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11624 SW LOMITA AVENUE-1 i N A r 0 C n i 1 E I 11624 SW LOMITA AVE C-1 I OHI CONSTRUCTION... 172555 PILKINGTON ROAD Pb (503)635-6248 LAKE OSWEGO,OREGON F?K (503)636-7183 97035 635-6248 Fax 636-7183 Client: PLAZA GARDE14 APTS.(SUMMIT Business: (503)223-9980 x 134 MANAGEMENT) Billing: 5320 SW MACADAM PORTLAND,OR 97201 Property: 11624 SW LOMITA TIGARD,OR 97223 Operator: DAN Estimator: Dan Nelson Business: (503)635-6248 Title: Estimator Reference: Farmers Ins.Co. Type of Estimate: Fire Date Entered: 8/9/2000 F rice list: PORTORD Estimate: PLAZA �4 CITYOF T I G A R D BUILDING PERMIT _ PERMIT#: BUP2000-00340 °s DEVELOPMENT SERVICES DATE ISSUED: 8/17/00 ' 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-417.1 PARCEL: 1S135DD-03703 SITE ADDRESS: 11624 SW LOMITA AVE A-1 SUBDIVISION: PLAZA GARnEN WEST ZONING: R-12 (� BLOCK: LOT: JURISDICTION: TIG I REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: REP FIRST: sf N: S: E: W: TYPE OF USE: MF SECOND: sf PROJECT OPENINGS? _ TYPE OF CONST: 5-1HR sf N: S: E: W: OCCUPANCY GRP: R1 TOTAL AREA: 0.00 sf ROOF CONST- FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: 1 HR BSMT?: MEZZ?: REQ_D SETBACKSREQUIRED FLOOR LOAD: psf LEFT: ft RGHT: �ft FIR SPKL: SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRIAS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 75,000.00 Remarks: F're Damage repair-Apartment units Owner: Contractor: PARKER, JEROME W TRUSTEE OREGON HOME IMPROVEMENT CO INC BY SUMMIT REAL ESTATE MANAGEME= DF, HI CONSTRUCTION 5320 SW MACADAM AVE 1 i_�,�; ,,WWWPIICCL;;KINopGTON RD PgpTLAND. OR 97201 L%F QS�6WQZ48R 97035 one: Reg#: LIC 00034908 FEES —iV REQUIRED INSPECTIONS –Type By Date Amount Receipt Framing insp 5PCT JMT 8/17/00 $43.82 0004555 Firewall Insp PLCK JINIT 8/17/00 $356.04 0004555 Gyp B nail/screw Gyp Board Insp FIRE JMT 8/17/00 $219.10 0004555 Final Inspection PRMT ,IMT 8/17/00 $547.75 0004555 Total $1,166.71 - This permit is issued subject to the regulations contained in the Tigard Municipal Crile, State of OR. Specialty Codes and all other applicable law. 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 foi more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987 You may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-1987. Pe .nitee Signature: Issued By: Call 639-4175 by 7 p.m. for an inspection the next business day CITY OF TIGARD Commercial Building Permit Application Plan Check I 13126'SW HALL BLVD. Tenant Improvement 'tec'd By'I .�1 Date Rec'd TIGARD, OR 97223 Date to P.E. ?, (503) 639-4171 Date to DST Print or Type Pem,it# e"01 un -dem Related SWR# Incomplete or illegible applications will not be accepted Called 'S F � 10r �' -- — Name of Developm I/Proiect —� �- Existing Building ElNew Building ❑ Job �— Address street Address I suite —" " Building 1 S .11;1`1 64 Data --- Bldg# City/Slate Zip Existing Use of Building or Property: Name - Proposed Use of Building or Property. Property Owner Mailing Address — Suite 1�13 _ No. Of Stories: City/State Zip Phone I ^ Sq. Ft. Of Project: Occupant _ ar,„' � — --_� Occupancy Class(es) -� ..._..-- Name C��,- nN[ t” orNgAir- Contractor v � — — Type(s)of Construction Prior to permit Mailing Address Suite — — Issuance,a copy Will this project have a Fire Suppression System? of all licenses -�7 SU.) 1 1 r,IT _ _Yes ❑ _ No ❑ are required If City/State Zip Phone Americans with Disabilities Act(ADA) expired in C.O.T. database � � Valuation X 25% = $ ---Participation Oregon Const.Cent.Board Lic.# Exp.Dale `; Complete Accessihili Form -3 Y9 � i 21 i�f Iv I Project $ - _-- —__Name Valuation _ 7 Architect Plans Required: See Matrix for Kumber of sets to submit— Mailing Address suue�-- on back City/Slate Zip Phone I hereby acknowledge that I have read this application,that the Information given is correct,that I am the owner or authorized agent of the owner,and that plans submitted are in compliance with Oregon State Laws. -Engineer Name _ - Si", - Sign ,ire or Owner/ftent Date Mailing Address Suite IV,» - oFtartllerion Name Phone City/State 21p Phone - -] L Z _ - - - FOR OFFICE USE ONLY Indicate type of work. New O Addition O Demolition O Map/TL# Land Use: - Accessory Structure O Foundation Only O Alteration O Repair O_ Other O Notes: Description of work: _ TIF ----- Note: Site Work Pennil Application must precede or accompany Building Permit Application 6i4-7 1 1\COMNEWTI DOC (DST) 1i/38 2�+ 0 4, COMMERCIAL PLAN SUBMITTAL REQUIREMENT MATRIX s'lan Review is dependent upon submittal of BOTH plans AND a COMPLETED application. For an electrical sribmittal, the application must contain the signature of the supervising electrician before p!sn review will be conducted. After plan review approval, Plans Examiner will ctintact the applicant to request additional plan sets for distribution purposes. (Copy for Contractor, City, Waw;,'-,,,:on County, Tualatin Valley Fire 8. Rescue) Total # of :TYPE OF SUBMITTAL Plans KEY-.. Submitted S (Private) _ -1 S = Site Work B = Building F (New or Add or Alt) 3 F = Fire Protection System M_(N_eW or Add or Alt) i1 M = Mechanical B & M (Nei- or Add) 1 P = Plumbing P (New, Add, or Alt) 2 E = Electrical B & M & P (New or Add) -- - —2 -- New = New Building E (New, Add, or Alt) 2 Add = Addition B & F & M & P & E 3 Alt = Alternation to Existing (New , Add) _ Building *BorB &M (Alt) *B & M & P E(M4 yy 3 NOTES: *Shaded areas designate ALT submittals only. I\dslsltorms\malrxcom doc 10130/98 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Businers Line: 639-44/1 - BUP _Gate Requested �� Z' —AM PM _ BLD Location �� %'r' — Suite 5� MEC _ — Contact Person _ _ Ph _9-B 2 J1/ z— PLM Contractor Ph SWR _ BUILDING -�. Tenant/Owner ELC ✓ Rr lining Wali ELR Footing Access: Foundation FPS __--- Fog Drain SGN Crawl Drain Inspection Notes - — -- — Slab _ —_-- - ------_.... ----- SIT Post& Beam --------- Ext Sheath/Shear �__---_—.--_— Int Sheath/Shear Framing _ Insulation Drywall Nailing Firewall — Fire Sprinkler -_--.- - Fire Alarm Susp'd Ceiling —_ --- ---- — -- Roof Misc ___ _ _ - -- - -— ------- - Final PASS PART FAIL --— -- ------- — - --- -- - ----._-_ PLUMBING_ Post&Beam �..— --------- -- ----- _ Under Slab TopOut -----------___ _- - ---------------- ----- Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL. Post&Beam Rough In Gas Line --- - - -- ----- _ __-- -- Smoke Dampers Final PASS PART FAIL Rough In UG/Slab Low Voltage Fire Alarm . -__-- S )PART FAIL 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 [ ] Please call for reinspection RE:-- [ j Unable to inspect-no access ADA Approach/Sidewalk Date L�.l _��— - Inspector —_-- -- — Ext Other — Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIG RD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST –_ BUP Date Requested— _AM PM BLD L-acation � -5 " <<� j Suite _ MEC Contact Person _ _ — Ph QGj J// Z--- PLM Contractor _ Ph SWR BUILDING Tenant/Owner —_— -- ELC �__B� 571 Retaining Wall V ELR Footing Access: -- Foundation Ftg Drain FPS Crawl Drain Inspection Notes. SGN Slab ----- '— Post 8 Beam ------- ---- — ------ -- SIT Ext Sheath/Shear — Int Sheath/Shear -— ---- ------. Framing Insulation Drywall Nailing Firewall — - Fire Sprinkler — --- ire Alarm - -- Susp'd Ceiling `— __ - - - Roof _ --- - - Misc: Final --- —__--- ---- - PASS PART FAIL PLUMBING -- Post& Beam ------- ----- -- __ Under Slab Top Out --- ---- ----_ -- - Water Service — Sanitary Sewer - -- - - _ ---- ---.T:—.�-- --- --- -- — Rain Drains Final — - - --- - -- --------- ----- — ---- - PASS PART FAIL MECHANICAL - _ --- ---- -- -- ---- Post&Beam Rough In Gas Line Line -- - - ----- -- Smoke Dampers —�- Final PASS PART FAIL _ — - Service Rough In ---- --- UG/Slab Low Voltage FLrm ASS ART FAIL Backfill/Grading - — - Sanitary Sewel Storm Drain [ j Reinspection fee of$ required 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 r� Other Date ��_Q Inspector _ _�_ /� _ Ext Final - PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF ITIGARD BUILr'14G INSPECTION DIVISION \ 24-Hour Inspection Line: 639-41. Business Line: 639-4171 ---- B Date Requested U AM/G� PM BLD — Location z w Lell i t'i, — _ Suite C _ y MEC Contact Person — Ph 7 9 " z `� PLM ' Contractor _ _ Ph SWR — �� Tenant/Owner V' �G� � �p U-�r Q-✓_�— ELC r. Retaining Wall ELR Footing Access: Foundation , 7,u b�� / >( FPS Ftg Drain L' (�U Crawl Drain Inspection Notes: SGN _ Slab SIT Post& Beam r. - - - -- Ext Sheath/Shear ► ` Int Sheath/Shear Framing Insulation - - -- -- -------� - Drywall Nailing Firewall -- - --- Fire Sprinklei Fire Alarm Susp'dCeiling I -- ------------ ------ - ------------ - Roof rrs-s) PARI FAILW.09 - __-_-.-------- --- ___-_ ._— 81NG Post& Beam Under Slab Top Out - - -- - Water Service Sanitary Sewer -- -- Rain Drains Final - -- - ------ - --_- - -- __ _.— ---- - ----- PASS PAR' FAIL MECHANICP.,_ Post& Beam - -- - -- - - — Rough In Gas Line - - ---- - - - _ Smoke Dampers Final - - --- --- - - --- PASS PART FAIL ELECTRICAL _------_-.- Service Rough In `---- ----` -- UG/Slab Low Voltage ___._--------_--- -- -- Fire Alarm Final ------- --.._.------------ - PASS PART FAIL SITE Backfill/Grading - - Sanitary Sewer Storm Drain [ )Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin Please call for reinspection RE: Fire Supply Line [ ) p _____________-__- ( )Unable to inspect-no access ADA Approach/Sidewalk Other Date C)I Z-4 C) y Inspector,_ _ E _LZ Final PASS PART FAIL 00 NOT REMOVE this inspection record from the job site. CITY OF TI G A R D CERTIFICATE OF OCCUPANCY DEVELOPMENT SERVICES PERMIT#: BUP2004-00237 1312E SW Hall Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 5/21/2004 PARCEL: 1 S135DD-03703 ZONING: R-1" JURISDICTION: TIG SITE ADDRESS: 11624 SW LOMITA AVE C-1 SUBDIVISION: PLAZA GARDEN WEST BLOCK: LOT: CLASS OF WORK: ALT TYPE OF USE: MF TYPE OF CONSTR: 5N OCCUPANCY GRP: R t OCCUPANCY LOAD: TENANT NAME: LOMITA WEST REMARKS: Fire restoration to Units C-1, C-2 R C-3. Owner: DALTON MANAGEMENT 8417 SW BEAVERTON-HILLSDALE HW PORTLAND, OR 97225 Phone: 503-297-4665 Contractor: 503-620-2215 HORIZON RESTORATION SYSTEMS 7301 SW KABI_E LANE SUITE 100 PORTLAND, OR 97224 Phone: 503-620-2215 Reg #: LIC 4608 1 This Certificate issued 7/29/2004 grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for compliance with theta3te of Oregon Specialty Codes for the group, occupancy, (And Use unLd r r.1% eferenced permit wo is sued. BUICDIN INSPEC BUILDI OFFICIAL POST IN CONSPICUOUS PLACE CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP Received Date Requested AM___PM BUP Location Suite C MEC Contact Person Ph(_—) � 3 PLM Contractor --. Ph(—) SWR A!;7 BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELIR Crawl Drain Slab Inspection Notes: SIT Post& Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Fitewall Fire Sprinkler Fire Alarm Susp'd Ceiling Root Other: Final PASS PART FAIL Post& Beam Under Slab Rougti-!!, Water Service Sanitary Sewer Rain Drains Catch Basin Manhole Storm Drain — Shower Pan Other: Final P_Sq PART FAIL MECHANICAL Post& Beam Rough-In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough-In UG/Slab Low Voltage ____—_--_-- FireAlarm Fbw- Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. >-.PART FAIL Please call for reinspection RE: Unable to inspect -no access Fire Supply Line ADA Approach/Sidewalk Date L 111nopector 60 y Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)63P-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUP Received __ 4' ' ' ` Date Requested_ _ ______ AM__ __ PM_ _ BUP Location Suite,__ MEC Contact Person -_._ Ph( ) L`/"-� -S -- � -_ PLM Con -- ---------- - Ph ---- SWR -- -- ----- Tenant/Owner -_ _ _ ___ ELC _-- q ELC Foundatior -----_-" Fig Drain Access: _ CL ELR Crawl Drain �,L7 Slab Inspection Notes: SIT Post& Beam — Shear Anchors - - - Ex:Sheath/Shea.- Int heath/Shea.Int Sheath/Shear Framing - - ---- - - --- - Insulation Drywall Nailing --- ----- Firewall Fire Sprinkler - - --- - -- - - - -�--- - — Fire Alarm Susp'd Ceiling --- _ - - Root Other: --- -- _ SS PART FAIL - _ ING - -- -- ------ -- 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 - ---- -- --. ----- ----- Final PASS PART FAIL - — - _ - -- - ------------------- ------------ ----- ELECTRICAL /Y Service — -- ---�`�--�-------- _ ---.._— Rough-In _--_ -- ---- -- UG/Slab Low Voltage Fire Alarm - - Final Reinspection foe 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 Approach/Sidewalk Date Inspector -_East____ Other Finni DO NOT REMOVE this Inspoction record from the job site. PASS PART FAIL CITY OF TIGARD BUILDING PERMIT PERMIT#: BUP2004-00237 DEVELOPMENT SER"ICES DATE ISSUED: 5/21/2004 13125 SW Hall Blvd., Tiqard, OR 91223 (503) 639-4171 PARCEL: 13135DD-03703 SITE ADDRESS: 11624 SW LOMITA AVE C-1 SUBDIVISIUNF PLAZA GARDEN WEST Z_UNING: R-12 BLOCK: I-OT: JURISDICTION: TIG REISSUE: _ FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ALT FIRST: sf N: S: E: W: TYPE OF USE: MF SECOND: sf PROJECT OPENINGS? TYPE OF CONST: 5N sf N: S: E: W: OCCUPANCY GRP: R1 TOTAL AREA: 0 sf ROG7- CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZ-Z?: REQD SETBACKS _ REQUIRED FLOOR LOAD: psf LEFT: ft RGHT: ft FIR S15—KL: SMOK DET: DWELLING UNITS: FRNT. ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 70,000.00 Remarks: Fire restoration to Units C-1, C-2 & C-3. Owner: Contractor: DALI ON MANAGEMENT HORIZON RESTORATION SYSTEMS 8417 SW BEAVERTON-HILI_SDALE HW 7301 SW KABLE LANE PORTL/',ND, OR 97225 SUITE 100 Phone: 503-297-4665 PORTLAND, OR 9/224 Phone: 503-620-22,15 Reg#: LIC 46081 FEES REQUIRED INSPECTIONS Description Date Amounts Framing Insp 1BUILUJ Pernir I-ee 5/21/2004 $580.20 Insulation Insp -t.AX18`4 St,ilc .tiurclGyp Board Insp Final 5/21/2004 $46.42 _ Final Inspection Total $626.62 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 wnrk is suspended for more than 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the k;regon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of these rules or direct questions to OUNC by calling (503}-24E-M99,or 1-800-332- Issuetl By. �l C Permittee Signature: Call 639-4175 by 7 p.m. for an inspection the next business day Building Pennit Application Re City Of Tigard ce Dete l3eJ Y I'cinui No 13125 SIN I iall I IIN d, I igard,OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1%0 Date/By: Other Permit: Inspection Line: 503.639.4175 Date Ready/By: m ® Ser Attached Piece_ lI l for Internet: www.ci.tigard.or.ua Notified/Method: Supplemental Information TYPE. OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition Permit fees'arc based on the value of the work performed. --.--- -- Indicate the value(rounded to the nearest dollar)of alt ❑Addition/alteration/replacement Other:Fire Damage Repair equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ I-and 2-family dwelling ❑ComValuation: $mercial/industrial __— ❑Accessory building ®Multi-family Number of bedrooms: ❑Master builder — ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 11624 SW Lomita Ave New dwelling area: square feet City/State/ZIP:Tilad,Oregon 97223 Garage/carport area: square feet uile/bldg./apt.no.:CI,C2,C3 Project name:Lomita West - — Covered porch area: _ square feet e:Lomita&90th ave Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: —� Lot no, f crmit fees"are based on the value of the work performed. Tax map/parcel no.. Indicate the value(rounded to the nearest dollar)of all --_ equipment.materials,labor,overhead.and the profit for the DESCRIPTION OF WORK work indicated on this application. Unit C-3 Remove and replace roof trusses,sheeting and roof.R&R drywall floor. Valuation: $S70,000.00 Restore to original before fire.>Fire damage repair Existing building area: 1050 square feet Unit C-2 Remove and replace roofing.Paint interior>Fire damage repair Unit C-3 Remove and replace roofing.Paint interior>Fire damage repair New building area: o square feet ® PROPERTt' Number of stories: 2 OWNER _ � ,'] TENANT 11 Name: Dolton Management Type of construction: Wood Structure Address:8417 SW Beaverton-Hillsdale Hwy Occupancy groups: -- City/State/ZIP:Portland Or. 97225 _ w Existing: yes Phone:(50312974665 Fax:( I -- ------- New: ® APPLICANT ❑ CONTACT PERSON NOTICE Business nan(c: Horizo.Restoration All contractors and subcontractors are required to be licensed with the Oregon(bnstructimt Contractors Board Contact name:Tom Armour under ORS 701 and may be required to be licensed in the Address:7300 Kahle Lane#100 Jurisdiction in which work is being performed. If the applicant is exempt from licensing.the following reasons City/Slate/ZIP: Portland Or 97124 apply: Phone:(403)620-2215 —�—Fax::1103)624-0523__ E-mail:tomat'suhorizonrestoration.com CONTRACTOR �— Business name:Some as above BUILDING PERMIT FEES* Address: Please refer to fee schedule. City/State/ZIP: —� _ _ Fees due upon application Phone:( ) Fax:( ) Amount received CC 13 lic.:46081 Date received: r Authorized signature: /� -- This permit npplication expire%Ira permit Is not obtained \ l/""'�' �• r" %slthin INTI da)%after it has been accepted as complete. �Prinl name: CAb (,, Date:_ ' Fee methodology set by ITi-C"ounly 13udding Industry Service Board. i nuildingPeimin'In1P.PermitAppduc ]ni M0.461)T(11102/com/wFn1 CITY OF TI GA RD ELECTRICAL PERMIT PERMIT#: ELC2004-00257 DEVELOPMENT SERVICES DATE ISSUED: 5/13/2004 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: IS135DD-03703 SITE ADDRESS: 11624 SW LOMITA AVE C-3 SUBDIVISION: PLAZA GARDEN WEST ZONING: R-12 BLOCK: LOT: JURISDICTION: TIG Project Description: 1 200 amp service with 6 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'L INSPECTIONS 0 - 200 amp: 1 W/SERVICE OR FEEDER: 6 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: PARKER JEROME W TRUSTEE MCCOY EMPIRE ELECTRIC LLC BY SUMMIT REAL ESTATE MANAGEME 2014 SE 9TH STREET 5320 SW MACADAM AVE PORTLAND, OR 97214 PORTLAND, OR 97201 Phone: Phone: 503-777-3108 Reg#: LIC 147727 — SUP 2430S FEES FIX 26-82C Description Date Amount Required Inspections 1iil'i NII I FAA I'crmit 5/13/2004 $120.20 — I AX I N"-„State Surcharge 5/13/2004 $9.66 Rough-in lect'l n 1(0fund-IFLPRh1'T1 1-1,(' 5/13/2004 -$120.20 Elect'I Finol (additional fees not listed here) Elecfl Final Total $129.82 I his 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 adopter'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 1-809,)32-2344 Issued By: _ Permit Signature: c t. `- _ OWNER INSTALLATION ONLY I I ie installation is being made on property I own which is not intended for sale, lease, or rent. OWNERS SIGNATURE: — _ _ DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: _ _-_ DATE:_ LICENSE NO: Call 639-4175 by 7:00pm for an inspection the next business day Electrical Kermit Application Itatereceivecir Permit no.' ' p� City of Tigard I'roiecl/appl.no.: Expiredat.: Address: 13125 SW Ball lilvd, figKd,OR 97273-i114 Date issued. H Rc-erptno.: Phone: (503) 639-4171 --- Fax: (503) 598-1960 iATY OF DUAHU Case file no.: Payment type: �r' ^""'rr"tOJi=NC,?INFFRINC: Land use approval: 1 L.1 1 rt 2 family dwelling or accessory U Commercial/industrial ulti-family LJ Tenant improvement U Ncw construction U Addition/alteration/replact•tncnt U Other:-_ U Partial INFORMJOB SITE 1 Joh address: UU- Z O fir,I T4 j t(js 1131dg.no.: suite no.:(73 Tax map/tax lot/accouni no Lot: I Block: Subdivision: Z 23 Project name:name: Description and location of work on premises: Estimated date of completion/inspection: Co —0 M"PJob no: C Fee Max Business name: OKC.(L G —Description Qt . (ea.) 7bta1 no.lns New residential-dnRte or muhi-family per Address: 1ti 5' �/�- dwellingunh.lnciudrtattached garage. City: f,.4" State: 00-1 Z111:01,7 t sf Seniceincluded: Phone:a �7t1 Fax: r{ Email: 1(xlu sq ft.or less _ -- — _ t CCB no.: -A fi� Elec.bus.lic.no: (o Q�C Each additional 500 sq.ft.or portion thereof City/retro lie.no.: '?an Llmitedenergy,residential 2 Limited energy,non-residential 2 Each manufactured home or modular dwelling Sin re of superli.gIng e ectrician(rc aired—)-- bate Service and/or feeder 2 Sup,elect name(print) Services or feeders-Installation, ! J '41k -- Liccnsenn: sS alteration or relocation: _2fv'amps or less 2 Name(print): 201 amps to 400 amps ---� — 2 Mailing address: - 401 amps to b(H)amps _ 2 --- -- 601 amps to I(xfl)amps 2 City: State: /.IP: Ove.1000 amps or volts --2 Phone: I Fax: E-mail: R,connecuonl — — t Owner installation:The installation is being made on property I otvtt Tcmporary services orfeeders- which is not intended for sale,lease,rent,or exchange accordinf tt, installation,Alteration,or relocation: ORS 447,455,479,670,701, 2n0 amps or less 2 201 amps to 400 amps —.Z� Owner's signature: Date: 401 to 6ft0 ams - 2 Branch circuits-new,alteration, or extension per panel: Name__ _ - _ _ A. Fee for branch circuits with purchase of Address: _ service or feeder fee,each branch circuit 2 City: _ State: 7,IP: H. Fee for branch circuits without purchase —^ "-- _-- of service or fader fee,first branch circuit: 2 Phone' l itx: f mail: Hach additional branch circuit:PLA N 06 RUVIL'W(Plense check all that appl�-) - Mlsc.(Service or feeder not Included): U Service over 225 amps-commercial U Health-care facility Each pump or irrigation circle 2 U Service over 320 amps-rating of 1&2 U Hazardous location Fach sign or outline lighting 2 familydwellings U Building over 10,00()square fort lour of Signal circuit(s)or a limited energy panel, U System over 600 volts nominal more residential units in one structure alteration,or extension* 2 U Builoing over three stories U Feeders,400 amps or mon "'Description: _ U Occupant load over 99 persons U Manufactured structures or R V pntk Fich additional Inspection over the Allowable in any of the strove: U I*ressAightingplan U Other: - ---_ Per inspection Submit,.._. sets of plant with any of the above. Investigation fee •Ilse above are not applicable to temporary construction service. Other ----- -- ------ -- -- ---- Permit fee..................—$ Not nll jnrialictirota ttc rpt mrtle cauls,ple;rsr call juriwliLfV n fin num tndxntari„n Notice:This pctnrit application d U visa U MamerVard exp,r°s if a pemtit is not obtained Plan review(at _, 461 $ n- !'mdit J withht 180 days after It has hectl State surcharge(846) ....$ - l:apires accepted as complete. TOTAL .......................$ uZ9. Nm of cerdhule,m rho%n nn rmdn rm�l -— $ t�ardhdder dpoturr Amount 446J613(tMtlalCOM)