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11481 SW HALL BLVD STE 202-2 w cn T A r r 00 Q C. r m A X v I N O N R r i y� 8 syy d 1.1481 5W HALL BOULEVARD #202 M m = m m m m p m n � \\ sci \ \\ \ \- \o f\ aw G oRoM o // f9 (D / 2 W n o\(/ \ \ \ 0 0 ( » ! $ 'COD # \ ID / 2 f k < F \ 0 m D n _ o <' } m. @ / ƒ \ @ k $ § \ 9 $ - 2/ m \ \ \ / / § § $ $ 0 E, o c ; f 0 � ) o \ \ / \ f O o m = m = nm c C) � 01 } < o a a c § § § f § b \ § \ 22 i t @ @ w � � c 4 � q -4 ) k§ (D ( }\ ( ( / ( g ` ! � z (OBD O O V -4 O O ` - v 1. pD O O N Q O O V( r0 Ur W _ W U b U1 Tl C N S 7 W n y' (o a n n o D v � (D a W p o v m D 0 < m r+; N in (Np O Q. 52 (D p a� (WD (WA ((D (OV (V w t' Ul in T.O O m 4 X r rn r m o O ` O 9 r, W K (D CD UG D O D O rn p N d m rn En Cn m m m O O O N.1 n S V m a u C .d x (n m0 ; t O r CL M0 m CL A W W W �C t0 63 O lD O_ O a p (D at ((D co tLi tOD (O iP Q U Z DJ O to N r V CITY OF TIGARD PIJJMBING PERMIT DEVELOPMENT SERVICES PERMIT #. . . . . . . : PLM99-009.-', r0&_.9b4M 13125 SW Hall Blvd., Tigara.OR 97223(503)639-4171 DATE ISSUED: 03/31/99 PARCEL..: IS135DA -03500 MTF ADDRESS. . . : J. 1481 SW HALL BLVD #202 SUBDIVISION. . . . : 70NING: C—P BI_.00K. . . . . . . . . . : LOT. . . . . . . . . . . . . JURISDICTION: TIG CLASS OF WORK. . :AL.T GARBAGE DISPOSALS. : 0 MOB IL-E HOME SPACES. : 0 TYPE OF USE. . . . :COM WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0 OCCUPANCY BRP. . :B FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0 FIXTURES------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . : I URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0 L-A1.10TORIES. . . . : 0 OTHER FTXTUREc.i. . . . : 0 TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 0 WATER CLOSETS. : 0 WATER L-INE ( Ft ) . . . : 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft. ) . . . : 0 Install a new sink. Owner-: FEES L. N. PROPERTIES, LL.0 type amoi-int by date r-ec,pt 11461 SW HALL BLVD PIRMT $ 25. 00 DI-H 03/31 /99 99-3141tE'1 STE 100 5)P CT 1. 25 DL-H 03/31 /99 99-31.41c"I TIGARD OR 97223 Phone #: Contractor----------------------------------- D P Pl__UMBT NG/DARREN T PLACEK 904 C CHEHAL.EM NEWBERG OR 97132 PI-inne #: 537-9492 $ 26. 25 TOTAL Reg #. . : 001106 ------- REOUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Pottgh—in Insr) Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Insper�tion applicable laws. Ali 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 enrp. than 188 days. ATTENTION: Oregon law requires you to fellnw rules adopted by the Oregon Utility Notification Center. Those rules are set forth in GAR 952-888I-0011 through OAR You may obtain copies of these rules or direct questions to OLW by calling (503)246-1967. Issi-ted By -. Permittee Signati.ire : 4--#-++++ ...........f-++++++4....++++++.. + ++++4--4.........4- + Call 639-4175 by 7:00 p. m. for an inspection needed the next bi.isiTleSs day +++4-++++++.............................4.........4-++++4+++-+4-++4..............4-+++ CITY OF TIGARD Plumbing Permit Application Plan�h ck# 13125 SW HALL BLVD. Commercial and Residential Rec'd'By _ TIGARD, OR 972'.3 Date Recd -7 (503) 0.39-•4171 Date to RE 9T Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit# Pl-J�t Related SWR#-�9 O0 3� Called__ Name of Development/Project _ FIXTURES Individual L,ievT ✓/y , i^. _ _ _ --�( ) QTY PRICE AMT .�Ub SLR ��1�- - Sink � Address Street Address Shite Lavatory 9.00 W l s�� ( ✓t `� Tub or Tub/Shower Comb 9.00 Bldg# C, to zip Shower Only 9.00 LFA__ Name Water Closet 9.00 e • A4 AedswlrsDishwasher _ 9.00 Owner Mailing Address Suite Garbage Disposal 9.00 Washing Machine 9.00 City/Slate ZIP Phone Floor Drain/Floor Sink 2" 9.00 Name 3 9.00 4" Occupant Mailing Address Suite Water Neater O conversion O like kind 9.U0 _ __ Gas I In re uq Ires a separato mechanical permit. City/State ZIP Phone Laundry Room Tray 9.00 -- _. Urinal ~^ 9.00 Namr Other Fixtures(Specify) 9.00 rk �lt' Contractor Mailing Address J Suite - 9.00 "� 1 ' __ 9.00 Prior to permit City/State ZIP Phone Sewer-1st 100 y 30.00 Issuance,a copy ( 'WIC, - --�, -?- S 3 7 Sewer-each additional 100' 25.00 of all licenses zee Oregon C oruh.Cont.Board Lic.# Exp.Date required If U�, �?.z _ Water Service-tat 100' 30.00 expired in COT Plumbing Lic.# Fxp.Date LL Water Ser- GT earh additional 200' 25.00 database 36 AT60 _ f Z �(�' Storm&Rain Drain-1 at 100' 30.00 Name Fmclflle torm&Rain Drain-each additional 100' 25.00 Architect _ _ Home Spacrt 25.00 Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 2.5.00 Pollution Device Engineer City/Stale Zip Phone Residential Backflow Prevention Device* 15.00 _ (Irrigation timing devices require a separate Describe work to be done. restricted energy permit.) New O Repair O Replarre with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00 Residential O Commercial 5� Catch Basin 900 Additionat description of work: Insp.of Existing Plumbing 40.00 en'hr Specially Requested Inspections 40.00 _ per/hr - - Rain Drain,single family dwelling 30.00 Are your capping, moving or replacing.ny fixtures? Yes O Pio O Grease Traps 9.00 If yes,see back of form to indicate work performed by QUANTITY TOTAL fixture. FA;LURE TO ACCURATELY REPORT FIXTURE Iscanetric or riser diagram is mqulr_ed H OuanlRy_T0181 1, >s WORK COULD RESULT iN INCREASED SEWER FEES. _ _ ~•SUBTOTAL I hereby acknowledge that I have read this application,that the Information given is correct,that I am the owner or authorized agent of the owner,and _ 6%SURCHARGE that la ubmitted are in compliance with Ore on Slate Laws. Signat re f Owner/Aenj I Date A``"PLAN REVIEW 26%OF SUBTOTAL - fly Re :rlred ont rt fAure qty total is>9 TOTAL Contact Person Name Pho ne i l-7q� 1..- `Minimum penult fee Is$25+5%surcharge,except Residential Backflow Prevention Device,which Is$15+5%surcharge "AU New Commercial Buildings require plans with Isometric or riser diagram and plan review I WrWpkxnepp doc MW PLEASE COMPLETE: Fixture Type �_ Quantity by Work Performed New Moved Replaced Removed/Capped Sink - ----- I Lavatory -- Tub or Tub/Shower Combination— Shower Only ~^ _ — --- ---- - Water Closet Dishwasher Garbage Disposal Washing-Machine _ ^— Floor Drain/Floor Sink 2"— -- Water Heater Laundry Room Tray --�- Urinal_ —�- Other Fixtures (Specify) _ -~ COMMENTS REGARDING ABOVE: 1 41llekqumap,d, 1171'.7N Accumulative Sewer Tally Tenant Name: This SWR# Address: // Fr/ .`�c✓�At i /rte dl���:� _ -I'his PLM# (1 _v ` Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New # Value Capped off value added# added #s total Count off#s count value values_ Baptistry/Font 4 Bath-Tub/Shower 4 -Jacuzzi/Whirlpool 4 Car Wash-Each Stall 6 -Drive Through 16 Cuspidor/Wale r Aspirator 1 Dishwasher-Commercial 4 -Domestic 2 A Drinking Fountain 1 Eye Wash 1 Floor Drain/sink-2 inch 2 3 inch -4 inch 6 Car Wash Dm_ 6 Garbage Disposal 16 Domestic(to 3/4 HP Commercial(to 5 HP) 32 Industrial(over 5 HP) 48 Ice Machine/Refrigerator Drains 1 _ Oil Se Gas Station 6 Rec.Vehicle Dump Station 16 Shower-Gang(Per Head) 1 -Stall _ 2 Sink-Bar/Lavatory _2 Bradley 5 -Commercial _ 3 / 3 -Service 3 _ Swimming Pool Filter _ 1 Washer-Clothes 6 Water Extractor 6 Water Closet-Toilet 6 Urinal 6 TOTALS Total fixture values: divided b) 16 - _EDU HISTORY PLM# 9-9-do// EDU# SWR# 74 -oo/3 PLM# EDU# SWR# PLM# 4q 0 q-T6 EDU# SWR#qn -03;Y PLM#__-_---_ EDU# SWR# PLM# g r. -G,3;r3 EDU# SWR#rtg-off ?t: PLM# EDU# SWR# _ PLM#9`6 -oixo EDU# SWR# $ . c,094 PLM# J EDU# SWR# 1:1WsWswrtaly.doc i CITYO F T I V A R D _ CERTIFICATE OF OCCUPANCY DEVELOPMENT SERVICES PERMIT#: BUP99-00075 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/3/99 PARCEL: 1 S 135uA-03500 ZONING: C-P JURISDICTION: TIG SITF ADDRESS: '11481 SW HALL BLVD 202 SUBDIVISION: BLOCK: LOT: CLASS OF WORK: ALT TYPE OF USE: COM TYPE OF CONSTR: 5N OCCUPANCY GRP: B OCCUPANCY LOAD: 14 TENANT NAME: SCR, INC REMARKS: Tenant Improvement Final Inspection Approved 4/29/99 by Ron Church, Building Inspector Owner: LN PROPERTIES LLC 11481 SW HALL BLVD #'100 TIGARD, OR 97223 Phone: Contractor: PAGfFIC CREST STRUCTURES INC 7301 SW KABLE LANE STE 700 PORTLAND, OR 97224 Phone: 503-958-8949 Reg #: This Certificate grants occupancy of the above referenced building or portion thereof and confirms that the building has been inspected for compliance with the State of Oregon Specialty Codes for the group, occupancy, and use under which the referenced permit was issued. it BUILDING SFS CTOR BUIL lob OFFICIAL POST IN CONSPICUOUS PLACE CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24--Hour Inspection Line: 639-Q175 Business Line: 635-4171 BUP—1�q LOP�-75 Date Requested -AM-__ PM BVP'�aq Location LK V 4L Suite MEG Contact Person � Ph ��,�1 " SNt� PLM Contractor _ _ Ph _ SWR -tenant/Owner �L�'-� — — ELC Retaining Wall ELR Footing Access: Foundation FPS _ Ftg Crain SGN Crawl Drain Inspection Notes -- Slab SIT Post& Beam Ext Sheath/Shear int Sheath/Shear _ Framing -------- - --—---- - ------------- ---- - ..._�. - _._ - -,. --- Insulation Drywall Nailing Firewall _----+--- - Fire Sprinkler Fire Alarm Susp'd Ceiling - -- ---- - - --- — ----------- - ----- - -- -- Roof Misc: ---- S PART FAIL - - - - BING Post&Beam -- -- Under Slab Top Out Water Service _ Sanitary Sewer Rain Drains Final — PASS PART FAIL MECHANIGAI. — Post& Beam -- Rough In i Gas Line - --- Smpkg Dampers fsXW- -" PART FAIL ELECTRICAL Service r Rough In UG/Slab Low Voltage Fire Alarm —T Final PASS PART FAIL SITE Backfill/Grading s----- -- Sanitary Sewer Storm Drain [ j Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ j Please call for reinspection RF [ j Unable to inspect-no access Fire Supply Line ADA C Approach/Sidewalk Date ` li»pector Lf Ext Other _ Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. I a CITY OF T GA RD BUILDING PERMIT PERMIT#: BUP99-00111 DEVELOPMENT SERVICES DATE ISSUED: 4/13/99 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 1S135DA-03500 SITE ADDRESS: 11481 SW HALL BLVD 202 SUBDIVISION: ZONING: C-P BLOCK: LOT: JURISDICTION: TIG REISSUE: FLOOR AREAS_ _EXTERIOR WALL CONSTRUCTION CLASS OF WORK: FPS FIRST: 0 sf N: S: E:— W: — �- TYPE OF USE: COM SECOND: 0 sf _ _PROJECT OPENINGS? TYPE OF CONST: 3N 0 sf N: - S: E: W: OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 0 BASEMENT: 0 sf AREA SEP. RATED: STOR. 0 HT: 0 ft GARAGE: 0 sf OCCU SEP. RATED: BSMT?: MEZZ?: READ SETBACKS _ REQUIRED_ FLOOR LOAD. 0 psf LEFT: 0 ft RGHT: 0 ft - FIR SPKL: Y SMOK DET: DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM : HNDICP ACC: BEDRMS:O BATHS: 0 IMP SURFACE: 0 PRO CORR: PARKING: 0 VALUE: $ 1,2.50.00 Remarks: Installation of fire sprinkler systern. Owner: Contractor: L N PROPERTIES LLC A + R FIRE PROTECTION CO 1272.5 SW 66TH AVE IDO BOX 459 PORTLAND, OR 97223 NORTH PLAINS, OR 97133 Phone: Phone: 7_L�{(�� Reg #: J� FEES -- -�_ REQUIRED INSPECTIONS Type By Date Amount Receipt Sprinkler Rough-In PRMT DLH 4/1/99 $25.00 99-314206 Sprinkler Final 5PCT DLH 4/1/99 $1.25 99-314206 FIRE DLH 4/1/99 $10.00 99-3142.06 -- --- Total $36.25 1 his permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Special�t Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days cf issuance, or it work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-1987. Pe rm Itee ` Signature: of A CI ugG -_E1lkk Issued By: P4k(, (i►-_ --- _—_ —._ -- Call 639-4175 by 7 p.m. fog an inspection the next business day Fire Protection Permit Application Plan Chec/k; J CITY OF TIGARD Commercial or Residential Recd By,\ c 13125 SW HALL BLVD. Date Recd - G' TIGARD, OR 97223 Print or Type Date to P.E. (503) 639-4171, x. 304 Incomplete or illegible applications will not be accepted Date to DST ' Permit# i� n n 7 Called Jab Name of Development/Project - Type of System (Complete A or B as applicable) 5 C R_ _ _ Address drgs I I � I ALL ISL VV-7 A.) Sprinkler Wet ® Dry 0 Name _ Standpi es L.. rel c) N�4 Owner Mailing Address Hazard Group (14 61 S Q H Q L-L 8 Lv 0 100 Additional L , City/StatePhone Information DenQity zip — -- Name Design Area Sic- R _ Occupant Mailing Address- l K. FaPor 4 d S t r Nn lS IL V-o ZO,� _ J - (� C City/State- zip Phone &1) Sprinkler Project Valuation $ 2 S U Contractor Name B.) Fire Alarm (Sprinkler or � -f `{ [ P 'f _____ Alarm Company) (ling Add r ss Submittal Shall Include Battery Calculations YES❑ J— Prior to permit o x_LJ —L _ issuance,a CitylState Zip Phone Individual Component YES El cagy _ Cut Sheets of all licenses (,4 7 -z y(ag B.1_) Fire Alarm Project Valuation $ are required if State Const Cont Board Lic.# Exp. Date expired+t COT Z O ' Project Valuation Subtotal (A&-or B) $ database (0 Name Permit fee based on valuation 11 -� D E-Jr,es,v t _ Architect n�iling Address —� - --^ -- _ (see chart on back) t� o 0), $ Z 5% Surcharge $ city/S to zip Phone �— FLS Plan Review 40% of Permit _ N Q a J .) 1 -Z(Jq $ Describe work A.)New O Addition O Alteration• Repair O -—"— TOTAL $ to be done: - �B.) Modification to sprinkler heads only --=- --- --... — - 1. 1-10 heads=No plans required Plans regltired Siibmit three sets of plans,including a vicinity map and 2. 11—Plan review required the location of the nearest hydrant. I hereby acknowledge that I have read this applicatinn,that the Information given Is Number of sprinkler heads: correct,that I am the owner or authorized agent or the owner,and that plans submitted Additional Description of Work' are In compliance with Oregon Stale laws Suture of caner! gent Dale A.)In Existing Building W New Building ❑ Building CBntact Pe on Name Phone Data B.) Commercial g Residential Cl - - -- - _r N on Name (- SET t 1 t FOR OFFICE USE ONLY: No.of stories: - �— Plat# Map/TM S4,Ft: Notes ~--v--- Occupancy Class Type of Construction iAdsts\forms\firesupr.doc 11/5/98 CITY OF TIGARD BUILDING PERMIT FEES TOTAL STATE BUILDING VALUATION OF PERMIT F.L.S. TAX PERMIT PROJECT FEES (40%) (5%) FEES 1-1500 25.00 10 010 1.25 36.25 1,501-1600 2.6.50 10.60 1.33 38.43 1,601-1,700 28.00 11.20 1.40 40.60 1,701-1,800 29.50 11.80 1.48 42.78 1,801-1,900 31.00 12.40 1.55 44.95 1,901-2,000 32.50 13.00 1.63 47.13 2,001-3,000 38.50 15.40 1.93 55.83 3,001-4,000 44.50 17.80 2.23 64.53 4,001-5,000 50.50 20.20 5,001-6,000 56.50 22.60 2.83 81.93 6,001-7,000 62.50 25.00 3.13 90.63 7,001-8,000 68.50 2740 3.43 99.33 8,001 000 74.50 29.80 3.73 108.03 9,001-1u,000 80.50 32.20 403 116.73 10,001-11,000 86.50 3460 4.33 1;5.43 11,001-12,000 92.50 37.00 4.63 134.13 12,001-13,000 98.50 39.40 4.93 142.83 13,001-14,000 104.50 41.80 5.23 151.53 14,001-15,000 110.50 44.20 5.53 160.23 15,001-16,000 116.50 46.60 5.83 168.93 16,001-17 '100 122.50 49.00 6.13 177.63 17,001-18,JJ0 128.50 51.40 6.43 186.33 18,001-19,000 I 134.50 53.80 6.73 195.73 19,001-20,000 140.50 56.20 7.03 203.73 20,001-21,000 146.50 58.60 7.33 212.43 21,001-22,000 152.50 61.00 7.63 22,1.13 22,001-23,000 158.50 63.40 7.93 229.83 23,001 -24,000 164.50 65.80 8.23 238.53 24,001-25,000 170.50 68.20 8.53 247.23 25,001-26,000 175.00 70.00 8.75 253.75 26,001-27,000 179.50 71.80 8.98 260.28 27,001-2.8,000 184.00 73.60 9.20 2.66.80 28,001-29,000 188.50 75.40 9.43 273.33 29001-30,000 193.00 77.20 9.65 279.85 30,001-31,000 197 50 79.00 9.88 286.38 31,001-32,000 202.00 80.80 10.10 292.90 32,001-33,000 206.50 82.60 10.33 299.43 33,001-34,000 211.00 81440 10.55 305.95 34,001-35,000 215.50 8� ?0 10.78 312.48 35,001-36,000 220.00 88.00 11.00 31900 36,001-37,000 2.24 50 89.80 11.23 32553 37,001-38,000 229.00 91.60 11.45 33205 is\dsts\forms\firesupr.doc 11,5198 IUKt Fly - ___ �... ..W.. ......-_•� gyp' s X55 ° S,e �►� , _R� C �� essE0 � 5 P to 1E+ 14CA v Fd re f i -71 Etc I s T/ N fr' (.•../M 8 s + , � -•�:-sig.. ' .-/N� S' I ! r i iN'-•�•sncrc" - , I + I + I ' OTOFI i T21 rr lo hn,.� 1:.,1'I 1. , � I T �Iff✓�� ,:..�• �. u. lJ f' � , 17 r , I •P � � t._ r ,������4 •1!tr,p " �; WAI I -t— Cal ¢c� 10acn 1�J0}3 r.� �IFMii J ' I CITY OF TIGARD MECHANICAL i DEVELOPMENT SERVICES PERMIT PERMIT #. . . . . . . : MEC99-0102 13125 SW Nall Blvd., Tr,ard,OR 97223(503)639.4171 DATE ISSUED- 03/15/9'9 PARCEL: 1S135DA--03501. SITE ADDRESS. : 11481 SW HALL. 131-VD tt "ZIi- SURD I V I S I ON. . . . : ZONING- C--P i81...00K. . . . . . . . . . . LOT. . . . . . . . . . . . . .JURISDICTION: TIG CI..ASS OF WORK. . :ALT FLOOR FURN. . . . : 0 EVAP COOLERS: 0 TYPE OF USE. . . . :COM UNIT HEATERS. . : 0 VENT FANS. . . : 0 OCCUPANCY GRP. . :F VEN-fS W/0 APFIL: 0 VENT SYSTEMS: 0 STORIE-i. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0 FUEL TYP'r-5---__._.__.__—,__..._. 0-.3 HP. , . , : 0 DOMES. I NC I N: 0 :EL_.0 3-1n HF'. . . . : 0 COMML. INCI'N. 4 MAX 14*,.>UT: 0 BTU 15-30 HFA. . . . : 0 REPAIR 1_IN I TS: 0 F I RE DAMPERS% . : 30-.50 HP. . . . : 0 WOODSTOVES. . : 0 GAS PRESSURE. . . : 50-► HP. . . . : 0 CLO DRYERS. . : 0 NO. OF UN I Ti --— _ ______ AIR HANDLING 1.IN 11 S OTHER UNITS. : El TURN < 1O0K BTU: 0 t= 10000 r. fo, : 0 CTAS OUTL_ETS. : 0 TURN i =1O0K BTU: w > 1.0000 cfm: 0 Remarl.s : Alteration to mechanical, Owner: ___.____ _.._..._.._._..... .__ ____._____.__..____.____.__.__.-_..- ___.______..___._.__ FEES I_... N. PROPERTIES, type amOkrnt by date r^ecpt 11481 SW MALL. BLVD PRMT f 25. 00 DLH 03/15/99 99--313681." STE 100 51-ICT t 1. 25 DLH 03/15/99 99-31.3682 T 1GARD OR 972 .3 PLCK 6. 25 DLH 05/ 15/99 99—:3136821' Phone #: D L HOWARD CO INC 5340 SW DOVER LN f 32. 50 TOTAL PORTLAND OR 97225 Phone #: 246-6764 ---- --- REOU I RED INSPECTIONS — ---- this permit is issued subject to the regulations contained in the ;Mechanical 1n�;p Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection 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 rs suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification f.enter. Those rules are set forth in OAR 952-001 0010 through OAR x_101-0080. You mai obtain copies of these rules or direct questions tc (XNC by calling 1503)246•-9187, — -- By: Permittee Signat�_ +•4-++++++++++.4+++-1•++++++++4+++++4-+++4-+4-+4++++++.h+++++++-4-+'f++++t+4•++++++•t4++++t+ Call 639--4175 by 7:O0 p. m. far- inspections needed the next business day ++++4-++++4'++++++4'++++4 i t 4.1'++++++++++.+'I'+++++T+'I•+++'I'++++++++++++++++++++'I.4+++++ CITY OF TIGARD Mechanical Permit Application Plan Check# ._3 :3C. Recd By >/l� 13125 SW BALL BLVD. Commercial and Residential Date Rec'd_T TIGARD, OR 97223 Date to P.E. 1 (503) 539-4171, X304 Date to DST r Print or Type /�I Permit# /1E Incomplete or illegible applications will not be acc ed Called N e of Develop Project Description — L.- lable 1A Mechanical Code _�,. � _— Qty Price Amt Job St treat Address Sune# A) Permit Fee 10.00 Address /�;/�/ )/1%/ / �.% 1) Furnace to 100,000 BTU including ducts&vents __ see footnote 1,2 6.00 Bldg# Cdy/Slate Zip 2) Furnace 100,000 BTU* r ,�. /.i. including ducts&vents see footnote 1,2 7.50 Name(or name of business) 3) Floor Furnace Owner �, _, including vent _ see footnote 1,2 600 Mailing Address .0"— 4) Suspended heater,wall heater ~� /da` or Floor mounted heater see footnote 1,2 6.00 , �� �Q �� 5) Vent not included in appliance permit CRY/State Zip Phone _ 3.00 Check all that apply *Boiler Heat Air Name(or name of business) For Items 6-10,see or Pump Cond city Price Amt �/� � ' footnotes 1,2 Com •• C_ r`f 6)<3HP;absorb unit to Occupant Mai;:og Address 100K BTU _ _ s.ou .�Q�, 7)3-15 HP,absorb unit — City/State zip Phone 100k.to 500k BTU 11.00 � �� 8)15-30 HP;absorb '— Contractor Name unit.5-1 mil BTU 15.00 L . , �" ('� 9)30-50 HP,absorb teXt''. L- _ __ V _unit 1-1.75 mil B7 _ _22.50 Prior to permit fda�liny ddress 10)>50HP;absorb unit issuance,a copy �w VO��r `,�i , >1.75 mil BTU _ 37_.5 _0 of all licenses y/ — zip Phone 11)Air handling unit to 10,000 CFM are required if (ne l l?Z5 2A1--(-U1 expired in COT' Oregon Const C B erd Lic q p Datr, 4.50 ®� 4q{ Q 12)Air handling unit t0 100 CFM+ _ database —•1_-�fn ..� Architect Name 7 50 13)Non-portable evaporate cooler -- __ _ 4 50 or Mamng address -i— 14)Vent fan connected to—a single duct 3.00 15)Ventilation system not included in Engineer cny/stete zip P1QnP- 9 a pliance permit _ _ 4.50 _ 16)Hood served by mechanical exhaust Iiescribe work to be done, _ 450 17)Domestic incinerators New!7' Repair O Replace with like kind Yes U No O _ _ _ 7.50 Residential O Commercial tl 6)Commercial or industrial type incinerator 30.00 Additional information or description of work '— 19)Repair units _ 4.50 20)Wood stove NOTE: for Commerciat projects only,Units over 400 lbs require _ _ 4.50 _structural gas calcis 21)Clothes dryer,etc — Type of fuel oil O natural gas O LPG O eiectric _ 4.50 22)Other units 1 hereby acknowledge that I have read this application,that the information /I�i 4 50 given is correct,that I am the owner or authorized agent of 23)Gas piping one to four outlets the owner,that plans submitted are in compliance with Oregon State laws I Se?footnote 1 _ 200 a than 4-per outlet(each) Stun ure of Owne Date -- _ Minimum Permit Fee$26.00 SUBTOTAL S Contec Person ame Pt►one--- UKA SURCHARGE 7 (• `I PLAN REVIEW 25%OF SUBTOTAL Foonotes for commercial projects 1ilf, Required for ALL commercial perm50its only (t 1 Provide full schematic of existing and proposed gas fine and pressure. TOTAL 2 Provide drawings to scale showing existing and proposed mechanical units. •State Contractor Boiler Certification required "Residential A/C equires site plan showing placement of unit I Vnechperm doc rev 0214/99 1,4: CITY OF TIGARD DEVELOPMENT SE13VICES BUILDING PERMIT PERMIT #. . . . . . . : BUP39-0075 13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 DATE ISSUED: 03/03/99 PARCEL: 1S135DA--03501 SITE ADDRESS. . . : 11481 SW HALL BLVD #202 SUBDIVISION. . . . : ZONING:C-P, BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . JURISDICTION:TIG REISSUE: FLOOR EXTERIOP WALL CONSTRUCTION— CLASS OF WORK. :ALT FIRST. . . . : 0 s N: S: E- W: Ty'PE OF USE. . . .COM SECOND. . . : 1608 5 f PROTECT OPENINGS?----------- TYPE OF CONST. :5N . . . . 0 Sf N: S: E: W: OCCUPANCY GRP. :F TOTAL------------: 1608 fi-F ROOF CONST: FIRE RET?: OCCUPANCY LOAD: 14 BASEMENT. : 0 sf AREA SEP. RA-FED: STOR. : 0 HT: 0 t C. I GARAGE. 0 F,f OCCU SEP. RFiTED: BSMT'.) - MEZ 7") REOD SETBACKS------------- REQU , ED--- FL(JOR LOAD. . . . - 0 psf LEFT: 0 ft RGHT : 0 ft F I R SPKL:Y SMOK DET. DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM: HN ICP ACC: BEDRMS: 0 BATHS: 0 IMP SURFACE: 0 PRO CORR: PARKING: 0 Vnt-UE. $ : 24120 Remav-ks : T1 - Separate mechanical, plumbing, electrical and sprinkler permits required. clwrlet-: ------ FEES L. N. PROPERTIES, LLC type Amol.tnt by date t-eept 11481 SW HALL BLVD PRMT $ 170. 50 DL.H 03/03/99 99-313425 STE 100 5PC'T $ 8. 53 DI-H 03/03/99 99-313425 T (GARD OR 97223 PLCK $ 110. 83 DLH 03/03/99 99--313425 Phone #: 684-506E F I RE $ 68. 20 DL 11 03/03/99 99-31:34`5 Contt'actot-: PACIFIC CREST STRUCTURES INC 7,3501 SW KABLE LANE STE 700 PORTLAND OR 97224 Phone #: 503--968--8949 $ 358. 06 TOTAL Reg #. . . 006691 --REQUIRED ACTIONS or- INSPECTIONS—— This permit is issued subject to the regulations contained in the Framing Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other SIASP Ceilng Insp applicable laws. All work will be done in accordance with approved plans. This permit will expire if we.-N 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 the rules adopted by the Oregon Utility Notification Center. Thosp rules are set forth in OAR W-001-4010 through OAR 952--80I01987. You many obtain a copy of these rules or direct questions to O(K by calling (503)246-1987. Permittee Signati-it-e: I S S k.k e d By: +4--4-++-I-+++++++--4--4-++4.+,+-++4--+-+4-4-+4-4-+++-h...........................4-++++++-1-+++++-+.+-+.+4 Ca 11 639-4175 by 7:00 p. m. for- an inspection needed t h(- next b1AS i n e S S clay .........4-++-V++++-f...................4......+++4-4................4............. t ( OF TIGARD Commercial Building Permit Application Recd Date Rea J✓t ff 13195 SW FALL BLVD. New Construction and Additions cd __ TIGARD, OR 97223 Date to P E. (503) 639-4171 O .rC Date to DST Permit* Print or Type Related SWR#4 Incomplete or illegible applications will not be accepted Called Name of Development/Project — a Job r-/ - /4'A" Pkfzk r4t;Fief T%� -~- Existing Building ; New Building Address Street Address Suite 1 r 4/ 5a�/ / ;. / I,t� =_ Building Bldg# City/state zip Data 7-iAtA" T /1fl- _ 0" `T 72'tExisting Use of Building or Prop erty^ Name Property l r rel, r'/2',/'frz ri F 5 Owner Mailing Address - suite _ Proposed Use of Building or Property: — City/State - zip Phone No. Of Stories - Tl(,lin OR C?7 2 Z-7 t. Occupant Name _ - Sq Ft. Of Project: ���-- Name _ --~ Occupancy Class(es) Contractor i"A-e F le eWf- Prior to permit Melling Address suite Types)of Construction Issuance.a copy , of all licenses ��/ sem' k it "�CY 6�(i j/'/fir a(/c_c 1, f, are required if City/State zip Phone __- Will this project have a Fire Suppression System? expired C.O T. eyzr .AA1d -)e 97 1 `f LF� :' �c Yes N0 [f database / ADA Act Ac ---T�- Oregon Const.Cont.Boers LIc* Exp.Date Americans with Disabilities (ADA) 4-G y/S- Valuation X 25% =$ Participation �r Name Complete AccessibilityForm - --- ---- Architect /14 k--A/'/'�.+ DfS��( l 17'*#J/ 14A"ih Project $ Valuation '_.4/ / 2r� Mailing Address Suite ` Plans Required. See Matrix for number of sets Lo submit CNy/State Zip Phone on back Engineer Name I hereby acknowledge that I have read this application,that the information ,klA given is correct,that I am the owner or authorized agent of it e owner,and Mailing Address suits that plans submitted are in compliance with Oregon State Law;. _ Signature of towner/Agent Date City/State zip -Phone Contact Person Name�^ Phone Indicate type of work New O Addition O Demolition O /k 1003_ A c essory Structure O Foundation Only O AlteretlonAl", — Repair0 Other d FOR OFFICE USE ONLY _ Description of work: MaprTL# Lend Use: 7 s n�.�rl•f I Nt/3rt:�v�iK fN 7's _____ �- Notes: Parks: Estimated#of Employees TIF.---�_.___ If the above figure Is not supplied at the time of application,the city will , calculate the fee based upon the number of arkln s aces. Note: Site Work Permit Application must precede or accompany Building hermit Application I u;OMNFW DOC (DS T) 5/98 COMMERCIAL PLAN SUBMITTAL REQUIREMENT MATRIX Plan Review is dependent upon submittal of BOTH plans AND a COMPLETED application. For an electrical submittal, the application must contain the signature of the SLIpervising electrician before pian review will be conducted. After plan review approval, Plans Examiner will contact the applicant to request additional plan sets for distribution purposes. (Copy for Contractor, City, Washington County, Tualatin Valley Fire & Rescue) ._�.. __�....�..�, Total'# of TYPE OF SUBMITTAL plans KEY: _ Submitted S (Private) �1 S = Site Work B = Building F (New or Add or Alt) 3 F = Fire Protection System M (New or Add or Alt) _ 1 M = Mechanical B & M (New or Add) i �1 P = Plumbing P (New, Add, or Alt) 2 E = Electrical B & M & P (New or Add) 2 New = New Building E (New, Add, or Alt) 2 Add = Addition B & F & M & P & E 3 Alt = Alternation to Existing (New , Add) Building *B or B & M (Alt) 1 *B & M & P (Alt) ... 3 'B & M & P & F_(At) 3 *B & M & P.& E & 1=(Alt) 3 NOTES: 'Shaded areas designate; ALT submittals only. I\dsts\forms\metrxcom doc 10/30/98 m m m m m M m ni m m a x X x xl x x x x Tl n n n <_' 00 4 cn -4 -4 -4 -4 o o -� J O co o cNn 0 o0 0 0 n to m m m r M o W n t it -n m -n o n n j. y w w � w (p m O N 0j D i w (D 0 n CUD 0 O 7 -4 Wn N D raD n (v.4 <. W w ccO cp m O N jw ` N W N W N W W w 0 QD O O ; o a3 w n m cf N O o,o fp n � o « UOo m ° r- m W �Y O D O D m O m z cn -A cn D z n " Q m N rn cn r m C7 O Q O� tC� 0 0 0 rox 4 4 g m a n n n C A ` O D C7 O O U O W$ f0 CL -d -4 W A W W W W W C c3 Q U O O O G O (WDa ,p N w 0 G a w m AN C N V1 0 CD a�m M w r n z o c �= 0 n C) CITY OF TIG,ARD DEVELOPMENT SERVICES ELECTRICAL PERMIT 13125 SW Hall Blvd., Tigard,OR 97223(603)639-4171 RESTRICTED ENERGY PERMIT #: ELR99-0069 DATE ISSUED: 03/30/99 PARCEL.: 19135DA- 03500 SITE ADDRESS. . . : 11481 SW HALL. IALVF) #202 SUBDIVISION. . . . : Z ON ING:C--P BLOCV. . . . . . . . . . : LOT. . . . . . . . . . . . . JlJRISDICTN: TIG Project Description : Electrical TI A. REST DENT IAL.—- B. COMMERCT AUDIO & STEREO. . . AUDIO & STEREO. . : INTERCOM & PAGING. . : BURGLAR ALARM. . . . BOILER. . . . . . . . . . .. L.ANDSCAPIE/IRRIGAT. . : GARAGE' OPENER. . . . . CLOCK. . . . . . . . . . . : MED icnL. . . . . . . . . . . . : HVAC. . . . . . . . . . . . . DATA/TELE COMM. .. :Y NURSE CALLS. . . . . . . . . vnCLJUM SYSTEM. . . . : FIRE ALARM. . . . . . : OUTDOOR LANDSC LITE: OTHER: HVAC. . . . . . . . . . . . : PROTECTIVE SIGNAL. . : TNSTRUMENTATION. : OTHER. . : TOTAL. # OF SYSTEMS: I Owner. FEES L. N. PROPERTIES, LI-C type a in o 1.kn t by date r e c p t 11481 SW HALL BLVD PRMT $ 40. 00 B 03/30/99 9-9 -314085 STE 100 5PCT $ 2. 00 B 03/30/99 99--314085 TIGARD OR 97223 Phone #: G84-5066 Contractor- COMMWORLD OF PORTLAND 4L. 00 TOTAL ROBERT WARREN OLSEN PO BOX 3675 REQUJRED INSPECTION'; PORTLAND OR 97208 Ceiling Cover Low Voltage Insp Phone #: Wall, Cover Elect' l Final Reg #. . : 001039 This peroit 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 pertit will expire if work is not started within too days of issuance, or if work is suspended for tore than 180 days. ATTENTION: Oregon law requires you to follow rule adopted by the Oregon Utility Notification Center. Those rules are set forth in DAR 952-0e1-WIP through DAR 952401-080. You tay obtain copies of these rules or di�t question I OLW, at (43)246-1987. 2 1- T - st-ted b'/ �r �__ "`!1.__� ._ _._........__. __ ..._ Permittee Siqnati(re INSTALLATION The installation is being made on property I own which is not intended for lease, or rent. OWNER' 9 SIGNATURE: DATE: ..__._._--_.---_-----.--_____—CONTRACTOR INSTALLATION L" T r AJRE OF SUPR. ELECI N.- ) NA1 DATE: LICENSE NO: +•++++++•i++4......4•..................I.........4............... 4................. Call 639-4175 by 7:00 P. M. fat- an Inspection needed the next bi.isiness day 4......................................4..+++.4..................................*+++++4 CITY OF TIGARD Electrical Permit Application Plan Check 13125 SW HALL BLVD. Recd Rv- � TIGARD OR 97223 Date Rec'a Date to P,E Phone (503)639-4171, x304 Print or Type Date to DST �-- Inspection (503) 639-4175 Permit n. Fax (503) 084-72.1 r7�vPa�-Gb7S Incomplete or i.legible will not be accepted � Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Developmen' -_ Number of Inspections per permit allowed Nome (or name of business) SCR, Inc. __- Service included: Items Cost Sum Address 11481 S.W. Hall Blvd.yd. to. 2 0 2 4a. Residential-per unit 1000 sq.ft.or less $110-00 __ 4 City/State/Zip Ti g,zrd•. �_ 9 7 2 2 3 !._ Each additional 500 sq.ft.or Commercial ® Residential ❑ Limited Energy � $25.00 _ Each Manut'd Home or Modular Dwelling Service or Feeder $68.00 p ?a. Contractor installation only: --- _ (Attach copy of all current licenses) 4b.Services or Feeders Wo r 1 d o f�_ -QrtU �[L_ Installation,altoration,or relocation F e^tnral Contractor_ Comm - 200 amps or less $60.00 2 Address 5711 S.W. Arctic Drive ____ 201 amps to 400 amps $8000 2 City $e_&WSrto[b ____ ,State_Q� Zip-2 0 5`�, 401 amps to 600 amps $120.00 2 Rhone No, 523-5 Z-Q_L2-2_Q__ 601 amps to 1000 amps $180.00 _ 2 Jo'o No.:,-0 0 5 0Over 1000 amps or volts $340.00 e_ 2 C, Elec.Cr,nt. Lice. No. 21-8 9 0 CLE_Exp Date 10-1 - 9 r_ Reconnect only $50.00 2- OR State CCB Reg. No.-1 91 6 Exp.Uate Q 1I 4D.Temporary Services or Foedel s COT Business Tax or Metro No. 5 2 7 6 Exp.Dat 01 bo Installation,afterahon,or relocation 200 amps or less $50.00 _ p 201 amps to 400 amps $75.00 11 Signature of Supr. Elec'n r "`-' 401 amps to 600 amps �i $100.00 Over 600 amps to 1000 volts, License No. 3 3 4 0 J L p.Date 10101 /99 one"b"above. Phone No. 503-520-1220 4d.Branch Circuits New,alteration or extension per panel 2b. For owner installations: a)The fee for branch circuits with purchase of service or Print Owner's Name_ _ _ leader fee. AddressEach branch circuit $5.00 Cit State ZI b)The fee for branch circuits City - -- P without purchase of Phone No. _ service or feeder fee. First branch circuit $3500 The installation is being made on property I own which is not Each additional branch circuit $5.00 1 intended for sale, lease or rent. 4e.Miscellaneous (Service or foeder not Included) Owner's Signature Each pump or irrigation circle $40.00 Each sign or outline fighting 3. Plan Review section (if required):' Signal circuit(s)or a limited energy.4/Cj101� panel,altoration or extension 1 $40.00 40 .00 . < �. Please checK appropriate Item and enter fee in section 5B. Minor Labels(10) $100.00`� 4 or more residential units in one structure 4f.Each additional Inspection over Service and feeder 225 amps or more the allowable In any of the above System over 600 volts nominal Per inspection $3500 Classified area or structure containing special occupancy Per hour - $55.00 as dnscdbed in N E C.Chapter 5 In Plant $55.00 _ #Submit 2 sets nt plans with application where any of the above apply. 5. Fees: 40 .00 Not required for temporary construction services. 5a.Enter total of above fees $ ---T.-U7- 5%Surcharge(.05 X total fees) $ NOTICE Subtotal $ --- 5b.Enter 25%of line Be for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review i rq%&W(Sec.3) $ NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account a $ 42 .00 Total balance Due IADSTMELC99.A1111 nev 4/9G CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: ELC99-0145 io ik 13125 SIN Hall Blvd., Tigard,OR 97223(503)639-4171 DATE ISSUED: 03/17/99 PARCEL : 15135DA-0,3501 SITE ODDRE95. . . : 11481. SW HALL BLVD #20*2 SUBDIVISION. . . . : ZONING-.C--P' BLOCK. . . . . . . . . . : L.0"1.. . . . . . . . . . . . . JUR I c3l)T CTION: TIG Project Description: Add twelve (12) branch circuits. RESIDENTIAL._ UNIT--.--- SRVC/FEEDERS---- -M I SCELL.ANEOL)S-----­- 1000 SF OR LESS. . . . : 0 0 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . .ON. . . . : 0 EACH ADD' L 500SF. . . : 0 201 400 amp. . . . . . . : 0 L-TGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0 MANF. HM/ SVC/FDR. . : 0 601+amps-1000 Volts. : 0 MINOR LABEL. ( 10) . . . - 0 ------SERVICE/FEEDEP--- --- ----BRANCH CIRCLJI'TS------- INSPECTIONS-- 0 NSPECTIONS—0 E"00 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0 201 400 amp. . . . . . : 0 1st W/O SKIC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0 401 600 amp. . . . . . : 0 EA ADD' L. BRNCH CIRC: It IN PLANT. . . . . . . . . . . : 0 601 1000 amp. . . . . : 0 REVIEW SECTION-.____---_---_.--__.._ 10001- anlp/vult. . . . . : 0 ) =4 RES UNITS. . . . . . . . . ) 600 VOI_T NOMINAL. . - Reconnect only. . . . . : 0 SVC/FDR 225 AMPS. . : CLASS AREA/SPEC OCC. : ownpr: FEES L. N. PROPERTIES, LLC type amol.tnt by date recpt 11481 SW HALL. BLVD PRMT $ 90. 00 GE-.O 03/ 17/99 99--313768 STE 100 5PCT $ 4. 50 GEO 03/17/99 99--313768 TIGARD OR 97223 Phone #: Contractor: R 0 COSTELLO ELECTRICAL $ -94. 50 TOTAL ROGER cosTELLO 1439 SE 17TH LOOP, REQUIRED INSPECTIONS CANBY OR 97013 Ceiling Cover-, Elect' 1. lervice Phone #: 266-8483 Wall Cover Elect' l r- inal Reg #. . : 000874 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all othe', applicable laws. All work will be onne 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 the rules adopted by the Oregon I.Itility Notification Center. Those rules are set forth in OAR 952-00I-00I0 through OAR 952-001-11987. You may obtain a copy of these rules or direct questions to OLINC by calling (503)246-1987, Issi-ted BY : ------------------------------OWNER INSTALLATION The installation is being made an property T own which is not intended for, sale, lease, or rent. OWNER' S SIGNATURE: DATE: ION SIGNATURE OF SUPR. ELECIN: %_,_,e��_ c DATE i 0 LICENSE NO: 41 3c/ - 5. ...........4.........................1+4•.............#-+-++4,+++4•............. ....4-4++f Call 639-4175 by 7:00 p. m, for an inspection needed the next biAsiness day ...... ................*............. •++-t-+++++++++++++++++++++++++++.++++ + ooy4; CITY OF TIGARD Electrical Permit Application Plan Check n 13125 SW HALL BLVD. Recd By TIGARD OR 97223 Date Recd _ Date to P.E. Phone (503) 639-4171, x304 Print Or Type Date M DST � Inspection (503) 639-4175 �� � Fax (503) 684-7297 Incomplete or illegible will not be accepted Permit it l° Called 1. Job Address: 4. Complete Fee Schedule Below: Name of Development--_� 1���_ Number of Inspections per permit allowed 7 � Name(or name of business) r ice. :fl Service included: Items Cost Sum Address ---j' i S 1^J nn 11 OZ 4a. Residential-per unit Cif /StatelZi i �+r (� f� 1000 sq.N or less $110.00 _ __ 4 City/State/Zip p Each additional 500 sq,It.or Commercial © Residential❑ Limited thereof $25.00 _ 1 mited Energy _- $25.00 Each Manuf'd Homo or Modular Dwelling Service or Feeder $68.00 2a. Contractor installation only: Feeders r oFee (Attach copy of all Trent licenses) Installation,4b.Services s or Fee or relocation Electrical Contractor 1 ' In200 amps or lase _ $60.00 2 r P Address (_ 201 amps to 400 amps $80.00 2 City StateZip i 401 amps to 600 amps $120.00 2 Phone No 15 r 601 amps to 1000 amps $180.00 2 Job No. Over 1000 amps or volts $340.00 2 Elec. Cont, Lice. No. - '7' Exp.Date ' c _ Reconnect only $50.00 2 '�' OR State CCB Reg. No.8-71.1 D L Exp.Date 4c.Temporary Services or Feeders COT Business Tax or Metro No. ! 7 Exp.Date Installation,alteration,or relocation 200 amps or less $50.00 2 201 amps to 400 amps $75.00 2 Signature of Supr. Elec'n C, 401 amps to 600 amps � $100.00 2 Over 600 amps to 1000 volts, License No. -. c5 V Exp.Date i ase"b"above. Phone No c, - 4d.Branch Circuits New,alteration or extension per panel 2b. For owner installations: a)The fee for branch circuits with purchase of service or Print Owner's Name---, _ _ feeder fee. Address _ V Each branch circuit $5,00 CI State Zip b)The lee for branch circuits ty-�-_ -_� I without purchase or Phone NO. _ servfce or feeder fee. I irsl branch circuit 1 $35.00y �/V 2 The installation is being made on property I own which is not I Each additional branch circuit 1 t $s.00 z intended for sale,lease or rent. 49.Miscellaneous Owner's Signature ------------------- (Service feeder included) � $40.00Echpumporiirrigation circle Each sign or outline lighting $40.00 3. Plan Review section (if required):* Signal circult(s)or a limited energy- panel,alteration or extension $4000 �.. Please check appropriate item and enter fee In section 58. Minor Labels(10) $100.00- 4 or more residential units in one structure 4f.Each addltlonal Inspection over Service and feeder 225 amps or more the allowable In any of the above System over 600 vol's nominal Per Inspection $35.00 Classified area or structure containing special occupancy Per hour $55.00 as described In N.E.G.Chapter 5 In Plant $55.00 Submit 2 sets of plans with application where any of the nbove apply. S. Fees: r1(),Lr Not required for temporary construction services. 5a.Enter total of above fees $ 5%Surcharge(.05 X total fees) $ NOTICE Subtotal $ 5b.Enter 25%of line 5a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan RgVIeW if reuire (Sec.3) $ NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal IC SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY 1IME AFTER WORK IS COMMENCED, Q Trust Account Total balance Due d I VATMELC96.APP Rev W96