10120 SW MOLLY COURT 0
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10120 SW Molly court
CIY OF T I G A R D _s_ MASTER PERMIT
PERMIT#: MST2003-00094
DEVELOPMENT SE RVICES DATE ISSUED: 3/31/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 10120 SW MOLLY CT PARCEL: 2S1023B-MM008
SUBDIVISION: MOORE'S MEADOWS ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIC
REMARKS: New SF detached.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 24 FIRST: 1 f/4 M BASEMENT. at LEFT: / SMOKF DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1.25' of GARAGE: 105 at FRONT. 23 PARKING SPACES:
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD at RIGHT: 5
OCCUPANCY GRP. R3 BDRM: 4 BATH: 3 TOTAL 2,626 at VALUE: 260,331 90 REAR: 23
PLUMBING
SINKS: I WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 109 SF RAIN DRAINS. I CATCH BASINS:
TUBISHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTW I GREASE TRAPS:
MECHANICAI-
OTHER FIXTURES.
FUEL TYPES FURN<100K: BOILICMP c 3HP: VENT FANS: 4 CLOTHES DRYER: 1
(,AS FURN>-100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP btu FLOOR FURNANCFS: VENTS: I WOODSTOV-1: GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 -200 snip: 0 200 amp: WISVC OR FOR: PUMP/IRRIGATION: PER INSPECTION:
EAAOD'L 500SF: 5 201 400 amp: 201 400 amp. 1st W/O SVC IFDR: SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 900 amp. 401 900 snip. EAADDL BR CIR: SIGNALIPANEL: IN PLANT:
MANU HMISVCIFDR: 901 - 1000 amp: 901♦rnps-I OOOv MINOR LABEL:
1000+AMPIVolt
Reconnect only: PLAN REVIEW SECTION
—4 RES UNITS: SVC/FDR>:225 A.: >900 V NOMINAL: ..6,; 1RFA/SPC UCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 8 STEREO: VACUUM SYSTEM: AUDIO d STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATAlTELF.COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 7,560.93
This permit Is subject to the regulations contained in the
IDG JLS CUS roM HOMES
PO BOX 91 185 17200 NW CORRIDOR CT.#110 Tigard Municipal Code,Stale o OR. Specialty Codes and
PORTLANE OR 97291 BEAVERTON,OR 97006 all other ce with
a 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 the
work Is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 501-250-0793 Phone: 503-511-4006 Oregon Utility Notification Center. Those rules are set
forth in OAR 952-001 0010 through 952-001-0080. You
Rea M: LIC 119x)70 may obtain copier of these rules or direct questions to
CLINIC by calling(5031246-1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8, Post/Seem Mechanlca Mechanical Insp Shear Wall Insp Rain drain Insp Plumb Final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Ins► Water Line Insp Final Inspection
Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Appr/Sdwlk Insp
Foundation Insp Footing/Founds Ilan Dr; Electrical Rough In Gas Line Insp Electrical Final
Post/Beam Structural PLM/Underfloor Framing Insp Insulation Insp Mechanical Fin,gl
Issued By : ' 7 Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
r
CITY OF TIGARD SE�A'ECCU�VNEC"17N PERMIT
DEVELOPMENT SERVICES iIERMIT#: SWR2003-OOC82
13121, SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/31/03
SITE ADDRESS; 10120 SW ALLY CT PARCEL.: 2S102BB-MM008
SUBDIVISION: MOORE'S MEADOWS ZONING: It-t.5
_ BLOCK: LOT:OOx _JURISDICTION: 1I(
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 7
TYPE OF USE: SF NO OF BUILDINGS.
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection permit for new SF residence.
Owner:
FEES --
IDG Description _ nate Amount
PO BOX 91 185 ---
PORTLAND, OR 97291 IS\'NI ISAI Swr Connect 3/31/03 $2,300.00
'-'A]Swr Connect 3/31/03 $0.00
Phone: 503-250-0793 I`-,WINSI'I Swr Inspect 3/31/03 $35.00
IS�VlNS1)1 Swr Inspect 3/31/03 $0.00
Contractor: Total $2,^35.00
Phone:
Reg#:
Required Inspections _
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located,the installer shall purchase a"Tap and Side Sewer" Perm
Issued by: ,` - . . Permittee Signature:,,
Call (503) 639-4175 ty 7:00 P.M. for an inspection needed the next business day
Building Permit A pplication
"D.tercceived,..2' /0 t95 Permit no.:N3i6KJ d'Or%'f'
City of Tigard ,, [{--��`** ---
it y o f Tig-iril
Address: 13125 SW Hall Hl�ti,'1`i�ar ,OW 7229 ,— Ihoject/appl.no.: Expire
Phone: (503) 639-4171 / Date issued: By: Receipt no.:
Fax: (503) 598-1960O'se file no.: Payment type:
I•' / t Y ,
Land ose approva'r i'eEamily Simple complex:
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family 0 New construction U Demolition l})
U A(ltlilitm/allertion/trplacemettt 11 Tenant improven!ent U Fir.,sprinkler/al-am U Other:
fl ) C
Job address: a 1 2 v Sc� iL(s // _/ _ ! tdg.no.: Suite no.:
L oc Bla k: Subdivision: /1`t f a c/ S ��zc Tax map/tax lot/account no.: 2 I U z L3:-13
Project name:
_ 1
Description and location of work oat premi;es/special conditions: I C 1V
FOR SPECIAL INFORMATION,
Name: 1. D L (Floodlplaln,septic
Mailing sddress: P 3 civ Cr//9 1&2 family dwelling:
City: _ I State: ZIP: Valuation of work..................................... ..
Phone: ' t, C 3 Fax.' ,> No.of bedrooms/baths.................................
Owner's repri.sentative: illy Total numlter of floors.................................
Phone: I ar _ I titan: New dwelling area(sq.ft.) L b _
APPLICANT Garage/carport area(sq.ft.)......................... '•'tL(Cos
Name: Covered porch area(sq.R.) ......................... (A6 _--�
Mailing address. Deck area(sq.ft.).......................... ............. _
City: State: ZIP Other structure area(sq. ft.).........................
Phone: Fax: E-mail: CommerviellindustrinUmulti-family:
Valuation of work........................................
Business name: Existing bldg.area(sq. ft.)\................ ....... —
Cvst��rt — —
-
Address: � New bldg.area(sq.ft.) ....... ... .................
U .> /V to *;�cr.R 12_ I Number of sutries...........
City: State: ...... ................. e��s__
e��,�, t�tti _ Lit ZIP: • 2 i t Type of construction
Faz: E-mail: .........................-,. ...
Phone: UU4
E-mail: Occupancygroup(s): Existing.
C.CB no.: / c,4 7 trJ M— New:
City/metro lic.no. -�-
- -- Notice: All contractors and subcontractorsrc arequired to Ix
licensed with the Oregon Construction Contractors Board under
Name: V I provisions of ORS 701 and may be required to be licensed in the
Address: If 7 jurisdiction where work is being performed. If the applicant is
City: ► ' State:U� ZIP: exempt from licensing,die following reason applies:
9-76
Conlact person: i)i1 RS Plan no.: -- ---
I'htme Fax: I E-mail• T -
Name: PIC OJW .,t ' Contact person: 1PAP K Fees due upon apphtaUon ........................... $ —
Address: ( 2 e 2 vn LII 01Z_ 1N) Date received: -- _-
City: s u-.5 lstate: ZIP:::: -73 S_/_ Amount received .........................................
Phone:S-73 'y Fax: 3"r OA E-mail: _— —� _Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all judsAiclimts accrp cmdit cards,pleare call junsdiction fin mom i4mmvion
attached checklist. All provisions of laws and ordinances governing this U visa U MasterCard
work will be complied with,w -cified herein or not. In attl numtter
Fspams
Authorized signature!. Date: l 3 Nurse of cardholder a down on credii cetJ
wanes .r sl`��tr--"_ s Amoun —
Notice:Phis permit application expires if a permit is not obtained within 180 days alter it has been accepted as complete. 440-4613(rwtNNt'oM)
Mechanical Permit Application
-- '--- --- Dine received Permit no.: h`,T _Z",�.- `!'� y
w, It�`Ot 1 i)lr(� pp
I'ro'J ect/a I. n, Expire date:
Ciq,ofTtgard Address: 13125 SW hall Blvd,Tigard,OR 97223 -- - - -
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.. Payment type: _
Land use approval: _ Building permit no.:
rJ 1 &2 family dwelling or accessory ❑Commercial/industrial J NiLliti- aill i. mint improvement
U New construction U Addition/alteration/replacement U Other:
Job addres w 7 / Indicate equipment qualm ,in boxes below. Indicate the Jollar
Bldg. no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: 0 Z (,8 profit. Value S
Lot: I Block: Subdivision: 'See checklist for important application information .rad
Project name: jurisdiction's fee schedule fior iv�idential permit fen
11
City/county: j.La4. 7_1P: rt.
Description and locition of work on premises:
Ieirtell.
) ! rtl
Est,date of completion/inspection: ,)�it Desch tion Qt Iles.onl Rt..o II
Tenant improvement or change of use:
HVAC-
Is existing space heated or conditioned'?U Yes U No Air handling unit _#CFM
Is existing spnee ins dated'„U Yes U No Air conditioning(site-plan required)
Alterationo ex sting system
State --
Business nan„ iJ l/�9R/Cy �rt'z f7,x State boiler permit no.
- ---- IIP—_Tons_ BTUA
Address: Fire%smo�ampers/ uct sato a detectors
CityState: Q ZIP: 7 jfC licat um (site plan require
Phone:774( Q/4,I Fax:'7 7t/fg1 I E-mail: nsta /repace urnacc urner_
Including duetwork/vent liner U Yes U No
Cl` It t1O' _ ��' 3 nsta rep aceire ocatc eater. suspended,
0t..0netro lie,no.: 34g3 –-- wall,or floor mounted
Name(please print): % ' r-- / ` -�--- Vent fur u liana other Diann Ilonace
t e gerat on:
Absorption units BTU/I1
Nance: — r" - 4_5 Chillers lip —
Address: Compressors_ Pp
Environmental exhaust andrent at on:
City: State: ZIP: Appliance vent
Phone: (Fay - -- -- E-mail, - U er ex ami ust - -
1 lion x,Type 11 Res kitchen/haznnat ---
hood fire.u11pre"loll system
Name: I — _ Exhaust fain with single duct(hath liras) -
Mailing address: f/ S Exhaust system apart from heatin or AC
City: i Sum eZIP: '7 2 et Fuelp itnl;an xtr ution(up to 4 outlets)
t
_— 1-- Type - ca- 1_1 i NG
Phone: �' rax., I nail Fuelt to clt aJ ui, a ovt r-Taut ere
rorewe piplini1scherriatic require )
�-- 1 <•�(_.- .'t/`•�rr-- _';'�l�.l G1 R
�/l `J•`----Number of outlets
ter listea P7
fin
�ee_
or
Adds Decoralwe fireplace
City: Insert type--- nn stove:pelfel love
l e
h u M.•t
Phone:
Other:
Applicant's signature: Date: iI otit":
Name(print):0OVe ---- — --
Not all juriatictioan accept credit card„,please call junsdicuon for more information Notice: This permit application Permit fee ..................... S
U visa U MasteWard Minimum fee................ S
Credit card number expires ifit permit is not obtained Plan review(at — %) S
- --�ipires within 180 days ager it has been State surcharge(8%)••.. S
Name or catdhub er ax shown on credit card accepted as complete ---
_..� _ TOTAL........................ S -..�
Cardholder signature _ A noun 440-461f n fit) I t I
HUG-7-2001 07:098 FROM:EownRD MULLEN P(_UI.18I 503 628 1633 TO:503533,1306 P:
r,uy. d rJi &0:11 FAX P.
Plumbing1.1crmit-Ap liration
i ---- Uetempdvrxt: Prxmilno.: )j -DOD7
City of Tigard Sewer pelnrit no.: _ Building permit no.:
Addreas: 13123 SW Hall Blvd,Tigard.OIL 97223 lto1a ppnn da t Rspiredate:
crryrdrisard I'lwue: (303)639.4171 - - —
Fax: (503) 598-1960 Dateluued! - 13y: Recalptno.:
Land use approval:
1 dt 2 family dwelling er accesstwey U Commerc) industrial U(.1u1 1 Iandly ❑Tenant irnpmvement
U New consitucUcm U Addltlun/a radmJrepiacemeni _I I i�Kl gtrvi.e U(Alter. __
e ll T tttii
_ILL Fey(m. lilial
_job address: C'/1 :.' /� Now -m1•[etdlyAff14ilirgmn� y
Supe (nchdes190ft. brearfiWlitsycons"Itao)
Tax map/ta>t lot/Account no.: 2 Ifi?'— _ Shit(1) M111--
t:
_
trot: �— Mock: Subdivision: /!'ate, •It(2) st11
P. Ject nems: _y S (3)his /
Clt.ylctwnt � 71P: Loch adtiit�on e c en
Description and IocatJra of wuX on irte MAM filllsatllltltst
Catch be.Rin/afes drain _
LW. otcwnpletioNinspectlon� - - - _ rYwel-�s7leecFi IGtcTticttc�t rem
k — _
nct ing n nu. in. t.)
nnufacnia u�1t 1 uei�-_ '_
Dusinoty name:
Address: 2 y yr�o g u I (�, -Rails drain connxwr I _
City: Siete:ar aewei oo�.fl _
phtme: FAX:(p &mall: _ itnm sewer(no.ilii-iF) e
CCB na, `��..f�`i__.__ Plumb.bus.fro. _ 360
Water service no. In.
Nltrttars or Ileml
Cit /metro he.no., Al>,sa tion valve
contractor's n: itelive signeiLturQe: Aw -,,
jam ) low venter
Ptiat name: 0 -��
"BucTtwatnr valve
IR c sum
��s' n In�rnlnta n 1) _
state: rlr:
)Nana: Pnx ti-mail: _x�natcnt Wtk
- .1tu sewer cit -
filaoc�tr n out eii3ca-7f7� _
Numr.(print): b G ( Uerii- e s ------
ivinllin8 a ldtee/' Dir Oce S oil r_
Qty: 1'(y t _ Stale: Zlr: �r 7 rc oemW" -
Phonc: L e 1 (I I Fax: 1 I-r &mai(: ruertx ornu ltttp
(hvtier inxt.'llalioWM%identlal maintenonoe only: The Actu irt+lalletion mer(n) _
will be inadt by me or the myWar►cr.urcl repair made b my regular )7w(�taln(comma
etttpinyee oits(1hapter 447. In (sj, nisi. av) -
Uvvnm'a si stun: " E Date: Sum _
7.2 u owed owet;w�A)— I s!gLAter c out e Z l eifi // I�i2 /4a ,! r State!p/L Zit'S/SLI Faa: ) c Umall: l sal
Nu se 0ay�,e z step tndl alar,pom to I■+�s 11M As nwa Y�r ailreview
Minimum fee.............. S
Nodne:ihb p.:rmlt application plan review(al
DYIM 0 Ma:rtercard trpires it a prrmit is nm obtained State surcharge(816)
cveeaU erd nemM:__� -- wnhin IW days alley it his been
i err T(1TA .......................
'-�3�ar�lel�i'See�n���--- ecce{+tnl ave cxrrnplete --
__..—"�.�^''-�-�--��- --- —AeroW— IAJa16(MA4.1Jbf1
I
llcctrical Permit Application
-- --- - I Mie received: Iles nut[to.:").' v3•
City of Tigard I'I++Icel/appl.no.: Expire date:
Cits,olTigard Address: 13125 SW Ilall Blvd,Tigard,OR ')!.':i 1I,ueissued: Ill: Receiptnu.:
fluor (51111) 63'1-4171 -- - -
I-ax: (503) 598-11160 1 ,I,I file no I'ayntenttype:
I,anti Ilse appror,al:
TYPE OF
lfl & 2 family dwelling or accev:oiy U('0111111014,1.11 ln,l, In II U Mulu I:nnll` J I, mutt intprovcnx•nt
U Ncw conSnu01011 _I Addition/allclaulmht p+l,ltcnlrnl U Other U Partial
J011 SITE INFORMATION
Joh address: 10 120 5W Me 0 Bldg. no.: Suite no` - fax map/lax IoUaccount no.: 25102ao
IAA: _y _ Block:_- Isubdiviskn: �l�ar7ltJ `Lc ew
Project name: __— I Description and location of work on prelnl
liainraled date of corn plelion/inspection:
CONTRACTOR APPLICATION FEE StHEDULE
Job no: 1'ee Max
IT119111etis nantc:� (,� � ►escriplion Uly. (ea.) 'l mal no.blr
Newresidenlial-single ornulhl-Osndlyper
Address: (� '(` LkA _ dncllhlgunh.luchldnoaaclrnlgAraRr.
_('l�y _�«-(QQ�Q. ' I Cf I I'll'gl?123 Senlee Included:
— I(NNIsq fl.urless 4
f hone:r o Fax:$ A+1,16 I I' mall: ---�- _-- -_
- Each additional 5W scl ft.or portion thereof
CCB nit.: _ - bice.hos, tic.no: � -
Lf roiled energy,residential 2-
Cily/Idle ro lic.Ito.: _ _ I.inlYledenergy,nun resideraial 2
Each mmlufactured hanYe or modular dwelling
SI nature of supn•l,i',Irlg,electrician(required) _ Ualr Service amUar feeder _ 2
Su .elecl.nnmctpl 111 p,i+,.,,,, Services or feeders-InstallAlion,
alteration or relocation:
PROPERTY 20(1 amps or less 2
201 amps to 4 W amps 7
Name(print): - - ----
�2 401 amps to 600 amps 2
M_ailingaddiess: U _3LG1E �t 11 YS 601411111x111IWUnmps^ 2
City: PjI el Slate:(, 7.11': F-" q/ Over 1(l(1(l amps or volts — 2
r'hone: G 157I'ux ; z'j r-mail: Reconnect only I
owner installation:The inslallnlion is being made on property I )wn Temporary wrvle"ar feeders-
which is not intended for sale, will,or exchange according to Inslallallou,alteration,orrelocaliun:
2ps less
(WS 447,455,479,670,701 '/,
, 20011 Aa"imps to 4W aulpa
t)wncr's sf mature: I cur: 2 G 401 to 60N1 mn s -
Branch circuits-new,alteration,
or exlenslon per panel:
A I re lot branch cucmts with purchnse of
Address: q2R I •-u v// // _service or feeder fee,each branch cocuit� - 2
Ci manch circuits without purchuse
t , P, // lti.ate: zlr_� � B pee fur hr_
---� of service tit fender fee,firs)branch circuit' 2
i:adl addiuou d branch clnvll
Mise.(Service or feeder nod included):
U Servicer -,2.1snnq,s PIIIIIIII•rrllll U llralrh care 11111, Each pump(it irligalionarcle 2
U Setvn 14+Imnps rutingol IX 2 U IlaranluusIII,all„II F:achsign aroullinelighting ---� 2
fonult dwellings IJ Iruildmgovrr 10,000%quate feel four or Signal circuit(%)ar a hooted energy Panel,
USystenrLiver 600voltsnnourlal 1111.1reresidentlalunit%Inone siloclute alteration,tit extension• `- - 2
U nI111thllg l/Vl'1 IIIICL•SIrIrIL•xU lceders,41.10 amps or onto �•Ikstn nn•n ,g_n_____,._.�-_.
U Occupant Iond over 99 persons U Mnnufaelured structures or RV park Foch additional Impeelion over the allo"able ill ally of Ilse Above:
Y U lign•ss/ly lihnl:ldan J+hh,r .... -- Put ilspe,Iwo
Sulrnth xels 01 plans 1011 ARV of the simile. hwrsllhawnl tee
1 he abuse arc not applicable to lentlmsrary construction service, t hhor
No.d1 pu„di I,n, a[,•elll rredrl card” I.I.-.1w i till lunate,row I,n mune udunndm tri Mint'e I hl�petlllli illph,.alloll - --
U Vf5tr Uast
McsC0111 cyllev YI a u
Ilrult I,not I,btanfed Ilan n v u•u ('11
l'rrdo+,Int IIIIIIIIkY , tsllhlll 1S dues alder it has been Shue tial, _.-.-_-_--
1 ,inn•, 101 A1, ....... I.
n•p+lc'd do cnnq,lrte —
N:unr ul rardhttjjrr at fhuwn,m,,r.Ll,.nd
nmama 1
1'7 1�IurI+Tr1 rfRltulUur .r-ur Jhl s(IJrxlx't lA I
1 Er
off'cdma sup F�„�
1 00
rr�,l.c
fjq5 /� 170 .
...J.�............ 10' S.S.E.
01.
O O
r
10 Storm LInS (y)
-- - �. (Tract A)
0 166 Private ST
�nnilary!irw '
23.7
•
.................. ......Y..r}~
7 �°'
76, 26
Scala 1 " -= 20'
Loot 8 Moore's Meadows Subdivision
10120 SW Molly CT Tigard, OR Applicant:
Intercoastal Development GrOLJp LLC
PO Box 91 185
Portland, OR 97291
wl�� �� �I���D _� ELECTRICAL PERMIT
`
\ PERMIT#: ELC2003-00140
DEVELOPMENT SERVICES DATE ISSUED: 3/18/03
13125 SW Hall Blvd.,Tiqard. OR 972.23 (503) 639-4171 PARCEL: 2S102BB-MM008
SITE ADDRESS: 10120 SW MOLLY CT ZONING: R-4.5
SUBDIVISION: MOORE'S MEADOWS
BLOCK: LOT : 008 JURISDICTION: TIG
Projert Description: Temporary power.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ — 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 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- e _ PLAN REVIEW SECTION
1000+ amp/volt: >-4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVCIFDR>=225 AMPS: _CLASS AREA/SPEC OCC:
Owner: Contractor:
IDG ROSS ELECTRIC
PO BOX 91185 23810 SW DRAKE LN
PORTLAND,OR 97291 HILLSBORO,OR 97123
Phone: 503-250-0793 Phone: 519-5700 CELL
Reg #: 161112-2800 34-436(
1.1(' 118821
_ FEES SI ill 42;25
Description Data Amount
Required Inspections
I I.I'RM rj 1,11'I'crmil 3,'18/03 $66.85 ---
i
3L n $5.35 Rough-in
__ Elect'I 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 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 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)246-6699 or
1-800.332-2344.
Issued By: G' Z Pe-rmit Signaturo:
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
ATE:CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR ELEC'N: _� % 1 r ��lJ� - __. DATE: _—_—
LICENSE NO: —_ " a4 -`, -- __ _ - ---- – ---- -- _
Call 639-4'175 by 7:00pm for an inspection the, next business day
Electrical Krmit Application
City of Hillsboro IDate received:3-j� Permit no.
123 W. Main Street,Ste.250, Hillsboro,OR 9-1=_ Projectlappl.no.: Expire date.-
Phone:
ate:Phone: (503)681.61. 1, Inspections: (503)681-624-4 Date Issued: By• Receipt no.:
Fax: (503)681-6.169 Case frie no.: Payment type:
Internet Address: www.ci.hillsboro.or.us
TYPE OF
❑ I &2 family dwelling or accessory ❑ Commerc!airindustral :3 Mu'n-Family ❑ Tenant imurovement
❑
New construction ] Addlnon,alteranon%replacement ❑ Other: ❑ Panial
.108 SITE IN FOAXIATION
Job address: C) ;tj k1l � C Bldg. nu I Suite no.: ITax mapitax lot/account no.:
Lot: ;Block: Subdivision: In C, u R,C ►� vIAFtW 6 Vt.)
Project name: Description and location of work on premises:
Estimated date of completion inspection:
CONTRACTOR e
Jot) no: Fee liar
Business name: «- Description tv. (ca.) Total no. insp
Yew residential-single w multi-family per
Addre55: S(-o Z)k dwelling unit.Include+attached garage.
City: r I State:G R i ZIP:G1 712 3 Servke Included:
Phone: (o Fax 2nE-mail: 1000 so.i3.or less
CCI3 nit.: I I I Elec, bus, lie.no: �( (p� Each additional 500 sq.R.or portion thereof IS.00I I
Limited energy,residential 20.0 _
City,rtlerro IIC. no.: Limited energy,non-resrdendal 40.ocj -
/41 T ' / t3 0, Each manutactured home or modular dwelling
Siazure of supervising clecmclan ireowred) _ Date Service anrLor r'eeder 40 0q
Sup.elect.name(print) a License no: L Services or feeders-installation.
alteration nr relocation:
PROPERT'lli
_00 imps ,r ess So Ooi
_'1 awes•u�+'0 1mC9 I
Name f pint): 60.1)0
tU. tmrs u'rur) imps 100.01 -:-
�Ialling address: 001 tmrs to :1100 amps 11x0
City: _ State: ZIP: Over 1000 amps or volts .30o.001j
Phone. _ I Fax: I E-mail: Reconnect oniv 40.00 1
Owner in.sralluriun: The :nstallanon is being made on property I awn Temporary services or feeders-
which Is not Intended for sale, lease,rent,or exchange accord ,l8:o installation.alteration,or relocadon: �.
ORS 44",a55,479,670, 7 1. 200 gimps or less
20ps to 401)amps 55.00
Owners si etllre: Date: I im401 to h00 amps $0.10
Branch circuits-new,alteration,
or extension per panel:
Name:_ A. Fee for branch circuits with purchase of
Addtess: service or teeder fee.each branch circuit 2.00
l-rty: I State: ZIP: B Fee for branch circuits without purchase
Phone: of sen Ice or seeder fee,first branch circuit: 35.00
FaX: E-mail: Each additional hrnnch circuit: 2.00 1 _
}fisc.(Service or feeder not included): i
°,ervice over_25 amps—commercial 0 Health-are tacility Each pump or:mgmion circle 4000 I _
J Service aver 120 amos•rating of 1&2 7 Hazardous location Each sign or outline lighting 40.00
tamely dwellings 3 Building over I00V square..feet four or
Signal circwuSi or a limned energy panel, -
0 Systcm over 600 volts nominal mots residential units In one structure alterwwi.or estenston' 40.00 _
3 Building over thrr stones 7 Feeders,51)0 ampsor more 'Description
C3(Occupant load over 99 persons _]Manutbcttued structures or RV park Each additional inspection over the allowablt in arty of the above:
❑E;msr.lighting pian O(Other. Per;nspectwn
Subinit 2 sets of plans with any of the above. (mestigu,on ter
T)re ahnvr are not applircrble to remporan•ronsrnirrron service. Other `-
Permit fee......................S�
Not ill;untdlcnuns srcrpl cretin cards.phasecall jurisdiction for more mtormanon. Notice: Tlus permit application
-
3 VISA Z1 %lasten,jrd erptres rty'a permit s not 9brained Plan review(at 25410) ....S
Crean card nwrrherwithin 181)Slays crier it hus been State surcharge(34'0).•...S 3--37)
--
spuei
_ _ TOTAL.. S 7,:X-D V
--_-.--- _ pied as cvmorrte� ......................
"o-11111 J Okon COM
r �r.�rdTiufiier rr. own on cretin�ar+ii—�- aero`
S
._ .. - i lies w rr i azure _ _�♦manor
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 4175 MST t>C)0 22
INSPECTION DIVISION Business Line: (503) 171
BUP
Received ____ Date Requested - AM__ __ -__ PM - - _-___ BUP --__--__
Location Suite______ - MEC
Contact Person _—__T_ Ph( ) - ___ _ _ PLM
Contractor _ Ph SWR
BUILDING Tenant/Owner -_- ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain _
Slab Inspection Notes. SIT
Post& Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear �- VtA
Framing ------
Insulation I
Drywall Nailing - -- --
Firewall
Fire Sprinkler - - --- -
Fire Alarm
Susp'd Ceiling
Roof
O er: -
ASS PART NAIL _--
_ ING
Post&Beam - -�
Under Slab -- --- -- -----
Rough-In
Water Service
Sanitary Sewer
Rain Drains - -- —
Catch Basin/Manhole
Storm Drain _--
ShowerPan
Cather:_�_ - -- -- --- --�—�
Final
- -------------
PASS PART FAIL — --�-- ---
MECHANICAL__ --
Post& Beam -
Rough-In --------
Gas Line
Smoke Dampers
Final
PASS PART FAIL _ _ ---- _- - - --- - - --- - -
_ELECTRICAL
Service _
Rough-in
UG/Slab
Low Voltage
Fire Alarm
Final ( Reinspection fee of$- __-required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
_- --- --
SITE I ) Please call for reinspection RE:- _____ __ Unable to inspect-no acress
Fire Supply Line
ADA --�
Approach/Sidewalk Date�"� -C _ ._�. Inspector _ __� Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
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CITY OF TIGARD 24-Hour /
BUILDING Inspection Line: (503)63 175 MST
INSPECTION DIVISION Business Line: (503) 71
BUP
Received Date Requested ____ C� `� AM_-_.-__ PM- __ BUP
Location ._ _ (�( U Suite MEC
Contact Person �_ _...__-_ Ph(—) --__ PLM
Contractor _-- _--�_-- - . -- Ph(.—) r__.-._-- SWR ._--
BUILDING i Tenant/Owner __ __ _ ELC
Footing --- ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam
-- --------------- ------------------------
Shear Anchors -------- - -- ---
Ext Sheath/Shear
Int Sheath/Shear � � � tiv"�S ���.� Q •7 r�� �
Framing -_.Z—-- -- �— -
l �—--'�----- Tom- ------
Insulation Lp N v25 —'
Drywall Nailing — - - -- --- -
Firewall
Fire Sprinkier �-- �----- - -- ------- -- ----------------
------------
-- -- --
Fire Alarm
Susp'd Ceiling ��-i- ----�-- - --
Roof
Other: -
Final ,�_� �'Zl G �'ti1 V1 -c�`y�2�5 �►ti--2X
-----------
PASS PART FAIL - -
PLITMBIN -
I
Post seam
Under S;db -- U.— —
Rough-In
Water Service --- --
Sanitary Sewer
Rain Drains ---
Catch Basin/Manhole,. �� --
Storm Drain -
� 1
Shoer Pan f t'� Vj C`1 �"L �_ �►-0�_ �
Other; ---e---"-
�AS�1S PART FAIL
N ECFtANICAL
Post&Beam
Rough-In
Gas Line
Smoke Damp k -
final
.__ART FAIL -- - - - - -
TRWAC
Service
Rough-In
--------------------- ---- - ---
UG/Slab ---------- - -
Low Voltage --- -- --- --
Fire Alarm
Final Reinspection fee of$- required before next inspection Pay at City Hall, 13125 SW Hall Blvd
PASS PART FAIL
SITE LJ Please call for reinspection RE:__ ( ijnabh in in,,I�ect nn aru t.
Fire Supply LineADA (e/!
Approach/Sidewalk
Date_ �� Inspector �/, �� � - Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BlUiLGING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (60.3) 639-4171
BLIP
Receiv, Date Requested (:P PM BUIP
Location MEC
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing --—---
Insulation
Drywall Nailing
Firewall T�A I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other,
—
Final
PASS PART FAIL
PCUiM_8i_Nd'_
Post& Beam
Under Slab
Rough-in
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Sturm Drain
--
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage 5
Fire Alarm
na Reinspection fee of required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
--PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA I
Approach/Sidewalk Date Inspeew
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST 3 c�-d�� / /
INSPECTION DIVISION Business Line: (503)639-4171 - -
BUP
Received ._._ ._________.___ Date Requested .._�. _�'__ AM----_.-__. PM---_-_- BUP _-- --__._--
Location --__- � -U ___ --- Suite ---- --_.___.__- MEC - _--
Contact Person _-_-- � --------- _ Ph ( _ -) .._ -- -0?-,FL U PLM
Contractor -�ff' �t(�-�r
�� -.._- Ph (--) ------ SWRr It
_--
BUILDING_ Tenant/Owner __--- - _�-_ ---- -- ELC
Footing
Foundation ELC _
Access:
Ftg Drain ELR ------- -. _-_--
Craw Drain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors _ -
Fxt Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing ------ --- - - ------
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Coiling
Roof
Other. - -- --- - - - - - -- — - -
Rnal
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 ------- - - --- ----- -_ _.._ --
MECHANICAL
Post& Beam
Rough-In — ---- - -- -_.. -- - -
Gas Line
Smoke Dampers - - - - - - --— --------—------ ---
F inal
PASS PART FAIL ----- - - - - ----- - - - - _ -
ELECTRICAL
Service
Hough-In
UG/E,lab
Low Voltage
Fire Alarm
PART FAIL Reinspection fee of$_ __--_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
$I7'E n Please call for reinspection RE:_ ___ —_—________ __ J Unable to inspect-ro access
Fire Supply Line
ADA
'` � -
Appraach;Sidewalk Daft - � —.___e__ IniperOt �L:��L>L_ � - E"t
Other
Finii — DO NOT REMOVE this Inspection record from the Job site.
PASS PORT FAIL