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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 B siness Line: 6394171 MST
i -�
Date Requested Z,. l _AM -PM 4 / BLD BLIP`� —_.---,_-�-
Location /14 L j 1� 2k �.�= L Suite
MEC _
Contact Person Ph
Contractor `<> Ph wR
BUILDING�_-� TenantrOwner r
ELC
Retaining ll
Footing _
Acc ELR
Foundation FPS
Ftg Drain - -' -- --
Crawl Drain Inst SGN
Slab _ -
Post&Beam - SIT
Ext Sheath/Shear
Int Sheath/Shear -- _
Framing
Insulation - -- - - - -------._____�__--
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - -- - --
Roof ------- -----
Misc:
Final _ -- _- _---- -----.-.—__
PASS PART FAIL I - - - --- -- - _ -__
%UMfAG
Post& Hearn
Under Slab � --
Top Out
Water Service
Sanitary Sewer -- * - - --- -- -
R Drains
Fin — — --------�—r�
t
ART FAIL
Post u Beam
Rough In I 1 A —
Gas Line --- - _�
5muka Dampers
Final ---- _----
PASS PART FAIL
ELECTRICAL - -- -- — - - - _ —
Prvice —
Rough In - - - —
UG/Slab -
Low Voltage —� --- - -—�-
Fire Alarm
Final
PASS PART F AIL
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line I 1 Please call fer reinspection RE:——- —�_ - [ ) Unable to inspect-no access
ADA
Approach/Sidewalk 1
Other Date t �' Inspector C� ExtS
Final _
PASS PART FA's- DO LVOT IREMVVE this inspection ret;oid from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line; 639-4175 Business Phone: 639-4171
/
1)ate Requested: 6471/9 / — A.M. 1 P.M.�— —_ MST:
Location- L -7/5 .L —eAA—A j--' —_ — BUP: _
reliant Suite: Bldg: MEC:
Contractor. Phone: 247-0(p� PLM:
Owner: �— Phone: / -- ELC:�� �
BUILDING BLDG(con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post(Beam Post/Beam Post/Beam Covet Service Seder/Storm
Footing Roof t1ndF1/Slab Rough-In Ct ilmg Water Line
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Ifood/Duct Reconnect Vault
Bsmt Damp Drywall Stonu Furnace Temp Service. MLSC.
Masonry Ceiling Rain Chain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found lh beat Pump Low Volt
Approved Approved Approved Approved At.u..ved
Appr/Sd xlk Not Approved Not Approved Not Approved rNvt A prmn cd . 'A}.proved
FINAL FINAL. FINAL FINAL Fi IAL
&zc-a= 51 .Al-L'`Q L�
C]Call for reinspection // C3 Reinspection fee of S required before next inspection 0 l lnahle spect
Inspector: It U e(e Date:� ` — Page-- J of- ----
CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC97-0323
13125 SWIiall Blvd., Tigard,OR 97223 (5503)639.4171 DATE ISSUED: 06/02/97
PARCEL: 2S110BC-00600
SITE ADDRESS. . . : 14615 SW HAZELTREE TERR
SUBDIVISION. . . . :AMES ORCHARD ZONING: R-- 1
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . JURISDICTION- TIG
ProJert Description : instl 3 branch :ircuits // .job # 6459
UNIT---- ---*rEMP SRVC/FEEDERS------ ------MISCELLANEOUS------
I1000 SF OR LESS. . . . : 0 0 "160 amp, * , * " * , - 0 PUMPlIRRIGATION. . . * -. 0
EACH ADDIL 500SF. . . : 0 2,01 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . .. . : 0 401 600 amp. . . . . . . : 0 SIGNAL/PANEL.......: 0
MANF. HM/ SVC/FfR. . : 0 60I+amp-'--I000 volts. : 0 MINOR LABEL ( 10) . . . : 0
CIRCUITS------ ----ADD' L INSPECTIONS—
0 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 2. PER INSPECTION. . . . . : 0
201 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. - I PER HOUR. . . . . . . . . . . : 0
401 600 amp. . . . . . : 0 EA ADDIL BRNCH CIRC: 0 IN PLANT. . . . . . . . _ . : 0
601. 1000 amp. . . . . : 0 REVIEW SECTION-------------
1000+ amp/volt. . . . : 0 )=4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. .
Reconnect only. . . . . : 0 SVC/FDR 225 AM-IS. . : CLASS AREA/SPEC OCC. :
Owner: FEES
DALE SYKES type amoi-int by date rec-pt
14615 SW HA7ELTREE TER PRMT $ 90. 00 TAT 06/02/97 97-J-95287
TIGARD OR 9722,3 5PC'T $ 4. 50 TAT 06/012/97 97-2195287
Phone #:
Cant t-actot-:
RrSE CITY ELECTRIC CO INC $ 94. 50 TOTAL
4012' NE CULLY BLVD
REQUIRED INSPECTIONS ------
PORTLAND nD 97213 Ceiling Cover Under-gt-oi.tirld Cove
Pho-)e #: 287-6164 Wall Cover- Elect, 1 Set-vice
Reg #. . : 000035
This permit is issued subject to the regulations contained in the
Tigard 14unicipal Code, State of Ore. Specialty Codes ind all other Per itt�e Signat Ura
applici ie laws. All work will he done in accordance with
approved plans. This permit will expire if work is not started
within HA dans of issuance, or if work is suspended for more
than IPA days. I ss i.t e d By
--- - ------------------- --OWNER INSTALLATION
The installation is being made on property I own which is not intended for,
sale, lease, or rent.
OWNS RIS SIGNATURE. D-4TE:
--------------CONTRACTOR INSTALLPTION ONLY_----_----------------_
I GNATURE OF SUPR. ELECI N: DATE-
LICENSE NO: z
Call for inspection - 639-4175
Community Development ELECTRICAL PERMIT APPLICATION
f 13125 SW Hall Blvd.
/ Tigard, OR 97223 Permit # loe�
Phone (503) 639-4171 Date Issued
CITY OF TIGARD FAX (503) 684-7297
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
Addressq�91 'Tiservice included Items Cost(ea) Sum �
City/State/Zip---L / 4a. Residential -per unit
1000 sq. ft or less —_ $11000
Name (or name of business) A4& Each additional 500 sq ft or
portion thereof $2500
Commercial ❑ Residential Limned Energy - $2500
Each Manufd Home or Modular
Owalllnp Service or Feeder $6800
2a. Contractor in llation only:�l 4b. Services or Feeders
� Installation,alteration,or relocation
Electrical Contractor
f 200 amps or less $6000 _
Address 201 amps to 4%amps S8000 _
City Se� Zip _ 401 amps to 600 amps _ $12000 _
Ph O. .Z - �Qtj/ 601 amps l0 1000 amps $18000
Over 1000 amps or volts $340 00
Job NO. Reconnect only $9000 _
contractor's license NO. 4c. Temporary Services or Feeders
Contractor's; Board Reg No. �� Installation e^eratlon,or relocation
z
Signature of Su r. Elec'n_ 200 amps u,lave 2
201 amps to 400 amps $50 00 --
License No, Phone No. l 401 amps to 600 amps $7500 -- 2
Over 600 amps to 1000 volts $100(X
2b. For owner installations: vee"b•'above
4d. Branch Circuits
Print Owner's Name New,alteration or extension per pane
Address a)The fee for branch circuits with
State purchase of service or feedr feeder fee. 2
City tate _ Zip Each branch circuit �' $500
Phone N0. _ b)The tae for branch circuits without
4,
The installation Is being made on property I own which Is purchase of service or heeler tae ��.-
�_ ,
not intended for sale, lease or rent. First branch circuit 335 00 >�
Each additional branch circuit $500
Owner's Signature 4e. Miscellaneous
(Service or feeder not Included) 2
3. Plar Review section (it Each h pump or Irrigation circle —�_ 34000 2
Each sign or outline lighting __ $4000
Signal circuits)or a limited energy 2
Please check appropriate Item and enter fee in section 5B. panel,alteration or extension _ _ 34000
_ 4 of more residen'Jal units in one structure Minor Labels(10) > 0 00
_Service and feeder 225 amps or more
Sy;tem over 600 volts nominal 0. Each additional Imipection over
Classified area ar structure containing special occupancy the allowable in any M the above
as described in N E C Chapter 5 Per inspection _ 335 00
Per hour $5500
In Plant $5500
Submit 2 sets of plans with application where any of the above ----
apply Not required for temporary construction services. S. Fees: CSO ► "`-�
NOTICE 5a. Enter total of above fees $
5%Surcharge (05 X total lees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal q
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25%of line A for
CONSTRUCTION Ot',WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED Trust Account #
Mme $ _
Balance Due
CITY CSF' TIGARD 01- UMBING PERMIT
DEVELOPMENT SERVICES PERM'IT #. . . . . . . : PLM97...17104 J
13125 SW Hall Blvd., Tigard,OR 97293 (503;639.4171 DATE ISSUED: 02/19/97
PARCEL,: 21,3110BC-00600
'311F ADDRESb. . . : 14bl'i '�W 14AZELTREE TERP
SUBDIVISION. . . . : AMES ORCHARD ZONTINIG- P.-I
. .. . . . . : LOT. . . . . . . . .. . . . . .3
,L.Aq1-i OF WORKI. AI-T GARDAGr: DISPOSALS. : 0 MOBILE HOMF SPACES-- 0
TYPE OF USE. . . . .-SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0
C)CCUVIANCY GRP. . : R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . .. . . . . . .. . . . . . . 17.1
S TO R I ES. . . . . . . . : 0 WATFR HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
1-IXTURES-- LAIINDRY TRAYS. . . . . : 0 SF F?ATI\l DRAIN3. . . . . : 0
SINKS. . . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0
I-OVATORIES. . . . . : 0 OTHER FIXTURES. . . . : 0
TUB/511OWERS. . . . : 17+ SEWER LINE (ft ) . . . : 0
WOTEP CLOSETS. . : t WATFR LINE (ft ) . . .
DISHWASHERS— . : 0 RATN DRAIN (ft ) . . . 0
ReMAI'kq .- Replare water, ('10set
llwnev-. FEFS
1)A'-'E SYKFS i V P P amol.1111- by date t-flcpt
t4615 SW HAZELTREE TERR PRMT $ 25. 00 ,ISD 02/19/97 97-290546
5PCT $ 1. 2.9 JSD VIE'/13/97 97 0 5'1
TIGARD OR 97224
CHP19TlAN PLUMSTNG
231.712 SW STAri:ORD RD.
TUALATIN OR 97062
Clf'itirlo it: '503--r-,38-G671 26. '25 TOTAL_
Reg #. . - 42671 REDU I RED I NSPECT 101\15
This persit -s issoied subject to the reyulations contained in the RoUgh-in Insp
Tigard Mi-icipal Code, State of Ore. Specialt,,, Codes and all other PL.M/Uiider-f I om-
applicabl, laws. All work will be done in accordance with Top-oi-tt Ir)sp
approved plaiii. This pervit will expire if work is not started F= inal Inspection
within 18@ days of issuance, or if work is suspended for &or@
than 19 days.
ri By
Call for inspectinti 639-4175
CITY OF TIGARD Plumbing Application RecIsi�`
13125 SW HALL BLVD. Commercial and Residential Date Reca c''/ 7
IGARO, OIC 97223 ^Jle!o P E
503) 639-4171 DJIe io DST _
Pnrmd a 1 .,T�-Fr
Print or Type Related SbVR a .v //4
Incomplete or illegible applications will not be accepted Coiled r
/Name of Ceveetoomee�nbProl ct FIXTURES (individual) QTY I PRICE AMT
Job10 �G- 1�(_ Y% Sink 90 V
Address S:reef Address Suite
Lavatory goo--
t^L c L
'7,,jt ',ub or uor5hower ,omo I 900
Sl!'I s dy 51ate p Shower Only _ 9 UEK e 4 o'-Xr waler Closet _ A (N(r 90
Nal e \, �1ldJ. -
/) r) .�� UISr1W05ner 9 00
Owner �6ulln9 Address r Suite Garbage Disposal �— �1I. 9 oo y
C i1lYlI r�s �) washing Machine 900
�;.tyiSlate ap Phone Floor Crain goo
I
9 00
Name - 14
9 o_ I
--
Occupant Mailing Address Suite 'ater Mester —_ 900 T
vndry Room Tray 900
i ityrSlale Zip Phone
kinnal �- _ I 900
Name
Other Fixtures iSoecifyl i 9.00
^ _
^_
00
Contractor (','ailing Ad rens Suite I goo
9.00
i (Pnor to Issuance citTsiate Zip Phone -
aochcant must yT ,� i 9.00
provide alt Cregon Const Cont. Board Lica Exp Date 900
contrac*ors 'u I 9.00
license Plumbing Llc a Exp. Date Sewer- Ist 100'
30 00
information
-q 6�r' �� Sewer•each additional 100' 25 00
'or f CCT Business Tax c. bistro a Exp Date water Service- Ist 100' - 90 00
aatabasesel
Name :later Service-each aoditional 200 25 ;0
Storm 3 Rain Drain- 1St 100' Moo
Architect ----------------111111------------______
Or Marring address i Suite Sturm d Rain Crain-each additional ICO' 125 00 I
Mobile Home Space -- 22500
m
Engineer ClryrState Zio Phone ComPrc,al Baca =ow Pa
revention Cece or Anti- I 25 JO
�_ Pollution Device
Ces.: be .vcrx New _ addition Alteration C Recair C ��es dentias 9acx1cw 'evention Ce oce• 5 )0 T---
t0 to cone nesidertiai C Non-residentiary trap �r:�:as:e xt JnreCeq t0 a=lxturP. I 9 C0
aC01`f]nal deSCr1Q110n Jt vvCfK I ato 3asin I ]GO
t
ns0 of casting =umomg I 4000 W
'Jer;7r
:--twlrg use of -- Specialty Requested Inspections 40 00 _
zuddir.g or arouetty — Pain Cram.singe`amity Cweltirg �� I 20 :0 !
' cecsed use ofwease Tracs -- -- I 4 CO
Cwlairg or prceerty
QUANTITY rCTAl, i
are .cu-aoeirg movirg or reoiacirg any 'Ixtures' YesNo ( lsometrc. -ser.'straw Y-ecwrm f:ualty-:-Ws >-. _
ilf yes see back of forms
-e'aby acknowledge tha: 'lave read this.iooiicaticin, !hat the nfOrmaUOn _� _
.,ver s correct !rat I am re owrer or aut"nzed agent of Nne owner and 5°10 SURCHARGE I *✓
--.,at_sans sutrnitted are _ :omchanr with ^ gon State Laws
S1 ns a of OwnonA�gent / , Dass PLAN REVIEW 25% OF SUBTOTAL i
�. Aecu.rs
CL_
r I z _// '7 J' I TOTAL I ��,
'antact Person Name Phone I
- •
Minimum permit fee s 325 - 5s.,lcherge -xc2pt Residential BackMw
�
Prevertion Ce .z -. n^Ion�s 515 5'6 surcharge
lasts olmaoo aoc 3146
_LEASE COMPLETE AS APPR(2PR PROJECT:
Fixtures to be capped. moved or replaced i Qty I
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only
Viater Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
30MMENTS REGARDING ABOVE: