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11310 SW GREENBURG ROAD SITE PLAN FOR NEIN 28' X 44' DOUBLE-WIDE MANUFACTURED HOME: WINDSOR "R" SERIES MODEL 6020 APPROX. 1203 SQ. FT. WITH A 400 SQ,, FT. ATTACHED GARAGE ADDRESS 18" EVERGREEN CHAIN LINK FENCE 11310 S.W. GREENBURG ROAD � TIGARD, OREGON 97223 ELI 90.8 _ ELI 90.4 SIDE WALK 5, 0' S. 0' 6 FEET WIDE iei' 20.00 SILT FENCE �3. 4' GARAGE 28.00 31, 6' i .12 o FINISHFLOOR q HOUSE o �' �:•, Ir'.•.%4 4"STORM AND N ELI 94.5 0 FINISH '?. . SANITARY TO FLOOR \ �1 NEW LATERALS 5 20 EL194.0 �� �►.~'� °"�� ------ ELE� ------ -------- POWER •rL 5 ROOF--- c SAN ------ POLE DRAIN o SEWER--- , MANUFACTURED HOUSE ;��""<e ,'� �TYP.) A�" EL192.6 ELI 94.3 SCALE 1 " — 20' INSTALLATION OF MANUFACTURED HOUSE TO BE WATER 24" EVERGREEN .��„ �.;S,TOi�M ELECTRIC � IN STRICT COMPLIANCE WITH THE CITY OF ,;,� .,.,, .,.r. 4 PVC TIGARD, OREGON MUNICIPAL CODE 18.94.040, " GAS LEGAL MANUFACTURED HOMES ON INDIVIDUAL �/ _.^ 4 PVC l" ,� METER S C4 `�J� �,, _ BUILDING LOTS DATED: 1994. �/ >• r• _ N t't4 '►, 28.00' B��K - PARCEL # 1 S135CA04500 �,� �• 0' v' - `- WASHINGTON COUNTY. _ AN. SEWER---�- or^ ��� , OREGON 'GASB WATE R ELS 9 5.6 1.19 4.�4 ' NOTE : s ELEVATIONS PROVIDED BY tiw�a} I THE OWNER Y ;• •�-fit;�• CITY OF TIGARD ZONINGACCESS BASEMENT ZONED ( R - 12 ), SETBACKS U �. �r. y,; FOR SUBJECT PROPERTY OWNER FRONT 15' " GLEN LHOTKA SIDE 5 REAR 15' ---• xy o p cr �, Sc.�5 0 �-- DRAWN BY: RAJ 2-10-96 .. ,:�.` .., � ._•., .t -� _. - ��y�y y� R•_ Y,µrr.,.,,+ yy�pA!,` i .... e5rlu.tJwid w•.:.. _..- ,. ,.' ....._. -, — ..-. � w.. .*r. .;� ,.� � - i. . - 'IQL�1 4�e'�•9M. F.., •�^M17A . .. ,+ +^-^. , ......._ .... .rrnw �-.,,,,r- __�.r�:, .net i� NOTICE: IF THE PRINT OR TYPE ON ANY � � I � gill � 1 � � � 111 ' 11111 � ' 1 '1111 11111 qTF �7 �-1 11 �� f1".rI �f f1i ' fII. 11f `f � I 1ilillf I ( III f � I II"! fJl 1 � 1 T11 1If CIf 111 f �� 1� f11II fIf L.1.1 1111111 i1i iIi iI11 � II I l I I I l l I 1 I IDe, IMAGE IS NOT AS CLEAR AS THIS NOTICE �. I � 3 4 15J 6i + 12 IT IS DUE TO THE QUALITY OF THE No.36 rl` "w.. '""� ',�!!! ORIGINAL DOCUMENT E 6Z gZ LZ 9Z 5Z � Z EZ Z IZ U7• 6i 8i GT 9T 9i fii Ei ZT ii i 6 8 L 8 9 fi E Z I3IVAR I SII 11111111iIII) Iillllill1111IIII111111!111111111 111111llI1111 Il� llll �ll� illllll� ►iii 1111 IIIIIIi,::lIiIIII1111ill� Till1111I1ii111lllll !lllillilLllllii I� I 111 111 UI1111 lllLllll [lll 1U111�11 , r I O I I AY t 1 I 1 4 11.31.0 SIN' 4jREEN6IJRG IZOAD I CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-4171 i Footing Rain Drain Cover/Service FINAL: Foundation Water Line Ceiling -Plumb. Post/Beam Mach. Shear/Sheath Framing -Mach. Plbg.Und/Flr/Slab Plbg. Top Out Insulation -Elect. Post/Beam Struct, Mech. Rough-in Gyp. Bd. -Bldg. San. Sewer Gas Line Appr/Sdwlk Reins. Other: P.M. Date: �. — ��A.M. __ Entry: Address: ���X /�.�.• x --__�_ Tenant: ( � _1 Ste: ST BUP: -- `�— — MEC: — PLM: ELC: THE FOLLOWING CORRECTIONS ARE REQUIRED: ELH: .___—� Inspector::*4L_. J---RI-14- ! Data: APPROVED , DISAPPROVED/CALL FOR REINSP. -- C CO 1 CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FIN - Foundation Water Line Ceiling -PlumL. Post/Beam Mech. Shear/Sheath Framing -Voch. Plbg.Und/Flr/Slab Plbg. Top Out Insulation -E ect. Post/Beam Struct. Mech. Rough-in Gyp. Bd. lbl9 % y San. Sewer Gas Line Appr/Sdwlk ein-. Other: Date: —[2! A.M. _ .M. Entry:__Q_,�(�_�_ Address: �/�.1�/-- Tenant: Ste: C BLIP: Con/Own: CY J -! _ _ MEC: PLM: _ THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: Inspe ____— 4 Dat PROVED —DISAPPROVED/CALL FOR REINSP. CF CO CITY OF TIGARD BUILDING INSPECTION NOTICE Inspoctior. Line: 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL: Foundation Water Line Cei►Ing -Plumb. Post/Beam Mach. Shear/Sheath Framing -Mach. Plbg.Und/Flr/Slab Plbg. Top Out Insulation - Idc. Post/Beam Strict. Mech. Rough-in Gyp. Bd. -Bldg. San. Sewer Gas Line Appr/Sdwlk Reins. Other: ---- Date: II 'J --1��, A.M. �.-P. _ Entry:_ Address: ,1J-25 Tenant: _ _ __\/--.-_— Ste:__ �� q �q/_ BUP: Con/(O— -- PLM: — ELC: —_ THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: i Inspector _+ �./.�"al Date \ � CO APPROVED —DISAPPROVED/CALL FOR REINSP. � STPERMIT CITY' T MACR OF IGARD PIZ17111"' -4. . . . . . . .. K-',T�,., 004.­; COMMUNITY DEVELOPMENT DEPARTMENT I)A-M TSSULD: OZ/1 � 1'', 13125 SW Hall Blvd.Tigard,Oregon 97223e8193 (503)539.4171 IL cl;l cit". . . . x K_r, 9"7 0015 ZOt4INGi R )JI"h1l; IWSTALLAI�,G 4**XK1M 01E PZ A710 JARAGE -------- BUILDIK --------- OTORIrls........ I FLOOR AREAS--- BASEK-NI...1 0 XQUIRMSETPACKS-.­ REQUIKD-­ ------ 3F WORK.INEW HEIGPT........: M FIRST....., 0 sf GARAGE.....: 401 Sf LEFT..........: 'd SMX DETECT": i 7 USE.. r,.Oor% I,=..... 40 GECMT... 0 sf r M, '-!........... CIO r"AFMAG GpAcrj: ' OF 7"'7, DWELLING 'iNITS: I FINBSXNT, 0 Sf RIGMT.......... 5 er BATH: 0 TOTAL---­---; a 0 VALUE.-1; 8340 ROAR....,.....: IS -%URBINO ------------------------------------- ------------- l? WA MN MMI., LA1,00 VMS.. 0 RAN (FAIN fl; I TrWE. z DISHWASHERS— 0 FLOOR DRAINS.,: 0 SEWER LICE ft: 2 SF RAIN DRAINS: I CATCH BASINS..: 0 Z MATER HEATERS,; t WATER LINE ft. 0 BMW Pq[VNTP. 0 GREASE TRAPS.,: 0 OTHER NXTURES: Q0 ( I 80K . I kOIL/CPP ( 3HPi 0 VEr r4K.....: t, runN )-100N, c '."QT !-EATIMS..; C !,mcs.......... 0 BTU FLOOR FURNAMS; I w lot#.`YTS........,; 2 WOODST Q GAS P -------­'.......... ELECTRICAL -------- e'k DL r4UN'T- - 9P,%/Ft:DEP;r,-- 7:"1075--- -----141'7!�Un't?" Lrj C 1 alp— W. "I",''-;`; q, PER 11!s 1 40 'T ' "i LT, 0 MIR HO III)% '!"V. Z, 322 asp..: Z ke I 0 I _ ,t_ tt W;­ �-qj t SIGN/O &.I. . :.,`ufu"V, 441 6c0 Rep..; C, EA R: 2, 141SNAL/pANEL...; 2 ;;041 ~ 10" art, 0 MINOR LABl :4N+: %M PtVIE.4 SECTIO!k"N4, all; o XrA)-21',' A.: 600 of, N0N;:Ql­ wj­ r, ­"k REST n I CTCD EJ,1" OW S, rlM ALAW..... 001100P LNVK ....... MAC. . . LAIWKIIRRIG: PROTECTI't S! CL76V.......... . .. . ........ OTHP,: DATAIT11 E COW, NUR., CALLS—.. TIAL syclT TOTAL rECSO 211116.0 &Win HwWS RD 2232 'it K LOUCXIN BLVD NILWW',IE OR 1122: Ail "Jott tt ,,)I .-tp.Aatior� contained in t'F '13 v - 1i "tatv of Ore. Sptcia­ l!Saiantej 01- it work Is fi�ivrldld for mare t 7 M�>T �h -� ory � CITY OF TIGARD MASTER .. .PERMIT PERMIT ##. . . . . . . : Msr96-004: DATE ISSUED: 04/16/96 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,Oregon 97223.0199 (503)030-4171 PARCEL: 1 S 13SCA--04500 51. I i. ,1jDRE.::>'_i. . . . 11 11/1 'z�W 61 fl.-_-NLAU1{6 RD SUBL)I V I S I GN. . . . : MLF' 93-0015 ZONING: R--1 ' EXLCICK. . . . . . . . . . . LOT. . . . . . . . . . . . . ..001 Remarks: INSTALLING MANUFACTURED HOME AND ATTACH GARAGE --------------------------------------------..------------------ BUILDING ---------------- REISSUE: STORIES.......: 1 FLOOR AKAS---------- BASEMENT...: 0 sf REQUIRED SETFi4CKS---- REQUIRED--- ------- - CLASS OF WORK.:NEW hE1GHT........ : 0 FIRST....: 0 sf GARAGE—- : 400 sf LEFT..........: 5 SMOKE DETECTRS: Y TYPE OF USE...-,SF FLOOR LOAD....: 40 SECONC...: 0 sf FROM.........: 20 PARKING SPACES: 1 TYPE OF CONST.:5N DWELLING UNITS-. 1 FINBSMENT: 0 sf RIGHT.........; 5 OCCUPANCY GRP..R3 BDRM: 8 BATH: 0 TOTAL------: 0 sf VALUE..t: 8340 REAR..........: 15 ------------------------------------------------------------ PLUMBING ------------------- SINKS.........: 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0 LAVATORIES....: A DISHWASHERS...: 0 FLOOR DRAINS..; 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0 TUB/SHOWERS...: 0 GARBAGE DISP.,: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFIW PREVNTR: 0 GREASE TRAPS..: 0 OTHER FIXTURES: 0 FUEL TYPES----------- FURN ( TOOK ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 0 CLOTHES DRYERS. 0 FURN i=100K ..; 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0 MAX. INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...: 0 ------------------•---------------..•----------•------------------- ELECTRICAL --------------------------- —RESIDENTIAL UNIT--- ---SERVICE/FEEDER---•- --TEMP SRVC/FEEDERS-- ---BRANCH LIRCUITS--- ----MISCELLANEOUS—- -ADD'L INSPECTIONS— IM SF OR LESS: 0 0 - 200 amp., ; 0 0 - E00 amp..: 0 W%SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0 EA ADC,L 588SF.: 0 281 - 400 amp..: 0 201 400 amp..: 0 1st W/O SVC/FDR: 0 SI6N/OUT LIN LT: 0 PER HOUR......: 0 LIMITED ENERGY.: 0 401 - ('00 amp..: 0 401 600 amp.,: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL....: 0 IN PLANT......: 0 MANF HM/E9C/FDR: 0 601 1000 amp.: 0 601+amps-1888 v: 0 MINOR LABEL -10: 0 1000+ amp/volt.: 0 ---------------------------------- PLAN REVIEW SECTION --------------------- ------------- Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A. : ) 608 V NOMINAL: CLS AREA/SPC OCC: -----•---------------------------------------------- EJ-ECTRICAL -- RESTRICTED ENERGY --- A. SF RESIDENTIAL- -------------------- B. COMMERCIAL------------------------------------------------------------------------------ AUDIO d STEREO.: VACUUM SYSTEM..-. AUDIO 6 STEREO.: FIRE ALARM.....: INTERCOM/PAGING; OUTDOOR LNDSC LT, BURGLAR ALARM..: OTH: t: BOILER..,.....,; HVAC'...........: LANDSCAPE/IRP1G: PROTECTIVE SIGNL: GARAGE OPENER..: CLOCK.....,....: INSTRUMENTATION: MEDICAL........-. OTHR: HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL 0 SYSTEMS: 0 Owner: ---------------------------------Contr•acter-: ---------------------------- TOTAL FEES:f 2816.06 GLEN LHOTKA BANANZA HOMES MFG 11130 SW GREENBURG RD 13432 SE MC LOUGHLIN BLVD 11GARD OR 97223 MILWAUKIE OR 97c'2c Phone N: 639-9652 Phone N: 659-8814 Reg 1.. . This porn t is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit, will empire if work is not started t.ithin 180 days of issuance, or if work is suspended for more than 180 days. -------------------------------------------------------- REQUIRED INSPECTIONS - - -- _----___-------------------- -------------- Footing Insp PLM/Underflonr Gas Line Insp Mechanical Final Footing Insp Mechanical Insp Gyp Board Insp Plumb Final _ Foundation Insp Electrical Servi Rain drain Insp Building Final Foundation Insp Framing Jnsp Water Service In Erosion Control Crawl Drain Low Voltage Electrical Final -- - - F>er•mittee Siynati-ir-e - Issued By: Call for, inspection - 639-4175 1 • CITY OF TIGARD R61`Lkilj. i COMMIUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,Oregon 97223*8109 (603)639.4171 711',� 1-4,4 r7,17,F141?till V I S 47,ON. I2: ZONIN',--,. R -O"r . . . . . . . . . . . . .0 C . . . . . . . . . . F-1 XTURE UN I TS. 0 rJ-7 "-WC-LA-rNr' LR-41'7�% WUM'.. NEW t Lj L`l 'ASE. (21'r NO. OF LSU IL!tINGT z INSTALLING MANurACTURED HOME ANI) OTTOCH OWiAGE ti i.Ant by Clint ypc, a m,:j t: PRM! 1 2"200. 00 J*1-4 l)72.12-1 ,%Lt al' I ""')CTOr NOT ON FILZ Tl`�Tnt_ is Applicant agrees to �Vzply With all the rules and voltilatiorl n 5 iae* err, the U'rJied Sewele Al!ncp the pfrait expires IPA days flog ...... ,e date The total amount paid will ttle fc?-feited If the artit expires. The AgencV does iGt guarantee the atcarelty of the de iew laterals, If the irwvt- it not located at the measurement -.1til-1, the installer shall pi-cspect 3 feel, in al, dl;-octions from -t dstancii liven. If not So the installer shall purchase 'Tap and Side Sewer" Pei-Nit and the f lent Ill a lellel. ��- �f d, -—----- Ca I I ror i ne,c:t i -1 7 w q i Manufactured Dwelling Permit Application City of Tigard _ 13125 SW Hall Blvd. T79ard, OR 97223 (503) 639-4171 Jobslte Address: 3/Q G•W 6 r c e n hNry Subdivision: Nom , do Lotx #! �,qp Me Use Onhr /.35.- y'J"W g rb i' # Valuation: �' landc/Reco Corner Lot? Y JN ,Perm., # "C� Flag Lot? YF) Reissue of _ Map & TL# � h f' Owner: �,. . ,..:. Address: JI I ; t7 S W r Approvals Required � r� Yi g l4 f c� ©I� 7 v2 Planning i / L 2 � Phone: .�n� �9-� s,� Engin ing ` _ � � of13 no os p (JOm (f fli iverr Address: A5 P ` ..Items Required. t t / 7 Subcontractors 9 1APhone: _S_ S / Truss Details Contractor's License #. 'en)aw S Cl 9 a� Other - /�b�ih � na rnoAft ago X73 MDI License # � (attach copies of curry',; Oregon licenses) 1 j��, Subcontractors: " �u1Y1�JIr1q Of Mfg. Dwelling Dealer: ZIMNL4 nth r avd 1Ilb31:30 Plumbing: I`iNAtiz liom i s M{9 Address: ' q 3 aZ F Plc/tea h ),'„ QW Mechanical: OR (attach copy of current OR Contractors license) '01114i'} ✓�/ ,, Phone: JOB DESCRIPTION: r n /~q 22 �I�l i n �! 4, & C I, I a. �h M. � �, o�ka S 3/ 63 9-965 Applicant Signature & Phone -camber "'-- Received by: i ,;l Date Received: l x— .+'t CG.N%,E RREE'1LFC3APP Permit #: 1r1���� —00"k3� c�VAP_% Address: ` Issued by. , Date: Statement: Information Notice to (Property Owners About Construction Responsibilities Note: Oregon law, URS 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 be issued. This statement is required ,for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt,from registration under URS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate bla iks and initial boxer; I and and either box 3A or 313: r 'I z 1. I own, reside in, or will reside in the completed structure. J 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. D3A. 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 F-1 313. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I chinge my mind and hire a general contractor, I will contract with, a r.,on�ractor who is registered with the CCB and will immediately notify the offic,- issuing tb;s building permit of the name of the contractor. ' hereby rertif-that the above information is correct and that I have read and do understand the Information Notice to Property Wners ab qu Construction Resp:msioilities on the reverse side of this form. (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) i; i SEE 35MM ROLL# 23 FOR LARGE DOCUMENT CITY OF TIGARD CE ERTIFICATOCCUPANOF' CY PERMIT #. . . . . . . : MST96-0043 COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/11/96 13125 SW Hall Blvd.Tigard,Oregon 97223*8'.99 (503)6311-4171 PARCEL: 16t35CA-0450171 I I L HL)UkL!Ll . . . x 11310 '�W ljRLltA'4BUR6 RD UDDIVISION. . . . z MLP 93-0015 ZONINGsP- 12 1. ("It'14. . . . . . . . . . 2 LOT. . . . . . , . . . . . . 1001. I-A'US OF WORK. -NEW YPE OF USE. . . i MH ,LCUPANCY GRP.11J#4- K3 ,1 r'.UPANCY LOAD i I emarks : INISTALLING MANUFACTURED HOME AND ATTACH GARAGE 1-14OTKA 1310 SW GREENBURG RD 10ARD OR 97C23 hone #s 639-965),R. OTA Y-,A(A Or- -CIHANZA HOM[-E MFG3 i343iP '-,E MC LOUGHLIN BIAD NILWAUKIE OR 9722i? 1-11--imilp #l: $a59-8014 Vpq #. . I (his Certificate grants or-c-upency of the above referenced building or portion ' hereof and confirms that the building has btion inspected for complionce with the State of nreWon Specialty Codes for the groupf) occupancy, and use under which tte re erenced ormit was issu@d. iii 6 ,,,UILDING INSPECTOR BUJI D ING 0 ilfqL POST IN CONSPICUOUS PL.00E' CITY OF TIGARD DEVELOPMENT SERVICES ELECTRICAL. PERMIT 13125 SW Hall Slvd, Tigard,OR 97223 (503)639-4171 PERMIT #: ELC97-0094 DATE ISSUED: 02-1/18/97 PARCEL: IS135CA-04500 TE ADDRESS. . . 1 1,310 SW GREENBLIRG RD 81)1 V T S I ON. MLP "3--0015 ZONING:R-12 tit_OCK. . . . . . . . . . LOT. . . . . . . . . . . . . .001 Project Description: Relocate seovice UNIT------ -----TEMP SRVC/FEEDERS--.---- 1000 SF OR LESS. . . . : 0 0 200 amp. . . . . . . : 0 PUMP/IRRIGATION....: 0 FACH APT)DI L 500SF. . . : 0 201 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 ,-TMTTF:.[) ENERGY. . . . . : 0 401 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : IZI MANE. HM/ SVC/FDR. . : 0 601+amps-1004 volts. : 0 MINOR I.-ABEL 0 .-., .-.r:)ERV T CE/FEEDER---- CIPCUITS----- --- INSPECTIONS.- 200 amp. . . . . . : 0 W/SERVICE OR FELDERi 0 PER INSPECTION. . . . . : 0 400 amp. . . . . . . 0 1st W/O SRVC OR FDR. : 0 PER 1-40LIR. . . . . . . . . . . 0 401 600 amp. . . . . . : 0 EA ADD' L. BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . 0 0 1 1000 amp. (A — REVIEW SECT 1000+ amp/volt. . . . . z 0 ) =4 RE"I UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . ; Rrcannect only. . . . . : I SVC/FDR ) = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owners ------------------------------------------------------- FEES GLEN LHOTKP type amol-trit by date t-eept 1. 131.0 SW GREENBURG RD PRMT $ 50. 00 JSD 02118197 97-2,90462 5PCT $ 2, 50 JSD 02/113/97 1-37-2,90462 TTCAPD OR 972;.",3 ­'hine #: 639-9652 I-cintractort VIWNER 52. 54 TOTAI.- ------- REUUIRCD INSPECTIONS F I ect' 1. Sev,v ic-p Elect' l. Final. permit is issued subject to the regOations contained in the lard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signati.tr-e applicable laws. All work will be dnnp in accordance with approved plans. This permit will expire if wore is not started within 180 days of issuance, or if awk is suspended for more �h�ri IFA diys, !k 6 INSTALLATION The installation is being made on property I own which is not intendpci fo!- lease, or rent. r)WNERvS SIGNATURE: DATE: INSTALLATION ONLY------ ----- . :'IGNATURE OF SUPR. ELEC' Ni DATE - -I CENSF NO. - Call for inspection — 639-4175 CITY OF TIGARD Electrical Frirmit Application Plan C,.dck# 13125 SW HALL ELVR. Recd By TIGARD OR 97223 Date Rec'd ac'I Phone (503)639-4171, x304 Date to P.E. Print or Type Date to DST Incpccti0n (503j 633 n,76 Yp rorinnit L� r, 7--lr tai Fax (.503) 684-7297 Incomplete or illegible will not be accepted Called 1. Job Address: 4. Complete Fees Schedule Below: Name of Development_ r1 �Z 1 Number of Inspections per permit allowed Name(or name of business) -_ Service Included: Items cost Sum Address \ l J r ( r : t'�' i` , a 4a. Residential•per unit City/State/Zip ! I?, _ (_1 ' 1000 sq.ft.or less $110.00 q Each additional Soo sq.ft,or Commercial ❑ Residential porton thereof $25,00 1 Limited Energy $25.00 _ Each Manuf'd Horne or Modular Dwelling Service or Frieder $68.00 2 2a. Contractor installation only: ----- (Attach copy of all current licenses) 4b.Services or Feeders Electrical Contractor Installation,alteration,or relocation Address 200 amps or less $60.00 2 201 amps to 400 amps $80.00 City -State Zip 401 amps to 600 amps - 2$170.00 _ _ 2 Phone No. _ I 601 amps to 1000 amps $180.00 Job N0. Over 1000 amps or volts _ $340.00 2 Elec.Cont. Lice. No. Exp.Date-- Reconnect only _1. $50.00 2 OR St?te CCB Reg. No - Y Exp Date 4c.Ter.porar Services or Feeders COT Business Tax or Metro No. Exp.Date- _ Installation,alteration,or relocation 200 amps or less $5000 _ 2 Signature of Supr. Elec'n 201 amps to 400 amps $75.00 2 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No. __� Exp.Date_ see"b"above. Phone No. - 4d.Branch Circuits New,alteration or extension per panel 2b. for owner installations: a)The fee for branch circuits with I �- f"dpurcilase of service or t Print Owner's Name L � ,� C ► � !��a teedi'r lee. Address 1�`. i. lti , r , I r,t r ,ti Each oranch circuit $5,uo state-;.- i Zip � ) ' h)The ho for hrchas circuits City 1fee " -, � without purchase cf Phone No. t. service or feeder lee. First branch circuit $35.00 _ The lnstallat on is being made on property I own which is not Each additional branch circuft $5.00 intended for sale, lease or gent 4e.Miscellaneous / r. (Service or feeder not included) Owner's Signature ' U Each pump or irrigation circle -- $40.00 Each sign or outline lighting $40.00 3. Plan Review section (if required):* Signal circuit(s)or a limited energy panel,alteratlon or extension $40.00 2 Please check appropriate item and e,iter fee in section 5B. Minor Labels(10) $10090 -- _- __ 4 or more residential units in one s, tc ure 4f.Each additional inspection over Service and feeder 225 amps or more the allowable In any of the above System over 600 volts nominal PPr inspection $'15 0o Classified area or structure containing special occupancy Per hour --- $`,_.on as described in N.S.C.Chapter 5 !n Plant $115.00 Submit 2 sets of pians with application where any of the above apply. 5. Fees: Not requ!red for temporary construction services. 59.Emer total,,r abnvA!P,,s $ _ 5%Surcharge i 05 x total fees l $ NOTICE Subtotal $ 5b.En!er 25%of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plar.Review 11 reouired(Sec.3 $ --- NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal ) s IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY ��++ TIME AFTER WORK IS COMMENCED. lJ Trust Account tr_.,� t`i Total balance Due t �` I\DSTS\ELC96 APP Rev P ��'~ -'�--