10920 SW HIGHLAND DRIVE _x
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10920 SW Highland Drive
CITY OF TI GARD `ELECTRICAL PERMIT
x PERMIT#: ELC20D2-00215
DEVELOPMENT SERVICES DAT17. ISSUED: 5/14&2
13125 SW Hall Elvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S110DD-10,'00
ITE ADDRESS: 10920 6IN HIGHLAND DR
SUBDIVISION: SUMMERFIELD NO.6 ZONING: R-7
BLOCK: LOT : 373 JURISDICTION: TIG
Proiect Description: - hranch circuits f x kitchen & bath remodel.
_ RESIDENTIAL UNIT — TEMP SRVC/FEEDERS _ _ _ MISCELLANEO 'S �_ 1
1000 SF OR LESS: 0 - 200 amp. PUMPIIRRIGATION: ^
EACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 600 amp: SIGNAL/PANEL:
MANE HMI SVC/ FDR: 601+amps - 1000 volts: `INOR LA3EL (10):
SERVICE/FEEDER BRANCH CIRCUITS
__- _ AlJ_v'L INSPECTIONS _
0 - 200 amp: WISER`JICE OR FEEDER: PER INSPECTION: W v
201 400 amu: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L. BRNCH CIRC: 3 IN PLANT:
601 - 1000 amm: _ _ _ PLAN REVIEW SECTION
11000+ amp/volt: >=4 RES UNITS- > 600 VOLT NOMINAL: _
Reconnect only: >=225 AMPS: CLASS AREA/SPEC OCC: _
Owner: Contractor:
JOANN GILLESPIE EVERGREEN ELECTRICAL CONTRACTO
10920 SW HIGHLAND CT 23861 SE 442ND
TIGARD, OR 97223 SANDY,OR 97055
Phone: Phone: 503-668-4608
Reg#: LIC 136311
ELE 3-472C
SUP 4581S
FEES Requirt d Inspections_ _
Type By Late Amount Receipt Rough-in _
PT CTR 5/14/02 $66.80 2720020000( Elect'I Final
R;
5PCT CTR 5i 14/02 $5.34 2720020000(
Total $72.11
This Permit Is Issued suoject to the regulations contained in the Tigard Municipal Code,Stale of OR. Specialty Codes and all other applicable
laws. All wh_k 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 yuu to folioW rule`s fidopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952.001.0010 though OAR 952-001-00160. You may obtain copies of these rules or direct questions to
ued By:
Permit Signature: I�
CWNER INSTALLATION ONLY
The installation is being made on ptopf�rty I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE: _
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELFC'N: � ': __ �_ DATE:
Call 639-4175 by 7:00pm for an inspection the next business day
k
05, 02 10:13 FAX Z001
04 ,'2: 15:21 PAZ 5035981980 CITY 4F TIGARD a002
Electrical PernvtApplication
y
PDaTtcrcceived: S I'l 0A Permit no.:fr C a.eo a-o�Al
ity of Tiger let 1 e date:
c uyofTigurd Address: 13125 SW Ha . 3rd,Olt 97233 Dateisaued: Recaiptno.:
Phone. (503) 639-4171
Fa (503) 598.1960 Case filo no.: P,yfncnttype:
L-and use approval: (Xr17-s
').;irl &2 family dwelling or accessary Q Cornmminl/indtrstrial ❑ Multi-family ❑Tenant trnprovcmcnt
O New constru^tinn J Additrort/alterauun/rrpl:a^mens D C►ther. O Partial
0
lob addres_ : `p t�'► 1u 1 r Bldg.no-. Suit-no.; Tax map/tax lotlaccount no.:
Lot: _ Block; Subdivision:
Projtrt ti.R+^' Dt scriptior and location of work on cemistaa: Itt •.,,•_.. 1'y{{y + {
Estimated date of com iuion/inspection; -i
Rossi 2005"U"
Job no:
Business nerno;E i l- ec.j r i c.c�l m1wri�io ea Ta1al he.IN
Addred�
ss: r.aet,+na
I lht, -et4t.Ira nit.+att.Ii•aiprHaee.
Scene;yr{Z ZIP: Ira�3 Ser•iaittel+ukd.
Phone;L.x 8-'c4 l Fax - F•mill: ID00 Sq.ti rK Irsa 4
CCB no.:► 3 1 \ �_ flee.bus.lie.no: 3-y L cD adeiuond 501)3q.(Lor portion dtemef
Lin+iladwai trsidmtial 2
Clty/r11eUo llc.ho.' t �,� _ l.lmieedeevgY.noa-KsiEenu►1 _
_ �j- ij-�,J,- Esch manuraatiund Aomc or modulrr dwcllinp
Ip3+auue of supervi_"ing oiccnie sn((--gutted) - (late Service ancJo:laedn _T 2
Sap,e3'eL hdnw(ptinr) 1 v:j r.- LlctWe ne-�}=J��1_`� �iervices or lv des-ifratstlalion,
alletaMwt or relatale.s"
ino nwpt nr Itzo 2
Name( t: zo t srnito�+wpa � 2
Mailing addren- -"� sot amps uy 60u arep _ 2
-- _ 6111 ampe to 1(100 n.ups I FA2
Cit Sratc: 2IP: - - '- - 2
Photre: Fax: Frmail: Rrowisumtfin ty 1—
Owner installation:The llamtllxtioli is being madc un ptoperty I own enjaii'y'a"tc*'"n't`T-(k"('
which is not intended for sale,Larae,root,or exchnnec ar•ording to thobilidoa,ahem-miun,
ORS 447,455,479,610. 701. ?UO ampz et ks, I
501 Imps to 000,mps 2
o-t wes 31 alum. Date: 001 In 600 ami — - 2
Brntch dmielty-sew,*heraden,
Natue: A. Fee for bmacn c1ma)u with pwrhrue of
Addmsg; _ segs or tea feo,wch brvx b ontWt 2
City. - -- -- - �ti19tE: ZIIX _ r Fee for branch eunoia widwin puni'm
--
}1 Iunc; i E-mail of srtvire at feel--&r,fust branch circuit: 1 2
Euh edditlooal bnrtdt e7roait „�
Nis. orttder�lud } _
u .;.�a u.a ,(rcpt.rrnnxRial "�1►e.rth.�ae r.�ility EAch(weep or itrl arson etch• 2
1:1 5ctvicc ovu 370 arr.ptatadng of 1 k2 U Ha"MMS Incatlan i-y_i6n or outline li tR hilts 2
faAlydwellinm 0 Building over IOAW•aumc foot(nut m Signal citwlt(s)Ora limited energy panel,
❑Sytti m—orb l valts noa+ila) R(otte residentialuni(s In am amaur' alteralien.orntgnsian• — 2
U Railding aver daft stories U Fred xL 400 Aa"of mote • tLm
U Ocrupont Toed aver 94 M1`30111 G Manufac tired svuetur"or RV�,k neer the t) wakk is my of above
Vi Fgreas &Vningplan 0 Other. ---, -- -- Perinsycetlon
(9rtwwt —Ito atp1mm with arty of the abvvc Invrtrixedor fee -�
The*have are but ap AcdAk to 4mprsry cowtttaction aorvitx ASIer
— taetmit fex....--..............$
1.&4 Ms.r40)WAao.►mnineteM.w;.v,. Notix:This permit apphra(inn pig,review(at
O Y. p!M - exp",t-t if a permit is not obtatun A )
State sure (896 ....S
aril7tnl 160 days after it has I.rery Iratgt' )
C. ra se ��cr accapledwcompict, TOTAL......... ..
... .......S
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,� -l:d•I�i
MECHANICAL PERMIT
CITY OF T d G /� R n _
DEVELOPMENT SERVICES PERMIT #: MEC2002-00280
-- 13125 SW Hal! :_'!vd.,Tigard, OR 97223 (503) 639-1171 DATE ISSUED: 7/2/02
PARCEL: 2S11ODD-10700
SITE ADDRESS: 10920 SSV HIGHLAND DR
SUBDIVISION: SUMMERFIELD NO.6 ZONING: R-7
BLOCK: LOT:323 J'jRISDICTION: 'rIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: _BOILERSICOMPREbSORS HOODS:
FUEL TYPES 0 - 3 HP: J DOMES. INCIN:
LPG !� 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP:
OU
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS C
FURN >=100K BTU: <= 10000 cfm:� � OTHEF? UNITS:
>
GAS OUTLETS:
10000 cfm:
Remarks: Installation of gas piping for gas range.
Owner: FEES
JOANN GILLESPIE Type By Dale Amount Receipt
10920 SW HIGHLAND CT PRMT CTR 7/2/02 $72.50 272002000C
rIUARD, OR 97223 5r-:'T CTR 7/2/02 $5.Rn 2720020000
Phone:
Total $78.30
—
Contractor:
C M DEVITA PLUMBING
GEORGE DEVITA JR
308 NE 74TH AVE REQUIRED INSPECTIONS
PORTLAND, OR 97213-6310 Gas Line Insp
Phone:503-252-2572 Final Inspection.
Rr g M LIC 25477
This permit is issued subjec` to the regulations contained in the Tigan/ Municipal Code, State ~)f Ore.
Specialty Codes and all othe applicable laws. All work will be done it accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if ,vol k is suspended
for more than 180 days. ATTENTION: Oregon law requires you to fellow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling
(tinii.)an-Q1aa , 4 �
Issue By: ! ,�,�;��,. 1 /1.l' ,c!1� Pe-mittee Signature: Ili.
Call (503) 639-4175 by 7:00 P.M. fog ....spections needed the next business days
.w
Mechanical Permit Application
pate received: J-/� .` Permit nu.:i'
Project/appl,no.: ire date:
City Of rr;garf(�
Address: 13125 SW Nall Blvd,Tigard,OR 97223 pate issued: g . Receipt no.:
cityuJTigard Phone: (503) 639-4171Paymenttype.
Case file no.:
Fax: (503) 598-1960 Building permit no.:
Land use approval: — -
1
❑Multi-family U Tenant improvement
7UU
&2 family dwelling or accessory ❑Commer/,tite ation/ al'J Additirm/alteration/replacement U Othrr.w construction 1 t
1 1 i
Indican .yuipmcnt quantities in boxes below. Indicate the dollar
Job address: ' G-/ } - '�- �-- value of null mechanical materials,equipment,labor,overhead,
Bldg.no.:
Suite no.: profit.Value$
Tax map/tax lot/account no.: *see checklist for important application information ,mod
Lot: Block: i Subdivision: jurisdiction's fee schedule for residents:,: permit fr.r.
, a!t
Project name: t
:AP.
city/county:
t .
Description and location of work on prctniac::
--- -- I)mription (r>. 1t�r.only 1tty.onl
Est.date of complet—spection: C: ---
Tenant improvement or change of use: Airhonflingunit _____ r CFM
I coudiuoni (site p an requirt )
Is existing space heated or conditioned'/D Yes L1 No teras ono existing AC sysam
Is cxi�ting space insulated'?U Yes U No of er compressors
State boiler permit no.: BTU/11
Business Hume:
t Z� ----- HP Tons
�� Fir smo c damper act aro a electors
Address: ? `/ , , , c 7, eat pump(site p an require ) /
City: • u - C!atet�� Z.II
ossa rep ace urnac nrner_._,_.
X_
E-mail' Including ductwork/vent liner ❑Ycs U No
Phone:• 5 ❑sta rep ace/re ocate caters-suspen c ,
r
CCB no.: `/ t _ w;,ll,or floor mounted
Cit.'metro lie.no.: 5 r �" ( ent for a iance of er t tan furnace
_- - ;- t'1 t`�r t �{ a gerat on:
Nnme(plcseprint): r'w,l {11U/I{
Absorption units_ _
Chillers
ntc: i:�, - Com ressors
Na _----- 11I
-- ---- :nv ronmenta -. oust Rnd vent at on:
Addrrss:
-------- State: ZIP: Applianccvcnt _
City: -- Email: )ryercx taust. ____._-_ -
!'I one: Fax: oot s,.-' 'ype / /res. sleben/haztnat
hon-ri'-suppression systen)
l'.xhaust fan with sinple duct(bath fans)
Name: — ----- I. haust�'ttn from tcatin or�—
Mailing address: __ :oe p III gall sir ut on(up to out els)
Slate: ZIP: Lf NG Oil
i-y •:
City: ----- uc pi is cac additiona over outlets
- -- -- I m;til
Phone: _ - I rocess PP ng(sc sematic require ) --
Nunil)cr of outlets
_ t er ste spp ancr or equ pment:
Name: -- Decorative fireplace
Address: nocxlstov et dove
sert-type .s. _,--- '-
State:_ ZIP: --- - _
City: -
- rax: �-mail: otter—� —
Phone: Date: 1 et:
Applicant's signature.;.,
$a. . ,, /
5 �
Name (print): . ':.�, • Permit fee..................
Notice:'I'his permit application Minimum fee................$ —
N)t all jurfsdictlnne n ce,'credo card.ptea+e cosi)urixlicacxt for mare tnfrxmniton, expires it a permit is not obtained plan review(at %) $ - --
QVisa OMnstrrc'ard `��
Credit cord number � —-- —" :xpim within 180 days alter it has been state surcharge(8%)...•$
accepted as complete. TOTAL .......................$ ��
dame of car hataer u t non crc it card S 440-4617(QOM)
--- Cpm r el�nalure `�
Amount
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMI _Y DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Des,ripbon: _ Price Total
$1.00 to$5,000.00 Minimum fee$72.50 Tnb P',A Meci.anical Code _u Qty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 11 Furnace to 1(0,000 BTU
$1.52 for each additional$100.00 or n:luding do,is&vents 14.00
fraction thereof,to and including 2) Furnace 100,000 BTU+
$10,000.00. Including ducts&vents _ 17.40
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or lnciuding vent _ 14.00
fraction thereof,to and Including 4) Suspended heater,wall heater
_
$25.000.00. _ or floor mounted heater 14.00
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vont not Included in appliance permit
$1.45 for each additional$100.00 or i 6.80
fraction thereof,to and Including 6) Repair units
$50,00 .00. 12.15
$50,0_01.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boller Heat Air i
$:.20 for each additiuns!$100.00 or For Items 7-11,see it Pump Cond
fraction thereof. footnotes below. Comp •'
Minimum Permit Fee$72.50 R"BTOTAL: 7) <3HP;absorb unit
- �$ to_IOOK BTU _ 14.00
8%State Surcharge I e 8)3-15 HP;absorb �-
g unit 100k to 500k BTU 25.60
Review Fee(of subtotal) $ 9)15-30 HP;absorb unit.5-1 mil BTU 35.00
_
Required for ALL commercial permits onl _
TOTALCunit PERMIT FEE: a 10)30-50 HP;2';• 52 20
unit 1-1.75 mi'BTUU
11)>50HP;absorb
- - ^- unit>1.75 mll BTU 8720
-- - 12)Air handling unit to 10,000 CFM
ASSUMED VALUATIONS PER APPLIANCE: _ 10.00
Value Total 13)Air handling unlc 10,000 CFM+
Descri tion: O (Ea) Amount_ 17,40
Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler
ducts&vents
Furnace> 100,000 BTU Including 1,170 15)Vent fan connected to single duct
ducts&vents _. 680
Floor furnace Includino vent 955 16)Ventilation system not Included in
Suspended heater,wall heater or 955 appliance permit 10.00
flocr mounted heater 17)Hood served by mechanical exhaust
Vent not included In appliance 445 10.00
permit -- 18)Domestic Incinerators
Repair units 805 17.40
<3 hp;absorb.unit, 955 -
to 100k PTU 19)Commercial or Indust,;z'type incinerator
_ _._ _ - X9.95
3-15 hp;aosr+rb.unit, 1.706-1 20)Other units,including wood stoves
101k to 501'r BTU 10.00
15-30 hp;a;isoiti.unit,a^1k to 1 2,310 21)Gas piping one to fo%:r wtlets
mil.BTU _ 5.4_0
30.50 hp;absorb.unit, 3,400 22)Mo;e than 4-per outlet(each)
1-1.75 mil.BTU 1.00
>50 hp;absorb.unit, 5,725 Minimum ;*armlt Fee$72.50 SUBTOTAL: $
>1.75 mil.BTU _
__Air handling un:!to 10,000 cfm 656 8%State Surcharge
Air hi ndling unit>10,000-:fm 1,170
-Non- ortable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: S
Vent fan connected to a single duct 446 _
Vent system not Included In 656
a liance permit
Hood served by mechanical oxhaush 656 _ Other Insaecuon�and Fees:
Domestic Incinerator _ _1.170 1 Inspections outside of normal business hours(minimum charge-two hours)
$62 50 per hour
Commercial or Indus_trisl Incinerator 4,590 2 Inspections for which no fee Is specifically indicated (minimum charge-half hour)
Other unit,Including wood stoves, 656 $82.60 per hour
Inserts,etc. 3 Additional plan review required by changes,additions or revisions to plans(minimum
Gas piping 14 outlets 360 charge-one-half hour)$62 50 per hour
Each additional outlet
- - *State Contractor Boller Certification required for units>200k BTU.
TOTAL COMMERCIAL a **Residential A/C requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets plans.
I:ldstsUormMmach-fees.doc 02/11/02
CITY OF TIGARD 24-Hour Z�
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
1 BUP
Received _Date Requested_ ''�" AM. -_ PM BUP
Location Swrh � ��, Utz _Suite MEC ��oZ"D� Z86
Contact Person __� _ — Ph(--) 3 PLM _
Contractor —_. Ph( ) _ _ SWR _
UDING — Tenant/Owner _ _ _ —_-. ELC
Footing ELC
Foundation Access:
Fly Drain ELR
Crawl Drain
Slab Inspection Notes: SIT ^_ _
Post&Beam
Shear Anchors
Fxt Sheath/Shear _
Int Sheath/Shear
Framing
f "r-, 'r-DA. _
Insulation r
Drywall Nailing ----t'— �'`f�iI"��S- Jk Si 0�v' Tfl " iZz—S cE= _
Firewall
Fire Sprinkler - — -
Fire Alarm
Susp'd Ceiling --- — —
Roof
Other:
Final � ---
PASS PART FAIL — — --`�`_—'-
_PLUMBING
Post&Beam
Under Slab
Rough-In
Watar Service --- —
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain ----- —
Shower Pan
Final
PASS PART FAIL
as Line
Smoke'Dampers
Fi
W' RICAL
PART FAIL 1 - ------- --
f — -- —_ — _----- -- —
Service
Rough-In
UG/Slab
Low Voltage ,--
Fire Alarm
Final Reinspection fee of$_ required before next ins
PASS PART FAIL ❑ � — � inspection. Pay at City Hall, 13125 SW Hall Blvd.
E] Please call for reinspection RE: _ ❑ Unable to inspect-no access
Fire Supply Line
Ar+
. i
Approach/Sidewalk Date_� �` nz— _ Inspector -_ _—.__, Ext
Other:
Final DO NOT REMOVE this Inspectlon record from the Job site.
PASS PART FAIL
J
/ CITY OF T I GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00254
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED. 6/10/03
SITE ADDRESS: 10920 SW HIGHLAND DR PARCEL: 2S110DD-10700
SUBDIVISION. SUMMERFIELD NO.6 ZONING: R-7
BLOCK: LOT: 323 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
_ _FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB/SHO' VERS: 2 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 1 basin/lav, 1 clothes washer, 2 tub/shower, 1 water closet, 1 water heater _
Owner: — FEES ---
Description Date Amount
JOANN GILLESPIE
10920 SW HIGHLAND CT I'I I '%413I I'crmit I�rc 6/10/03 $99.60
TIGARD, OR 97223 I:1 tiinrc rrx 6/10/03 $7.97
Total $107.57
Phone
Contractor:
MP (MILWAUKIE) PLUMBING CO
P.O. BOX 393
CLACKAMAS,OR 97015
REQUIRED INSPECTIONS
Phone : 503-655-9161 Rough-in Insp r
Final Inspection
Reg#: LIC Slue
PI.M 3-1'71)(1
This permit is issued subject to tho regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable Izws. All work will be done in accordance with approved
flans. This permit will expire if w)rk is not started within 180 days of issua,,ce, or if work is suspended
for more than 180 days. ATTEN--ION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: _ ? �— Permittee Signature:
Call (5 3) 639-4175 by 7:00 P.M. for an inspection needed Cie next busiries� day
jUN-09-03 07:04AM FROM-MP PLUMBING 5036551726 T-277 P 02/02 F-369
Plumbing Peru&Application
UaG:r�:cetved: Permitno.:pC�J„(�3 -
CityCit of Tigard
� Srrwu pernut nu.: Building permit no.:
Cit)nfTiKprt/ Andress: 13125 SW Hall Blvd,Tigatl,OR 97223 ro�cct/appl.no.: _ Expire date:
Phone: (503)639.4171 _ _
Fax: (503) 598-1960 Uateissued• By: Receipt no.:
Land use approval; _ _ erweflleno.: Paymenttype:
F III
1
=New
y dwelling or accessary 0 Comm:rcial/industrial U Mulu-family O Tenant improvement
urtion Addittc n/alteratinn/replaretnenr U Nand service 1 Other.
01101 if]113 Fill I FEE SCHEDLILE(for speclid iii(orin�iii)lo 111311V chech ist)
Job addressNew dw
ucttc.r:,tion Fce(r•a.)_ '1'o(ttl
Bldg.no.: Suite:nu.: 11-and 7'rfnaiidy e0iugp only:
m.tp/ttxlot/ncccuntno.: r —T pncluda100 ft.for each WWty conuection)
Tax __._ SFR.(1)bath
-Kit: — 131ock: I Subdivision: --
9ttoject nL»e: r s��,�,�_ SFR(3)bath l "
;City/county: Z1P: �9 -- Rach addition@-biftficitclien
Descripdon and Mcation of Hprk on prentues;. Site ut111t1e�:
I& � �, Catch bmin/area drain
�8st (late of completiot flWection: Drywel.Wearh line/lrenc drain
Footing drain(no.lin.ft) _
;•4anufaciured�iome utilises -'
Business nam(: ZIAo CS
Address: _ RA rain connector
City: State 2IP:&gjdC .utital;'♦ewer no.lin.R) -
ne: Fax: B•mail: =farm siI(no.lin.ft.
no.: Plumb.bus.rr'g.no: Vater service(no. in,ft.) —
Clty/metro llc.no.: — — ,Fixture or itetu
don valve
Coniraetor'ss melpse�tattve sjgnatttre. 4bs�tptver
iter
Print mune• Dt Backwater valve
� Basins lavatory
✓Lx/� /���� Clothes washer
Dishwasher --
- � ngfountnlp(s)
State: 151?-J — B actors;surf
1'bcne F'ax: B mall; FA an-ion t�—�
FixturtAewer ca
F1ooc drans/loor sin u _
Name(print)- Gar a e disposal
Mail{ng addtr osc bibb
City: State: ��' _ Ice maker
PLnn'a Fax: �E-ruail: nterce for grease
0wr-A inAallation/rmidential maintenance only: The actual installation rimers)
;cjnploy�ee
l be trade by me nt the maintenance and repair mar le by my regulm �f drain(commercial) _
on tht,ptopesty I own as per ORS Chapter 47.nets s ature: Di to: _ Sum
u s ower/ tower
till
Name:
� ------ Water close,
Addmas: �- ate(WR7
c.`iiy: State l Other.
at aujittilidicatim 41
va D MartCud t awn..ptmw call ienraiouuan for rose 10nwuon Notice:This ptrntit application Mtnimutn fee.................$
PIP])review(ut _ 4f) $
expit>s If a permit is not ciotained T
x card nNmbc- — State s,M 10' within 180 dnyv alter it hast .-I .....gC(69F) ....;
TOTAI
n�e�dvoehoanea acrd - ncerptedxAcomplete. .•.,•. .. ... .�"
f
CITY OF TIGA RQ 24-Hour
BUILDING Inspection Line: (503) 639-4175
i ISPECTION DIV±St'ON Business Line: (503 639-4171 MST
Receiv,,d _____ _. Date Requested. ? �L— AM PM BUP
Location _ d�a� , _Suite__ MEC
Contact Person Ph( ) PLM
ContractorSWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: -- ELC _.
Fig Drain ELF!
Crawl Drain
Slab Inspection Nota!;:
Post&Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear -
Framing
Insulation
Drywall Nailing _- --- -�-
Firewall
Fire Sprinkler - -- --%
Fire Alarm
Susp'd Ceiling -- -
Roof
Other: -"-
Final -"
PASS PART FAIL i-�---
PLUM_BING
Post RBeam �—
Under Slab
Rough-In
Water Service ---- ---- _ _ _
Sanitary Sewer
Rain Drains - - ----
Catch Basin/Manhole
Storm Drain ------_-----__ Y _
ShowAr Pan
4AS _PART FAIL
HANICAL_
Post& Beam
Rough-In
Gas Line
Smoke pampers
Final
PASS PART_ FAIL
ELECTRICAL
Service __-- --_- ---- --------- _ - -
Rough-In
UG/Slab
Low Voltage _-
Fire Alarm
Final u Reinspection fee of$_ required before next inspection. Pay at City Hail, 13125 SW Hail Blvd.
PASS PART FAIL
SITE i [� Please call for reinspection RE: Unable tr,inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Dab inspecter .� --E--
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY ) '-
--
DEVELOPMENT SERVICESPERMIT#: ELC2003 00363
DATE ISSUED: 6118103
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639-4171 PARCEL: 2S110DD-10700
SITE ADDRESS: 10920 SW HIGHLAND OR
SUBDIVISION: SUMMERFIELD NO.6 ZONING: R-7
BLOCK: LOT: 323 JURISDICTION: TIG
Project Desc iption: Install 12 branch circuits in kitchan,laundry,foyer,entry.
0-20-03 Add 2 branch circuits.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ _MISCELLANEOUS_
1000 SF OR LESS: 0 - 200 amp: PUMP rIRRIGATION—
EACH ADD'L 500S-: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
_—SERVICE/FEEDER BRANCH CIRCUITS ADU'L.INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 13 IN PLANT:
601 - 1000 amp: _ _ PLAN REVIEW SECTION
1000+ amp/volt: _ >=4 RES UNITS. >600 VOLT NOMINAL: —
_ Reconnect only. — SVC/FDR>=225 AMPS: ---CLASS AREA/SPEC OCC:
Owner: Contractor:
JOANN GILLESPIE ROSE CITY ELECTRIC CO INC
10920 SW HIGHLAND CT 4012 NE CULLY BLVD
TIGARD,OR 97223 PORTLAND,OR 97213
Phone: 503-624-7285 Phone: 287-6164
Keg #: SUP 212
Description FEESDate Amount
Required Inspections
It .l'Rh1'111iLr Pcrmil 6%18`111 $120.00 — --_-- ---- --
I r-N.t1 S Stale'la.r 6/18Ml $9.60 Rough-in
11 L.I'RMT1 F,L('Permit 6/211'01 $26.66) Elect'I Final
(additional fees not listed here)
Total $158.33
This Permit is issued subject to the regulations c3ntained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws
All work will be done in acoordance with approved plans. This permit will expire if work is n)t started within 180 days of issuanoe,or 4 work is
su ended for more than 180 days. ATTENTION: Oregon law requires you to follow rules aiopted by the Oregon Utility Notification Center Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)
246-6699 or 1.800-332-2344.
Issued By: / /2��� ' Permit Signature:
OWNER INSTALLATION ONLY
The installation Is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE': DATE
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF ;'UPR. EI_EC'N: _ DATE.
LICENSE NO: _--
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical F %emit ApplicationNVAUMM
— Received irlcetncal
_Dat"Y: NMI No.
CUY of Tigard NBplanning Approval Sia„
13125 SW Hall Blvd. D'`tr/By 0.:
Tigard,
Oregon 97223 Plan Review Other ---
DatclB Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 POet-ReLIeW Land Use _
Internet; www.ci.tigard.or.ue CVA, koma Case t:o
24-hour Inspection Request: 503.639-4175 Contact Juris. See Page 2 for
Nartx✓Method: Supplemental laformation.
CAV-c-s
OF WOILK _ PLAI►'
Itlsis cheek xll tW,t apply)
New eonsmietion Demolition Service over 215 arnps- Health-cue fucil,,
Addition/alteration/re lacement Other: C0TS menial Hazardous 1a:adt,,
CATEGORY OF C014STRUCTION 1 0 Service over 320 amps-rating of Q Building over 10,000 square feet.
1 &2-Famil dwellin i I&2 family dwellings four or More residendel units in
Commercial/industrial System over 600 volts notrdrnl one structure
Accessory Buildin Multi-farnily Building over thrar stones Feeders,400 amps or more
Master BuilderI Occupant load over 99 persons ManufacturctI strums or RV park
Other: Egress/lighting plan Other
1'' 3 IS INFOPMATION tt1W L ATIIDN, Submit sets of plana with any of thu above.
Job site address: 1 U 2-l� _� The above ore not appileabla to tem construction service.
t Suite#: Bld �N— u—mb ;bsEucnons Cr ermlt auo>iye,l
Pro act Name. Q Description pry Fee(ea.) Total
Cross Street/DL-ectionS to Ja site: Ldwelling
residen"I.slnale or mu'ti-LaWy per
unit Includes attached garage.
ice locludedt
sq.R.or less 145.15 q
additional 500 s ti or Trion thereof 3J.4Q 1
Subdivision: Lot#: Limited coir ,residential 75 j
FT—ax maU pdrCCl#: -- Limited energy,tion residential 75.00 2
Each manufactured home or modulo dwelling
B6CRd TION OF WORK service anNor finder 9090 j
services or feeders-lesisnatlon,
-- alteration or relocation
200 amps or lead 60,30 2
201 atm a to 400 amps I06.L5
4t 01 am to 000 sm GO 2
P110PE TY OWNER TENANT 601 amps to 1000 amps 240.60
Name: _ Over 1000 am 9 or volt, 154,65 j
--- R°C°nntcl E 66.65 2
Address: 46-85 Temperary services or faMers-installation,
City/State/Zi : _ alteration,or rNecatios:
•less 66.95 1
Phone: 200 amps o
Fax: 01.lnp5ro,,un n s loo.3v a
APPLICANT CONTACT RAN 40l m 60o am 133.75 12
Branch circuits-new,alteration,or
Nie'------ -_ extension per panel:
Ad(iress: A.tree for branch cneuiM With p°rrhea°of
'ervice or feeder fee.each branch circuit 6,65 2
C1 /State/Zip: B Fee for branch circuits without purehsoe of
Phone: service or feeder fee,first branch circuit 46.35 2
Fa.C_ Each additional branch circuit
6,65 j
1r-fIl.11 Misc.(Service or reeler not included):
C ETON Ea°h pump or urigation cucle 53.40 2
Job.�0: _ — -ach alga or oytli7e 1� — 2
Signal circuit, 53.40 or a limited energy panel,
Business Nalne: POSE CITY ELMR "r`d°"'°r`�1e°'i0" pa e2 z
Address:- _ VNc►iPtion:
Cl /State/ZlBach additional ins ection over tboailoweble In as or th aboverPcron hour rl62.30
Phone: ves:i ion fee:CCB Lie.#: 3 other.Supervising electrElec>hlcltl 'ermit'1(ters" ( (06)Subtotal ! Sture rt uiredPlan Review 25%of Pettnit Fcc s
Print Name: State Surcharge 8%of Perotit Fee s
Authorized TOTAL PEIRMiT rEE S
Notice: This permit applintles eapiros If a permit is
Signature: bate: 160 days after It has been accepted as complete.
'Fee mrthodelop set by Tri-Counry Building industry Service Board.
(Please pnnt name)
i:VOsu',Perrait FormslElcPcrm�-Aup.doc 01/03
Ii lectrlcal PeKmit_ A,,I PIiration-City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for 9!l systems.....................................I...................... 575.00
Check Type of Work In volvert:
Audio and Stereo Systems* -
Burglar Alarm
Garage Door Opener*
Neuting,Ventilation wd Air ConCittoning System*
Vacuum Systanu*
' Other
COMMERCIAL WORK ONLY:
Feefor tel system.......................................................... S75.00
(SEI;OAR 919.260.260)
Check Type or Work Involved:
0 Audio and Stereo Systcros
Holler Controls
Clock$ystrnu
Q Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
lnstrumettt:ion
►nteremom and Paging Systems
QI.Andseape Irrigation Control*
Medical
F-1 Nurse Calls
Outdoor Landscape U{hdng*
Protective Signaling
Other
Number of Systems
* No lirenses are required. Licenses are required for all
other installations
i:%Dsts''\Perttrit Fotms+BlcP-TdtAppPg2.doc 01/03
Z0oz " 9L1 10 .L.LIJ 098T88SCOS TFd L0:T1 C00L/0T/Z0