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12287 SW LANSDOWNE LANE-1 i i I i N N CA �1 Ul r �. U) r �Z I � i i i I I 12287 SW LANSLOWNE NA14E CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: FA-4171 ----- BUr _ _— Date Requester; —I F` _— FSM— PM _ BLD — _-- Location__�Z_c_ b' / Ali j/S [iL K c Lim — 'quite _ MEG Contact Person �— -- _— Ph ___U6 ,3 =' PLM)'POO 16 616, — Contractor Ph SNR BUILDING -- Tenant/Owner ELC — Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN r Crawl Drain Inspection Notes: o l.i`� �� I�,�� ------ Slab SIT Post& Beam '- Ext Sneath/Shear Int Sheath/Shear Framing Insulation r`rywall Nailing _ Firowall Fire Sprinkler -_ Fire Ala.-m Susp'd Ceil;rr9 - - ------- -- Roof I Misc _ _-- ------- --- Final / PASS PART FAIL ------ - ---- ------ --� -- PLUMBING Post& Beam -^— Under SINK Top Out - Water Service Sar.i,ary Sewer _ ---- ------ -� Rain Drains Final -- --------------- �_ - - -_ .- PASS PART FAIT_ MECHANICAL Post&Beam I ---- --- ------ - Rough In Line,Gas Smoke Dampers ina ---- ---—------------- PASS PART FAIL ELECTRICAL -- - --------------___ _ Service Rough In UG/Slab --------- ---.- -- -- - _ Low Voltage Fire Alarm Final PASS PART FAIL'11- _.__----_-- -.�-------- _ -.---- __-.-- -- iSIT _ -------- —_— —__—�—.^-------- ackfill/Grading SanitarySewe. G T;form raiP'' l6 / [ J 11einspection fee of$-- -required brrore next inspection Pay at City Hall, 13125 SW Hall �flvd C�fCtt-Beatn'`• Fire Supply Line [ ]Please call for reinspection RE: [ ]Unable to inspect -Pr,access AD'. I'Approach/Sidewalk "7 4 �� 1 - --- - - 3 t cl (Other _ Date ! Inspector 1 L Ext l Final �� PART FAIL DO NOT REMOVE this inspection record from the job site. CITYO F T I G A R D __ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00034 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/2/01 PAPCEL: 2S 103BC-08100 SITE. ADDRESS: 12287 SW LANSDOWNE LN SUBDIVISION: MLP1999-00005 MOSES PP2000-077 ZONING: R-1+ 5 BLOCK: LOT: 001 JURISDICTION: TIG CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BP CKFLOW PRFVNTRS: OCr:UPANCY GRP: R3 FLOOR DRAINS: 'RAPS: STORIES: WATER HEATERS: CATCH BASINS: _ FIXTURES _ LAUNDRY TRAYS: SF RAIN, DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIATURES: TUB/SHOWERS: SEWER LINE: 268 ft WA'rER CLOSETS: WATFR LINE• ft DISHWASHERS: RO.N DRAIN: 109 ft Remarks: Instal ation of 268' of sanitary line to inclur e two laterals and 109' .f storm drain lines. F- - ----_ FEES _ Owner: - - - Type By Date Amount Receipt JAY MOSLS PRMT CTR 2/2/01 $342.00 27200100000 12287 SW LA ADSDOWNE 5PCT CTR 212/( 1 $27.36 27200100000 i IGARD, OR 97223 INSP CTR 2/2/0 $62.50 27200100000 Total $431.86 Phone 1: - Contractor: BRIAN CLOPTON EXCAVATING INC PO BOX 509 REQUIRED INSPECTIONS Viewer Inspection Phone 1: 503-682-0420 Storm Drain Insp Reg#: Final Inspection This permit is issued sljh;eul to life regulations contained in the Iigard Muoicipal Code, State of OR. Specialty Codes and all other apphco hle Is/vs. All work will ',e done w acco-dance 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 re:juires you to follow rules adopted by the Oregon Utility Notification Center. Those rales are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules o - direct questions to OUNC by calling (5C3) 246-1987. Isque4y: 1 "111,11L Permittee Signature: iw �l l Call (503) 639-4175 by 7:00 P.M. for an inspection needej the next business day Plumbing Permit Application City of Tigard - Date received: Permit no.: -;iL±L3 Address: 13125 SW Hall Blvd,'I'igatd,OR 97223 Sower permit n:r.: Building permit no.:- CityofTigard Phone: (503) 639-4171 hojecl/appl.no.: Ex•rrredate: Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approN al: -- Case file no.: Payment type: 1.1 I &2 family dwelling or accessory U Commercial/industrial U Multi-family U'fenant improvement U New construction U Add i(ion/al teration/rep'aceinen I U Food ser-ice U Other: Job address: g'� -f Description Qt . Fee(ea.) Total -1 -_-s]"Ih� 1� iN�- New 1-and 2-fiamll dwellings only: Bldg.no.: Suiteno.: (includes 10011.for each utitltyconnection) Tax map/tax lot/account ro.: U U t� _ -_ -- SFR(1)bath Lilt: Bh>ck Sutxlivision: --- --_ SFr ,2)bath --- -_ _ - -- -- Project name: ' _ SFR(3)bath — City/county. 5r•). ZIP: a'j- E.,.-I,additional batlr/kitchen Description and location 1•work on premises:--- - -. _ - Slteutillties: a Catch basin/arca drain Est.date of completion/inspection: - - Drywells/leach line/trench drain - Footing drain(no. :in. ft.) AL Maoura_tured home utilities _ Businc ss name: l3k't tAnJ C 1.'u f curl- y}yAr)NG _ Marirolcs Address: 1� L' c3tJk �57� �, RAn drain connector City: �!i/,:JCSrsC'1[ Stater 7.IP , -Z,� Sanitary sewer(no.lin. ft.) - --- - ---- j J g Phone_.4-Ls2iiu, Fax: - L11 E-mail: St(rmsewer(no.lin. ft.) _- - IVA CCB no.. i-; ` I Plumb.bus,reg. no: '%eater service(no. lin. ft.) Cit metro lie. no.: j2�IX.;jFixture or Item: Contractor's representative signature: : - Absorption va ve Print name: LR ------ - bat Back flow prevti,er --- - - Backwater -- valve Basins/lavatory _ - Name: Clothes washer _ Address: -- -- -� -- -- Dishwasher - --_ -- - --- -- Drinking fountain(s) _ City: - State: ZIP:- Ejectors/sum Phone: - Fax: E-mail: Expansion tank - Fixture/sewer cap - Name riot : Floor drains/floor-sinks/Ftch` -- (P ) ft`� �'d C -- Garbage disposal - - Mailing address: AMf% &5 1 Pose bibb -- - -- -- CiIY_---- _ Slate: ZIP: Y -- let maker---_-- - -- - Phone: Fax: E-mail: Imerc^ptor/grease;rnp _ Owner installation/residential mainten:mce only: The actual installation Primer(s) will he made by me of the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sink(s),basiu(s), lays(s) Owner's signature:_ _ _ Date: Sump - mom 101 Tubs/shower/shower pan Urinal Name: Water closet - - Address: - ---- - ---------_ --- ------- -- -- Water heater — - --- -- - State: ZIP: Other: '1��.-•�---- --- Phone: ---- - Fax: E-mail: Total --- -- -- — NM nil jurisdictions accept cmdil cants,ptense-all jurisdiction 6x num Informaricar t`'oticc:I hspermit is not obtainednobtainedpctnu!application Minimum fee................$ U Visa U MasterCard expires il•a wits m I fi0 days after rt has been Plan review(at - %) $ - Credit card number'_----. —�� Stale surcharge(8%)....$ _A --- ----- Expires accepted as complete. TOTAI. ...... $ . ,'��9•:'�G Name of^Rrdholdrr as shown on credit card p P """ """"' Cantholrkr dRneture -- Amount —------- ------ 440-46 16(64N1ICOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: FIXTURES (individual -- _f,fY ea AMOUNT (Includes all plumbing flxtures!n PRICE TOTAL Sink 1±16.60 60 the dwelling and the flrst100 ft. QTY (ea) AMOUNT Lavatory for each utility connection One 1 bath _ 3249.20 !LTC I r Tub/Shower Comb 16.60 _ Two 2 bat' ^ - -- Snowier On,; -L---- -- _ 3350.00 16.60 TiTuree3h .�.)bat--. 3.399.0_0_ W iter Closr. _ 16.60 _ _ SUBTOTAL _ Urinal _ A- 16 60 - ---6%STATE SURCHARGE - Dishwashe — 16.60 PLAN REVIEW 25%OF SUBTOTAL _ Garbage Disposal 16.60 —— TOTAL Laundry'Fray — 16 fi0 Washing Machine 1660 Floor Drain/Floor Sink 2" 16,60 ?-- - 16.60 1 PLEASE COMPLETE: 4" - 16,60 Water Heater O conversion O Re kind 1660 Y Quantic b LWqrk Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ ermil. _ _ MF Home New Water Service 46.40 Sink _ MFG Home New San/Storm Sewer 4640 Lavatory--- Tub avato Tub or-rub/Shower — --- Hose bibs 1660 Combination _ Roof Drains 16.60 Shower Only — - Drinking Fountain — 1660 Water Closet O, Cher Fixtures(Specify) --- 16_60 _ Urinal - - -- ---- Dishwasher Garbs a Disposal Laundry Room Tray _ -- Washin Machine— Sewer-1st 100' 55.00 Floor Drain/Sink: 2" �. 3" Sewer-each additional 100' 4640 — 4" — - Water Service-1st 100' --- '- 5 00 --_ --- __ „00 Water Heater Water Service-each l litIona1 200 46.40 Other Fixtures S eriiy, _ Storm 8 Rain Drain-1st 100' -L 5500 l y7 nr --_- --- -- Storm R Rain Drain-each additional 100' 46.40 J q0 _ Commercial Back Ftew Prevenhon l.evice _L 46,40 _ Residential Backflow Prevention Device' 2755 - -- -- -- Catch 3asin 16.60- --_- -_ -- _- - -- Inspection of Existing Plumbing or Specially 72.50 Rin ul ested Inc ectlons erlhr _ ^:OMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps QUANTITY TOTAL --- ---- --- -- ---- __�. _-_ Is-mettic or riser diagram Is required it ------ ------ --------- Quonti y Total Is p —-----— -- -- – -------- ----- •SIJBTC'fAL �ccs - ---.----------�-�---- 8%STATE SURCHARGE _ "PLAN REVIEW 25%OF SUBTOTAL �` �• - Re aired only if fixture,qty total Is>9 _ / 41 TOTAL $ --- ----- - _ - 1 3 . - "Mlnlrrum permit fee is$72 50+8`Y slate surcharge,except Residential Backllow Prevention Device,which is$38 25+8%stote surcharge ""All New Commercial Buildings require plans with Is omeldC or riser rt;dgram and plan re.vl^w i:ldstslforms\plm-fees.doc 10/10100 CELECTRICAL PERMIT CITY O F T I�A R D PERMIT#: ELC1999-00713 DEVELOPMFNIT SERVICES DATE ISSUED: 12/01/1999 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S103BC-01200 SITE ADDRESS: 12287 SW LANSDOWNE LN SUBDIVISION: Z014ING: R-4.5 BLOCK: LOT : JURISDICTION: TIG Proiect Description: Peconnect only RESIDENTIAL UNI i _ TEMP SRVC/FEEDER_S_ _ MISCELL I!�NEOUS 1000 S- OR LESS: 0 - 200 amp: PU"-1P/IRRIGA i ION: 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: WISERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st WIO SRVC OR '=DR: PER HOUR: 401 - 600 amp: EA ACD'L BRNCH CIF'. ,: IN PLANT: 601 • 1)00 amp: _ _ PLAN REVIEW SECTION 1G00+ amp/volt: >=4 RES UNITS: >600 VOLT NOMINAL: Reconnect only: 2 SVC/FDR >= 223 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: MOSES. JAY H + MARY JO OWNER 19061 S01 INDIAN SPRINGS RD LAKE OSWEGG, OR 97035 Phone: Phone: Reg#: _^ FEES Required Inspections_ Type By Date Amount Peceipt _. Elect'I Service PRMT BON 12/01/199. 1C'.g0 99-310082 Elect'I Final 5PCT BON 12/01/199 $8.56 99-310082 ORIGINAI Total $115.56 This Permit is issues; suhject 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 A work is suspended f-r 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 352-001-0010 thr-ugh OAR 952-001-0080 You may obtain copies of these roves ord rest questions to OUNC at(503) 246-1987 f ERMITTEE'S SIGNATUREISSUED BY:/ i >�t(^& -� , "L J,i _ _OWNER INSTALLATION ONLY _ I he installation is being made en property I own which is not intended for sale, lease, or rent. r, J OWNER'S SIGNATURE- _ Ll' �' l�l� I�!Y1 - 1� �1.t y-1�\ DATE:— CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. EL.EC'N: _._ _ _ DATE:----.- LICENSE NO: Call 639-4175 by 7:00pm for an inspection the next business day an CITY OF TIGARD Electrical Permit Application Rlec'd By 131Z6 SW HALL BLVD. TIGD ZD OR 97223 Date Recd Date to P E. Phone (503)639-4171, x304 Date to DST Inspection (503)639-4175 Print of Type Permit# (-L ,f�Q7�l 3 Fax (503) 598-1960 Inccmplete or illegible will not be accepted Called 1. jo b Address: i 4. Complete Fee 5-hedule Below: Name of Development Nuitiber of Inspections per permit allowed �-1 Nam=(or name of busine^s) Service included: Items Cost Sum Address JLt) L_a.�,SACL,;,'� 4a. Residential-per unit \ 1000 sq ft or less _ $ 17 75 4 CitylState/Zip �tiG z (Z- Farh additional 500 sq.ft.or portion thereof $ 2';75 T 1 (:ommerc al ❑ Residential Limited Energy — $ c0 00 Each Manuf d Home or Modwdr 2a. CCFill ildetor installation only: Dwelling Service or Feeder _ $ 72 75 2 (Prior to{.errnit issuance,applicas-its must provide contractor license 4b.Services or Feeders Information for COT data base). Installation,alteration,or relocation Electrical Contractor _ _- 200 amps or les, $ 64,25 _ 2 Address _ — 201 amus to 400 amps — $ 8550 2 401 amps to 600 amps $ 12850 _ _ 2 City State.--—Zip _ 601 amps to 1000 amps $ 192,50 w 2 Phone No. _ __ Over 1000 amps or volts $ 363,75 2 ,lob NoReconnect only . $ 53.50� i, �0% 2 Elec Cont Lice. No _ Exp.Date 4c.Temporary Services or Feeders I p7'o), OR State CCB Reg, No._ _Exp.Date e Installation,allegation,or relncation COT Business Tax or Metro No Exp.Date 200 amps or less $ 5350 2 201 amps to 400 amps $ 8025 _ 2 401 amps to 600 amps $ 100.00 _ 2 Signature of Supr. Elec'n Over 600 amps to 1000 volts, see"b"above. License No .. _________--Exp Date_`. 4d.Branch Circuits Phone No _ --- -- New,alteration or extension per panel a)The fee for branch circuit, 2h. For owner installations: with purchase of service or feeder fee. Print O�,?ers Name �C� _ Each branch circuit ^ _ _ $ 5.35 Address 0k00r h)the fee for branch circuits without purchase of service City ( o Slat- fl- Zip (' 1( �- or feeder fee. Phone No G R4 C(y�{ �� Cl l�E� _ First branch circuit $ 37.50 Eau,odditlonal branch circuit _ $ 5.35 The installation is being made on property I own which is not 4e.Miscellaneous intended for rale, lease or rent. (Service or feeder not Included) Each pump or irrigation circle $ 42.75 Owner's Signature a Each sl3n or outline lighting $ 42.75 Signal circult(s)or a limited energy panel.alteratior;or extension $ 60 n0 _ 3. Plan Review section (if required):' Minor Labels(10) $ 100.00 Please check appropriate item and enter fee in section 58, 4f.Each additional in:•pection over 4 or more residential units In one structure the allowable in ar,, of the above —-- Per inspection $ 50.00 Service and feeder 225 amps or more Per hoar $ 50.00 System over 600 volts nomina' In Plant $ 59.00 --------Classified area or structure containing special occupancy as described in N F C Chapter 5 5. Fees: on 5a.Enter total of above fees $ Submit 2 sets of plans .ilth application where any of the above apply. 8%Surcharge(.08 X,total fees) 5 O Not required for temporary construction services. Subtotal 5b.Enter 25%of line So for NOTICE Plan Review If required(Sec.3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION Al1THORI7.ED Subtotal $ IS NOT COMMENCED WITHIN 160 DAYS,OR IF CONSTRUCTION OR n WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS LJ Trust Account#_ —_ AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 5 Odsts4orni \electricdoc CITY OF TIGARD ELECTRICAL PERMIT PERMIT#: ELC2001-00237 DEVELOPP49NT SERVICES DATE ISSUED: 05/08/2001 13125 SW Hall BI, Ticiard, OR 97223 (503) 639-4171 PARCEL: 2S103BC-08100 SITE ADDRESS: 12287 SW LANSDOWNE LN SUBDIVISION: MLP1999-00005 MOSES PP2000-077 ZONING: R-4.5 BLOCK: LOT : 001 JURISDICTION: TIG Proiect Description: Service change. Install (2) 200 a .ip services. _ RESIDENTIAL UNIT_ TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRR.,CATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG. LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANE NMI SVC/FDR: 601+amps - 1009 volts: MINOR LABEL (10): _ SERVICE/FEEDER _ _ BRANCH CIRCUITS — AUD'L INSPECTIONS 0 200 amp: 2 W/SERVICE OR FEEDER: PER INSPcCTION: 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+ amp/volt. >_,AkES UNITS:`--� N > 600 VOLT O_MINAL: Reconnect only: _ SVC/FDR >=225 AMPS: CLASS AREA/SPEC CCC: Owner: Contractor: MOSES, JAY 1"1 + MAkY JO WILLAMETTE ELECTRIC INS, 19C-J1 SW INDIAN SPRINGS RD PO BOX 230.54 LFXE OSWEGO, OR 97035 TIGARD, OR 97281 Phone: Phone: 624-3631 Reg#: LIC 75059 SUP 1965S ELE 34-2830 FEES_ _ _ Required Inspections _ Type By Date Amount Receipt Elect'I Service PRMT CTR 05/08/2.001 $160.60 2720010000( Elect'I Finai 5PCT CTR 05/08/2001 $12.85 2720010000( Total $173.45 This Permit is issuers subject to the regulations contained in the Tigard Municipal Code,State of OR ')pecialty Codes and all other applicable laws. All work will he done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance,or ff work is suspended for more than 180 days ATTENTION Oregon law requires you to follow rules adopteu by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0019 through OAP 9112-001-0080 You mdy obtain copies of these rules or direct questions to OUNC at(503) 246A6699 or 1-800-332-2344 cj. Permit Signature: r Issued By: OWNER INSTALLATION ONLY The installation is being made on property I „A-.- : hrch is not intended for sale, lease, or rent. OWNER'S SIGNA rURE: _ —^� DATE: — CONTRACTOR INSTALLATION ONLY _ SIGNATURE OF SUPP.. ELEC'N:/ L/'l ( �, y(j�� crl DATE:— LICENSE NO: /�(G>� ==:) — -- ------ _ — — ----- Call 639-4175 by 7:00pm for an inspection the next business day i Electrical Permit Application ` l�. Dar err%ived t� G' Permit no.: City of Tigard Project/appl.no.: Expiredate: City of Tigard Address. 13125 SW Hall Blvd,Ti ,OR 97223 Date issued: By- Receipt no.: Phone: (503) 639-4171 — -- —_--- Fax: (503) 598-1960 Calc file no.; Payment type: Land use approval: r I c&2 family dwcllkw,or accessary U Ccnuucrcial/in(lustnal U h1ulti-family U Tenant improvcnicn( U New anlsiruction U Addition/alteration/replacement U Othel: _ U Pattial 1 ' INFORMATION Job address: J 2? 5•,,'({ tidcdawwe'<< Bldg.no.: Suite no.: Tax map/tax IaUaccount no.;_ Lot: Ulock: Sulxlivision: Project name: j A y r4 Ls t SI Description and location of work on premises: Estimated date of cont letion/ins cion• 5-- r5- CON I It AVI Op Job not //g 9 - Per Max . Business name: W.l �' � Ucscriptla tpy. (ea.) 'local no.ln% New res lderdial-singleor,.W'd-(Andl)per Address: 0 !h Z - dwtBllly Illltl.her blrltS AItAr'IM`d r Pge. City: r,S,14 An SteIC:C ZIP: _ / Seniceinchn": Phone: 621 . 51, r Fax:(,14 -2y�& E-mail: I(x)O sq.ft.or less - — — -- 4-- Lach additional.5o0 sq.ft.or portion ihereof _ CCB no.: `/ Elec.bus.hc.no: Z alc_ Limited energy,residential 2 City/metro I;c.no.: 1A 9 6 Limited energy,non-residerial 2 Each nlanufacUlred hoioe Of rnOdUla:dwelling Signature of supervlsl2Lfrctriclan(required) - _Date Service and/or feeder __ 2 Sup elect.name(print): 1 h, t.icensrno r S .SComps keders-Iustaltalion, r relocation! I 1L 1 less b�' CL 2 Name(print): 400 amps 2 ---- 600 amps _2 Mailing address: _ _ 601 e;npsto IW)ntnps 2_ City: Slate: ZIP:_ Over 1000 amps or volts - 2 Phone: v Fax: _ Email: Reconnectonly I_ Owner installation:The installation is being made on property 1 own Temporary wrvk'es or feeders- which is not intended for s^.ie,lease,rent,or exchange according to Ino nation,itherat Ion,or relocat Ion: 2 ORS 447,455,479,670,701. 211011$nips or less 2 _amps to 400 amps 2 Owner's signature: Date: 401 io 600 ams `--v- — 7 t Branch circults-new,alteration, or extension per panel: Name: A Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit _ -7 City: State: ZIP: - B. Fee for brrnch circulus without purchase ---- -- of service or feeder fee,first branch circuit: 2 Phone: Fax' C mall' Each additional branch circuit: M Ise.(Service or feeder not Included): 7Syslein er 125 amps-commercial U licahh-care Iacility Each pump or irrigation circle _ 2 er120enrps-rating of 1&2 Uliazardouslocation Fachsignoroutlinelighting _- 2 llings U Building over 10,000 square feet fou,or Signal circuit(%)or .Nmiled energy panel, er 600 volts nominal rtwre residential units in one stmctuic Alterntion,or extension* 2 U Building over three stories U Feeders,400 strips nr more •t)r:%lrl,tion: U(>.:cupant load over 99 persons U Manufactured structures or RV park F'ach additional i tspeclion oyer the allowable In any of the above: U I-gresylighlingplan U Other -_ � per inspection —T -- Submit_sets of plans wish any of the above. Investigation fee--- Ile above are not■pplicaltle to temporary construction service, Othet Nor all jurisdictions accept credit cods,plea ie call Jurisdiction for more InfornWlan. Notice:This permit application Pcrtnit fee.....................$ L� U Visa U MasterCard expires if a permit is not obtained Plan review(at ` %) $ Credit gird number: �_-�� _ _��__ within 180 days alter it has been State surcharge(896) 1 2 Rxpires accepted as complete. TOTAL, $ J 3 --Name of cardhn r u wn tm credit cud L Crdholder d` alui Amount_ 4404615(60WQM) Electrical permit Fees: Limited Energy Fees: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Complete Fee Schedule 3elow: --- - �— (� Restricted Energy Fee...................................................... $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved. Residential-per unit 1000 sq It,or less $14515. Audio and Stereo Systems Each additional 500 sq it or portion thereof $33.40 1 Burglar Alarm Limited Energy _ $75.60 Each Manurd[ionic or Modular Garage Door Opener' Dwelling Service or Feeder $90.90 2 Services or Feeders E:] Healing,Ventilation and Air Conditioning System' Installation,alleralir:r,or rc. ition 200 amps or le;s _ $8010 2 U Vacuum Syshuis' 201 amps iu 4U0 amps $106.85 _ 2 401 amps to 600 amps $160.60 _ 2 Other �� 601 amps to 1000 amps $240.60 2 Over 1000 amps or volts $454,65 _ 2 --------- - -- Reconnect only $66.85 _ 2 Temporary Services or Feeders installation,alteratlon,or relocationTYPE OF WORK INVOLVED -COMMERC �1L ONLY Fe 200 amps or loss 566.85 1 e for each system.................................................. $75.00 201 amps to 400 amps J T $100.30 2 (SEE OAR 918 260-260) 401 amps to 600 amps $133.75 2 Over 600 amps to 1000 volts Check Type of Wor' volved: see"b"above. Audio and Stereo Systems ©ranch Circuits New,alteration or extension per panal Boller onlrols a)The fee for branch circulls with purchase of service or feeder fee. Clock Systems Each branch circuit _ $665 _ Z b)The fee for branch circuits - Data Telecommunication Installation without purchase of service or feeder fee. L-1 Fire Alarm Ins'Allalion Firs(branch circ ill $46.85 _ Each ar+^lrir:,al branch circclt ___ $6.65 (� HVAC Miscellaneous (Service or feeder not included) InstiumentatIon Each pump or Irrigation circle _ $53.40 Earh sign or outline lighling $53.40 Intercom and Paging Systems Signal circuit(s)or a limited energy panel,alteration yr extension 575.00 Minor Labels(10) T� $12500 El Landscape Irrigation Control' Each additional inspection over Medical the allowable In any of the above Per inspection _ $62.50 Nurse Calls _ �1 Per hour -' $62.50 J In Plant $73.i 5_ El Outdoor Landscape Lighting' Fees: Prolective Signaling Enter total of above fees $ Other 8%5!+le Surcharge $ - .—Number of Systems 25%Flan Review Fee See"Plan Reviow"sedlon on $ runt of application No licenses are required Licenses are required for all other hislall-tions Total Balance Due $ Fec:s: Trust Account p Enter total of above fee3 ---� --- --- ---J — - ll'/.State Surcharge =_ Total Balance Oue I\41sts\luno•\cir fors dot 10/119/00 CITY OF TIGARC BUILDING INSPECTION ["VISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 —� BUP '')ate Requested wM _PM — 3LD _ Location Suite ME" �1iy9 ' cl I W r9 e'_ -- Contact Person _ Ph e'- ,� �� :aC� 5 t PLM Contractor -�C �yr�Q�� Ph SWR BUILDING T-enant/Owner ELC Retaining Wall ELR _ Footing Access: Foundation FPS Ftg Drain --- - SGN Crawl Drain Inspection Notes Slab .-yt �� n J 16 / -j 1 - ---- --- 7 SIT Post 8 Beam - Ext Sheath/Shear Int Sheath/Shear Forming — Inaulation Drywall Nailing --' --- ---- -- - ------- ---------— Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Miss: / - / ---- - - Final PASS PART -FAIL -- PLUMBING_ post&ec` Jnder Slab Top Out - --__- __----- - — Water Service _ _ Sanitary Sewer _ Rain Drains �?' ✓ Final PASS PART FAIL MECHANICAL Post&Beam ---- - - Rough In Gas Line Smoke Dampers Final -- ------—- 'f%few PASS PART FAIL ELECTRICAL_ ------ --- ~— Service Rough In -- --------------- ---�;-- - i UG/Slab Lc N Voltage Fire Alarm PASS ART FAIL 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 Pinspection RE. _ [ I Unable to inspect-no asses; Fire Supply LHP ADA � (' Approach/Sidewalk Date �7C Inspector Ext Other =-- - —�--- — Final �- PASS PART FAIL DO NOT REMOVE this inspection record from the jeb site.