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11492 SW LAUREL GLEN COURT JO J A CID N C m 0 CD 1 i M 11492 laurel Glen Ct CITY OF TIGARD BUILDING INSPECTION DIVISION \' �• MST 24-Hour Inspection Line: 639.4175 Business Line: 639-4171 ' / BUP 'A KJ Date Requested__ -~ / AM PM gLD Location��r'l z�Z jeAtfii lg f , � Suite _ MEC _ Contact Person � LI 67 7 _ Ph PLMn(� Contractor `— — _ Ph — SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: j FPS Foundation `f Ftg Drain SGN Crawl Drain Inspection tloek — -—--' Slab ___-_ - SIT Post& Beam - Ext Sheath/Shear Int Sheath/Shear Framing --- --- ------- - ------- — Insulation Drywall NailingFirewall Fire Sprinkler ---.----- Fire Alarm l �, Susp'd Ceding --- Roof ~ Misc. -- - - Final PASS PART FAIL --- - - -- - BI ost& Beam - ------ Under Slab Top Out _--..� / -- ------- - Water Service 31 ary oewo1 Rain rams SS' PART FAIL #AWh!ANICAL _ Post& Beam ---- - - ---�--- Rough In _ 1. Gas Line - Smoke Dampers Final PASS PART FAIL �- ELECTRICAL _ Service Rough In -'� '' l .000�� UG/Slab - Low Voltage Fire Alarm Final PASS PART FAIL - ---SITE Backfill/Grading -— - Sanitary Sewer Storm Drain ( J Reinspection fee of$ _required before next inspection. Fray at City Hall, 13125 SW Hall Bivd Catch Basin Fire Supply Line ( J Please call for relnapection RE: [ J Unable to inspect no access ADA Approach/Sidewalk J ��(� Inspector__ 7 �/ ✓ Ext Other Date p _ ___ Final PASS PART FAIL 00 NOT REMOVE this inspection record from the job site. CITY O F T I GA R D ___PLUMBING PERMIT UIEVELOPMENT SERVICES PERMIT#: PLM2000-00226 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 06/19/2000 SITE ADDRESS: 11492 SW LAUREL GLEN CT PARCEL: 2S110AC-LG004 SUBDIVISION: LAUREL GLEN ZONING: R-4.5 BLOCK: LOT: 004 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS: 1 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES _ _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: 100 ft WATER CLOSETS: WA',-R LINE: 100 ft DISHWASHERS: RAIN DRAIN: 0 ft Rerrarks: Install roof drains, Sewer line, and water lines for existing dwelling. FEES Owner: - ---- -"— Type By Date Amount Receipt DON BUSS PRMT GEO 06/19/2.000 $87.50 0003098 PORTLAND, OR 9772 440 NW HILLTOP 210 5PCT GEO 06/19/2000 $7.00 0003098 — Total $94.50 Phone 1: Contractor: PERKINS + SON PLUMBING 8524 NE 147TH PL BOTHELL, WA 98011 REQUIRED INSPECTIONS Phone 1: 106-488••3535 Sewer Inspection Re #: LIC 00118162 Water Line Insp Reg Rain Drain Insp PLM 37 391 PB Final Inspection ORIGINAL 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 952-0001-0010 through OAR 952-0001-0080. You may obtain copies_of these rules or direct questions to OUNC by calling (503) 246-1987. Issued B = 4t-- Permittee Signature. �— Call (503) 63 4175 by 7:00 P.M. for an inspection neede� toe next business day CITY C& TIGARD Plumbcng Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential Recd - TIGARD, OR 97223 �- <' Date Recd (Ms) 639-4171 ✓ / Date to P.E Print or Type Date to DST-- Incomplete or illegible applications will not be accepted Permit#�= -D° �, Related SWR#R�-601 7 Called Name of Development/Project - FIXTURES (individual) QTY PRICE AMT ,lob korcl G/GI, Sink 11.60 Address Street Address Suite Lavatory 11.50 '19 Z Lav rel Glut C# Tub or Tub/Shower Comb. 11.50 Bldg# City/Slate Zip Shower Only 11.50 _ r" ZL Name Water Closet 11.50 Dori Urinal 11 50 Owner Mailing Address Suite Dishwasher 11.50 qqo 'W' YdlAa 4edGarbage Disposal 11.50 City/State Zip Phcne Laundry Tray 11.50 Name _ 7Z l� Washing Klachine/Laundry Tray 11.50 Floor Draln/Floor Sink 2" 11.50 Occupant Mailing Address Suite 3" 11.50 ----- 4" 11.50 City/Stale Zip Phone _ Water Heater O conversion O like kind 11.50 Nam Gas piping requires a separate mechanical permit. fD� MFG Home New Water Service 32.00 Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00 g'S 1,/ NE /Y7f*& Hose Bibs 11.50 Prior to permit City/Stale ZIP Phone Roof Drains 11.50 Issuance,a copy / v✓h z 7 Nf - r5s Drinking Fountain 11.50 of all licenses are Oregon Const.Cont.Board Llc.# 'Exp Date required If 3 7- Other Fixtures(Specify) 15.00 expired In COT PI robing Lia# Exp.Date database /I Fit,Z Name -- Architect Sewer-1st 100' 38.00 Or Mailing Address Suite Sewer-each additional 100' 32.00 Engineer [-CllylState Zip Phone Water Service-1 st 100' 38.00 � Water Service-each additional 200 32.00 Describe work to be done, Storm&Rain Drain-1st 100' 38.00 New O Repair • Replace with like kind: Yes O No O Storm&Rain Drain-each additional 100' 32.00 Residential • Commercial O Additional description of work: Commercial Back Flow Prevention Device 32.00 Residential Backflow Prevention Device* 19.00 Catch Basin 11.50 Are you capping,moving or replacing any fixtures? Insp.of Existing Plumbing or Specially Requested 50.00 Yes O No O Inspectionsper/hr If yes,see back of form to indicdte work performed by Rain Drain,single family dwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. OTA! TY T I hereby acknowledge that I have read this application,that the Information Isometric or riser diagram is required H Quantity QUANTINTITotal Is >8 3 given is correct,that I am the owner or authorized agent of the owner,and *SUBTOTAL that plans submitted are In compliance with Oregon Stale Laws. 7� Sig natur f w er/A Date --- - 8%SURCHARGE Z,OU Contact Person Name` Phone*112 "PLAN REVIEW 26%OF SUBTOTAL 1 BATH HOUSE$178.00 Required only If fixture qty.total Is>9 -_ 2 BATH HOUSE$250.00 TOTAL i3 BATH HOUSE$285.00 ;(This fee Includes all plumbing fixtures In the dwelling and the first "Alnlmum penult fee is$50*e%surcharge,except Residential Backflow Prevention 1100 feet of 34ithary sewer stortrf sower and water service) Device,which Is$25.e%surcharge All New Con^.merclal Buildings require plans vAh Isometric or riser diagram and plan review I VIstsVorm"lumopp doc 11119/99 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed/Capped Sink _-- - -- Lavatory �— --- ---` __ ----- -- -- - Tub or Tub/Shower Combination Shower Only Water Closet Urinal Dishwasher G_arbaga Disposal Laundry Room Tray Washing Machine Floor Drain/Floor Sink 2" 311 411 _W_ater Heater Other Fixtured (Specify) COMMENTS REGARDING ABOVE: 1Y551lVnm,lY,km',nln rl -I111 fl/'79 CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: S !1 9/2600 0-001 47 DATE ISSUED: 06!19/2x 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S 110AC-LG004 SITE ADDRESS; 11492S'�v LAUREL GLEN CT SUBDIVISION: LAUREL. GLEN ZONING: R 4.5 BLOCK: LOT: 004 JURISDICTION: TIG TENANT NAME: DON BUSS USA NO: FIXTURE UNITS: 1 CLASS OF WORK: ALT DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for an existing dwelling. Owner: — _ FEES DON BUSS Type By Date Amount Receipt 440 NW HILLTOP RD — PORTLAND, OR 97210 PRMT GEO 06/19/2000 $2,300.00 0003098 INSP GEO 06/19/200C $35.00 0003098 Phone: Total $2,335.00 Contractor: Phone: Reg #: Required Inspections-- ORIGINAL This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. 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 riot located at the measurement given, the installer shall prospect 3 feet in all dimctions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Triose rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain cop i ;of thes r les or direr questions to OUNC by calling (503)246-1987 Issued by: !- - _ Permittee Signat — — Call (503) 63 175 by 7:00 P.M. fo- an inspection need4d the next business day CITY OF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2003-00127 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/20/03 PARCEL: 2S 11 OAC-02100 SITE ADDRESS: 11492 AUREL GLEN CT SUBDIVISION: LAUREL GLEN ZONING: R-4.5 BLOCK: LOT: 004 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORSHOODS: FUEL TYPES 0 - 3 HP: _ DOMES. INCIN: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 -30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 + HP: FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS: FURN >=100K BTU: <= 10000 cfm:V OTHER UNITS: 2 > 10000 cfm: GAS OUTLETS: 3 Remarks: lw.iall gas furnace, water healer and stub for range. Owner: FEES DON BUSS Description Date _ Amount 440 NW HILLTOP RD --- PORTLAND, OR 97210 [MECH] Permit Fee 3/20/03 $72.50 [TAXI 81/0 StaleTax 3/20/03 $5.80 Phone: 503-245-9876 Total _w$7830 Contractor: ALPENGLOW 5620 S1N KELLEY AVE. PORTLAND, OR 97239 REQUIRED INSPECTIONS Phone: 503-793-3866 Gas Line Insp Mechanical Insp Reg #: LIC 131932 Heating Unt Insp Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore 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 in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 Permittee Si nature: Issued By: �c2 t. 4 K �� �6<. " 9 Call (503) 639-4175 by 7.00 P.M. for inspections needed the next business day NLY Mechanical Permit Application ' ' ' Received LL Mechanical Date/By',' "DLC' -Of) Permit No. ,t 7 'IO f a' City of Tigard Planning Approval Building Y b Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other 'Tigard,Oregon 97223 Datc!By: Pcrmit No.: Phone: 503-639-4171 Fax: 503-598-1960 Post-Review land Use Date/By: Case No.: Internet: www.ei.tigard.or.us Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method _ Su lemental Information. TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST New construction 1 0 Demolition Mechanical permit fees*are based on the total value of the work Addition/alteration/rtecement I M Other: performed. Indicate the value(rounded to the nearest dollar)of all CATEGORY OF CONSTRUCTION mechanical materials,equipment, labor,overhead and profit. 1 &2-Family dwelling Commercial/Industrial value: S_— See Page 2 for Fee Schedule -InAccessory Building_ Multi-Family RESIDENTIAL EQUIPMENT/SYSTEMS FEF.*SCHEDULE Description __ I t Fec ea. Total LJ Master Builder Other: Hestin Coolin _ JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning" 14.00 _ Job site address: 11 L19Z- 5 Lpc�crr t., o� Gas heat pump __ 14.00 Suite#: _ Bld ./A t.#: Duct work 1_4.00 Project Name: Hdronic 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 o Flue/vent for any of above 10.00 � units Subdivision: _ Lot#: RepairOther Fuel Apt I1ances 12.15 Tax map/parcel #: ___ Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 _ Ce-c,, or,'- c'-j S Flue vent(water heater/ as fireplace) 10.00 -_�_ -- Log lighter(gas) 10.00 Wood/Pe11ct stove 10.00 _ Wood fireplace/insert _ 10.00 Chimney/liner/flue/vent 10.00 _ ROPERTY OWNERJEITENANT Other: 10.00 ame: P� �H Environ I_ Ion Range hood/other kitchen equipment 10.00 Address: ,� �.✓ e/ - - _ - Clothes dryer exhaust 10.00 City/State/Zip: Cl 71 3 Single duct exhaust Phone: q -3 (a6 Fax: 2.qj- 7-765- (bathrooms,toilet compartments, APPLICANT CONTACT PERSON utility rooms 6.80 Name: 6c2 k!=4 �+ _ Attic/crawl space fans _ 10.00 Address: Other: n t 0.00 _uel Piping Cit_/State/Zip: "•(55.40 for Oral 4.51.00 each additional) Phone: Fax: Furnace,etc. �__ _ •• Gas heatup mp ** _ E-mail: Wall/suspended/unit heater _ •• CONTRACTOR Water heater Business Name: Fireplace ** I o� � �` -----�---- Ranke •a _Address,: - te/Zi }- , p/�_ q 7 z 3 --- Cl Cit /Sta �_ p� � Clothes d r as Phone: -719 V ,5Wo I Fax: 2 it S-7 76-f Other: vC,E r '• CCB Lic. Total: — _ Mechanical Permit Fees* Authorized Subtotal: $ Signature _ ^--_— --^ Minimum Permit Fee$72.50 S —._Plan Review Fee 25%of Permit Fee $ _ (Please print name) State Surrharge(8%of Permit Fee) 5 j -- TOTAL.PERMIT FEE Notice: This permlt application expire!If:permit Is not obtained isithi❑ 'Fee methodology set by Tri-County Building Industry Service Board. 180 days after It has been accepted■s complete. "Site plan required for exterior A/C units. 0171stsTermit i nrms\MecPermitApp doc 0I/03 Mechanical Permit Appliczition - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Pernait Fee: $!.00 to$5,000.00 Minimum fee$72.50 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$101.00 or fraction thereof,to and including$10,000.00. $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and $1.54 for each additional$100.00 or fraction thereof',to and including $25,000.00, $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and $1.45 for each additional$100.00 or fraction thereof,to and including $50000.00 $50,001.0)and up $742.00 for the first$50,000.00 and $1.20 for each additional$100.00 or fraction thereof. Assumed Valuations Per A 1lance: __ — value fowl Drscri tion: t Ga Amount Furnace to 100,000 BTU,including 955 ducts&vents Funtnce> 100,000 BTU including ducts 1,170 &vents Floor furnace including vent 955 Suspended heater,wall heater or floor 955 mounted heater _ Vent not included in appliance permit _ 445 Re air units 805 <3 hp;absorb.unit, 955 to 100k)ITU 3-15 hp;absorb.unit, 1,700 101k to 500k BTU 15-30 hp;absorb.unit,501k to I mil. 2,310 BTU 30-50 hp;absorb.unit, 3,400 1-1.75 mil.BTU >50 hp;absorb.unit, 5,725 >1.75 mil.BTU Air handling unit to 10,000 cfm 656 Air handling unit>10,000 cfm 1,170 Non-portable evaporate cooler _ 656 _ Vent fan connected to a single duct 446 Vent system not included in appliance 656 permit Hood served b mechanical exhaust 656 Domestic incinerator 1,170 Commercial or industrial incinerator 4,590 Other unit,including wood stoves, 656 inserts,etc. Oas piping 14 outlets 360 Each additional outlet 63 TO'T'AL COMMERCIAL VALUATION: i\bsts\Permit Pones\MecPcrmitAppPg2.doc 01/03 CITY OF TrGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST _- INSPECTION DIVISION Business Line: (503)639-4171 BLIP Received —- --_- Date PNuested __- AM_- -/ PM - _- BUP -- r Location _ �.�_ Z_ ^� - Suite --- --- EC 3 B�C� P cm Contact Person ------- -- - - - - Ph (---- -..) -7T Z - Contractor Ph ( -_ -) -_ --__ __. _ _ SWR —_-' BUILDING Tenant/Owner - - - - _---- ELC �_� Z Footing Foundation Access: Ftg Drain ELR - Crawl Drain Slab Inspection Notes' SIT Post& Beam Shear Anchors Ext Sheath/Shear - ------- Int Sheath/Shear Framing ------ Insulation Drywall Nailing Firewall Fire Sprinkler - - - - -- - - -- Fire Alann Susp'd Ceiling Roof Other. Final __�PA,� J�iT FAIL 'flecit'�ISIJ�,__ Beam Urid 9h'� a Service - —----- - ---- -- -- Sanitary Sewer Rain Drains - - - Catch Basin/Manhole Storm Drain --- - — - Shower Pan Other. - - - - - Fi -- - RT FAIL - -- -- Wost& Beam ough-In as me Smoke Dampers ----- - --` AS PART FAIL -- ELECTRICAL Service u r - - --- UG/Slab -UG/Slab Low Voltage - - - --- -------------------- -- -.. -- Fire Alarm F 1--] Reinspection f(-f,of$ _.__required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL_ SI �� Please call for Unable to inspect-no access Fire Supply Line ADA ApproacIVSldewalY. Date � � - / O Inspector- _ ..-- .-- ---_---- ------------ -- Ext.__-- Other:_ Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CELECTRICAL PERMIT CITY O� T I G A R D PERMIT#: ELC2000-00344 DEVELOPMENT SERVICES DATE ISSUED: 6/27/00 13125 SW Hall Blvd.,Tigard, OR 9722? (503) 639-4171 PARCEL: 2S110AC-LG004 SITE ADDRESS: 11492 SW LAUREL GLEN CT SUBDIVISION: LAUREL GLEN ZONING: R-4.5 BLOCK: LOT : 004 JURISDICTION: TIG Proiect Description: Install a 200 AMP service feeder and seven (7) branch circuits. 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 amp: SIGNAL/PANEL: MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): ^_ SERVICE/FEEDER BRANCH CIRCUITS _ ADD'I- INSPECTIONS _ 0 - 200 amp: 1 W/SERVICE OR FEEDER: 7 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+amplvolt: >=4 RES UNITS: — > 600 VOLT NOMINAL: Reconnect only: SVC/FDR >=225 AMPS: CLASS AREA/SPEC OCC_ Owner: Contractor: DON BUSS WEBER ELECTRIC INC 440 NW HILLTOP RD 14524 SW CHARDONNAY AVE_ PORTLAND, OR 97210 TIGARD, OR 97224 Phone: 503-245-9876 Phone: 579-5168 Reg #: LIC 44087 SUP 4028S ELE 34-442c FEES Required Inspections _ Type By Date Amount Receipt Elect'I Service PRMT GEO 6/19/00 $101.70 0003098 Elect'I Final 5PCT GEO 6/19100 $8.14 0003098 0 R I (")' l N / Total $100.84 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 rot started within 180 days of issuance,or if work is suspended for more than 180 days ATTENTION O,egon 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 th"arules ordirect questions to OUNC at(503) 246-1987 PERMITTEE'S SIGNATURE / %ISSUED BY: ' --- __ OWNER INSTALLATION ONLY The installation is being made on property I own which is riot intended for sale, lease, or rent. OWNER'S SIGNATURE: —__ __________�. —_ DATE: CONTRACTOR INSTAILATION ONLY SIGNATURE OF SUP/2. ELEC'N: _� ��� �Dz DATE: LICENSE N C: Call 639-4175 by 7:00I)m for an inspection the next business day ik ki' `Y CITY OF TIGARD Electrical Permit Application Plan Check# 13125 SW HALL BLVD. Recd By _ TIGi4RD OAR 97223 Date RecdDate to P E Phone (503)639-4171, x304 Date to DST Inspection (503)639-4175 Print of Type Permit Fax (503) 598-1960 Incomplete or illegible will not be accepted Called �1. Job Address: 4. Complete Fee Schedule Below: Name of Development 4-6de-z i-_-__ Number of Inspections per !rmit allowed Name(or name of business)�� �e+..� /cunc.3---- Service included: Items Cost Sum Address �o�raLG a4a. Residential-per unit 1000 sq it or less $ 117.75 _ 4 Cit /State/7_i Each additional 500 sq ft or 1 T/G�RQ Z -17 Zy 2 portion thereof _ $ 28.25 1 Commercial L' f`< lentiax, Limited Energy _ _ S 60.00 Each Manufd Home or Modular 2a. Contractor installation only: Dwelling Service or Feeder $ 72.75 2 (Prior to permit issuance,applicants must provide contractor license 4b.Services or Feeders information for COT data tease). -�- Installation,alteration,or relocation Electrical Contractor �� +LF tf�t` L•Li_ _ _ 200 amps or less / $ 64.25 Gy• 25' 2 Address Iy�Ly 'et.) (..1_r. .,luvt< A v"C 201 amps to 400 amps $ 8550 2 401 amps to 600 imps $ 128.50 2 City ,, �� State [)k _Zip CJ 7 2,Z4 601 amps to 1000 amps - $ 19250 2 Phone No. 50.; f4 r I%yc _.- Over 1000 amps or volts $ 36375 2 Job NO. _ _ Reconnect only $ 5350 2 Elec Cont Lice. No ') 4/912C, Exp.Date it / (-C 4c.Temporary Cervices or Feeders OR State CCB Reg. No._! gL)u "7 Exp.Date ('9 -dJ Installation,alteration,or relocation fc 7 $ 5350 2 200 amps or less COT Business Tax or Metro No. � �.}7 Exp.Uate --- 201 amps to 400 amps $ 80.25 2 Signature of Su r. Elec'n 401 amps to 600 amps ` $ 107 00 - ` Over 600 amps to 1000 volts, g p License No /+ � see"b"above. I u 'L `�.S Exp.Date IG "e� 4d.Branch Circuits Phone NO. New,alteration or extension per panel a)The fee for branch circuits 2b. For owner installations: with purchase of service or feeder foe. Print Owner's Name Each branch circuit _�_ $ 5 35 7. Y5 1 - -- - ----- h)The fee for branch circuits Address without purchase of service City State _Zip or feeder fee. Phone No. Fust branch circuit $ 37.50 F ach additional branch circuit $ 5.35 The installation is being made on property I own which is not 4e Miscellaneous intended for sale, lease of rent. IServi(c or feeder not included) Each pump or irrigation circle _ $ 42.75 _ Each sign or outline lighting Owner's Sigr ature g 9 g $ 42.75 Signal circuit(s)or a limited energy if required):* panel,alteration or extension $ 60.00 3. Plan Review section Minor Labels(10) _ _ $ 19F. 9 Please check appropriate item and enter fee in section 5B. 4f.Each additional inspection over 74.,06 4 or more residential units in one structure the allowable In any of the above Service and feeder 225 amps or more Per inspection $ 5000 ---- Per hour $ 50.00 _ _ System over 600 volts nominal In Plant _ $ 59.00 _ _-Classified area or structure containing special occupancy as described in N E C Chapter 5 5. Fees: 5a.Enter total of above fees $ O " Submit 2 sets of plans with application where any of the above apply. 7/./,Surcharge(-e5 X total fees) $ _�� 1g Not required for temporary construction services. Subtotal .ON $ 5b.Enter 25%of line Be for NOTICE Plan Review if required(Sec.3) $ _ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ IS NOT COMMENCED WITHIN 180 DAYS.OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account# - AT ANY TIME AFTER WORK IS COMMENCED Total balance Due $ i d.ts,lurntslciccaic doc i CITY OF TIGAF. '*, 24-Hour BUILDING Inspection Line: '503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 �ldv00w" BUN Received Date Requested 5 �� AM _--_PM BUP Location _-_--__ Z- Suite MEC Contact Person _ - _ c 1,T=[- Ph( ) 2?Z - 3 ZZE h" PLM Contractor Ph SWR BUILDING T-nant/Owner -_ _ ELC -_- Footing ELC Foundation Access: . Drain ELR Cr Crawl Drain - � �- Slab Inspection Notes: SIT Post&Beam - Shear Anchors ---- - -- Ext Sheath/Shear Int Sheath/Shear - - Framing - - - --- -- --- -- - --- - - - -- -- ---- -- ---- Insulation Drywall Nailing --_--- Firewall Fire Sprinkler - - Fire Alarm Susp'd Ceiling - -- RoofOther: - - Final PASS PART FAIL PLUMBING_ Post 8 Beam Under Slab ---- - - — Rough-In Water Service ----- -- - - -- - Sanitary Sewer Rain Drains --- -- - --- Catch Basin/Manhole Storm Drain ---------- ----- - Shower Pan I I PART FAIL HANICAL ----------------------------------------- Post& Beam Hough-In - ---------- - --- - - ------ --- Gas Line Smoke Dampers ----- -- - - -- ------ Final _PASS PART FAIL ELECTRICAL Service - ------- -- --- --- Rough-In UD/Slab --- ------------------ Low Voltage Fire Alarm -- -- -------- - --- - - Final ❑ Reinspection fee of$--.__ _ required before next inspection. Pay Fit City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE— F1 Please call for relnspection RE:--__—._- Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Dats _------- _---- -- - Inspector Ext _-__- Cther: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL