13762 SW LIDEN DRIVE i
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210 [�I(iI7 MS Z91-£T
Code Enforcement Case # Cf0 q l_001.._
Received by: 4- 141-19 Date: /0 Time: /r
RECEIVED FROMr' --'
d!ZJO CITY OE TIGARD
/3 1
��ti d_ 5a y 3 98 OREGON
PROPERTY OWNER: _ �-
(site address) _ L,1
PARCEL #:
Map Page: 122-50 Bed
Fax Lot (s;.
DESCRIPTION OF ALLEGED VIOLATION: _
—�� ��•Ll%i�'W C',C'Z��cl-F' .i1-GGYLYL�.�'1.C�' �tZi�j/ti, �.Q,1
DATE OF VIOLATION 1 _�0�9� TIME OF VIOLATION:
The following information to be completed by Code Compliance OffiicerlCommunity Development
Type of Violation: 01(-41 Class of Violation: T
Compliance Deadline Date: Penalty ($/day):
Compliance Deadline Time: _ -- Misc. Fees:
Code Citation: Reviewed by: 1�l �n.. Final Disposition Date:
Municipals- Date: �r '/ /.
CDC -—` r 13 -�--
1�. 0q. 030
:?8 0 / �• iLIZQ C 2�Gt�, .
LSP ' k
.........................................................................................................................................................................
1 st Inspection: 0 3 Z 5 1 st Letter: fa de
2nd Inspection: 2nd Letter:
..................... .................................................................................................._.. ...
I\OMCOMPLANT DOG
13125 SW Hall Blvd., Ticgcrd, OR 97223 (503)639-4171 TDD (503)684-2772 _
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Nail Blvd., Tigard,OR 97223 (503)639.4171
CGR'C 1F 1CATEr OF
OC.C.-1PANC.Y
PERMIT #. . . . . . . : MST94-0o00
DATE ISSUF_D: 07/03/97
PARCEL: 29104BA—OS400
SITE ADDRE+SS. . . : 13762- SW L I DEN DR
SUBDIVISION. . . . e CASTLE HILL #r. Z ON I NG a R--25 Aft
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . e 119 jupisDic.TION:TIG
CLASS OF WORK. aNEW
TYPE" OF' USE. . . SF
TYPE OF CON5TR:51\1
OCL.UAANC:v GRP. :R3
OCCUPANCY LOAD:E
Remarks j PATH I
DON MOR I SSETTE
•;000 tiW MEODOWS RD
5,UIT 151
LACK 0c3WE^GO OR 97035
Phone #: 620--7533
L;ant--act or•: ---_...___.___.__. .
DON MOR I SSE TTT.-. 1-10ME ti
WOO SW MErADOW5 RD
FE 151
OKE OSWEr.N GR 9703 .,
iione #a c.:-_--75 38
Hist ce+^tificatp gr-ants ock:upancy of the above rpfer,enced building ov- portion
ipt-eof and confirms, that *',e building h. been in�pec_twd far compliance with
�+e �itate of Ov,egun E;pec:ia, ,:y Codas for, the grou jpanwy, anti use under
ir_t the ref r r�nc:ed perrrii w ►s xs9+.+ed.
l
__... . _ .._ . --____.__-_.......-.._.
iJILDINU INSPECTOR 61JIL_ NG OF ILIAL.
005T IN L ONSP I L:UGUS PL_ACF
CITU OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Phone: 639-4171
Date Requested,
. .-) 7-//-L� A.M. P.M. MST:
Location: to 2-
Tenant: BUP:--
Suite: 131d
MEC:
Contractor:------ PlionePLM:
Owner: ETC;_.
ELR;--
BUILDING SIT:
BLD (co
PLUMBING C
Site �A ELECTRICAL SITE
errntI)ostA Jeani I)os earn COVCT/Nervice
Footing Sewer/Storm
Roof I hidFl/Slab Rough-111 Ceiling Water Line
Slab Framing .1,op Out (Yas Line Rmigh-In UG Sprinkler
Foundation Insulation Sewer I 1rXxVi)1jCt Reconnect Vault
bsmt Damp Dr}vnll Storm hirnace Tem p Service misc.
A/C U
Masonry Ceiling Rain Drain G Slab
Shear/Sheath Fire S-pkir/Ahn Crawl/hound Dr I lent I'tifill) Low Volt
pprov- Approved
Appi/Sdwlk . .o%V( Approved Approved
of A) roved mit-ArrTr1r,
Not Appioved 'ed Not Approved Not Approved
AL FINAL 'INA FINAL
FINAL
0 Call for reinspection 0 Reinspection fee or$ required before next inspection 0 Unable to inspect
Inspector: Date: -7- Page--'2—Of
e'
Page No. i CABG HISTORY FOR CASE NO., MOT94-0400
DON MORIBBWM
13762 BN LIDRN DR
09/21/97
Action Description Req/ Schd/ and/ Action Note■ Dimp By rlpdate upd
Code sent Dona Done Date By
------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- ----'
MSTA007 Application received / / / / 10/20/94 FASB JF 10/21/94 BLT
MOTA010 Plan check deposit paid / / / / 10/21/94 PASS JF 10/21/94 DLT
MSTA020 Plan check by 10/21/94 / / 10/21/94 PASS RT 10/21/94 HLT
MOTA030 Check for prol. restrict. / / 10/21/94 10/21/94 PASS JLG 10/21/94 BLT
NOTA092 (F) Issue combination -ermit / / / / 11/16/94 PASS JLO 11/16/94 XB
-49TA125 PERMIT BXTHNSION REQURST / / / / 05/27/97 This permit should have expired, HOLD JMH 05/27/97 J*H
checking with David if lie wants new
fees, or to direct applicant to request
an inspection.
MSTA705 Foot/found Insp / / / / 11/22/94 #-1- extend electrical grouuling rod A/M XB 11/23/94 XR9
twelve inches above mud sill
#-2- expand ftg as shown Befit: j/e6
detail
#-3- excavate piers to lower level
adjacent to cut
MRTA710 Post/Beam Structural / / / / 12/06/94 PASS RB 12/06/94 RB
MSTA71n Poet/Beam Structural / / / / 12/05/94 #-1- no approved plans an site DIS 98 12/07/94 XB8
MOTA711 Post/Beam Mechanical / / / / .12/06/94 PSND'NG- SECURING PLENUM; VWX DUCT PABB RE 12/06/94 RE
cLBARA?-R To BARTH 4".
MBTA711 Port/Beam Mechanical / / / / 12/05/94 #-1- plans not m mite DIS XB 12/07/94 XBS
MSTA717 rLM/Underfloor / / / / 12/05/94 PASS M8 12/06/94 MRS
MSTA717 PLM/Underfloor / / / / 03/16/95 PASS MS 01/16/95 MRS
MSTA720 Mechanical Insp / / / / 02/13/95 PASS MS 02/13/95 MRS
MSTA720 Mechanical Inap / / / / 02/22/99 822 REPORT FAIL RB 02/24/95 RB
MOTA720 Mechanical Insp / / / / 03/06/95 see report PAIL RB 03/14/95 RB
MSTA120 Mechanical Insp / / / / 03/09/95 PASS RB 03/14/95 RB
MBTA722 Plumb Top Out / / / / 02/08/95 PASS MS 02/09/99 MRS
NSTA725 Framing Insp / / / / 02/22/95 SBE REPORT FAIL RB 02/24/95 RB
MOTA726 Framing <REINBP> / / / / 03/06/95 2 2x9 CBILIW. JOISTS OVER MBTR BD/BATH DIB 08 03/06/95 OBs
O^ER $PAN 13-1 MAX
#224 23 OF PREVIOUS INSP NOT DOME
MOTA726 Framing <REINSPs / / / / 07/08/95 see report FAIL RB 03/14/95 RB
MOTA726 Framing <PEINSPs / / / / 03/09/95 PASS RB 03/14/915 RB
NOTA735 Gas Line Insp / / / / 02/13/95 soffet heat ducts in garage FAIL M8 02/13/95 MRS
exhaust fgan■ need to be hooked up
floc coon too short
1
Page No. 2 CASE HISTORY FOR CASE NO., MST94-0400
DON MORISSE'rTE
1x762 SW 1JDF:N DR
06/27/97
Action Dencripticn Req/ Schd/ End j Act_iun NoL"s Diap By Update Upd
Code Sent Done Don" Date By
MRTA740 Insulation Insp / / / / 03/08/95 see report FAIL RB 03/14/95 RA
MSTA740 Insulation Insp / / / / 03/09/95 PARS RD 03/14/95 RB
MSTA745 Gyp Board Insp / / 7 / 03/13/95 #-1- not raedy DIS Ke 03/13/95 KBS
MSTA745 Gyp Board Inep / / / / 03/14/95 PASS RB 03/14/95 PH
MSTA745 Rain drain Inep / / / / 12/06/94 PASS MB 12/08/94 MRS
MSTA760 Water Line Insp j / / / 12/06/94 PAS.] MS 12/06/91, MRS
MSTA765 Appr/Sdwlk Insp / ! / / 03/26/95 1) Sawcut existing curb/gutter and dig PEND LT 04/07/95 JS
out for fu) lo^ depth.
2) Be prepared to protect finish.
MSTA770 Mise. Inspection / / / / 01/12/95 SHRAR- HOLD-DOWNS UNDER STAIR PLATFORM; FAIL RB 01!73/95 PH
C HALLS AT GARAGE WINGS- MST-37 STRAPS
REQ'D; SHEAR. BL0CK WING WALL.
MSTA710 Mier_, Inspection / / / 01/:8/95 SHEAR- HOLD-DOWNS NOT INSTALLED UNDER FAIL RB 01/16/95 RB
WINDING OF STAIRS
MSTA770 Minc. lnepecticn / ; / ! 01/25/95 SHEAR PASS RH 01/25/95 RB
MSTA790 Electrical Final / / / / 05/23/97 Wash- Co. #05063693 PASS MJP 05/27/9'7 J•H
repair landscape sprinkler control
This master permit ham expired bn�ause
of limitation. Aaking David if
this needs to be extended, or if new
feen need to be paid.-jeanh
MSTA795 Mechanical Final / / / / 07/03/97 PARS PA 07/06/97 J•H
MSTA795 Mechanical Final / / / / 05/15/97 GAPAGE/OFFICF: ONLY- nee building final PART PH 05/21/97 RB
this date
MSTA795 Mechanical Final 07/08/97 / / 07/02/97 see bldg final notes 070297/RB FAIL PH 07/08/97 J+H
M.STA797 Plumb Final / / / / 04/25/95 PASS MS 04/26/95 MRS
MSTA799 Building Final / / / / 05/13/97 electrical final FAIL, PH 05/28/97 RB
smoke detector
possible use- bedrm; several insuee
egress must be addreneed- window
installation
removal of combustion air from furnace
roan
smoke detector placement
Page No. 3 1ASE HTSTORY FOR CASE NO.: MST94-0400
DON MORISSE'3TE
13762 3N LIDb'.N DR
06/21/97
Action Description Req% Schd/ End/ Actium NoLen Dinp Hy Update Upd
Code Sent Done Done Date Hy
MSTA799 Building Final / j / / 05/15/97 OARAOE/OFFICE ONLY FAIL RB 05/21./97 RE
provide intent of room to be left w/o
conversion
tempered glazing adjacent to door
r
combustion air for furnace- not to be �
from bedrm
If bedrm- egrens req,d
if bedrm smoke detector
usa erosion
NOTE_ slab never received adeq+.iate
insulation perimeter type w/ vapor
barrier.
MSTA799 Building Final / / / / 07/03/9.1 PASS RB 07/06/97 J•H
MSTA799 Building Final 07/0t/97 / / 07/02/97 1. Main residence okay FAIL RB 07/06/9'1 J*H
2. Office space not to be used for
bedroom ties.
3. Change nt circuit breaker 60/80 to
either 40/40 (malt) or 30/30 (min) for AC
unit.
MSTA960 (F) Issue Cert. of Occupancy / / / / 07/03/97 mailed 8/21/97 JT 06/21/97 S+M
MSTB706 Erosion Control / / / / / / 10/21/94 HLT
MSTS713 crawl Drain / / / / / / 10/21/94 HLT
CITE' CSF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT r1fASTLR PILRMII
1'125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)639.4171 #. . . . . . . : ms'r'44 -1640(!
DATE ISSULD: 11/16/94
PARCEL: 2510413f2i-08400
SITE 13"t'6j- SW LIDEN DR
SUBDIVISION. . . . : UqSTLE HILL. #.R ZONING: R-12 PD
13LOCK. . . . . . . . . . .. LGI.. . . . . . . . . . . . . . I 11)
BUILDING
REISSUE: DWELI- ING UNITS: l BASEMENT. . . . . . . . :0 s
LLH6b OF WORK. :NEW BEDRMS:5 BATHS:3 GARAGE. . . . . . . . . . :4-62 S f
TYPE� OF . . . : :"F' FLUOR REQUIRED
TYPE OF CONST. :5N FIRST. . . . : 1280 S f LEFT. . : .10 ft RIGHT. :9 ft
OCCUPANLY GRP. :R3 SE(*-"(')IqD. . . : 1,380 SF FRONT. :1'20 ft REAR. . :414 ft
"'TUR I ES. . . . . . . :2
S FINBSMENT:0 S REOUI
HE I G1--1I . . . . . . . . r, D f-1; .1.0 1()L-- --:2C IS0 S f SMUKL DETECTOR','). -Y
F--LU(,JH LOAD. . . . E!8 psf VALUE.. . . . . f : 179513 r,l`4 R 1-0 N PACES. . : I
Remarks : PATH I
......... PLUM81NG
S 11141-115. . . . . . . . . . : I FLOOR DRAINS. . . . :i6 BACI-I\FLDW PREVNTRG. 1.
LAVATORIES. . . . . :3 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
1 UB/SHOWERS. . . . :3 LAUNDRY I-RAYS. . . :0 CATCH BAIZ)INS. . . . . . . .0
WATER CLOSETS— :3 SEWER LINE (ft ) . :O GREASE TRAPS. . . . . . . :0
D15HWASHERS. . . . : 1 WATER LINE (ft ) . : 100 OTHER F1 XTURES. :0
UPHBAGL D15p,. . . : I RAIN DRAIN (ft ) . :0
WA51AING MACH. . . : 1 SF RPIN DRAINS- 1
---.1-1.............. MECHANICAL FEES
E-ULL UNIT HTRS. . rO type i-Amol-Int by dai- - V-e(^pt
/GAS/ VENTS . . . . . s0 BPRT s 633. 00 KS 11,e . 6/94 --
MAX INrDUT-0 BTU VENT FANS. . :4 BP1.J t 411. 45 JF1 10/20/94 94-215199 1
FURN ( 100K . . :121 HOODS. . . . . . : 1 B5PC * 31. br-i KS 11/16/94 ---
FURN ) -100K . . . I W 0 0 1)S I'D V E S. :0 S50C i. c.180. 00 KS I I/ 16/94
FLUOR FURN. . . . ..0 ILO DRYERS.: I PARK $ 500. 00 KS I I/16/94
b0I1-/CMP ( 3HP-0 OTHER UNITS: 1 MPIRT $ 45. 00 KS 11 / 16/94
GAS OUTLETS): I MPL-C $ i I. t:-'5 KS 11/16/94
1. 1 /16/94
DUN MORIBBL71L 3BIH $ 225. 00 KE; 11/16/94
bftilb SW MEADOW,.; RD P 5 P C $ 1 1. ='5 KS 11/ 16/94
' I
I I 1::,1 E ROS $ 64. 00 KS 11/16/0)4
I-ACK (J,')WLGU OR 970:-'��5 ERPC s .-,-,0. B0 F;:3 11/ 16/04
Phone #- ERP(" $ 20. 80 KS 11 /16/94
U()ntt-ACtot': --_.._.__._ _._.... . __._._._______..._.__ ___ ___TIF $ 1550. 0Q) K5 ll/16/94
DUN MUR I b(nE I f L HOMES
"-)11100 �3W MEADOWS RD
'nU I IE 151
I-AKL OGWE*GO OR 97035
Phone #: baO-7538
Req 35533
$ ;I606. 45 lOTAL
This Pvsit is issued subject to the regulations REOUIREb INSPECTIONS
hoard Muricioai Code. State of Ore. Sipecilt aii of er Foot/fol.md Insp Fireplace Insp
applicable laws. All work will be done in _'r;ance W1 a oved Post/Beam Str-.lct Gas Line Insp
pians. This persit will expire if wo- not starte "it r 180 Post/Eleam Meehan Insi.tiation Insp
days of issuance, or if woTri: :'1"sW P fir mor Plm/�indsizib Insp Gyp Board Inso
PA dAys,
d
t, I-P FILM/Un d e r,F I a o FREiin di-air) Insp
lylecti'mlical 1115P WAtev Litie Insp
Pl�imb Top Diat "ppt,''Sdwlk Insp
.............
11)".imirig Insp
639-4175)
CITY OF TIGARD SEWER CON14ECTION
IDERhi IT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . .
13125 SW Hall Blvd.Tigard,Oregon 9722390109 (503j631111-4171 DATE ISSUED: 11/16/94
PIARCEL : 2,6104BA-06400
51TE ADDRESS. . . : 13762 SW LIDEN DR
SUBDIVISION. . . . : CASTLE HILL #2 ZONING: R-12 PID
BLOCK. . . . . . . . . . . L0*1 . . . . . . . . . . . . . 1 P)
rENANT NAME:. . . . . .
USA NO. . . . . . . . . . : FIXTURE UNITS. . .
CLASS OF WOFRI-',. . . :NEW DWELL ING UN I T5. . - I
I YPE OF USE. . . . . :SF NO. OF BUILDINGS: 1
INSI ALL TYPIE. . . . :BL)SWIR IMPERV SURFACE. . : S f
Hemar-Hc, .- PAIH I
Oil FEES
DON MORISSETTE type amoil by date 1'ecpt
5000 SW MEADOWS RD PRMT $ 2,�-*00. 00 KS 11/16/94
'3UIT 151 INSP $ 35. 00 K5 11/16/94
L.(4KL OSWEGO OR 97035
i=1-lone #: bi.10-7538
(An';ractor—
GONTRACT-OR NOT ON FILE
'I 10 Tie # "2235. 00 TOTAL
R e q
pp-OU IRET) INSPECTIONS
fhis Applicant agrees to comply with all the rules and regulations Seller, liispec.-i: icin
of the Un;fied Sewage Aqancy. The permit expires IN days from
the bate Issued. The totil amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accur of the
he sewer is not ' led at
side sewer laterals, If t located asurem
given, the installer prospect ' fleet in'Al Irectiors fr
the distance given. If not so "ca ed, the i st ler Oail pu , se
a "Tap and S)de Sewer" Per:jt and t A cy w 11 inst ;3teral.
y
L) Call foi, irisq)ec:tion 639-4175
'►�`f� I tires C`-'-� .
f
Residential Buildina Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, on 97223 ( � ��L I y, f��t�
(503) 639-4171 V ' I l m
U
I
Jobslte Add ��ress: �� IaG '
11�� Office Use Only
Subdivlalon:C.C'�le" it I Lot# +
p Planck/Rec#
Valuation: —
Permit # '� y �y
Owner: �-A t `, kn Y-I )L-_A-1C Reissue of _
Address: � ) e-�V��' �Y 1 Map& TL# r!,516 4 tY`l UU
Approvals Ac uirpd
Phone:
Planning
C'
Contractor: �t"E 6� � �. �,l ?�' � Engineering
Address: -- Other
Phone Items Required
,+ ..
�r9,- 1 �7"�Y _� -_
Suix;c.,ntractors_
Contractor's License #
__..(attadt copy of current Oregon license) Truss Details
Subcontractors: Y (pI ' o Other
Plumbing:
Mechanical: \
(attach copy o,current OR Coniractor's Li nse)
ArchltectlEngineer: \ 14"L4
1
Address:
Phone: -
COMMENTS: --
)L
Applicant Signature & Phone number
Received by: Date Received:
Permit # Account Description Amount Amt. Pd. Bal. Due
U10d "Idg. Permit (BUILD) ✓l�,.i�_�� (y Yj',
Plumb. Permit (PLUP,113) 111-212,w s12S ••=v
Mech. Permit (MECH) L� j_• y�� -
State Tay. (TAX) �/ �— - y j-t�.
Bldg: 3/ .
Plumb: //•'i- t� v
Mech: 2.7 ,r ✓
Plan Check (PLANCK) 2.71, /72 ,
Bldg: //. N
Plumb:
Mech:
U 5%_S Sewer Connection (SWUSA)
Sewer Inspection (SWINSP) 31 3�
Parks Dev Charge (PKSDC) ✓ 5 S��'
Storm Drainage Chg (SUSDC)
Residential TIF (TIF-R) L 1� U L 2710
Mass Transit TIF (TIF-MT) 0
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS) _
Office TIF (TIF-0)
Wai-n ' ( ) 1 '
U)4 f1zc A -----
Water Quantity (We"A T) ;;!-ekD
C. c,�.r 1 / C C ._
Fire District (f4gf�y 4V �D'�D
TOTALS:
DEFAFITMENT OF LAND USE&TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION
155 NORTH FIRST,HILLSBORO,OR 97124
COUNTY, INSPIcCTION REQUESTS: 503/640-3561/693-4415
OREGON AXXXXXXXX-- b4U-.14 /U
Page 1 of 1
Date U2/1U/1'1)
'Time 1U : b8
c-lermi.t 'Type Resiaential Electrical Permit Permit # VbU638 13
eovrmit Status APPRUVEU Applied U2/1U/9_
:.�1tu:s AtAdress 1j /b2 SW LIUEN UR '1'I Issued 02/1U/95
r4--unit 'Title : bh'H - NEW HUME bERVICE Completed
vo-L .11t Uescr. 1'o Expire 08/U9/9b
E'ru sect l'it.le bk'R - Nt:' HUME SERVICE Project # P004'/499
1•'1 u lect Uescr .. * EROSION
earcel Numtyer 251.1,1 - Land Use District
valuation 0
Liegal Uescr ,
Uwner 1NaPEC'1'IUN - 'ri( ARD Construction U'1'H
Applicant Name Cl'1'Y ELEC'1'RIC Classification 900
Applicant Addr . : 10014 SW CANYON KU Occupancy R3
PUR'L'LANU UN 9122b Validated by MJ r'
Applicant Phone : X92-9664 inspector Area
epe description Units t'ee/Unit Ext fee Data
- ---------------------------------------------------------------------------
c,quare k''ootage L Enter Sq . t't , 3000 21 U , U
z,ut.,tot.al Electrical tees : 210 . 00
State Lurcharge of bi 1U . 50
'.total `Electrical tees : 2LU . bu
tees ees Required Fees Collected & Credits ***
Method Check # Receipt No. Date Payment
CK 1588b 02/10/9b 22U . 50
1'01'AL 'THIS DATE ********* '120 . bo
Fees : 12U . bU
i .1 lustments : . U 'Vot-,al Credits ., 0
Total tees : 220 . bU 'Total Payments : 22U . SU
balance Uue : . Uu
NOTICE: This permit becomes null and void It the work or construction for which It Is Issued Is not commenced 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 permit Is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
,ipon false And misleading Information may Invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will he compiled 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 ou`hority to access private property ur to use easements. i further acknowledge that the use or occupancy of
the structure or building permitted dependt upon my calling for Inspertlons r*.various times during the process of construction and the building
Inspection staff verifying compliance with the various codes. Use or o,.cup-ncy 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 occupancy Is revocable until all Inspection requirements are satisfied and
approval Is given by the Building Official. I further acknuwledge that a lien may be placed on the title of the proplRty upon which the permit la Issued
specifying that the use or occupancy of the building or structure Is provielonel and revocable until the"faction of all Ins tJon requirements
u
LICANT'S SIl3N URE
WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
Electrical Inspection Section
155 North First Avenue, #350-12 APPLICATION
Hillsboro, Oregon 97124
Information: 503 640-3470 Fax: 503 693-1412 Project/Permit,-
PRINTPLEASE
Number -- -=-)- `O - `� -- Date 2-ID =cf
Pleas
• • • •
4, C -+replete Fee Schedule below
i. Locai::, n of installation-J -Lr �>',,
Address L.3740 _ SLk.L 1 n k • Number of Inspections per permit allowed
�� Building Service included: Items Cost(ea.) Sum
City ASuite No.
Tenant Name A. Residential -per unit
(if commercial) _ 1000 sq.ft.or less $1 10.00 Q Q�� _ 4
Each additional 500 sq ft
Tax Lot— Map No. -- or portion thereof _ $25 on QUO OL)
Limited Energy _ $25.00 1
Thomas Map Book: Page:_. Dr ��S eetlon:_ Each Manuf'd Home or Modular
Directions_- __ _ _ _.. _ Dwelling Service or Fetader $68.00 2 .
B. Services or Feeders
Commercial Cj Residential Installation,alterations or relocation
200 amps or less $60.00 — - 2
201 amps to 400 amps $80.00 ___ ____ 2
2a. Contractor installation only. 401 amps to 600 amps $120.00 — 2
Electrical Contractor 0�} i A Pr')'7 P __- 601 amps to 1000 amprt - — $180.00 — - 2
Address 1)0 j y S la._r_C Over 1000 amps or volts $340 00 2
Date_L�-�-
'— Job N mbar _ Reconnect only _.__ $5000 2
Property Owner - C. Temporary Services or Feeders
Contractor's License No. 42.( a8>i CJ
Contractor's Board Reg. No. i-1.3.y vZ�� Installation. or lesion or relocation
200 amps or less ______ $50.00 -- '?
_9 -. 201 amps to 400 amps $75.00 2
Signature of Supr. Elec' 401 amps to 600 amps $100.00 r._ 2
License No.351,2,5 °hone No. _meq - Over 600 amps to 1000 volts see'B'above
2b. For owner installations: D. Branch Circuits
New,alteration or extension per panel
1''nt wn�- s Ramo — --�e-�-- --- a) The fee for branch circuits with
purchase of serv/ce or feeder lee.
Aacire s Each branch circuit _— $5.00 2
b) The'ee for branch circuits without
- — --- - -i�
Stnto---- �
---- - purchase of service or feeder fee.
First branch circuit $35,00 _ 2
The installation is being made on property 1 own Each add'nl branch circuit $5.00 _ 2
which is not intended for sale, lease or rent. E. Miscellaneous (Service or Feeder not included)
Each pump or Irrigation circle $40.00 _ 2
Owner's Signature —_ __. ____- Each sign or outline lighting $40.00 _ 2
Signal circuit(s)or a limited
3. Plan Review section (if roquired) energy pane;,alteration
PleAse check appropriate Rein and enter fee In section 5B. or extension __- $4000 _ 2
1 & 2 family dwellings over 320 amps s/c meter F. Each additional inspection over the allowable
4 or more residential units in one structure its any p the above
Per inspection $35.00 _
Service over 225 amps; feeder 400 amps or more Per hour ___ $55.00
System over 600 volts nominal In Plant $55.00
Building over 3 stories In height
_ Building over 10,000 sq. ft. 5. Fees
Occupant load over 99 persons A. Enter total of above fees $ '
Manufactured Structures Park or Recreational 5% Surcharge (,05 X total fees) $
Vehicle Park; new, addition or alteration Subtotal $
_ Classified area or structure containing special B. Enter 25% of line A for
occupancy as described in N.E.C. Chapter 5 Plan Review if required (Section 3) $
Submit 2 sets of plans with application where any of the Subtotal
above apply. Not required for temporary constrt.Ictiort
Less Bulk Label Fee $
services. Balance Due $ �
2,01
For Inspections call This permit becomes null and void It the work suthort[ed by the permii Is not cor-rmsecod
640-3561 or 693-4415 wflhin 90 days from data of issuance of such permit or H the work authorired Is
suspended or abandoned d any time after work Is commenced for a period of 1.0 days
24-hour recorder,one working day In advance of need Electrical Permits ars non refundable and non tnnsfrrablw
5/93