Loading...
InitiallyGood Z f D J1 4 '1 No* � L��cc cwa4�CAAc��r/ 6e nro��V � M W-4 J ' I i 91.49A t 4X> pwf&—Q.-4 OL Ck for o I ¢, , id, CO �� .01 C�' ite.� vd oe GH or @ �' I / Q� r7 +o,,,_ . 'r0ve+�, OF Fes' ! Oanditi ? Former UST IQr pna' Approved... I Location I i .01 / Only th wok a •� MW-3 pEglr r escrl ,,..,, j .0101 loll See Lett r 92.29 to; FO IIO W... 93.94 �/ \\ I i\\ I .' / 1 1i Attach.. . .. Y MW-1 I I 91.43 - _ —= _ � I I I o I e4eqJ S'w ,be Pro �'�'e� w•-� f+e r 4.�'c_- aa 1 erM po I l I I e1'a5 roe^ G0'"'-�vc` MW-2 . r '� e p C�yox M W-6 I 711 NEW UST I 92.02 O �"' t-0\ 90.94 +� I I I I (CLs4'C LEGEND MW-2 Monitoring Well Designation and , /+ � Approximate Location 0 1020 � Water Elevation on 2-21-96 Below ' 9� '4 Tigard pport Center an Arbitrary 100' Datum Scale in Feet Tigard, regon Storm Drain 1- --- o .w SITE PI ;A iq -- — �` Sanitary Drain December 1996 T-1497 20 Gasoline Fiping m _ SHANNON IL.SON, INC. ' FIG. 2. EnvwavnenW Conwt3ncs ,fir-- 49--17-74 NOTICE: IF THE PRINT OR TYPE ON ANY _I �'1 � IIItIl � I � II ► � � 11 � I � IIII � I � IIII ilili ��- ..L..h.�rl.�. _� ,tlT �1r�.�Tl , i ! �1.� i i ! illl � ► ili � il � Ililill il � ll � l ilil � li I ! Ilili il �Ir� � rlr� r; l ; lr��� tTI � �� I II ► 1il ► -hlr! ili Ali IMA I I , . GE S NOT AS CLEAR AS THIS NOTICE, � 1 2 3 4 5 I 6 7 � - lU _ _ _ 11 12 �� �,• :-�---- -� � �- - C ___-- __ -- _--- -_ — — — S _— ____ IT IS DUE TO THE QUALITY OF THE _ _ _ _ _ _ - No.36 � ORIGINAL DOCUMENT E 6 Z 8 Z i L Z IIII lilIII8 T Z O Z 6!1 iil!III8II TIIIIIIII IIII IIIIIIIIIII! ITE , 1 6 TZIIIIIIL1Z11i, T �aw lllll(lllllll(.1.11 11 11 ll 1i11 11_illllll�ll w 00 E bo En 1 I I i 8838 SW BURNHAM STREET �— CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-41'75 Business Line: 639-4_�'- MST � / BUP `'1 Oct Date Reque ed _AM M� BLU _ Location— jam 4— Suite MEC — Contact Person PIS & 4/ ���' _ PLM R&I::_ 2� Contractor _ Ph SWR BUILDING Tenant/Owner , / _ ELC _ Retaining Wall ELR Footing Access: — Foundation �n FPS Ftp Drain Crawl Drain .pection Notes: SGN Slab _ Post& Beam -- SIT _ Ext Sheath/Shear Int Sheath/Shear F raming Insulation --'--- Drywall Nailing Firewall _---- Fire Sprinkler Fire Alarm - Susp'd Ceiling Roof Misc Final - 00� �� ) PAS RT FAIL LUMBIN cf �� Post& Beam --+ ---- -_--- tinder Slab Top Out --- - Water Sarvice Sanitary Sewer - -- ains ART FAIL NICAL �- ---- -� -- Post& Beam Rough In Gas Line Smoke Dampers Final -- I PASS PART FAIL ELECTRICAL — —�-- --- — — — Service Rough In ----- __ _- -- UG/Slab Low Voltage ------ ----..__ __- - - - ----_ Fire Alarm Final ---- ----- ------- _�-_-- - ---- - PASS PART FAIL SITE -- Rackfiil/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 [ ] Please call for reinspection RE _- _ ( ]Unable to inspect - no access ADA /• Approach/Sidewalk L- �Other Date —� ' /� _—Inspector Ext Final r PASS PART FAIL J DO NOT REMOVE this Inspection record from the job site. CITY OF T I GA R D PLUMBING PERMIT _ DEVELOPMENT SERVICES PERMIT#: PLM2001-00126 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/29/01 SITE ADDRESS: 08838 SW BURNHAM ST PARCEL: 2S 102DB-00100 SUBDIVISION: ZONING: CBD BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: 'TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2 OCCUPANCY GRP: B FLOOR DRAINS. TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: Sl- RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft PiSHWASHERS: RAIN DRAIN: ft Remarks: Replacement of two backflow prevention devices for fire sprinkler systern. Owner: - FEES Type By Date Amount Receipt GTE NORTHWEST INC GARY N WILLIAMS PRMT CTR 3/29/01 $72.50 27200100000 GTE TELEPHONE OPERATIONS 5PCT CTR 3/29/01 $5.80 27200100000 IRVING, TX 75015 Total $78.30 Phone 1: Contractor: BEACON BACKFLOW 800 NW 59TH ST VANCOUVER, WA 98663 REQUIRED INSPECTIONS Phone 1: 360-694-0587 RP/Backflow PreventerFinal Inspection Reg #: LIC 137485 This pennit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and ail other applicable laws. All work will be done in accordance with approved plans. This permit will expire it work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 througn OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. Issued By: , _ _ permittee Signature: Call (503) 6394175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application City of Tigard "Datereceived: C/ Permit no.: L J Jct�1 Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Buiiding permit no.: City of Tigard Phone: (503) 639-4171 Project/appl.no.: Expiredate: Fax: (503) 598-1960 Date issued: By: 1.Receip(no.: Land use approval: _ Casc file no.: Payment type. alimalimmolikill U 1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New construction U Addition/alteration/replacement U Food service U Other: Job address: ��$ S 4/ u s'>1���, Desert on Fee(ea. Total --� New 1-and 2-fa W y dwenRa only: Bldg.no.: !_ I Suite no.: Tux rr,ap/tax lot/accaunlno.; (inrludev100ft.for each utility connection) SFR(1)bath _ Lot: Block: Subdivision: SFR(2)bath _ Project name: SFR(3)bat) City/county: ZIP: Each additional bath/kitchcn Dcscript'on a�ld locatio of w rk on premises:_ t' Siteutilities: 1 ! !' ;[;�I ) Catch hasitt/area drain -- Est.date orcompletion inspe tion:—T Drywells/leach line/trench drain — Footing drain(no.lin.ft.) name: Manufactured home utilities Business CQ s o h Sac I C�w _ Manholes Address: U U N tN 5 R 1( S Rain drain connector City: ` ,1A c VLA �� State:�'IP: q 6 6 Z Sanitary sewer(no.lin.ft.) Phone:3 60-0cjt`4 0S& Fax: Sam.P I E-mail: Storm sewer(no.lin. ft.) Water service(no. lin.ft.) CCB no.: 13 7 t.,'&S- Plumb.bus.reg.no: _ City/metro lic. no.: _ Fixture or Item: Contractor's representative signature: - Absorption valve Print name: A,,, � , Se-I ( Date: 3-2,4 -Q( Back flow preventer R a Backwater valve Basins/lavatory Name: k a. Co (e Cye I'_I. Clothes washer Address: P.U Q — Dishwnsher — -- Drinking fountain(s) City: 1?Pam. or Statep2 ZIP:q 707 Ejectors/sump Phone:S3 l ' 3 4 7 Fax: E-mail: Expansion tank Fixture/sewer cap Name(print): Flmr drains/floor sinks/hub Mailint+address: -- -- G,•rbage disposal Hose bibb City: State: lIP: Ice maker Phone: Fax: Email: Interceptor/grease trap _ Owner in stallation/residential maintenance only: The actual installation Pnmer(s) will he made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Ch.,pter 447. Sink(s),basin(s),lays(s) Owner's signature: Date: _ Sum Tubs/shower/shower pan _ Name: Urinal -- ---- -- Water closet _ Address: _Water heater City:Cit _ State: 'LIP: Other: _ Phone: Fax: E-mail: Total Not all jurisdictions weep credit cards,please call jurisdiction La Lor ne.nfmmtmn. Minimum fee................$ Notice:'This permit application U Vita U MasterCard Plan review(at _ 9F,) $ expires if a permit is not obtained Credit card number: _ ._,L(_ State surcharge(8%) ....$ Expires within 180 days after it has been acce ted as complete. TOTAL .................... ..$ Name of cardholder u ahmvn on credit cased p p _ S Cudholder elpmme Amami 440.1616(60K-IOM) PLUMBING PERMIT FEES: - PRICE TOTAL New 1 and 24amlly dwellings only. FIXTURES (individual) QTY ea AMOUNT (Includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT for each utility connection) Lavatory 16.60 One 1 bath _ 3249.20 Tub or Tub/Shower Comb. 16.60 Two 2)bath _ - $350.00 Shower Only 16.60 Three 3 bath _ $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.6( 8%STATE SURCHARGE _ Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.60 �__. TOTAL Laundrytray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" _ 16.60 PLEASE COMPLETE: 3"- 16.60 q" 16.60 Water Heater O conversion O like kind 16.60 Quantit b Work i elformed Gas pining requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Stonn Sewer 46.40 Lavatory - __ Tub or Tub/Shower Hose Eiibs 16.60 Combination _ Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Jther Fixtures(Specify) 1660 - Urinal Dishwasher _ Garbage Disposal Laundry Room Tray. -- - Washing Machine Floor Drain/Sink 2" Sewer-1st 100' 55.00 3"- Sewer-each additional 100' 46.40 4" Water Service-1 st 100' 5500 Water Healer Water Service•each additional 200' 46.40 Other Fixtures- Storm&Ruin Drain-1st 100' 55.00 (Specify) Storm&rlaln Drain-each additional 100' Commercial Back Flow Prevention Device 46.40 --- Residential Backflow Prevention Device' 27.55 -- Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections er/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling 65.25 Grease Traps 16.60 --- QUANTITY TOTAL Isome.rir,or riser diagram is reoulred if Quantity i alai Is >9 "SUBTOTAL --- 8%STATE SURCHARGE "PLAN REVIEW 25%OF SUBTOTAL Re 'rired onll iffixtuvecity total Is>9 TOTAL $ *Minimum permit fee is$72 50+8%state surcharge,except Residential Backflow Prevention Device,which Is$36 25•8%state surcharge **All New Commercial Buildings require plans with Isometric or riser diagram and plan review i I:\dsts\forms\plm-fees.doc 10/10100 CITE( OF TIGARD SITE WORK DEVELOPMENT SERVICES PERMIT PERMIT #. . . . . . : SIT98-0045 13125 SW Hall Blvd., Tigard,OR 97223(503)6394171 DATE ISSUED: 10/12/98 PARCEL: 25102DB-00100 '3I TE ADDRESS. . . : 08B38 SW BURNH011 ST SUBDIVISION. . . . : ZONING: CBD BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . JURISDICTION: TIG ........... CLASS OF WORK. . :OTR PAVING?. . . . . . . . . . RESO. NO. TYPE OF USE. . . . :COM GRAD I IAG'). . . . . . . . : VALUE. . . 10000 EXCV VOLUME: 100 Cy LANDSCAPING?. . . . : FILL VOLUME: 100 Cy SITE PREP?. . . . . . FNG FILL?. . . . . . : N STOR11 DRAINS?. . . : SOILS RPT REDD ) : IMPERV SURFACE: 0 -,f Remarks - Excavate contaminated sail, fill, compact I readjust catch basin if necessary. Maintain erosion control protection on all stuck piled material. Owner: FEES ------------------- GTE NORTHWEST, INC type amount by date recpt 1-10 BOX 1003, WA101LB P9MT $ 80. `x0 GEO 10/12/98 96-309906 EVE RETT WA 98206 5PICT $ 4. 03 GEO 10/12/98 98-309906 P1_CK $ 52. 33 GEO 1.0/12198 98-30990E, Phone #: FIRE $ 32. 20 GEO 10/12/98 98-3,09906 EROS $ 80. 00 GEO 10/12/98 98-309906 Contractor: $ x'6. 00 GEO 10/12/98 98-309906 SAYSP CONTRACTORS IN(.' ERPC $ X6. 00 GEO 1.0/12/98 98-309906 17803 51ST AVE S SEATTLE WA 98188-461,7 Phone #: 206-439 14 4 $ 301. 06 TOTAL_ Reg 127907 REPHIRED INSPFCTIONS This permit is issued subject to the regulations contained in the Er,osi on C'Ontr-01 Tigard Municipal Code, State of Ore. Specialty Codes and all other F i r al Insper-tion applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within IN days of issuance, or if wor!4 is suspended for more than IN days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-88I-00I8 through OAR 952-08I-NN. Your may obtain copies of these rules or direct questions to OX. by calling 1503)246-9187. fs-,ued h __.lPermittee Signature - +++ F++++++++.+++++++++++++++++.++++++++++++++++++++++++++++++. ...++++++++++++++++ Call 639-4175 by 7:00 p. m. for- an inspection nppded the next business day . ..................4................4............4-++4............................. C-ITY*OF TIGARD Site Permit ,Application Recd By 0 r Date Rer,'d 13125 SW HALL BLVD. Commercial: Complete ENTIRE form Date to P.E. TIGARD, OR 97223 Residence: Complete SHADED areas Date to UST_ (503) 639-4171 x304 Permit• 5/11-0-cavy— Related /11-0-cRelated SWR 0 Called Print or Type Incomplete or illegible applications will not be accepted u�i:e'H kP a ect Ngma P� x,.r e K,;u �, :��, ,� �• �y'��� Utilities(Complete all that apply) Storm Sewer (d "' Linear Ft. ,t Sanitary Sewer Linear Ft. Fresh hater h•' G . Linear Ft. tate ,: Catch Basins � � 4 u �ai�i' ~t,�v�'' r t�' ;�'�•.' +i; Clean Outs r a t I M 'i i dtess"etrh sar ,r "" # Describe work to be done: NewQ AdditlonQ AlterationQ Repair[] IAwT YI'e�u�rC+P" r. St9t tibd:1pv a w eer,i,,p�i i 1l hb�, Cr ?'qI Add`tl1ftAl+[9ley96Vlitio Work: ' r, q ., St$ 'Cb §C Cont�Bbg LICA "{r' 'E�cp Qa a' Cb,�r i 'Yv W'i" Name ` � a <a 6 �" W a ?" ' of r Architect Mallin Address t ur x "� Mailing P`iC l�'.`R�a�fr��Ult0d'V,,3kdlMatrix,on tack 0 y , 4�� �OUO�IItt �'UT1U�4 Jul, e q� eccomparl hili It _ City/State Zip Phone �Sitl,i��Ise pity Map r •jaariUg" rigf ' rnaVi" fiance Na a Engineer f�allin Addres 9 t (� ?J_ _ Is Fitl'dl��r�11 and °R�t�inif�i A :S tlrb5r a icludng City/State Zip Phone , ." o rik L' � � ( Itpt II 4�Ir1tl details SollRrji bnl'to '(d uif rl M35 Excavation Volumd �I ts�eny 1!n►Ve gad this PRI,Cab a It (Soils report required for>5,000 cu.Yards "if r�af`iR1" hov3+ttet OQ cu.yds. agentof lh owne v!I 1t itit p"`a s ed'fte jn c7f ifiiriu9 t _ ;witfr re ori 5(ite laWri'" � � - Fill Volume • tit (Soils report required for>5,000 cu.Yds.) St r D' _ 00cuyds. r i v Will the fill support a structure o (Engineer required if answer is yes) YESO NOX Retaining structure?(check ane) ❑Rock FO OFFICE USE ONLY C]CMU Notes: NU Nlv pConcrete QOther Total new impervious area including ell Land Use Case Map L# buildings,sidewalks, and paving �- -'Sq. Ft. siteapp doc 3/98 70071 t1Nt011 d0 .l3,IJ 0961 969 Cog \t'd L7:11 311 96/91 '60 \ — 2 \ LL k0 �- \/ U) e o Co ¢ ui �! p� k = k) / f 0a ! 2 z]2« / 3/ en e a c° / 4 @ m u / £ 9 m z % 7 \ � + Cl / K � � x � x � � x & * x x x x • . F|G. 1 SEE 35MM ROLL# 22 FOR LARGE DOCUMENT CITY OF TIGARD BUILDING INSPECTION DIVISION 24-hour Inspection Line: 6394175 Business Phone: 639-4171 Date Requested: _ 3`��7 S` ____ A.M. __— P.M. MST: Location: — c /L -LBUP: � _ — _ T'enan,: C�7�E .Sc v 1 Q Suite: Bldg: MEC: Contractor:C,� '1� + i hone: 4�� C 7 PLM: _ 4�w++w'� pfCNfX � bS`�=3F��() _ - Phone:Oy� (� / ELC:�!_� BUILDING BLDG(con't) PLUMBING — —� MECHANICAL LECTRICAL SITE Site PosUBenm Post/Beam Post/Bearn over cc Sewer/Ston Footing Root UndFl/Slab Rough-In Ceiling Water line Slab Framing Top Out (ins bine Rough-In UG Sprinkler Foundation Insulation Sewer Ilood/)uct Reconnect Vault Bsn)t Damp Drywall Stonn Furnace Temp Service NIISC. Maumn? Ceiling Rain Irain IVC 11G Slab Shcar/Sheath Fire Spklr/Alm Crawl/1'ound Ir I lent Piunp lei Approved Approved Approved �INAL Approved �ppr/Sdwik Not Approved Not Approved Not Approved Not Approved FINAL FINAL FINAL FINAL Cl Call for reinspection O Reir,q)eon,n Ire A S requredI -- 1f lore nexxtinstxclion fl 1 11111111C to Inspect ' h,slrect,r _ I)ale 37ti_ Of CITE' QF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: ELC98-0013 DATE ISSUED: 01/09/98 13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171 PARCEL: 2S102DB-00100 SITE ADDREb' . . . :08838 SW BURNHAM ST' SUNDIVIST.ON. . . . : ZONING:CBD BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . . JURISDICTION: TIG P'r-o.ject Descrlptian : Installing one feeder, to 288 amps, and 4 branch circuits. ----RESIDENTIAL— UNIT—— -----TEMP SRVC/FEEDERS---- -----MISCELLANEOUS---- 1000 SF OR LESS. . . . : 0 0 — 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH ADD' L 500SF. . . : 0 0,11 — 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 — 600 amp. . . . . . . : 0 S I GNAL./P'ANEL.... . . . . . . : 0 MANF. HM/ SVC/FDR. . : 0 601-, -imps—.1000 volts. : 0 MINOR LAPEL ( 10) . . . : 0 __. ---SERV I CE/FEEDER----- ----BRANCH CIRCUITS-------- ---ADD' L I NSF'F_CT I ONS---- 0 — 200 amp. . . . . . ; 1 W/SERVICE OR FEEDER: 4 PIER INSPECTION. . . . . : 0 1-7,01 — 400 amp. . . . . . : 0 1st W/0 SRVC OR FDR. : 0 PIER HOUR. . . . . . . . . . . : 0 401 — 500 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0 6,01 -- 1000 amp. . . . . : 0 ------------------FLAN REVIEW SECT ION------_.________.___ 1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : PrIconnec t, only. . . . . : 0 SVC/FDR ) = 225 AMP'S— : CLASS AREA/SPEC OCC. : flWner: —_------ --_-- - -------------------- --- FEES GTF NORTHWEST, INC type 8m1)1..11-.t by date recpt H840 5W BURNHAM P'RMT f 80. 00 DRA 01 /09/9B 98-302395 TIG(IRD OR 97223 5PCT f 4. 00 DRA 01/09/98 98-302395 Phone #: PHOENIX ELECTRIC CO $ 84. 00 TOTAL 7379 SW TECH CENTER DR. REQUIRED INSPECTIONS ------ TTGORD OR 9722? Ceiling Cover Eler_t' l Service F'fhone #: 684--3600 Wal 1 Cover Elect' 1 Final Rerl #. . . 0005122 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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 188 days of issuance, or if work is suspended for more than 188 days. ATTENTION- Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952.881-8818 thr W1 952-881-1987. you may obtain a copv of these rules or direct questions to OtW, by calling (?3)246-1987. \ 1 Permii;tpe Signati_Ire: .L t! . 1 d By -----__--nWNFR TNSTALLATION ON -._—_...._.__._ -------------.----- The installation is being made on prOperty I own which is not intended for, gale, lease, or rent. OWNFR' S SIGNATURE; DATE: _ -------CONTRACTnR INSTALL..ATION a , 113NATURE OF SUPIR. ELEC' N: ._ / C.� / `.� DATE: 1. 1 CENSE NO: ++++++++++++i-+i ++++i+++++++++++++t+•4+t+++++++++++++.I-++++++4•+++4•++++4++++++. ++H+ Call 6.39-4175 by 7;00 p. m. for an inspection nppded the next bi-i.iness da; +.4•+++++++++++++++++++++++++++++++++++++++•++4•+++++++++•+•++++++++++++++i++++�+++++ I'a JkN-.OR-98 THII 01 :20 P11 PHOENIX ELECTRIC FfiX NO, 503 6811 3611 P. 02/02 CITY 01FTIGARD Electrical Permit Application X l "Pian� 13125 SW HALL BLVD. i Recd TIGARD OR 97223 ;' Date Recd Date to P.E. Phone(503)639-4171, x304 /' Date to DST p Ins ection (503) 639-4175 Print or Type Incomplete or illegible will not be accepted Permit f► � Fax (503) 684 7297 called 1. Job Address: 4, Complete Fee Schedule Below: _ Name of Development Number of Inspections per,permit allowed Name(or name of business)L: \_Sj �y:�� i:�2�� Service included: Items Coat Sum Address 4a. Residential-per unit 1000 sq.fi.or less 11110.00 4 City/State/zip �ellI A- (�_�_ �~`r k� Each additional 500 sq.h,or Commerct E2S.00 1 ay� Residential ❑ portion thereof Limited Energy $25.00 Each Mailut'd Home or Modular Dwelling Service or Feeder f6f9.t� 2 2a. Contractor installation only: � - (Attach cop qll current licens45 4b.Salm es or Feeders Electncal Contmgl �` ' Installation•alteration,or relocation �1 Addrokss- '711+ 200 amp:or le60 ss S .0o IJ�.J 2 ' a 201 amps;0 400 amps Sf30.00 _ 2 GltyC� . " t_ State CTJp ' .�r 401 amps tri 600 amps 5120.00 2 Phone No,17 <_ --' .1 *�) 601 amps+o 1000 amps a180,00 Z Job NO. _ I - ^` Over 1000 amps or Volta $.940,00 2 I - Pvconnect only _ 550.00 Elec.Cont, floe. No. '<��i1� Exp.Date � - - 2 OR State CCB Reg, Exp.Date_ _ 4c.Temporary Servicas or Feeders COT Business Tax or Metro No.� 1U�-Fxp,Date ' Installation,alteration.or relocation 201-,amps or less S.50.00 _ 7 I Siqnature of Supr. Elec'n _. 201 amps to 400 amps 575.00 2 I 401 amps to ti00 amps _ $100.00 2 Over 500 amps to 1000 Volta. License No. _ Exp.Date I see"b"above. I j � Phone No, i -tel.C t 4ii Branch Circuits New,alteration or extension per panel 2b. For owner installations: a)The fee for branch circuits with purchase of service or Print Owner's Name feeder fee. Address Each branrh circuit 't_ 55.00 ^�' 2 bi The fee for branch rimuits State Ilp Without purchase of Phone No, service or fuer fee. First branch circuit $35.00 2 The installation is being made on property I own which is not Far_h additional branLh circuit� $5.00 2 intended for sale, lease or rent- 4e.Miscellaneous (Service of feeder not included) Owner's Signature Each pump or irrigation circle W.00 2 Facn sign or outline lighting 540.00 2 3. Plan Review section (if required):* Signal circui,(:1 or a limited energy panel, ,fterati.xi or extension $40.00 f'Irlase check appropriate item and enter fire Miner Labels 1 ill) 11100.00 in section 58. "" n or mere residenbat units in Line structure 41.Each additional Inspection over Service and treder 225 amps or more the allowable in any of the aboaa -iystem over 500 volt nominal Per mspection $35.00 Classified area ur structure containing spe%:ial occulaarlcv PNr hour 555.00 4%described in N.E.0 Chapter 5 In Plaint $55.00 Submit 2 sets of plans with application wherw any of the above apply. 5. Fees: r i � Net required for temporary construction services 5a.Enter total of above tees S e°'e Surcharge(.05 X Loral teen NOTICF Subtotal 5b.Enter 25%of line 5a for PERMITS BECOME VGID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Revlewif requireC IS#+c 3) $ --- --___ NOT COMMENCED WITHIN 1140 DAYS,OR IF CONSTRUCTION OR WORKuKi5tedl 3 IS 3USPENDF0 OR ABANDONED FOR A PERIOD OF 190 CAYS AT ANY TIMAFTER WORK IS COMMENCED ` Erust Account#-�a �_ ?•(J IITotal balance Due pSt]lf.lC9t goo an 996 -.