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14420 SW HAZELHILL DRIVE ....-...,.._;;... ,.. ., .....,,.w..__. _.___ ,._..:.. ...:...::-dW,..�»�+w.u!::o.......W.:...Lw.....•ru:;.1iw16�._.,.,...._ .........,...,.i...�wi.u�k.WIWIIMf�w� �r�;.�...... ........_.....eS.�Ya.._.. �A T hi ,,0 cn 4 .ry J. �r IT'S' r r v f i i I I I l 1 420 SW HAZELHiLL DR / \ CITY O F TIGARD ___. ELECTRICAL PERMIT PERMIT#: ELC2003-00652 DEVELOPMENT SERVICES DATE ISSUED: 10/23103 13125 SW Hall Blvd.,Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S110BB-02000 SITE ADDRESS: 14420 SV, HAZELHILL DR ZONING: R-1 SUBDIVISION: AMES ORCHARD BLOCK: LOT: 020 JURISDICTION: TIG Project Description: Installation of(2)branch circuits for bathroom remodel. RESIDENT:AL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS_ 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 snip: SIGN/OUT LINE LTG: Li,,vrED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF -IM/SVC/FDR: 601+amps - 1000 volts: MINOR LABEL 110): SERVICE/F2EDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 200 amp: W/SERVICE OR FEEDEP: PER INSPECTION: 201 - 4C0 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: I IN PL 1NT: 601 1000 amp: PLAN REVIEW SECTION_ 1000+ amp/volt: -4 RES UNITS: >600 VOLT NOMINAL: Reconnect only: _ SVC/FDR—225 AMPS_ — GLASS AREA/SPEC OCC: Owner: Contractor: HELSETH.DENNIS t!AND WEBER ELECTRIC INC NANCY L PO BOX 231154 14420 SW HAZELHILL DR TIGARD,OR 97281 TIGARD,OR 97224 Phone: Phone: 503-620.1906 Reg #: 1.1(' 44087 -- ---- Still 4028S F E L S 1.1.1 34-442c Descripti(•n Date Amount _ Required Inspections jFIAI R TFT Lk Permit 10/23/03 $53.50 i-- [TAX]8%State Surcharge 10123,103 $4.29 Ru F tlect'l Final Total $57.78 This Permit is issued subject to the requi3tiuns contained in the Tigard Municipal Code,State of OR.Specialty Codes and all caner applicable laws. All work will bo 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 morelhan 180 days. 4TTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set foj*Kin OAR::52-001-0010 ttirough OAR 952_-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)246.66y9 or 800-332-2344. Issued By: �� .!' Permit Signature: / OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE --�CO_N_TRAC i OR INSTALLATION ONLY _ SIGNATURE OF SUPR. ELEC'N: 7 1' �j Isd�s�_--_— � DATE:LIZ-_�3-��- IACENS�7 NO: - --- ---��-- — —_--- Call 639-4175 by 7:00pm for an inspection the next business day 1 FOR OFF ICE CISE Electrical Per nit ApplicationReceiycd lacctn.ri — Dat./By ��' O ` _ Permit No.: Planning Approval Sign City of Tigard /� Date/By: Permit No.: 13125 SW Hall Blvd. / \\ Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: Phone: 503-639-4171 Fax: 503-598-1900Post-Review Lsnd Use Dalc/By: Case No.: Internet: www.ci.tigard•or.us Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 NameNethod: Su lemcntal Information. TYPE OF WORK PLAN REVIEW LPlease check all that a New construction _—T j Demolition Service over 225 a,ans• Health-care facility commercial ❑Hazardous location ddition/alteration/re lacement Other: ❑Service over 320 amps-rating of ❑Building o%�r 104M square feet. CATEGORY OF CONSTRUCTION _ I&2 family dwellings four or more residential units in 1 &2-Family dwellia- Commercial'Industrial ❑System over 600 volts nominal one structure ❑Building over three stones ❑Feeders,400 amps or more Accessory BuildingMulti-Family ❑Occupant load over 99 rsrsons ❑Manutactured structures or RV park Master Builder Other' ❑Egress/li�hting plan JOB SITE INFORMATION and LOCATION Submit sets panne wi n any of the above. The above are not applicable to temlutrary consr•uctlon service. _ Job site address:_14`�2�SCJ a�,�h FEE*SCHEDULE Suite#: ./A t.#: Number of Ins ections per pe mit allowed Pro•ect Name: Description Qty Fee It a.) T°tal hew resldentlal-finale or multi-fai.dly per Cross streedDirections to job site:_ dwelling unit.Includes alviched garage. tn.-Q.�_ t'rt 1►'� �O �t�� re C �J ( 7�2 e��'vl Service included: 1000 fl.or less _ 145.15 •1 Each additional SINI sq.A.or portion thereof 33.40 1 —-- Limited energy,residential 75.00 2 Subdivision: Lot#: Limited energy,non residential %5.00 Tax ma /parcel #: — Each manufactured home or modular dwelling DESCRIP r1ON OF WORK sen ice and or feeder 90.90 _ 2 Serviced or' r •Installation, relocation:alteration or relocation: 200 amps or less 80,30 2 I C i i -'a� 6 201 ams to 400 ams 106.85 2 401 amps to 6M ams 160-L 2 PROPERTY OWNER TENANT _ 601 amps to Impams 240.60 2 Over IOW amps s or volts _ 454.65 2 Name: Reconnect only 66.85 2 Address: — Temporary sers ices or feeders-installation, ---- alteration,or relocation: City/State/Zip: 200 amps or less _ _ 66.85 1 —� 201 amps to")ams 100.30 Phone: Fax: 401 to 6tN:ams - - 133.15 APPLICANT I U CONTACT PERSON Branch circuits-new,alteration,or Name: extension per panel: ---- — A.Fee ror blanch circuits with purchase of Address: service or feeder fee,each branch circuit 6.65 2 City/State/ZIP 8.Fee for branch circuits without purchase of service or feeder fee,first'iranch circuit 46.85 = Phone: FAX: Each additional branch circuit 6.65 2 E-mail: ^ Misc.(Service or feeder not included) Each pump or irrigation circle _53 40 2 ' CONTRACTOR Each sign nrutlin oe li htin 53 40 2 Job No: Signal circuit(s)or a limited energy panel, alteration,or extension Page' Business Name:_illQDescription Address: Each additional Inspection over the allowable In any of the above: _ City/State/Zip: Per inspection pet hour min. I hour) 62.50 I _ Phone: — = l Sc�� Fax: c, W Investigation fee: Other: CCB Lic. #: Lic. #: _ y L Electrical Permit Fees* Supervising electrician Subtotal $ signature required: Plan Review(25%of Permit Feel S Print Name: /'y��, 1r�sL Lic. State Surcharge 8 of Permit Feel t TOTAL PERMIT FEE S Authorized Vntice: This permit application expires If a permit is not obtained within Signature: ____ _.____ Date: INO days after it has been accepted as complete. •Fee methodology set M Tri-(ounty Building Indust,y Service Board. (Please print name) i'Dsts`,Permit Forms I-10crnutApp.doc 01:03 Electrical Permit Application - City of Tigard Page 2 - Slipplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems............................................ .............. S75.00 Check T.%pe of Work Involret': F1Audio and Stereo Systems* Burglar Alarm CJr iarage Door Opener* I Icating,Ventilation and Air Conditioning System* Vacuum Systems' Other _ --—— COMMERCIAL WORK ONLY: Feefor tach system.......................................................... $75.00 ISI-F.OAR 918.260-2601 Check Type of Work Involved: Audio and Stereo Systems 7 Boiler Controls Clock Systems Data Telecommunication Installation [—_ Fire Alaim Installation IIVAC Instrumentation Intercom and Paging Systems I.rindscapc Irrigation Control* n Medical n Nursc Calls Outdoor Landscape Lighting* Protective Signaling Other Number of Systems * No Ilcenies are required. Licenses are required for all other installations i`,Dsts\Pennit Foms+IcPenm tAppPg2.doc 01103 CITYOF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2003-00562 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 16/28/03 SITE ADDRESS: 14420 SW HAZFLHILL DR PARCEL: 2S 110BB-02000 SUBDIVISION: AMES ORCHARD ZONING: R-1 BLOCK: LOT: 020 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE :,;SPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS. OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER 14EATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: — SINKS: U URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB/SHOWERS: 1 SEWER LINE: ft WATER CLOSETS- I WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Bathroom remodel, replace fixtures -- --- ------ FEES - ----- Owner: - Description Date Amount HELSETH, DENNIS H AND -- — NANCY L I'I t \Iltl I'rrnur I rc 10128/03 $72.56 14420 SW HAZELHILL DR I I n\l 8 Sf,itr Surcliml 10/28/03 $5.80 TIGARD, OR 97224 Total $78.30 Phone Contractor: RAYBORN'S PLUMBING INC PO BOX 69 TUALATIN, OR 97662 REQUIRED INSPECTIONS Phone ; 503-692-4130 Top-out Insp --- --------..-- ---! ----i Final Inspection Reg #: ME"' 0000 1800 LIC 87852 PI.M 34-1661113 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION. Oregon ;aw requires you to follow rules adopted by the Oregon Issued By: — „ I)L, 1�'t� _ _--- PerrT,ittee Signature: ` Call ('X03) 639-4175 by 7:00 P.M. for an inspection needed the next business clay Oct- 27-03 09 : 29A Rayborn' s P l urrtb i ng, I ric . 15036912328 P . 01 Building Fixtures '�� "'�'' - • • Plumbing, Permit Alli tion 11 � DatervBy � �.1 PermttrNo City of Tigard Planning Approval Sewer ., Date r By Permit No Tigard, OR 97223 5W Hall Blvd RF:C�".I M Plan Review othef Tigard, Date I By Permtl No Phone 503 639-4171 Fax 503 598-1960 Post Review rand use Inspectton line 503 639 4175 ` Date/By Case No Contact Junsdiclion Name/M a1 TYPE OF WORK FEE SCHEDULE 1 New Construction 1 1 Demolition DescH Ion I Qq r Each Total i i Addition/Alteration/Replacement Other New One i Two Fertility Dwelling(including 100 R for each ulildy) r 1/Repair Others SFR(1)bath $25500 $000 CATEGORY 000CATEGORY OF CONSTRUCTION SFR(2)bath $31500 $000 Ll One R Two Family Dwelling n Commercial I Industrial S FRbath _ $37:i 00 $0 00 n Accessory Building i Muni-Family Unds n ditional bath I kitchen $15500 $000 i i Master Budder i i Others _ nkler-Sq Ft �e 2JOB SITE INFORMATION AND LOCATION ities _ Job site address 14420 SW Hazelhlli V Catch basin or area drain $16.6b $000 Suite Bldg I Apt 0 � Drywell,leach lirie,or trench drain — $i6 60 $000 Project Name Hr•lseth I Royal Looting drain(no 1_innar Ft ^-_)' _ $27 50 $000 Cross street/Direction to Job T Manufactured home utilities(each) $11000 $000 Manhole $1660 $000 Subdivision .ot no _ Rain drain connector S16 60 So 00 lax reap/lot/account(parcel K) Sanitary sewer(no linear R )' _ Page 2 $070 DESCRIPTION OF WORK Sloan sewer(no linear fl _ _�' _ Page 2 $000 Bathroom Rernodei- _ Water service(no linear ft 1' Page 2 $000 Fixture or Item Absorption valve $if"60 $000 u PROPERTY OWNER f 11 TENANT Backflow preventer _ Page 2 $000 Name Flelselh Backwater valve $1660 $0()0 Address 14.420 SW Hazelhill Clothes Washer $1660 $000 ity I Slate l7ip Tigard — Dishwasher $1660 $000 Phone 503 620-0199 Fax Drinking fountain $16 w) $000 n APPLICANT n COtlTACT PERSON Ejectors/sump $11;60 So 00 Name Expansion tank _ $1660 $000 Address Fixlure/sewer cap $16 60 $()00 City I State I Zip Floor drain/floor sink!hub $1660 $000 Phone lFax Garbage disposal $1660 $000 CONTRACTOR Hose Bibb $1500 $000 Business name RAyBORN'S PLUMBING r Ire Maker _ $1660 $000 Address P O 90X 69 Interreptor/grease trap _ _ $1660 $000 014,1 State/Zip TUALATIN,OR 97062 Medical gas(value $_ Page 2 $000 Phone 503 692.4139 ax 503 691-2328 — CCB Lic 87852 Exp 12lU3 Metro Lir, 01806 Exp 7104 _ Primer v $16 60 $U 00 � D- Roof drain(commercial) _ $1660 $000 Authorved l/i/ C4. ) k t(JuO sink/basin I lavatory 1 S16 60 $16 60 Slr nature JP Llc 4075JP Ex 11 OS Tub I shower/shower pan M1 $1660 $1660 p: Print name: Woyne Silt wl ete. 10127103 Urinal S 16 60 $000 Water closet 1 $1660 $1660 Wp ter heater $1660 $000 Others $1660 $0.00 Notice This rw rrml application expires of a permit is no;obtained wilhm 180 days after d has bem en accepted as complete Others. 16,60QA, PLU O PERMIT FEES Permit Subtotal: $7250 Minlrrurn permit fee$72 50/Res Backflow$36.25 Commercial Plan Review(25%of pemtit fee 1 State Surcharge(8%o!permit fee) $580 Total Permit Fee; S78.30 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BLIP Received __.._-3-f_LZ4�--k Date Requested 2 l — AM-- PM BUP Location Suite — _ ME — _—_-- Contact Person __-__.____ -_ ___ -------- Contractor _._Contractor -- --- - - ._------- -- - Ph( ----) - - SWR -- BUILDING Tenant/Owner __- __ _--_._______ __ _ ELC a Footing ----- ELC Foundation Access: Ftg Drain ELR —- Crawl Drain Slab Inspection Notes. SIT —__—.- Dost& Beam ---- ----- ----- _ _ Shea,Anchors Ext Sheath/Shear ---- -- -- Int Sheath/Shea; Framing — - ---- _.- - - ---- Insulation Drywall Nailing --- - - ----- - ------�— Firewall Fire Sprinkler -- -- ------ - - -- ,_�— ---------- Fire Alarm Susp'd Ceiling — -T -- Roof � Other: -- ---�-- - --------- - - --- - Final _PASS PART FAIL PLUMBING - - - -- ----------- Post& Beam -- Under Slab --- - --------- -- Rough-In Water Service - Sanitary Sewer Rede Drains ---- -- - - — _—. ------- --- — - Cdoh Basin/Manhole Storm Drain -- ----- -_-- Showei F'an PART FAIL MECHANICAL _ - — - - ----- - --- Post&Beam Rough In - -- - — -- Gas Line Sn'loke Dampers - ---- - -- ---- -- Final J?US PART FAIL --- -- ---- —_.— ELEC-T�iF6A�, Service Rough-In UG Slab Low Voltage - --- ----- ---- - - -- ---- ------------ Fire Alarm Reinspection fee of$ --required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. c PA _PART FAIL SiT [-] 'lease call for reinsp ction RE:_- —_ ---_.�. Unable to inspect-no access Fire Supply Line — ADA Ext Date_l -� __- -_ _ Inspector Approach/Sidewalk -- - (Aher: F�nai DO NOT REMOVF tills Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE ADAMS ELECTRIC CO INC 2340 SE CLATSOP PORTLAND OR 97202 Electricdl Signature Form Permit # . . MST97-0548 Date Issued. : 01/02/98 Parcel . . . . . . : 2S110BB-02000 Site Address : 14420 SW HAZELHILL DR Subdivision . : AMES ORCHARD Block . . . . . . . : Lot : 020 Jurisdiction: TIG Zoning. . . . . . . R-1 Remarks : Construction of 400 aq :Et gunroom addition on existing patio. Your company has been indicated as the electrica; 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 OWNED : ELECTRICAL CONTRACTOR : DENNIS HELSETH ADAMS ELECTRIC CO INC 1442.0 SW HAZELHILL DR 2340 SE CLATSOP TIGARD OR 977.24 PORTLAND OR 97202 Phone # : 620-0199 Phone # : Reg # . . : 000005 Signature ou ervis+ng Electrician Please return this completed form to the address above. ATTN: Building Dept. If you have any questions, please call 639-4171 , ext. #310 CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: ELC98-0016 DATE ISSUED: 01/2'0/98 13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 PARCEL: ":IS110BB-0000 SITE ADDRESS. . . : 14420 SW HAZEL..H I L_L_ DR SUBDIVISION. . . . :AMES ORCHARD ZONING:R--1 BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . .020 JURISDICTION: TIG Pro.jer_t Description: 4e1seth Jobt36410-R ---RESIDENTIAL._ UNIT------ ---TEMP SRVC/FEEDERS------ ------MISCELLANEOUS---__- 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH ADD' L 500SF. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/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/FEEDER----- -----BRANCH CIRCUITS----- -----ADD' L INSPECTIONS----- 0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPEC.TION. . . . . : 0 201 - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . 0 401 - 600 amp. . . . . . : 0 EA ADD' L SRNCH CIRC: 1 IN PLANT. . . . . . . . . . . : 0 601 - ' 000 amp. . . . . : 0 -------------.-----FLAN REVIEW - 1000+ Amp,'volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR > = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner: -------- -__-------- ---__-----_-__-_--- ___--- ----- FF_F_S - -------- -- -- --- DENNIS HELSE'TH type amount by date recpt 144210 SW HAZELHILL DR PRMT $ 40. 00 .JSD lei /,- 0/98 98--302581 T I GARD OR 97224 SPCT $ .:'. 00 _,�Zr) 01 /20/98 98-:302581 Phone #: 620-0199 Contractor: -___._----------------.__. ---_.__----------------____--------_-___-___.._.. ADAMS ELECTRIC CO INC $ 42. 00 TOTAL. J,340 SE CLATSOP - ------ REQUIRED INSPECTIONS - - - PORTLAND OR 97202 Rough-in Flect' l Final Phone #: 234-9651 Elect' 1 Service Req #. . : 000005 i This pereit is issued subject to the regulations contained i � e Tigard Municipal Code, State of Oregon Specialty Codes and all other applicable laws. All work will be done in accordance with appr ved plan}11 This per@ t will expire if work is not started within 10 days of issuance, or if work is suspended for to a thanjlb@ da s. ATT. TION: Oregon law requires you to follow the rules adopted by the Oregon lRility Notiiication Center. Those r es are set d) 11h in %2-981-NIO through OAR 952A*1- Y7 oay obtain a copy of these rules or direct questions to 113n� (5@312 41187 l ermit.tee C,zynat�_ir'e : _ slued By: ----------------------------OWNER INSTALLPTION The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER' S SIGNATURE: _ _. DATE: ------------CONTRACTOR INSTALLATION ONLY---------------------•------- SIGNATURE OF SUM ELEC' N: ---- DATE: LICENSE NO: ----_ _------_--.-—.- ++++++++++++++++++++++++++t•+++-1-++++++++++++++,-+++++++++++++++++++++++++++++..4 ' Call 639-4175 by 7:00 p. m. for an inspection needed the next business dry +++++++++++++++++++++++++++++.f•h++++++++++++++++++++++++++++++++++++++++++++++++ CITY OF TIGARD Electrical Permit Application Plan Check# 13125 SW HALL BLVD. Fec'd By_ TIGARD OR 97223 Date Roc'd- C7 I Date to P.E._ r; Phone (503)639-4171, x304 Date to DST Print' t or Type nspection (503)639-4175 Incomplete or illegible will not be accepted Permit# `� 91-0 c?ni Fax(503)684-7297 Called Y. Job Address: 4. Complete Fee Schedule Below: Name of Development _ Number of Inspectlons per permit allowed Name(or name of business) t'7,6-L J,C- Ty Service included: Items Cost Sum Address 1477o?D s l�7 7//�.� �, �/i L. L.PDQ 4a. Residential-per unit Ci /State/Zi /(?j��f'17 ��J�h� 1000 sq.ft.or less _-- 110.00 1 ty P y Each additional 500 sq.ft.or Commercial ❑ Residential , portion thereof = $25.00 - - Limited Energy $25.00 Each Manuf'd Home or Modular Dwelling Service or Feeder $68.00 2a. Contractor installation only: --_--- ' (Attach copy of all current licenses 4b.Services or Feeders Electrical Contractor-B P.4/I)5 F' 7-A/14 Installation,alteration,or relocation 2 _ r, -- 200 amps or less $60.00 2 Addre s �?'yC _ �9 201 amps to 400 amps __ $80.00 - 2 city i State Zip 5 z-;e e'. 401 amps to 600 amps $120.00 2 Phone No. j `� 601 amps to 1000 amps $180.00 2 Job No, r ,�• - ' Over 1000 amps or volts $340.00 2 Elec.Cont. Lice. No. Exp.Date -T 7 Y Reconnect only $50.00 OR State CCB Reg. No. L Exp.Date -, 7-q 4c.Temporary Services or Feeders COT Business,rax or Metro No.JC�- Exp.Date 7-�-9�' Installation,alteration,or relocation 200 amps or less $50.00 Signature of Supr. EIec:11` �;~r°�1 �-�€ ti 1�1.. _ 201 amps to 400 amps $75.00 _ 401 amps to 600 amps $100.00 Over 600 amps to 1000 volts, License No. '< S Exp.Date C'`- %r� see"b'•above. Phone No. • "3 X- � - - 4d.Branch Circuits New,alteration or extension per panel 2b. For owner installations: a)The fee for branch circuits with purchase or storvlce or Print Owner's Name feeder fee. Address - Each branch circuit $5.00 _ b)The fee for branch clrcuib, 1 City State _ Lip- without purchase of Phone NO. service or feeder fee. `<t First branch circuit $36.00 3 The installation is being made on property I own which is not Each additional branch circuit�_ $5.00 r intended for sale,lease or rent. 4e.Miscellaneous Owner's Signature__ (Service f rirr achpum por irrigation r not Included) $40.00 �- 2 Each sign or outline lighting $40.00 - 2 ?. Plan Review section (if required): Signal circuit(s)or a limited energy panel,alteration or extension $40.00 2 Minor Labels(10) $100.00 _ Please check appropriete item and enter fee In section 5B. -- 4 or more residential units in one structure 411.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 $35.00 Classified area or structure containing special occupancy Per hour $55.00 as describaf In N.E.C.Chapter 5 In Plant $55.00 ' Submit 2 sets of plans with application where any of the above apply. S. Fees: l � Not required;or temporary construction services. 5a.Enter total of above fees $ 3 e , 5%Surcharge(.05 X total fees) g NOTICE Subtotal $ �- 5b.Enter 2590 of line 5a for ' PERMITS BECOME VOID IF WORK OR CONSTRUCTIuN AUTHORIZED IS Flan Reviow 4 r ui;id(Sec.3) $ --- NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Sub"C!c! $ ---- IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I ❑ Trust Account# �f Total balance Due L � I\U'1!i1ELCBfi At'1' Rtty 9196 CITY O TIGARD MASTER PERMIT DEVELOPMENT SERVICES PERMIT #. . . . . . . : MST97-054H d 13125 SW Hall Blvd„ Tigard, OR 97223 (503)639.4171 DATE ISSUED: 01/02/98 ."ARCEL: 2,110BB-02000 SITE ADDRESS. . . : 14420 SW HAZE_H11_L- DR SUBDIVISION. . . . :AMES ORCHARD ZONING: R-1 BLOCK.. . . . . . . LOT. . . . . . . . . . . . . :0 0 JURISDICTION: TIG Remarks: Construction of 40 sq ft sunraom addition on existing patio. --------------------- BUILDiN6 REISSUE: STORIES.......: I FLOOR AREAS---------- BASEMENT...: 0 sf REIh1IRED SETBACKS---- RE()UIRFD------------- CLASS OF WORK.:ADD FEIGHT........: 9 FIRST,...: 400 sf GARAGE.....: 0 sf LEFT.......,..: 0 SMOKE DETECTRS: N TYPE OF USE...:SF FLOOR LOAD....: 0 SECOND...: 0 sf FRONT.........: 0 PARKING SPACES: 0 TYPE OF CONST.:5N DWELLING UNITS: 0 FINBSMEMT: 0 sf RIGHT.........: 0 OCCUPANCY GNP.:R3 BDRM: 9 BATH: 0 TOTAL------ 400 sf VAUE..f: 31000 REAR..........: 0 -------_------------------------_____w ____— PLUMBING ________---------------- SINKS.........: d WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: a TRAPS........: 0 LAVATORIES....: 0 DISR*0ERS...: 0 FLOOR DRAINS..: 0 SEWER LINF. ft: 0 SF RAIN DRAINS: 0 CATrH MINS.. : 0 TUB/SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS—: 0 OTHER FIXTURES: 0 ----------------------------------------- ----- —--- -- MECHANICAL -- . --------------- ------------------------------------------- - - FUEL TYPES---------- FURN ! IOW .,: 0 BOIL/CMP 1 3HP• 0 VENT FANS....,: 1 CLOTHES DRYERS: 0 FURN >=100K ..: 2 UNIT HEATERS..: 0 HOODS...,.....: 0 OTHER UNITS..:: 0 MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.......,.: Co WOODSTOVFS....: 0 GTE OUTLETS...: 0 ------------------------------------------------------------------ ELECTRICAL -----------_— ------------------------ -------_---------- ---RESIDENTIAI- UNIT--- --SERVICE/FEEDER--- --TEMP SRVC/FEEDCRS-- -—BRgNCH CIRCUITS--- ----MISCELLANE(ti,;S---- --ADD'L IYSPECTIONS-- 1000 SF OR LEJS: 0 8 - 200 amp..: 0 0 - 200 asp..: 0 W/SVC OR FDR.,: 0 PUMP/IRRIGATION: 0 PFR I14%FCTION: 0 FA ADD'L 500SF.: 0 201 - 400 amp..: 0 201 400 amp..: 0 1st W/O SVC/FDR: i Sl&4/OUT LIN LT: 0 PER HOUR......: 0 I LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL BR C1R: 0 SIGNAL/PANEL...: 0 IN PLANT........ 0 MANF HM/SVC/'DR: 0 601 - 1000 asp,: 0 60141ps-1000 v: 0 MINOR LABEL -10: 0 1000+ amp/volt.: 0 --------------------------------- PLAN REVIEW SECTION ----------------------------------- Reconnect only.: 0 )=4 RES UNITS : SVC.'FDR)=225 A.: 1 600 V NOMINAL: CLS AREA/SPC OCC: --- ----- -- ----------------------------------- ELEr,RICAL - RESTRICTED ENERGY ---- ----- A. SF RESIDENTIAL---- --------------------------- B. CW.:RCiAL--------- —..--------------- ---------------------------------- AUDIO 11 STEREO.: :'!?C" SYSTEM.,: AUDIO d STEREO.: FIRE ALARM.....: INTERCOM/PAGING: RITDOOR LNDSC LT: BURGLAR ALARM..: 0TH: :: BOILER.........: HVAC...........: LP.NDSCAPE/IRRIG: PPOTECTIVE SIGNL; GARAGE OPENER..: CLOCK..........: INSTRUMENTATION- WMICAL........: 01HR: . HVAC......,....: DATA/TELE COMM.: NURSE CALLS....: TOTAL N SYSTEMS: 0 Owner: ------------------------------------Contractor: ------------------- TOTAL FEES:s 412.51 DENNIS HELSETH TIM SEELEN CONSTRUCTION SERVICES This permit is subject to the regulations cuntained in the "An SW HAZEMILL DR 2405 BE 38TH Tigard Municipal Cade, State of Ore. Specirlty Codes and all t,BRRD OR 972.24 PORTLNND OR 97214-0000 other appli_able laws. All work Kill be done in accordance with epproved plans. This permit will expire if work is Phone A: Phone 11: not start 4ithin 180 days of issuance, or if the work is Reg C.: W19 suspended fur more than 180 days. ATTENTION: Oregon law --------------- requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-01-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling 15031246-:981, ---- RFOIIIRED INSPECTIONS — ._-----•--------_—_—_�------...___--- Mechanical Insp Final Electrical Servi Misc. Inspection Electrical Final Mechanical Final Issued By: Pet-mittee Signatures/' _ ++++++++++ .+++++++++++++++++a-+++++++++++++++++++++++++++ + ++ ++++++++++ Call 639--4175 by 7:00 p. m. frit• an inspection needed t e xt a iness day ii Plan Check Xr�- Ct I OF ("IGARD Residentia, Building Permit Application Recd By 1312E SW:r HALL BLVD. New Construction Additions or Alterations Late Recd / 1 TiGArD, OR 97223 Single Furnily Detached or Attached (Duplex) Date to P.E. /%t /`.) V 503-639-4171 Date to DST 7,141, F 503.684-7297 Permit# M 7/7S--y I Print or Type Called /9 ''`117 Incompletk or illegible applications will not be accepted --- -- Name of r'rolect �v- _ Name —�— — -- Job "a Address site Address Architect Mai'ing Address i`-I-izo Svc `f 42 f lt.N.11 ba.r)e City/State Z!p Phone rime rvt4ls 111. Name Owner Mailing Add as J04 1 -fq" 3 rJ l.44Z'J JC iry/State zip P��one Engineer Mailing Address I '(,i O� —1 n ~ 'W f S City/State Zip Phone General Name _ c / Contractor Describe work New O Addition O Alteration U Repair O Mailing Address to be done Prior to permit )"-J1 V /1�r Additional Description of Work: issuance,a copy City/Sa Zip Phare of all licenses �rh�- d J'5 v 171 J are required if Oregon Const.Cont.Board Epp.Date PROJECT expired in COT Lic.A �r 1 �U VALUATION $ ---database J — MtechanitVal Name NEW CONSTRUCTION ONLY: _ Sq. Ft. House: Sq. Ft. Garage 1 Corttrar„for Mailing Ad drF lko Prior io permit Corner Lot YES NO Flag Lot YES NO Issua•ce.a copy CiA4tate Zip hone ,'r T- (check one) (check one) — if all licenses ' _ Restricted Audio/Stereo Burglar are required if Oregon Const.Cor., Board xp. ate Energy System Al?rrTt expired in COT Lic# — datsbase Installation Garage Dcor - — ----- H\/AC Plumbing Name LOttuierj�'.., ner System ns (checkallthat Sub apply) 100 Contractor Contractor Mailing Address Will the e'ectrical subcontractor wire for all YES NO restricted ci-mrgy installations? Prior to permit City/State Zip Phone Has the Subdivision Plat recorded? N/A YES NO issuance, a copy _ of all licenses are Oregon Const.Cont.Board Exp Date required if Lic# Reissue of MST#: Solar Cornpliance expired in COT _ _ ,C2lculatian Attached)_ database Plumbing Lic.0 Exp. Date I hearby acknowledge that I have read this application, that the I information given is correct, that I am the owner or authorized Name age 'iqf the owner ano that plans submitted are in compliance r ["r with Or on State laws. L Electrical P� h- � S atuof ne /Ayent / Sub.. Mailing Address a ( �Q Contractor Contact Person Name Phone# City/State Zip Phone Prior to permit FOR OFFICE USE ONLY: issuanc4, a copy Plat#: N Map/TL# of all licenses are Oregon Const. Cont Board Exp Date /M-!f9 di, / // required if Lic# Setbacks: , Zone. Solar- expired olarexpired in COT database Electrical Lic * Exp.Date Engineering Approval: Planning Appro%..i: TIF: l SFREM.DOC (DST) 4/97 DE�NrS N s n,',q,�Ul L. S'f.%N �v L6 1.)i H H Z J L�J P4.'_u.HIP,- A 0.I)e �- TI ci AA-5 OR. Ci -7 2-2y & pin PKU,j 2 d 610 o l 5s (% S) 4 rrA c k I c F ,N,j NSD P4-f)0 op' A P16 i C nn••nn T. N 0 /1St;M��;S k . �,)� QA t,�d,Q.q►,JS L,)l J- tJA :76.1 M . N A ' P-6 e 7.64 nl N 14 a4.1 d . Pao P6.4,--� Si.OP-t.r P, N.A psi. 7 4 N� g � ► � ��j ��J -- C-��;✓I-�t-�arL � r�d�ec��` � A2a✓,.4E Mo 7- t�;a fire Loa, Inspectj:�;r COUNTI OF_ WASHINGTON _STATE OF O,jEGC)N LEGAL DESC.9IPTION: LOT-----;a _ _`BLK.—— W&WtL SUBDIVISiJN:_�� CHARD I CUENT; !l.t,`1BIN SERVICES, INC. _ - and a�sociat SENGINEi i C. LN.!JOB No.: :5-64 i9il�__ —�4TTN.: DEBBIE "GI BBS_ SURV EYJ \ /t/ DATE: 8/4/87 _SCALE: 1" =Y � I HEREBY DECLARE THE STRUCTURAL IMPROVEMENTS TO THE ABOVE DESCRIBED PROPERTY TO BE SITUATE THEREON AS SHOWN7THE ARE NO APPARENT ENCROACHMENTS BY OR AGAINST THE PROPERTY IN QUESTION, EXCEPT AS SHOWN. THIS LOCATION IS BASEDMONUMENTS FOUND. NO WARRANTY IS MADE AS TO THE CORRECTNESS OF SAID.MONUMENTS AND NO LIA&L TY/S ASSUMED IF MONUMENTS A: _IN ERROR THIS DECORATION IS MADE AT THE REQUEST AND FOR THE EXCLUSIVE USE OF HE TRANSACTION AND CLIENT NAMED ABOVE, AND iS NOT TO BE USED FOR CONSTRUCTION PURPOSES, L. D JI N BOON RV L N. b ti SURVEYOR th � I1 , M� I ho"X I / /1 ar, `N N Under2° IL 0jl 25• = �'� 1b. • � '.as i denee 0 I1- z' Under Const. zt fV rJ Dennis Helseth 14420 S.W. :Hazelhill Drive ,iTigard i (Oto- c199 I I') Lot 20 N m nA �M i 1�,Q� pEtrj. � E.tCir 11 Pum / Z51 / ORS, _ �LoVo .L) !AR iAW Y IS MADE AS 70 [tit t:URR-CINESS OF SAID MONUMENTS AND NO LIABIL TY IS ASSUMED IF SAID MONUMENTS ARE IN ERROR. THIS DECLARATION IS MADE AT THE REQUEST AND FOR THE EXC USIVE USE 'F HE TRANSACTION AND CLIENT NAMED ABOVE, AND IS NOT TO BE USED FOR CONSTRUCTION PURPOSES,,LA DI N� pOUN RY LQCA/ N. SURVEYOR 11 1 , t�. p m� Gar; N N Under2° zs ' ±t v,Residence <1 2° N Under Const. V 2G� libi log 0 2.O1rlrr�(; �- Dennis Helseth 14420 S.W. 'Hazelhill Drive Tigard 99 Lnt 20 m J fM I i i 1 1 I OFF TA S��1^t_m E.Al r i `1 : F r,Js eo S326 4230 N E Fremont Street Portland Oregon 97,113 (5031 2845890 FILE NO Li _ __ _ Z CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 6394175 Business Phone: 6394171 Date Requested: IP- _/0 - P.M. MST: 9—0 SQ Location: .,L Zi5BUP: Tenant: Suite: / Bldg: MEC: Cmtractor: Phone: JrO2"-76 rl.� PLM: Owner: 111A Phone: ELC: .b 014- ELR: SIT: BUILDING BLDG(con't) PLUMBING MECHANICAL LECTRICAL�, SITE Site Post/Beam Post/Beam Post/BeamoveC r e�ice _ Sewer/Storm footing Roof 1Fndl�l/Slab Rough-In Ceiling Water Line Slab framing 'fop Out Gas Line Rough-In IJG Sprinkler fotmdation Insulation Sewer Ilood/Duct Reconnect Vault lismt Damp Drywall Storm furnace 'temp Service MISC. Masonry Ceiling Rain Iry!in A/C DIG Slab Shear/Sheath fire Spklr/Alm Crawl/1 ound Ir heat Pump Low Volt Approved Approved Approved Approved Approved Appr/Sdwtk No!Approved Not Approved Not Approved Not Approved Not Approved FINAL FINAL FINAL >' FINAL ---��-12 Q Q 3.�'. _ o � .1 - -- --------- I7 Call for reinspection !1'tJwction fee 01 required before next inspe tion 17 Unable to inspect Inspector:_ ,� __—__ Date: ! C Page _of.-- CIT OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 6394175 Business Phone: 639-4171 Date Requested: A.M. P.M. MST: Location: usL. _ BUR Tenant: Suite: Bldg: MEC: Contractor: add one: __23 �_ PLM: /� _ Owner: Phone: _ ELC: C'YS_00/ ELR: SIT: _ BUILDING BLDG(con't) PLUMBING MECHANICAL EL ver/SECTRICAL' SITE Site Post/Beam Post/lIcam Post/Beam Coervice Sewer/Stonn Footing Roof Undl-1/Slab Rough-In Ceiling Water I.ine Slab Framing Top Out (las I.ine Rough•-In IJG Sprinkler Foundation Insulation Sewer ll(Xxl/D)uct Reconnect Vault lisnrt Damp Drywall Stonn Furnace "Temp Service MISC. Masonry Ceiling Rain Drain A/C I1(i Slab Shear/Sheath Fire Spklr/Aha Crawl/Found Ir I leat Pump i.ow Volt _ Approved Appro.ed Aprroved Approved Approved Appr/Sdwlk Not Approved Not Approved Piot Approved oved Not Approved FINAL FINAL FINAL, FIINAL FINAL J gbuc� 4 1P - - -- - -- -- - - -- I,Call for reinspection einspection fee of S _required before next inspection rl i 111aN ,�, Inspector — �— Irate: ^_L—�?