10875 SW 108TH COURT J
C�
�J
C1
w
0
00
x
D
m
z
c
m
10875 SW 108TH AVENUE
CITY
ITY o f T I G A RD
ELECTRICAL PERMIT
ELC2DEVELOPMENT SERVICES DATE 13SUED: 6/9103 PERMIT#: 6/9/03 3-00339
13125 SW Hall Blvd., Tigard, OR 972:3 (503) 639-4171 PARCEL: 1S134AD-03000
SITE ADDRESS: 10875 SW 108TH AVE
SUBDIVISION: BLACK BULL PARK ZONING: R-4.5
BLOCK: LOT : 016 JURISDICTION: TIG
Project Description: Install 1 branch circuit to AC.
RESIDENTIAL UNIT _TEMP SRVC/FEEDERS M!_°,CELLANEOUS_
1000 SF OR LESS: 0 200 amp: PUMP/IRI.IGATION:
VALH ADD'L 500SF: 2.01 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL.
lVAN.F HM/ SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE./FEEDER BRANCH CIRCUITS ADD'l.INSPECTIONS
0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PFR HOUR:
401 - 600 amp: EA ADD'I_ BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ _ PLAN REVIEW SECTION
1000+arriplvolt: > 4 RES UNITS-: >600 VOLT NOMINAL:
Reconnect only: _ SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
SONDRA GUIZAR OWrJFR
10875 SW 108TH
TIGARD,OR 97223
Phone: 503-670-n295 Phone:
Reg #:
FEES
.'eacrlptlon � Date Amount
I11,11li-kri FIT 1 -,nit 0/9/03 $,1,; R. Required Inspections
1"1"AX!s State T_X 6,9%03 $3.75 Rough-in
Elect'I Final
Total $50.60
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 wcrk Is not started within 180 days of issuance,or if work is suspended
for more than 180 days. ATTENTION: Oregon law reyulres you to follow rules auopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies Y these rules or direct questions to OUNC at(503)246-6699 or
1-600.332-2344.
Issued By: ,r; L �, c L. _ , c -_ 'c �, Permit Signature:
OWNER INSTALLATION ONLY
The installation is being made ot, property I own whir,h is not intended for sa e, 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
fa'Rrr)Ia17'
Folt
VSE
N LN
Electrical Permit Application Received � t
— -- -- i � [�crtrn:'i c
-- Date/B)':� C/ _L - Ick
Mt.' tG� -
Planning Approval Sign
City of Tigardi)at By: PennitNo.:
13125 SW Hall Blvd. Plaii Review Other
Tigard,Oregon 97223 Da:SIE Permit No.: _
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review iaUse
Date/By: Case
No.:
Int -net: www.ci.tigard.or.us Contact .luris.: Seepage 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: — Supplemental Information.
TYPE OF WORK PLAN REVIEW Please check all that apply)
New construction Demolition Service over 225 amps- I Icalth-care facility
commercial ❑Hazardous location
Addition lteratio a lacement Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1&2 family dwellings four or more residential units in
1 &2-Family dwellingCommercial/Industrial ❑System Ivor 600 volts nominal one structure
-. ❑Building over thm-stories ❑Feeders,400 amps or more
ACCeS50 I3uildin Multi-Famil ❑Occupant load over 99 persons ❑Manufactured structures or RV park
�] Master Builder Other: ❑Egress lighting plan ❑Other:- —_
JOB SITE INFORMATION and LOCATION Submit_sets plans with any'of the above.
n
The above a :not applicablMe to temporary construction service.
Job site address: (_) r it) r 11 FEE' SCHEDULE
Suite#: Bld ./A t.#1: _ _ _ Number of It ections per pcrmit allowed
Project Name: Description I Vly Fee(ea.) Total
New residential-single or multi-family per
Cross strecluDirections to,lob site: dwelling unit.Includes attached garage.
Service Included:
1000 sq ft or less 145.15 4
Lach additional 500 sq,A.or portion thereof 33.47 1
Limited enetgy,residential 75.40 2
Subdivision: Lot#: _—— Limited cner y,non residential 75.00 _ 2
Tax map/parcel #: — - Each manufactured home or modular dwelling
DESCRIPTiC N OF WORK service and/or feeder 90.90 2
— Services or feeders-installation,
alteration of relocation:
--- --- 80.30 2
--- --- --_ -- - 200 amps or Icsa _
201 amps to 400 amps --_— 106.85 2
-- — — ------ — 401 sm to 600 ams — 160.60 2
TY OWNER TENANT er 601 am to 1000 a 240.60 2
PROPER
—— �------ Ov1000 em tis or r volts _i _ 454.65 2
_Name: 5[,42,1�4. e✓ Reconnect only 66.85 2
Temporary servicea or feeders-im(allation.
Jtddresa:_� _L_ alteration,or relocation:
City/State/Zi� c2-,.. _ Z2 2 100.30 2
3 2tN)am rs or Icss _ 66.85 1
--- 7 201 amps 400 amps
Phone: _', l aX 401 to W)ams 133.75 2
i PPLICANT _ CONTACT PERSON Branch circuits-new,alteration,or
Name: extension per panel:
---- -------— — A.Fee for branch circuits with purchase of 6.65 2
Address: _______—___ service or feeder fee each branch circuit
I /State/ZB.Fee for branch circuits without purchase of
Clt t
y
�: — service or feeder fe,.first branch circuit _ 46.85 2
Phone: Fax: _ _ _ Each additional branch circuit 6.65 2
— Misc.(Service or feeder not included):
1'-mail: Each pump or irrigation circle 53.40 2
_ CONTRACTOR -- Each si or outline lighting _ 53.402
.lob No: O(� �_- Signal cirruit(s)or a limited energy panel. —
-- —— alteration or extension—_ Pae 2 2
Business Name: Description:
Address: — --- Each additional Inspection,over the allowable In any of the above:
City/State/Zip: Pyr inapeeticn per hour(min. I hour _._-J 62.50
Fax: Inv:sli ationI-e ----
Phone: _. Of'ier:
_CCB Lic.#: Lic.#� Electrical Permit Feel"
Supervising electrician _ _ subtotal 1 S
Lsi ature required: _ _ Plan Review(25%of Permit Fee
r_� _ _ State Surcharge(8%of Permit Fee) S
Print Name: LIC. #: _ --- — — TOTAL PERMIT FEE S
Authorized / r .0 -' Notice: This ptrmit application expires Its permit Is not obtained within
Signature: ! r. mat". IRO days after It has been accepted as complete.
*Fee methodology,set by Trl-C ounly Building Industry Service(bard.
(Please print name)
i\Dsts\Pennh Fomrs\ElcPemnitApp.doc 01 03
0� !
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: _
Fee for all systems............................................................ $75.00
Check Type of Work Involved:
EJAudio and Stereo Systems*
I_7 Burglar Alarm
F1 (iarage Door Opener*
Heating,Ventilation and Air Conditioning,System*
Vacuum Systems*
❑ Other
COMMERCIAL WOkK ONLY: _
Fee for ink system. ..................................................... • 3.00
(SCI:OAR 918-26r.2661
r'hrck Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
U Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
I.andscopc Irrigation Control*
Wlcdical
Nwsc Cells
0 Outdoor Landscape Lighting*
Protective Signaling
Ej Others`.-------- -- ---.� ----
Number of Systems
* No licenses are required. Licenses are required for all
other installations
1\Dsts\Permit Forms\HcPermitAppPg2.doc 01/03
CITYOF TI GARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00408
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 8/7/03
SITE ADDRESS: 10875 SW 108111 AVE PARCEL: 1S134AD-03000
SUBDIVISION: BLACK BULL PARK Z.OI ;NG: R-4.5
BLOCK: LOT: 016 JURISDIC 'ION: TIG
CLASS OF WOI: (: AI_T GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAT.:S; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 35 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 35 ft. of water service
FEES
Owner: — -
-- Description Date Amount
RICARDO GUIZAY
10875 SW 108TH I I'I.UNIBI Permit I-ee 8/7/03 $72.50
TIGARD, OR 97223 1 I AXl 9%)State Tax 8/7/03 $5.80
Total $78.30
Phone
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND,OR 97206 REQUIRED INSPECTIONS
Water Service Insp
Phone : 5(13-771-9449
Reg #: LIC 42671
PLM 34-70PB
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 bo done in accordance with approved
play.,. This permit will expire if work is riot started within 180 days of issuance, or if work is suspended
fC: ITore than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: t_Z rni�L � Permittee Signature: _ley) —� .• �Q ,��
Call (503) 639-4175 by 7:00 P.M.for an inspection needed the next business day
AUG-06-e,003 01 : 47 PM CROM PLUMBING 503 771 9454 P. 01
'0(403 &M, ox3
Plumbing Permit Application
E
T `bP�1�A��"�+'i Mftl�i � .l',r'r7 Dotilu0�lvoda-'�•� Pettfi tlo.:
City Of igardxirr.�su,irJ a k +,.Il.t ( ���,. , �
pesmlt no.: Building p nilt no.•
r AddroSA:19125 Si/M"Bl �ry OR''
and ., „, i r,
uYofni Pboue:(903)6394191 t �`i;-' r 1 ProJtscveppl.nzt.: Bxpirodate:
Fax:MJ)998-1&150 ^t':�;r,�,N 1 , Dataluued! ? "
By: Recclpt no.:
Land !':�' ty 1 CYefileeloa
usa approval: s `'` I. i Psreq7":
1 & famlly rtwe'.ling or, ('rmlmencl "'ial . _.....__. .Q MWd-ftunily i ❑Tenant improvement
New ao[utlVcti:,n PAddltionhltctuion/mplac4ment 0 hood eervlce' U tither.
Job addreg: /O b 1 S" ;f Yj. /es � �_, 1 - J�rl !loo Fes sa. Total
B141no.: :.1 i ;. .. Salle oo.f ear, y w i p only!
Qoclad"100 it.5W MWh utility caerarUw)
Tax nuJAM IoVeccount no.: ' SFR(1)bath, i
W. Block: Suhdivision:
F'rr,oct nam . , ... .►.u.,tSM(3)bath _---_--
City/cottn :.-rt- c 71p. EA, aikidonal b_aTW1dt_cTc_n
1eSctiptl !ltdlo�w, ao f work ooi�l promises: Ske ntluttess
3 � Ulx�a� j2 vj Vlc. Catch basintarea drain
BSL date of compledon/inapection: + t. a Bac tenor r riln
70--0- t.����
FtIle111eae IlArrle: � IRr�I; I
Manufactured 110711E U. . ell s
1'Ota? 1" ��i nn d i
Addreas: i� 9 _� rl`r,r,lr Rain dmin connector
City_ rt L&V%J &tato: K_' Z[p: a
rrnits! Bower ao.l n.
1'faoe:�'11-�11�y9 mut: '�1: B•mell: conn newer oo. n.iL
(.`CB oo.: Plumb.bw.roX.no: 3!&?Q�,e Ater Se ce no.
Cityrmotro lic.no.: /y 31
Iutme or em
-_ rCbnMW1W2 tWvoAi
ac ow proventer
Hint twee: �: ac Ater valve
Rialn avat V
Name: aY,, eie wuhez - -
Addmss: war Ior
-En1cT'tA� _
" ectotATAum—•
Phone: pax: r &Mau:
dame1nt): [['1 r._� oor aindfl000r finks ui_ Y
_ l� Cu.trc�(Q 6- r� 1 "7 GO e dis
MailittaAddltaA: _ --
�'�t+ State: d 7II' - ?_ oro
ice"Urr
Illrine: Fu.: F mail: Tntetre trap --
0wner inirtalletionhrsidentW nlalmnanee only; The RMAi tMIAllulon mo s
will be mock by me or the nuintcnance And repair nude by my mgu er po
rMployec on the,pmputy I own as per OPS C3u+ptrx 447,
owner'r d twe: - Dato:_ ummp
we weir pan
Urinal —
Nfwte; -- ---- - ---- const
Addreae: !.ter hester
d — State: L1P. t ier.
Phone. —TPu: �!nail: r 'otsi
N a lel iirbinaow tauar r>r�ei�Y tt,ew ai as...n 1.�larrl.r► Midt�1100................: 7_. 5
Notice:"IWA p".7 W appllcalkn ( )
lk� O�Aa Wl Wd swelw If a pert.!!!If Ont OWAinut Nae 1°W" sd— _ -p
M*-0 syle.r —,, '- � L within ISO day.after it hu hnr, 3!110 wrctlArYe(8llr)....tf
eoorpted at complete. 70TAL ......................._
_ f
dM -
M44ele l
CITY OF TIGA RD 24-Hour
BUILDING Inspection Line: (',03)619-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BLIP —.---_.__.—
Received _ _�__� pDate Requested `( -AM PM-_____...._ BLIP
Location =Suite MEC
Contact Person — — - Ph (—___—) _--______ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ___ _--__T — _-_--- ELC _---
Footing ELC
Foundation Access:
Ftg Drain i ELR
Crawl Drain -.
Slab Inspection Not«.>: SIT
Post&Beam ----- -- — ---------- _ _ _ _
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing --- --- -- - -
Insulation ,
Drywall Nailing ----- -- - — - ----
Firewall
Fire Sprinkler - - --- - -
Fire Alarm
Susp'd Ceiling _---- - -
Root
Other:
Final
PASS PART- i AIL
PLUMBING
l.,
Post&Beam
Under Slab - - --- - - ---- __
Rough-in
erervice
Sarn ary.ewer
Rain Drains
Catch Basin/Manhole
Storm Drain --
Shower Pan
Other:
Find.._ -- ------------ -
OAS PART FAIL
_
ANICAL _
Post&Beam �—
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL ---- - -- - - - - _
ELECTRICAL
Service - -
Rough-In
UG/Slau
Low Voltage �-
Fire Alarm
Final n Reinspection fee of$_ ---_required before next inspection. Pay at City Hall. 13125 SW Hall Blvd.
PASS PART FAIL
_i-TE Please call for.�Inspectlon RE: —____ ❑ Unable to Inspect-no access
Fire Supply Line �. i►�
AD:. �/
1
Approach/Sidewalk `ass �. 7 Inspector ut
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
�i rY OF TIOARD 24-Hour
BUILDING Inspection Line: (503) 638-4175
OASTINSPECTION DIVIS,10N Business Line: (503) 638-4171
SUP - - _ -
Received Date Requested -- s AM __ ----PM SUP
Location ._ �'l �' Suite_ MEC
Contact Person —__ t�,� A-'. y..�� Ph( ) 60Jb - �a'qs PLM
Contractor -- Ph( ) ____ SWR - --__
BUILDING Tenant/Owner -_ _ _ — EL('
Footing
Foundation E`C -- - --
Access:
Fig Drain ELR
Crawl Drain
Slab Inspection Notes: SIT --
Post& Bean _-
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear ,
Framing _ AV tat,i.euR t c 14� v," T' L/ d'47>4."" C`t'cxs71�c.9t
Insulation
Drywall Nailing — Pug
Firewall --
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other. _-- - -- - - -- --- _ _ _--------- __-
Final —_i^---- .
PASS PART FAIL ---— --- - --
PLU_MBING
Post$Beam
I Inder Slab — --
Rouyh-In
Water Service
Sanitary Sewer )
Rain Drains - - - --
Catch Basin/Manhole
Storm Drain —
Shower Pan
Other: -
Final J
_PASS PART FAI1.
MECHANICAL
Post R Beam
Rough-In
Lias Line
Smoke Dampers -- -
flnal
PASS PA! FAIL -� ----- — —
ELECTR
Service------------ ----- - - -
Rough-In
UO/Slab -
Low Voltage
Fire Alarm
Final Reinspection fee of$ required before next inspection. nay at City Hell, 13125 SW Hall 9lvd.
PASS _PART FAIL
SITE --- [] Please call for reinspection HE: Unable to Inspect-no access
Fire Supply Line
ADA Data G S ~ ` ? Inspector Ext _
Approach/Sidewalk Ip --
Other. __--
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITYO F TIGAR D _ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00280
13125 SW Hall B!vd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/30/03
PARCEL. 1 S134AD-03000
SITE ADDRESS: 10875 SW 1087 H AVF
SUBDIVISION: BLACK BULL PARK ZONING: R-4.5
BLOCK: LOT: 016' JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: f_3_O_ILERS/COMPRF-SSORS HOODS:
_FUEL TYPES 0 3 HP: 1 DOMES. INCIN:
FII F 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - .50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS-
1-u.-:1 < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN —100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Install exterior AC unit. AC cannot be plaLCLI ui the required srth:n l,•,
_Owner: _ FEES
SONDRA GUIZAR Description v Date Amount
10875 SW 108TH [MECH] Permit Fec 5/30/0^ $7250
TIGARD• OR 97223 ['1 AXI 81t;,StateTax 5/30103 $5.190
Total $78.30
Phone: �W-(,70-0295 —
Contractor:
A-TEMP HEATING& COOLING
1600n SE EVELYN ST
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS _ __
Phone: 503-650-9602 Cooling Unt Insp
Final Inspection
Reg #: LIC 71878 03
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 i..r`+rk i5 not started within 180 days of issuance, or if work is suspendt,,
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregoi I
tf
Utility Notification Center. — ose rules are set forth in OAR 952-001-0010 through OAR
952-001-0100. YoU may obtain copies of these rules or direct questions to OUNC by calling
(503)246-6699.' /--
Issued By: �,-� _- c C Permittee Signature: U,_ L`���� "
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business da;
O
BUP - Building Permit ELC - Electrical Permit
Inspection Description Date Passed By Inspection Description Date Passed By
Footing/Setback Underground cover _
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bslnt walls Electrical rou h-in _
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls/anchors ELR - Restricted Energy Permit _
Roof nailing Inspection Description _ Date Passed B
Firewall _+ _ Low voltage
Tilt-up panel Electrical final
Masonry/Re riffirverrient
Framing _ —
MFG-Structure set-up MEC - Mechanical Permit
Insulation --
Drywall nailing Inspection Description Date Passed B
Post/beam mechanical
Suspended ceiling _
Gas line
Engineered soils - _
Mecha• --•il rough-in
Welding Lab Final
Concrete Lab Final udamper
Duct work
D
Bolti.n Lab Final Duc _
Smoke detector
Structural observation _
Fireproofing Lab Final Mechanical final
Final inspection - — -- --
PLM .• Plumbing Permit
BUP— Fire Protection System Permit Inspection Description Date Passed B
Inspection Description Date Passed By Plumbing underslab
Sprinkler underfloor/slab — Crawl drain —
-p- Post/beam plumbing
Sprinkler rough in Plumbing top-out
Sprinkler final _RP/backflow preventer _
Fire alarm final Rain drain
• Storm drain
• Water service
SIT - Site Permit Sanitary sewer
In sp cNon Description Date Passed By Culvert/catch basin_
Footin s Pum /fill septic tank_
�.� R.L.ndation walls _Plumbing final
Sprinkler supply lines__ H
Sprinkler underfloor/slab
Catch basin/Manhole SWR - Sewer Permit
En ired soils
-Engineered Inspection Descri tion_ Date Passed R
En ineerin acce tance So sitar sewer
k' Final ins ection ,--�----
— Fiv. inspection
i Inspection Record - BUP, PLM, SWR, ELC, FLIZ, NIFI ', SIT Permits
i:\deti\fonnelitspRecordBUP.doc 04/17/01
r�
w