REUUI
16FI I . . . . . . . . ..k�4 ft TOTAL - -- % 1634 -;f SMOKf.- DI-TrCTORS. : Y
UOk LOAD. . . . :40 ptf VALUE. . . . . I.E5094 PARKING bPAC'.(_S. . * I
�Mar'ks. : PAIH I
PLUMBIN6 --------------
.NKS. . . . . . . . . . : 1 FLUOR DRAING. . . . :0 13PLKI-LOW PREVNI RI.D.
)Vi.,) OR I ES. . . . . .. 4 WAJER HEA7L.RS. - 1 T R A PS. . . . . . . . . . . . . . 0
1`1("�qCRG. . . . :3 LAUNDIiY TRAYS. . . . 1 (:ATCH BASING. . . . . . .0
iTER GLOGETS. . -3 SEWER LINE (ft ) . :0 GRE(45E rRAPIS. . . . . . . :0
ISHWASHERS. . . . : 1 WOTER LINE ( Ft ) . : 10 ILI OTHER FIXrURES. . . . . :w
i4"HB(4GE DISP. . . : 1 RAIN DRAIN (ft ) . :0
H I N G 11 A L H. . 1 GF RHIN DRAINS. . . 1
MLLHONILAL F-L.Lb
JL-..L U N I T 1-11'P'--,. 0 type .4111OLlylt by dAte r-ecpt
,AS/ VENTS . . . . . :0 1IF $ 1550. 00 JF 02/03/95
0 1 NPU T .0 bTU VENT FANG. . :4 13W�, $ 180. 00 JF* 0 2/0 3/9_-J
I CAO. 00 J 0210319c,
_JHN < 100K HOODS. . . . . . . I SWM $ J
jRN 100K :0 WOODSTOVES. :111 HIPH V $ -19 8. 00 JF 1&-'l LA 3/9')
�UUP. UHN. . . . it) LLO DRYLRS. : I BPLL*; $ 5 LA. 00 KAR 12/c'::9/94 9 4-c,:':b 0 0 4
.1 Al. I lbe./03/9ti -
'IL/(-'MF-' ( 3�4 lb U11 R UNIIS: 1 bbl-Al. $ c�4. " 0 Ji-
GAS OUTLE'15: 1 PARI'� $ 500. 00 JF 02/03/95
$ 4 3. 5 0 JF 1111R/03/95
1Y MILLER MPLA 1, 10. 86 JF 02/03/95
U BOX 12.3291 M5P"_' i, i-_'. 18 J I-- oc�/03/9b
3BTH $ 25- 0 0 JF 02/03/95
.41D ON P51)l_ $ 11. 25 Jf�
)ove #.: 684-754.� ERO�) $ 6'4. 00 JF 02/03/95
R P C .,0. E30 iF 02/03/95
,)Y MILLER ERK, $ L'O. 80 JF 02/03/95
I BOX SPL(,, $ 50. 00 JF 02/03/95
-OFIRD OR
onp #'. b34
-------------------------------------------
$ -3351. 31 TOTAL
is permit is issued subject to the regulations contained in tht REUUIRED INSPEL.11UNS
;jarci Municipal Code, State of D-e. Specialty Codes anc all 2ther Foot/fot-Ind Insp Fit-ppliice Insp
ac I
. plicable laws. All work will tf done ir accardince with ;ocroyed Plost/Bearn Sqtt,t.ict Gas Line Insp
ojars, This permit will expirp if work is not started with; 1241 Plost /BeeArn fyle&lan InsLilation Insp
uays of issuance, or if work is -;isppndPd for acr@ than �t! i,s. PIM/Undslab Insp Gyp Sciatt-d Insp
r:,LM/Undet-f I oor- Ra.n dt-ain I n s p
I"M I t; e e i qTli:.At W(I �K-ov Insp Watpv- Line Insp
Pli.imb Top Uk.tt Appt-/Sdwlk Insp
13 y r,a in i T1 q
-.-#If ITISP lyleetl�Aylic'_AL t lncAl
SEWER CONNECTION
CIN OF TIGARD PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : SWR95-00�."u
13$25 SW Hall Blvd.Tigard,Oregon 9722341199 (503)839-4171 DATE ISSULD: 02/03/9'.5
PARCEL: 2S104BD--RM00k*'--
I E ADDkL-Li,..+). FERN ST
JbDIVISION. . . . ROSE MEADOWS ZONING: R-7
. . . . . . . . . . LOT.. . . . . . . . . . . . . :002
I-ENANT NAME.
USA NO. . . . . . . . . . FIXTURE UNITS. . .
LA�13G (IF WORI-,. . . :NEW DWELLING UNITS. . - 1
YPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
NISTALL TYPE:. . . . :LAUSWR IMPERV SURFACE. S f
eriiarks � PATH I
Uwner: ------------------------------------------- FEES
J"Y MILLER type ainal-int by date recpt
BOX dsd9l FIRMT $ 2c'?00- 0 CA J F 0 2 CA 3 9 5
INGP $ 1611, J1.
TIC-3ARD OR
Phorie 1*: 684-7543
Contractor:
L,Ul\llf?HLJ0R NOI UN FILE
ihone $ 2235- 00 'IOIAL
He'4 #-
REQUIRED IN6PEC'FIONS
This Applicant agrees to comply with all Ve rules and regulations Sewer Itispec,tic)n
of the Unified Sewage Agency. The permit expires 180 days from
the date issuec. T�e total amount paid will be forfeited if the
wermit empires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measlit-event
given, the instailer shall prospect 3 feet in all directions from
the distance given. If not so located, the instalier shail purchase
i "Tap and Side Sewer" Permit and 1hp A�encv will install'..? lideral.
ewltnittee biqtiat ure
f �,9—4 1
Y'(119s ,
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
.lobsite Address: �-'� ,l '-V �'l '� t■..
Subdivision: )�.�
1 ('. i "I���O�U�__ Lot # Office Use Only
�
Planck/Rec# "C
Valuation: �: � 0 y,L�•
Permit#
Owner: Reissue of
Address: ',5 ti '� a �'�
Map & TL # „�.., � ��'( _�_���, l
A Drovals Regulred
Phony:
C .' Planning 4
Contractor: Engineering
Address: Other
Items Required
Phone:
Subcontractors
Contractor's License #
(attach copy of current Oregon license) Truss Details —
Contact name & phone: —_ Other
Subcontractors: Noma
Plumbing:
(attach copy of current OR Contractor's License)
11ll
Architect/Engineer: r LW1 0
Address.
Phone: 217tp
JOB DESCRIPTION:
Applicant Signature & Phone number
Received by: �_ Date Received.
Permit # Account Description Am,lunt Amt. Pd. Bal. Due
191.VL5-_,je102 Bldg. Permit (BUiLCr; A/�f•u , ry ✓
Plumb. Permit (PLUMB) r ,•✓ �2 _c�
Mech. PerrTA (MECH) 3.So D
State Tax (1 AX) 3k'.3 .3
i
Plumb:
Mech:
Plan Check (PLANCK) I<'• F i li �,0 ,�a
Sv
Bldg: U•�, ,�
Plumb:
Mech:
„�a.R S Uzof Sewer Connection (SWUSA) ?1v✓ 7 Z w
Sewer Inspection (JWINSP) }�' 3J'
Packs Dev Charge (PKSDC) SU U S p U
Sturm Drainage Chg (SDSDC)
Residential TIF (TIF-R) .3 n .3 U
Mass Tram it TIF (TIF-MT) �7 v
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS;
Office TIF (TIF-0)
Water Quaidy ;WQUAL) _ �v
Water Quantity (WQUANT) L7 1.1
Fire Di3trict (FIRE)
Erosion Cntd Permit (ERPRMT)
Erosion PlancWSA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: �SS_ S U (i•-? I
SEE 3 ..) M,.Nl
ROLLi-t ),))0' 2
F (� R
LARGE
DOCUMENT
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12
'C
155 NORTH FIRST, HILLSBORO, OR 97124
COUNT', PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415
t; !. `. UL,4956 Project_ # F10048221 Status APPROVE,, P3q4t
7i ��d A3/1p/uC Isesuat9 0:3/1U/9s Expirpsi 07/06/95 05 ? :
RESELEC
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I Address 1. 3749 SW :'E.�RN ST TT
,„rt_dr Name 1N8PE(,.,rI(:1h -• TIGARD It�girril l
} 1 tic si►t Niamey T & M ELE•:-''TRI+"., INC
nurnbrr_r 648-615$6 Valus►tl(.arn
Approval # AVII'k
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DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12
COUNTY, 155 NORM H FIRST, HILLSBORO, OR 97124
PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415
+.t # 05064956 Praj*ct. 4 . P0048221 St.attis F'aq 2 ciF
+d 0;3/10/95 Iscut-d 03/ 10/95 ExPir"s 09/ 07/06/95 0 .
: : :tt Titl ,., FR NEW TtEc,EC,I.C:
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Ad4reas 1 3749 SW FERN ST T'
+tlpn Detail Re, 1''pn
i i rant Name T 6 M ELECTRIC' , INC .
fie number 648-65S6 valuation 0
i i cant Addr 633 .NE BALDWIN T Approvall # A.PPR
HtLL,clB0Ro, OR 97124
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DEPARTMENT OF LAND USE&TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILLSBORO,OR 97124
COUNTY, INSPECTION REOUESTS: 503/640-3561/693-4415
OREGON xxxxxxxxx-- b40-347(i
Paye : 1 of. 1
Date 03/lU/9b
Time ib : 42
ei hilt 'Type : kesidentlal Electrical Permit. Permit # UbUb49bb
Ir-Mini'. Status APPHOVEL) Applied 0:3/lU/y5
:, I tur, Address 13'/49 SW E'E:RN 5'T 'I'1 Issued 03/10/95
I •milt. 'Eitle SE'H - NE;W Completed
['etmlt. uescr. To Expire 09/0b/9b
,,to Ject, 'Title : ;N'H - NEW Project # P00482ZI
ill a sect De.scr . + EROSION
I ._rtr_el Number l MITI - Lanni Use District
Valuation U
rae(;al Descr .
r)wlier INSPECTION - l'1 VAN L) Construction O'1'H
/r.pplicant Name 'L' & M ELECTRIC, INC. Classification 9UU
i�ppl icant A�Idr .. : 833 NI.; bALDW.LN 6'1' Occupancy R3
HILLSBORO, OH 91124 Validated by LV
d+;--I,,llcant Nturne , 6413-65bt) Inspector Area
tee de,—It:viptlon Units E'ee/Unit Ext fee Data
---------------------------------------------------
:,gtiare I-ootaye IE,nter Sq . E't. . ) 2500 185 . UU
,_,ubtcrtal Eiectrlc-ai E'ees : 18b . UU
,tate Surcharge of b't 9 . 25
l'r.rtal b;lectr ical Fees : 194 . 2b
A * * Fees Hequlred Fees Collected 6 Credits *�*
Method Check ft Receipt No. Date Payment
(:Y. 4049 U3/10/95 194 . 2b
'1'OTP L '1'H 15 LWPE: ***** *** 194 . Z'-)
Fees : 194 . 2b
hdlustments : 00 'Total Credits : 00
irital E'ees : 194 . 2b 'Total Payments : 194 . 25
Balance Due: . 00
NOTICE This permit becomes null and void If the work or construction for which It is Issued Is not commenced within 100 days Once conslructlon has started,
the permit becomes null and void If construction Is Interrupted for a period of 180 days. I certify that the Information presented by the applicant and
his agent or agents In support of this permit Is true and correct to the best o:our knowtedge. I acknowledge that the Building Department's reliance
upon false and misleading information may Invalidate this permit. All provisions of applicable laws ar,d ordinances governing the construction and use
of this building or structure will be compiled with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowtedgv that the use or occupancy of
the structure or building permitted depends upon my calling for Inspections at varlous times during the process of construction and the building
Inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department is solely at the risk of the applicant and such use or occupancy is revocable•mill all h.opectlon requirements are satisfied and
approval Is given by the Bulk ng Official. I further acknowledge that a lien may be placed on the title of the property upon which th ermlt is Issued
specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction o'all I�nspect!o r uirements
APPLICANT'S SIONATUR
,ddlikii WASHINGTON COUNTY ELECTRICAL PERMIT
_ Department of Land Use & Transportation
Electrical Inspection Section APPLICATION
155 North First Avenue, #350-12Hillsboro, Oregon 97124
Information: (503) 640-3470 Fax: (503) 693-4412
Permit SZ' ;-�,
PLEASE PRINT Number Dated
Pleasecomplete all sections, 1 through 5. 4. Complete Fee Schedule below
1. Location of installation Number of Inspections per permit allowed
Address / .3 1 �Tl _5 _ !�F-�►�ti' `�� Service included: Items Cost(ea,) Sum
City
Build ingg Z. 1 A. Residential- per unit
� r r,�t Suite No ,� rY '
�`— 1000 sq.It.or less $110.00 /�� I 4
Tenant Name Each add;,innal 500 sq It
(if commercial) _ or portion thernof $25.00
Limited Energy $25.00 1
Map No. __ Tax Lot Each Manuf'd Home or Modular
Thomas Map Bonk: Page: Section: Dwelling Service or Feeder .—_ $68.00 _ 2
Directions _..-- B. Services or Feeders
--- -- -- — Installation,alterations or relocation
200 amps or less _� $60.00 2
CommercialF-1 201 amps to 400 amps $80.00 _ 2
401 amps to 600 amps _— $120.00 2
!: 601 amps to 1000 evils $140.0011
2a. Contractor installation on
? Over 1000 amps or volts $340.00 2 2
Electrical Contractor ;r'ch IV N er Ce L/,,l, Reconnect only -- $50.00 2
Address _ ��,n, -
City _)I 11 • �M _ State it ZIP C. Temporary Services or Feeders
Date Job Number Installation,alteration or relocation
Property Owner ) ^4 /t'\ It {t 11=—Z. f' 200 amps or less $50.00 2
Contractor's License No. d�'1 /►�'3 �' 201 amps to 400 amps $15.00 _ 2
Contractor's Board Reg. No. ,�; 3 y I 401 amps to 600 amps $100(,0 _ 2
Over 600 amps to 1000 volts see'B'above
v>
Signature of Supr. Elec'n cJi l D. Branch Circuits
License No. .�'{,- J) S Phone No. Sri/ New,alteration or extension per panel
Ek) The fee for branch circuits with
2b. For owner Installations: purchase of service or feeder fee.
Each branch circuit .-- $5.00 _ 2
b) The fee for branch circuits without
Print Owner's ave —� onriTJo purchase of service or feeder lee.
First branch circuit $35.00 —_ 2
Each add nl branch circu.t $5.00 _ 2
C—Ity— —� —oia —� -7,—p-- E. Miscellaneous (Service or Feeder not included)
Each pump or irrigation circle $40.00 2
The installation is being made on property 1 own Each sign or outline lighting $40.00 2
which is not intended for sale, lease or rent, signal circuit(s)or a limited
energy panel,alteration
Owner's Signature �__ �� -- or extension $40.00 _ _ 2
F. Each additional inspection over the allowable
in any of the above
3. Pian Review section (if required) Per inspection $35.00
Per hour $55.00
Please check appropriate hem and enter fee In section 5B. In Plant $55.00 _
_
—4or more residential units in one structure
Service and feeder, 800 amps or more FI• Fee3
System over 600 volts nominal A. Enter total of above fees $
_.Classified area or structure containing special 50a Surcharge (.05 X total fees) $ Ij 7S
occupanq as described in N.E.C. Chapter 5 Subtotal $
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review it required (Section 3) $
above apply. Not required for temporary construction Subtotal $
services. Trust Account 5
Balance Due
For rasp ec Jons call this permit becumea null and void If the work authorlred by the rwmtt Is not commenced
640-3561 or 693-4416 within 111i from date of lsauance of such permit or d the work authorized le
suspended or abandoned at any time after work b commenced lot a period of ISO days,
24-hour recorder, one working day in advance of need Electrical Permits are non-refundable and non-transferable.
8/94
DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12
155 NORTH FIRST, HILLSBORO, OR 97124
COUNTY, PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 50:3/640-3561 or 693-4.<15
F'erm.it # ' 050649S6 Project # P0048221 Status APPROVED Page t .:t .
Applied 03/10/95 Issue9 Expires U9/U6/'fir, OS/ I0/9!1 ()r,
R1ESLLEC
Permit Title SFP - NEW OTH
D*scription Begun: 03/
J:>b 7lddress 1374'9 SW FERN !3T TI
Owner Name INSPECTION - T11ARD Region D
Applicant Nams T & M ELEt7TRr'" INC
Phan* number 648-•6556 Valuation . U Approved�. .
In-spMc: