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CITY OF TIGARD BUILDING INSPECTION DIVISION M,
24-113ur Inspection Line: 639-4175 Business Line: 639-4171 ¢ --- —
�i BUN
_Date Requested I Z 0 _ AM .__PM BLD
Location ��� ,Sc✓ 'ZotLrpr` Ch Suite _ MEC
Contact Person _Sa _ Ph !r`G�z�i _ PLM —
Contractor ,w N ��_��_ _ Ph —_ SWR —__--.—
BUILDING Tenant/Owner _-- _ -� EL.0
Retaining Wall ELR __-_---_
Footing Access:
Foundation �G / ✓ ` FPS --
Ftg Drain `-7 SGN
Crawl Drain Inspection Notes. -
Slab � - t ` �_.. "'�- �' SIT --- -- --
Post& Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing __.__ — - -------- - -
insulaticn
Drywall Nailing --- -._ — ----- -- -._._
Firewall
Fire Sprinkler ---
Fire Alarm
Susp'd Ceiling -- -_.-
Roof
Misc: _ ---- -
Final
PASS PART FAIL --- -- -
PLUMBING
Post& Beam
Under Slab -
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL -
MECHANICAL
Post& Beam _ .------- - --- - -
Rough In —-
Gas Line ----- --- ---- - -----
Smoke Dampers
Final --_ _ .._ _ -- -- ---------------.-- _ -------
RT FAIL
��. ELECTRICAL
Service ......-----, --- - - —---------- — --- -----
Rough In
UG/Slab ---- ---- - ------- ------- --------_ ....- -- -----------
Low Voltage
FireAlarm - -- ---- ------- ----------- ---..----�-
Fi
f S PART FAIL -------
S - --- _
Rackfill/Grad:ng - - ---- - --
Sanitary Sewer
Storm Drain [ ]Reinspertion fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ]Please call for reinspection RE- [ ]Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk 7 _
Other
Date 1 L�_.l Inspector
Final
PASS PART FAIL [rG NOT REMOV E this inspection record Brom the job site.
CITY
O� ������ ELEC'iRICALPERMIT
PERMIT#: ELC2000-00576
DEVELOPMENT SERVICES DATE ISSUED: 10/3/On
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639-4171 PARCEL: 2S104CA-02300
SITE ADDRESS: 13625 SW LAJREN LN
SUBDIVISION: HILLSHIRE ZONING: R-7
BLOCK: LOT : 023 JURISDICTION: TIG
rroiect Description: Installatiorr, of one 200 amp or less service/feeder and two 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: SIGNALWANEL:
MANF HM/ SVC/ FDR 601+amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS _-- ADD'L INSPECTIONS_
0 200 amp: 1 W/SERVICE OR FEEDER: 2 PER INSPECTION:
201 400 amp: 1st W' SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT.
601 - 1000 amp: _ PLAN REVIEW_ SECTION
1000+ amp/volt: >=4 RES UNITS- > 600 VOLT NOMINAL:
Reconnect only,: _ _ SVC/FDR >= 225 AMP. —_ CLASS AHEWSPEC OCC: —
Owner: Contractor:
Y/-\RBR000H, DAVID S + CAROLYN J OWNER
13625 SVV LAUREN LANE
TIGARD, OR 97223
Phone: Phone:
Reg#:
_ FOES — Recluireti_Inspections
Type By Date Amount Receipt Elect'/ Service
Fr.<MT CTR 10/3/00 $93.60 2720000000( Elect'/ Final l
5PCT CTR 10/11/00 $7.49 2720000000(
Total $101.09
This PP,mit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laws
All w irk will be done in acoordance with approved plans This permit will expire if work is not started within 180 days of issuance,or if work is
suspended fa more than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are ser forth in OAR 952-091-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at(503)
246-1987 l
PERMITTEE'S SIGNATURE = ISSUED Y:
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 INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: __ _- �_ ___ _�— DATE:_____.____
LICENSE NO: - ---- - -- - --- ------- --
Call 639-4175 by 7:00pm for an inspection the next business day
electrical Permit Application
- nate received:/O-��a Permit no.: CL C -GD5
City of Tigard Project/appl.no.: Expiredate:
CrtyrijTignrd Address: 13125 SW I tall Illvrl,'I igard,OR 47221 Datcissued: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-19611 Case file no.: Payment type:
Land use approval:
1 &2 family dwelling or accessory U Coinn)ercial/indusirial U Multi-family U Tenant improvement
U New construction U Addition/aheratiun/i-eplacenicnl U Ocher: U Partial
JOB SITE INtORMATION
Job address: t ? _r;�; � 1 _ �, lildl. nr,.� Suite nu.: Tax map/tax lot/account no.:
Lot: Blcx k: Subdivision: _
Project name: Description and location of work on premises:4 X44% j IA-4 Po--)i
F.slitnalecl date of completion/inspection:
Fee
JuL no:
_ IkwcrictionhM,• (ra) Total d Iy
Business name: -,.j --- - New residential-single or mulls-fan fly per
Address: Z ;C', _ dwellingunit.Includes ntlachedgarege.
City: —rI ,- Stale:( Service Included:
Phow _5 Fax: E-mail: 1000 sq.ft.or less _- �-- _ - 4
CCB no.: Elec.bus.tic.no:
Each additional SIR)sq it.or portion thereof
�_-_--- l.imitedenergy,residential
2
City/metro lic.rl .: M ► Limiredenergy,non-residential 2
Fach manufactured home or modular dwelling
Signature of supervising electrician(required) Date _ __ Service and/or(ceder _ 2
Sup.elect.name(print): Liccusc[to, Services orfeeders-Installation,
alteration or relocation:
20t)amps or less
Name(print): �t ' , r h► tic 201 amps w 400 amps 2 _
401 amps to 600 amps 2
Mailing address: 13(ex5 i ► 601 amps to 1(x)0 amps _ 2 _
City: C Q u Sta(e,:I ZIP:Q�,2 j Over 1000 amps or volts 2
Phone:,T-5 Z Fax: /j/H E-mail: g Reconnect only
Owner installation:The installation is being made on pro rty I own Tempor-ry services or feeders-
which isnot intended for sale,lease,rens,or exchange according to
Insiallation,alterallou,or relocation:
200 amps or less
OILS 447,455,479,670,701. I __
p 201 amps to 4W 400 m ups
Owner's signature:
C. Date: 1 1' 401 to 61x)amps — — — -- —'
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: Stale: _ ZIP: _ B. Fee for branch circuits without purchase
-- - of service on feeder fee,first branch circuit: 2 _
Plume: FF-m
ax: ail: Fach additional branch circuit: _
Misr.(Service or feeder not Included►:
Cl Service over 225 amps-commercial UHcalth-care facility Eachpumpoiirrigatione'rcle_ _ 2
U Service over 120 amps-rating of 1&2 U Hazardous location Each sign or eudine lighting — 2
family dwellings U Building over 10,0(x)square feet fouror Signal circuit(s)or a limited energy Panel,
U System over 600 vnits nominal more residential units in one structure alteration,or extension* I 2__
U Buildingover three stories U Feeders,400anipsormoue +Description: ��—
U Occupant load over 99 persons U Manufactured sr•uctures or RV park Fitch additional Inspection over the allowable in any of the alcove:
U Egress/lightingplan U Othvr: _ _—_ Per inspection _-
Submit___sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
— � ��----
Not all Jurisdictions accept credit cards,please call)urisdictirm for mor infon"ation. Notice:This permit application Pcrniit fee.....................$
U Visa U MasterCard expires if a permit is not obtained Plan review(at _ rhe) $
Credit card number, �__L___. within 180 days alter it has been Slate surcharge(8%)....$
Expiresacceptedas complete. TOTAI. .......................$ _
Name or cardholder ass own on credit cord
S
lCardholder slgnsmrc Amount 440-4615(6Ax)K'OM)
--' --- TYPE OF WORK INVOLVED- RESIDENTIAL ONLY
4. Complete Fee Schedule ,Below:
Number of hhspections per Permit allowed Restricted Energy Fee........................................ :75.00
Service i(l luded: Items Cost Total (FOR ALL SYSTEMS)
4a. Residential-per unit Check Type of Wolk Involved
1000 sq It or les; _ $147.15 4
t_adr additional 510 sq ft of LJ Audio and Stereo Systems
portion thereof _ $33.40 _ - 1
limited F-nergy _ $75.00_ Burglar Alarm
I-adh Manufd Home or Modular
Dwelling Service or Feeder $90.90_ 2 � Garage Door Opener'
4b.Services or Feeders
Installation,alteration,or relocation p ���� n Heating,Ventilation and Air Conditioning System'
200 amps or less $80.30 U� _._--- 2
201 amps to 400 amps _ $106.85 2 Ll Vacuum Systems'
401 amps to 600 amps _ $160.60 7
Got amps to 1000 amps $240.60 _ 2 Other -
Over 1000 amps or volts $454.65 2
Reconnect only $617,85 2 TYPE OF WORK INVOLVED -COMMERCIAL.ONLY
dc.Temporary Services or Feeders
installation,al(eration,or relocation Fee for each system.......................................... $75.00
200 amps or less _ _ $66.85 2 (SEE OAR 918-260-260)
201 amps to 400 amps -__ $100.30 2
401 amps to 60o amps $133 75 2 Check Type of Work Involved.
Over 600 amps to 1000 volts,
see"b"above. Audio and Ste.eo Systems
4d.Branch Circuits
New,alteration or extension per panel L� Boiler Controls
a)The fee for brands circuits
with purchase of servic^or , Clock Systems
feeder fee.
I arIf branch circuit _ _ $6.65 �d ' _ 2 L] Data Telecommunication Installation
U)The fee for branch circuits
withouf purchase of service C] Fire Alarm Installation
or feeder fee.
First branch circuit - _ $46.85
Each additional brandh circuit $6.65 H'/AC
4e.Miscellaneous r] Instrumentation
(Service or feeder not IndudM)
I adr pump or Irrigation circle __ $53.40
ch -
l-asign or outline lighting $53.40 _ - LJ Wercom and Paging Systems
Signal circult(s)or a limited energy
panel,aperalion or extension $75.00 Lj Landscape Irrigation Control'
Minor Lobels(10) $125.170
Medial
4f.Each additional Inspection over
Ute allowable.In any of the above Cl Nurse Calls
Per Inspection $62.50
Per hour _-_ _ $132.50 _ _In Plant $73.75 _ (� Outdoor Landscape Lighting'
5. Fees: Prolective Signaling
6a.Lnler told of above fern $
8%Surcharge(0.} total lees) $ � � Other
Subfofal $
I tab.Enter 25%of line Ga for N umbel of Systems
Plan Review H requirM(Sec 31 $
Subtotal $ No licenses are required Licenses are required for all other Installations -
r`
FEES:
j Trust Account q -- - r
Total balance Due $ � T ENTER FEES
---------------- -- �_�_- 8% SURCHARGE(.08 X TOTAL ABOVE)
TOTAL $____-