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13784 SW FERN STREET-1 w w 1 ' I i3784 SW FERN STREET a.. CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Lith: 629-4171 MS (�544'<J'�bateG � 'BOP Requested 1 2 �y / [ 1 AM PM � — � — --- Lo, BLD ation� `:� 1 Zr V1 Suite Contact Person — _ Ph Contractor ` ` Ph SWR BUILDING Tenant/Owner — ELC - Retaining Wall ELR Footing Access: -- Foundation FPS Ftg Drain - Crawl Drain Inspection Notes: SGN _ Slab - — — ---- -------- Post& Beam IT _ — E-xt Sheath/Shear Int Sheath/Shear — Framing Insulation `— Drywall Nailing Firewall - ----_.._-�.�---------- - Fire Sprinkler Fire Alarm — --'— Susp'd Ceiling Roof Misc: --- -------- Final PASS PART FAIL -------- -_ -----__-_---_--- - — PLUMBING Post& -earn - ------ -------.-- �- Under Slab Top Out ---- - ---- - --.-- -- - ---- Water Service Sanitary Sewer -- _ --- -- - --_ _— Rain Drains Final — --------------------- _. ��- -- PASS PART FAIL MECHANICAr ------ - ^- - - Post& Beam - -- _-- ----_ _ --- - Rough In Gas Line - -- ----- ---_-_--__- Smoke Dampers Final PASS PAR- FAIL ELECTRICAL — --- Service Rough In - UGiSlab Low Voltage — Fire Alarm Final - — -- - - PAS PART FAIL ---- --_ _- --.--- -- —. _ _ SITE B3ac i I/Grading Sanitary Sewer Storm Drain [ ]Reinspection fee of$ V_required before next inspection. Pay at City Hall, 13125 SW Hal Bled Catch Basin Fire Supply Line I I Please call for reinspection RE: _--- _ [ ]Unable to inspect-no access ADA _ Approach/Sidewalk Other Date I Inspector "�-J� y ---- ext ,— -7— — —� c PASS_.JPART--FAIL DO NOT REMOVE this inspection rec-ord from the j,oh site. Ub- Ib U.5 U:I l 45 U.5113 lira 7'::+ 111 u1 11+..AKV uu: rlri:, Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd, Tigard, OR 97223 Planck/Rec. # Permit # r .eL,s Z-5. O-2 5 Phone (503) 639-4171 Date Issued CITY QlG TI4AR�f FAX (503) 684-7297 Isrwed by _ -,,, 11.1_-J_-- TDD No. (503) 684-2772 c7 �- Inspection (503) 639-4175 1. Job Addross: 4. Complete Fee Schedule Below; Name of Davelopmont Number of ine.pecilone per parmil allowed — Addres5 I �c� G/ �% 5 Servim Included Items coct(ea) Sum City/5tate(zip ll�� /`�� �,_ 4a. Residential-px unit < -- 1000 oah or lass t % / l , Fnon addnlnnal 500 w 11 or Name (or name of business) pom'onthereof W5 Do mmercial ❑ Residential I(muse nvi'gr s25 00 Co EJrh MaN'd Nome or Mou:ler � pwelhng Servioa or Powder f+tSB 00 � F'AF'k;I N EI_EC1"f''I 1�., IN,'-':. G. MOLAL...L.A AVE. 4b.Gwvic+es or Feeders j �, it Ir>atalladon,allerauen or Rrf Or (-I reltr�hor 0N I TY, OF' 97 . 1,.j 200 amps or IRs sFn or, C.,57. 950 201 amps In 400 amps J 69000 _ 2 Oat "PI&10 Boo e'Tpo ., $120 00 2 QNTr'AC'tflr'S LAC CavNSE # 34-4C tat amps w 1000 snipe s,ao 00 2 Over 1000 snipe 0,yr",p S340 00 —._--- t ONTPAl'"TORS f?OARD REI.J. tf 35151 Reconnect only t:5oo0 `)IjP[.RV I SOP # 1313—S — 4c,Temporary Servicaa or Feeders Insiallalion aher$Iion,or reloaalion signature of Suer. Elea'n� :y=/ s r /�_ 200 Inim or lose "o 00 No.1 L �c _ 201 ampu Is 400 ammo -- 0s oo 1 (cense Phone No. 40+a mps In two em pe $'0()00 Over 000 snipe 1e 1000 vphe 2b. For owner installations: aim V atxWo 4d. Branch Circuits Print nwripr's NaMA _M - New,nile'flmn or ertenmon per panel 4ddresss)"h.lee for branch arcane with 2 — -_—_—_ ,tate Zipw_ purchsel or"OVkv w Mdw!M. City �tM branch orwil 55 W Phon3 No. u, i ne Ise for branch orwne mlhoull 'rhe installation is beir.g made on property I own which iq purcheee of service or N%O&r kr. Fir51 branch arouit $35 OC _ riot intended for sale, lease Or rent Eanf+$60410,01 ac cr d,cud 55ao Ownof's SiOn�turA _ — --- 4e. MlaoeUaneous (Servlcs or feeder net included) 3. Plan Review section lit required): erne fiW.Orequired): Each pump or ongellenFa&sign of willme lighting „o OC Signal:lmu4(s)yr■limil ear gr --- 1 PIAnfe Bleck appropriate item and solar tee In wlion 5U. rinnel,eherel'on or ar4ene•un W v 1 _ 4 or more relidontial units in one strvcturp Mnor Latah II01 110000 SQrvloe and feeder 225 amps c,more SystOrn ovor 600 wits nom,na 41. Each additional n a G1e the ab over .�IRAFIf1Qrf arca nr -tn1:ure rc chaining special occu ne the allowably in any of she above y (� Y per nspiWion _ tJ`.00 :15 riR v.ii.,ar in N F :� Chaplr4f 5 per hour 555 alp n Plan) _—_ 555 OC Submit 2 sets of plans with application wh'ero any of the above apply. Not required for temporary oonstrur:tion services. 5. Fees: I-%. Fnter total of above teas � NOTICE 5%Surrhargo(05 X total fees) $ _ rrrnmIT8 I3CCOMC VOID IF WORK OR CONSMUCTION subtotal $ AUIHOHIZEp IS NUI COMMENCED WITHIN 190 DAYS,OR IF 5h. Enter 25%vi of A for rt7NSTRUCTION OR WORK IS SUSPENDED on A©ANDONED roR Plan Rousse Ift r required 1Sr+r 11 � A PERIOD OF 190 MlYS AT ANY TIME AFTER WORK !S Subtotal g COMMENCED ❑ Trust Account 0 Balance Due $ I C l i PERT CITY OF TIGARD PE'R'MIT" E:LC9Mj-OE,04: ZOMMUNITY DEVELOPMENT DEPARTMENT DA-rE ISSUED: 13125 SW Hall Blvd.Tigard,Oregon 97223.9199 (503)639-4171 PARCEL: =S104I3D-�1£JIIrG� ,. ITE F DDREG5. _ . . 137B4 SW FERN ST ,!.JBDI VISION. . . . : HANDY ACRES ZONING: R-7 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :`r_, Pr°oject Description: One service or feeder 200 amps or, less. FZESIDErV'TIAt_ UNIT----•- ----•TEIhP ,RVC/FEEDERS----- --- --MISCELLANEOUa- --- 1000 SF- OR LESS. . . . : 0 0 2`00 camp. . . . . . . : 0 PUMP/I RR I G!)T I ON. . . . : 0 EACH ADD' L 5005F. . . : 1,71 L01 _ 400 amp. . . . . . . : 0 SIGN/OUT LINE: LTG. . : 0 i_.IMITE.-D E'NE.RE2Y. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANFL. . . . . . . : 0 MANF. HM/ OVC/FDR. . : 0 601 *amps--1000 volts. : 0 MINOR LABEL_ ( 10) . . . : 0 iFwRVICE/f'CEDCR-- -- - - -DRAIVCH C.T.RCUITS-_ - ._---ADD' I_ IN(_�1='FCTIONLi--- 0 - 2017, oamo. . . . . . : i W/SERVIC.E OR FEEDER: 0 PER TNSPE:CTION. . . . . : 0 201 - 4.00 amp. . . . . . : 0 1st W/O 5RVC: OR FDk. : 0 PER HOUR. . . . . . . . . . . : 0 401 - Ci00 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : Q O1. 1.000 ,amp. ,. . . . 0 _.______........_._.__._..__._ -.PL(iN REVIEW SECTION_.__________._. __.__.._-.. 1000+ amp/volt . . . . . : 0 ) =4 RES UNITS. . . . . . . . : > 600 VOLT NOMINAL-. . t Reconnect only. . . . . 1 0 SVC/FT)R AMPS. . : Cl ASS ARF=A/SPEC OCC. Owner.: __------.__________.___________.__.______.___.____._________. FEES RANDY TANNI'R type amoc_cnt - kry date r,ecpt 1:3748 SW FERN PRMT $ 6121. 00 CJS 12/05/95 95-273527 5PCT $ 3. OIa r.JS 12/05/95 95­27:35017 OREGON CITY OR 97045 P17one #: Contractor: PAFK I N ELECT F71 C INC (13. 00 TOTAL. 20E50 S MOLLALA AVE REQUIRED INSPECTIONS ---- OREGON CITY OR 97045 Ceiling Cc,ver• Elect" : servir-e Phoie #: Wall Cover Elect' 1 Final Rep #. . . This per@it is issued subiecl to the regulation: 7ontained in the Tigard Municipal Code. State u' Ore. S3ecialty Codes and all other, Permittee Signatur-e apolicsble laws. All work will be ;.•-e in accordance with approved plans. This per@it will ex1dr+ if work is not started / within i8t days of issuance, or if w)rk is suspended for @ore than 131? days. I s s,,ted By INSTALLATION ONLY---_.____._._.._..-.__.___._ TI-ie installation is being made on ptoper-tv T own which is not intenclec., for ,ile, IEasw., Dr' r'ent. UWNE R' S SIGNATURE: __. DATE: INSTALLATION IC:+NA'TURE OF SUPR. ELEC' N: �/1 __.Gfi . DATE: I CE:NGE NO: Call for inspection - 639--4175 Un lb tl5 UH. a5 U-51.130,54 72N i 111 1.11 11+,.�hLr ,_tlLl: UUP Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. Tigard, OR 97223 Planck/Rec. # Pet'rrlit # _Zi cji, - oEO:� Phone (503) 639-4171 Dato Issued /j 6 y5 FAX (503) 684-7297 Isrfied b CITY OF TIDARD TDD No. (503) 684-2772 c y - =' ----- — — — Inspection (503) 639-4175 1. .fob Address. Q. Complete fee Schedule Below: 1 N,�t +Tor4'ev opmeni U I 166 111111 lX,)-- [Aumber of Inapeoilon r per permit allowed — Addres5 L-4e� _ Service included Iten Cost(ea) Sum City/StatefZip qa. Residential- per unit 100090 It or lee. Name (or name of business)_ _ Esoh addelorel 600 r-0 it or '— ponion Ihenof t:25 00 1 Commercial [] Residential❑ Limped Fina py s25 00 �.�Manut'd HQ,ne or Madu'ar 2 E'l N ELEC.TR 11--, I NI::. Dwell,rip service or Feeder f8&00 - 20250 S MOL..AL.LA AVENUE 4b. Services or Feedere OREGON C:I TY, OF '9704a- Invlallahon,werahern or relor�bor / /� 1 .� (,fi() l 200 amps or loss -�- SM00 l./ Z 657-4958 201 amps to 400 amps _ $40 00 _ 2 4n1 amts+a nolo ams �— $12000 2 CON TRAC:TOPG3 LICENSE # 34--4C 801 amp%10 1006 amps $10000 2 t7ver 1000 Shrine on vdlc $340.00 2 I_ONTF?AI�:TOF',5 HOARD PEG. # 35151 Roconneraonly _— $5000 , _-- SUFEcRV L SOR # 1313—S 4c. Temporary st rvlcae or Feeders / Installation alteration or olocation Signature of Supr. Elec'nL-n! 200an1p%0,In$ � $5000 u 2 �L-- 201 amp%to 400 ampe $7s 00 -' I lCC?nSg No. Phof a No. 401 Armpit 10 600 Amps $10000 Over floo em pa Ie 1000 Vohs 2b. For owner installations: 6m V awe e Prior Owner's Name d. Branch Circuits New,911e Mbrn or■llencien yet pAnP Address 4)Yho lee for branch tarcude w4h City__,_ -_ _--�� State_ Zip— purchA"el service a Amdw lee. EAU+branch prcwt $5 U0 Phone No. _ b;The los to,branch aro ne rw;houl _ The installation is being made on property I own which is purchase of servira or reader be. 1 not Intended for branch circuit $35 00r sale, lease or rent Each additional branch urruit $S 00 Owners Signature _ 4e. Miscellaneous (Service or feeder not included) 2 ? 3. Plan Review section (if required): Each pump er vngalien 6rcle $30.00FA&slam or oytll s l ohttng r.4a ac. - S,pnAI cimunta)or A limned anergy 2 PIMM shack Ppproprials Item and metal tee In //Cilon SH. pane!Alterahor or emeneton }+C c0 4 cr more residential units in one structure Minor uhel4 Iia! "�- t u>r cc Service and fonder 225 amps or more _ System over 600 volir nominal 41. Each additional Inspection over Onset Il'iAd arse nr strurturs containing il.-%sial ocGlpancy the allowable in any of the above as described in N F C Ch;;;, Per impsoUon tJ5 00ptnr 5 Per hour $55 ro Submit 2 sets o'plane with application where any of the shove ,n Plam $5600 apply. Not required for temporary oonalruclion services. 5. Fees: NOTICE Ga. Enter total of above tees $ 5%Surcharge(05 X total fees) r'rnMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ __ AUTHOHIZEU I$NOT CJMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of line A for CONSTRUCTION OR WORK IS SUSPENDED On ABANDONED POR Plan Review it required tsar 3) $ – A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ COMMENCED, r Trust Accounl e ; Balance Due s - ELECTRILAL PE*RM 11' CITY OF TIGARD PERMII #. LLC96­111100 COMMUNITY DEVELOPMENT DEPARTMENT LAZE ISSUED: 02/15/96 13125 SW Hall Blvd.Tigard,Oregon 97223@8199 (503)639-4171 PARCEL : 2G104BD-01000 .jBDIVISION. . . . -. HANDY ACRES ZONIIqG;R-7 -OCK. . . . . . . . . .. .. LOI.. . . . . . . . . . . . . ..R6 oject Description. Install circl.iits - - RESIDENTIAL urirr—­­. ---TEMP 5RVC/FEEDERS----- __.____MISCELLANEOUS_-..._. 1000 ISCELLANEOUS-- 1000 Gp OR LESS. . . . Q) 0 200 amp. . .. . . . . : C PUMP/IRRIGATION. . . . . V. :ICH ADD' L 500SF. . . 0 201 400 Eimp. . . . . . . : 0 SIGN/OUT LINE LTG. . 0 _ 111ITED ENERGY. . . . . t,) 401 600 . . . .. . . . : 0 GIGNAL/PANEL.. . . . . . . V) "'ANF. HM/ SVC/FDR. . . CA 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . --5L.R V I CL/FELDE R 11RF1NG 1 CIRCUITS---- -ADD' L INSPECI I rIO1 oflip. . . . . . : 0 W/SERVILE OR FEEDER. 0 PER INSPECTION. 11 4012, amp. . . . . . : 0 Ist W/O ERVC OR FDR. : 1. PER HOUR. . . . . . . . . . . )1 600 ttmp. . . . . . : 0 EA ADDIL BRNCH CIRC: a IN PLANT. . . . . . . . . . . 711 i000 amp. . . . . : 0 ___222___2.---22__22._..._...- .r-LAN REVIEW SECI ION-­­­­­­­ arnp/Volt. . . . . S 0 ) -4 RES UNITS. . . . . . . . . ) 600 VOLT NOMINAL. . t>cuni)ect Only. . . . . . 0 SVC/FDR i = 2,25 AlIr-1C. . : CLASS ARBA/SPEC OCC'. 14ner- . FEES )NDY TANNEFtype amol.Ant by date r-e c p It :;734 SW FERN FIRMT fi 45. 00 JSD 02/15/96 96-275991-.1 5PCT i E. 25 J 17,D 0.21/15/'3& 9C �7";9')1 .'G A P D OR ')7223 ione N C $ 4 7. (,-;"5 TOTAL RE UUIRLD INSPECT1ON5 r,eiling Cover- Elect, I 1-1r)�Al one11 tqa I I C,U V L.r- is pervit is issued subject to the regulations containei in the N - in 1 t yard MULIpili Code, Statp of Ore. Specialty Lodes aPL all other t- 4 tee 51gnatj.fv�p piicable laws. Ai, ;4orK oiii, be dope in accordance with 54--- .droved plans. This persit will expire if work is not started 180 days of issuance, at, if work is suspended for sore 3n 180 days. I s d B�� I OWNER I NGTA1_.L(-'J i ON ONLY iiistallatiori is being miacie on property I own which is not intended for +lv, I.Pase, 0)" t-ellL. OWNER' S bIGNA,rURF DATE : ------CONTRACTOR 11,17-TI)LLAT11-IN CflNP T(JRE OI" 1311Jp1p, E.J.EC' N: DATE: Gal i far inspect 1 on -- 639--41 ; J Community Development ELECTRICAL PERMIT APPLICATICN 13125 SW Hall Blvd. Tigard, OR 97223 Planck/Rac. # Permit # ` "tl Phone (503) 639-4171 Data Issued FAX (503) 684-7297 Issued by -� CITY OF TIGARD TDD No. (503) 684-2772 Inspection (503) 639-4175 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed — Address r j/D j .K Service included Items Cost(ea) Sum (` C ^ p 1'c• �j Z i 4a. Residential •per unit City/State/Ziv l000 eq it or lass $11000 Fach additional 500 aq 11 or Name (or name of business) portion thereof $2500 Limited Energy $2500 Commercial❑ Residential Fach Manut'd Ham@ or Modular !)welling Service or Fender $88 00 2a. Contractor installation only: 4b.Services or Feeders Installation alteration.or relocation Flectrical Contractor 200 amps or leas $6000 -- 201 amps to 400 amps $8000 Address 401 amps to SOo amps $,20 00 2 Ciy State Zip_ _ sot amps to 1000 nmpe $18000 Phone No. Oyer 1000 amps or volts $34000 Reconnect only $5000 Contractor's License No._ _ Contractor's Board Reg. No. 4c. Temporary Services or Feeders Installation.alteration,or'eloc:attinn 201 amps or lags $5000 Signature o' Supr. Elec'n 2 201 amps to 400 amps $7�00 t icense No. Phone No 401 amps to son amps $,0o 00 Over 600 amps to 1000 volts 2b. For owner installations: sr,'b'nbmo 4d. Branch Circuits Print Owner's Name Y L ___ New alteration or extension per panni Addres��2, 7�", _moi a)The tea for hranch circuits with 2 Cil (' State(K,'(-"- Zip � 7�_. Eacpurh beat nr.«uit o.M.e..y... " �r�L� Each brain.)circuit $500 / Phone-Nb. b)The lee for branch ciruns 00thout� 2 The installation is being made on property I own which is Fimi lira.or circuiowvt or t.@d.r tie. 2 Ftrel branch circuit $35 00 _ not intended for sale, lease_Qr rent. Each additional brant circuit $5 00 O Owner's Signature ) , 4e. Miscellaneous (Service or feeder not included) ? 3. Plan Review section #t equlred): Each pump or outline etion arae $4000 _ Each sign m outline Irghlmg $4000 Signal cimu4tsi or a limited energy Please check appropriate Item and enter fee in section 5B. panel,alteration or extension $4000 4 at more residential units in one stricture Mmor I shots(101 $10000 _ Service and feeder 225 amps or more 4f. Each additional inspec,,ion over System over 600 volts nominal the allowrblo in any of �he above _ Classified area or structure containing special occupancy par mspertiw, $3600 as describod in N E C Chapter 5 nit,hou• $6600 _ In Plant _ $6600 Submit 2 sats of plans with applio-elion where any of the above apply. Not required for temporary construction services. 5. Fees: NOTICE 5a. Enter total of above fees $ 51%Surcharge(05 X total fees) $ � Subtotal $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25%of line A for AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Plan Review if required(Sec 3) $ _ CONSTRUCTIC-N OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED rt-1TrustAccount N $ CC >7 Balance Due $ wardco—AHn-Qri GITv MJF TIGARD SITE WORK PERMIT COMMUNITY DEV11LOPMENT DEPARTMENT . . . . . . . . .�i �•­;__' 12115 SW Hall Blvd.Tigard,Orogon 9722398199 (503)039-4171 DATC Ic-'35UED: PARCEL. 25104111)--01500 �W rEnN ST J801VISION. . . . 1ANDY ACRES ZONING: R-6 —OCK. . . . . . . . . . LOT. . . . . . . . . . . . . Yr-.,E OF WORV. NE34 P I N G N RESO. NO. :N 4CV VOLUME. - cy G RAD I NG?. . . . . . . . 9 N VALUE. . . $ L ' VOLUMr . : 7uO Cy LANDSCAPING'. . . . ;N +IC F I LL?. . . . -N' SITE PREP?. . . . . . :N ')'L:.-S RPT 'Rr0l)".,N STCRM N IMPERV GURPACE. . . 5f i,i izA r-H 1 A 1,11i�L_i_!NG API'ROX 7'10 CU Yr. Or r-ILL r Cc 113 i'OXY TANNE'(11 t y i)e a.mol_mi by d"�t 9. 162 Sw Ji_rjsicn 14Y PRMT $ 76. 00 B 0 4/'?5/9'5 15PCT 4 3. 80 B 04/ S/9!5 Or? 97000, rk.M $ i 72, 'i 1L 13 04 one #s &44 --3' 44 SPCT s t. 13 B 04/25/95 WNE=R ipnra #1: $ 103. =1 ' I-10TAL REQUIRED INSIV,ECTIONJ 74s ptrait is issued sijbjtct to the >-equlations contained in the Eir-usiati Coi)Lv of .pard MUniCipai %'Ddf, MAE Of Ore. Sptcia'tj Ecoles and &!] ether E>icayatian Insp -..plicabli laws. All NGrk will be done in ac:orianct with Fill Inspection )proved plans. This per-sit will expire if worw is not started Or-adivig Insp Al,an lal daps of issuance, or if #0 is i-spended for eare Strm D,--,Aj.ri Insp ,in 160 days. Er;q! iievv'-ecJ r g v-aid 1 r'iy, 1 Iiispol:tian 1",7, CT °L Com ' Address: 1T71 q �1 zf'1.j rCXo M ISIAIM by:_, _1,Glu L ' Date: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requit es residential construction permit appli- cant, who are not registered with the Construction Contractors Board to sig-i 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 ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 313: /tFVI 1. 1 own, reside in, or will reside in the completed structure. � ?. I understand that I must register as a construction contractor if the structure is sold or offe, ; :W sale before or upon completion. F] 3A. My general contractor is - - ————— (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who ivm k ()n the structure must be registered with the Construction Contractors Board. OR (M 3B. I will be my own general contractor. f ` If i hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If t 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 certif at the above information is cor.ect and that I have read a nd do understand ilio Information Notice to p ty Ow ers abou Construction Responsibilities on the reverse side of this form. -- �5 (Signature of permi► applicant) (Dat (White copy to issuing agency permit ftle, pink copy to applicant) Information Notice to Property Ownets About Construction Rebponsibilities Note.: This Infnrination Nolte, to Property Owners about Construf lion Responsibilities l frac dei,el(q,e i by the Construction Contractors Board in accordance with ORS 701.05SO). If you are acting as your own contractor to construct a new home or make a subs'antial improvement to ali existing s.ruclanr. you can prevent many problems by being avyare of the following responsibilities and areas of concern. EMPLOYER iRESPONSIBILITIES. if you hire persons not registered with the Construction Cuntractors Board to do labor in constructing or assisting in the construction or improvement of a residential stricture,you will,in roost ',nstances,be ruled to be au employer and the people you hire will be employees. T%s the employer,you must comply with flit!following: Oregon's withholding tsix law: As an employer you nntst withhold incomc taxes from employee w,rges at the time employees sire paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information,call the Oregon Dept. of Revenue at 945-8091. Unemployment Insurance tax: As air cmnlnyer, you are required to pay a tax for unemployment insurance purposes on the t wage,,of all employees. For more information,call the Oregon f mployrnent Division at the"-pwtment of Human Resources at 378-3524. Workers'compensation insurance: As an employer, you are subject to the Oregon Workers'Compensation Law,and must obtain workers compensation insurance for your employees. if you fail to obtain workers'compensation insurance,you may be subject to penalties and will he liable for rill claim costs if one of youremployces is injured on Oejoh. For more information, call (fie Workers'Conipew ation Divi,ion at the Department of Consumer and Business Servia:s at 945-7998. U.S.internal Revenue Service: As an employer.you must withhold feder,)I income tax from employees'wages. You will be liable for the tax paymen+v%on if you didn't actually withhold the tax. For mese information,cull the.Internal Revenue:Service at 1-800-929-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code comp4anre: As the permit holder for 1bi project,you are responsible for resolving any fat lure to meet smite requirements that may be brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insur:znee coverage for accidents and omissions such as falling tools,paint overspray,water damage from pipe punctures, fire,or work that must be re-done. Time to supervise employees: N are you have sufficient time to supervise your employees. Vxpertise: Make sure you have the expertise to act as your own general contractor,to c oo-dinate the work of rough-in and finish trade., and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contra.:turs Board(PO Box 14140.Salm,OR 97309-5092. 503/:378-4621). The Board is located at 7(X)Summer St. NF Suite:';iU,in Salem. prop-own nm4 1/94 /-/ f- K - G 4 -' 7 J 1'1 �.J IY 1 -J ♦ t/ L 1 23 t K 1 1 Y' K L J J 1' tJ i ny r = ' l cov n;i to CLI n P b � O , l�� U ►ate->� c � c fta Al a, r r r CITY OF TIGARD COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,Orogon 617223*8199 (503)639-4171 PLUMBING PERMIT P1:T 'r 1y,I #. . . . . . . ; PL-1195-0 E,39...4171 DATE ISSUED: 08/1212-195 01" 3. 13734 SW F EPN .JL;lj I V I S I ON. HANDY ACRES ZONING: R-6 . . . . . . . . . . LOT. . . . . . . . . . . . . .1 26 JRK. NEW GARBAGE 0 1 SPOSAL-S. MOBILE HOME GPACES. L.-,E. . . . :SF WASHING MACH. . . . . . . a BACKFLOW PREVNTRS. . : CCU,-ONC Y GRP. R3 I-."L(.IOP DRAINS. . . . . . . : TRAPS. . . . . . . . . . . . . . . '1'U R 1.(-:5. . . . . . . . I WATER FlEATERE. . . . . . : C.AtCH BASINS. . . . . . . : LAUNDRY TRPYS. . . . . . : SF RAIN DRAIN'S. . . . . 4 URINALS. . . . . . . . . . . . .. GREASE TRAPS. . . . . . . o'nir-R rIXTUREG. . . . . UD/SHOWURS. . . . SEWER LINE (ft ) . . . . -.25 ATIEI? (ILOGE'rs. . s WATER LINE (f t ) . . . . . 15HWAS)HERS. . . . s RAIN DRAIN (ft ) . . - . ; Hook i-tp sewer line ft,om main street sewer i des' i it al; ion ;)mt s.We i gr-:L of way and inside the privat P property line. I;t.r :! . — ..- .. .. _ 1. - - ...- . - FEE5 5 1"I D y T AN 1\1 E 114 type alli 0 U nt by date i eciaL 91'. :. �W JESSICA WY PRMT $ 30. 0'41 JD 0G/0 9 5 95 Z'C 5PCT 4; I. ZO JD 08/02/915 95--c68 ()rR ;37006 fii .,. 644-3444 � T' ROOTER 71 *,' `�W NIMBUS f1'AVLRTDN OR 97006 —--- - " 3- 117" 31. Sib TOTAL I U T)L� 0. - .:.'/1C. eq N. . . 44677 REGUI RED lNEX'E.Li 1ONS is opt,sit is issued subject to the requiatizini contained in the SeWet- InS,PeL'. i0l) gard 111vnicipal Code, State o' Dre, Specialty Codes and all other Fiy,al ln,,pecticin -plicable Iiits. All work will be done in accordance with ,proved plans. This persit will expire if work is not started ithir i80 days of issuance, or iF Noek is suspended far acre IN, days. 4L Call F i n E p e c:t i o 1 639- 417'. City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 13125 SW Hall Blvd. Permit # re�t'j S'l Tigard, OR 97223 (503) 639-4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE N.m.•� .m New Single Family Residences Only Q1 ❑ 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE$195.00 Job 3 rS 1 U �J�t/ Sfi ❑ 3 BATH HOUSE$225.00 ,'address uer m ao Fee includes all plumbing fixtures in the dwelling and the first 100 feet -�_���� 222 o water service, sanitary sewer and storm sewer. See fees below. wm•i•n•m•of lh ••) FIXTURES CITY PRICE AMT .� Sink 9.00 MN,o A4 a1O1• Lavatory 900 Owner Tub or Tub/Shower Comb. 900 za Shower Only 9.00 Water Closet 9.00 wm.��*�•m• hu•^•••I Dishwasher 9.00 Garbage r+,3oosal 900 — OcCL,pant M•+w•�••• P^•^• Washing Maa ne 9.00 Floor Drain 9.00 �•• Water Heater 9.00 Laundry Room Tray 9.00 wm. Urinal 9.00 Other Fixtures (Specify) 9.00 UN&V Aesw Ph— 9.00 Contractor �'� i U c� : n�a / 95 _5 _— 9.0U ahb�a• cit '10 9.00 Ile ( E F Sewer 1 st 100' 30.00 +•n.y.v«vn +• COV Wo T••N. Sewer -ea. Addit. 100' 25.00 77 Water Service 1st 100' 3000 1 hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00 information given is correct, that I am the owner or authorized agent of — the owner, that plans submitted are in compliance with State laws. that Storm 8 Rain Dram 1st 100' 30.00 I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00 number given is correct (If exempt from State registration, please -- give reason below.) Mobile Home Space 25.00 Back Flow Prevention _ Device or Anti-Pollution Device 9.00 s�.n*•boa«a.v«,n �•�' Any Trap or Waste Not Connected to a Fixture 900 Describe Work new addition O alteration (D repair Q Catch Basin 9.00 to be done residential X) non-residential. 0 Insp. of Exist. Plumbing � 40.00/hr Specially Requested Inspections 40.00/hr Existing use of building or property — __— _ Ram Drain, single family dwelling _ 30-00 Residential backflow prevention devices 1500 Proposed use of budding or property — '(iixcept res,dentfal backflow prevention devices) NOTICE, *Minimum Fee $25.On SUBTOTAL r " PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF 5% SURCHARGE CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PLAN REVI1N c 25 OF SUBTOTAL CCMMENCED TOTAL 5i Soecial Conditions - Date issued - by `"- -- Department ELECTRICAL PERMIT Department of Land Use&Transportation Electrical Inspection Section APPLICATION 155 North First Avenue,#350-12 Hillsboro,Oregon 97124 Information: 503) 640-3470 Fax: (503) 693-4412 PLEASE-PRINT — Permit n _ _ Please rrsections, e • Number �5 a2�_ Date 4, 11 1. Location of installatign 4. Complete Fee Scheoule below Address 3 '� _' 5'•v. ��'�/' Number of Inspections per permit allowed �, �Z3 Building Service included: Items Cost(ea.) Sum City- r�rl (7 , '� Suite No. A. Residential-per u tit Tel Cant Name (if commercial) _ - - 1000 sq,If or less -__—- $110.0c 4 Ma) No. _—Tax Lot 2 ' �Vy�iJ����`' Each additional 500 sq.ft (� { or portion thereof ---- $25.00 -- -- - Limited Energy $05.00 1 Thomas Map Boole Page:-_ Section: _ ____ Each Manuf'd Home or Modular Directions -_-__ Dwelling Servire or Feeder $68.00 -------- -- B. Services or Feeders Commercial❑ Resident.al Installation,alterations or relocation 200 amps or less -- $60,00 GO' it - 2 2a. Contractor installation only: 201 amps to 400 amps _____ $80.00 -- 2 401 amps to 600 amps _ $12000 2 Electrical Contractor _ _ ._ -____ 601 amps to 1000 amps $180.00 2 Address _- --._. __- Over 1000 amps or volts $340.00 ___ __- 2. City State _ ZIP__ _ _ Reconnect only __- $5000 z Date - - Job Number - Property Owner _ - - C. Temporary Services or Feeders Contractor's License No Installation.alteration or relocation Contractor's Board Reg. No. 200 amps or less _— $5000 - - 2 _-- - 201 amps to 400 amps __ $75 00 ' 401 amps to 600 amps --_ $100.00 - __ _-__- 2 Signature of Supr. Elec'n __ ___ -- Over 1300 amps to 1 000 volts see"B"above License No. Phone No. D. Branch Circuits 2b. For owner installations: New,alteratimi or extension per panel /] dY - _ -- al The fee.for branch circuits with I' t 11wLrers emN e T'Tione T�Tu purchase of service or feeder fee. t , ¢z( s• �/. CA_A .5— Each branch ciicuit $5.00 2 Address bi The fee for branch circuits without V-4 r 2- purchase of service or feeder fee. ?Wl tate —STP First branch.circuit ___ $35.00 2 r Each adcHl branch circuit__-__ $500 __ 2 The installation is being made on property 1 own E. Miscellaneous (Service or Feeder not included) which is not iocf'i, d f S>a ease or rent. Each pump or irrigation circle _— $4000 _ 2 Each sign or outline lighting ........ $4000 ___ 2 Owner's Signature/ � "�`'_-_-- Signal circuit(s)or a limited energy panel,alteration 3. Plan Review section (7f required) or extension -- S4000 - - Please check appropriate item and enter fee in section 5B. F. Each additional inspection over the allowable In any of the above _4 m rnore residential units in one structure per inspection $3500 Service arid feeder. 800 amps or more Per hour $55.00 -- JSystem over 600 volts nominal In Plant --- $5500 - Classified area or Structure containing special occupancy as described in N E.C. Chapter 5 5. Fees Submit 2 sets of plans with application where any of the A. Enter total of above fees �- above apply. Not required for temporary construction 590 Surcharge (.05 X total fees) $ _�_'0 services. Subtotal $ chis perrnit becomes null and void It the work authorized by the permit Is B. Enter 2510 of line A for not commenced within 180 days from date of Issuanco of suo.permit or Plan Review it required (Section 3) $ -- if the work authorized is suspended cr abandoned at any timr after work Subtotal $ Is commenced for a period of 180 days Electrical Permits are non- ❑ Trust Account $ refundable and non-transferehle For inspections call Balance Due 24-hour recorder, one working day In advance of need Fit ,H 6135- x0 7.5 CITY OF TIGARD COMMUNITY DEVELOPMENT DEPARTMENT MASTER FSE:RMI 1 13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)539.4171 PERM11- #. . . . . . . : 11 T1�,' DA-FE IEiSUE.li: 03/e3/ 9b PARCEL: fl- (,;�ORES35. . . 1,3184 ".-)w FL R1\1 51, .j8DIVISION. — i FJONDY ACRES ZONING: R--& . . . . . . . . . . . LOI.. . . . . . . . . . . . . BUILDING I StSUL r. DWELLING U114ITS: 1 BA(5EMENT. . . . . . . . :0 Ll-iSb U1 WURK. :NEW BELIHMb-3 LAH'I FIS:3 GARAUE. . . . . . . . . . :864 S f REIDUIREJ, 521 (JJ-- LUNIS] . :bN FIRST. . . . .2560 f LEFT. . :50 ft RIGHT. :65 t t (A-UPANr:Y GRP. : R" SECOND. . . :0 at FRONT . ii 4.1 ti: REAR. -P) t.t JRI ES. . . . . . . FINBSMENI -.0 S f REUU I RED----- ,L101­11 . . . . . . . . : 14 it TO 1 ii4l,_ s1` '311014 DEJEr-CTORS. LOUR LOAD. . . . :40 P�S f- VPLUL. 1401)7 PARKING SPACES— : 1 0 NEW MANUFACTURE HUML AND LAIJILDINU k' NEW GARA,13E. i t-UMLA I Nb J NKS. . . . . . . . . . :0 :171 BACK17LOW I hi:o. I HV(4 I OR J LS. . , . . :14) WATER HLAIERb. . . :0 (RAPS. . . . . . . . . . . . . :0 UB/SHOWERS. . . . -.0 LAUNDRY TRAYS. . . -.0 C'ATCH EAASI�15. . . . . . . :0 HlLri LLUaE'rS. . :0 SEWER i_lNE (ft ) . :0 bRLP:;k- I R(4Pb. . . . . . . :0 I JF1W(-6l-JLRb. . . . -.u! WPTEr. LINE (ft ) . 11-00 ()(HER HH.bPUL. JISP. . . :0 RAIN DRAIN (ft ) . :0 :0 5F POIN DRAINS— MLLH1,ANILAL I-LEb ULL I Y PES UNIT [111 IRS. .0 t ype amount by date ir,e c jj': VENTS . , . . 3 1211 TIF $ 1550. 00 SW 03/23/95 (1/ INV.'LlT :0 P.TU VENT FAN(S. :0 GWM $ 180. 00 5W 03C'.',3/9', !JHN ( 100K LA HOODS. . . . . . :0 bwM $ 10111. 0 '' 5W 03/t.13/95 'JHN ) =ALAVIK . . :W W0Ol)b1UVLS. *0 11653 $ 1 V113. 00 SW 5 L.U(JR I URN. . . LA CLO DRYLRS. : q, MFb $ Lb. :b bvj 0. /e3/95 Lr4. 31-9, ka U1liLR L11-11 15:0 111 00 5W 0 BAS OU'TL.ETG.*0 MF b 6 0. 7b EW 0.3 C'3/95 --EAPHI $ 1 1141. 51P 13W 0 131,,-.,3/'j`) �ONDY rANNkR BPLL $ 71. 83 BON 03/14/95 95- 5, I b ;_A Jk-LiSIGA W1 B5 $ SW 0:.s/;.. :,195 PARK $ bo0. 00 bw 03/23/95 LI(Ub $ t:. LAO �:,W 03/w:3/9 j L144-344.4 E R PL 1, 6. 4,'-1 bW 03/23/9ti C)r, . ­ -- - ..-E I t 1-,1- $ 13. 45 bW 03/a3/9�) iHi,kiUl VILIURLD L)WEL1. 1AL) lN(., 1(4LE5 ,4C ! llkJIKIWI-' �...T 44-LiI OR 97 ,fl no itr 469MDI 0 r AL ,,is permit is issued tutijoct tp, the regu.ations contained in the REOUIRED INSPECTlONb igard 1unicipai Lode, State cf Ore. Spocialty Codes and ail other Footing Insp Rain drain Insp applicable laws. All work will be done it &CCordarrf, wltm approved Fotmdr%tion Irsp Water Line Insp pians. This pervit will expire if work is sti within 180 post/beam stv-mct Mechanical Final days of it,svir-r, or if work is ' Post/beam Meehan 111�amb F in.A I Li-awl Di-ain 144.111dinq I Ill'i -.ILM/Under,f I aor, ErO 13 i 011 C.OTI t;t (3 F"r-a m j,Ti g Insp ...... ­I P Line Insp CITY OF T I GARD SLWER CONNECTION COMMUNITY DEVELOPMENT DEPARTMENT K.RM I. T 13125 SW Hall Blvd.Tlgard,Oregon 972230199 (503)639-4171 PERM I T #. . . . . . . DATE ISSU-1): 03/L,3/95 PARCEL. .::S 104£'-D-01(300 13-i84 131A PERN S1 )LAD I V I S I ON. . . . a HANDY 7-1,3 -"OfqlNG.- R-6 tJI�K. . . . . . . . . . . LE)T. . . . . . . . . . . . . :1-6 .NANII NOVIL. . . . . . -)H NO. . . . . . . . . . I FIVIURE. UN! 15. . . -H'Sla Of WURK. . . :NEW DWELL I lq(.j UN I TS. . : (Nt:. Of- U(,)L. . . . . i ESFNO. OF BUILLQ'INGS SI 45TAL1_ TYFIE. . . . 1.BUSWR IMPERV 5URI:-,ACU-:. . ' : of �.mlar ks : ING'I"ALL ING 0 NEW MANUFACTURE HOME AND BUILDING A NEW GARAGE 4NIJY I F41\11`4LR type amount by date recpt ":)w JF-5b1GA We {..'RMI $ SW 03/23/95 35. 00 SW 03/23/95 ...OI A 011 9-1006 lone #.- 644-3444 )nt V'act Or I (INT RPC,"l"OFR NOT ON FILE I 'hune 111 , s E,,,'-,35. ovA "roTAL i{eq RLIJUIRED I Nt4-'LC 'I I LJ N b ois Applicant agrees to comply with ali the rulet, and regulations Eiewer, Inspection .,,f the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be fortelte(i it the persit expires. The Agency does not guarantee the accuracy of the tide sewer laterals. If the sewer is not located at the measurement -yen, the installer shall prospect 3 feet in all directions from e distance given. It' not so located,^ installer shall Purchase "TAP And Side Sewer" Permit 91-mittop L -t e U } L-al I fot, inspection V Manufactured Dwelling Permit Application City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 (503) 639-4171 Jobsite Address. L Z01- 8E LIA-1 Subdivision: _ Lot # Office Use Only _ Valuatlon•,,,� 75a(}, LSU PlancWRec # 3 Corner Lot? Y N Permit # S � Flag Lot? 0YN Reissue of Map & TL # �.�'..�� 11,60, Owner: /?GAG( ?4 Address: Approvals Required Planning l / Engineerin I Other Installer: /�i�U(�Fi "(U� � �ll�� i�ST /t'6 Address: �P/N6--4 41 ��f} Items Required �/ Subcontractors !�f�� r/ 4 wk Phone: Truss Details —. Other � Contractor's License # ; iff MDI License # �(C9_ �i — (attach copies of current Oregon licenses) Subcontractors: Mfg. Dwelling Dealer: Plumbing: ZIA)C d n57iRX77611 r Address: Mechanical: (attach copy of current OR Contractor's License) Phone: J,QE3 DECRIPTION: ! MP— CA.) 1 UI'A:ETl M hOOtdd W,hrNC Applicari Signature & Phone number -- --- -- �-1 c Received b;i: y Date Received: J �crn�r�Ea�EernF�+?r Permit# Account Description Amount Amt. Pd. Bal. Due 012r;, E:31d�. Permit (BUILD) l' _ Plumb, PermitmF„ (PLUMB) Mech. Permit (MECM) State Tax (TAX) 2 Bldg: S. Plumb: 7�J 'J Mach: Plan Check (PLANCK) Bldg: _ mb: Mech. Sewer Conned n (SWUSA) Sewer Insp,Rction SWINSP) 5 Parks Dev Charge (P C) Residential TIF (TIF-R) 3y /�/ % u ✓ Mass Transit TIF (TIF- T) / 2-v Commercial TIF (Tit=-C) � Industrial TIF (TIF-1) Institutional VF (TiF-IS) Office TIF (TiF-O) Water Quality (WQUAL) Water Quantity (WQUANT) / c. / ✓ Fire Life Safety (FLS) Erosion Cntrl Permit (ERPRMT) ('r r Erosion Planck/USA (FRPLAN) Erosion Planck/COT (EROSN) - TOTALS: L�Im 5 3,, j I i I rA I � U Ps l a � a rn a m a lilll ` �' m II III J III i ( h r J I � r n H �p �o ' .�.. a � � � ; � K ! 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M �� I � � , � I � ' ti� � ' � i , ;I r � —� ' _ J � � � � ..c � � � r � i � �( I i ' o I � I', � I y � � n I � ----- �I III I '' '' i 'll i I !� .11. ; , � I ' l 2 I `I� rn � r � �,� I, ' I� �' " � t �' ; i �, � � 1 a li � � Iii r �� � .... � I � , � � ; 4 �� �� 0 1T Lh LA LA vs N. lIx D ' FN C � � a y. a r � r 3 a yo I i • I t I J � M , :1 I II I h n ZL (A I� II � � --1.,4 a.-v rn rn e N a I I ! 1 II I � h i i � r rn e IA Ada n r"" _ T x y CZ Lr) o n l U n r n �� a a o p r \ r �2t a r � k � o N to � O a 4'1tA ac C \ In T� b� n O •i` ' �c, •� �' a° it n IL k ° `^ • d N �h Ub t v� 'i I' of i � c � �• � '� i � I y ° y