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12110 SW HALL BLVD ..na .i 0 cn 2 Q1 W 12110 SW Nall Blvd CITY OF TIGARD BUILDING, INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Businsss I ine: 639-4171 NIST BUP -. Date Requested_ C9' Y AM PMJI ------- BLU Location / Sv +,C� / —_ Suite J — - ^. __-- MEL _ Contar,t Person Ph �- Z 6 l � PLM _ Contractor Ph _ SWR BUILDING Tenant/Owner ELC C��-'��� Reiaining Wall - `- ELR - Footing ------------ - - -- Foundation Ar,CeSS: FPS Ftg Drain -- Crawl Drain Inspection Notes: SGN Slab _ - SIT Post&Beam — ----_.. .__-- -------.---- Ext Sheath/Shear Int Sheath/Shear - - - Framing — Insulation --- -�- Drywall Nailing — — 119 Firewall - - - Fire Sprinkler Fire alarm Susp'd Ceiling Roof - Misc: I -------- Final -- PASS PART F AIL PLUMBING _ Post&Beam -- — ---- -- . Under Slab Top Out - -- - --- ---- Water Service Sanitary Sewer ------ -- ----- ----._. Rain Drains Final --- ----------- ---------- - - — PASS PART FAIL MECHANICAL — —�- — -- Post& Bearn ------- �_ _ Rough In --- Gas Line - --------- - Smoke L`ampers Final PASS PART FAIL — - — --.--------_'. LECTRIC ,e Rough In i2��h���.� -------- -- ------ — ------ --_ -- - — UG/Slab Low"I'oltage Fire Alarm 'PASS VART FAIL NackfilUGrading --- —-- Sanitary Sewer — Storm Drain [ J Reinspection fee of$— _regUired before next inspection. Pay at City Hall. 13125 SW Hall Blvd Catch Basin Fire Supply Line [ )Please call for reinspection RE: — _ [ ) Unable to inspect- no access ADA — Approach/Sidewalk Other Date _ .___Inspects ---- _—�Ext Final -" PASS PART FAIL DO NOT REMOVE this inspection record from titre job site. CITY OF TIGARD BML LING INCD;=r fILN DIVISION MST 24-Hour Inspection Line: 639-4175 131:.-iness Line: 638-4171 -- ----- -- BLIP Date Requester' � '� �� AM PM ___— BLU Location 1 //U SSuite MEC Contact Person Ph _, 2 f- 72-y _ PLM Contractor _ Ph SWi LILDING Tenant/Owner ELC ,tripy rr,j U 144- 'Retaining Wall ELR Footing Access- Foundation FPS Ftg Drain — — Crawl Drain Inspection Notes: SGN Slab — _-_-- `-- SIT Post&Beare - Ext sheath/Shear Int Sheath/Shear - Framing Insulation -- _- Drywall Nailing Firewall -- -,- Fire Sprinkler _ _ Fire Alarm -- Susp'd Ceiling Roof 01 _ Misc: --------------- Final PASS PART FAIL ----_-- — - PLUMBING Post is Beam ------ Under Slab Top Out --- - — --- —__ --------- - -- — Water Service Sanitary Sewer -- - —— -- -------- ------- — --- -- _ -- Rain Drains Final PASS PART FAIL MECHANICAL Post& Beare Rough In ---------- -----_. -. Gas line Smoke Dampers Final --------- _ _--____-_-- PASS PART FAIL EtEt-T --- --- ---- ---.-- -------- -- --- -- -- rvice Rough In UG/oiab Low Voltage --- --- - _.-----------___—. --. Fire Alarm Fin PART FAIL E - Backfill/Grading --- ---------- -- -- Sanitary Sewer Storm Drain [ Reinspection fee of$ _quired before next inspection Pay.11 City Hall, 13125 SW Hall Blvd Catch Basin [ )Please call for re'nspection RE —_ —_— r J Unable to inspect-no access Fire Supply Line -- - ADA Approach/Sidewalk Other Uate Inspector - -Ext _ Final PASS PART FAIL 60 NOT REMOVE this inspection record from the job site. CITY OF ) .GARD BUILDING INSWECrION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 — --- G SUP Date Requested_ b �y AM PM _--_ BLD -- —_--__ Location l- 44A/vj Suite MEC -- Contact Person Ph 2* - 2,2vd FLM Contractor - —,--- --- Ph _ — SWR BUILDING Tenant/Clwner --_ — — (!�!./ �r�'` Retaining Wall ELR --- Footing Access: 'Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post r3• Beam Ext Sheath/Shear Int Sheath/Shear framing Insulation Drywall Nailing Firewall - — 7 Fire Sprinkler- Fire prinklerFire Alarm — Susp'd Ceiling ---- -- - Roof Misc: -- ---- ---.. __ Final PASS PART FAIL - - — PLUMBING Post a Beam _..-_.-._------- - --- ---- - --._.—_—.. Under Slab Top Out Water Service Sanitary Sewer —— - Rain Dmins ------------- ---------------------------- ---- Final --------- - ---- PASS PART FAIL _ - --- ------ - ---------- ----------- - MECHANICAL Post& Beare -----..____..--------_—_---- -_ __. --_ Rough In GasLine - ------- ------ ---- -------- -- --- -_--_--- Smoke Dampers Final --- ---- --- --- — - -- ---- - --- PASS P FAIL Service 12<Rough In In UG/Slab -- Low Voltage Fire Alarm -- ------------------------ - _ —__ AS PART FAIL __- - - ---_--- ----- b Backfill/Grading — Sanitary Sewer Storm Drain ( j Reinspection fee of$ _required before next inspection Pay at City Hall, 13125 3W Hall Blvd Catch Basin [ ]Please call for reinspect n RE: _--. _- _ j j Unable to inspect-no access Fire Supply Line ADA Appiosch/Sidewalk Other Date V Inspector_ —_ ���Ext Final PASS PART FAIL_j DO NOT REMOVE this Inspection record from the job site. CITY OF TIGA RD BUILDING INSPECTION DIVISION MST 24 Hour Inspectio,. '_ine: 639-417v Business Line: 63�-4111 BUP _ Date Requested ,Sl�'l AM__ PM , BLD Location, '' Suite MEC ___ Contact Person Ph 2�_ -- PLM Contractor Ph SWR- _— — +— BUILDING_---� Tenant/Owner -- — (�JLC ELR Retaining Wali Footir.g Access: FPS Foundation Ftg Drain SGN Crawl Drain Inspection Notes: SIT Slab --- Post&Beam _ Ext Sheath/Shear _ Int Sheath/Shear Framing _ - - _- ---- ---- Insulation Drywall Nailing - -- -- -. --------- - - Firewall Fire Sprinkler - -� Fire Alarm Susp'd Ceiling I - - Roof - Misc: -- Final -- - --- PASS PART FAIL v PLUMBING Post&Beam Under Slab Top Out -----_---.. Water Service Sanitary Sewer Rain Drains -- Final - PASS PART FAIL --- - -- -- MECHANICAL --- - Post&Beam -- --- - - _---- Rough In - Gas Line -- .-------__--_ -_ --- Smoke Dampers --- --- - F final PASS PART FAIL -- -- - - rvice Rough in r2r(-�nn,y,I _ -- -- - - UG/Slab ------ Low Voltage - - Fire Alarm ---- -- Fi - ASiS FART FAIL — --- - —� Backfill/Grading �- Sanitary Sewer before next inspection. Fay at City Hall, 13125 SW Hall Blvd Storm Drain ( j Reinspection fee of$ required- Catch Basin [ j Unable to inspect-no access [ J Please call for einspecilon RE:_ Fire Supply Line — ADA Ext Approach/Sidewalk Date Inspector - - Other Final LPASS PARE FAIL DO NOT REMOVE this Inspection record from the job sit ELECTRICAL PERMIT CITY OF T'GAR® / \ PERMIT#: ELC2000-00466 DEVELOPMENT SERVICES DATE ISSUED: 8/11/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S101BB-01000 SITE ADDRESS: 12110 SVV HALL BLVD D' / SUBDIVISION: T!GARD ROAD GARDENS 7.ONING: C-G BLOCK: LOT : 006 JURISDICTION: TIG Proiect Description: Reconnect only. _ _RESIDENTIAL UNIT TEMP S_RVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: _ 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OU-I- LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER _ -_ BRANCH CIRCUITS _ ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W!O SRVC OR FDR: PER HOUR.- 401 OUR:401 - 600 amp: EA ADD'L BRNCH CIRC- IN PLANT: 601 - 1000 amo: _ PLAN REVIEW SECTION 1000+ amo/volt: >=4 RES UNITS: T� > 600 VOLT NOMINAL: Reconnect only. 1 SVC!FDR >=225 AMPS: _ CLASS AREA/SPEC OCC: _ _ Owner: Contractor: LITERAL, RONALD H OWNER 9021 BARTHOLOMEW PORTLAND, OR 97225 Phone: Phone: Reg #: FEES Required Inspections Type By Date Amount Receipt Elect'i Service PRMT BLD 8/11/00 $53.50 0004437 5PCT BLD 8111/00 $4.28 0004437 Total $57,78 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 spproved 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 arF it forth in OAR 952••001-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at(503) 246-19; I PERMITTEE'S SIGNATURE ISSUED BY: �l OWNER INSTALLATION ONLY The installa'ion is being madeoperty I wn which is not intended for sale, lease, or rent. 7�r! OWNER'S SIGNATURE: _ — DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF,;UPR. ELEC'N: taATE: —_ LICENSE NO: __--- Call 639-4175 by 7:00prn for an inspection the next business day Wd9b:Z1 '0ti'JDd 3WI1 Q3aI3038, CITY OF TIGARD Electrical Permit Application Redd By — 13125 SW HALL BLVD. Date Recd TIGARD OR 97223 Date to P.E. Phone(503)639-4171, x304 Date to DST Print of Type Permit#� r2� p�1 '� Inspection (503)639-4175 CalledFax(503) 598-1960 Incomplete or illegible will not be accepted T. Job Address: 4. Complete Fee Schedule Below: Number of Ir r—clions per permit allowed Name of Development Service included: Items Cost Sum Name(or name of business) —IN r�V''�I I \ all $lU ' ,�_M 10 Residential-per unit s 117.75 Address W 1005 sq.rt.or less _. ---'�'—' City/State/Zip �1Captt� 0 Each additional 5o0 sq Q or $ 26.75 ' portion thereof S 6000 Commercial 1:1Residential Limited Energy _ Each Manufd Home or Modular S 72.75 Dwelling Service or Feeder 2a. Contractor installation only: (Prior to permit issuance,applicants must provide conte ctor license Installation,bServices csorFeet � or relocation Information for COT data base). 200 amps or less —__—_ $ 655.50.50 6 Eler.Idcal Contractor - 201 amps to 400 a nps _ S Address 401 amps to 600 amps $ 19250 128.50 Ci State �zjp -- 601 amps to 1000 amps S 363.75 ry or volts $ 5350 S-� Phone No. econnect nl Job No. Ex .Dale __ 4c.Temporary Services or Feeders Eloc.Cont.lice.No. Exp.Date Installation,alteration,or relocation Old State CCB Reg.No Exp.Exp.Exp•Date $ e5 25 200 amps or less $ 53 55 --_ COT Business Tax or Metra No -- 201 amps to 400 strips — --. 401 amps to 600 amps _ i 10000 Signature of Supr. Elec'n Over 600 amps to 1000 volts, see"b"above. License No. Exp.Date`_ 4d.Branch Circuits Phone No. _ New,alteration or extension per panel a)1 he fee for branch circuits with purchase of service or 2b. For owner installations: reader tee. $ 915 U Each branch circuit ---- — Print Ownet s Name.A Ry b)The fee for branch circuits Address b j— without purchase of service City State _Zip �3 3 _ or feeder fee. _ $ 3750 ,n. —1 r�G First branch circuit Phone No. y80 �� Cath additional branch circuit _ _ $ 5.35 _ The installation Is being made on property I own which is not 0.M(service ,IansOuG feeder not Included) intended for saler,lease re t. Each pump or t4Tlgabon circle $ 42 5 1( Each sign or outline lighting $ 42 7 75 Owner's Signa,IU6 — --— Signal dreult(s)or a limited energy —� 60.00M— panel,alteration or extension y 100 00 3. Plan Review section (if required):* Minor Labels(13) — se check appropriate item and enter tee In section 5B. 4f.Each additional Inspection over the allow1ble In eny of the obuve $ 50 00 or more residential units in one structure Per inspection _ _ Service and leader 225 amps or more Per hour $ 50.00 _ System over 600 volts nominal In Plant S 59.00 _ Classified area or structure containing special occupancy as 5. Fees: described In N E.0 Chapter 5 5a.Lnler total of above lees ' Submit 2 sets or plans with application where any of the above apply. 8%Surcharge(08 x total fres $ Subfotaf $ Not required for temporary construction services. 6b.Enter 25%of line tier for NOTICE Plan Review If mquhcft (Sec 31 S -- PERMITS BECOME VOID IF WORK OR CONSTRUCTION AU1 HORIZED Subtotal S -- IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED rOR A PERIOD OF 180 DAYS U Trust Account# $ Al ANY TIME RT-ER WORK IS COMMENCED Total balance Due i\dsts\forms\electric dnc �„ , , nna r one. Pnr ti"7.1 till no ti I ELECTRICAL PERMIT TY OF T I G A R D PERMIT#: ELC2000-00465 DEVELOPMENT SERVICES DATE ISSUED: 8/11/00 13125 SW Hail Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL.: 2S101 BB-01000 SITE ADDRESS: 12110 SW HALI- BLVD. SUBDIVISION: TIGARD ROAD GARDENS ZONING: C-G BLOCK: LOT : 006 JURISDICTION: TIG Proiect Description: Reconnect only. RESIDENTIAL UNIT TEMP SRVC/FEEDERS__ ___ MISCELLANEO_US 1000 SF OR LESS: 0 200 amp: _ PUMP/IRRIGATION: EACH ADD'L 500SF: 201 400 amp: SIGN/O1JT LINE LTG: LIMITED ENERGY: 401 600 amp: SIGNAL/PANEL: MANF HMI SVC/ FDR: 60'+amps - 1000 volt: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUI rS _____ ADD'L NSPE;TIONS___ 0 - 200 amp: W/SERVICE OR F_EDER: PER INSPECTION: 201 - 400 nmp: 1st WIO SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L_ BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ _ PLAN REVIEW SECTION 1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only—._1 SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC- Owner: CC Owner: Contractor: LITERAL, RONALD H OWNER 9021 BARTHOLOMEW PORTLAND, OR 9722.5 Phone: Phone: Reg # FEES _ _ _ Required Inspections Type By Date Amount Receipt Elect'I Service PRMT BLD 8/11/00 $53.50 0004437 5PCT BLD 8/11/00 $4.2811004437 Total $57.78 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 d work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth In OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at(503) 246-1987 PERMITTEE'S SIGNATURE Q _ ISSUED BY: OWNER INSTALLATION ONLY The installation is being made property I n which is not intended for sale, ease, or rent. �1 OWNER'S SIGNATURE: �(IZ� CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR ELEC'N: ____._. _ —__—___—_—_ DATE: LICENSE NO: — --- --�a -- _ —---- _ -- -- -- ------ Call 639-4175 by 7:00pm for an inspection the next business day Wd9b:ZT 0T'`�fltl 3WI1 Q3aI, I= i w!__ CITY OF TIGAP.D Electrical Permit Application Rec'd By 13125 SW HALL BLVD. Date Rec'd _ TIGARD OR 97223 Date to P.E. Phone(503)639-4171,x304 Date to DST _ Inspection (503)639-4175 Print of Type Permit 0 MIl'-Fort-60 V6 S Fax(503)598-1960 Incomplete or illegible will not be accepted Called 1. Job Address: - 4. Complete Fee Schedule Below: Number of Inspecuons Per permit allowed Name of Development _ Service included: Items Cost Sum Name(or name of business) „ ✓ ,� Residential-per unit Address_ Ic7`I l� SW flu L 1000 sq.n.or less _—_ $ 117.75 CirylSlate/Zip —T1G14 — Each additional 500 sq ft.or $ 28,75 portion thereof Limited Energy $ 60.00 Commercial❑ Residential Each Manurd Home or Modular Dwelling Service or Feeder $ 72.7E 2a. Contractor installation only: (Prior to p±rnit Issuance,applicants must provide contractor license 4bta Seances or Feedtion,orselocation infonnauon fur COT data base). insYep imps or less $ 64.25 Electrical Contractor—__�_ 201 amps to 400 amps $ 85.50 Address 401 snips to Boo amps $ 19250 128.50 City _ State_ —7Jp 601 amps to 1000 amps $ ar volts 363.75 Phone,No. -- — (Reconnect nl S 63 50 Job No. — Eloc.Cont.Lice.No. Fxp.Dale—__ 4c.Temporary Services or Feeders Exp. Installation,alteration,of relocation $ 53 50 OR State CCU Reg.No p — 200 amps or less — 001-Business Tax or Metro No._ EXP.Date 201 amps to 400 amps S 80 25 401 amps to Goo snips r $ 1 On 00 Signature of Supr. Elec'n_ — Over 600 amps to 1000 volfs. see"b"above. License No Exp.Date_ - 4d.Branch Circuits Phone No. New,alteration or extension per panel 9)1he fee for branch dreuits with purchase of service or 2b. For owner installations: feeder fee. (�C Each branch circuit $ 5.35 Pont Owner's Name`'M`D b)The fee for branch circuits Address ' tar' — without purchase of service City State _71p '1 J 3 or feeder fee. First branch circuit $ 37.50 Phone NO _—la l) Cacti additional branch circuit _ $ 5.35 The installation is being made on property 1 own which is not 4e.Miscellaneous intended for sale,It or re t (Service or feeder not included) $ 42 75 _ / Each pump or irrigation circle N_ -- — L Each sign or outline lighting $ 42.75 Owners SlgnatllTB_ Yr Signal circult(s)or a limited energy b panel,alteration or extension $ 60.00 3. Plan Review section(it required):" Minor l_sbels(10) J� $ 100.00 se check appropriate item and enter fee in section 513. 4f.Each addition..°Inspection aver the allowable In any of the above or more residential units In one structure Per inspectia„ __ E Service and feeder 225 amps or more Per hour _`_ $ 50.00 _'system over 600 volts nominal In Plant $ 59.00 Classified area or structure containing special occupancy as 5. Fees: described in N E.0 Chapter 5 = Sa.Enicr lulal of above fees n " Submit 2 sets of plans with application where any of the above apply. 81A.Surr large(08 X total fees) $ Not required for temporary construction services. Subtotal $6b.Enter 25%of lifle 69 for NOTICE Plan Review if requaeci(Sec 3) $ --- PERMITS BECOME VOID IF WORK OR CONSTRU(;TION AUIHORIZEU Subtotal $ �-- – IS NOT COMMENCEn WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS 1 rust Account K_ _ AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due Ss= i.\dsls\rurms\electric dric n%i nr r in t i r'1 nUFI Rne 1'ng TVA W71 1181 00'01 C ._ ELECTRICAL PERMIT CITY O F T I�AR® PERMIT#: EL"WO-00464 DEVELOPMENT SERVICES DATE ISSUED: 8/11/00 13125 SW Hall Blvd..Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S101 BB-01000 SITE ADDRESS: 12110 SW HALL BLVD.-S SUBDIVISION: TIGARD ROAD GARDENS ZONING: C-G BLOCK: LOT : 006 JURISDICTION: TIG Proiect Description: Reconne.,t only _ RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS _ _ MISCELLANEOUS 1000 SF OR LESS: _ 0 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG. LIMITED ENERGY: 401 - 600 amu: SIGNAL/PANEL: MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER _ BRANCH CIRCUITS M—_ _ADD'L INSPECTIO_VS _ 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION_ 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT': 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp/volt: ?=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only 1SVC/FUR >= 225 AMPS: CLASS AREA/EPEC OCG: Owner: Contractor: LITERAL, RONALD H OWNER 9021 BARTHOLOMEW PORTLAND, OR 97225 Phone: Phone: Reg#: _ FEES —_ — Required Inspections Type By u Date Amount Receipt Elect'I Service PRMT BLD 8/11/00 $53.50 0004437 5PCT BLD 8/11/00 $4 28 0004437 Total $57.78 This Permit is issued subject to the regulations contained in the Tigard Murnapal 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 wrthm 180 days of issuance,or if work is suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at(503) 246-1987 PERMITTEE'S SIGNATUR ISSUED BY: OWNER INSTALLATION ONLY _ The installation is being made on property I own which is riot intended fo-sale, lease, or rent. I' OWNER'S SIGNATURE: �'� DATBs �— t CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: __ ��__--_ DATE: LICENSE NO: -- Call 639-4175 by 7:00prn for an inspection the next business day CITY OF TIGARD W&V:2T eT'E)nd 3WI1 Q3a I3Q3d # Electrical Permit Application Rec'd By .4� Z H 1125 SW HALL BLVD. Date Recd TIGARD OR 97223 Date to F.E. Phone(503)63911171,x304 Date to DST Inspection (503)639A175 Print of Type Permit#_ c p zwtU ' y6// Fax(503) 598-1960 Incomplete or illegible will not be accepted Called 1. Job Address: V 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed -- Name(or name of business) Service included: Items Cost Sum INA rr 4a. Residential-per unit Address Ol b SW t t6LL' LL - 1000 sq.ft.or less $ 117.75 City/State/Zip MG-R _ Each additional 500 sq ft.or portion thereof S 26.75 Commercial❑ Residential Limited Energy _ $ 60 DO Each Ma rufd Home or Modular 2a. Contractor installation only/: Dwelmg Service or Feeder $ 72.75 (Prior to permit Issuance,applicants must provide contractor license 4 .4btServiicealte-Fee,dnerrsrelocahon information for COT data base). 200 amps or less $ 64.25 _ EIP;.trir;al COntractr7f - 201 amp:,to 400 amps $ 85.50 Address _. - 401 amps to 600 amps S 128.50 City__ State Zip - 601 amps to 1000 ami,s _ $ 192.50 Phone No. - _ or volts S 363.75 `-- Rernnnecl nl $ 5350 Job No. ------- Elnc.Cont.Lice.No._ Exp.Dale --_ 4c.Temporary Services or Feeders OR State CCB Rey. No ,_ Exp.Dale_ I Installation,alteration.or relocation - COT B,,siness Tax or Metro No._Exp.Date_ 200 amps or less $ 93.60 201 amps to 400 amps $ 80.25 401 amps to 600 amps $ 100.00 - Si(jrlature of Supr. Flec'n over 600 amps to 1000 volts. see"b"above. License No. _Exp.Date 4d.Branch Circuits Phone No. - New,alteration or extension per panel a)1 h iee for branch circuits 2b. For owner installations: with,ourchase of service or p feeder fee. Print Owner's Name�1D �C t"'� Each branch circuit 5.35 _ �i7 b)The fee for branch circuits Address S 1 �= w; CITY ®F II I G A R D __— ELECTRICAL PERMIT PERMIT#: ELC2000-00463 DEVELOPMENT SERVICES DATE ISSUED: 8/11/00 13125 SW Hall Blvd. Tigard, OR 97223 (503) 639-4171 PARCEL: 2S101 BB-01000 SITE ADDRESS: 12110 SW HF,I_l_ BI_.VD A 1 SUBDIVISION: T'IGARD ROAD GARDENS ZONING: C-G BLOCK: LOT : 006 JURISDICTION: TIG Proiect Description: Reconnect only. RESIDENTIAL UNIT _ TEMP SRVCIFEEDERS ---MISCELLANEOUS 1000 SF OR LESS: 0 200 amp: PUMPIIRRIGATIOW EACH ADD'L 500SF: 201 400 amp. SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): _ SERVICE/FEEDER _ BRANCH CIRCUITS ADD'L INSPECTIONS _ 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:- T 201 A00 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'I_ BRNCH CIRC: IN PLANT: 601 - 1000 amp: _—_`____ PLAN REVIEW SECTION 1000+ amp/volt: >=4 RES UNITS: i > 600 VOLT NOMINAL: Reconnect ons1� SVC/FDR >= 225 AMPS: _CL!1SS AREA/SPEC OCC:___ Owner: Contractor: LITERAL, RONALD H OWNER 9021 BARTHOLOMEW PORTLAND, OR 97225 Plione: Phone: ( Reg#: _ FEES Required Inspections _ Type By Date Amount Receipt Elect'I Service � PRMT DLD 8/11/00 $53.50 0004437 5PCT BLD 8111/00 $4.28 0004437 Total $57.78 This Permit is issued subject to the regulations contained In the Tige..I Municipal Code,State of OR. Specialty Codes and all other applicable laws All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of Issuance,or 0 work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC at(503) 246-1987 PERMirrEE'S S!GNArUR6L a__-- � ISSUED BY: OWNER INSTALLATION ONLY _�-- The installation is being ma property, I own which is not intended for sale, lease, or rent. �} OWNER'$ SIGNATURE: -- DATE --- CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: _ DATE: LICENSE NO: ------- - -- -- — Call 639-4175 by 7:00p,n for ao inspection the next business day bld�b:2 T 'OT'9f1H 3WI1 Q3a I303�Ja CITY OF TIGARD Electrical Permit 4pplication Recd By Z> At 13125 SW HALL BLVD. Date Recd T IGARD OR 97223 Date to N.E. ?hone(503)639A171,x304 �) Date to DST Print of T e Permit* 4rcC o1a�_Y� Inspection (503)639.11175 YP Called Fax(503)598-1960 Incomplete or illegible will not be accepted _ 7. Job Address: 4. Complete Fee Schedule 600w: u Nmber of Inspecl.vns per permit allowed Name of Development service included: Items Cost Sum Name(Or name Of business) a �r 4a Residential-per unit Address Ic'�-I l C all �lu dl �---- 1Doo sq.n.or ie55 _ $ 117.75 _ __ ___- a City/State/Zip Each additional 500+q ft.or — S 26 15 portion thereof $ 6000 Commercial❑ Residential Limited Energy -- Each Manurd Home or Modular $ 72 75 2 I)wellir,g Service or i'eedrr 2a. Cantractor installation only: (prior to permit Issuance,applicants must provide contractor license ins Services to on,alteration,n,orrelocation $ 8425 2 . information for COT data base). 200 amps or less — 7 Electrical Contractor J — 201 amps to 4W amps $ 85.60 2 201 amps to 800 amps ~� S 128.50 Address — S 192.50 _ 2 City State.. ZIP 601 amos to 1000 amps _ $ 363.75 �— 2 _ or volts 2 Phone No. - Reeonner.t nl $ 5350 .S S� Jus No. [x — E:�c.Cont.lice.No. p.0ate ., 4c.Temporary Services or Feeders Exp. Installation,alteration,or relocation $ 53.50 2 OR State CCB Reg. No p 200 amps or less COT Business Tax or Metro No. p Date 201 amps to 400 amps Y $ 60.25 2 Exp. : 100.00 2 401 ;imps to 800 amps — Sirt,..,cure of Supr. Eledn — Over 600 amps to 1000 volts. sea"b"above. License No. _Exp.Date 4d,I ran:h Circuits Phone No. New alteration or extonsion per panel a)1 he fee for branch circuits with purchase of service or 2b. For owner installations: feeder(ee. (y� I'�1,,�,, Each branch circuit 5'i5 ---- 2 Print Owner's Name 1�,D "r' r�7 -- b)The fes:for branch circuits Address. to — wftha if purchase of service State.�-,ZiP 3'�3 or for der fee. s 37.50 City -1� 1) First 0anch circuit ----- Phone No. '� s— �� Each additional branch circuit ___ $ 5.35 The installation is being made on property I own whir;h is riot 4seeMlce o l/eeadoer not included) intended for sale,I se or re t. Each pump or irrigation circle $ 42 75 Each sign or outline lighting S 4275 _ Owner's Signatthe TVI— Signal cimult(s)or a limited energy Plan f[eVteW 5@ panel,alteration or extension S 6D.00 —_ 3, ction (if acquired): Minor Labels(10) — —_ $ 10000 ttse check appropriate Item and enter tee in section 6B. 4f.Each additional inspection overthe allowable Ir,any of the above ;�• 4 or more residential units in one structure Per inspection S 50.00 Service and feeder 225 amps or more Per hour _ $ 50'00 System over 600 volts nominal In Plant _ — $ 59.00 Classifiod area or sinicture intolning rpecial occupancy as I — described in N E C Chapter 5 5. Fees' sm.Enter wtal of above tees s " Submit 2 sets of plans with application where any of the above apply. 0%Suhrharye(08 X local fees) $ jblotar Not required for temporary construction services. 6b.Enter 75%of line fill for NOTICE Plar Review it required(Sec 3) $ Subtotal = --- PERMITS BECOME VOID IF WORK OR CONSTRUCTION AU1 HURIZEU IS NOT COMMFNCFn WITHIN 180 DAYS,OR IF CONSTRUCTION OR El Trust Account R WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS — $ AT ANY TIME AFTER WORK IS COMMENCED Total balance Due i hdsts\forms\electric dnt 021V011 :10 A.LIJ 0961 969 COS at'a tt£•ZI .11-11. OO/Ot/90 9001PJ I i Customer Receipt Printo is OR/I 1/2000 14:19 CITY OF TIGARD User:front Station: 02 Operator: DLH Rcpt No: 0004437 Date: 08/11/2000 Customer No:000000 Amount Due: 231.12 Name: JANE'r STRANSKI Cash: 0.00echk: 231.12 Addr^ss: 4347 NE WISTARIA DR Check: PORTLAND, OR 97213 Change: 0.00 C y L 0"d Amount Tvnc 53.50 ELPRMT Electrical Permit 4.28 UD y� TAX St. Build Permit Tax 8% 53.50 ELPRMT Electrics)] Permit .28 z—/TAX St. Build Permit Tax 8% 54. 50 J ELPRMT Electrical Pennit TAX St. Build Permit Tax 8% 4'28 '; ELPRMT Electrical Permit 53.50 C TAX St. Build Permit Tax 8% 4.28 I