11390 SW 92ND AVENUE i
ADDRESS:
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
/ + BUFF
Date Requested — Gf GI__AM _Pro BLD _
Location, �1 q2-� Suite
Contact Person I� �� j� _ Ph �v�,� ,�L' -� � r�
Contractor _ Ph _ �� J I I Y`��(�
BUILDING Tenant/Owner ELC —
Retaining Wail ELR
Footina Access:
Foundation FPS
Ftg Drain — SGN
Crawl Drain Inspection Notes: --
Slab _ �.- SIT
Post& Beam -
Ext Sheath/Shear
int Sheath/Shear
Framing
Insulation
Drywall Nailing _
Firewall —
I ire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: _�— -- -------- - - -
Final
PASS FART FAIL
`� LU
Post& Beam -- -�—v �—
Under Slab
Top Out ------ - ---- -- —
Water Service
Sanitary Sewer
Rain Drains
A PART FAIL -
Post& Beam
Rough In
Gas Line ----- -- -- ---
Smoke Dampers
PART FAIL
ELECTRICAL
- Service
F- Rough In _ ---
�' UG/Slab
Low Voltage
Fire Alarm
J
Final
PASS PART FAIL _
SITE
J
Backfill/Grading - —�-
Sanitary Sewer
Storm Drain [ J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ J 'lease call for reinspection RE: — [ J Unable to inspect-no access
Fire Supply I ine
ADA /7
Approach/Sidew,,lk `7
_ Data � ! Inspector _ _Ext
011ier
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY O F T I GA R D ORIGI
PLUMBING PERMIT
�. :
&ERMIT#: PLM1999-00200
DEVELOPMENT SERVICES IV
13125 SW Flail Blvd.,Tigard, OR 97223 (503) 639-4*i71 ISSUED: 6/30/99
SITE ADDRESS: 11390 SW 92ND AVE
PARCEL: 1 S 135DB-03900
SUBDIVISION: DOGWOOD RIDGE ZONING: R-4.5
BLOCK: LOT: 012 JURISDICTION: TIG
CLASS OF WORK: ( 'R GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: Sf- WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS. TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SH01'VEP.S: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of new water healer.
Owner: FEES —
Type By Date Amount Receipt
JOHNSON CHARLIE
11390 SW 92ND PRMT DEB 6/30/99 $50.00 99-316518
TIGARD, OR 07223 M13C DEB 3/30/99 $2.50 99-316518
Total $52.50
Phone 1:
Contractor:
JACOLS HEATING +A/C INC
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 234-7331 Top-out Insp A
Rey #: LIC 1441 Final Inspection
PLM 26-548PB
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 you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
issued B �` � t Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed next' siness day
CITY OF TIGARD RECEIVED Plumbing Permit Application
Plan Ci�K
13125 SW HALL 8 Y(,� q 1999 Commercial and Residential Reid
TIGARD, OR 97a�
22 +�� ' Dale Recd
(503) 639-4171Date to P.E.
CUMMUNITY DEVELUPMEN print or Type Date to DS
Incomplete or illegible applications will not be accepted Permitf�E
Related SWR f_
failed_
Name of Dcvelopment/Projad i 141d t f ' ?i Cg'c
.fob Sink 900`
Address Street AddressV�116;,*;J
rSuite Lavatory 8.00' 2"), Tub or Iub/Shower Camb. 8.00
/Slate Zip Shower Only 9.00
NameT Wafer Closet 8.00
G1✓ - /C 1l�r l`_�C.- Dishwasher 9.00
Owner Melling Addrou Slitlts Garbage Disposal 9.00
-i, �. 1 l,: �-' �ar"rG Washing Machine � 9.00
Gry/Stale ZIP Phone _._--
6 `1 , y 3�y�� Floor DrakUr Icor Sink z• _ 9.00
Name 3' 900
9.00
Occupant Mailing Address Suite Water Heater O conversion O Oke kind 9.00
__ ______ Gas piping requires a separate mechanical permit. 1
Cfly/StalN Zip Phone I aundry Room Tray 900
Name — Urinal 9.00
L-kc`. e I' , Olhor Fixtures(SpeJfy) 9,00
Contractor kwft Address Suite 9.00
9.00
Prior to permit GN le Zip Phoney Sewer-1st 10U' 30.00
rssuance,a copy ?_.{,- (�.1,i �,.2 j - '� r ` ' Sewer-each additional 100' 2500
of an limses am Oregon Corot.Cont.Board Lief Exp.[kite
required If f 1-4 I Water Service•1st 100' 30.00
expired In COT Plunlbing UC.0Exp. Water Service.e„eh additional 200' 25.00
database s «y+'/r� 1 �"�Il'oc Storm 9 Rain Drain-1st 1 W' 30,00
Name Storm 3 Rain[rain-each additional 100' 25.00
Architect Mobile Horne Space 25.01
Or Honing Address Suite Commrxda[Back Flow Prevention Device or Anil- 25.00
_ Pollution Device
Engineer City/Stale Zip Phone Residential Baddlow Prevention Device' 11500
(Irrigation liming devices require a separate
Describe work to be done: _ restricted energy potmJ
New O Repair O Replace with ilke kind: Yes b No O Any Trap or Waste Not Connected to a Fbduse 9.00
_ResidenUal O Commercial O _ Catr.h Basin — 9 00
Additional d"Liiplion of work: Inca.of Eyisltng Plumbing 40.00
per/hr _
l , S"Ily Requested lnsrwcilons 4000
--- __ per/hr
Rain Drain,single family dwi-lling 3000
Are you capping,moving or replacing any fixtures?IM Grease Traps -9 MYes O No
If yes,see back of form to Indicate work performed by
J fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTALy r;
Isometric a neer d' b used a Ouantity Total Is >9 - ''��•
WORK COULD RESULT IN INCREASED SEWER FEES. — *SUBTOTAL
I hereby acknowledge that I have read IN&appilration,that the information
i given is correct,that I am the owner or authorized agent of the owner,and 6%SURCHARGE `
-� that plans submitted are In compliance with Oregon State Laws
Elgnalure of OwnerfAgent Date —PLAN REVIEW 26`A,OF SUBTOTAL
Rhuned only N fixture qty.feral Is>9
1, lc , �.. 4,• I I TOTAL
Contact Person Name Phone __ �s
'Minimum pertnft fee is 525•5%surcharge,except Residential Baddlow
Prevention Device,which is$15•5%surcharge
"All New Comrrrercial Buildings require plans with imimalric or neer diagram
and plan review
lwslMres00 baa NOW
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 a
BUP
Date Requested S 1 AM^ PM BLD
Location 1 i ���U _ Suite MEC
Contact Person (c�1.li1Q (L. Ph �%�`� '� `_� PLM
Contractor � C^ �V � Ph r SWR
BUILDING Tenant/Owner V ELC �' �� ' '�(
Retaining Wall ELR
Footing Access:
Foundation FPS _
Fig Drain
Crawl Drain +:ispection Notes: SGN _
Slab _ SIT
Post& Beam —i
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing _
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling --
Roof
Misc:
Final
PAA SS PART FAIL
PLUMBING
Post& Beam
Under Slab _ - � -� !�y / A� .
Top Out
Water Service
Sanitary Sewer / 1 n
Rain Drains �L-e -y ro C� h lVy L, /' a - cz) // Y�s'S !7-�
Final T`—
PASS PART FAIL —
MECHANICAL
Post& Beam - - --- --
Rough In
Gas line - -- -- --
Smoke Dampers
Final -
PASS PART FAIL
LLECTMAL
- 3ervrc,
Rough In ----- -- -
UG/Slab
y Low Voltage
Fire Alarm
BASS1 PART FAIL
TE
Backfill/Grading -- --- --�- ---
Sanitary Sewer
Storm Drain ( (Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ease call for reinspection RE: Unable to inspect- no access
ADA
Approach/Sidewalk
Date V `t'
Other Inr pecto� _Ext
Final T
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CELECTRICAL PERMIT
CITY O F T I G A R D
PERMIT M ELC1999-00212
DEVELOPMENT SERVICES DATE ISSUED: 4/12/99
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 1S135DB-03900
SITE ADDRESS: 11390 SW 92ND AVE
SUBDIVISION: DOGWOOD RIDGE ZONING: R-4.5
BLOCK: LOT : 012 JURISDICTION: TIG
Proiect Description: Installation of 2 branch circuits. 7R� 330�ot5
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS of
ADD'L IIVS. CTIONS
0 - 200 amp: W/SERVICE OR FEEDER: PER INSF ECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 SER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC/FDR >=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JOHNSON, CHARLIE
11390 SW 92ND {}J 4__,
TIGARD, OR 97223 Ap2r�q G2.. q-7 a,y
Phone: Phone: 2 bi-tSgg
Reg #: t33o1�
FEESRequired Inspections
Type By Date Amount Receipt _ Rough-in
Elect'I Service
PRMT DRA 4/12/99 $40.00 99-314406 Elect'I Final
5PCT DRA 4/12/99 $2.00 99-314406
Total $42.00
J
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 you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at(503)
246-1987
Permit Signature: r) Issued B j
_ OWNER 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 7:00pm for an inspection the next business day
RPR-09-99 04 :19 PM WEST SIDE ELECTRIC 503 735 0677 P. 01
Now
CITY OF TIGARD Electrical Permit Application plan Ch V _
13125 SW HALL BLVD, Aec'd s _
TIGARD OR 97223 Date Recd
Date to P.E.
Phone(503)639-4171, x304 Date to DST
Inspection (503)639-4175 Print or Type Permit•
Fax(503)684-7297 Incomplete or Illegible will not be acceptod Called
1. Job Address: 4. Complete Fee S.-hedule Below:
Name of Development Number of Ins sections per parmlt allowed
Name(or name of buslness) LhGr I' rd�"50" Service Included; Items Cost Sum
Address 0 3°i 5 9 2 Af4 4a. Residential-per unit
City/State/ZipJ i� �►�{ fono seri.M.or less 61 to,o0 __ ' 4
Each add lionitl 500 sq ft.or
PortioCommercial E Residential d Limited
neigythereof $25 DO
1
Limited Enatgy _�
Each Manuf'd Home or Modula
2a. Contractor installation only: Qwelling service or Feeder �•_ Er1e.00 _� f
(Attsch enpy of all current 1lea ea 4b.Services or Feeders
Electrical Cp actor / /� Inslollnllon,alleratign,or relocidion
Address / 200 amps or ie.ys SRO fXl 2
Ci _O� , 2o1 amps to 400 amps $8000 2
city State _ ZD___ 401 amps to 600 amps _� S12MDO _ 2
Phone No. 2 J Z��� 601 amps to 1000 amps �_ 5180.00 ___. _ 2
Job No. T d f Over 1000 amps or volts $34000
Reconnect only $50 00
Llec.Cont.Lice No _Exp.Dale /o-/-f Y _
OR State CC13 Reg.No.� l5 Exp.Date _ 4c.Temporary Services o, Feeders
COT Business Tax or Mntro No Exr,Date Installation,alteration,or relocation
200 amps or less M 00 2
Signature of Supr Eloc'n -- - 2ol amps to 400 amps $75.00 --� 2
e01 amps to rwo amps S 100.00 2
Mar 600 amps 10 1000 rolls,
License Nc Fxp,E)Ate see"b"above.
,?
Phone Nr 3T -
Id.Branch Circuits
New,allernlinn or estom lon per Parisi
2b. For owner installations: e)The lee for branch,:irculls with
purchase of senlee or
Print Owner's Name _ feeder fee.
Address Fitch branch circu t $5.00 2
CI StatO Zi h)The fee Int branch clrculls
H _ P without purchase of
Phone No. service or fene or Me.
— First bronrh circuit
The installation is being made on property I own which is not Farb additional branch circuit
intended for sale,lease or rent. 4e,Miscellaneous
(SorvIM or leader rot Included)
Ownpr'ti Signature _ Each pump or Irtigatlon circle :40.00 _— 2
Each sign or outline lighting $4000 _ 2
3. Plan Review section (if required):' Flpnel 1.Illorall or s limltnd enerpy�� $oo 00 _ 2
panel,slleratlon or edonslan
Minor l shelf(10) $100.00
Please check appropriate Item and enter tee In sectl.n 58.
4 or more residential units In ono 6tructuro 41.Each additlonsl Inspection over
9ervIce and feeder 225 amp,or more the allowable In any of the above
System over 000 rolls nominal Per inspection $35.00
Classlflnd area or structure conlalnlnp special occupancy Per hour - - si5'00
as deerrlhwri In N E C Chapter. In Plant
s Submit 2 sets o!plans with application whorl ant/of the above apply. Jr. Fees: /_/o
Not required for temporary conalructlen services. Se.Fnlor total of above Nes L Z
51=Surcharge(o5 x total fees) 6
NQTIGE subtotal
ab.Enter 2S'/.of line fa fnr `
PERMITS BECOML vO1D IF WOr1K OR CONSTRUCTION AUTHORIZED IS Plan Review If Ttagylt W(Sec-3) s —
NM CdMMENCtD W)jAjN Zito DAYS,OR IF CONSTRUCTION OR WORK 8ubrotsl
115 SUSPIENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY Ea Trust Account a , y Z
TIME AFTFR WORK 15 COMMENCED.
Tota!balance Due T PHS
CITY O F T I G A R D MECHANICAL
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd„ Tigard,OR 97223(503)639-4171 PERMIT #. . . . . . . : MEC99-0110
DATE ISSUED: 03/18/99
PARCEL.: 1S135DB-03900
SITE ADDRESS. . . : 1179q, SW 92NO AVE
SUBDIVISION. . . . : DOGWOOD RIDGE ZONING: R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . .012 JURISDICTION: TIG
----------- ------- -----------------------------------------------------------------
CLASS OF WORK. . .-ALT FLOOR FURN. . . . : 0 EVAP COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCv GRP. . : R3 VENTS W/O ADPL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL- TYPES------------ 0-3 HP. . . : I DOMES. INCIN: 0
3-15 HP. . . . : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15-30 HP. . . . : 0 REPAIR UNITS: 0
FIRE DAMPERS ). . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0
GAS PRESSURE. . . : 50-+ HP. . . . : 0 CLO DRYERS. . : 0
NO. OF UNITS- ---------- AIR HANDI- ING UNITS OTHER UNITS. : 0
FURN ( 100K BTU- 1 1.10000 cfal: 0 GAS OUTLETS. : I
FURN > =100K BTU: 0 10000 cfm : 0
Remarks : Install a new gas furnace, A/C unit and gas line.
Owner: --------------------------------------------------- FEES --------------
CHARLIE JOHNSON type amoo-int by date recpt
11390 SW 912ND AVE PRM7 $ 25. 00 GEO 03/18/99 99-313813
TIGARD OR 97223 5FICT $ 1. 25 GEO 03/18/99 99-313815
Phone #:
Contractor-:
JACOBS HEATING & A/C
4474 SE MILWAUKIE AVE
$ 26. 255 TOTAL
PORTLAND OR 97202
Phone #: 503-234-7331
Reg #. . : 1441. REQUIRED INSPECTIONS
Th't permit is issued subject to the regulations contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Heating Unt Insp
applicable laws. All work will be done in accordance wit', Cooling Unt Insp
approved plans. This permit will expire if work is not started Final Inspection
within IN days of issuance, or if work is suspended for sore
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 952-001-0080. You say
obtain copies of the.p rules or direct questions to OURC by calling
(503)246-9187.
Issi-le By , Permittee Signat'.1re
++++4.......................................4..........................4......4-+
Call 639-4175 by 7-00 p. m. for inspections needed the next bi-tsiness (lay
..................................................................4•.............
Plan Check II
CIN OF TIGARD Mechanical Permit application Recd By
13125 SW HALL BLVD. Comme1Ci it and Residential Del@ Recd
Tlr Ren, OR 97223 Date to P E.
171, x304 Date to DST
Print or Type Permit Mrfj1 qL_, z�c�
Incomplete or illegible applications will n;t be accepted called
Nam•of Deve$wmriVPmjod - Description
Table 1A Mechanical Code _ Qly Price Amt
.lobslr.. Address - --Pe--rmit Fee
------
Address �I- u ` 111 1) Furnace to 100,000 BIU _ V
Includin ducts 8 vents _
8" Cnyislate zip ---�- �— 6.00
_ 2) Furnacr. 100,000 BTU#
Including ducts&vents 7.50
Name(or name of business) 3) Floor Furnace
Owner
T 1 c. Includin vent _ _ 6.00_
M. Address e. �J U` `��Qil 4) Suspendf,.d heater,wall heater
or floor mounted healer_ 6.0.0
IC) �j� �t 1� 5) Vent not Included In appllanca permit
City/State zip ph
a,a _ 3.00
r �v�G G� ���. I� '1-?�l�i? CHECK ALL 'Boiler Heat Air
N;;• name of businers) T HAT APPLY: or Pump Cond Qty price Amt
_ _ _ _Comp ••
Occupant MaNi"9 Address 6)<3liP;absorb unit to — -- ---
100K BTU I 6.0;1
7)33-15 HP;absnrb uiril
ceytStale -- zipphone - - 100k to 500k BTU 11.00
ej 15-30 W absorb -- - —
--- unit.5-1 mil BTU 15.00
m
Contractor Nae --- —
Q)30-50 HP;Absorb
JACOBS rCAT ING 6 AIn CUNUITIONI G unit 1-1.75 mil 8 1 U _ 22.50
Prior to pemiil Me"Address 10)>50HP;absorb unit
Isararrcxs,•mPy r- sl 75 mil nTU __ _
��17C1_�C_MILWAL11:1C___ _-- ___ - - _ _un
1-1
_ — --- 37 RO ----- '
of all licensed cb/Stels zip phone _ 1 0 Air handling unit to 10,000 CPM
are required IfN0I LU[I__5] _Z7 4.50
expired M COT Oregon Comm Conl aoard Lk a Esp.Date 17.)Air handling unit 10,000 CPM♦
database 14� 7.50
Architect Ne 1e 13)Non-portable evaporate cooter
_ 4.50
or Marra Address V - 14)Vent fan connected to a single dud
3.00
_ 15)Ventilation system not Included In
Engineer cbB�• zip phone eppllancepe-it 4.50
16)Hood served by mechanical exhaust
Describe work to be done: —^_ - 4.50
11)Domestic Incinerators
New CD Repak O Replam with like kind Ye-.O No 0 _ 7.50
Residelllal di Commercial O 18)Comrnerclal or Industrial type Incinerator
30.00
Additional Information or description of work: 19)Repair units
t1 C C Z450--LA 11UC K�� �r���1 �
i ' ����; \ / 20))Wood stove
450
3i)Clothes dryer,etc.
A.50
Type of fuel. oil O natural pas Op LPO O electric O 77)Other units
4.50
I hereby acknowledge that I have road this application,that the Information 23)Gas piping one to four outlets
gtven Is coneri.that 1 am the owner or suthorirr.i agent of _ 2.00 p�
the owner,that plans submitted are In compliance with Oregon State laws 24j More than 4-per outlet(each)
- - - --- - - - .50
-
Signature of OwneNAgent Date
Minimum Permit Fee$25,00 SUBTOTAL
5%SURCHAnGE_ I +�
Contact Parson Name Phone PI AN REVIEW 7r,%or- 1;11111 OTAL
Required for ALL commercial permits only
+4-1 AN I F MCMLFiTRY 234-7331 TOTAL
�'Slatis Centrarier Boiler Certification r tired
"Residential AIC requires site plan sho.ang placement of unit
I:Ynechperm doc rev 07/20/98
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21 S.E. HOLG/ATE
FoR T. OR . 17Z62
503 - z3q- 7331
ELECTRICAL F,ERMIT
4: EC96-0610
CITY' OF TIGARD DATEPER11IT ISSUED:L09/25/96
COMMUNITY DEVELOPMENT DEPARTMENT PARCEL_. 1!*3135DS.-03900
Blvd.Tlgard,01 pp1 �L�72r73�81DQir( 3)D�o�4171
SUBDIVISION. . . . : DOGWOOD RIDGE ZONING: R- 4. 5
5 L 0 C K�. . . . . . . . . . : LOT. . . . . . . . . . . . . : 12
Project Descr-iption : JOB 6324WA - 1 BRANCH CIRCUIT
UNIT--,- --- -.-.-TEMPI S)RVC/rEE7DERS-- -
1,000 SF OR LES']. . . . : 0 0 200 Amp. . . . . . . 0 PUly1F-,/IRRIGnTION. . . . 0
EACH ADDIL 5010SF. . . : 0 21711 4:.10 am p. . . . . . . 12.1 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . . 0 401 600 ramp. . . . . . . . 0 SIGNAL/1--'ANEI.. . . . . . . : 1�
11ANF. HM/ SVC/FDR. . . 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
CIRCUITS------- -----AL)D' L IN'-DP,ECT IONS
0 - -2,00 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PIER INSP,ECTION. . . . . .
'01 - 41210 amp. . . . . . : 0 1 ,7t W/O SRVC OR FDR. . I PER HOUR. . . . . . . . . „ V1
401 - 600 amp. . . . . . : 0 EA ADD' I._ BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . 1.71
601 - 101210 amp. . . . . : 0 __....._._._._.....---._... ._--__--_..__PLAN REVIEW SECTION—
112100+ Amp)/vo It. . .. . . . 0 ) =A. RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL.
Rec=onnect only. . . . . : 0 SVC/FDR ) = 225 AMPIS. . : CLASS AREA/SPEC OCC. 4
Owner': ------------------------------------------------------ FEES
JOHNSON type amol.tnt Icy date t-ecpt
11390 SW 92ND AVE PRMT $ 35. 00 JMfA 09/25/96 96-284-234
SPCT $ 1. 75 T1111 09/25/96 1`6 -23430/t
Phone #:
Contr-actol-.
ALL- CITY ELECTRIC 11 36. 73 TOTAL
7017 NE HIGHWAY 99
SUITE 116 REQUIRED INSP,ECTIONS
VANCOUV[�R WA 98665 Ceiling Cover Elect' 1. ''e"-Vice
!"hone #: 360-223-0592 Wall Cover- Elect' l Final
Reg #. . : I187014
-his peroit is issued subject to the regulations contained in the
I - '7-V
igard Municipal Code, State of Ore. Specialty Codes and all other fret-mittee Sig'natf.o-e
applicable laws. All work- will be done in accordance with
approved plan:. This persit will expire if work is not started
� 4
c
Athin 180 days of issuance, or if work is suspended for vore (
than 180 days. By
-------OWNER INSTALLATION
The installation is being made on property T own which is not intended for-
.�ale, lase, at, rent.
'IWNERIS SIGNATURE: DATE:
INSTALLATION ONLY-------_._----------------...
CC "�IGNATURE OF SUFI R. ELECIN: DATE:
ICENSE NO:
_J
Call for- inspection - 639 , 4175
CITY OF TIGARD BUILDING INSPECTION NO fICE
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 Erec .
Post/Beam Struct. Mech. Rough-in Gyp. Bd. Bldg.
San Sewer Gas Line Appr/Sdwlk Reins.
0the7
Date: �D Al ' 7 A,M. _pP.M Entry:
Address' --
Tenant: — Ste:__- MST:
BUP:
Con/Own:. MEC:
:C�o
L
E �
THE FOLLOWING CORRECTIONS ARE REQUIRED ELR:
<:X 06
r-y
O�
W
Inspector: C�?�f�l \cr c+d Date:/� I
APPROVED —DISAPPROVED/CALL FOR REINSP. C CO
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rer. #
Permit #
Phone (503) 639-4171 Date Issued ' ,y1 J9 04'
CITY OF TIGARD FAX (503) 684-7297 Issued by �-:)'� CI L—
TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development ��l � /IW` " 'd Number of Inspections per permit allowed
Address90 ,ice included: Items Cost(ea) Sum
� 4
City/State/Zip� �` 7v? 4a. Residents I per unit $+1000
Name (or name of business) _ Each additional 500 sq n or 1
portion thereof $2500
Commercial❑ Residential Limited Energy $2500
Each Manuf'd Home or Modular 2
Dwelling Service or Feeder $68.00
2a. Contractor installation only: 1 4b.Services or Feeders
j Installation,alteration,or relocation 2
Electrical Contractors — 200 amps or lire $6000 2
Adds ss''�l ' I ` •.; I 201 amps to 400 amps $8000 2
r _ 401 amps to 600 amps $12000 2
Ci State/ State __�,:; Zip ' 601 amps 10 10u0 amps $18000 2
Phone No., ( a Over 1000 amps or volts $34000 2
Contractor's License No. 7 ")\14(r r Reconnect only $5000
Contractor's Board Reg. No. 7 4c. Temporary Services or Feeders
Instalialion,alteration,or relocation 2
Signature of Supr. Elec'n --r11 _ 200 amps or leas $5000 2
Q 2
License No. �(' 'i��S PhorTiS o..,_',� `> "' j�� 1 201 amps to 400 amps 17500
� 401 amps to 600 amps $10000
Over 600 amps to 1000 volts
2b. For owner installations: see•h•above
4d. Branch Circuits
Print Owner's Name Now,allaration or extension per panel
Address n)The fee for branch circuits With
City State Zip_ purchsee of eervke or Areder Are. 2
Each branch circuit _ $500
Phone No. _ b)The tee for branch circuits without _�r
The installation is being made on property I own which is purcheu of eervke or feeder.'w. 2
not intended for sale, lease or rent. Fest branch circuit $3500 2
Each additional branch circuit $500
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) 2
3. Plan Review section (if required): Inch pump or irrigation tide $4000 2
Fach sign or outline lighting $4000
Signal crcu4fs)or a limited energy 2
Please check appropriate Item and enter fee in section 59. panel,alteration or extension $4000
4 or more residential units in one structure Minor Labels(10) $10000
Service and feeder 225 amps or more
F_ System over 600 volts nominal 41. 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 inspection $3500
Per hour 155 00
r-- In Plant 155 00
— Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construction services. 5. Fees:
00
W NOTICE Sa. Enter total of above toes $
-� -
5%Surcharge(05 X total fees) $
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 FOR Plan Review if rpquired(Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED ❑ Trust Account N $
Balance Due $ L�v.
�dd'['411NNM�C'pT Sp