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21ill-3-1603) 284.6806 FILE NO.
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NOTICE: IF THE PRINT ORTYPE ONANYTI '� � I � � II � II � � I � I � II II � I11 � IIIIiII IIIII�T ��r��. T ' Ii�T� fII 111 111 I I III III III III III 111 111 I I III ( III I�7 "I�1 1 � TlI 1II I T III ,]fill -Ill II-_1 111 111 111111 111 111 1111111
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IT IS DUE TO THE QUALITY OF THE � - No.36
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14115 Sa CH&HALEM CT _
CITY QF TI6A RD
COMMUNITY DEVELOPMENT DISPARTMENT o PLUMBING PERMIT
13125 SW HWI Olvd. P.O.Box 23307,TOW.O"Poon 97223(6W)6394175 PERMIT #. . . . . . . i PLM92-0186
639-4171 DATE ISSUED: 11/17/92
LITE ADDRESS. . . 4///!)-,.57&j 111AZ C41 PARCELI0BB .-
SUBDIVISIUN. . . . ZONING( . 4 ------)
BLOCK. . . . . . . . . . : LUT. . . . . . . . . . . . . a
--------------------------------- ------ ---
( LASS OF WORK. . iADD GARBAGE DISPOSALS. . : MOBILE HOME SPACES. : ----
TYPE OF USE. . . . :SF WASHING MACH . . . . . . .. BACKFLOW PRFVNTRS. . : t
OCCUPANCY GRP. . sR3 FLOOR DRAINS. . . . . . . : TRAPS. . . . . . . . . . . . . . .
STORIES. . . . . . . . : WATER HEATERS. . . . . . : CATCH BASINS. . . . . . . :
LAUNDRY TRAYS. . . . . . : SF RAIN DRAINS. . . . . :
SINKS. . . . . . . . . . . URINALS. . . . . . . . . . . . : GREASE TRAPS. . . . . . . .
LAVATORIES. . . . . : OTHER FIXTURES. . . . . :
TUB/SHOWERS....: SEWER LINE (ft) . . . . a
WATER CLOSETS. . : WATER LINE (ft) . . . . s
DISHWASHERS. . . . : RAIN DRAIN (ft) . . . . v
Remarks : INSTALL BACKFLOW DEVICE IN PUBLIC RIGHT—OF—WAY AT CASTLE HILL
SUBDIVISION. LOCATED AT CORNER OF SW WALNUT & NORTHVIEW, ADJACENT TO WATER METE. �
Uwnero -- ----------------------------------------------------- FEES
MATRIX DEVELOPMENT type amount by date rpt.:pt:
7160 SW HAZELFERN RD PRMT $ -25. 00 JH 11/17/92
5PCT $ 1. 25 JH 11/17/92
TIGARD OR 97224
Phone 0i
Contractors
ABEL IRRIGATION
4242 SW PRIMROSE ST
PORTLAND OR ---------------------------.___--___-._-.
Phone #c $ 26. 25 TOTAL
Reg #. . s 5569 REQUIRED INSPECTIONS ------
This permit is issued subject to the regulations contained in the Top—out Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applirable laws. All work will be done in accordance with
approved plans. This permit w0 expire if work it riot started
within 188 days of issuance, or if work is suspended for more
than 180 days.
P e r ni i t t e e S i g n a t u r e
Issued By
—
Call for inspection 639-4175
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13126 SW Hall Blvd.Tigard,Oregon 97223.6199 (503)630-4171
i
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tlpud,Oregon 97223.8199 (503)839.4171
I
t�
11
�j-tr(�! ,3,usw,,,uotid. PLNCK/RECT HCITY OF 1 1tJ� „-"�� 5 ��I.3 - �'_..._
COMMUNITY DEVELOPMENT DuARTMENT To r4Oregon97M PERMIT q ff) O 3( 0
(503)639-4171 DATE ISSUED
JOB ADDRESS: _ J /,' C ci "ti,► _ TAX MAP/LOT A S l U y!3G—D S'a✓
SUB: C ST C= A-//[/ LOT: /0 LAND USE:
VALUATION:
OWNER SPECIAL NOTES
NAME: Nl 4-4 &JJ Z,4�? 10 t y /C REISSUE OF: V115��13-0 1 o J
ADDRESS: /� �q Sw -01M 0S7;770EY -w12LAST REISSUE:
I F-,4L)6- U%J FLOOD PLAIN/
PHONE: �/ SENSITIVE LAND:
CONTRACTOR ^ APPROVALS REQUIRED Srj g 9D -ovoc/
NAME: 3.4 j2/C' � �'�' �4,2 gC-Fy r7t S PLANNING: St=r, ils�SD�A -bAC
ADDRESS: ENGINEERING:
FIRE DEPT: _
PHONE: � ✓ �' �/ — OTHER: 'Novi'of I)ONeNE.R QQ PAY 71f —
CONTR. BOARD #: -4 4 J' EXP DATE:
ITEMS REQUIRED
SUBCONTRACTORS: PLU.Mfi: UC .� !:� �`� lr' +' 'f <.�'' LIST/SUBCONTRACTORS:
MECH: y�,��[-- 1.,� , _?�ti °+ BUS TAX: _
ARCH/ENGINEER CALCULATIONS:
NAME: /4/ 4'U TRUSS DETAILS:
ADDRESS: 1'r ` -' 2 3 { v OTHER:
PHONE:
PROPOSED BLDG. USE: F S'�d e- 7 Sw ldr�-
COMMENTS:
APPLICANT SIGNA
Received By: Da Le Received:
PERMIT # ACti # DESCRIPTION AMOUNT / AMOUNT PD. BAL. DUE
17)yt 5�u 10-432 00 Building Permit Fees ,
10-431 00 Plumbing Permit Fees /Z
10-431 01 Mechanical Permit Fees U• >-v -y
10-230 01 State Building Tax (5%) _ 6, y� � 3
Building .4L.(>>'
Plumbing l �
Mechanical
10-433 00 Plans Check Fee .0 i 3 �Q /U• y
i
Building u
Plumbing _
Mechanical ,I L i3
10-230 06 Fire
fw11 -±0 30-202 00 Sewer Connection
30-444 00 Sewer Inspection 3 J""
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Dev Charge (PDC) S v 0
31-450 00 Storm Drainage Syst De. Chrg
(SSDC) /' ty
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of) —
TOTAL
I
nm/3587P.WPF
CITE( CF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Bivd., Tigard,OR 97223(503)639.4171
t_ERTIFICATE OF'
OCCUPANCY
FE RM I T M. . .
GATE. ISSUED: OS/04/97
I'l litC : 51049B-05700
ITE F�DUIIEfiCi. . . 14115 SW (':tif�l-if�tl_Et+1 �:T
'I'D I V I S I ON. . . . : CASTL.E:. MIA. /ON I N(-'t i R--.?!5 PI)
OCK. . . . . . . . . . LOT. . . . . . . , . . , ,. . :011h JURISD I CTIONol"IG
ASS OF- WORK. :NEW
PE�E: OF USE. . . e SF
T,E OF CONSTR.-5N
C'If'ANCY UPP. :R3
f-UPANCY LOAD e 1
mo r ti 3 t PATH I
,Here .. ._. _. _ _......__.._.. . ...__.__._.._. _.. - -. _ ..
NNE TIA k 1111.U
1 J Tj SW CNE.HAI._T-M CT
Vhone #:
TP 1 • COUNT'Y' TEMP CONT ROL_
SE AMBLER RD
( t_ACIIIAMAS OR 97015
f'Itr1110 11: 65-4-31,115
Itaat� *. . : 0007.:'6
I!r.i
Certificate grants nc.c.U. 1 )r,cy of the Above rpferenr..eci bt..)i ldiny or ptTr t 1 •
' t ,:-rerjf And confirms that thw ht_r . idiny has bt-tin inspected for (7omCili.ance
Ma"tp Of ter
Oregon iait,
&1 F r Code!;
for the grotaF,, or..r_t.)Ftt•ancy, unci t.trfl c�n�IF•,
1) the r-pi-erenr._d permit
i,
f
L1J1il_ .1 IT;PAC C T ttl '=',i_If�► :
POST IN CON�3P I C UO Jy F't_Fjh L
CITY OF TIGARD MASTER PERMIT
DEVELOPMENT SERVICES PERMIT #. . . . . . . : MST97-0171
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 06/27/97
PARCEL: 2S1.04BB-05700
..I TE: ADDRES5. . . . 14115 SW CHLHALEM CT
SIABDIVISION. . . . :CASTLE HILL_ ZONTNG: R-25 PD
TA 1..0CF!. . . . . . . . . . LOT. . . . . . . . . . . . .. :0t0 JURISDICTION: TIG
Remarks: Addition to SFD PATH I
------------------------------------------------------------- BUILDING ----------------------------------------------------------_--
REISSUE: STORIES.......: 1 FLOOR AREAS---- ---- BASPIENT...: 0 sf REQUIRED SETBACKS---- REQUIRED-----------
CLASS OF WORK.:ADD HEIGHT........: 12 FIRST....: 168 sf GARAGE.....: 0 sf LEFT..........; 0 SMOKE DETECTRS:
TYPE OF USE....-SF FLOOR LOAD....: 40 SECOND...; 0 sf FRONT.........: 0 PARKIN SPACES: 0
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT........,: 13
OCCUPANCY GRP.:R3 BDRM: 0 BATH: 0 TOTAL------: 168 sf VALUE..f: 11239 REAR..........: 0
-------------------------------------------------------------- PLUMBING -------------------------------------------------------------
SINKS.........: 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....; 0 DISHINASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0
TUB/SHOVERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 8 BCKFLW PREVNTR: 0 GREASE TRAPS..: 9
OTHER FIXTURES: 0
•----------------------------------------------------------- MECHANICAL ----------------------------------------------------------------
J.L TYPES---------- rURN 100K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 0 CLOTHES DRYERS: 0
GAS TUPM -100V ..: 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0
MAX INP.; 0 BTU FLOOR FURWCES: 0 VENTS.........: 1 WOODSTOVES....: 0 64 OUTLETS...: 0
-_ .--------------------------------------------------------- ELECTRICAL ------------------------------------------------
RF:SIDENTIAL UNIT--- ----SERVICE/FEEDER----- —TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS-
1000 SF OR LESS: 0 0 - 200 amp..: 0 0 - 200 amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 8 PER INSPECTION: 0
FA ADD'L 508SF.: 0 201 - 400 amp..: 0 201 - 400 amp..: 0 let W/O SVC/FDR: I SIGN/OUT LIN LT: 0 PER HOUR......: 0
i-IMI TED ENERGY.: 0 401 - 600 amp..: 0 401. - 600 amp..: 0 EA ADDL BR C1R: 0 SIGNAL/PANEL...: 0 IN PLANT......: 0
MANP HM/SVC/FDR: 0 601 - ION amp.: 0 SQ++,.ps-1080 v: 0 MINOR LABEL -10: 0
1080+ amp/volt.: 0 --------------------------------- PLAN REVIEW SECTION ---------------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.! ) 680 V NOMINAL: CLS AICA/SPC OCC-
--------- ------- ELECTRICAL - RESTRICTED ENERGY ----------------------------------------------------
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL-----------------------------------------------------—-------------------
AUDIO X STEPEO.: VACUUM SYSTEM..: AUDIO I STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: :: BOILER.........: HVAC...........; LANDSCAPE/IRRI6: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR:
HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL 0 SYSTEMS: 0
Owner: -----------------------------------Contractor: ----------------------------- TOTAL FEES:t 303.16
KEN HOLTON ARSE HOMES/MLADEN BARICEVIC This permit is subject to the regulations contained in the
14115 SW CHEHALEM CT PO BOX 284 Tigard Municipal Code, State of Ore. Specialty Codes and all
TIGARD OR PORTLAND OR 97207 other applicable laws. All work will be done in accordance
with approved plans. This permit will expire if work is
'hone is Phone t: 227-2231 not started within 180 days of issuance, or if the work is
Rag L)..: 888786 suspended for more than 188 days. ATTENTION: Oregon law
-------._--------------------------- requires you io folliw rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-881-0010 through OAR 952-081-0888. You may obtain copies of these rules at,
direct questions to OUNC by calling (583)246-1987.
---- ----- REQUIRED INSPECTIONS ---------------------------------------------------- -
Erosion Contol Crawl Drain Shear Wall Insp Electrical Final
"acting Insp Mechanical Insp Low Voltagt Mechanical Final _
Goundation Insp Electrical Servi Insulation Insp Building Final
Post/Beam Struc -, Electrical Rough Gyp Board Insp
Post/Beam Lan taming Ins Rain drain InspIssr.red Permittee Signat�_+re: �0�++++++ +++ + f++++++++ + +++++++++++++++++++++++++++++++ ++++++i- -+a + + r
Call 639-41.75 by 5:00 p. m. for an inspection neeaed the next business day
=11 ' F TIGARD Plan Check
Residential Building Permit Application Recd By
O —
3125 SW HALLBLVD. New Construction Additions or Alterations nate Recd -15-;k; y:;?
rIGARU, OR 97223 Single Family Detached or Attached (Duplex) once to P E
r 503-639-4171 Oats to OST 0
503-684-7297 Permit s �i� Cr/�/
Print or Type calved E
Incomplete or illegible applications will not be accopted 11
Name of Prolect '- Name
Job
Address Site Address TrGac4 Architect Mailing Addres
/9 I/S S .moi C+/FN►)C E r7 C.i
Name citylstate Zip Phone
C F A/ HUL7V AJ
Owner Madiog Address Name
CrtyrstateZipph
p one Engineer Mailing Address
lr..jNlGi) 11 J r>'fJJc ?,
Nanta City/State Zip Phone
General r�R Ir Heti S
Describe work New O Addit9on O Alteration O Repair O
contractor
Mailing Address to be done:
r- A f,'V, 12i 9 Additional Description of Work:
City/State ZIP Phone
r'L142r7q ia�� `.7 �J.. t -12 ) -L23r f`x l t,ZL�: �_
Oregon Const.Cont,Board Lrc.0 Exp.Da
Mach Copy of - 145- 1'7 -
Current COT B mess syr or Metro N Exp. PROJECT 1
Licenses �Y 1+ �'-- VALUATION $ 11 ,�s79
Name _
Mechanical CIA -L NEW CONSTRUCTION ONLY:
Sub- Mailing Address Sq. Ft. House: !r 4-6 Sq. FL Garage
Contractor
C.ryrState Zip Phone '"-
Comor Lot YES NO Flag Lot YES O
k .ne) (check one)
Oreyon Const Cont. E�oord Lrc.11 Exp,nay Restn d Audio/Stereo u lar
-iach copy or ! ,l (; Energy \ System Ala_
Current COT Business Tax or Metro 411 �xp. Uats Installabon — Garage Door HVAC
Licenses Name --1 Opener Systems
Plumbing (check all that r
9 app )
Sub_ Marling Address Will the electrical subcon,taftor Nn or all YES NO
Contractor restricted energy ins tions
GryrState Zip phone Nes the Sucdivis Plat recorded? N/ YES NO i
( Oregon Const Cont Board tic.# I Exp. Date Reissu MST# Solar Compliance \
attach Copy oY
Current P umning Lrc. x Exp Cate (Calculation Attached)
Licenses I I hearty acknowledge that I have read this application, that the
COT Business Ta: dr Metro r information given is correct, that I am the owner or authorized
iA— � p mate agent of the owner, and that plans submitted are in compliance
Name with Oregon State laws.
Signa)t}lt7!of ner/Ag t Date
Electrical OW 1J ��� —�_ N / ' L ec
Sub- Maung Address Contact Person Natoli Phone e
.ontractor
C-ry/State -^- z;p— phone - FOR OFFICE_USf NLY_:
_ _ Plat 9. � � ; Map/TL#:
Oregon Const Cont. Board Lrc.* I Exp. Date
ach Copy of �J
Setbacks: I
-urrent CIQC.rtCal L,c #— FXp Date - (It, I' if'
ne: ,.?i.-, � Solar
_menses __ _ L.
Engtn erfh9�proV1�lli' P!an rng ipproval: TIF:
COT Business Tar or Metro a Exp. Date k
-- -
iAdfa0p.doc(dst) 1/97
r
t
Permit# Account DescnpIl
8[II!?S1III Amt- Pd- B�C�
_ MST. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELC/ELR Permit (ELPRMT)
z
State Tax (TA,X) •�� �,
Bldg: 1�`, ,• _
Plumb:
Mech:
ELC/ELR: �
Plan Check
MST: (BUPPLN) 61)0 . --
Plumb: (PLMPLN)
Mech: (MECPLN)
CDC Review (LANDUS) c
— Sewer Connection (SWUSA)
Reimbursement District ( )
Sewer Inspection (SWINSP)
Parks Dev Charge (PK(,DC)
Residential TIF (TIF-R)
Mass Transit TIF (TIFF-MT)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT)
Erosion Planck/USA (ERPLAN) �" 4
Erosion Planck/COT (EROSN)
Fire Life Safety (FLS)
-""i i:*W0.0oc ON) 11197
7 ' C'17
Address: 1(111 SU-) CkE,4 '1H C .
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can tie issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
bill in the appropriate blanks and initial boxes I and 2, aaad either box 3A or 313:
I
ot I I own, reside in, or will reside in the completed structure.
I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
❑ 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. 1 will be my own general contractor.
If 1 hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If 1 change my mind and hire a general contractor, i will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
1 hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about C nstruction Responsibilities on the reverse side of this form.
(Signature of permit applicant) (Dat
(White cope to issuing agent_v permit.lile,
pink copy to applicant)
I 1
I nformation Notice to Property Owners
About Construction Responsibilities
EMPLOYER RESPON`IBILITlk .'13;
1 ,,, �tlr„�f�ti,`t�1.1•. I�It+' .�a(Irl��rn�+ltyyer;ytlt�rrirl�t�tlhNt7tl�ii�� 'fh'xev-fw'�tfti+l�Pty°}� ;,,,,• „ ,,,•, �_ ,I,1,,
1 t'l f t I, Iltl, for thd 6t1 PJY0i ftt14,lr*Vdi ift,,Wddhl*U0i11V'WftlR'.)td;the tax Ill I,t t o"I, 1 ,tir::
I lent I'f It'evbnW at,945•8091,
1 ,• „illi,,, � ,_ . .1 .I.� ,,ti ,
1001 i(f �,�( Iii. 1 li,'.rl.a- i I"h;,.�11, 'ili i lit i,nw .i! l.it:
1�t11'�i1'f'` ('�1111[, � , r'• ,;r _ i � .,t.t
III'• 1Vi,rkk
Illttrilial IltoI111H S('I Ili..
I60t Ibt the,ta)c payrnev c' ,n
:it f •SIN?-�t21-1[hti1.
LATHER RESPONSIBILITIES AND AREAS OF CONCERN-
('1►a9ccornplia.11c(•r �,,�lilrl>; irnllt �•!,, ;hl. hl:,, i, , n:l:;'r.'�,lll�r,',1►,I,. ,
Owl ill;ir h_. hroilight to vntit o0c'Ittll'n thilim.!II In�•li', till,',
,iabilit;, and prupet•ty damage insurallim Collul:.1 ;cu11 I11"m all,(c agolit It ,4c Ft Y,�u havv adcyuette i.115UI;Ill c
16 lit, 1116 ollwo,itttl, "UCh a`. 1C111111g It-sols, paill1 t,�t'i�11!;!1, '�'-al"I I11i11 age Irk III 171It" It!lil,IllrcS;, Elft. Lit ;.-11'h ! I'q
I ;fill' It, i"4' I'llihltrll'a""! V.11. _ .,l ._1 , _ . I . . la
I'vPertiom- tt
%'fil,lrim,rlrl'!1PTll/.1.111 l('iliT ttCn(ifYllltll`1yI' 'll'r,ll'llf!'1l'!'�! ti!,lrlill,.rli
til :1
I", .-nd Ifo ivoli!V h11,1(Illlli (,Iti("I114 ;`wl thl' '.Ilthftlltf lt114'lltrit`, so Ih. (illi 11Nrlftl'lll the w(jillr,'ll Ilii;r?,'ti(ill'..
It;1,.c .ltl(hoolullytt:.",lw(1'., N!!tt' tI- t'.III tll; t , II,I!ilk,ilk It TioatclQ)k) 13;1ic 11141), Sale.m.OR9'13;l l
T'lle N1 ' Imi: 301, 111 Salem
11ioll PITA
1 IU
Electrical Permit Application AbIr—OFFICE USE ONLY
City of tigard ;;�;�'�,� LJ Penmt N-FLDO. UD `o
,r
1 3125 SW Ilall Blvd,Tigard,OR 97223 flan Rcue„ Other Pertnn
Phone 503 639 4171 1-us 503 598 1960 Dale It,.
Inspection I-me 503,639-1115 Dale Read,H, Iw, 0 See page 2 lar
hitcrllct wsvw c1 tigard or us :uul d Method_ Supplemental I-durntatiun__
TYPE OF WORD. PLAN REVIEW _
F1 Nety construction ❑ Addition alteration replacement PleLise`heck all that apps)
❑Scrvlce o%cr 225 amps.comni'I ❑Ituturdtn.IuCa uun
❑ Demolition ❑Other ❑Scl'vlce mer 3211 amps rating 171%11 ldl.li otet III oro Ny It
CATEGORY OF CONSTRUCTION of I-and 2-tantlly d,velhngs 4 or rune net, Iesidew a.
❑ I-and 2-family dwelling E)Commercial industrial ❑ Accessory building
❑Svstcnl ocrl(dn)volts nummai nnit,til one siructurc
❑Budding user three stones ❑I rrdcl,.100 amps or mule
❑ Multi-family ❑Master builder ❑Other: ❑0ceupant loud otcr 99 persons ❑�l.tIllllactured>uucuocs t
JOB SITE INFORMATION AND LOCATION []Egress lighting plan R� palk
so— L�y� calth-cure fuctluy ❑U!hcr ___ .-- - - .
.lob no.: Job site uddres. K/ 7//(/ uhnlli�,sob nl plulls,utll a11V ulthe ah.ttc
C'Ily Stale ZIP The uhntc Lire nm
nut applieuble to tupu'lur\eonn seri L
stluctioc
FEE' SCHEDULE
r Sulte/01(ag%apt.no.. Project name_ �- nr,trgtu t,t QN. Frr j lural
Cross street/directtons to Job site: Nett reddential simile-or multi-rarriM dttellinll unit.
--- Includes attached uaral;e.
1,1111(1 S4 ItuI less 145 15 1
Subdivision _ _-- Lot no.:
Eu udd'I 500 sq Il or portion 33 41) I
— -
Limited energy,residential 75.00
Tax map/parcel no.: Limited energy.nun-resldenoul 75 00 2
DESCRIPTION OF WORK _ Mach mvlufaclurcd Lir modular
_ d,tcilulg,scat Ice and or(ceder a 90 90 ----- '
5emIce%or feeders ImIallullon,alteration•andior relucullou
i
--r ,
1' 200 umps Lir less _ I SU 30 b;
201 umps to 400 anlp5 11)(1 95
❑ PROPERTY OWNER ❑ TF.NAN1' _ 401 amps In 664 amps 16000 ,
Name: 6ul amps to 1,.)(10 amps
Address: 0%cr bona umps Lir Colts 454,05
Ret.uonect only 66 85
CltviStatet'ZIP: Temporary services or feeders installation,alteration.ood(or
�- relocation
Phone:( ) Fax 1 ► _ 200 amps Lir less 66.85 Fl
Owner Installation:This installation is being made on property that I own 11 hr:h 1<nol 201 umps to 400 amps I(St 311
Intended for sale,lease,rent•or exchange,according to ORS 447,449,670,anti a 4o umps to 6011)amps 1!3'5
Owner signature: _ __Dalc:_ _ __ Branch circuits-nett,alteration.or extension,per panel
❑
APPLICANT _-- ❑ CONTACT PERSON A Fcc for brunch circuits wth
service Lir lecdcr fec,each e
CDN'_�0 CO2t� 6
Business name: )r �hnlq brunch t:u•curt
ll Fre fur brunch circuits
Contact name: C(/a ✓ ) onhow service Lir lecdcr ice. 4685 '
each branch circuit
Address. � Jw uic ky ' r Each add'I branch circuit 6 65
City/State.iZlP. �^ETZ �1 I U k). rJ 3 ) Miscellaneous(sc, ice or re',tier not included) '
Fax: :1�i) ► Pump Lir irrlgatior,,mole 53 40
Phone:l ,N)('70 q Z Z C °J ��+Q �(�,� Sign or outline hghung
E-mail. S'L:nal circulllsl or limited-
CONTRACTOR 1OR
encrgy punct,alteration.or
extension Uexrihr I Page 2
Business name. �14ME �✓� I I 1— _
Each additional inspection oter allottahle in ant orthe ahme
Address: v Per Inspcc!um — 1`2>t'
City State ZIP. _ Imcstiganon per hour(I hr nun)
Industrial plant per hour -3
Phone:I ) Fax.l ) J-1
—�-- ELECTRICAL PERMIT FEES,
CCB Lic :(v 3 l Electrical Lic.: _y 3y.U� 5upry 1.1c 44,255 tiubu'L,: 93 (,moo -•_
1
r' Supra Electrician signature,required Plan trtlett 12- tit prrnn!!cc,
�1 state surcharge IS",,tit permrtice
) /�,�f
Print name Date I -
i-
TOT L PFRMIT FF F. /0/, ()
.-kuthorned signature chit permit application etpirei if a permit is not nhtained„ilhiu Ino
-- dart after it hat hren accepted at complete
i Print name- Datefee.nK!hrd„b,eN:ct I,% i n.t nuns,Hutldnlg In,lu.tn amu.tie
••\anther of urpet urn.per!,encu all,tt cJ
i nuddmit Permits rt.t'Pom-t App Jcc I.r' 44 +,,151,1 :C0%1 tt 111
Electrical Permit Application - City of Tigard
Page 2 •• Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for_all residential systems combined........ ►75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for ich commercial system....................... $75.00
ISLE ' AR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems \
❑ Boilcr Controls ,
❑ 0ock Systems
❑ Data Telecomir-inication Installation
❑ Fire Alarm Installation
❑ 1-IVA;'
❑ instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
n. .l-nq Permm r:LC.Pei mmlArp d,k a n�
tt
CITY OF TIGARD ELECI RICAL PERMIT
DEVELOPMENT SERVICES
PERMIT#: E -00226
DATE ISSUED: 5/33/2004/2004
13125 SW Hall Blvd., Ticiard, OR 97223 (503) 639-4171 PARCEL: 2S104BB-05700
SITE ADDRESS: 14115 SW CHEHALEM CT
SUBDIVISION: CASTLE HILL ZONING: R-25
BLOCK: LOT : 010 JURISDICTION: TIG
Project Description: 125A service with 2 circuit breakers.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADO'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITEL`ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANE' HM/SVC/rlji:. 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W/SERVICE OR FEEDER: PER INSPECTION:
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: -4 RES UNITS_ >600 VOLT NOMINAL:
Reconnect only: SVC/FDR>=225 AMPS: CLASS AREAISPEC OCC:
Owner: Contractor:
GUTHRIE,JOHN R TRUSTEE ENVIRONMENTAL CONI ROL CORP
14115 SW CHE.HALEM CT 7606 SW BRIDGEPORT ROAD
TIGARD,OR 97223 PORTLAND, OR 97224
Phone: Phone: 620-4228
Reg#: LIC 04"'-A
FEES Sl�P aa';ti
Description Date Amount
Required Inspections
1 I LPRMTJ GLc'Pcrmu < t �nu�I $93.60 - — - --
I'AX 8%State Surcharge i 'nna $7,48 Rough-in
— Elect'I Service
Total 1101.08 Elect'I Final
This Permit is issued snblect to the regulations contained in the Tgard 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 if work is
suspended for 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 952-001-0010 through OAR 952-001-0100 You may obtain copies of these rules or direct questions to OUNC at 1503)
246.6699 or 1-800-331-2344 1�
Issued By: Permit Signature: -
_ OWNER INSTALLATION ONLY /
1 he installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: A^ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:-.
LICENSE NO:
Call 639-4175 by 7:OOpm for an inspection the next business day
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE RECEIVED
ENVIRONMENTAL CONTROL CORP. 1004
7606 SW BRIDGEPORT ROAD LI1 r OF t luAHL)
PORTLAND, OR 97224 BUILDING DIVISION
Electrical Signature Farm
Permit #: ELC2004-00226
Date Iss!,ed. 5/3/2004
Parcel: 2S104BB-05700
Site AdOress: 14115 SW CHEHALEM CT
Subdivision: CASTLE HILL
Block: Lot: 010
Jurisdiction. TIG
Zoning: R-25
Remarks: 125A service with 2 circuit breakers.
Your company has been indicated as the electrical contractor for the )ermit indicated above. In order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual frorn your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN Building Division.
No electrical inspections will be authorized until this completed form is receiv ed
OWNER: ELECTRI;;
CITY OF TIGARD 24-Hour
BUILDING Inspection Ling 13)639-4175
INSPECTION DIVISION Business Line. (503)639-4171 MST
8UP --_
Received — DatePeques ed—_"J AM__ —PM BUP
Location �// .5 Com`"I��'�,`�1�11�2. T Suite MEC
Contact Person ilt -.- Ph(--) 1 LI }j3' PLM _
Contractor --_- Ph ( ) SWR
BUILOING Tenant/Owner ------ ELC --, .,L�=CX.';?Z
Footing -
Foundation Access: ELC
Fig Drain ELR
Crawl DrainSlab -
Post& Beam Inspection Notes: 11���� /� L /��r SIT
Po —
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear -
Framing --_ --_�-_� -----
Insulation
Drywall Nailing ----- ---- - _
Firewall
Fire Sprinkler -- - --- ------
Fire Alarm
Susp'd Ceiling --- ------ -- ---
Roof
Other: -- - -- -- - -
Final
PASS FART FAIL -------- - -�-- - -
PLUMBIN03
Post& Beam --- ---_.. --------- -
Undei 'Olab _..- --- -- -- -
Ro,:g',-In
Water Service --
Sar'tary Sewer
Rain Drains - - - - -- ----
Catch Basin/Manhole
Storm Drain ------ --- --- -----,---- -
Showb.-Pan
Other:___ ---- - -- - - -- --- - --
Final
PASS PART FAIL — - ------- -� -
MECHANICAL
Post r3 Beam -------- --- ---------- - - --
Rough-In - - ------- - --
Gas Line
Smoke Dampers - ------------- --- _ - -
Final
PASS PART FAIL -- --
1
Rough-In
UG/Sl m - —
,w Voltage -------- - ----- -- -- -
Fire Alarm
a PART FAIL_ Reinspection fee of$-_--_ required before next inspection. Pay at City Hall, 13',25 SW Hall Blvd.
SITE L] Please call for reinspection RE: u Unable to inspect-no icr.ess
Fire Supply Line
ADA �
Approach/Sidewalk Date--�-�c'—� �— Inst��ctor -�� Ext_--
Other:
Final --- — - DO NOT REMOVE this Inspedlon record hem the fob oft.
PASS PART FAIL
SEE 351`✓IM
ROLL# 22
FOR
LARGE
DOCUMENT