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11720 SW HAZELWOOD LOOP 11720 SW HAZELWOOD LOOFA ^� _ ELECTRICAL PERMIT CITY OF TIGA�( _ PERMIT#: ELC2003-00544 DEVELOPMENT SERVICES DATE ISSUED: 8/29/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-41171 PARCEL: 1S134ED-04200 SITE ADDRESS: 11720 SW HAZELWOOD LP ZONING: R-4.5 SUBDIVISION: ENGLEWOUD NO.2 BLOCK: LOT : 130 JURISDICTION: TIG Project Description: Installation of temporary service to begin fire repair. RESIDENTIAL UNIT _ TEMP SRVCIFEEDERS _ MISCELLANEOUS_ 1000 SF OR LESS. 0 _ 200 amp: 1 PUMP/IRRIGATION: EACH ADD'L 500SF: 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 ADD'L INSPECTIONS 0 200 amp: W/SERVICE OR FEEDFR� PER INSPECTION: 201 - 400 arnp. 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 a.np: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: REV_IEW_SECTION_ 1000+ amp/volt: -4 RES UNITS: >600 VOLT NOMINAL: Reconnect only: __ SVC/FDR —225 AMPS: CLASS AREA/SPEC OCC_ _ Owner: Contractor: ACHUGBUE,MOLLY KELSO ELECTRIC INC 11720 SW HAZELWOOD LP 545 SE 3RD TIGARD,OR 97223 HILLSBORO,OR 97123 Phone: Phone: 503-648-6360 Reg M LIC 116254 — — SUP 4270s FEES f:LE 34-433c Description Dr to Amount _ — Required Inspections _--------- I LI.PRIVITI 1:11'Permit �")ul $66.85 I TAX)8%,Statc Tax _"i tl3 $5.3.5 Elect'I Service Elecfl Final Total $72.20 This 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 4 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 itl OAR 952-001-0010 through OAR 952-001.0100. You may obtain copies of these:ndes or direct questions to OUNC at(503)246.6699 or 1-r0-332-2344. 119 ied By: 1 Permit Signature- LZ OWNER INSTALLATION The installation is being made on property I own which is riot intended for'4we, lease, or rent. OWNER'S SIGNATURE: f______ _ DATE: _ CONTRACTOR INSTALLATION ONLY r! ' SIGNATURE OF SUPR. EI_F C'N: _ U ��",`- r ee"f'�` DATE: LICENSE NO: Call 639-4175 by 7:00pm for an inspection the next business day i;le 'cal P�init Ap licat on � / Received t/B , Punct No GL� O�'O0`>r7' 0 „�jL� City of TigalydPlrnfting ApOMval Sign Test Forza Datta l 1t No 13125 SW HaU Blvd. Plan Review – � Other Tigard,Oregon 97223 Dstua : Permn No — Phone: '03.639.4171 Fax: 503.598.1960 Pott-Awgw Gnd UM DttdB � a Nu.: Internet, tvwwxLtigtrd,or.us contact loris Sea Page 2 for 24 hour Inapt cbon Request: 503 639-417", .4 ne/Mcthod Sysiplemustal Information. . TYPE OF WORK PLA.�I VIEW UtM'ehtcli all that apply) ,1 Nein construction I D Demolition � LJ Servlooover 22Sturtp/- Heald,-cars facili-y —' Addiron/alteratlon/re lacement Other: commercal H Ha"dous lo:auot CATEGORY F CON �F., ❑Semae ova 320 amps-ratirs of C3Buildtng wet i0,DJ0 sclu m M; 1 do 2 fbntlly dwdhnts four or wire msicleatial ur:13 In 1 &.2-Fan-diy dwelhnz Commercial/Industrial ❑System over 600 volts ronitnal one stricture Accessory Buildin Multi-Famil 8 Building over three rtanes 8 Feeders too invo or more. _ Occupant load over 99 gators Manufactured ta-uctures or RV pink Master Builder Other: ❑Eg"Aighting plan ❑other JOB SITE iNFORhIATION and LQCATiON . SubmitaeN of plans with amy of the above The above are not applicable a po temrary con"ructlon ionic•. Job site address / 7 t �./ / ��rn �.I" ItEt!Sr Suite a Bld ./A t.#: Numbs of ins actions per permit allow d Project Name: J4LI H !, K U- — — Description I Qt1 Fee et Ttur Cross street/Dirt'ctians to Ob Lite: New residaadoWingle a multi-Nmby par J dwelllrrt unit-Inchidw attached garage. x rte" ��/ti/¢<J✓�!s �n Service Incbrded: 1000 1Q.R or ICU 143.13 14 Sdrviston: Lot#: Urnited energy�ruldennat t--- -mit!l enrity.non rt ident,a] 1 . Tax tnarV%mel &ch manufacnued home or r-,o&ly d%illi is TrisC irmoN F.WO rervice aad/m tNder 0 l 1 i Sarvleea a r•eden-iostailatutt, I NteraNuo orteloeatfoe: 100 trnpt or leas $OJO 1 -- 400 Wrig 04 H 2 4_6___1m ODate 1 1ti0,6G PROPERTY'OWNZR TWANT " ' , a 2 er..Wamp orvolts Name its 2 Address: ,ti; Temporary seMea or feeden•InRalltties, Ci /State/Zi : etterawl%or mlocatlon: 00 myt or loss E6 t5 I Phone: 3015 Do-,04T-of laa�o 1 Asol to 6o0.m 133.13 PPLICANT _ ONTA T1P N Branch simile-new,dteratlea,or Name. eiteatlon per panel: Address: .1.Fcc Eta bench chuits with purchase of •/ a tcrviec or kader h nth branch 01rouit 6 6g 2 ca.'State/7.ip: 7/7J 3 treat for branch circuits without pumhrw of Phone: Y3-c:.Te_, .1m1!of Fax: r� - t Uch additional b ch ciroult 6.6! E-mail. Misr(Semea at feeder not tnclu d): CO - scn r t n circ:e O Eanh a ear at6n•L hn 57.40 2 Job No: gn+l arettrit) .ud wr pans, Business Name 114 Address: �n Cit;% tateiZi : 411"!,� r r?.D 0 c tb additional Iasoadloa ever the allowable In tory of the above: _ S 3. Q i 7/" --:— - P I hour-m' harts) 0 Phone: �/$ Fc Fax: c,. a op CCB Lic. if: i .1 rl LIc.N; tf othtr EltleWal'P�rtnkP Super-,ising slectnc:an �/ �,--r—; Su to a1 Plan Review 23%of Permit Fee ! Print Name: S./�� / drL s,• Lic,M: Y't 7 Stotts a v.of tnnit L ------ ----- " e(IV. E° A uthorized TOTAL PERM'FRt I s . = Notice: Title"It appliestloo aspire.Va permit u not ebtalsed within Sigtuttae Date. IID dm after it has been somptad as"Mioloak rage oast MU) *Fee rr•thodology set by Tri-County Building Industry ae"iel Board. 100(8 (1)0511 d0 00676 9CU2 rVJ tt.tl ZnOZ 9Z e0 n TY O r �� ---��MASTER PERMIT _ �•- PERMIT#: MST2003-00469 DEVELOPMENT SERVICES DATE ISSUED: 0116/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SHE ADDRESS: 11720 SW HAZELWOOD LP PARCEL: 1S134BD-04200 SUBDIVISION: ENGLEWOOD NO.2 ZONING: R-4.5 BLOCK: LOT: l.-O JURISDICTION: T16 REMARKS: Fire restoration BUILDING REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: REP HEIGHT: FIRST: of BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYP5 OF USE: SF FLOOR LOAD: 40 SFCOND: sf GARAGE: of FRONT: PARKING SPACES TYPE OF CONST: SN DWELLINU UNITS: I TNFa sl RIGHT: OCCUPANCY ORP: R3 BDRM: BATH TOTAL: 0 a VALUE. 75,000 00 REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUBISHOWERS: GARBAGE DISP: WATER HEATERS: WATER LUES: BCKFLW PREVNTR: GREASE TRAPS: OTHL•R FIXTURES: MECHANICAL FUEL TYPES FURN<100K: BOIL/CMP<7HP: VENT FANS: I CLOTHES DRYER: FURN>-100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: blu LOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS. ELE^TRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS _ AbD'L INSPECTIONS 1000 SF OR LESS: 0 200 amp: 0 •200 amp: WISVC OR FDR: PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp. 1st WID S VC/FOR: M SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp' 401 - 600 a np EAADDL BR CIR: 2 un SIGNALIPANEL. IN PLANT MANU HM/SVC/FDR! 601 1000 amp: OOt.a nps•tlx)0v MINOR LABEL. 10604 amplvolt PLAN REVIEW SECTION Reconnect only: >•4 RES UNITS: SVCIFDR>•226 A.: >800 V NOMINAL CLS AREAISPC OCC ELECTRICAL-RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL _ AUDIO&STEREO, VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTE.RCOMIPAGING: OUTDOOR LN DSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR- MVAC: DATAITELE COMM NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,194.32 ACHUGBUE,MOLLY LORENTZ BRUl1N CO INC rhes permit Is subject to the regulations contained In the 11720 SW E,M L LY Lf' 3636 SE 20TH AVE Tigard Municipal Code,State of OR. Specialty Codes and T1GARD•OR ZELW PORTLAND,OR 97242 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 the work is suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Phone: Phone: 232-7106 Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through 952-001-0080. You Rep M: LIC 73 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Mechanical InsD Electrical Final Electrical Rough In Mechanical Final Framing Insp Final Inspection Insulation Insp Rath drain Insp _._ P ed B r 1 ry er- ermittSitr ee gnaue I s y - — Call (503) i;39-4175 by 7:00 p.m. for an inspection needed the next Lsiness daly Buil(lin Pert�itplieation Received y� _--T —�� Date/B : 1� 1d13 — Penmt tiu../'; Planning Approval Other City of Tigard Date/By: Permit No 13125 SW Hall Blvd. Plan Review Other Date/Dy: Permit No.: Tigard,Oregon 9727.3 , Post-Review Land Use Phone: 503-639-41'11 Fay, 5vV -)96-1960 Date/By Case No. Internet: www.ci.tigard.or.us Contact Jt�rag' See Pagefor 24-hour Inspection Request: 503-639-4175 Name/Method: "7 Supplementall Information - - r tNew7Ff ItFQI IR17D DATA.constructionDemolition &21AM1IIIA' U��"I: -1(Idrlltm%ulteratlon/replacement Other: A j;](;OK�Y,"Q F�LOIVS i GT+ Note: Permit fees*are based on the total value of the work performed. Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor, l�+I do 2-Family dwellfn CommercialMdusthal overhead and profit for the work indicated nn this application. .,,)'� c00 — - Accessory Buildit Multi-Famil $ Master Builder Other: Valuation..................:...................................... 'and L'O ATION No.of bedrooms: No.of baths: B SqEL ORIVITi �_ ----!--- Total number of floors..................................... Job site address: 11 0 sW_Lt n��E,dL -1� New dwelling area(sq.ft.).............................. Suite #: Bld ./A t.#: Garage/carport area(sq. ft.)............................ _ Project Name: Covered porch area(sq. .)••••.•.......•••••.•.••••••• -- Deck area(sq. ft.).................................••......... Cross street/Directions to job site: other structure area(sq.ft.).......................... RLQUFItFr7I).ATA ,: •�-„t"1',,. C'OMMER LAL -USl?C'tJF CKL,IS -- - - Subdivision: _ I_ot#: --` Tax m:1� tart el i/: Note: Permit fees'are based on the total value of the work performed Indicate ---a —GIt1PxIO1V b WO + the value(rounded to the nearest Dollar)of all equipment,materials,labor. overhead and profit for the work indicated on this application ----- - — S -----yam-i Valuation.. .............. ..............................:........ - /' r_ n( A,9'&ArdPCt 6� 1' t�c'S.__ Existing building area(sq.ft.)......................... 0 0 Ir' New building area(sq.ft.)............................... —. - Number of stories............................•............... <<y ! ' Type of construction.......................... x-i....tingg. : - — Occupancy group(s); Exi NNew: —-- Address: S>_f_ AAnVZ Cit /State/Zip: -__-� 1/r -0 OiG Q 2Z 3 NOTICE: All contractors and subcontractors are required to be Phone: Fax: licensed with the Oregon Construction Contractors Board tinder provisions of ORS 701 and may be required to be licensed in the Business Name: — jurisdiction where work is being performed. If the applicant is exempt from licensing,the following reason applies: Contact Name: _ Address: Cit /State/ Zi Phone: _ Fax._ ` ;' B[Ill.I)ING PERNlIT r FES• E-mall: Please refer to fee schedule._ ' t ss Name: DIZr1=tl►'t�_ ,jt-LA Fees due upon application... ....... Address: SE 4-— Amount received.................................... ........ S -- Ci /State/Zi o 111 __ `► ZU 2_ Phon�Q31 2 3 L ( Z 3�5� -- Date received:- --- _- CCB Lic. #_ ex ires If a permit Is not obtained within-Fee Authorized Notice: This permit application p p Signature: �_ Date:gIRO days after it has been accepted as complete. �-_-- •Fee methodology set by Tri-County Building Industry Serflee Board. 3 t lease iADsts\Pernnit Fomts',BldgPermitApp doc 01/03 Mechanical Permit Application Rece'ved 4� Mechanical Date/B : D-3 Permit No. Planning Approval Building City Of Tigard Date'B Permit No: 13125 SW Hall Blvd. ` Plan Review Other Tigard,Oregon 97223 Date'Bv Permit No.: _ Phone: 503-639.4171 Fax: 503-598-1960 _-n Post-ieview [.And Use Date/By Case No.: Internet: www.ci.tigard.or.us Contact Juns.: See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method Supplemental Inform-don. TYPE OF WORK COMMERCIAL FEE'SCHEDULE-USE CHECKLIST New construction I I I Demolition Mechanical permit fees*are based on the total value of the work Addition/alterationheplacement Other: performed. Indicate the value(rounded to the nearest dollar)of all CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit. V1&-Family dwelling L Commercial/Industrial Value: S_ _ See Page 2 for Fee Schedule AccessoryBuildin Multi-Family RESIDENTIAL.EQUIPMENT/SYSTEMS FEE*SCHEDULE Description I Qty I Fee ea. "rota) Master Builder L Other: HeatinlWUConlin JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning'• 14.00 Job site address: I I 1 'Lp 5W -Al-kwwa._Loaf Gas heat ptimp 14.00 Suite#: Bld ./A L#: Duct work 14.00 Pro est Name: H dronic hot waters stem 14.00 Residential boiler Cross street/Directions to job site: for radiator or h dronic system) 14.00 Unit heaters(fuel,not electric) in wall,in-duct,suspended,etc.) 14.00 Flue/vent(for anyof abovel 10.00 Subdivision: Lot #: Repair units _ 12.)5 Other Fuel Appliances Tax map/parcel #: Water heater 1 10.00 — _ DESCRIPTION OF WORK Gas fireplace 10 00 Flue vent(water heater,gas Fireplace) 10.00 — ---- -- -----— log lighter as 10.00 —_ --- -- Wood/Pellet stove -- 10.00 Wood ftreplacelinwit 10.00 Chimney/liner/flue/vent 10.00 PROPERTYNAN OWNER Other: 10.00 Name: �L N.��t3 �_ � _ Environmental Exhaust/c Ventilation -S Range hood/other kitchen equipment 10.00 Address: _ __--_ Clothes dryer exhaust 10.00 City/ tate/Zi : _ Single duct exhaust Phone: Fax: (bathrooms,toilet compartments, 1 APPLICANT I Ll CONTACT PERSON utility rooms) Name: Attic/crawls ace fans ---- Other: 10.00 Address: Fuel Piping Cid/State/Zip: "(55,40 for first 4.St.00 each additional Furnace,etc. T F—.* - Phone: Fax: —_ Gas heat pump " E-mail: Wall/sus ended'unit heater CONTRACTORWater heater Business Name: Jl : Fire Ince ----._. Range .. Address: - — -- BBS _ — _ •• City/State/Zip: Clothes dryer(gas) - Phone: _ Fax: _ Other: CCB Lic. #: cal _- - -------_---- Mechanical Permit Fea• Authorized Subtotal 7 S Signature: - ---_.--_-_...-- -- Date:,---- Minimum Permit Fee 572.511 S Plan Review Fee(250o of Peimit Fee) S --- -- - --- -- --- — Stare Surcharge(8°0 of Permit Feel S (Please print name) - TOTAL PERN117 FEF I S Notice: rhis permit application expires Ira permit is not obtained'A Ithin •Fee methodology set by TN-County Building Industry Service Board. IAO dans after It has been accepted as complete. "Site plan required for exterior AX units. t:`,Dsts`,Pernit Fortns,MecPemutApp doe 01,03 Mechanical Permit AVI)liration - Cite of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: TOTAL VALUATION:_ PERMIT FEE: $1.00 to$2,000.00 Minimum fee$72.50 $2,001.00 to$5,000.00 $72.50 for the first$2,000.00 and$2.30 for each additional$100.00 or fraction thereof,to and including$5,000.00. $5,001.00 to$10,000.00 $141.50 for the first$5,000.00 and$1.80 for each additional$100.00 or fraction thereof,to and including$10,000.00. $10,001.00 to$50,000.00 $231.50 for the first$10,000.00 and$1.35 for each additional$100.00 or fraction thereof,to and including$50,000.0_0. $50,001.00 to$100,000.00 $771.50 for the first$50,000.00 and$1.25 for each additional$100.00 or fraction thereof,to and including$100,000.00. $100,001.00 and up $1,396,50 for the first$100,000.000 and $1.10 for each additional$100.00 or fraction thereof. All New Commercial Buildings require 2 sets of pians. iABuildingTermit FormMMecPermitAppPg2 09-01-03.doc Electrical Permit A_pplieation Received Electrical Date/By— E9 6/03 _ PernutNo.:rf% -r.an�� Planning Approval sign City of Tigard Date/By: ParmitNn.: 13125 SW Hall Blvd. Plan Review Other Date/B Permit No.: Tigard,Oregon 97223 Post-Review land Use Phone: 503-639-4171 Fax: 503-598-1960 Date/B Case No.: Internet: www.ei.tigard.onus Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: Su lemental Itt[urmation. R . toe over 225 amps-— Health-care facility New construction _ Demolition �eteial ❑Hazardous location Addition/alteration/re lacement Other: ice over 320 amps-rating of F]Building over 10,000 square feet, 2 family dwellings four or more residential units in over 600 volts nominal one structure 1 & 2-Famil dwellin C;ommercial/Industhal ❑Feeders,400 ams or more y g _ [J Building over three stories P Aecesso Buildin Multi-Family ❑occupant load over 99 persons ❑Manufactured structures or RV park ❑Egress/lighting plan [3 Other:_ Master Builder Other! _ „ . Submit_sets of plans with any of the above. IT FO$Mi�T1, and U A'I'IO _ � _._.W� The above are nota Ilcable to temporary constriction service Job site address: /7!Bl:d�/ [ - Q ., . A t#: Number of Ips ectloas er ermit allowed i Suite #: p • -— Qry Fee(ea.) Total _ Dcacrl tion PiO eCt Name: - New residential-tingle or multi-family per Cross street/Directions to Job site: dwelling unit.Includes attached garage. Service Included: 145.15 4 1000 s .ft.or less 33 I Each additional 500 s .ft.or portion thereof 75.4 2 Limited ener ,residential 75.00 S 4 2 Subdivision: Lot#: Limited ener non residential Each manufactured home or modular dwelling 90.90 2 Tax map/parcel cl #: ery eand'.r feed 11SGRIPT1 L ON WO ser teen feedq�s I am atlafi r re(ocltl - 200 amps o_fess 80. 2 201 am s to 400 amps 106.8855 2 - -- to 6(10 ams 160.60 2 401 am s - -- 240.60 2 601 ams to 1000 amps 11VY�AN)I Over 1000 amps or volts 454.65 2 _ 66.85 2 Reconnect onl Name: Na �� - Temporary services or feeders-installation, Address: --- — alteration,or relocation: 66.85 1 Cit /State/Zip: __ 200 am s or less _ 100.30 2 201 ams to 400 ams 133,75 2 Phone: 1'aX. - 401 to 600 am s 7 BE dN_ _ Branch circuits-new,alteration,or extension per panel: Name: --- A.Fee for branch circuits with purchase of 2 _ service or feeder fee each branch circuit Address: 6.65 H.Fee for branch circuiU without purchase of r 4695 2 Cit /State/Zip: — service or feeder fee first branch circuit Fax: - Each additional branch circuit 6.65 2 Phone: Misc.(Service or feeder not included): E-mail: Each um or irri stion circle 53.40 2 �`�Vii' 53.40 2 Each sign or outline lightin¢ -- Job NO: --- Signal circuit(s)or a limited energy panel, - Pa e 2 _ 2 r---- alteration,or extension _ Business Name:! L_ l L iC' 7 l_i Description Address: Each additional Inspection over the allowable In any of the above: ------"T62.50 Cit /State/Zip: Per inspection per hour min. 1 hour - Fax: Investi ation fee: Phone: _ __ — Other: CCB Lic.#: Lic.#:_ — Subtotal $ Supervising electrician silznature required: _--_ Plan Review 25%of Permit Fee $ Lic.#: State Surcharge 8%ot'Pernut Fee S Print Name: _ _ TOTAL PERMIT F EF S _ Authorized Notice: This permit application expires If a permit Is not obtained within Date' 190 days atter It has been accepted as complete. Signature: ,_—_.___-— -- *Fee methodology set by'rri-County. Building Industry Service Board. (Please print nate) i:\DM\PermitForms\ElcPermitAppdoc 01/03 Electrical Permit Aaalication - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for sill systems............................................................ $75.00 Check'rype of Work Involved: Audio and Stereo Systems* Burglar Alarm DGarage Door Opener* I J Heating,Ventilation and Air Conditioning System* L, Vacuum Systems* QOther —. -- — COMMERCIAL WORK ONLY: Fee for each system.......................................................... $75.00 (SEE OAR 91 g-260-260) Check Type of Work Involved: Audio and Stereo Systems C� Boiler Controls Clock Systems Data Telecommunication Installation Fire Alarm installation HVAC instrumentation intercom and Paging Systems Landscape irrigation Control* Medical Nurse Calls 0 Outdoor Landscape Lighting* F1 Protective Signaling F1 Other Number of Svstems * No licenses are required. Licenses are required for all other installations i^.Dsts\Pcrmit Forms\ElcPermitAppPg2.doc 01/03 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 _ BUP _ c Received _Date Requested AM --_PM BUP Location l l GC� vL' L[I-� r2- Suite----- MEC Contact Parson �iU-c� Ph( -) 2 5'3 - 3 PLM - Contractor--- p �/� Ph 2f g SWR _ BUILDING Tenant/Owner ELC Footing - �-?' ELC Foundation Access: , / Ftg Drain L ✓� _ �-' 1N f' ELR --.- Crawl Drain Slab Inspection Notes: SIT --- Post&Beam Nliy� wood –_-- Shear Anchors - Ext Sheath/Shear Int Sheath/Shear -— Framing -- -- -----..-_.- Insulation ./ Drywall Nailing - Firewall Fire Sprinkler -- -- ------ - -- -- -�- Fire Alarm Susp'd Ceiling --- - - -- -- - Roof Othcr. __- Final -- PASS PART FAIL PLUMBING -.-- -- ----- -- --------- ------ Post&Beam Under Slab --- ---- - ---- _- - ---_------- _ -- --- Rough-In Water Service ----- --- -- --- ----- --- ---- Sanitary Sewer Rain Drains -- --- - - - Catch Basin/Manhole Storm Drain --------- — ---- - _-- - Shower Pan Other: - ------- ----- ---- -------- -- - ------ Final PASS PART FAIL --. _._.---.-�----- ------- ---- --- - -_. IL MECHANICAL Post&Beam Rough-In - -- ------- _..... -------- -- -- Gas Line Smoke Dampers �- Final PASS PART FAIL _-.-----------.----------- --------_._._._-_�^_ _ - - — EL - ICAL Rough-In - --- -------- --------- --- ----------- -- UG/Slab Low Voltage -- Fire Alarm Final--- Reinspee reo of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SS ART FAIL ttTE— -- Please call for reins ction RE:_ Unable to inspect -no access Fire Supply Line ADA Approach/Sidewalk. Dat* Z -_-__ Inspoeo Ext Other Final DO NOT REMOVE this Inspectlon record from the job site. PASS PART FAIL