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11865 SW 95TH AVENUE a Ul rt 9 C C m I snNSAV RIS6 MS S99TT C ITY OF TIGARD r,r.R'hlTT t_LC''17- 07-_.r, DEVELOPMENT SERVICES DOTC' 1J./04P�1F F� 13125 SW Hall Blvd-,Tlfsfd,OR 97223 (503)6394171 Eq I TE PDD - - - I I-aGr) SW 01-ITH AVE S 1 .1 rDD T T I ON IJBI,)I Y T S T ON. . . . I o I Add Nrst branch circuit to and -0isting dingle `aN ', *L ­TT)r_NT1N_ UNTLT , , - — ­ T!7MP GRVC/FCE )F_R',^)-­­-­ ! q jM1-_,1 I RR I Con'r I M11- ORi ,rr)s 200 Amr) 400 omp. jb,t/01J'T LTNf-' jr 0 r,nvn 40:1 GOO 81aP. IMITC-n E7,NCROV- 0 0 11117, 1 C, 41 r, R r W-10ERVIM, ":00 . . . . . . I Ksi. W/0 , 0 r, , 1)R. g I P[: I . . . . . . .. . 00 amp. . . . . . . 0 RC E111) ADD 0 1 6 0 0 amp. 0 RY V I FW S r.-CIT T f7N 0 WO V(1j!_T N 1.000 'Amp, T- r;� UNTT�, S v r. F 1)R r_1 A T1 ill y a "11CHnPr t_INN 37 t" (3Er) 1 7 97 4 -? 7s n r.n i, t v114 T OR 97F,67 + r State of Drijon SPeciiltV CUlts and �11 otht� I pgroit �s jjs4ed subijct� to the regulations CCntAjttd ji,, the 7ijard ?Jlnir-4al Cu�", 5tarted 0hln A % It work ii not 1� laws. MIL wo� W.�11 be eanp in a,ccol-da:lct with approved plaos, sage; will if e rulles adapted pppl work J1 suspended more than t8f divs. ATWION3 yori to follow th s,jspen you soy obtain a an e, or i,f T� se rules are set forth in'Aility Notificatio,", Center. oo DX 1,41es or direct questions to by calling nNt Y ­ t'!A ki Q T t IYO txa � A. .1, j 'I Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hrl' Blvd. Tigard, OR 97223 Pl�ln ;k/Rec. # — Permit # _ �V—:-!i 2 -- F`lone (503) 639-4171 Date Issued _FAX (503) 684-7297 Issued by CITY OF TIGARD TDD No. (503) 684-2772 Inspection (503) 639-4175 —_ 1. Job Address: 4. Complete Fee Schedule Below: Number of Inspections, per i.-wrmit allowed Name of Dei elopment Address 1 (LJ.. C/ Sorvtce Included Items Cost(ea) Sum r4a. Residential• per unit 4 CitylState[Zip 1000 sq It „r t*" $11000 Each addittonel 500 nig it or 1 Name (or name of business) portion thereof $,1500 --- Limited Energy $25 00 i Commercial ❑ Residential Each Manul'd Nome or Modular Dwelling"Qrvla or Feeder SM W 2a. Contractor installation only: 4b.Services or Feeders Installation,aReralan,or reloc:atron 2 $60 00 2 Electrical Conttactory { �A — 200 amps or w" 2 i 201 amps to 400 amp. $80 00 2 AddressUk 401 amps I0 600 amps $120 00 City(.`` tate ',Zip sol amps to 1000 amps --- $18000 2 Over 1000 amp"or volt" $04n 00 _ Z Phone No. ( Roeonned nnly, $5000 Contractor's License No. –� Contractor's Board Reg. No. 4c.Temporary Services,or Feeders Installation,alteralmn,of relocalmn Signature of Supr., lec'n_ , '�` 200 amps°r 1""' $50 uo — — 201 amps to 400 xnpe $7500 License No.-1 ' Phone o. 401 am"Wo amps $too 00 Over 600 amps to 1000 volte 2b. For owner installations: b.°''°"" 4d. Branch Circuite Print Owners New,aflerauon or extension per panty Address_-------A--V a)The fee for branch°mutt all purchase of serelce or Mods►Me. rity State Zip Each txanch arcus $500 ----� Phone No. h)The fee lot branch aranu al111101 f 2 The installation Is being made on property I own which is purchase of service Of Meda Mo.First branch orail S3500 not intended for sale, lease or rent. Fadi addowinal branch drat $600 saunas s Signature �� 4s,- Miscellaneous 2 (Service or feeder not included) 2 3. Plan Review section (if required): Eads pump or inVation cird" $4000 _ Each sign or oulllnt IipMxrp $4000 Sxpnd rateutlq or a lensed errrpy Planes check appropriate Item end enter fee in section 5B. panel,atleratxon or estersion $4000 4 or more residential units in one stricture Minot Labels(to) $10000 - -~V Service+and feeder 225 amps or snore 41. Each additional inspection over System ovor 800 volts nominal the allowable in any of the ab ave Classified area or structure containing special occupancy ct.r epertwn s3500 as described in N E C Chapter 5 Per hots $6500 in Plant $6500 Submit 2 sets of plane with application where any of the above apply. Not required for temporary oonstruction services. 7. Fees; Sa Enter total of above fees NOTICE 5%Surchar(,e(05 X total es) _ Subtotal $ S� PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25%of line A for AUTHORIZED IS NOT COMMENCED WITHIN :80 DAYS,OR IF plan Raview If required(Sec 3) $ CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal : M=J A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account M $ Balance Cue $ c_� C� CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business"hone: 6394171 Date Requested: / �� _ " A.M. P M. f MST: Location: I . ,� G` - c . f ...��-- BUP: Tenant: Suite:— .—Bldg: NEC: Contractor: u,! ( 4 7 A �" � �;lone: G `� � , ( ���f PLM: l (� (�. _ _/Phone: ._r t T ELC: (honer: l � _ ELR: _ SIT: _ BUILDING BLDG(con't) PLUMBING MECHANICAL ELECTRICAL ' SITE Site Post/Beam Pogt/Beam Post%puun Cover7Service Sewer/Storm Footing Roof UndFUSlab Rough-In Ceiling Water Line Slab Framing Top Out Gas Line Rough-In UG Sprinkler Foundation Insulation Sewer Hood/Duct Reconnect Vault I3smt Damp Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Drain A/C UG Slab Shkxr/Sheath Fire Spklr/Alm CrawUl'ound Ih heat Pump Low Volt Approved Approved --ApprovedApproved Approved Appr/Sdwlk Not Approved Not Approved Not Approved oved Not Approved FINAL FINAL FINAL FINAL, FINAL � D D dw UA61 C]Call for reinspection einspection fisc of S--_—_- 'quired •titte next in.. cUQ11 t Jnnble to inspect I)ate - _ Page________of t CITY OF TIGARD BUILDING INSPECTION DF,VISION 24-Hour Inspection Line: 639-4175 Business Phone: 639-4171 Date Requested: Location: ` 6_X_A__ P.M. MST: Tenant: /�J BUP: Suite: Contractor-: Bldg: MI?C: ./ — _���_- C -- Owner: Phone: PLM: o ELC: ELR: BUILDING �. LDC�r�•t� Lp UMBING SIT: _ Site Post/Beam Post/Beam MECHANICAL ELECTRICAL SITE Footing Roof Post/Beam Cover/Service Slab UndFl/Slab Rough-In Sewer/Storm Framing lop out Ceiling Water Line Foundation Insulation tiaa bine Rough-In W Sprinkler Sewer Bsmt Damp Drywall Storm Hood/Duct Reconnect `vault MasoFurnace Temp Service MISC. Shear/Sheat)eaU Ceiling Rain Drain NC Fire Spklr/Alm C���Apc�d �N wl/Found Dr UG Slab Heat Pump Low Volt Approve A EAppr/8dwIk NravedApprovedlmavot Approved Not Approved Approved ~ INAL FINAL FINAL pp Not Approved FINAL FINAL -------------- D Cell far reinspcetiot a 17 Reinspection fee nl-S --__ --- �-- -- --__ — required hefore next inspection I'l Unable to ir.slx•t In.+pector: — `- — _ Date Page- of 5 I CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 6394175 Business Phonc: 639-4171 /e;-- C Date Requested: 1 I_ 7 A.M. _ P.M. MST: Location: —� .S % J BUP: Tenant_ ��" Suite: Bldg: MEC: C' a Contractor: �.�(_C�lr / —�.-t'..�I 11,x/ Phone. PLM: Owner: � Phone: ELC: ELR: BUILDING BLDG(con't) t,.UMBING MECRANIELECTIUCAL ?TE Site Post/Beam 'lost/Beam os .learn Cover/ ice ewer/Storm Footing Roof UndFI/Slab Rough-In Ceiling Water Line Slab Framing Top Out ,as . Rough-In UG Sprinkler Foundation Insulation Sewer Hood/Duct Reconnect Vault Bsmt Damp Drywall Storm Furnace Temp Service MISC. Masonry Ceiling Rain Drain A/C UG Slab Shear/Sheath Fire Spklr/AIm Crawl/Found j`r Heat Pump Low Volt Approved Approved �Approv Approved Approved Appr/Sdwlk Not Approved Not Approved roved Not Approved Not Approved FINAL FINAL cirm,Wj FINAL FINAL G'1�1 G �0�— oYe- G' c��,r– .zip Cl Call for reinspects / CI Reinspection fee of Si required Wore next inspection D 1!nuhle to inspect Inspector _ _7i -....--- --------- Date:_ .� _."_rL'_.'___� Pw"_ CITY OF TIGARD R DEVELOPMENT SERVICES `'°ar,IT IT it MrC97-1�—" W HBO Blvd.,Tigard,OR 97223 (503)639-4171 131258 10,131/17 FTWCEL ^ 15135CID-04700 770NING.� R, ROETCHEr5'3 1011)ITION 1 -,r - T 1(7 P.jRT!7 11( TTON, PI-OCK. . . . . . . . . . N L C)T 00 T-1-00P FURIN, t1i" WOPK, nLT UNIT HEATERS. VENT I-PINS. 0 "I YPE OF USE. . � SF 1)ar' SYSTE.MS: 0 OCCUPMCY GRP- . gR7, VENTS wc, mini... S T 0 R T 1.3 0 LAO I LE RS/CMIPPESGO RS HOODS. 0-. 0 DOMES. I r-tJEL INrIN: cnmmi-.. 0 BTU 1,C--0 1-it". 0 R U INPUT: 30-11150 HP. 0 WOODSTOVES. . .- 0 DnmPERsr,- 0 HP. 0 rt-l- DRYE.Rs. . 0 r)A!7, PRESSURE. - i NO. OF- UNITS-,-----....... ()TR HANDLING UNT`'t OTHC.R UNITIS. OIUTI-ET�71 SLTU; I Q1, I OOK BTU: 0 i 10000 le, P, : Convert furnace frog k,Al to gas and add air conditioning and gas piping an existing single fatily dwelling, Air conditioning ijnits cannot be placed 11,� required setback areas. r?'.f ,f,�HARD 171N .l 0 0 9Fn 10 1/97 97 -300!�A7 17,73,07 SE OnT71CLD ROAD 17,11m" 0/7't P17 00" t A; TFN!r, Hrr)TTNG EVELYN ST TOTAL 011 9701", W7 1.3 PrOUT RED 7,1s pertit is issued subject to the regulations contained in the L ii, I # Tigard Municipal Codet State of Ot- Specialty 1,rodes arid all c-hcmioe.0 applicable laws. All work will be done in accordance with - U t,1pr,oypd plarts. This pvNit will expire if work is tzt,t stal ted U. T Rhin 180 days of isitlanclo or if work is suspended for tore ,:,sn 180 days, PMNY10N., Oregon law requires you to follow rules M i t i. ;.I,opttd by the Oregon Utility fttififdtiOr Center, Thole ,t fol-th in DAR ISP-HI.-N11 thr�,uj•i top 7 !tain copies of these rules or direct questions to MA'"' ti +4 41 A I A.4 11 d..} -1,.i- 4 + 4+-4,j-+—f A,4 4,+f+4 + 1- F+ +4 4..*L'... 4' -1''9 A 4- Pian Check#— Y— CITY OF TIGARD Mechanical Permit Application Recd By 13125 SW HALL BLVD. Commercial arid Residential Date Reid TIGARD, OR 97223 Date to P.E._ e Dale to DST__ (503) 639-4171, X304 Permit# Print Or Type called Incomplete or, islegible applications will not be accepted Name of DeveloVnent/Pro}ed Description y — �— !�l TalAe 1A Mechanical Code 4TY PRICE AMT Job Svest baa SIMae A) Permit Fee -0- -0- 10.00 Address 10 — Bidg# CMy/Sute Zip B) Supplemental Permit— 3.00 Name(or name of business) 1.) Furnace to 100,000 BTU 6.00 Owner /t_' G'/t r�r //1") ind.duds 8 vent- Owner I Mal V Ad*m 2) Fumac*100,000 BTU+ 7.50 / 7,30.7 �,E 4 re-le-l' ind duds&vents _ _ _ CRy/slata SP Priab 3.) Floor Furnace 6.W r J I, /(z>n r/c';r' -cj!/y"1 _ ind vent --- — �— Nam,lot name of busrwss) -'-- 4) Suspended heater,wall heater _ or floor mounted heater _ Occupant Malang Address 51 Vent not incl.in 3.00 appliance permit City/State Zip Phone 6) Boiler or comp,heat pump,do we 1 6 W to 3 HP;absorp ung to 100K BTI; _—` _ Narr+s 7.) Boiler or comp,heat pump,air:lend. 11-00 3-15 HP,absorp ugd to 500K BTU Contractor Me"AdtMaa 8.) Boiler or comp,heat pump,air cond 15.00 Fre/ i 15.30 HP;absorp unit 5-1 mil BTU Attach copy of city/sh" Zip pnww 9.) Boiler or comp.heat pump,air Bond 22.50 Current Licenses !./ '! !! 1 "j( 30-50 HP,absorp unit_1-1 75 mil BTLI Oregon Cana Cont.Board Lic.M W.Dirla 10.) Boiler or comp,heat pump,air cond -� 37.50 >50 HP.absorp ung 1 75 mil BTU COT Business Tax or Metro N IF NN 11.) Air handling unit to 4.50 10,000 CFM 12.) Air handling ung --� — -- u— 750 10,000 CTM+ or Mail"Address — 13.) Non portable —^— 4.50 evaporate cooler Engineer CMyI`utale z1p Prvxes 14.) Vent fan connected 300 to a single dud Describe work New O YAddition OT Alteration O Repair O 15.) Ventilation system not 4.50 to be done Residential© Non-residential O included in appliance permit Additional Description of work 16) Hood served by mechanical exhaust 450 ej /-1 e4 e?c'/c✓ /1` 17) Domestic incinerators — 7.50 1 EuisGny use of --- 18) Commercial or industrial 30 00 - building or property — incinerator — 19.) Cbthes dryers,eta. 450 Proposed use of 20) Other units 4 50 building or property ------- 1 ype of fuel-oil O natural gas Q( LPG O electric O 21) Gas piping one to four outlets 200 I hereby acknowledge that I lave read this application,that the 22) More than 4-per outlet (each) .50 information given m wired,that I am the owner or authorized agent of the owner,that pians suhrtgted are in compliance with Oregon State CITY.SUBTOTAL r laws. Signature of OwnerfAgent-- --T—Date'- 'SUBTOTAL. — - - r- r , e 5%SURCHARGE Cotrtact Person Name Phone PLAN REVIEW 28%OF SUBTOTAL 1 - I 7J�' r/[ _ TOTAL t arty spy—doo 'MlMmum permit fee is$25+501.surcharge Pev 7196 10/90/97 11:43 FAX 5572990 A TEMP HEATING IJO1 A4 � n J�o �SrN lZ' 1