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Community Develo;ament ELEC1 RICAL PERMIT APPLICATION
13125 SW Hall Blvd.
i Tigard, OR 97223 Permit # i cil,- `
Date Issued _ 0
Phone (503) 639-4171
CITY OF TIGARD FA•; (503) 684-7297
TDD No. (503) 684-27/2
,spection (5C3) 639-4 175
i. Job address: Complete Fea Schedule Below:
Name of Development_ I Number of lnpections per permit allowed
Address Z;—'12 LJ �t- / /1 U// /� !� Serwc; included Items Cost(ea) Sum
City/State/Zip ��CpQ f 9 L)�, _ ��� _ 4a. Residential -per unit
//Y 1000 bq ft or less $11000 �
Name; (of l�mne of business)10/ S L/f `��1�— I Erch additional 500 so ft or
portion thereof $2500
Limited Energy $2500
Commercial 0 Residential ---
Each Manurd Home or Modular _
Dwelling Service or Feeder fF
2a. Contactor installation onitr
4b. Services or Feeders
/ .. ' C installation,aheratwn or relocation
Electrical Contractor /,' , /6 C4 200 amps or less $60 00 2
Address i C ee e— ,.t ( 201 amps to 400 amps BO OU 2
7 401 amp-rn 600 amps $12001) _ 2
City..% 4 t c' State Zip f L 601 amp. .1000 amps $180 on 2
Phone No _[ S - ' Guar 1000 amps or vote $5
s $ 0 00 _
Job NO. - G} I Reconnect only $50 00 _
contractor's license NO. / S 4c.Temporary Services or Feeders
Contractor's Board Reg. No._ O _ Instslleti n alteration or mlocotion
I 42V
Signatt're of Supr. Elec'ni+ `" 2ai eml s or less
Phone No. 'Y ; 20, amr s to a0a amps $so 00
License No.,( S ��J �„L 401 arrys to 600 amps sus on --
Over 600 amps to 1000 votes $10000 - --
2b. For owner installations: see'b'•above
4d. Branch Circuits
Print Owner's Name__ _ New,alteration or extension per pane
Address __ a)The fee for branch circuits with
State_ ;Ir purchase of service or feeder fee.
St
City __ Each branch circuit ___ $``''n
Phone No.- bl The fei for branch circuits without
The installattun is being made on property I own which is purchase of service or Feeder fee.
First branch circuit $3500
not Intended for Bale, lease or rent. Fach additional branch circuit $5 00
owner's Signature4e. Miscellaneous
(Service or feeder not included)
3. Plar Review section (if required): Each pump or Irrigation
lig tangle $4000 _
Each sign or outline ligcircle
T $4000
Signal circult(s)or a limited erergy
Please chack appropriate item and enter fee In section 68. panel,aheration nr extension $4000 _
4 or r,)re residential units in one structure Minor Labels(10) E10000
Service and feeder 225 amps or rnore
Svste�•t over 600 volts nominal df. Each additional Inspection over
the allowable Irl any of the above
Clat,gVied area or structure containing special occupancy
as described in N F C Chapter 5 Per hour Inspection say 00
Per hour $5500
In Pit7nt $5500 _
Submit 2 sets of plans with applicdtiarr vthcr^ a;iy of the above
apply. Not required for temporary construction services. 5. Fees:
5a. Enter total of above fees $
NOTICE 5%Surcharge (05 X total fees)
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal g _
6b. Enter 25% of line A for
AUTHORIZED IS NOT COMMENCED WITHIN '.8O DAYS, OR F Plan Review if required (Srlc 3) g
CONSTRUCTIO14 OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS $ ��"r
COMMENCED. *, m�.�.r^ a Trust Account#
wm.on
Balance Due $
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CITY aF TIGARD
DEVELOPMENT SERVICES ELECTRICAL- PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 PERMIT #: ELC96--0655
DATE ISSUED: 10/18/96
PARCEL: 2SI0IBC—e,1600
SITE QDDRESS. . . : 12420 ;�W KNULI_ DR
SUBDIVISION. . . . : TIGARDIA TERRACE 7.ONING:R-4. 5
SLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : 1
r-'r,oJect Description: ADD SERVICE FEEDERS & BRANCH CIRCUITS
---RESIDENTIAL UNIT---- ----TEMP SRVC/FEEDERS---- ------MT!3CEL.LANEOUS-----
1000 SF OR LESS. . . . : 0 0 200 amp. . . . . . . : 0 PUMP/INRIGATION. . . . : 0
EACH ADDIL 500SF. . . : 0 x'_01 400 amp. . . . . . . : 0 STGN/OUT LINE LTG. . .- 0
LIMITED ENERGY. . . . . : 0 401 600 amp. . . . . . . : 0 SIGNAL/PANEL.......: 0
MANF. HM/ SVC/FDR. . -. 0 601+amps -1000 volts. : 0 MINOR LABEL ( 10) . . . 0
------SERVICE/FEEDER------ ------BRANCH CIRCUITS------ ----ADDII- INSPECTIONS.-.-
0 200 amp. . . . . . : I W/SERVICE OR FEEDER: 2 PER INSPECTION. . . . . : 0
201 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 0 PER HOUR. . . . . . . . . . . : 0
401 600 amp. . . . . . : 0 EA ADDIL BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
60! 1000 amp. . . . . : 0 ------____._—_—_—_..._PLAN REVIEW SECTION------------__----- i
1000+
ECTION-----------------
1000+ amp/$'Olt. . . . . 1 0 )=4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 S')C/FDR > = 225 AMPS. . : CLASS APEA/SPEC OCC. :
Owner,: FEES _______________
WEST SIDE E,_ECTRIC type amoi-int by date t-eept
7518 SW MACPDAM AVE PIRMT $ 70. 00 TAT 10/16/96 96-285215
5P(.',T $ 50 TAT 10/1-6/96 96-285215
PORTLAND OR 97219
Phone #- 245-3385
Contractor-:
WESTSIDE ELECTRIC 9 '73. 50 TOTAL
7518 SW MACADAM AVE
REQUIRED INSPECTIONS
PORTLAND OR 97219 Ceiling Cover- Undet,gr�oi.And Cove
Phone #: 503-245-3385 Wall Covet, Elect' l Service
Reg #. . : 1,3306
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signatl-kv-&-
applicable laws. All work will be done n 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. Issuedsy
INSTALLATION ------------------------
The installation is being made on property I own which is not intended for-
sale, lease, or- rent.
OWNER' S SIGNATURES
DATE.
IN'_-;TALI__ATION
SIGNATURE OF SUPR. ELECIN: DATE:
LICENSE NO:
Call for inspection 639-4175
CITY OF TIGARD __— PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2004-00263
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 6/11/2004
SITE ADDRESS: 12420 SW KNOLL DR PARCEL: 2S101BC-01600
SUBDIVISION: TIGARDIA TERRACE 'JNING: R-4.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS. WATER LINE: It
CISHWASHE'RS: RAIN DRAIN: t
Rema;ks- 50ft. water service replacement.
Owner:
FEES - --�
_�- =—
Description Date Amount
MC(7-EE, JUDITH —
12420 SW KNOLL DR I I'LUMBI Permit I-:r 6/11/2004 $72.50
TIGARD, OR 97223 I'l ANI M4,State Surchan 6/11/2004 $5.80
7o':al $78.-n
Phone : 501-015-0451 -�— —
Contractor:
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2007
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Phone: 667-1781 Water Service tnsp
Final lw;pection
Reg#: LIQ' 23847
PLM 26-20811f3
This permit is issued subject to the regulations contained in 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 --ii to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-0001--0010 through OAR
952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246-6r" )J.
Issued By: rF:rmittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business—day
CITY OF TICARD PLUMBING PERMIT
DEVEELOPMENT SERVICES PERMIT#: PLM2004-00263
13115 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/11/2004
SITE ADDRESS: 12420 SW KNOLL DR PARCEL: 2S101BC-01600
SUBDIVISION: TIGARDIA TERRACE ZONING: R-4.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PRE`/NTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: :"rA I ER HEATERS: CATCH BASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: U I HF.I< FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: YvAI cR L!NF-: 50 ft
DISHWASHERS RAIN DRAIN: ft
Remarks: 50ft. water service replacement.
---__ FEES
Owner: ---_— – — -
- Des,►iption Date Amount
MCGE , . _LITH
S
12420 SW KNOLL DR � t 'J11Lil Permit Fee 6/i 112004 $72.50
TIGARD. OR 97223 I'l A1C]8%State Surcharl 6/11/204 $5.80
Total — $78.30
Phone : 503-615-6451
Contractor:
WOLCOTT PLUMBING CONTRACTORS
PO BOX 2001
GRESHAM, OR 97030 REQUIRED INSPECTIONS
Water Service Insp
Phone: 667 1781 Final Inspection
Reg#: LIC 23847
I'LM 26-208PB
This permit is issued subject to the regulations contained in 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 v.III 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 rifles adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR
952.-0001-0100. You may obtain copies of these pules or direct questions to OLINC by calling (503)
246-6699.
Issued By: ��2'� f cc �� Permittee Signature: ( t
Call (503) 639-4175 by 7.00 P.M. for an inspection needed the next business day
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4115
NIST
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received ___- .__ Date Requested- AM_�_PM BUP
Location _ Suitc MEC h,, _ -.
Contact Person --- _-_ o.�-_ - --- Ph (_- -------) �f� PLM Ai Qo �'11.6.?,6
Contractor __ _--___._ _- Ph ( .___-----) -. --__ --- SWR
BUILDING Tenant/ wn [l G '
------------..__. ELC
el - - --
Forting ELC
For ndation Access:
Ft,j Drain ELR --
C,rawl Drain 11 -�,
Slab Inspect on Notes: SIT
Post&Beam
Shear Anchors -
Ext Sheath/Shear J
Int Sheath/Shear
Framing -- ---- - -
Insulation
Drywall Nailing --- --
Firewall �' ✓
Fire Sprinkler -Y-�- '�2��~ LZ 17
Fire Alarm
Susp'd Ceiling -- �-- -- --_-___
Roof J-r 107
Other: -- --- - -7-�-- --� --
Final
PASS PART FAIL
PLUMBING 0d
Post
Under Slab -- ---- ---- --
Rough-4, `
r er i --- --- --- --- ----- - -
Sanitary Sewer
Rain Drains _--__
Catch Basin/Manhole
Storm Drain ---- --- - ---
Shower Pan
Other:
F19S fit FAIL --
Post&Beam
Rough-In - -- — - -- ---
Gas Line
Smoke Dampers - - —
Final
PASS PART FAIL -
ELECTRICAL .v
Service --__--
Rough-In
-------------------- ---
UG/Slab - - - -- ----- - --
Low Voltage
Fire Alarm
Final [� Reinspection fee of$ -regUired before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART _FAIL
SITE -_ ---
�� Please call for reinspection RE:__ _-_ _ Ej Unable to inspect-no access
Fire Supply Line / l
ADA t
L
t
I
Date L / Inspector l '/' _ - _ i
Approach/Sidewalk --� � -
Other- 1
Final LIO NOT REMOVE this Inspection L scord from the job site.
PASS PART FAIL
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mech.
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.
I
Other:
Date: -;fib 1 A.M. P.M.--,— Entry:
Addres s:
Tenant: .-- --- te: - MST: —
Con/Own: _ MEC:
-G�� PLM:
THE FOLLOWING CORRECTIONS RE REgUIRED: ELH:
L"V
04
Inspector {=' — Dater /C1 ^
/K
APPROVED _DISAF-Pn1VED,'4ALL OR REINSP, CF CO