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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 6394175 Business Phone: 639-4171
Date Requested: O _ A.M. P.M. MST:
Location: �� -- — -_
Tenant: _ Suite: Bldg: MEC:
Contractorjl t� Phone p PLM:
Owner: l�` �7`" XT= ��_�d ELC:
—�_ - -- ELR:--
S .
IN
BUILDING BLDG(con't) PLUMBG MECHANICAL + XCTRr I— Cw�� SITE
Site Post/Beam Fost/Beam 1'ost/13cam Cover/Service Sewer/Storm
Footing Roof UndFl/Slab Rough-ht Ceiling Wate.:,inc
Slab Framing Top Out Gas bine Rough-!n i1G Sprinkler
Foundelion Insulation Sewer llood/Duct Reconnect Vault
Bsmt Oamp Drywall Storm Furnace Temp Service MIST'
Masonry Cciling Rain Drain A/C 1W,Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found Dr Bent Plump Lo v Volt _
Approval Approved Approved Approved Approved
Appr/Sdwlk Not Approved Not Approved Not Approved Not Aktvroved Not Appr,ved
FINAL FINAL FINAL FINA1 FINAL
CL
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O 'all for reinspection 1 Reinspection fee of S required before next insixxtion !1 table to inspect
Inspector: ___- -_. __—_ — Date lLIP `� Pae of
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspectior Line: 639-4175 Business Phone: 639-4171
Date Requested: 7_ I� f / A.M. P.M. MST:
Location: r S2 BUR
Tenant: Suite: Bldg: —
Contractor:. % j (7 (h Phone: PLM.
Owner:_ 1 1V,L_ Phone: ELC:^
ULR:
CV,etc, 0 SIT:
BUILDING BLDG(con's) PLU ING LWCHANICAL ELECTRICAL SITE I
Site Post/Beam Post/licam I5sSVn nr- - Cover/Service Sewer/Storm
I opting Roof UndFUSlab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line. Rough-In UG Sprinkler
Foundation Insulation. Sewer IloodA)uct Reconnect Vault
Iismt Damp Drywall Storn, Furnace Temp Service misc.
Masonry Ceiling Rain lkain A/C IJG Slab
Shear/Sheath Fire Spkh/Alm CrawUFound Dr I Icnt Pump Low Volt
Approved Approved! Approved Apploved Approved
Appr/Sdwlk Not Approved Not Approved Not IR2Lovcd Not Approved Not Approved
FINAL FINAL dr NAL FINAL FINAL
1
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C]Call for reinspec ' O Reinspection fee of S required before next inspection 0 Unable to inspect
Inspector: L __ Date: – _ Page— of _�
CITY OF TIGARD MECHPNICAL.
DEVELOPMENT SERVICES PERhITT
#. . . .. 2-
13125 SW Hall Blvd., Tigard,OR 97223 ,'503)6394171 DPERMTTATE 113SLIc-.1). . ME r,97 -04 A.
1 1
PARCEL: 1r)I36CD--002I8
TTE ADDPESS. . — 10'17`1 9W WIND AVE'.-.
'JBI)T V I S I ON. . . 700INO: R 4,, 7
r) -7
CK. i_aT. . . . . . . . . . . . . .01 JURISDICTION: TIG
._ASS) Or- WORV. . �PLT FLOOR FURN. . . . : 0 EWW, COOLERS. 0
YPE OF UE-)E. . . . :qF UNIT HEPWTERS. . : 0 VENT FANS. . . :
'CUPANr-Y ORP. . :R-,3, V17NTIZ W10 APDL: 0 VENT SYSTrW3): 0
TORIES. . . . . . . . : 0 BL)TL.ER�."j/C011r,PESPj(.'IRP3 H 0 0 DS. . . . . . . : 0
' iEL TYPES.._._...,.... 03 HP. . . . 0 C,1211"). TNCIN. 0
A S 3-15 HP. . . . COMML. INCTN- 0
,AX INPUT; 0 DTI.! 1.3-30 HP. . . Wr7r"(41P UNTT!-,;: o
'RE DAMPFR,":,,'. . . 0 WOODSTOVES. . . 0
PRES"'U"E. . . 130 r HP. . . . 0 CU.) DRYERS. . . 0
7)- OF UNITS-------- PIR HANDI-1ts4ra UNITS nTHER UNITS. 0
!"RN ( 100K PTIJ: 1 101"2100 r_-Fim : 0 GZAS OUrLETS. t
JRN BTL1. 0 10000 c f m : 0
,ema,r,kCooper
rr
tyirr. amolant 1-.)
1132,5 SW nVr-' PRMT $ 'F5. 00 11/05/97 97-300630
OR 97�1213 5PCT $ 1.. JSD 11/05/97 97- 3 0 41 C,0,0
#
I Titt-.AC''t 01-".
ssw srnv��.o-rmi spni.r. ,-4wY -
26. 0`5 TOTAL..
nVrIRTON 0�1 17005
PrDUIREJ.) TNSPI"."f7TONS
is persit is issue's subject to the regulations contained in the 111e&ianival. Insp
gard Municipal Code, State of Or?. SpEcialty Codes and all other llvnAtillu Unt Tr17,P
ipOicable laws. P11 work will he done in accordance with ri.11AI InSPF rt inn
-approved plans. This pe,-Ct wil! cwpire if work is not started
thin IV days 0 isvian,-F, or if tivp is suspended for care
Ln w days. ATTEWION: Oregon la,, requires you to follow rules
ptPd by the Oregon Utility Notification "enter, Tose rules are
Irf-th in OAR 95c 881- 010 through CAR S5C.2441-MR. You say
_J 'air, ropier of these rules cr direct q,,Pstiorls to OX by callir;
W
Y' PL3fmittee, 0i gnat )3
itL
+ 4- i--1,++-1-4 1 4-•f J I f- 4q..r f ++ r.4 -1-+t•+-+++++4 4-4-+4-+4--I--f 4 4- 1-+4-4 4...,,._,-.,_4..i. 4-+
171 ley 7"04" P. m 'ui tir-erleC lJie i,ext, bu,.� jnv,
+,. ..x,_-4.4.+++.4..{.++•4.J.-4 +++.+. A. ++4-++++44++4-+4-A-4.A-++4.+4-4,+,4-4 + 444.+++.1,
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Plan Check#
CITY OF TIGARD _
Mechanical Permit Application Recd By
13125 SVy HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 Date to DST
Print or Type Permit#"Ak'f%T�t/Sf
Called__ Lf
Namaot0evelopmecomplete or illegible applications will not be accepted --'-
ftProject Description
Table 1A Mechanical Code QTY PRIG AAff
Job Street Address ---
<1 . I su•,# A) Permit Fee -0.
Address /C'715 , , j� -0 10�0
aide# CnyfState11 z� 1.) Fumace to 100,000 BTU 6.00
Tt c � '!a including ducts&vents
Name(or name of business) j 2.) Fumace 100.000 BTU+ 7.50
Owner U o'vl( \-Cr 'l including ducts&vents
Marling Address 3.) Floor Furnace _ 600
ncluding vent
City/State Zip /Pnone 4.) Suspended heater,wall heater 6.j0
or floor mounted heater
Nome(or name of business) 5.) Vent not Included in appliance_-:.mit 3 70
Occupant Mailing F,Jdross 6.) Boller or comp,heat pump,air cored. 6.00
to 3 HP,absorb unit to 100K BUT"
C tristate zip Pirone ) 7.) Boiler or comp,heat pump,air cond. 11.00
3-15 HP;absorb unit to 500K BTIJ"
Contractor Name 8.) Boiler or comp,heat pump,air cond. 15.00
"Y-1 • M A I Y v, 15-30 HP;absorb unit.5-1 mil b-U""
Prior to permit Melling Address 9.) Boiler or comp,heat pump,air cond. 22.50
issuance,a copy ,('r�C) ""� ���,y-2 �6(*'-L l_p 30-50 HP;absorb unit 1-1 75m1 BTU"
of all licenses Cn estate zip Phone _ -To)-Boiler or comp,heat pump,air cond. 37 50
are required if eU• 9 .
-7( "� �' -7 i�_ - 50 HP;absorb unit 1.75 mil BTU**
expired in COT Oregon Const.Cont Boa Lic.x Exp. ate 11.) kir handling unit to 10.000 CFM 4.50
database_ jn.
Architect Name 1?) Non-por ble evaporate cooler 4.90
or Mailing Address --
14.) Vent fan connected to a single dud 300
Engi,leer CnyiState zip Phone 15.) Ventilation system not included in 4.50
appliance permit _
Describe work New O Addition O Alteration 0 Repair O 16.) Hood served by mechanical exhaust 4.50
to be done Residential O Non-residential O _
Additional Description of work: 17.) Domestic incinerators 7.50
18.) Commercial or industrial type 30 00
Incinrarator
Existing use of 19) Repair units 4.50
building or property
20.) Wood stove 450
Proposed use of
building or property 21 ) Clothes dryer,etc. 4 50
_
- 22.) Other units 4.50
Type of fuel-oil O natural naso LPG O electric d 23.) Gas piping one to four outlets 2.00 --c.
2 �
I hereby acknowledge that I have read this application,that the 24) More than 4-per outlets(each) 50
information given is cured,that I am the owner or authorized agent of
the owner,that plans submitted are In compliance with Oregon State
QTY.SUBTOTAL
laws.
u Signature of Own`er/Agent / Date
T� 'SUBTOTAL
J :u.L`v f .r C1Lx I 1 l J� t` 5%SURCHARGE
Contact Person Name Phone (� PLAN REVIEW 25%OF SUBTOTAL
1 rXt-j 3n•-T-)e 01�1�7UTOTAL la.,
Vnechpmt doc (rev 9 'Minimum permit fee is$25+5%surcharge
"Residential A/C requires site plan shuwing placement of unit.
ECTRTCPI- PERMIT
CITE( OF TIGARD
DEVELOPMENT SERVICES r-'IERMT'r #,
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED, ;1 /04/97
fln-
I T r.:- r,D 1)R 1E 0S., 10723 3 W N 0 A V 1:
UBD I V I S I ON. . . . :SHANNONDOW ZONING:R---4. 5
._(7C1/. . . . . . . . . . . L-0-1 . . . . . . . :-Ole' JURISDICTION;
r1oj ect I)e-sc.-r-i pt j.on. Inst,,Llation of I branch circuit w/out purvhase of servi-&
.--- 7EL,j'1DENTInL UNTT- --- ...—TEMP -M I SCELUANEOUS
'1100 SF CR LESS, . . . 0 0 200 .amt. . . . .. . . , T1 P U1 M r- .'Ti R R To nT I ON. . . .
Ir'! APT)' L 500SF. . , s 0 201 4042) ::amp. . . . . . 0 SIGN/OUT LINE L-TO. .. 0
IMITED ENERGY. . . . . : 0 401 C500 amp. . , . . . 0 SIGNAL/PnNEL.. . . . . . . 0
nN77. H101/ SVC'/FDR. . 0 601+amps-1000 Vol 'I;r'. 0 MINOR L.WAFL (1.0) . - . "'
S I--r,v I CE 11 r-E E D E R - -11RANCH CIRCUITS .,-.."--ADD' L INr)PEr'rTDNQ"
c".__"00, amp. . . . . , . 0 W/SERVTCE OR FEEDFR; 0 PER INSPECTION. . . . . . 0
4020 amp. 41 L
4 -,
OR F-DR. I I r)t-'r). . w . . .
15t W'IF) SPL VC
fSvlel 'AllAp. AD
0 En DIBRNrr
H CTRL. 0 TN ,LnNT, . .
3
-V T EIA �7)r.rTION ---
1 112100 amt, . . . , : 0 - .—PI-nN RE.
017,3q amp/r,ol-t. . . . . : 0 ) =4 RES UNITq. . . . . . . . 600 VOLT
R%?r-onnect only. . . . , 0 SVC/FT)R > = AMPS, CLASS ARFAP7"Fr. OCC.
.... .. FEE.0
type amol.int Fey ache V'pc:pt
7MOO t)TW 11 /0,1/97 HnNPRF�rF'
, 3W S11.1ND 11VE PRMT t
T.G,,I- rD On 0- 7b.�7,z--,71 17,C7 t 77 1)R n o-,P.37 i,inNDRE['[-1V
r
,3PTLANr AIRE $ 36. 75 TOTAL
SW PEi7V7PTON-HTLL-ST'.,nL.F HW','
REOUIRFI)
OR 97000 TZ U 1A U h
irne 4: r 1.f,C t 1. S C,i-vi.(:0
to
is pervit is issued ;object . tL it regulations contained in the Tigard Municipal Codes State of Oregon Specialty Codes and all other
'-Iplicable laws, All work will be done in accordance with approved plans. This permit will expire if work is not started within 180
iys of iss-wes, or if wor4 is suspended for sort than IN days, ATTENTION; Oregon law requires you to folltw the rules adopted by
P Oreprn Utility NDtification Center. Those rules are set forte in DAR W-eol-mle through OAR 9512-001-1987. You may obtain a copy
these rules or direct questions to OUN^� by calling (j%3)246-1987.
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CITY OF TIGARD Elec Lrif-al Permit Application PlanChec _
13125 SHIN HALL BLVD. Recd Byk k
TIGARD OR 97223 Date Recd j / l
Date to P.E. _
Phone (503)639-4171, x304 Print or Type Daie to DST
Inspe�iion (503) 639-4175 Permit N � �
Fax (503) 684-729' Incomplete or illegible will not be accepted Called
I�
1. Job Address: 4. Complete. Fee Schedule Below:
Name of Development_ _ Number of Inspections ppr onrmit allowed
Name(or name of business) Service included: Items Cost Sum
Address f`LS h J IS vi �'`I. t 4a. Residential-per unit
(1 7 ? 1000 sq.ft.or less $110.00
q
City/State/Zip1t��11d�'r a ( I 3 Each additional 500 sq.ft.or
Commercial l_-1 Residentialportion thereof $25.00
Limited Enargy $25.00
Each Manuf'd Home or Modular
2a. Contractor installation only: Dwelling Servlco or Feeder � $68.00 2
(Attach copy of all urrent tic uses) 4b.Services or Feeders
Electrical Cont►ictor Installation,alteration,or relocation
200 amps or less $60.00 2
Address 0 - 5� 201 amps to 400 amps � $80.00 � 2
Cit 13 ' ,,tat _Zip_ 401 amps to 600 amps $120.00 2
Phone No. :U- 79 I$ - 601 amps to 1000 amps $180.00 __ 2
Job No. Over 1000 amps or volts $340.00
Elec.Cont. Lice. No. 3 tf- 6 7 G Reconnect only $50.00 Exp.Date (�^ ^ �� l --
OR State CCB Reg. No. A I I I Exp.Date 4c.Temporary Services or Feevers
COT Business Tax or Metro No._ -!j_Exp.Date 3-IS- Installation,sal',eratiun,or relocation
200 amps or less $50.00
Signature of Supr. Elec' - 201 amps to 400 amps 401 amps to 600 amps $100 00
Q
3 ( 1 5 Exp.Date 10-15- 1 Ovor 800 amps . 1000 volts,
License Nr p. _ sono"b"above.
Phone N( 6 29-7 I
4d.Branch Circuits
New,alteration or extension per panel
2b. For owner installations: a)The tee for branch circuits with
purchase of service or
Print Owner's Name feeder fee.
Address - - Each branch circuit $500
-- - b)The fee for branch circuits
City State,_ ZIP _____ without purchase of
Phone No._ _ service or feeder fee. ri0
First branch circuit 1 $35.00 . 35- 2
The installation is being made on property I own which is not Each additional branch circuit___- $5.00 - 2
intended for sale,lease or rent. 4e.Miscall,neous
(Service or feeder not Included)
Owner's Signature Each pump or irrigation circle $40.00
Each sign or outline lighting $40.00
3. Plan Review section (if required):' Signal circuits)or a limited energy
panel,alteration or extension $40.00
Minor Labels(10) R100.00 -
Plonse check appropriate(tern,and enter fee in section 5B.
4 or mote residential units to one structure 4f.Each ndditional Inspecttan over
Service and feeder 225 amps or more the allowable In any of the,above
System over 600 vrits nominal Per Inspection $35.00
Classified area or structure containing special occupancy Per hour __ $55.00
as described In W.E.C.Chapter 5 In Plant $55.00 _.
Submit 2 sets of puns with application where any of the above apply. 5. Fees:
-00
Not required for ternporary construction services. 5a.Enter total of above fees $
5%Surcharge(.05 X total fees) $ 7
NQTICE Subtotal $ --
5b.Enter 25%of line 5s for
PERMITS BECOME VOID IF WORK OR CONI TRUCTION At ITHORIZED IS Plan Review it reouired(Set:3) $ ---
NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY El
TIME AFTER WORK IS COMMENCED. Trust Account M $
��, 7
Total balance flue
I,pSTS\ELCBfl APP net B'N9�