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CITY OF TIGARD BUILDING INSPECTION DIVISION
C 24-Hour Inspection Line: 639-4175 Business Phope: 639-4171
Date Requested: J /�-� A.M. P.M. NIST:
Location: �/ .7'j[ �` BIJP:
Tenant: _ S te: $lug: MEC:
---r' — —`71 ° '� Phone. 7 3 �C% PLM:
vvnetr: Phone:
- � ...._...— ELF.:
SIT:
tr y BLDG(con't) PLUMBING MECHANICAL ELECTRICAL 5Y"i'F
Site Post/Beam Post/Remn PostMeam Cover/Service Sew,r/,torr
Footing Roof 17ndFl/Slab Rough-ht Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In UG Sprinkler
Foundation Insulation Sewer Ifood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain]rain A/C UG Slab
Shear/Sheath Fire Spklr/Alm Crawl/Found!r Ileat Pump Low Volt
t roved Approved Approved Approved Approved
1ppr/Sdwlk 1Gi
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phon 939.4171
Footing Rain Drain Cover/Se vice
Foundation Water Line '_'piling lamb.
Post/Beam Mech. Shear/Sheath Framing )
PIhg.Und/Flr/Slab Plbg. Top Out Insulation _-Elec .
Post/Beam Struct. Mech. Rough-in Gyp. Bd.
San, Sewer Gas Line Appr/Sdwlk Reins.
Other:
ll Date: . A.M.V/P.M. Entry
Address: / Q�_�
Tenant: Ste: MST: Cir
F-30 :7
�L�P:
Con/Own: �+� O 0 -�-t-� MEC:
/• PLM: _
-ELC:THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
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Inspector: Date: t'D�
__ PPROVED _-DISAPPROVED/CALL FOR REINSP, CF CG
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639.4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FIN.
Foundation Water Line Ceiling -Plur
Post/Beam Mach. Shear/Sheath Framing -Meeh.
Plbg.Und/Flr/Slab Plbg, Top Out nsulat -Elect.
Post/Beam Struct. Mach. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gam Line Appr/Sdwlk Reins.
Other. _
Date: 69 _ A.M. `.P.M. Entry:
Address: 4D _ 1W
Tenant: Ste: MST:IF4 01!b�
BUP:
Cones. MEC:
PLM: _
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED. ELR:
�� S'd/divL5 tT.
In or. —
Dat /
4EZWE-0 DISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-
Footing Rain Drain Cover/Service I AL:
Foundation Water Line Ceiling
Post/Beam Mech. Shear/Sheath Fra/n11�n� Mach.
Plbg.Und/Flr/Slab PIbg. TQD Out Insulation -Elect.
Post/Beam Stru ct. Mech, Rou Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: —4�- - A.M.—P.M. E try:
Address:
Tenant: __ Ste: MST:
BUP:
Con/Own: __ MEC: _
PLM: —
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: EI_R:
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Inspector _ Date:6�Z
_.ROVED DISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
g00 Rain Drain Cover/Service FINAL:
undatic Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath Framing -Mach,
Plbg.Und/Fir/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct, Mach. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Rn Ins.
Other:
Date: 1A A.M. P.M. Entry:
Address: 9�-3___ --1 l"e....�
Tenant: _ Ste:__ MST:2y� O�
BLIP: _
on/Own: MEC:
//ilS1LLv. t�.a�'lOn� Vc�CTS PLM: _
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
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t'TY�/yta�i_._f-.�O�'a.' C�lr<.✓�7fi___C�o~•/�'` tflJ�,t_.
!I T�."iG �✓o mit 0r /l�i��_�Tl�. :u t l+...��•.
pector: - Date:�L
APPROVED —DISAPPROVED/CALL FOR REINSP. CF CO
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CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-071
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plurr
Post/Beam Mach. Shear/Sheath Framing -Mech.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-iii 4!29D -Bldg.
San. Sewer Gas Line Appr/Sdwlk n;
Rei
/
Other: �.� �G &7rn_nt4,
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Date: 2, 40 4o A.M. ___P.M. ntry:� _
Address: _ �i „�;��-- fs—�-
Tenant: _ Ste: MST: v
`_ BUP:
Con/ w C¢ _ C4� _ MEC:
PLM:
ELC-
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR
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Inspector ,- Date:
DISAPPROVED/CALL FOR REINSP. CF CO
ITY OF TIGARD BUILDING INSPECTION NOTICE /
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service
Foundation Water Lina Ceiling
Post/Beam Mech. Shear h� 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 Rei
Other: —
Date: �v lY�i� 4o A.M. —P.M. entry _ —
Address: — l��' ��
Tenant:_ Ste: MST:
BUP:
Con/Own:_ MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
F-
CIO - - - -
LD
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Inspector: `_ Dai�,�j�7�, / -
APP _DISAPPROVED/CALL FOR REINSP. CF C(
C;TY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Busyness Phone: 639-4171
]l
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mech.
Plba Und/Flr/Slab Pl g. Tb O` Insulation -Elect.
Post/Beam Struct. ec Rough in Gyp. Bd. Bldg.
Sari. Sewer Gas Line Appr/Sdwik Reins.
Other:
Date: �O �U/ `t A.M. -) P.M. Entry:
Address: �_L '0
Tenant _ --_- Ste:___ MST:
BLIP:
Con/Own: _._ _. MEC:
PLM:
ELC: ._
THE FOLLOWING CORRECTIONS ARE REQUIRED ELR:
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Inspector _ Date:4�z��Wl
__ PROVED _DISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TICARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plurnb.
JPost/Beam Mach. Shear/94!� Framing -Mach.
Plbg.Und/Flr/Slab Pibg. Top Out Insulation -Elect.
Post/Beam Struct. Mach. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: �i � E' A.M. XP.M.__ Entry: `
Address: _��cz_ -' —'
Tenant: _ Ste: MST:�� O( C4�o
SUP:
Con/Own: _ MEC: _
PLM: _
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: _^
6+G G5,:5-
o7� �� 5
Inspector: , Date: li►
_APPROVED 4 IDIRAPPAOVED/CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspertion Line: 639-4175 Business Phone: 639-4171
Footing Rain Draii Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. Shearlo Framing -Mech.
PIbg.Und/Flr/Slat, Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwik Reins.
Other: ✓YI Cti -
Date: __ A.M. P.M. Entry:—
Address: n_' ,�—�2
Tenant: _ Ste: MST: w �
BUP:
Con/Own: MEC:
PLM: _
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
`fit>w-SAS c.Q,si Z!52�25 e s_ !�R,-4: . ,12 - -
vc77�6444 -
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Inspector: Date: G
_APPROVED DIIS_AP ROVED/CALL FOR REINSP. CF CO
001
RMIT
CITY CSF T I GARD MASTER
#'.. . . . . . . MST96• 0146
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 04/08/96
13125 SW Hell Blvd.Tigard,Oregon 97223.8190 (503)839-4171
r-'ARCFL: 2S111AC,-0 E:1¢I0
SITE ADDRESS— . : 14695 SW 9i 1N17 AVE
SUBDIVISION. . . . : P'INEBROOK TERRACE ZONING: R-4. 5
191_OCK. . . . . . . . . . . L...01.. . . . . . . . . . . . . :6
Remarks: 932 SQ FT ADDITION TO EXISTING HOME, OWNER TO DO ELECT, PLUMBING AND
MECHANICAL. HOFFARD TO DO GC WORK. (ADD 2ND STORY TO EXISTING HOME)
PATH I
--•-------------------------------------------------------------- BUILDING -----------------------
----------------------------------------
REISSUE: STORIES.......: 2 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED-------------
CLASS OF WORK.:ADD HEIGHT........: 21 FIRST....: 101 sf GARA.GE.....: 0 sf LEFT..........: 0 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 831 sf FRONT.........; 0 PARKING SPACES: 0
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBS14ENT: 0 sf RIGHT.........: 0
OCCUPANCY GRP.:R3 L ,RM: I BATH: I TOTAL-------: 932 sf VALUE.A: 60263 REAR..........: 0
--------------------------------------------------------------- PLUMBING ---------------------------------------------------------------
SINKS.......... 0 WATER CLOSETS.: 1 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 2 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0
TUB/SHOWERS...: I GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASF TRAPS..: 0
OTHER FIXTURES: 0
--------------------------------------------------------------- MECHANICAL --------------------------------------------------------------
FUEL TYPES----------- FURN ( 100K ..: 0 BOIL/CMF ( 3HP: 0 VENT FANS.....: I CLOTHES DRYERS: 0
/GAS/ / / FURN )=100K ..; 0 UNIT HEATER'—: 0 HOODS.........; 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES; 0 VENTS.........: 4 WOODSTOVES....: 0 GAS OUTLETS...: 0
----------------------------------------------------------------- ELECTRICAL -------------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER --- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L 1Nr,PECTIONS--
1000 SF OR LESS: I 0 - 200 am,,..: 0 0 - 200 amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 201 - 400 amp..: 0 201 - 400 amp..: 0 1st W/O SVCI DR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 amp.,: 0 401 - 600 amp..: 0 EA POOL PR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT......: 0
MANF HM/SVC/FDR: 0 601 - 1000 amp.: 0 601+amps-1000 v: 0 MINOR LABEL -10: 0
1000+ amp/volt.: 0 ----------------------------------- PLAN REVIEW SECTION -----------------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 1' NOMINAL: CLS AREA/SPC OCC;
--------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY --------
A. SF RESIDENTIAL--------------------------- B. COMMERCIAL------------------------------------I------------------------------------------
AUDIO h STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGIAR ALARM.. : OTH: ;: BOILER.........: HVAC...........: LANDSCAPE/IRR1G: PROTECTIVE 5IGNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR:
HVAC...........: LATA/TEL: COMM.: NURSE CALLS....: TOTPL M SYSTEMS: 0
Owner. ------------------------------ ---Contractor: ----------------------------- TOTAL FEES:$ 735.80
WAL' .R HOFFARD REMODELING COMM
14695 SW 92ND AVENUE
5708 9. 136TH AVE.
TIGARD OR 972i'4 PORTLANI OR 97236
Phone N: Phone N: '.61-8177
V Reg N..: `9498
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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.
--J ------------------------------------------------------- RECUIRED INSPECTIONS -----------------------------------------------------------
Footing Insp Mechanical Insp Gyp Board Insp Building Final _
Foundation Insp Plumb Top Out Rain drain Insp Erasion CoA rol
Post/Beam Struct Electrical Servi Electrical Final _
Post/Beam Machan Framing Inspp Mech
Crawl Drain Insulation lnsp P i ainspe—ut ' o
_
I ermittPe G _ - IssIsed Dy : .6 :._ _C 1 f0for - 6s9-4175
Cu Il�d
• Residential Building Permit Application
City of Tigard `
13125 SW Hall Blvd.
�.
Tigard, OR 97223 �
(503) 639-41-1
n n
Jcbsite Addres-,: e�
r�•c� Office Use Only
Subdivision: ��� v. C ��.��.�,k �) Lot#
7j, !j— Contact Date / / Initials
Valuation: / Result
NBvv-Genstwction Only: (Square Footacus)' o Planck/Rec # _
DK /7 " oI �?`'�S-} Permit #— NI`,Tgb-01
Garage. r►'--Reiss!je of MIA
Map & TL # 2�i1 Ac-02
C Q ner Lot? Y ��" Flag Lot? Y U `o e y 5 )bn
w cJZ�O- V--" Plat # - 2-
Owner: r""y\Y . d Vti`v s
Address: \L{C ,,clS ,0 e12" � S _ Approvalss-Required
Planning Setbacks Off- Solar. D
c 2 i -7 22 Engineering 'r(l f'Ati(-
Phone: Z-
_7 Other � � 51DE 4 L-INE
( ) to��l�-���'
Items Required
Contractor:
Subcontractors - .3,7,6k
Address: S C LAI Truss Details e ?w d 2'i J
Other
1 Notes AW OtAp v-
Phone: S1QYL
Contractor's License #
(attach copy of current !CrVQr�licen
Contact Name: «etc ;< CsTrT�—
Contact Phone: ( GC"2, ) -7(d 1 -2
Subcontractors: o Arch itect/EngIneer: e-A,
c Plumbing: �v.J n r" Addre;a: -
Mechanical: &J �� ✓ -PC,r'
►- (attach copy f current OR Contra is License)
J Phone: ( Sb 3)
C13
1.
,i? JOB DESCRIPTION
_ - 17
Applicant ignature Applicant Phone numb�ierL
Received by: Date Received: 07-I C.A ' _
H'Jnpn'MnVN•lq r
k W.Ad
q/2 /?6
Permit s Account Description Amount Amt Pd. tial. Dtrt
Bldg. Permit (BUILD) 6
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
ELS --
Ac
Bldg:
Plumb:
Mech:
6.L(-
Plan
LPlan Check (PLANCK) 0 �IC.J, •�''
1
Bldg: `�• C/o
Plumb:
Mech: I i1). 12 7
Sewer Connection (SWUSA)
Sewer Inspection (SVVINSP)
Parks Dev Charge (PKSOC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-,NT)
Commercial TIF (71F-C)
Industrial TIF (7F4)
Institutional TIF (TIF-IS)
Office TIF (TIF-0)
'Nater Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Etcsion Cntri Permit (ERPRMT)
rasion Planck/USA (ERPLAN)
Eresion PlancklCO i (EROS,1,4)
Q T ALS:
Permit#:
Address: 5/ 6LL)
N i ) nA ,, (�
Z/ Issued by: 1 "l& w Dater
Statement: information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Constru.:tign Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need rot submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
n 1. 1 own, residt in, or will reside in the completed structure.
❑- 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
3A. My general contractor is 4 5 A_-
(Name) Contractor regis. #
T will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
If 1 hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a eo,.itractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
—r name of the contractor.
m
I hereby certify that the above Information is correct and that I have read and do understand the Information
_J
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
, tom,\_ Aq"3-9(4
Signature of permit applicant) (Date)
(white copy to issuing agency permit file,
pink copy to applicant)
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Electrical Signature Form
Permit # . . . . : MST96-0146
Date Issued. : 04/08/96
Parcel . . . . . . : 2S111AC-02100
Site Address : 14695 SW 92ND AVE
Subdivision. : PINEBROOK TERRACE
Block. . . . . . . . Lot . 62
Zoning. . . . . . . R-4 . 5
Remarks :
932 SQ FT ADDITION TO EXISTING HOME, OWNER TO DO ELECT, PLUMBING AND
MECHANICAL. HOFFARD TO DO GC WORK. (ADD 2ND STORY TO EXISTING HOME)
PATH I
Your company has been indicated as the electrical contractor for the permit indicated above. In
order for the electrical permit to be valid, the signature of the supervising electrician
is required.
Please have the appropriate individual from your company sign below and return this Electrical
Signature Form prior to the start of work. No electrical inspections will be authorized until
this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER : ELECTRICAL CONTRACTOR:
WALKER OWNER
14695 SW 92ND AVENUE
TIGARD OR 97224
J Phone # : Phone # :
G' Reg
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J
X
Signature of9-upervising�iectr aci i n
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639-4171 , ext. #x310
Frorr': HOFFARD REMODELINU COMPANY PHONE No. 761 1316 Apr.02 1996 2:03PM P01
REMODELING COMPANY
Cr.:)RP0Rn11 C)FIK.1 13/08;I 11,36111AV[NUI • • PQI�ILAND,0REGUIJ97.2,10
I A51',II)I 161.8177 WLSISIDt 297-1170
April 2, 1996
City of Tigard
13125 BW Hall Blvd.
Tigard, OR 97223
Phone: 639-4171
Fax: 684-7297
Re: Receipt No. 96-276673
Plan Check 3-15R
Walker , 14695 OW 92nd
ATTF.NTIC7N c A _*Development Services
FolInwing is the plot plan for our project located at 14695 3W
92nd. Noted on the plot plan ere all of the elevatiwifr, an you
required.
We are very anxious to got started on thin project and would like
to Dick up our permits this weak.
If' you have any questions, correctioi n or concernn , pleaee give me
a call as soon as possible.
Thank you,
Francesca Hoffard/COM
HOFFARD REMODELING COMPANY
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From HOFFARD REMODELING COMPANY PHONE No. 761 1316 Apr.02 1996 2:03PM P02
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Sin OF ADDffION: 1 ST FLOOR 101 SQ.PT.+2ND FLOOR SSl SQ.1'f.a 972 SQ.Pf.
LEGAL DESCRIPTION:LOT 62-PINE BROOK TERRACE-WASHINGTON COUNTY '77`�
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14695 tM 448ND Pul-
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CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC96-0361
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 06/18/96
13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)639-4171 FARCE L: C2'5I, 11.AC-01.21 100
SITE ADWRLSS. . . : 14695 SW 92ND AVE
SUBDIVISION. . . . : PINEBROOK TERRACE ZONING: R--4. 5
LALOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :62
Pr-oject Deser-liption :
UNII------- ----TEMP SFRVC/FEEDERS-----
1000 SF OR LESS. . . . : 1 0 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . 0
EACH ADD' L 500SF. . . - 0 203. 400 amp. . . . . . . : 16 SIGN/OU*T LINE LTG. . 1/1
LIMITED ENERGY. . . . . : 0 401 600 amp. . . . . . . : 0 SIGNAL/PANEL.. . . . . . . 0
WINF. HM/ SVC/F--DR.. : 0 601+amps-1000 volts. : Q) MINOR LABEL ( 10) . . . 0
.-------SERV ICE/FEEDER---- -----BRANCH CIRCUIT'S----------- ---ADD' L INSPECTIONS—-
0 200 amp. . . . . . : 0 W/GERVICE UIR FEEDER: 0 PER INSPECTION. . . . . 0
201 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 0 PER HOUR. . . . . . . . . . 0
401 600 amp— . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . III
601 1000 amp. . . . . : 0 REV I EW SECT ION-----------------
1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . ) 60111 VOLT NOIIINAL. . :
Reconnect only. . . . . : 0 SVC/FDR > = 225 AMPS. CLASS AREA/SPEC OCC. :
Owner- FEES
WALKER type amoi.tnt by date t-ecpt
14695 SW 92'ND AVENUE PIRMI $ 110- 011.1 CJS 06/ 18/96 96-28'709
TIGARD OR 97224 `;PCT $ 5. 50 CJS 06/18/96 96--28709
11,1-)one #:
Lontr-actor-: -----------------------------------------------------------------------------
110GANIS ELECTRIC $ 115. 50 TOTAL
4127 SE 91ST ST
REQUIRED INSPECTIONS
PI)RI-LAND OR 97260 Ceiling Cover Elect ' I Get-vice
Phone 774--8824 Wall Cover- Elect11 Final
1'r,q #. 25644
"his permit is issued subject to the regulations contained in the
ligard Municipal Code, State of Ore. Specialty Codes and all other FeWmittee Signat Ur-e
.pplicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 160 days of issuance, or if work is suspended for more
than 188 days. Issued By
INSTALLATION
The installation is being made on property I own which is not intended for,
r, sal e, lease, or rent.
OWNER" S SIGNATURE:
NDATE:
INSTPLL!"1.710N
';IGNAIURE OF SUPR. Et-r:C,, N-
DATE C2 - 1.!g-
LICENSE NO:
Call for- inspection 639--4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit # ,L(' g( -036
�y Date Issued r - 2 - 1),G'
Phone (503) 639-4171
CITY OF TIOARD FAX (503) 684-7291
TDD No. (503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development /"�� �- li f/f f k� Number of Inspections per permit allowed
Address / Service included: Items Cost(ea) Sum
City/State/Zip l !� F 9'7,.-' 4a. Residential -per unit P 4
1000 sq ft. of less I $110 00
Name (or name of business) Each there)f 5q Ir or
portion on thereof $2500
Limited Energy $2500
i
Commercial ❑ Residential Eacl,Manufd Home or Modular
Dwelling Service or Feeder $6800
2
2a. Contractor installation only:
� 4b. Services or Feeders
Installation,alteration,or relocation 2
Electrical Contractor ' [I�r�I 200 amps or less $6000 2
C C} 201 amps to 400 amps
$60 00
Addres G. F — 401 amps to 600 amps $12000 2
City_ 1,�'= j SttJate l Zip_ 72/ 601 amps to 1000 amps -- $18009
2
Phone No. 7 !`T �'x Over 1000 amps or volts __ $34000 2
Job NO. Reconnect only $5000
contractor's license NO. -- 4c. Temporary Services or Feeders
Contractor's Board Rey,/'NC Installation,alteration,or relocation
Signature of Supr. EIeC fi 200 amps or less — 2
201 amps to 400 nmps $5000 2
License No.�U – Phona0. _ - 401 amps to 600 amps $7500
Over 600 amps to 1000 volts $10000 —
2b. For owner installations: see"b"above
4d. Branch Circuits
Print Owner's Nafne — New alteration m extension per pane
Address a)The lee for branch circuits with
purchase or service or Feeder lee. 2
City State— Zip_ Each branch circud 3500
Phone No. __. b)The lee for branch circuits without
purchase of service or feeder lee. 2
The inst211ation is being made on property I own which is 2
First branch clrrult _ 335 00 _
not Intended for sale, lease or rent. Each additional branch circuit $500
Owner's Signature . 4e. Miscellaneous
(Service or feeder not included) 2
Each pump or irrigation circle $40 00 2
3. Plan Review section (if required): Each sign or outline lighting $4000 -- __
Signal circudts)or a limited energy 2
Please check appropriate Item and ente fne In section 5B. panel alteration or extension $4000
4 or more residential units in one structure Minor Labels(10) S10e'o
V Service and feeder 225 amps or more 4f. Each additional inspection over
System over 600 volts nominal
_ 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 $5500
___
In Plant $5500
CIO Submit 2 sets of plans with application where any of the above
t� apply. Not required for temporary construction services. 5. Fee".
Sa. Enter total of above fees $ s�
NOTICE 5% Surcharge (05 X total fees) $ t
Subtotal $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 251/ of line A for
AUTHORI"EF 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
COMMENCED �^*^me•.•k ❑ Trust Account #
Balance Due
$ / '�"�