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vP IN q� TUALATIN VALLEY FIRE & RESCUE
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V� BEAVERTON FIRE DEPARTMENT
V FIRE MARSHALS OFFICE
�✓9E J ;i (503) 526-2469
POSTED: a
OCCiJPANT � V r 1 V�"� '"i I �-_
CONTRACTOR BLDG. PERMIT i1 -
PROJECT NAME PLAN REVIEW 1k
LOCATION ` �- �_-� .+.) C L AtJ 'w
JURISDICTION: 7.'= Be. 2= Dec, 3= I:IC,J4= Ti 5= Tu. 6= Sh 7= Wi. 8= CC 9= WC 0= Mcs
COVER FINAL SPECIAL FOLLOW-UP/RETASPECTION ATTEMPTED FINAL
❑ Framing ❑ Separation Walls ❑ Sprinkler System
Shaft ❑ Fire Dampers P (Overhead/Underground) I�{"
❑ Alarm System ❑ Hood' Extug Systems ❑ Conference !
❑ Spray Booth ❑ Ceiling Cover Other -),
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Date: dr— Inspector: q
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DEPARTMENT OF LAND USE 4 TNANSI 1RTATIQN
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
�k 155 NORTH FIRST,HILLSBORO,OR 97124
COUNTY,
INSPECTION REQUESTS: 503/640-3561/693-4415 b
` OREGON
� XXXXXXXXX--> 64U-3470
Page 1 of 1
±' Date 01/30/95 �►
Time 09 : 33
Permit 'Type Residential EiuctiicaL Permii hermit # 05063375
Permit Status APPROVED Applied 01/30/95
Situs Address 12160 SW LINCOLN AV '1'1 Issued 01/30/95 40
Permit 'Title Sb'R - BURGLAR ALARM Completed
Permit Uescr. To Expire 07/29/95
Project 'Title SN'R - BURGLAR ALARM Project # P0047152 0
Project Descr. * EROSION
Parcel Number 251'1'1 - Land Use District
1 valuation U
Legal Uescr.
Owner INSPECTION - TIGARD Construction OTH
App; icant Name ADT Classification 900
Applicant Addr. : 7U3 NE HANCOCK Occupancy
PORTLAND, OR 9'1212 Validated by PH
Applicant Phone : Z84-3265 X35 Inspector Area
E'ee description Units N'ee/Unit Ext fee Data
-------------------------------------------------------------------------------
Limited Energy/Alter,/Extension 1 40 . 00 4U. UU
Subtotal Electrical Fees : 40 . 00
State Surcharge of S% 2 . 00
Total Electrical Ir'ees : 42 . 00
*A* Nees Required *** ** Fees Collected & Credits ***
---------------------------- -----------------------------------•---------
Method Check # Receipt No, Date Payment
CL 24y86 01/30/95 42 , 00
TOTAL THIS DATE ****:k**** 4Z . 00
r'ees : 42 . UU
Adjustments : . 00 'Total Credits : . 00
Total Fees : 42 . 00 'Total Payt,�kants : 42 . 0
balance Due: . 00
N'TICE: This permit becomes null and void If the work or construction for which It Is Issued Is not commrmced within 180 days. Once construction has started,
the permit becomes null and void If construction is Interrupted for a period of 180 days. I certify that the Information presented by the applicant and
his agent or agents In support of this perml is true and correct to the beet of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading Information may invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of thld5hullding or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to ase easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for Inspectinns at vai lour times during the process of construction and the building
Inapectlon staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department Is solely at the risk of the applicant and such use or occul, ncy is revocable until all Inspection requirements are satisfied and
approval Is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit Is Issued
specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all Inspection requlrem9nts.
APPLICANT'S SIGNATURE
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WASHINGTON COUNTY RESTRICTED
Department of Land Use &Transportation
Electrical Inspection Section ELECTRICAL ENERGY � •
155 North First Avenue, #350-12
Hillsboro, Oregon 97124
Information: (503)640-3470 Fax: (503)693-4412 APPLICATION
PRINTPLEASE
completesR+ns, 1 throughPermit No,
3 �S
1. Location of Installation Date A 3 0 9s
Address S7 __ •
City.- _-__ _ Zip Code_2 Z 4. Type of work:
Map No. Tax Lot RESIDENTIAL Restricted Energy Fee $40.00 �
` (for all systems)
Thoma- Map Book: Page :vection ��
Check type of work Involved:
Directions / �
Audio and Stereo Systems'
Commercial ❑ Residential urglar Alarm
,,.�,_• Telephone Systems*
Tenant Name Garage Door Opener*
(if commercial) �` _-__ _ Fire Alarm
Heating,Ventilation and Air Conditioning Systems"
2. Contractor application: Vacuum Systems*
. �.- Ot.ger
Electrical Contractor I _- __
Address _ i � t — COMMERCIAL Fee for each system $40.00
City -_ State04 Zip9,77-1 z--- (see OAR 918-260-260)
Date _ Job Number Check type of work involved:
Property Owner 1 ' Fy7/
Contractor's License No.
r.
Contractor's Board Reg. No. L1
Boiler Controls
t � "—- Clock Systems
€ Phone No. ?i V 92,62 Data Telecommunications Installations
Fire Alarm Installation
3. Owner application: HVAC
Instrumentation
Print Owner's Name Phone No. Intercom and Paging System
Landscape Irrigation Control*
Address - Medical
Nurse Cells
City Outdoor Landscape Lighting*
This permit is Issued under OAR 918-320-370. The applicant agrees Protective Signaling
to make only restricted energy Installations(loo volt amps or less) Other
under this permit and to do the following:
1. Only use electrical licensed persons to do installations where
required. (Certain residential and other transactions are exempt Number of Systems f
front licensing. These have asterisks(*). All others need Iicens-
Ing.)
7.. Call for an inspection when all the installations under this permit No licenses are required. Licenses are required for all other i4lollations.
are ready for inspection.
3. Purchase separate permits for all installations that are not ready 5* Fees y,�/�
for Inspection when the Inspector is out to Inspect under this / C r
permit. Enter fees $
4. Assume respon,'hillty for assuming that all corrections required
by the a respoo! ire!Wl done,and 5% Surcharge .05 X.iotal above
5. Assume respons.Slllty for..c.,ing for a final inspection when all of g ( � ) $
the corrections are cofnplptbd.
Trust Account $ I�-
The person signing t s p r/n1t mutt be the applicant or a person l R —
authorized to birl @a Icant. \
�- - f 7
Signature "�'`w"~Z-� l o J-r $ -
Authority M other than applicant This permit becomes null and void If the work authorized by the
permit Is not commenced within teo days from date of Issuance
For Inspections call /� C of such permit or if the work authorized Is suspended or abandoned
4 5 at any time after work Is commenced tot a period of f 6o days.
640-356 1 or fi93-4
Electrical Permits are non-refundable and nnn-transferable.
24-hour recorder, one working day In advance of need RI.24-114
INSPECTION NOTICE
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 9722.3
Inspection Line (Rec-O-Phone): 639-4175 Business Ph ne: 639-4171
Inspection:,_____ 1 -
9 Footing Plbg. Underelab Hech. Rough-in Appr/Sdwlk
p.i
Pound. Plbg. Top Out: Gas Line FINAL:
}+, r,M5, Poet/Beam Strucl. San. Sewer Framing -Bldg.
,
Poet/Beam Hoch. Rain Drain Insulation -Plumb.
I;� 44yd Plbg. Underfloor Water Line Gyp. Bd. -Hoch. DC7
CPN
Date Requested: l Time:
Address: ��� C _ Permit �:_ f�C.�L c�
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Builders �
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THE FOLLOWING CORRECTIONS ARE REQUIRED: i
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Inspector: vv-4 Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinep.
3
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CITY OF TIGA RD
CITYOFTWARD MECHAN I CAL
COMMUNITY DEVELOPMENT DEPARTMENT 0 R04K)N P E R lyl 11' •
13126 SW HWI Blvd P.O.Bux 23397.TIgaid,Oregon 97223(5W)639-4176 PERMIT 0. . . . . . . I MEC93-0020
6 y 4171 DATE ISSUED: 01/22/93
SITE ADDRESS. . . : 12160 SW LINCOLN AVE PARCEL: 2S102AB-01600
SUBDIVISION. . . . : NO. TIGARDVILLE ADDITION AMEND. ZLIN111b.- R-4. 5
BLOCK. . . . . . . . . . a LOT. . . . . . . . . . . . . :64
------------
CLqSS OF WORK. . :ADD FLOOR FURN. . . . i EVAP COULL.RS:
TYPE OF USE. . . . :SF UNIT HEATERS. . v VENT FANG. . . *. I
OCCUPANCY GRr-1— fl11 VENTS W/O APPL.- VENT SYSTEMS
STORIES. . . . . . . . . I BO I LER3/COMPFRL1SSORS HOODS. . . . . . . :
FUEL 0-3 HP. . DOMES. INCINt
-/WOD/ 3--15 HP. . . . : COMML. INCIN:
MAX INPUT: ETU 15-30 HP. . . . : REPAIR UNITS:
FIRE DAMPERS?-- HP. . . . : WOODSTOVES. . : 1
GAS PRESSURE. . . 50+ HP. . . . : CLO DRYERS. . i
NO. OF AIR HONDLING UNITS yT*HER UNITS. I
FURN ( 100K BTU: 0: 10000 cfm: GAS OUTLETS. :
FURN )=10111K BTU-. > 1001110 cfm.-
Remarks: WOODSTUVE CHIMNEY
Owner: FEES
MARK SMITH type anialtnt by date rcpt
12160 SW LINCOLN ST PR M T $ 25. 00 JH 01/22/93 —
5PCT $ 1. 25 J1-1 01/22/93 —
'TIGARD OR 97223
Phone #: 620-0726
Contractor:
HOT SPOT FIREPLACE & PATIO
11929 SW CANYON RD
BEAVERTON OR 97005
Phone #: 626-4652 $ 26. 25 TOTAL
Reg #. . t 71782
REQUIRED INSPECTIONS
This permit is issued subliect to the regulations cnqtained in thi F=inal Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with
approved plans. This permi.t w;ll expire if work i, not starter)
within 180 days of issuance, or if work is suspended for vore
than 189 days.
f-'ermitteeTIE GiL 4Atret t"e :
Issi-ted BV :
Call for inspection 639-4175
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