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CITY OF TIGARD
DEVELOPMENT SERVICES
M:mp-4% 13125 SW Hog Blvd.,Tigard,OR 97223 (503)6394171
issuer; s,:bjert tG thp
.Clpal 'ode, state of lkt, 6pprialtv "Ops ar 6'.1
i... viii mrF ihi 1. be acne in acrvcwF t-i
4t y•7g of Issuanu., 01 if wv,: is
FINT i pirF!
JCN; Cj-ejor, 'filk y,e
ortgon i,tillity Notification Ceiter. Y'o!E a,r.-
9"Z-ml Ole nagh 00 3CJL- ew Ra
V+-4.#
CITY OF TIGARD Plumbing Applica+ion Recd By-r(T]t`�' �Ya/
13125 SW HALL BLVD. Commercial and Residential Date Recd I
TIGARD, OR 97223 Date to P E
Date to D
(503) 639•-4171 Permit#E �h
Print or Type Related SWR
Incorr plete or illegible applications will not be accepted Called_— _
Name of Development/Project —----- FIXTURES (Individual) QTY PRICE AMT
Job
Sink 900
_
Address Street Address Q Suite Lavatory 900
1<6(,) 54V CrQikl/ttTub or TubrShower Comb 900
Bldg# Citylstate Zip Shower Only 900
�+Y �f 7�� Water Closet 9.00 -
Name Dishwater 900
e Garbage Disposal � 9 00
Owiier Marlin Addresrq I Swte
�, 1 j/) 1 �:r 1'�A Washing Machine 900
City/State Z�ip� Phone��ne Floor Drain 2" 900
-- i71) 1)K —!!, r / 3' 900
Name --
4'• 9 00
Occupant Mailing Address Suite Nater Heater 900
Laundry Room Tray 900
CtyiStale Zip Phone Urinal 900
---- — — --
NaOther Fixtures(Specify) 900
m —
1 lam-rc 900
Contractor Mailing Address Suite 960
?&-10 S il A 4
— 900
CityrState Zip Phone - 9 00 T
C NN10Q yrcoo, . - o/-� --
Oregon Const Cont Board Lic# Exp CAte _ 9.00 -�
Attach Copy of GQ1000 7 - 3c'- 9 C0
Current Plumbing Lic # Exp i we Sewer- 1st 100" 9 00
Licenses Sewer-each additional 100'
COT BUST ess Tax or Metrc r Exp Date
-_--- mi fU �� L/Q- ,9_q8 Water Service- t st 100' 2
Name - I Water �rvice.each additional 200' 30(.0
Architect Storm S Rain Drain-1st 100' — 25 00
or Mailing Address Suite Storm&Rain Drain-each additional 100' 30 00
Mobile Horne Space 25 00
Engineer City/State Zip Phone Commercial Sack Flow Prevention Device or Anti- 2500
Pollution Device
Describe work New O Addition O Alteration O Repair O Residential Backflo v Prevention Device' 1500
to be done Residential O Non-residential O Any Trap r Waste Not Connected to a Fixture 900
Additional description of work Catch Basin 900
if p U 1 ifInsp of Existing Plumbing 4000 —�
per hr
Existing use of t Specially Requested Inspections — 40 0
p
building or property-
---- — Rain Drain,single family dwelling 3000
Proposed use of Grease Traps 900
building or property_____
_ QUANTITY TOTAL Y�
Isometric or diagram required if Quanit
Are you capping any fixtures Yrs❑ No r ris_ g _ y Tolai�s >9
I hereby'Acknowledge that I have lead this application that the information 'SUBTOTAL
S,0 U
given ,corp..,That I am a owner or authorized agent of the owner and
that �ibmitled are romphance w Oregon Slate Laws 54o SURCHARGE _
�norrAgiiinj Date
PlJ4xt REVIEW s> OF SUBTOTAL -
Requrte_d only d fixture qty total a>_9
Contact Person Name Phone TOTAL
'Minimum permit fee is S25+5%surcha ;e,except Residential Backflow
i ldstsiplmapp doc 8196 — Prevention Device which is$15*5%sur-harge
l
CITU OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Linc: 6394175 Business Phone 6394171
Date Requested: Zr /L 1 MST:
Location:
BUR _
Tenant: Suite:_-- BIdB: _ MEC:
2
Contractor: r – —
.— Phone: -Q Ci PLM: !q
(htmer:` ]'hone: ELC:
_ ELR:
BUILDING BLDG con't PLUMBING -- -- – SIT:
� � MECHANICAL ELECTRICAL SITE
Site Post/Beatn Post/Beam Post/Bearn Cover/Service Sem Lr/Stonn
Footing Roof UndFI/Slab Rough-In
Slab Framing Top Out Gas Line Cehling Water Line
Rough-In UG Sprinkler
Foundation Insulation � Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storni Furnace Temp Service MISC
Masonry Ceiling Rain Thain A!C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Heat Pump Low Volt
Approvedcm
' Approved Approved Approved
Appr/Sdwlk Not Approved Rim lova! Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL
C]Call for rein. ction O Reinspection fee of S_ r,^yuired befo next inspection O Unable to inspect
i
Inspector._ __` [ate: �� Page__�of_J—
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST
�BUP -2-
Date
Date Requested ��1 / -I AM PM BLD
Location �a U C,cz-C�YL.� Suite _ _ MEC
Contact Person :J Ph PLM
Contractor Ph SWR
BUILDING _ Tenant/Owner ELC
Retaining Wall 'ELR _
Footing Access:
FoundationFPS
Fig Drain
Crawl Drain RR SCCN _
Slab toot Requested
Post 8 Beam SIT
---
Found
Ext Sheath/Shear DuringRcsc;u ch
Int Sheath/Shear No In%nertion(sl In hila
Framing
Insulation
Drywall Nailing ---
Firewall
Fire Sprinkler
Fire Alarm
p'd Ceiling
r oo
Fin
ASS) PART_ FAIL
WING
LIV
Post& Beam —
Under Slab
Top Out —
Water Service C�
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post 8 Beam '✓�
Rough In
Gas Line ---
Smoke Dampers
Final -- _
PASS PART FAIL
ELECTRICAL --
Service
Rough In —
UG/Slab
Low Voltage
Fire Alarm
Final 9 -
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line C J Please call for reinspection RE:— [ J Unable to Inspect-no access
ADA
Approach/Sidewalk I /L�C1
D01ate ate _ Inspector JAExt
Final __ _—
PASS PART FAIL DO NOT REMOVE this inspection record from the ;ob site.
CITY OF TIGA14D
DEVELOPMENT SERVICES BUILDING PERMIT
�1J1='��13 .r��..ars•
' 13125 SW Hall 8W., T19F►d,OR 97223 (503)639.4171 DATE:. ISSUED: 06/IS/98
PARCEL. O.S11OCA 13 01,",-`
;i ADDRESS. . . : 11SW CROWN OR
-)t1BDTVISTC)N. . . . : KING CITY CONDO. l BOG #AXr ZONING:
rCV.. . . . . . .. I OT. . . . . . . . . . . . . .001 TIJpI1_rrr.rION:NIM
I aUt F'1.,Uf)F2 ArtE00— _ _.._ r_NIE_RTOR WRi_L CON5TRUC1"ION
" !_ASS n WORK. :OTR FIP9T. . . . : 0 5if N: Ss F: Wo
1"•(F''F OF U13F". . . :Mr- !.)f-:7COND. . . : 0 sf' PROTECT
TYr'rn r n-NI 7'. :150 . . . : 0 5 f' Ni 9 E: W:
ar_.CLIPANCY or4r. :R3 TOTAL.- ---- - 0 S f ROO1�- (.1ONST: FIRE RET'?:
IrCtJr°ANCY t. DAG): cI I1AC;E:MINT. : 0 S f AREA SEP. Rl1TED
`iTOR. : 0 HT r 0 ft GARAGE". . . : 0 sf OCC U SEP. RATC:I:l:
7-1SMT" : ME=77"1 : RE GlD SE=TEIACK^- _..._.._•__.._ .. RCG11-11 RF D __ .__.___.___...___..
"L_OnR LOAD. . 1•rsf t.F:FT: 0 ft RG 1T. 0 f-` FT 9P1-/,L . C01OR DET. .
DWELLING UNITS: V1 FRNT: o ft; REAR: 0 f-f; FIR ALRM: HNDICP ACCs
VDRMa: 0 BPI'! 143: Vi IMP SURFACE: 1"r PP' '11 CORR: F nHK T NG: 0
'JAI_UE. 544A
, Replace existing roof material w Class A Owens Co-ning. Tear Off.
LIS square feet of rorf vents.
rCCINTr ER GROUP type i4mnt.int by rJ,,Atc r-re(-1.-.)'.
314 ► SE: HAWTHURNE:: r'RMT s 1tl 6. 90 GFO O6/18 /9S 98-306649
1''OR7'_AND E�Fi '37 1 + ',r'C'T ?. 831 GED 061113!`• 8 98 :3106649
Ph rr n e! #: 239- 0015
I NTERSTATF Rr-WIF=I NG
1'�1506!5SW7� 74TI! ME
T T TART) OR 97PP31
."'hone #: G84 5611 t S'3. .33 TOTAL.
Rt?11 fit. i Qr0171r`i5t4
.._.F?EPLIIRF D Ar:TTONS o'r' INSPECTIONS---
--tis permit is issued subject to the regulation,- contained in the f i nrAl lrrgpar.t i nrr
Tigard Municipal Code, State of Oro. Specialty Codes and all other
applicable laws. All work wil' be done in ar.rnrdance with
spproved plans. This permit will expire if work is not started
within 188 days of issuance, or, if work is suspended for more �___ __y___�_�__•_�__. __�.._..._ _ _____.__
than 148 days. ATTENTION; Oregon law req+vires ynu to fellow the
rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-8814818 through OAR 952-We '0 ......
You many obtain a copy of these rr:les or direct qu-stiors to ______�_._-• ___ _ .
by calling (513)246-1987.
mi tJep Sigrat.,11-eaa,� ukt
} ++-+- +-+•1 —+ + +++++++•+ 4 F4--+•}-F•h+ ++•x•1-•4•+.++.+++-4-+4-+. J,-+++4—:-++++4. 4_1 .y.l-.{. ,
I , r n f, i -7r--, .• -y..k IT r, n r 4 r_+r~f r r r-r r.a. .a +1 n .,r } a 1,- , ••., . r
� : +
TY OF TIGARD Recd By:
125 SJV HALL BLVD Date Rec'd:_
GARD OR 97223 RE-ROOFING PERMIT APPLICATION Date-j PE: -
50:: 539-4171 X304 Incomplete or illegible applications will not be acc 3pted "Oats to DST:
503-664-7297 Permit# Se
Caned:
Name of Development/Business STEP Z. NEW ROC{FINer;ASSEMBLY
A 7 L'0,AJ11 Material Documentation(UBC Appendix
Street Address Ste# Please fill out applicable section and attach copy of roofing
Job Site i/_'G,G ScYi C"'w specifications.
Bldg# City/State zip Listed Assembly (-Circle&Complete A,B or C)
� IA16 C'e7- 71z V �—
Name A Specification# _ ey 5
Owner Mailing Address 2. Manufacti:,er: ((fes ;'.S �i;JR
Gity/S to Zip Phone 3a UI.Classification:
,r10, .2yq e1Dils
NsM& , Listed UI. Building Materials Directory Page#:
�sf�cc8 r4. CO (OR) -
Rooting Mailing Address 0 4 3b Warnock Hersey _ l
Contractor /-s 06 S S� 7� ---
Pnor to issuance City/ ate Zip. Listed Warnock Hersey Directory Page#:
applicant must / � 72Zy' (PROVIDE COPY OF ASSEMBLY
)rovide a copy of Phone# Fax#
all contractor r b q 5-!o /i G3� joS B. ICBO Research
licenses if State Constr.Contr. Board# Exp.Date
.xpired in COT S,S ;%i/'i'i DATED:
da'abase) COT Bus Tax or Matro Lac# Exp.Date (PROVIDE COPY OF ASSEMBLY) -�
WILDING INFORMATION C SPECIAL.PURPOSE ROOFING: WOOD SHAKES'
uilding -Type Of Use (circle ore) ('review required by plans examiner)
SF SFA COM
uildin Type of Construction; —(SMF y _
g- YP VALU/rT10N OF t'ROJECT $ ec-,
,54/x/ '
;fisting Deck Type: Permit fee based on valuation'
Combustible ) Non-Combustible ( ) ` see chart on back i
.ESIDENT1AL ONLY- lass of work:Alteration City _ enhyS4 r,—_, wAc
—� 0i _ _
o:
1 REPAIR (MAJOR) 4- <)(BUILD) I (UBUILD) 6 -5-6
Permit required ONLY when spaced sheathing is covered by --�'
solid sheathing. 5% State Surcharge $ ?
City use only W CO
51EWI. THREE f31-5ETS OF PLANS SPECIFYING. (TAX)_ i (UTAX)
A Roof area&nearest street.
_ 65% Plan_ Review $
B. Attic vents-Provide sq. ft. for each 150 sq. ft of attic City use only: WACO- -�
space&vents shall be located in the upper 1/3 of the roof. (BLIPPLN) _ (UBUPLN)
Provide 1 sq. ft. for each 300 sq. ft, when eaves& attic --
--_ TOTAL $ - 3
rEP 1. M COMMERCIAL ONLY - I acknowledge that I have read this application and that the
-ass of work: APoeratfon
ascribe work to be done. (check appropriate box) information given is correct; that I am the owner or authorized
I RE-ROOF (circle A,B or C) agent of the owner, and that the plans (if applicable) are in
A. Existing built-up roof covering to be REMOVED and deck compliance with Oregon State_law _
repaired- Signature of Ownerl""'19W Date
B. Existing built-up roof covering to REMAIN: note applicant
must submit an engineer's review of the roof structural ��
elements. Review shall bear the seal(or stamp) of the
architect or engineer licensed in Oregon Contact Peet lame Telephone
C. Asphalt o- wood shingle/shake
30OF1 DOC(dsts)
(PROCEED 70 STEP 2)
CLDLQf TIGARD
BUILU_INC-EkNI(I1EE S
TOTAL
PLAN STATE BUILDING
VALUATION OF PERMIT F.L.S. REVIEW AX PERMIT
PROJECT FEES (41 %) (65%) (5%) FEES
1-1500 25.00 10.00 16.25 1.25 52.50
1,501-1600 26.50 10.60 1723 1.13 5;i.Ob
1,601-1,700 28.00 11.20 18.20 1.40 58.80
1,701-1,800 29.50 11.80 19.18 1.48 61.96
1,801-1,900 31.00 12.40 20.15 1.55 6510
1,901-2,000 32.50 13.00 21.13 1.63 6 8.26
2,001-3,000 38.50 15.40 25.03 1.93 80.86
3,001-4,000 44.50 17.80 28.93 2.23 93.46
4,001-5,000 50.50 20.20 32.83 2.53 106.06
5,001-6,000 56.50 22.60 36.73 2.83 118.66
6,001-7,000 62.50 25.00 40.63 3.13 "31.25
7,001-8,000 68.50 27.40 44.53 3.43 143.86
8,001-9,000 74.50 29.80 48.43 3.73 156.46
9,001-10,000 80.50 32.20 52.33 4.03 169.06
10,001-11,000 86.50 34.60 56.23 4.33 181.66
11,001-12,000 92.50 37.00 60.13 4 f)3 194.26
12,001-13,000 98.50 39.40 64.03 4.93 .'06.86
13,001-14,000 104.50 41.80 67.93 5. 219.46
14,001-15,000 110.50 44.20 7183 5.53 232.06
15,001-16,000 116.50 46.60 75.73 5.83 2.14.66
16,001-17,000 122.50 4900 79.63 6.13 257.26
17,001-18,000 128.50 51 40 83.53 6.43 269.86 I
18,001-19,000 134.50 53.80 87.43 6.73 282.46
19,001-2.0,000 140.50 5620 91.33 7.03 295.06
20.001-2.1,000 146.50 58.60 95.23 7.33 307.66
21,001-22,000 152.50 61 .00 99.13 7.63 320.26,
22,001-23,000 158.50 63.40 103.03 7.93 332.86
23,001-24,000 164.50 65.80 106.93 8.2.3 345.46
24,001-25,00(170.50 68.20 110.83 8 53 358.06
2 5,00 i-26,000 175.00 70.00 113.75 8.75 367.50
25,001-27,000 179.50 71.80 116.68 898 376.96
27,001-28,000 184.00 33 60 119.60 9.20 38640
28,001-29,000 188.50 75.40 122.53 9.43 ?95.86
29,001-30,000 193.00 77.20 12.5.45 965 405.30
30,001-31,000 197.50 79.00 128.38 9.88 414.'76
31,001-32,000 202.00 80.80 131.30 10.10 424.20
32,001-33,000 206.50 82.60 134.23 10.33 43366
33,001-34,000 211.00 84.40 137.15 10.55 443.10
34.001-35,000 215.50 86.20 140.08 10.78 452.56
35,001-36,000 22C.00 88.00 143.00 11.00 462.00
36,001-37,000 224.50 89.80 145.93 11.23 47146
37,001-38,000 229.00 91.60 148.85 11.45 X80.90
1 ROOF DOC(dsts)
CITY' ^(�F T I G wH R D — ELECTRICAL PERMIT
T PERMIT#: ELC2003-00126
DEVELOPMENT SERVICES DATE ISSUED: 3/12/03
13125 ,143 W Hall Blvd • Tigard• OR 97223 (503) 639-4171 PARCEL: 2S110CA-KCG07
SITE ADDRESL -60 SW CROWN DR#7
SUBDIVISION- r,,,jG CITY CONDO. BLDG#803 ZONING:
BLOCK: I OT : 001 JURISDICTION: K/ti3 �' r 7Y
Project Description: Electrical reconnect.
RESIDENTIAL UNIT _ TEMP_SRVCIFEEDERS 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 HM/S'✓C I FDR: 601+amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDFR BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st WIO 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: 1— SVC/FDR—225 AMPS:_ _ CLASS AREA/SPEC OCC:^ _
Owner: Contractor:
HOMEOWNER'S PSSC
11560 SW CROWN DRIVE#7
KING CITY,OR 97224
Phone: Phone:
Reg #:
_
FEES
Description
- --
Description Date Amount
Required Inspections
I I.I'RMT] ELCI'crmu 3 17 113 $66.85 — -- ^ ._--
I'AK1 8%State Tax 3�12 W $5.36 Flect'I Final
Total $72.20
This Permit is issued subject to the regulations contained in the TigarJ 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 K York is suspended
for more thq 184-days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Car Those rules are set
forth in R"952-001 dT I", rough OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)24P-6699 or
1-8032-2344, \
Isa ed By: ' Permit Signature:
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 CIF SUPR. ELEC'N. _ DATE:— _
LICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next Business day
Electrical Permit Application Received � r� ` e , Electnea,
`"-—— -- -- Date/By: l p Q Permit No.: &1A
City of Tigard
1 card Planning Approval Sign
Date/By: _ Permit No.:
13125 SW Hall Blvd. Plan Review other
Tigard,Oregon 97223 Date/By: Permit No:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
lei
_
Internet: www.ci.tigard.or.us —Date/By: Case No.:Contact - See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method _ Supplemental Information.
_ TYPE OF WORK PLAN REVIEW Please check all that anPiy)New construction — Demolition Service aver 225 amps- LJ Hcalth-care facility
commercial ❑Hazardous location
❑ Addition/alteration/rep
laccrnentU Other: ❑Sr rvice over 320 amps-rating of ❑Building over 10,000 square feel,
CATEGORY OF CONSTRJCTION 1 &2 family dwellings tour or more residential units in
1 &2-Family dwelling I_❑ Commercial/Industrial ❑System over 600 volts nominal one structure
kccesso Hufldin Multi-multi [I Building over three stories Feeders,400 amps or more
�.—.— __— � __— ❑Occupant load over 99 persons ❑Manufactured structures or RV park
Master Builder Other: ❑Egress/lighting plan ❑Other:
JOB SITE INFORMATION and LOCATION Submit—_sets of plans with any of the above.
The above are not applicable to temporary construction service. _
Job site address: �� $ r ,1 6X= FEE*SCHLDULE_
Suite#: I Hld ./A t.#' — Number of Ins ections per permit allowed
Project Name: Deseri"tion Qly. Fee(ea.) I Total
--
Cross street/Directions to New resident hd-single or multi-family per
Job site: dwelling unit.Includes attached garage.
Service included:
1000 sq.Il.or less _ _ 145.15 4
Loch additional 500 sq.fl.or portion thereof� 33.40 I
Subdivision' _ — Lot#: Limited ener ,residential _ 75.00 2
Limited energy,nun residential 75.00 2
Tax ma / creel #: _ Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
-' -- Services or feeders-Installation,
altcratlon or relocation:
200 am s ur Ie�s 80.30 2
�.__-_.--.------------ -_ -- -- 201 am s to 400 ams 106.85 2
_ 401 zm s to 600 ams 160.60 2
PROPERTY OWNER Y _ TENANT _ 60 ^mps to 1000 amps _ 240.60 2
— Over 1000 amps or volts 454.65 2
1'4anic: �,-; - -- - - _ `r'Lel a i Reconnec,only -- 66.85 17-- 1
Address: f it // `c-d f if t {.,J r`j Tcmporary services or feeders-Installation.
alteration,or relocation:
City/State/Zip: t \ _ �l r"i y/ >'�� 200 amps or less GG.R6 1
Phone: ; - Fax: 201 amps to 400 ams - 100.30 2
APPLICA T J CONTACT► ^vi. 401 to 600 ams 113.75 2
-- — Branch circuits-new,alteration,or
Name: extension per panel:
Address: --_ A.Fee for branch circuits with purchase of
servir:or feeder fee,each branch circuit 6.65 2
City/State/Zip: B.Fee for branch circuits without purchase ei
service or feeder fee,first branch circuit 4b.85 2
Phone: _ Fax: Each additional branch circuit 6.65 2
E-mail: _ — Misc.(Service or feeder not included):
"TOR Each p rnp or ir.igation circle 513.40 2
Job No: Each sign or ou:line lighting _ 53.40 2
Signal circuit(s)or a limited energy panel,
Business Name: alteration,or extension _ _ Poe 2 2
- -- --
Address: Description:
Cit /State/Zl : _ F,ach additional Inspection over the allowable In any of the above: _
Per inspection per hour(min I hour 62.50
7#
Phone: Investigation fbe:
—" Other:
:
CCH Lic. #: Lic_ Electrical Permit?ees*
Supervising electrician Subtotal_ S
si ature required: _ Plan Review(25°x;of Permit Fee) $—r(ff '
Print Name: Ll C. #: State Surchar a 8%of Permit Fee S -- _
TOTAL,PERMIT FEE S
7,A So-
Authorized Notice: This permit application expires if a permit Is no:obtained within
Signature: —, Date: -- 190 days after It has been accepted as cumplete,
*Fee methodology set by Tri-County Building Industry Service Board
(Please pHnt name)
is\Dsts\Permit Forms\ElcPerrrnApp.doc 01 x03 4. 1 jL� ��� 'SL
Electrical Permit Application - City of'Figard
Page 2 - Supplemental Information
LIMITED ENERGY PERAUT FEES:
RESIDEN'T'IAL WORK ONLY:
Fee for all systems.......................................................... 175.00
Check Type of Work Involved:
.'udio and Stereo Systems*
Burglar Alurm
t inralte Door Opener*
F1H-ating,Ventilation and Air Conditioning System*
EJVacuum Systems*
O, ci --
COMMERCIAL WORK ONLY:
Fee for ad system.......................................................... $75.00
(SEE OAR 911-260.260)
Cluck Type of Work Invoked:
E] Audio and Stereo Systems
Boiler Controls
Clock Systems
Data Telecnmmonication Installation
E] Fire Alarm Installation
HVAC
Instnimen'ation
Intercom and Paging Systems
Landscape Irrigation C'omrol*
Magical
Nurse Calls
Outdoor landscape Lighting*
Protective Signaling
Other— -------- ---- ----
Number of Systems
* No licenses are required. Licenses are rettuired for all
other Inslrllations
iADsts\Pcrmit Fnrms\E1cPermitAppPg2.doc 01/03
CITY OF TIGARU 24-Hour
BUILDING
BUILDING Inspection Line: (503) 639-4175
INSPECTION DIVISION Business Line: (503) 639-4171
BLIP
Received Date Requested .. -13 _ AM PM — BLIP
Location 1� ��'l� _.�_ —Suite� MEC
Contact Person 921._-- .__ Ph(---) (�a1 `"(.Sq _ P--M
Contractor_ --__ Ph( ) - SWR
BUILDING Tenant/Owner _ ELC
Footing
Founuation Access: ELC
Ftg Drain ! I -C Rbu/iv _ ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear _.-
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler --- - --
Fire Alarm
Susp'd Ceiling --
Roof
Other:
Final -
PASS__PART FAIL
PLUMBING
Post 8 Beam -----
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains -
Catch Basin/Manhole
Storm Drain
-- -
Shower Pan
Other: - ------- - -
Final �—
ASS_ PART FAIL
MECHANICAL
Post& Beam
Rough-In --
Gas Line --- -
Smoke Dampers -
Final -
PASS PART FAIL - - - --
ELECTRICAL
Service — - ---- - --
Rough-In
UG/Slab %- -- ---- -
Low Voltage
Fir rm
�� 1 Rein required before next Ina on fee of$—�
nvis Pl.qT FAIL �� s - pection. Pay at .:ity Hall, 13125 SW Hall Blvd.
SITE Please call for reinspect. i RE: — [J Unable to inspect-no access
Fire Supply Line
ADA
I r
Approach/Sidewalk Daus _'" J 3 " _ Inspector - Ext
Other: _
Final DO NCT REMOVE this Inspection record rom the Job sate.
LPA�SS_PA!L AIL