The URL can be used to link to this page

14535 SW KLIPSAN LANE w CA cn N d r c� 14535 SW Klipsan Lane ..r° 1t3.-%o @J 24-Hour BUILDING Inspection Linc: (503)639-4175 MST INSPECTION DIVISION Busino.*!ss Line: (503) 639-4171 - BUP Receiver __._ Date Re�q/uested � _ AM PM BLIP - --_ LocationyS3..`�---A,� .- -- --Suite MEC Contact Person (/ Ph(--_ _) S��—�1. --�- PLM --- Contractor___ _ Ph ( ) ._ SWR BUILDING Tenant/Owner -__ -_ _ _-_-__--_ —_ ELC Footing LC Foundation -- Fig Drain Ac,cass. ELF! Crawl Drain — Slab Inspection Notes: SIT Post&Beam Shear Anchors - Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing - -- Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling - Roof OtherAL , PART FAIL _CUMBING Post&Beam — Under Slab - - --- --- Rough-In Water Service Sanitary Sewer —` Rain Drains - Catch Basin/Manhole Storm Drain - -- - ShowerPan Final PASS PART FAIL MECHANICAL Post& Beam Rough-In Gas Line Smoke Dampers PA PART FAIL - — CTRICAL --------------- - Service Rough-in UG/Slsb Low Vc!tage - Fire Alurm Final Reinspection fee of$. _required before next inspection. Pay at City Hall, 13125 SW I fall Blvd. PASS PART FAIL SITE_ i [j Please call for reinspection RE:. —�. _ [� Unable to inspect--no access Fire Supply Line t--/ ADA Approach/Sidewalk Date Inspector !Gr 7�Z--1 - Ext — Other: Final - - DO NOT REMOVE this Inspection record from the Job sit-. PASS PART FAIL ►♦AAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAA 41' (� ► �46 T1p ! rb rp / d rD ► P ¢. CD � ;y -4 -14 ` P 04 Pool � o ► 1 b � ► d 7 R �reeeeeeeeeeee�ieeee�►eeeeeiieeii►�eeeiieeeeiie� w cv{ a � Qy rr a 4 o `cr IN � I o a Fr o 4 9 i a 4 i• T "10 CITY OF TIGcARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST -2---0-0 INSPECTION DIVISION Business Dine: (503)639-4171 BUP Received // _____ Date Requested .__3 f __ AM_ __——. PM BUP - Location ------.-Suite MEC Contact Person _ _— _ Ph( —) `1 'L4 L_ PLM Contractor___ -- -- - ----- Ph(.--) _—_—.-- SWR –_-- --___-- BUILDING _ Tenant/Owner _ ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain - Slab Inspection Nole!; SIT Post&Beam ohaar Anchors -- Ext Sheath/Shear Int Sheath/Shear Framing ---- Insulation Drywall Nailing - -- -- - — Firewall Fire Sprinkler - -- Fire Alarm Susp'd Ceiling _ - __ _ -- -------- --- --- -- - Roof Other: - - - ----- Final --____-_-__---- PASS .- PAT FAIL - - - ------------------ Post&Beam Under Slab ---- ---- Rough-In Water Service - -- Sanitary Sewer Rain Drai-is - ---- _ - - Catch Basin/Manhole Storm Drain - --- - - ------ - Shower Pan Other- ---- i SPART FAIL ANIC:AL _— Post& [learn Rough-In - --- --�_ -- Gas Line Smoke Dampers -- ---- — — — -- Final PASS PART FAIL -- ELECTRICAL Service -----•- -_ —_—.___� .� Rough-In UG/S Ig --------- -_ -- Fire Alarm fin 'Q ALL ❑ ReInspection fee of s required before next inspection, Pay at City Hail, 13125 SW Hall Blvd. A PART FAIL -- __ �_-_____ Please call for reinspection RE: �_ ___ -- ❑ Unable to inspect-no access S I�' Lines p '9ii1 Ik Date � l l_-U � -- Inspector __—_-- er: DO NOT ki~MOVic this Inspection record from the job site. A iS at FAIL � r 11/27/2002 10:48 5035988705 GEOPACIFI� ENG PAGE 01/01 Ge0Pifito 7312 8W Durham Road Portland,Oregon 97224 Tel(503)596-W5 • Fax(503)598.9705 November 27, 2002 Project No. 99-2791 D.R, Horton 5125 SW Macadam Av . Ste 145 Portland, GR 97201 Fax No. (503)579-6002 Attention: Emery Smith C�QTECHNICAL REV EW OF FOUNDATION EXCAVATIONS ( Pacif c Crest--Lot 53 City a gard, Or^gon At your roquest, t;eoP cific Enginoer, Jim Imbrie, orrivbd on site on November 271", 200c to review the foundation excavati n subgrade on the above-referenced lot 1-he lot exposed mostly medium stiff-to-stiff native soilsand were excavated through most of the roadway embankment slope, which was less compact for the first three to fou; feet deep. In r;ur opinion, the exposed subgrades are suitable for spread foundation support to an allowable bearing pressure of 11,500 psf. The rear footing-to-slope setbacks should he more than adequate due to the gentle slope glad e►it for at least 30 feet beyond the rear footing. The interior steps appeared to be appropriately placed so as not to influence footings located above such stens. This review v►�.is p,3rf orr ied to the local standards of practice for geotechnical engineer irig. If you have any questiprls, plc--rise 0all. Sincerely, GeoPacific Engineeri g, Inc. /E0 PROF\ NGINEpIr Q' 14743 Jarnes D. Imbrie, P,F ;, L Geotechnical Engineer OREGON l ��ROMASTER CITY OF PERMIT#: MST2002-0171433 DEVELOPMENT SERVICES DATE ISSUED: 11/19/02 -�'-- 11125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 14535 SW KLIPSAN LN PARCEL: 2S105DA-16500 SUBDIVISION: PACIFIC CREST ZONING: R-7 BLOCK: LOT: 0-, JURISDICTION: I'IG REMARKS: N of attached, Path 1. BUILDING _ REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 26 FIRST: 1.287 at BASEMENT of LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,662 of GARAGE: 815 of FRONT. 29 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: of RIGHT: 30 VALUE: 292,292 10 F,1 OCCUPANCY ORP: R3 BDRM: 4 BATH: 3 TOTAL: 1,949 d REAR: PLI;MBINr- SINKS: 1 WATER CI-03ETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 109 TRAPS: LAVATORIES 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: I CATCH BASINS: TUSISHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: I WATER LINES: 100 BCKFLW PREVNT'R: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN c 100K: BOIL/CMP c 3HP: VENT FANS: 5 CLOt'HES DRYER: I GAS FURN>r100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2 MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: I ELECTRICAL _ RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 200 amp: WISVC OR FDR: I PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 50CSF: 6 201 400 amp: 201 400 amn: 1st WIO SVCJFDR: 00 SIGNIOUI LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT. MANU HM/SVC/FUR: 601 • 1000 amp, 1101+ampe•1000v: MINOR LABEL' 1000+amplvolt PLAN REVIEW SECTION Reconnect only: >•4 RES UNITS: SVCIFDR>•225 A.: >600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY _ A.SF RESIDENTIAL B.COMMERCIAL AUDIO&STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 0TH: ALL ENCOMP BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL OTHR: HVAC: DATAITELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,112.29 D R NORTON HOMES D.R.NORTON INC This permit is subject to the regulations containP,+In the Tigard Municipal Code,State of OR. Specialty Codes and 5125 SW MACADAM STE 145 4386 SW MACADAM all other applicable laws All work will be done in PORTLAND,OR 97201 SUITE#102 accordance with approved plans. This permit wil,expire if PORTLAND,OR 97201 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 follow rules adopted by the Phone: 501-222-4151 Phone: 503-221.-4151 Oregon Utility Notification Center. Those rules are set forth in OAR 952.001-0010 through 952-001-0030. You Rep N: 112 1 T0859 may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Post/Beam Structural Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Grading Inspection Post/Beam Mechanica Plumb Top Out Exterior Sheathing Inst Rain drain Insp Plumb Final Sewer Inspection Underfloor Insulation Electrical Service Low Voltage Water Line Insp Final inspection Footing Insp FootinglFoundation Dr; Electrical Rough In Gas Line Insp Appr/SdWk Insp Foundation Insp PLM/Underfloor Framing Insp Gas Fireplace Electrical Final Issued gy : 1 \-(� �� _�_—_ Permittee Signature : _Call (503)(503) 639••4175 by 7:00 p.m. for an inspection needed the next business day CITY OF TI GARD SEWER CONNECTION PERMIT PERMIT#: SWP.2002 oo2ae DEVELOPMENT SERVICES DATE ISSUED: 11119/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S 105DA-16500 SITE ADDKESS; 14535 SW KLIPSAN LN SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: TENANT NAME: USA NO. FIXTURE UNITS: CLASS OF WORK: NEW QWEI LING UNITS: 1 TYPE OF USE: SF NO. OF BUILDINGS: INSTALL TYPE: I.TPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF. Owner: --- -- — FEES _ D R HORTON HOMES Description Date Amount 5125 SW MACADAM STE 145 -- — - PORTLAND, OR 97201 SWUSA] Swr Connect 11/19/02 $2,300.00 ISWINSPI Swr Inspect 11/19/02 $35.00 Phone: 503-22-4151 Total $2,335.00 Contractor: Phare: Reg #: Required Inspections This Applicant agrees to comply with all ft- rules and regulations of the Clean Water ServiceF. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The -+gency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"Tap and Side Sewer" Perm r1 Permittee Signature: Issued by: i —/ , .— -�� Call (503) 639-4175 by 7.00 P.M. for an inspection needed the next business day 7 /.3 I Building Permit Application ^� Date,received: Permit ne.:tj5 rAe,,° City of Tigard Address: 13125 SW Hall Blvd,'rigard,OR 97L" Project/appl.no.: Expire date: Ciryn(Tigard Phone: (503) 639-4171 Date issued: By: Receipt no: Fax: (503) 598-1960 / Case file no.: Payment type: Land use approval: J 1&1-family:Simple Complex: U I &2 family dwelling or accessory 0 Commercial/industrial U Multi-family **New construction U Demolition U Addition/alteration/replacement ❑Tenant improvement _J Fit'spnnkler/alarm U Other: 11011 SITE INFORMATION Job address: l;ldg. no.: Suite no.: --- Lot: Block: Subdivision: q I Tax map/tax lot/account no.: m Project nae: I - - Description and location of work on premisesApecial conditions: Name: -?-• f'j" yrzl�, c e-7 _._ t - Mailing address: 11 &2 family dwelling: City: •t Q State: L1P: Valuation of work.........::' L.......!....... $ _� a Phone: ( Fax: mail: No.of bedrooms/baths................................. 6"; Owner's representative: MtW, r t Total number of floors... ........................... Phone: I� Fax: E-mail: New dwelling area(sq. ft.) ....•••.. Garage/carport area(sy.ft.).......t f± ....... Name: (�• Q 1'�Y i s t'� Covered parch area(sq.It.) ........•...... ......... Mailing address: C a k 0 V�' Deck area(sq. ft.) ........................................ _ City: Slate: ZIP: Other structure area(sq.ft.)........................ Phone; Fax: E-mail: CommerciaUlnduiltriaUmulti-family: 1 1 , Valuatio-of work........................................ $ 1911 1 1314 11 Existing bldg.area(sq.ft.) .......................... Business name: �V t-15 h New bldg.arca(sq.ft.) ............................. Address: G S ' Number of stories............................ ......... City: State:QK I"LIP:q1t 01 Type of construction............... Phone: - �, Fax: ZZZ Email: _ Occupancy groups) Existing: CCB no.: p _— New: _ City/metro tic,no.: �NolicvActors and subcot 'ors are reyurred to be Oregon Construction Contractors Board under Name: J.t provisions of ORS 701 and may be required to be licensed in the Address: �j� r �� jurisdiction where work is being performed.If the applicant is City: State: I ZIP: exempt from licensing,the following reason applies: Contact person: I,' Plan no.: — Phonc: / •t Tax: I E-mail: 1111111101EM10, 11111M rNamMe: -�/,(t/ (x&14 -ontact persow Vd t,,e- Fees due upon application ........................... $ Address: L_$I< 12,ofh Date received: _ City: _ State:0)1?— ZIP: / Amount received ............... ......................... $ i Phone: i j- Fax: /f y E mrtil: Please refer to fee schedule. 1 hereby certify I have read and examined this application and the Not all lunsdicnans accept credit cards.please call junwicti,n for more tnfomuuon. attached checklist.All provisions of laws and ordinances goveming this 0 Visa U Mastercard work will be complied wi , whether specified herein or not. Credit card numbet Authorized signature: _ Date: __,� Name of cardholder u shown on credit cud Print name: p� _ tudhoider signature S Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been aco.-pled as complete. W4613 NWCOMI L Mechanical Permit Application Date received: p. Permit no: City of Tigard Project/appl.no.. Expire date: City ofTi•,ard Address: 13125 SW Hall Blvd,Tigard,OR 97223 -- Phone: (503) 639-4171 Hate issued: Hy: Receipt nom_ Fax: (503) 598-1960 Case flit no: Payment type: Land use approval: _ _ Building permit nu. TYPE OF PERMIT ❑ I &2 family dwelling c, .ssory ❑Commercial/industrial U lulu-family ❑Tenant improvement ❑New construction ❑Addition/alteration/replacement U Other: 111W NF ORMAION COMMERCIAL VALUATION SU111111"DITE Job address: ' Indicate equipment quantities in boxes below. Indicate the dollar Bldg, no.: I Suite n,i.: value of all mechanical materials,equipment,labor,overhead, "Pax map/tax lot/account no.: profit. Value$ Lot: 6S 113lock: Subdivision: i(l( *See checklist for important application information and Project name: L- jurisdiction's fee schedule for residential permit fee. City/county: P: ZI + I I Description and ovation of work on premises: 1 t 1 s I Fer•(ea.) Total Est.date of completion/inspection: Description fry. Res.only Res.otily Tenant impro-anent of change of use: Is existing space heated or conditioned?❑Yes ❑No Air handling unit —CFM Is existing space insulated?O Yes ❑No Air conditioning(site plan required) A teration of existing HVAC system 1 1 oder compressors Business%ame: State boiler permit no.: HP —-Tons BTU/H Address: ire/smo a dampers/duct smoke detectors City: A IDW, Slate:( ZIP: 0 1 Heat pump(site plan required) Phone: r'1 Fax:_ E-mail: nstal replacetumace/bumer CCB nu.c �p Including ductwork/vent liner ❑Yes❑No Instal lrreplac reocateheaters-suspended, City/metro lic.no.: wall,or floor mounted Name(please print): - -- _ - e•t for ap liance of CONTACT er an furnace Refr Reration: Ah r,rpuonunits __. 13TU/H Name: NI 6 0I er�� p C'lulier,_-_ HP -- Address: Gj Cnin�rct,ors HP t nvirun' meolaex ia�and ventlation: City: 10State:ek I ZIP: If IX-10 Appliance vent _ Phone' -U;-14111 Fax: - •39P E-mail: ryerexhaust i 1JAOI 91 t 4 Hoods,Type U I Ures. itc eri/ azmat hood fire suppression system ;Nane: LY}�,� a/h( Exhaust fan with single duct(bath fans) _^ Mailing address: y.5- /W add M e- Exhaust system apart from heating or AC City: or,74 lid IState:-VA- ZIF': Fuel piping an st ut on(up to 4 outlets) T 1"ype: LPG NC, Oil Phone: Z - /s" Fax: Q,-3 /I i Email: ue i in ear additional over 4 outlets rumber of outlets ENGINEER ocesspiping(schematic requiredi Name: �i C / f N Address: L other listedapp ance or equipment: Decorative fireplace Cirv•-7/6 State: Zip: '70/� Insert _--_ Phone: Fax: LAC E-mail: oo stov pe etstove Applicant's s',gr.ature: e: Other Ot er: Name (part)72Z_ Not WI judZcurms inept credit cards,plew call lunsdictmn fnr marc infoffruuron. Permit fee.....................S _ ❑Visa C7 MasterCard Notice:This permit application Minimum fee................S _ Credit card number expires if a permit is not obtained plan review(at _ %) S within I80 days after it has been State surcharge(8R6)....S Nru^e of cardholder as shown nn credit cord accepted as Complete. s 'TOTAL .......................$ — Codholder signature Amount d40J617 i6AafCCJM1 i Plumbing Permit Application Date received: /VA/6y Permit no.:hyT6�cJ cd �� City of Tigard Se.+er permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 CaY of Tigard phone: (503) 639-4171 Prolect/appl.no.: Expire date: Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: TY Is E 1 U 1 &2 family dwelling or accessory O Commercial/industrial U Multi-family UTenant improvement New construction U ArldiUnn/alteration/replacement U Food service U Other: INFORMATIONJOB SITE t Joh address: G,` Description Qty. Fec(ea.) Total Bldg.no.: --✓��- New 1-and 2-family dwellings only: Swtt: Tax map/tax IoUaccount no,: no.: (inclludl s 100 Il.for each utility connection) SFR( bath Lot: Block: Subdivision: t! 4- SFR(2)bath Project name: G � _ SFR(3)bath City/county: / ZIP: Each additional badVkitchen Description and k1calint.of work on premises: _ Siteutilitiesr _ Catch basin/area drain Est.date of completion inspection: Drywells/leach line/trench drain 1 Footing drain(no.lin. ft.) Manufactured home utilities Business name:_ � M _ Manholes Addrtsss: 4w Arm_yd Rain drain connector City: State: LIP: qp Sanitwy sewer(no. lin. ft.) Phone: 10 - Iq Fax: E-mail Storm sev,ci (no. lin. ft.) CCB no.: I I OD I Plumb.bus.reg.no: Water service(no. lin. ft.)y City/metro lic.no.: Fixture or item: Contractor's representative signature' Absorption valve _Back flow preventer _ Print name: Date: Backwater valve Ala&to 0 W WMIN Basins/lavatory Name: Clothes washer Dishwasher _ Address: /7. Drinking fountain(s) City:&fJo'h State;04 I ZT11,441 Ejectors/sump _ Phone: 7LZ / Fax: .- r,7E-mail: Expansion tank Fixture/sewer cap Name(print): ➢. le . 1-f r4-rh 1-t-,orws Floor drains/floor sinks/hub Garbage disposal Mailing address: Hose bibb City: dj✓ State: ZIP: Ice maker _ Phone: Fax: 277-21/,7 E-mail: Interceptor/grease trap M _ Owner instillation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) 0%ktit-r's signature: Date: Sunt Tubs/shower/shower pan Name: �gjtle ' "P Drina) VVi'"f closet Address: __— W .seater _ City: ( State: Z1P: / Other: Phone: -� jp.� Fax: Em-rnai1: Total Not all jurisdictions accept credit cards,please toll jurisdiction for more infonmatmnNotice:This permi Minimum fee................$ t application pian review(at _ %) $ ❑Visa U MasterCard expires if a permit is not obtained Credit card number _ �_ _—L_L—. within 180 days after it has been State surcharge(8%) ....$ _ Nof cardholder as shown on credit card Expires------------ accepted as complete. TOTAL ....................... ame S Cardholtdet signature Amount 440-4616IfrV0+COMl Electrical Permit application Daft;received:I D I i b a Pa•nut no.Ary„p r.r 2 City Of Tigard Projectlappl.no.: Expire date: City ofTigrrrd Address: 13125 SW Miall Blvd,Tigard,OR 97223 Date issued: By: Receiptno.: Phone: (503) 639-4171 Fax: (503) 598.1960 Case file no.: Payment type: Land use approval: -- 1 O 1 fir.2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant irnproveme:ut New construction O Ad,biti,rr,taltcr iti m/replacement U Other:— U Partial - 1 1 t Joh address: ) Bldg. no.: Suite no.: Tax map/tax lot/account no.: Lot: Block: Su division: Project name: e� Description and location of work on prenuses: _ Estimated date of t ompletion/inspection: t 1 ' APPLICLI�ON FEE 1 ULE Job no: Fee oras - -- __ _ Description f)ty. It�.l 7utal no.insp Bu51nCSs(lame: - ✓s.(� - New residential-single ormulti-tanuIv per Address: AA _. dwelling unit.Includesattachedgnrage. Cit -y State:0 •l.IP:� _ Service included: I1X10 sq.(t.or Icss _ Phone: Fax: E.-mail: Each additional 500 sq.ft.or portion thereof CCB no.: �_ EICc.bus, Ili.nU: �- Limited energy,residentinl 2 City/metro lic.no.: Luniwdenergy,non-residential 2 F;uch manufactured home or modular dwelling and/or feeder S( naoi rrro suptrvblrrr deetrlcian irequlred)� _ Date _ Serrlcea or feeders-installation, Sup,elect.name(pant): License no: alteration or relocation: PROPERTY OWNER 200 amps or less — 2 201 amps to 400 amps 2 Name(pent): �_ amps to 6(X1 amps — 2 401 Mailing address: —Q � 601 amps to 1000 amps _ 2 City: K Slate: ZIP: Over 1000 amps or volts 2_ Reconnect only Phone: Fax:V-' E-mail: — 1'empornry srrrlces nr feeders Owner installation:The installation is bang made rut property I own indallotion,alteratIon.orrelocal ion: which is not intended for sale,lease,rent,or exchange according to 'oo amps or less 2 ORS 44",455,479,670,701. 201 amps to 400 am a 2 Owner's signature: Date: _ 401 to 600 amps 2 B "nch circuits-new,alteration, or extension per panel: Naine: �-f Q�l5 V14 A. Fee for branch circuits with purchase of Address P/ hi -_ service or(ceder fee,each branch circuit City: .�L�� State: ZIP: Q B. Fee for branch circuits without purchase _ of service or feeder fee,first branch circuit: 2 i hone: _ �' hax 1:-mail. Each ad!itianal branch circuit: M1tbt (Service or feeder not included): PLAN REVIEW(Plea%e check all that app Each pump or irrigation circle _ 2 U Service over 225 amps-conunerctal U Health catefacilit Each sign or outline lighting 2 U service over 320 amps-rating of 1&2 U Hazardous location -Signal sign ciror ( t or a limited energy panel, familydwellings UBuilding over lu.wosquare feet four or U System over 600 volts nominal more residential units in one structure alteration,or extension* _ 2 U Building over three stories U Feeders,400 amps or more *Description _ U Occupant load over 09 persons 0 Manufactured structures or RV park Fich odditlonal Inspection over the allowable in any of the above: U Egressilighting plan U Other s_ _ P•r inmecuon suhmit - sets of plans with any of the above. 1n,esugationfee The above are not applicable to temporary construction service. Other Permit fee..................... Not dcredit l jurisdictions accept t cards,please call jurisdiction tot more infcxrwtton. Notice:This permit application Plan review(at _ %) $ O Visa U MasterCard expires if a permit is not obtained / / within I SV days after it has been State surcharge(8%) ....S Credit cud number: Expires _ accepted as complete. TOTAL .......................$t __ Noma of cardholder v shown on credit card s Cudhu rler signature Amount 4004615(6100/COM) Ln 1 r � fr if 'A / - -t_ _ �_.. __.. �._• _.. f Y I•h� ' � ! .,.,�. ..-.. � ._. _ ......_-..�.•....._..� .._.__ .... I. L. _ ...:._. ._;;� } A'1CP,<.-APhy FMTuF !.'d ,'^� 56,ALL I?E FINISHED OF •l2R4.,t^Jfq, ''31 FR-' i >Y rRiOIR TG Ar. ml Y-4 (711 E W5!(DN Cc SOL F1 115t4E!! Si AL' 3E L THAN . TU rel ._E3 ,<_� . .;flJ� T',:'N I t'.f'� /i .F.r'eF. a '�•U IN JTF�E'I :IDE v f' ' 1 ( f;xRlC'.aY1C�tt r� I ItFAI. J o I-- e y