12419 SW KNOLL DRIVE I
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12419 SW KNOLL UH
CITY OF TIGARD PERMITS#ER. PERMIT. . . . : MST9
ERMITMST9 3-0568
COMMUNITY DEVELOPMENT DFP#ATJM6NT DATE ISSUED: 11/05/93
13125 SW Hall Blvd."i lgard.Oregon 97223.8199 (50:1)839.4171
/L.y/ Cf PARCEL: �_'��10180--0130121
S I•TL ADDRESS. . . : 1.24e5 5W KNOLL DR
SUBDIVISION. . . . : KNOLL ACRES ZONING: R--4. 5
BLOCK. . . . . . . . . . . LOT.. . . . . . . . . . . . . :6
^UILDING
RE?.SSUE: DWELLING; UNITS:O BASEMENT. . . . . . . . :0 5f
CLASS OF WORK. :MOV BEDRMSiO BATHS:@ GARAGE. . . . . . . . . . :0 sf
7 YPE OF USE. . . :SF FLOOR AREAS---- --- -- REOU I RED SETBACKS--_-.-._______.-_
TYPE OF CONST. :5N FIRST. . . . :0 S f LEFT. . :5 ft R I GHT. :5 ft
OCCUPANCY GRP. :R3 SECOND. . . :0 s f FRONT. :20 ft REAR. . : 15 ft
STORIES. . . . . . . : 1 THIRD. . . . :0 S f REQUIRED-
tiEIGHT. . . . . . . . : 1c ft TOTAL--- -:0 Sf SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :40 psf VALUE. . . . . s : 3500 PAPKING SPACES. . : 1
I Remar^ks : FOUNDATION ONLY
PLUMBING
3INKS. . . . . . . . . . :0 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . :O
LAVATORIES. . . . . :0 WATER HEATERS. . . -0 TRAPS. . . . . . . . . . . . . . :0
TUB/SHOWEF . . . s0 LAUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . :0
WATER CLOSETS. . :O SEWER LINE ( ft ) . :0 CREASE TRAPS. . . . . . . :0 i
bTSHWASHcRS. . . . :0 WATER LINE (f' i . : 14?kl OTHER FIXTURES. . . . . :0
GARBAGE D 1 SP. . . :0 RAIN DRAIN (ft ) .. :0
WASHING MACH. . . :0 SF RAIN DRAIN3. . : 1
MEL'AANICAL -- --- _______------__________.._.___-- FEES -- ----_- - ----
FUEL UNIT HTRS. . :O type amount by date recpt
VENTS . . . . . :0 BPRT $ 44. 50 JH 11/05/93 -
MAX INPUT.nl BTU VENT FANS. . :0 B5PC $ 2. 2*3 JH 11 /05/93 -
FURN ( 1.00K . . :0 HOG')S. . . . . . :0
FURN ) =100K . . :0 WOOJSTOVE S. :0
FLOOR FURN. . . . :0 CLO DRYERS. : 0
BOIL./CMF ( 3HP:0 OTHER UNITS:O
GAS OUTLETSiO
Owner:
FRED PASSM9RE
12665 SW 271'4 STREET
BEAVERTON OR 970u:5
Phone #:
Contr,actor,: _._______.-----•-----._______---•__--
EMMERT INTERNATIONAL_.
11811 BE HWY 212
CLACKAMAS OR 47015
Phone #: 655-7191
Reg #. . 00E305 ____.._____.____.____.___._..__-___.__.-___-.
s 46. 73 TOTAL_
Thus peroit is issued sabject to the -egulations contained in the - --- REQUIRED INSPECTIONS - - -- -
Tigard Municipal Code, 2+ate sf Ore. Specialty Codes and all other Foot/found I n s p
applicable laws. All work mill be done in accordance with approved Building Final
pians. This pereit will expire if work is nol started within 180 Erosion Contr•o 1
days of issuance, or if work is suspended foLalre than 180 days.
t Ernlzttee Sig tur e: -•�.-�• _ _� __ ___ —_
Call for insipe�tion - 639-4175
WASHINGTON COUNTY
(DELECTRICAL PERMIT
Department of Land Use & Transportation
�• Electrical hubp action Section
155 No1h First Hillsboro, Oregon enue97124�l- 12 APPLICATION
Information: (503) 640-3470 Fax: (503) 693-4412
Permit
PLEASE PRINT Number --_ ( Date � J
Please complete all sections, through
4. romplete Fee Schedule below
1. Location of installatio�l — — Number of Inspectlons per pen;it allowed
AddIess_L`l I S�_�—', r_ 1 `' , Service included: Items Cost(ea.) Sum
_ Building Y A. Residential- per unit
City -,pA 1�. Suites No.
1000 sq.n or Tess1 1000 d
Tenant Name Each additional 500 sq n
(if commercial)
-- ---- or portion thereof $25.00 —
Limited Erergi, $25.00 1 l
Map No.—____ Tax Lo' Each Manuf d Home or Modular
Dwelling Service or Feeder $68.00
Thomas Map Book: Page: Section:
Directions_. B. Services or Feeders
— Installation, ilterAlions or relocation
200 amps L,_less $60.00 ___ 2
Commercial Residential 201 amps to 400 amps $80.00 ._ 2
401 amps to 600 amps $120.00 _ _ 2
2601 amps to 1000 amps $180.00 -- 2
a. Contractor installation only: Over 1000 amps or volts $340.00 2
Electrical Contractor Reconnect only _4G_ $50.00 _—�� 2
Address
City i_ State ZIP C. Temporary Services or Feeders
Gate— Job Number _ Installation,alteration or relocation
Property owner . �� - K Fes_^ 200 amps or less $50.00 _ 2
Contracto''S License No. 201 amps to 400 amps $75.00 _ 2
401 amps to 600 amps $100.00 Y _ 2
Contractor S Board Reg. No. Over 600 amps to 1000 volts see'B'above �—
Signature -:f Supr. Elec'n D. Branch Circuits
License No. _ Phone No. .` Ni alteration ,r extension per panel
a) The fee for branch circuits with
2b. r owner Installations: purchase of service or feeder lee.
Each branch circuit _ $500 2
PrintOwner's Name �ione�.
-- _ o L I b) The fee for branch circuits without
_
purchase of service or feeder fee.
2� First branch circuit $35.00 _ss - A —..
Each add nl branch circuit $5.00 2
,y 1aI�A T-��Zp E. Miscellaneous (Service or Feeder not included)
Each pump or irrigation circle_Y— $40.01; —.� 2
The installation Pd
ng made on property ! own Each sign or outline fghting �_ $40.00 _ 2
which is not intr S leas rent. Signal circuit(s)or a limited -
energy panel,alteration
Owner's Signature or extension $40.00 _ 2
F. Each adciiiional inspection over tip allowable
in any of the above
3. Plan Review section (if required) Per inspection _! $35.00
Per hour $5500 _
Please check appropriate Nem and enter fee In section 58. In Plant _� $55.00 —
__4 or more residential units in one structure 5Fees
__Service and feeder, FOO arnp; or m .nre..—System over over 600 vols nominal A. Enter total of above fees $
—ClLasified area or structure containing Goecial 5% Surcharge (.OE.X total fees) $
occupancy as described in N.E.C. Chapter 5 Subtotal $ _ �
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $
above apply. Not required for temporary construction Subtotal $
services. ❑ Trust Account $ —^—
Balance Due $ ,, '} '
For inspections call
this psrmlt:enomoe null and void It the work authorized by the plane'-not ooaa mor 4
640-3561 or 693-4415 whhln ter,days from date of lasuanoe of ouch permit or"the wort,oulhorfrod Is
%
upended or sbandomd et any time emr...ort,M aomrrwno•A for•perbd d 1.0 deyw
24-hour recorder, one working day in advance of geed Etectrlwl Permits us non,c7ondabls and nrn4tonslerabte
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CITYOF TIGA D _ MA§TER PERMIT
PERMIT#: MST93-00.546
DEVELOPMENT ELRVICES DATE ISSUED: 4/5/94
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171
SITE ADDRESS: 12419 SW KNOLL DR PARCEL: 2S i01 BC-03300
SUBDIVISION: PP1994-025 ZONING: R-4.5
BLOCK: LOT: 002 ,JURISDICTION: TIG
REMARKS: MOVING IN ONE HOUSE
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS nEOU1REU SETBAt•KS REQUIRED
CLASS OF WORK: MOV HEIGHT: 12 FIRST n sf JASEMENT,� 0 at LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND. 0 sl GARAGE: 0 of FRONT: 20 PARKING SPACES I
TYPE OF CONST: -V DWELLING UNITS: 0 TRIM 0 sf F41GHT: 5
OCCUOANCYGRP: R3 BDRM: 0 BATH- TOTAL: 0 d VALUE: REAR t5
PLUMBING
SINKS: 0 WATER CLOSETS: 0 WASHING MACH: 0 LAUNDRY TRAYS: 0 RAIN DRAIN: 0 TRAPS: 0
LAVATORIES: n DISHWASHERS. ^ FLOOR DRAINS' 0 SEWER LINES: 0 SF RAIN"RAINS: 1 CATCH BASINS: 0
TUB/SHOWERS n GARBAGE DISP: 0 WATER HEATERS: 0 WATER LINES' 100 BCKFLW PREVNTR: 0 GREASE TRAPS: 0
MECHANICAI OTHER FIXTURES: 0
FUEL 1 YPES _ FURN c 100K: 0 BOIL/CMP c 3HP: 0 VENT FANS. 0 CLn'rHF.S DRYER: 0
FURN>•100K: 0 UNIT HEATERS I) HOODS: 0 OTHER UNITS: 0
MAX INP, 0 btu FLOOR FURNANCES: 0 VENTS: n WOODSTOVES n GAS OUTLETS: 0
ELECTRICAL
_RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEGF.RS BRANCH CIRCUITS _ MISCELLANEOUS AOD'L INSPECTIONS
1000 SF OR LESS: 0 0 •200 amp: 0 U •400 amp: C W/SVC OR FDR: ext PUMPIIRRIGATION: 0 PER INSPECTION, 0
EA ADD'L 5009r: 0 201 400 amp: 0 201 400 amp: 0 1 et WIO SVCIFUR. •s, SIGN/OUT LIN LT: 0 PER HOUR: 0
LIMITED ENERGY: 0 401 •6UO amp: 0 401 600.vnp: 0 EAADDL BR CIR: on SIGNAL/PANEL: 0 IN PLANT: 0
MANU HM/SVC/FDK: 0 601 • 1000 amp: 0 601 aamps•1000v: 0 MINOR LABEL: 0
1000+amo/volt: 0
PLAN REVIEW SECTION
Reconnect only: 0
a■4 RES UNITS: SVC/FJR>E225 A.: >600 V NOMINAL: CLS AREAISPC OCC:
ELECTRICAL•RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: 0
Owner: Contractor: TOTAL FEES: $ 2,521.56
This permit is subject to the regulations contained in the
OWY\31� Tigard Municipal Code,State of OR. Specialty Codes and
S--U:3 _ L I _ G)..1 4-'j 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 the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to followrules adopted by the
Phone: Phone: Oregon Utility Notification Center. Those rules are set
forth In OAR 952-001-0010 through 952-001-0080. You
Rep 0: may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
_ REQUIRED INSPECTIONS
Foottfound Insp Gas Line Insp Misc, Inspection
Post/Beam Structural Rain drain Insp Mechanical Final F I 1 J AL—
F ist/Beam
LFist/Beam Structural Water Line Insp Final Inspection
Crawl Drain Misc.Insplaction Building Final
Mechanical Insp Misc.Inspection Erosion Control Insp 8,
J
Issued By :12
__ Permittee Signature
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next busines ay
CITY OF TIGARD 24-Hour p
BlJILDIN Inspection Line: (503) 4175 MST -—L-u S 6
INSPECTION DIVISION Business Line: (50 3 71
J BJP
Received _ Date Req/uested lAM PM_ __._. BUP
Location .- � Lee,- 1d1�'�_` Suite--_- -------_-- MEC 3 -
Contact Persony�--�r- l_.- Al, ph p 1 PLM
Coi tractor -- °h SWR -- ---- -
SUILOING` TenanUOwner _ _ ELC _
Foolw
Foundation ACC@SS: ELC l�
Ftg Drain �1 ---
Crawl Drain 1/� � ELR
Slab Insp action Notes: SIT
Post& Beam
Shear Anchors -----------_—.
Ext Sheath/Shear
Int Sheath/ShearFraming _ '� �} T—i p-
Insulation
Drywall Nailing W14S. L ' sm pkA
Firewall I (, 0 l�
Fire Sprinkler 4,,-k
•.x_�F-�'
Fire Alarm
Susp'd CeilingRoof
ojherl
A S PART FA';.
Post& Beam U
Under Slab
Rough-In - — -
Water Service
Sanitary Sewer
Rain Drains -- - -- _
Catch Basin/Manhole
Storm main -- - _.-- ----- -------
Sh^wer Pan
Other:
Final
PASS PART FAIL - -- ----
-- --- _ `_, �2-Ua a o c�
MECHANICAL _ ► ►'1
Post& Beam -
Rough-In
Gas Line
S eDampers �-
1!in'al
- '_._PART_
PCTRIC,kLService --
Pough-In
UG/Slab ---
Low Voltage
Fire Alarm -- --
Final Reinspection fee of$— _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE __ Please call for reinspectlon RE,:--_ Unable to inspect-no access
Fire Supply Line
ADA I / Z /Q 1. �
Approach/Sidewalk Date _ Inspector � ut
Other:
Final DO NOT REMOVE thin ins,aection record from the job site.
PASS PART FAIL
CITY' OF TIGARG MFCHANICALPERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00696
13125 SW Hall Blvd.. Tigard, OR 97223 (5031639-4171 DATE ISSUED: 12/8/03
SIT,': ADDRESS: 12419 SW KNOLL DRPARCEL: 2S 101 BC-03300
SUBDIVISION: PP1994-025 ZONING: R-4.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: RVENTS W/O APPL: 1 VENT SYSTEMS:
STORIES: BOILERS/CON'IIRESSORS HOODS:
FUEL TYPES 0 - 3 HPC -- DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS?: 30 - 50 HP: REPAIR UNITS:
GAS PRES:URE: 50 + HP: WOODSTOVES:
FURN < 100K OTU: AIR HANDLING UNITS CLO DRYERS:
FURN >=100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 2
Remarks: Gas to free standing stove and water heater. Flue vent for water heater and I etas outlet.
Owner: FEES
KISH, ROBERT Description Date Amount
7510 SW ASHFORD ST. ----- ----
TIGARD, OR 9722.4 [NIECH] Permit Fee 12/8/03 $72.50
[TAX]8%State Surehart 12/8/03 $5.811
Phone: 503-201-5725 Total — $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Mechanical Insp
Final Insper.iion
Reg #:
This permit 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 acoordance wai i 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 in the Oregon Utility Notification Center. Those rules are set forth in OAR q52-001-00
Issued By: rC�l_�t.�; <<t )('YL Permittee Signature: lf(lI J �L
Call (503)639-4175 by 7:00 P.M. for inspections needed the next bu in s day
Mecham al Permit Application
Received Mechanical
1 Date B :l', s D Permit No
City of Tigard Planning Appruv I Building
Date/B 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 --
Internet: www.ci.tigard.dr.us11 DatdBL_ Case No. __
Contact Tu�7-
ce Pagc 2 for
24-hour Inspection Request: 503-639-4175 Name!Method Supplemental Information.
I _TYPE OF WORK COMMERCIAL FfsE*SCHEDULE-USE CHECKLIST
New constr _ Demolition kiechat,ical permit fees• ire based on the total value of the work
Addition alteration lacement� Other: performed. Indicate the i aluc(rounded to the nearest dollar)of all
CATEU Y OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit.
1 & 2-Family dwelling 1 J commercial/Industrial �'al�e: S Sec Page 2 for Fee Schedule
F] Accessory Building Multi-Family RESIDENTIAL EQUIPMENT/SYSTEMS FEE*SCHEDULE
_❑ tv ca. Total Master Builder Other: Description HeaNn ling Fe
_
JOB SITE INFORMATION and LOCATION Furnace-add-on air zonditionin •• 14.00 -
Job site address: ' �-`5w A,Jv L-t- AZ VE Gas heat pump 14.00
Suite#:#: 6!d ./A .#; Duct work 14.00
Project Name: H dronic hot waters stem 14,00 _
Cross StrPet/DirectlonS to job site: Residential boiler
for radiator or h dronic system) 14.00
Unit heaters(fuel,not electric)
in wall,induct,suspended,etc.) 14.00 _
Flue/vent f-)r any of above 10.00
Subdivision: _ Lot#: Repair units 12,15
Other Fuel Appliances
Tax ma / arccl #_T_�_- Water heater 10.00 _
DESr;cIPTION OF WORK Gas fireplace 10.00
/AJAR_ A-, 15J/AJ(i 1-A)5/137-1 Unl.l $ Flue vent(waterheater'gas fireplace) 10.00
Log lighter(gas) 10.00
- - Wood/Pellet stove 10,00
--- ----- - - -- _ _ Wood fireplace/insert 10.00
Chimnc 'liner/flue/vent 10.00 _
PROPERTY OWNER TENANT Other: _ 10.00
Name: j-` &K T-- Environmental E:hu ^t do Ventilation
Address: '� 5 I t7 `�t e) AS H Ft)IZRange hood/other kitchen equipment 10.00
S Clothes dryer exhaust 10.00
i ice//State/Zip: T- / ACZ Single duct exhaust
Phone: Spa Iv- ?2 ; Fax: (bathrooms,toilet compartments,
rl-kP- 0 CONTACT PERSON -_ utility rooms) _ 6.80
Name Attic/crawl space fans 10.00
Address: - Other: _-_ 10.00
Fuel Piping
City/State/Zip: — _ "(S5.40 for nrst 4,$1.00 each additional
Fumace,etc. ■■
Phone: Fax: _
--! - -------- Gas heat um •■
E-mail: Wall/suspended/unit heater ••
_ CONTRACTOR _- Water heater �— - ■. ___-__
BusinessNam,!: ,t Fire lace ■+ --
- +•
Address: Range
City/State/Zip: Clothes dryer(,gas) - +■ -
Phone: — _ Fax: � other: `-�— -- •■ --
CCB Lic.
Authorizer. , Mechanical Permit Fees' —
Signature• Date:L2/j/ - Subtotal: S
_ Minimum Permit Fee$72.50 $
, jam
-Plan Review Fee(25i!o of Permit Fee) S
(Please print name)
State Surchar a 8�•�°,0 ,Permit Fee) S
__
_ TOTAL rEWIn-FEE S 2 __
Notice: This permit application expires if a permit I.not ohinincd vsithiv •Fig methodolop ret by Tri-County Building Industry Service Board.
IAO days after It has been accepted as complete. ••Site plan required for exterior VC units.
Dsts\Permit Fonns\MecPermitApp.doc 01103
Mechanical Permit Application - Cite of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule: _
TOTAL VALUATION: PERMIT FEE:
$1.00 to$2,000.00 Minimum fee$72.50
$2,001.00 to$5,000.00 $72,50 for the first$2,000.00 and$2.30 for each
additional$100.00 or fraction thereof,to and
including$5,000.00.
$5,001.00 to$10,000.00 $141.50 for the first$5,000.00 and$1.80 for
each additional$100.00 or traction thereof,to
and including$10,000.00. _
$10,001.00 to$50,000.00 $231.50 for the first$10,000.00 and$1.35 for
each additional$100,00 or fraction thereof,to
and including$50,000.00. _
$50,001.00 to$100,000.00 $771.50 Cot the first$50,000.00 and$1.25 for
each additional$100.00 or fraction thereof,to
_ and including$100,000,00.
$100,001.00 and up $1,396.5G for the first$100,000.000 and
$1.10 for each additional$100.00 or fraction
tht,reof.
All New Commercial Buildings require 2 sets of plans.
i\Building\Permit Forms\Mec PermitAppPg2 09•J1-03.doc
CITY OF T I GARD SLWLR CUNNEL.1 ION
;:,ERMI'*r' #VIERI.IT
I 3 0
COMIMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 04 6 W R9 `1
/05/ )4
13125 SW Hall Blvd.71gord,Oregon 97223*81160i ('n3l'639-411711
FIPRCEL; ceS10IBC—KNOL,-,
I'T'E
,iUBI)TVISION. . . . . ZONING:
LA'L 0 C K. . . . . . . . . . .. L0 I . . . . . . . .. . . . . . .
VENANT NAME. . . . . :
USA NO. . . . . . . . . . : FIXTURE UNITS. . .
I.ILASS OF WO IRV. MO V DWELLING UNITS. . ', 1
I YPi [IF: USE. . . . . :SF NO. OF BUILDINGS' 1
I NFT ALL TYr-,E. . 1ALj13WR IMPERV SURFACE— -. : Sf
Remarks:
Owner: FEE9
FRED PASSMORE type amol-Int by date reept
12665 SW 27TH STREEI PIRMT $ 2200. 00 JG 04/05/2'4
II\IE3E-, $ 35. 00 JG 04/Q15/94
BEAVERTON OR 970073
k1hane #:
Contractor:
I.;OI�IFRAC TUR NOT ON FILE
11ione #: $ 2235. 00 TOTAL
Peg #. . :
-------- REDU I RED INSF,ECT IONS
This Applicant agrees to comply with all the rules and regulations Sewer lnspec!tion
of the Unified Sewage Agency. The permit expires 181 days from
il,e date issued. The total Lmount paid will be forfeited if the
,,)Prsit expires. The Agency does not guarantee the arcuracy of the
ride sewer laterals. if the sewe- is not located at the measurement
riven, the installer shall prospect 3 'Pet in all d)rpctians from
the distance given. If not so located, the installe,- shall purchase
i "Tap and Side Sewer" Permit and the Agpncy w s ,ill a lateral.
er-frittefo Si. �'.�%� ;.-...,�,-�-- ..�".�. ___._—._._ _._�_ _..�_.
gnati.tre:
By :
Call for trispectioti 639-4175
_7
CELECTRICAL PERMIT
CITY O F T I�A R D
PERMIT#: ELC95-00046
DEVELOPMENT SERVICES DATE ISSUED: 11/8/95
13125 SW Hall Blvd.,Tigard. OR 87221 io03) 63941-11 PARCEL: 2S10113C-03300
SITE ADDRESS: 12419 SW KNOLL DR
SUBDIVISION: PP1994-02.5 ZONING: R-4.5
BLOCK: LOT : 002 JURISDICTION: TIG
Proiect Description:
RESIDENTIAL UNIT TEMP SRVC/FEEDERS M13CCLLANEOUS
1000 SF OR LESS: 48 0 - 200 amp: 0 PUMP/IRRIGATION: 0
EACH ADD'L 500SF: 0 201 - 400 amp: 0 SIGN/0I1T LINE. LTG: 0
LIMITED ENERGY: 0 401 - 600 amp: 0 SIGNAL/PANEL: 0
MANF HM,SVC/ FDR: 0 601+amps -1000 v: Its: u MINOR LABEL (10i: 0
SERVICE/FEEDER _ BRANCH CIRCUITS _ ADD'L INSPECTIONS _
0 - 200 amp: 0 W/SERVICE OR FEEDER: PER INSPE3riON 0
201 - 400 amp: 0 1st W/O SRVC OR FDR: r) PER HOUR: 0
401 - 600 amp: 0 EA ADD'L BRNCH CIRC: 0 IN PLANT: 0
601 - 1000 amp: (1 _ PLAN REVIEW SECTION _
10G)+ amp/volt: 0 >=4 RES UNITS_ >600 VOLT NOMINAL:
�Reci rnnect only: 1 SVC/FDR >=225 AMPS: �— _._ CLASS AREA/SPEC OCC:
Owner: Contractor:
OMNI ELECTRIC OF OREGON
A.K.A OREGON ELECTRICAL CONSTR
1010 SE 11TH
PORTLAND, OR 97214
Phone: Phone:
234-9900
Reg#:
FEES _— -- _ Required Inspections _
Type By Date Amount Receipt
Electrial Final
PRMT TMP 11/8/95 $50 00 95-266672
5PCT TMP 11/8/95 $2.50 95-266672
Total $52.50
This Permit is issued subject to the regulations contained'n the Tigard 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-OOEO You may obtain copies of these rules or direct questions to OUNC at(503)
246-1987
PERMITTEE'S SIGNATURE `' ��� � ��� �4SSUED BY:
C.VNER 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 OF SUPR. ELEC'N: _ —_—_� __._ DATE: —
LICENSE NO:
Call 639-4175 by 7:OOpm for an inspection the next business day
TIGARD _
WASHINGTON COUNTY
Department oLand Use-8t Transportation ELECTRICAL PERM
IT I
i ISection
155 North Firs"venue,#350-12 APPLICATION
HI4sboro Oregon 97124
Information: 50 -3470 Fax: (503) 693-4412
PLEASE PRINT Permit
please • sections, • •
Numbe IS'LC C?S, q� Date 411-31
1. Location of installation 4. Complete Fee Schedule below
Address 12 419 S Ih--K no l 1 Number of Inspections per permit allowed
Building Service included: Items Cost(ea.) Sum
City, Tigard Suite No.
Tenant Name A. Residential-per unit
(if romnierciol) _- — 1000 sq.ft.or less $110.00
Each additional 500 sq.it
Map Na. _ Tax Lot _�_ _ or portion thereof - $25.00
Thomas Ma Book: Page: 655 Section: F-4
Limited Energy __._ $25.00 —
Map g - Each Manuf'd Home or Modular
Directions_HOUSE i s__behind 1112435" Dwelling Service or Feeder $66.00
� B. Services or Feeders
Commercial C_I Residential L"'j Installation,alterations or relocation
200 amps or less --- $60.00 -- —.--- 2
la. Contractor installation only: 201 amps to 400 amps $60.00 — 2
401 amps to 600 amps $120.00 _ ___ 2
ElectricalContrartorOmni Electric Contractors 601 amps to 1000 amps _— $160.00 __ _________ 2
Address PO--Box- 1788 Over 1000 amps nr volts $340.00 2
City Lake - State__QE_ ZIP___2_1.Q.35 Reconnect only _..L__ $50.00 — •UG 2
Date 6/7/95 Job Number 16074
Property Owner KISH, R. J. _ C. Temporary Services or Feeders
Contractors License No. 182 Installation,alteration or relocation
200 amps or less _- __ $50.00 _-__._.___ _ 2
Contractor's board Reg. N 201 amps to 400 amps $75.00 2
Signature of Supr. Elec' ' 401 amps to 600 amps �� $100.0, 2
2 3 4 5 5 635-4306
Over 600 amps to 1000 volts see"B"above
License No, Phone No,
D. Branch Circuits
2b. For owner installations: New,alteration or extension per panel
Ek) The fee for branch circuits with
Print wner's ame Pone o. purchase of service or feeder fee.
Each branch circuit —_ $5.00
Address ---- - ----- bl The fee for branch circuits without
purchase of service or feeder fee.
L�ty State Zili First branch circuit _-- $35.00
Each add'nl branch circuit __ $5.00
The installation is being made on property ! own E. Miscellaneous (Service or Feeder not included)
which is not intended for sale, lease, or rent. Each pump or irrigation circle _. $A0 00
Each sign or outline lighting $40.00
Owners Signature -- Signal circuit(s)or in limited
energy canal,alteration
3. Plan Review section If required) or extension $40
oo
Please check appropriate Item and enter fee In section 5B. F. Each additional Inspection over the allowable
In any of the above
__4 or more residential units in one structure Per inspection $35.00
__Service and feeder, 800 amps or more Per hour —_ $55.00
JSystem over 600 volts nominal I I In Plant ___ $55,00 ----
_Classified area or structure containing special
occupancy as described in N.E.C. Chapter 5 5. Fees
Submit 2 sets of plans with application where any of the A. Enter total of above fees $
above apply. Not required for temporary construction 5% Surcharge (.05 X total fees) $
services. Subtotal $
This permit becomes null and void If the work authorized by the permit is B. Enter 25% of line A for
not commenced within 180 days from date of issuance of such permit or Plan Review if required (Section 3) $
If the work authorized is suspended n•abandoned at oily t6ne after work Subtotal $
is commenced for a per id of 180 days. Electrical Permits ere non. ( 1 $
refundable and nontransferable. 1 1 rllst ACCOUnt
(;Vj"q I � �g1F3699 or ns 3698 ,)1 '-r'7 Balance Due $ 5.2. L
24-hour recorder, one working day In advance of need BL28 • 3/95
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CITY OF T!0=10 BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
li itpection: C� . LT['St-�.Ek—y`,"
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plhg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. lett.
Date Requested: G:. /e _" )!j �� rI_Mime: AM` PM
Address:_ _
Builder: Zj _ [/ �[ (o -,—Permit c
THE FOLLOWING CORRECTIONS ARE REQUIRED:
T
l
� c
Inspector. Dater
,XAFPROVED —DISAPPRCVED _APPROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF 1IGARD
Residential Certificate o f Occupancy
Permit No.:� `, ��+ Address: 0 I(j
Owner/Contractor:
Date of Final Inspection: I / " L a Inspector:
This structure has been found to be in substantial compliance with the previsions of the Stare of Oregon One& Two Family Dwelling
S)edalty Code and is hereby approved for oecu ane