7050 SW VENTURA DRIVE ADDRESS:
i:\records\mic.roflm\targets\building.doc
CITY OF TIGARD BUILDING INSPECTION NOTI:E
Inspection Line: 639-4175 Business Phone: 639-1171
Footing Rain Drain Cover/Service F!NAL:
Foundation Water Line Ceiling -Plumb. '
Post/Beam Mach, Shear/Sheath Framing ec .
Plbg,Urid/Flr/Slab Plbg. Top Out Insulation -Elect.
Post/Beam Struct. Mach. Rough-in Gyp. Bd. dg:
San. Sewer Gas Line Appr/Sdw!k Reins.
Other:
Date: A.M. M. Entry:
Address: G �L� �, ti 1 ./ t_._.-
Tenant: .. Ste: _ MST: _ C'
of/Own:_7 " 2—CJS(e _ MEC: j
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Inspector: 1�- _^ Date:3 _
APPROVED __ DISAPPROVED/CALL FOR REINSP, F � CO
— CITY OF TIGARD BUILDING INSPECTION NOTICE
inspection Line: 6394175 Business Phone: 639-4171
Footing Rain Drain Cover/Service IN '
Foundation
Water Line Ceiling urn .
.'ost/Beam Mech. Shear/Sheath Framing
-Mech.
PIbg.Und/Flr/Slab Plbg.lop Uut Insulation
-Eject.
-Bldg.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. g
SanA. Sewer Gas Line PPr/Sdwlk Reins,
Other: ;�---
Date: -___
�i 1-. r A.M. _ P.M. Entn-
Address: — —L.
__� --------___ _ Ste:___— MST:
Tenant:
BUP: —.
Con/Own __ .� Z- —_ MEC:.___
PLM: __------
ELC:
THE FOLLOWING COPRECTIONS ARE REQUIRED: ELR:
----------- --- --
Date: Y
APPROVED ___DISAPPROVED/CALL FOR REINSP, CF CO
CITY OF TIGARD
DEVELOPMENT SERVICES MECHANICAL.
13125 5W Hall Blvd., Tigard, 4R 97223 (503)639.4171 PERMIT
PF.RMIT' #. . . . . . . : MEC96-0:350
DATE. ISSUED: 10/16/96
PARCEL.. 1.S 125DC--Or`500
SITE ADDRESS. . . : 07050 SW VENTURA DR
SUBDIVISION. . .. . : WASHINGTON SQUARE ESTATES ZONING: R-4. 5
BLOCK. . . . . . .. . . . . I__O1". . . . . . . . . . . . . :..'6
C'I_.ASS OF WORK, . :REP FLOOR F URN. . . . : 0 EVAP COOI_.ERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRP. . :A] VENT!. W/O APPI-: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSOR HOODS. . . . . . . : 0
FUEL TYPES-.•---._----~_--- 0• HP. . . . : 0 DOMES. INCIN: 0
3- 15 HP. . . . : 0 COMM1_. INCIN: 0
MAX INPUT. 0 BTU 15-3,0 HP. . . . : 0 REPAIR UNITS: 0
FIRE DAMPERS''. . : 30_50 HP. . . . : 0 WOODSTOVES. . : 0
GA,G PRESSURE. . . : 50-1. HP. . . . : 0 CL.O DRYERS. . : 0
NO. OF UNIT'S-----------_.-- AIR HANDLING UNITS OTHER UNITS. : 0
E"I.IRN ( 1001; BTU: 1 (_ 1.000111 c f m : 0 CTAS OUTI__E TS. : 0
F;IRN ) =100K rTU: 0 > ]0000 cf m: 0
Remarks : FURNACE. REPA: R
FURNACE REPAIR
Owner: -- ---- ___.__________-------- -•------.______.____-_____.__-..-- FEES
DIANE BERENTSEN type amount by date r•ecpt
705O SW VENTURA DR PRMT $ 25. 00 TAT 10/16/96 96-x'75235
15PCT $ 1.. 25 'TAT 10/*16/9=, 96-28523E,
TIGARD OR 97223 PLCK $ F,. '25 TAT 10/16/96 96 5c'_39
Phone #: 244. O358
Contractor;
,JACOBS HEATING ti A/C
14c:1 SF_. HOLGATE BL..VD
PORTLAND OR 972O2
Phone t! : 503--234•-7331 $ 3._'. 50 TOTAL
- ------ REQUIRED INSPECTIONS -- ---
This persit is issued subject to the regulation, contained in the Mechanical Insp __.^�__ ______•__.
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mit. . Inspection
applicable laws. All work will be done in accordance with ilial Inspection -.--
approved plans. This persit will expire if work is not started
within 18@ days of issuance, or if work is su,pended for sore
than 18@ days. ___ �_�_-�•--
P e r m i t t 93 i r,n a t''i_r
T ssi-red Eby • y / "a-
e all for, inspection - F39-4175
City o, Tigard MECHANICAL PERMIT Planck/Rec. #
13125 .SW Hall Blvd. APPLICATION Permit # OC-0q6-(JYY)
Tigard, OR 97223
(503) 639-4171
S v c2-] ) '-7q 7"l 9
---� description
,Table 3A Mechanical Code OTY PRICE AMT
Job ~• ^� 1) Permit Fee G- 0- 10.00
Address1-1 V11•. —� —
h '1 % n n
L i 2) Supplemental Permit 300
a Furnace to 100,000
1) Incl ducts &vents 600 1
,A urnace + -
Owner �C_ 2) incl. ducts &vents 7 50
•• oor urnance
_V 3) incl. vent - _ 6.00
•m•in—0 a Suspended heater, wall seater
4) or Floor mounted heater 600
■ ••• -Vet-nut-Ircl In
Occupant 5) appliance permit 300
- Repair of seating, re rig -
__ 6) cooling, abscmtion unit G 00
•
Boiler or comp, neat pump, air con
7) to 3 HP: absorp unit to 100K Bl U 600
o •••., Boiler or comp, neat pump. air con
Contractor
�l7 8) 3.15 HP: absorp unit to 500K BTU 11 00
•• LJ_ -7�� �, Boiler or comp, eat pump. air con
l' L7 �(- �i / ( 9) 15-30 HP: absorp unit 5-1 mil BTU 1500
I oI e-1 r or comp. eat pump, air con
10) 30-50 HP: absorp unit 1-1.75 and BTU 22.50
I hereby acknow a gat at ave rea t !s plication, tat the Boiler or comp, heat pump, mr .on .
information given is correct, that I am the owner or authorized 11) n 50 HP: absorp unit 1.75 and BTU 3750
agent of the owner, that plans submitted are in compliance with Air han ng unit to
State laws, that I am registered with the Construction Contractor's 17.) 10.000 CFM 4 50
Board, that the number given is correct. (If exempt from State Ir handling unit
registration, please give reason below) 13) 10 000 CTM + 7 50
on porta e
14) evaporate cooler 450
ent an connected —
15) to a single duct 3.00
enu atlon system not
16) Included in apphance permit 4 50
I oo(Fserveu by
1 1 7) mechanical exhaust 4 50
escn a war new L) a ition - alteration repair Co7n7i7ercial or industrial
to be done residential non-residential O 18) type Incinerator 3000 —�
Existing use of Other I e, woo stove, water
building or property _ 19) heater, solar. clothes dryers, etc 450
Proposed use of 20) Gas piping one to four outie!s 2 00
building or property �-
21) More than 4-per outlet (each) 200
Type of fuel -oil Q natural gaa Q LPG Q electric Q --
ISE— C t
Minimum Fee 425 00 SUBTOTAL
PERMITS BECOME VOI^ IF WORK OR CONSTRUCTION -
AUTHORIZED IS Nrl, COMMENCED WITHIN 180 DAYS. OR 5% SURCHARGE
IF CONS1RUCTION OR WORK IS SUSPENDED Ort -
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25". OF SUBTOTAL �
AFTER WORK IS COMMENCED - — �,
TOTAL
Special Conditions
Date -ssued by
HL0OIM09T3.MECHPMT
CoMmurifIY Ut4;
ELECTR
L. PERMIT
CITY OF TIGARD PERMIT #:
ELC96-03J7
COMMUN!TY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/02/96
13125 3W Hall Blvd,Tigard,Oregon 97223.8199 (503)839-4171
PARCEL: 1 S 125DC-
511 E i4L)DRES5. . . : 14) "I 'DO bW VI::NTURA DR
SUBDIVISION. . . . : WASHINGTON SQUARE: E�, I N I ES ZONING.- P-4. 5
BL_OCI;. . . . . . . . . . LOI.. . . . . . . . . . . . . :26
Project Description : Reronner_I; & Ir"esider)tia1 to 100Sq. Ft. .
_._.._REaIDENI"IAL UNIT---- ----TEMP SRVC/FEEDERS---- -' ------MISCELLANEOUS-
1000 SF OR LESS. . . . : 1 21 ._- 200 amp. . . . . . . : 0 RUMP/IRRIGATION. . . . : 0
EACH ADD' L 500SF". . . : 0 201 - 400 amp. . . . . . . : O SIGN/OUT LINE= LTG. . : 0
LIMITED ENERGY. . . . . : 0 401 _ 600 amp. . . . . . . : 0 51GNAL./PANEL.. . . . . . . 0
MG1NF. HM/ SVC/FDR. . : 0 601+amps--1000 volts. : 0 MINOR LABE=L ( 10) . . . : 0
----•.--..SERV ICL/FEEDEwR -_- __.__._E?RANCH CIRCUITS.__.____ .._.-..-ADD' L INSPECTIONS- _..
0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 F'ER INSPECTION. . . . . : 0
201 - 410 Amps. . . . . . : 0 1st W/O SRVC OR FDR. : 0 PER HOUR. . . . . . . . . . . : 0
401 •- 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
601 1000 amps . . . . : 0 ___._.._.__-.--_.____._.__-_._PLAN REVIEW SEC
11200+ camp/vo 1.t. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 60C1 VOLT NOMINAL. . :
Reconnect only. . . . . : 1 SVC/FDR > = 225 AMPS. . : CLASS AREA/SPEC UCC. :
Owner,.. -___._____________.___ _..__.__-__.____ .___._.---_-__._____-.__ FEES
BERENTSEN type amof.tnt by date r•,ecpt
7050 SW VENTURA DR PRMT $ 50. 00 CJS 05/28/96 96-27988E
5PC:T $ 2. 50 CJS 05/28/96 96-279888-.
TIGARD OR 9722':3 PRMT $ 11111. 00 CJS 08/02/96 96-2824=,0
Phone #: 5PCT $ 5. 51A CJS 08/02/96 96-28,2440
Contractor: _ -_____________._____._______---____._______.__.___._________.___-.-.•---.--•---.___..
CRAFT ELECTRIC INC .1613. 00 TOTNL
PO BOX 16177
------ - REQUIRED INSPECTIONS
1='OR1l_A1\1D OR 97216 Ceiling Cover EI ect' 1 Service
Phone #: 503-6:55--1925, Wall Cover Elect' 1 Final
Reg #. . : 6864'
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of V,e. Specialty Codes and all other
applicable laws. All work will be done in accordance with
approved plans. This permit .rill expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days. I s s+-ted By
__._.---._._______.__._--•---____.._--.--.-(IWhILI� INSTALLATION ONLY--.-_
the installation is being made on property I own which is not intended for-
sale, lease, or• r-ent.
OWNER' S SIGNATURE: W _._ DATE:
INSTALLATION
SIGNATURE OF SUPR. ELEC' N: CL�J!Ct _ _ DATE: 2- 7-46
LICENSE. NO:
Call for inspection - 639--4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW .fall Blvd.
Tigard, OR 97223 Planck/Rec. #rr -a�ayyct _
Permit # €i Iv - 03S.'? _
Phone (503) 639-4171
Date Issued 3,- 915
GITY OF TIGARD FAX (5031 684-7297 Issued by Chc�r�s Sc
TDD No. (503) 6842772
Inspection (503) 639-4175
1. Job Address: C _ } 4. Complete Fee Schedule Below:
Name of DevelopmentLAS 41 I r ���Ti (� Number of Inspections per permit sllowei:
Address_ 7QS0 SW Ue4A1Y-C, PrIl tie_ Service included Items cost(ea) Sum
City/State/Zip 4a. Residential• per unit
1000 aq II or less $11000 f (�i
II or
Name (or name of business) Each additional 500 sy
portion,onthwool $2500
Commorcial❑ Residential ER Ltmded Energy $2500
Srch t' nu1'd limns of Modular ecn
lew.-of I Pod", Sfiq OO
2a. Contractor installation only:
4, rs or Feeders
C yzz / � nsla0 Am or less
or relceation 2
Electrical Contractor lS y t L �l _ 20n Amps or less 560 00
Address P,U 6;.>A 110 1) ) 201 amps to 400 amps $8000 2
401 amps 10 600 amps $12000 2
City_��Y[Nh;j_ � State L1 Zip sol amps to Inon amps $18000 _ 2
P Ione i:n. ;a SJ 1 OJ Over 1000 amps or volts $34000
Contrartor's t_it,tri,.,9 Reconnect only $50 00
Contractor's Board Reg. No, (v4c. Temporary Services or Feeders
�V✓�` _ // Installation,alteration,or relocation
Signature of Supr. Elec't•_ -, + �].p(,/, 200 amps or 1969 $5000
Jp'1 P n@ (�I0 """"'�—T'SS--- I�1—�S 201 amps to 400 amps $7500
License No. .:i`TOy rJ 401 amps to 500 amps $10000
Over 600 amps to 1000 vohe
2b. For owner installations: sea W above
4d. Branch Circuits
Print Owner's Name New,sMeration or extension per panel
Address a)The!49 for branch circuits wffh
City State Zip
purchase of service or Assde►Ass.
Each branch circuit $5 00
Phone No. _ b)The lee for branch circuits wffhow
The installation is being made on property I own which is purchase of servks or Alrredw Ase.
First
riot intended for sale, lease or rent. Each additionalonel al 531500
cbranchbranch arced 55 00
Owner's E1gnature� - _ 4e. Miscellaneous
(Service or feeder not included)
9. Plan Re vie.w section (if required): Each pump or irriga,on circle $4000 2
Each sign or outline lighting $4000 a
Signal r.Ircud(s)or a Ihnded energy
Please check appropriate item and enter fee in section 5B. panel 6heretion or extension $4000
_ 4 or more rusidential units in one structi-re Minor I.abalr.IM) $Ina no
Service and feeder 225 amps or-note
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N E C. Chapter 5 Per r-Arwo n 535 co
Pw hour $5500 _
In Plant $5500
Submit 2 sets of plans with application where iii of the above
apply. Not required for temporary construction services. 5. Fees:
NOTICE 5a. Enter total of above fees $ I 0
5%Surcharge(05 1'total fees) $ 15
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ --
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOIL Plan Revipw if required(Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ _
COMMENCED. ❑ 1 rust Account# $
Balance Due s 'i.5c,
ARM
MASTER F'EHM1 i
PER14I T #. . . . . . . MST96-0329v,
CITY GF TIGARD DATE ISSUEDT -
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 1 S 125DC--l%l2f:;00
Hap Blvd,Tigard,gropQ1722398199 (S03�839.417
SUBDIVISION. . . . : WASHINGTON SQUARE ESTATES ZONING: R-4. 5
BLOCK.. . . . . . . . . . .. LUT. . . . . . . . . . . . . .26
Remarks: REPAIR AND REMODE STORM DAMAGE PATH I
---------------------------------------------------------------- BUILDING ------------------------------------------------------------
ES.......: 2 FLOOR AREAS-----------
BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED---------
REl5SUE: STORICLASS OF WORK.:REP HEIGHT........: 16 FIRST....: 0 sf GARAGE.....: 0 sf LEFT..........: 0 SM "'r, DETECTRS: Y
TYPE OF USE...;SF FLOOR LOAD,...: 40 SECOND...: 0 Sf FRONT.........: 0 PARKING SPACES: 0
TYPE OF CONST.:5N DWELLING UN!TS: 1 FINBSMENT: 0 sf RIGHT......... : 0
OCCUPANCY CRP,:R3 BDRM: 0 BATH: 0 TOTAL------: 0 sf VALUE..t: 170744 REAR.......... 0
-------------------------------------------------------------- PLUMBING --------------------------------•----- •----------------
SINKS.........: 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAI•:i.........: 0
LAVATORIES....: 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 8
TUB/SHuWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATEN LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
-------------------------------------------------------------- MECKNICAL -------------------------------------------------------- ..._ _
FUEL. TYPES----------- FURN ( 16W ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS—-: 0 CLOTHES DRYERS: 0
/GAS/ / / FURN )=INK ..: 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLE75...: 0
--------------------------------------------------------------- ELECTRICAL -------._..--------------------------------_------
—RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- ADDIL. INSPECTIONS--
1000 SF OR LESS: 1 0 - 200 asp..: 0 0 - 10 alp..: 0 W/SVC OR FOR..; 8 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADW L 5005F.: 3 201 - 400 alp..: 6 201 - 400 amp..: 0 1st W/0 SVC/FDR: A SIGN/DUI LIN I.T: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 asp..: 0 40! - 608 alp..: 0 EEA ADDL BR ('.IR: 0 SIGNAU PANEL...: 0 IN PLANT...... : a
MAW HM/SVC/FDR: 0 601 - 1888 asp.: 0 601+asps-1080 v: 0 MINOR LABEL 10: 0
1000+ asp/volt.- 0 ------------------------------------ PLAN REVIEW SECTION -----------------------------------
Reconnect only.: 0 )=4 RES UNITS..: FVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
---------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY -------• ---------------------------------------------
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL-------------------------------- ----------------------------------•-----------
AUD1O b STEREO.: VACUM SYSTEM..: AUDIO b STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: DTH: :s BOILER.........: HVAC...........: LANDSCAPE/IRRIbi PROTECTIVE SIX:
GARAGE OPENER..: CLOCK.......... : INSTRUMENTATION: MEDICAL........: OTHR:
HVAC........... : DATA/TELE COMM.: NURSE CALLS....: TOTAL 11 SYSTEMS: 0
Owner: ---------------------—------------Contractor: --------- ----------------- TOTAL FEES 0.08
BERENTSEN HEHLEN COMPANY, THE
7050 SW VENTURA DR 65M SE 36TH AVENUE
T19RD OR 97223 PORTLAND OR 97002
Phone it: 244-03`8 Phone N: 774-2076
i Reg I.., 09584.?
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and a,i ctne�
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started witli r t°0
days of issuance, ar if work is suspended for sore than 180 days.
--------------------------------------------------------- REQUIRED INSPECTIONS -------------------------------------------------------
Mechanical Insp Low Voltage Mechanical Final
Plumb Top Out Insulation lisp Plumb Final
Electrical Servi Gyp Board Insp Building Final
Electrical Rough Rain drain Insp Erosion Control _
Frasinq Insp Electrical Final
l f i-mittee Si11nitt+are ~-- ._.. _ _ 1s.�Aed Bye
.-.
inspection - 639-4175
ResidentialBldin� ernitAionin
City of Tigard
13125 SW Nall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address:
Subdivision: _ �'C�ot# G Office Use Only
Valuation: 1.7.�� � _ Contact Date .Initials- _
Result i _I If, [?r.. •
New Construction Only: (Square Footage) �a r1 Fr 6-
Planck/Aec# �'
House . Garage. Permit#
Reissue of A/Id
Corner Lot? Y N Flag Lot? Y N Map &TL# _
n Zone
Owner: ink( vt,i. i` 1 1` i — Plat# = li' •�� `t �,r
t•7 ..fit..
Address C-� �� , i i r Al7RI�v��B�4�![�d > i °r� r✓ S )
Planning Setbacks,_ Solar
Engineering -/,4 , r • ,> .c.
Phone 1 G �/`� C/� ` � Other _
Contractor: L. h 4�_ <: l �t.rte• �_;f)t= �':.{L `� ftet]]-s-RWad
Address �� / ' ��� ��'� Jt�� Subcontractors f '�' -LC [l' 1
Truss Details
X11 t�.�..r) C►L rlw "L._ Other -
Contractor's License#
(attach copy of ourrent Oregon license)
Contact Name:
Contact Phone'
SubcontractorsArch;tect/Engineer:
Plumbing:' - 4Addrass.
Mechanical 3 cu r► ` 1' 4 —
1
(attach copy o rre OR Contractors License) _ _ —
Electrical: QcArr Et er rr C.Phone:
JOB DESCRIPTION: _i,,_ _ _Q:1/' F'�'�i k' c/ 11Lktr 1_�JR��lA
Applicant Si lure / Applicant Phone number
Received b . _ Date Received: (�� I t` `l
�.cpm am nsaoo
Permit ;* Account Oescripdon Amount Amt. Pd. tial. Die
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB) _
A� Mech. Permit (MECH)
State Tar. (TAX)
Bldg:
Plumb:
Mech:
Plan Chrck (PLANCK) i
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Darks Dev Charge (PKSDC)
Residential TIF ("TIF-R)
Mass Transit TIF (TIF MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
Water Quality (WQUAL',
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Emsion PlanckJUSA (ERPLAN)
`:rosicn Planck/COT (EROSN)
TOTALS:
1 r-•F. �ni � V��a.51�• 5G�L�,4 rti�"
WRIMARRIMUSUPUR
I I �
IN
NO Ex �►e�
AL'p�T►c7tyS ��
PL'C�rZ��'I O1-t
Ki
J�I c�'� �- f' • �II
• �"-=jet'•�.,,I z;,t== - .
IV'/ 11/�Irvl
?70S-C) �� t,c? U C�.� S-7 .
�cR-t A Nb - 977 a 3
CITY OF TIGARD - --
����/) tiU •111 V EXPENDITURE REQUEST' L�L 1. JILL,
This form, is a mfild-use form. Appropriate receipts and documentation must be attached to this form. Approved
request due Wednesday 10:00 AM to A/P for checks by Friday.
VENDOR NO.: DATE: ----
� t,
PAYABLE TO: / � __ REQUESTED BY:
55
MISCELLANEOUS EXPENDITURES:
Date Description. Invoice No.. etc. Account No. Amount
337
_ ___ ,�•G�c-u.Qd `�act `{;�.e r� ., _.—_
o „ laod
------ ad, cx
--
------
Total
Mileage 80.31
APPROPRIA I'ION BALANCE: - AS OF: 9IGNA'TI✓'RE:
(Up TO $25.00) Section Manager Purch. Agent -
($25.01-2,500.00) Division Manager —
($2,500.01-7,500.00) Dept. Head
($7,500.01-15,000.00) City A rator
($15,000.01-7) Local Contract Review Board
I:\adm\jo\expendrq
PERMIT
CITY aF TIGARD PERMITELECTRICAL#: ELC96-0337
COMMUNITY DE% ELOPMENT DEPARTMENT DATE ISSUED: 05/28/96
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171
PARCEL: IS125DC-02500
-,.)ITE ADr)RESS. . . : 07050 SW VENTURA DR
SUBDIVISION. . . . : WASHINGTON SQUARE ESTATES ZONING:R-4. 5
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :26
Project Description: Reconnect
--------------------------------------------------------------------------------------
UNIT---- ---TEMP SRVC/FEEDERS- --- ------MISCEL.LANEOUS-
1000 SF OR LESS. . . . : 0 0 200 amp. . . . . . . : 0 PIUMP/IRRIGATION. . . . 1 0
EACH ADDIL 500SF. . . - 0 201 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . s 0
LIMITED ENERGY.. . . . . : 0 401 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 601+amps1000 volts. : 0 MINOR LABEL (10) . . . a 0
-----SERVICE/FEEDER---- ----BRANCH CIRCUIT'S----- ---ADD' L INSPECTIONS---
0 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PIER INSPECTION. . . . . : 0
201 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. c 0 PER HOUR. . . . . . . . . . . : 0
401 600 qnip. . . . . . : 0 EA ADDIL BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
601 1000 amp. . . . . : 0 REVIEW SECTION----_______,_____
1000+-
N-----------
10004- aMp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . i ) 600 VOLT NOMINAL— :
Reconnect only. . . . . : 1 SVC/FDR 225 AMPS. . s CLASS AREA/SPEC OCC. :
Owner: FEES
BERENTSEN type amolt.11t by date recpt
7050 11.361 VENTURA DR PRMT $ 50. 00 CJS 05/28/96 96-279882
5PCT $ 2- 50 CJS 05/28/96 96-279882
1".GARD OR 9'7223
Phone #:
L.ontractoril
CRAFT ELECTRIC INC $ 52 . 50, TOTAL
PO BOX 16 177
REQUIRED INSPECTIONS
PORTLAND OR 97216 ectl I Sery ice
Phone #ii 503-255-192b Elect' l Final
Reg #. . : 68645
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Lodes and all other Permittee Signat Lir,e
applicable laws. All work will be done in accordance with
approved plans, this permit will eili -e ,f work is not started
within iqPj days of issuance, or if work is suspended for more
than 180 days. Issued By
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
SIGNATURE OF SUPR. ELEC' Niitrt,lc��..__.___ DATE: !s :ld,- og
LICE19SE NO
Call for inspection - 639-4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. # 14/-:-, ,%��£eRa
Permit # fire • -23 37
Phone (503) 639-4171 Date Issued 5- ay- (IG
FAX (503) 684-7297 Issued by c j,.—
CITY
,CITY OF TIGARD TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Natne of Development Number of Inspections per permit allowed_
Address Ve,^6yt^ Service InCIUdAd Items Cost(ea) Sum
4a. Residential- per unit 4
y/State/Zip T� cut C�4-0 f,m'v\ 33 3 $„0 00
1000 sy It Or(Res
Each additional 500 ep it or t
Name (or name of business) ����^^+ � St portion thereof
i250o _
Limited Energy $2500 2
Commercial❑ Residential ts Each Manul'd Home or Modular
Dwelling uervio or Feeder $61300
28. Contractor Installation only: 4b.Services or Feeders
/(11_� �n Irre;tallabon,alteration,or relocation 2
1�/L.. VLL IY rL C 200 amps or leen ti60 00 2
Electrical Contractor $8000 2
n �� _x 1 201 amps to 400 amps 2
Address r I �� act em{n to 600 amps $120 00 _ _
cityState Zip_ 601 amps 10 1000 amps $18000 _ 2
� Over 1000 sm or volta $34000
2
Phone No. )'� — Reconnect only $50 00
Contractor's License No._ -
Contractor'S Board Reg. N0. fc7 _ 4c. Temporary Services or Feeders 2
rrstallnuon,alleralion,or relocation 2
200 amps or leve $5000
Signature of Supr. Elec'n ��_✓ .� $�5oo 2
201 amps la 400 ern pe
I license No, _3L/��"S Pho No.��S /`I t�5_ 401 amps to 1100 amps $10000 _
Over 600 IYnpa to 1000 volln
2b. For owner installations: See•h•a""e
4d. Branch Circuits
Print Owner's Nagle _ M New.alteration or extension per panel
Address a)The lee for branch circuits with 2
purchase of osrvke or Wolof he.
(:Ity State_ Zip____ Each branch circuit $500
Phone N0. b)The lee for branch circuits wilhout 2
2�.
The installation is being made on property I own which is purchau of service or hoeFsst branch circuit Y $3500
not intended for sale, lease or rent. Each addm oral branch circuit 111i")00
Owner's Signature_.------- 4e. Miscellaneous
,Hrvlce or feeder not in
2
l�� r
Each pump or irrigation circle $4000
3. Plan Review section (if required): Each sign or outline lighting $4000 _ 2
Signal cm;u4(s)or a limited energy $40 DO
please check appropriate item and enter tee in section 58 panel.alteration or extension $10000
4 or more residential units in one structure Minor Lahels(10)
_ Service and feeder 225 amps or more 41. Each additional inspection over
r_System over 600 volts nominal the allowable in any of the above
Classified area or structure containing special occupancy t $3500
as described in N E C Chapter 5 $55 00
„
$5500
Submit 2 sets of plans with application where any of the above
apply. Not required tot temporary construction services. 5. Fees:
Sa. Enter total of above leas $
NOTICE 5%Surcharge(.05 X total fees) $
Subtotal $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25%of line A for
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF plan Review if required(Sec 3) $ _
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $ --
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
❑ Trust Account M $
COMMENCED.
Balance DUe $ S_ C
eedearrMw�om rro
Mf-M ;F_
CITY OF TIGARD BUILDING INSPFCT1n�1_—••- k
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-41-71
Inspection:
Footing Susp. Ceiling
Sprink, Rough-in Appr/Sdwlk
Foundation
Plbg. Underslab Mech. Rough-in Fireplace
Rough-in FINAL:
Post/Beam Struct. Plbg. 'fop Out Elec.
Post/Beam Mech. San. Sewer
Gas Line -Bldg.
Plbg. Undertlool
Rain Drain Framing -Plumb.
Alarm Water Line
Insulation -Mech.
Undertlr. Insul. Shear YVall, Gyp. [3d. L�01)Elect.
Time: Ano PM
Date Requested:__
Add1ess: 0S6 y QM Vt
Permit #:
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED.
�'►� "h Date.
Inspector -
_ APPROVED DISAPPROVED _APPROVED SUBJECT TO ABOVE
Call For Reinsp.
A
City of Tigard, Oregon VVZo<
Detailed Damage Assessment Form
BUILDING DESCRIPTION: — - - OVERALLRATING: (Checkone)
INSPECTED(Green) U
LIMITED ENTRY (Yellow) 4
Name: ----- _ UNSAFE (Red) U
Address-
DATE ly ay —_TIME am pm
No.of Stories:
Basement: Yes No U Unknown U REPORTED BY -
Approximate Age: years
Approximate Area: — square feet INSPECTION TEAM MEMBERS
Structural System: -- --- - -----" - t
Wood Frame Unreinforced masonry Ll
Reinforced Masonry f,U Tilt-up l.0
Concrete Frame U Concrete Shear Wall ❑
Steel Frame U Other
Primary Occupancy:
Notified occupants to vacate
Dwelling Other Residential U Commercial U premises U
Office U Industrial U Public Assembly U Occupants indicate temporary housing
School U Government U Emer.Serv. U is required 0
Hospital U Other_`_ -���- — ------ --_— ------ - -
Instructions: Complete building evaluation and checklist on next page and then summarize results below.
Posting ^� Existing Reconrniendcd
Posted at this Assessment:
None U
Inspected(Green) U U Yes U No
Limited Entry(Yelloul) U Existing posting by:
Unsafe(Red) ❑ ---
Area Unsafe U U ----
Recommendations:
U No further action required -
Engineering Evaluation required (circle on ) Strueblra Geotechnical Other --
U Barricades needed in the following areas — ------- "—"
U Other(falling hazard remoinal,shorinX/1)ra(4rig required,etc.):
Comments(Why posted Unsafe,etc.): T141
a
Sheet ---