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10365 SW MEADOW ST
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� ®� TIGARD
'���� ELECTRICAL PERMIT
PERMIT#: ELC1999-00510
DEVELOPMENT SERVICES DATE ISSUED: 8/18/99
13125 SW Hall Blvd..Tigard,OR 97223 (50311639-4171 PARCEL: 1S13bCC-01200
SITE ADDRESS: 10365 SW MEADOW ST
SUBDIV13ION: THE MEADOW ZONING: R-4.5
BLOCK: LOT : 013 JURISDICTION: TIG
Prosect Description: Add a first branch Circuit to an existing dwelling.
_ RESIDENTIAL UNIT ^_ TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp. SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGN . JPAAEL:
MANE HMI SVC/FDR: 601+amps- 1000 s,•elts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS
ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE: OR FEEDER: PER INSPECTION:
20'1 - 400 arno: 1st W/O SRVC OR FOR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ PLAN REVIEW SECTION
1000+amp/volt: >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only^ SVC/FDR>=225 AMPS: CLASG AREA/SPEC OCC: _
Owner: Contractor:
DOROTHEA SZYDLOWSKI PHOENIX FLECTRIC CO
10365 SW MEADOW ST 7379 SW TECH CENTER DR.
TIGARD, OR 97223 TIGARD, OFc 97223
Phone: Phone: 684-3600
Reg#: LIC 00052288
SUP 4140S
ELE 34-247C
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRMT GEO 8/18/99 $37.5f 99-317736
SPCT GEO 8/18/99 $2.63 99-317736 ORIGINAL Total $40.13
This Permit is issued subject to the regulations contained in tho Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws.
A 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 law requires you to follow rules adopted by the Omgon Utility Notification Center. Those
rules are set forth in OAR 952-001 0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to 0 JNC at(503)
246-1987.
1 i
—� Permit Signature: �, Issued By:
00
_ OWNER INSTALLATION ONLY _
The insi�;!lation is being made on property I own which is not it for sale, lease, or rent.
OWNER'S SIGNATURE: _� _ ____ _ DATE- _
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: ct=�
LICENSE NO: «/q0- S 4f—
Call
Call 639-4175 by 7:00pm for an inspection the next business dray
AUG-17-99 TUE 03. 17 PM PHOENIX ELECTRIC CO FAX N0, 15036843611 P. 02/02
CITY OF TIGARD Electrical Permit Application Plan Check S
Date
cd
1312'5 SW HALT. BLVD ODBy d
este Re
TIGARD OR 97223 Date to P.E.
Phone(503)6394171, x304 Oete t0 OST �
inspection (503)639-4175 Print of Type Permit 3��!
Fax (503) 598-1960 Incomplete or illegible will not be accepted Called
1. Job Address: - 4, Complete Fee Schedule Below:
Name of Development __ Number of Ins wectloMer permit#Hawed
Name(or name of business 1� Service included. Items Cost Sum
Addressc4m. Residential-per unit
�) 1000 sq.It.or less $ 117.75 _ 4
city/State/ZiQ ���--___� --- Each additional 500 sqf►.or
portion thereof $ 26.25 __ 1
Commercial❑ Realdential Limited Energy Y 60.00
_ Each Manufd Home or Modular
Dwelling Service or Feeder S 72.76 2
2a. on�aCt rD �ns illation�nly: ------ -
(Prior to permit issuance,arpiicants must provide contractor license 4b.Services or Feeders
inlormatic-for COT to base). Inslailation,alteration,or rglor etinn
Fiectrical Conlraglor `� �,[ 200 amps or ass s 65.25 _ 2
-ZT 201 amps l0 500 amps � f 85,50 2
Addre4.s •st L) Q ' 401 amps to 600 amps S 126.60 2
Cly V_ S(tate Gl_ 11p 501 amps to 1000 amps $ 192.50 2
Phone -�lr. L� Over 1000 amps or volts ! 353.76 2
Job No. �� + Reconna.-t only S 53.60 _ _ 2
Elec.Cont,Lice.No. Exp.Data 4c.Temporary Services or Feeders
OR State GCB Req. No. Erp.Date Installation,alteration,or relocation
COT Business Tax or Metro No. ;KoXAj Exp.Dete 200 amps triose S 63.60 2
201 amps to 400 amps , t 60.26 2
401 amps to 500 amps __ S 107.00 2
Signature of Suf.r.I'�lec'n _. Over 600 amps to 1000 volts,
�-� C�$ -Exp.DatG eco b"above.
License 4d,Branch Circuits
Phone N.).�. , = ly. L Now,alteration or extension per panel
a)The fee for branch circuits
1b. For owner installations: with purchase of service or
Feeder fee.
Print Owner's Name _ Each branch drwit _ S 5.35 �� 2
- b)The fee for branch circurls
Address - __ --- without purchase of service
City-� _State _Lip or feeder fee.
Phone N0. First branch circuit - S 37,50
Each additional branch Circuit S 3,36
The installs tine i c b-nnq made on property I own which is not 40.Miscellaneous
intended for sa!p.IQ39e or rent. (Service erfeeder not Included)
Each pump or irrigation circle 3 42.75
Owner's Signatul4 Each sign or outline lighting S 42.75 ---
- - Signal circuit(%)at a limited enorgy
e panel,alteration or extension _ $ 60.00
3. Plan Review section (if required): Minor Labels 110) _ _$ 107.00
please check appropriate item and enter fee in section 69. 4f.Bach additional Inspection over
4 or mora residential units M one structure the allowable in any of the above
---..---• Per Inspection S 50.00
-t -.-Service ar d feeder 225 amps or more Per hour _ s 50.00
_-System over 1300 volts nominal In Plant S 50.00
Classified urea or structure containing special occupancy as `
J described in REC Chapter S S. Fees:
6a.Enter total of above fees S
Submit 2 sets of plane with application where any of the above apply. 5%Surcharge(.06 x total fees) i
Not required for temporary construction services. Subtotal $
5b,Enter 25%of line In for
NOTIf& Plan Reviewt).required(Sac.3) S
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AU rHORIZED Subtotal S
IS NOT COMMENCED 1.111THIN 180 DAYS,OR IF CONSTRUCTION OR �
WORK IS SUSPENDED On ABANDONED FOR A PERIOD OF 180 DAYS Trust Account N f
AT ANY TIME AFTER WORK IS COMMENCED. Total balance Due $ 7'b. d
i�dsIsllLrtnyleloclrieA�C
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639.4175 Business Line: 639.4171
/ BUF
Gate Requested S-5j --f�y ]q AM >� _PM
✓� � BLD
Location_ UCD`� I �.f�a � Suite C� MEC
Contact Person `� �. Ph LPLM
Contractor _—_ Ph SWR -
BUILDING Tenant/OwnerELC
Retaining Wall ELR
Footing Access: FPS
Foundation
Ftg Drain SON _
Crawl Drain inspection Notes:
Slab - SIT
Post&Beam
Ext Sheath/Shear I ----- -
Int Sheath/Shear
Framing - --
Insulation Q�� �`_ •'�/�_
Drywall Nailing _ -1 .�L - pa
Firewall -�
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -- - - — -�
Roof
Mise. _-
Final
PASS PART FAIL
PLUMBING _ (frF
Post&Beam
Under Slab _
Top Out
Water Seivice -
Sanitary Sewer
Rain Drains - -
Final
PASS PART FAIL -
CHANIC �
Pos eam — ---- - ---
Rough In _
Gas Line �.- - ---- — -- _---
Smoke Dampers
AS PART FAIL -
IL Seivice
Rough In
F- UG/Slab
U) Low Voltage
Fire Alarm
m S ART FAILLu
Backfill/Grading
Sanitary Sewer
StormDrain [ ]Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin i ]please call for reinspection RE: [ ]Unable to inspect-no access
Fire Supply Line
ADA `
Approach/Sidewalk Date Inspector Ext
Other _ ----'�---�--
Final
PASS PART FAIL 00 NOT REMOVE this ia.spe,t[on record from the job site.
CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT M MEC1999-00347
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 8/17/99
PARCEL: 1 S 135CC-01200
SITE ADDRESS: 10365 SW MEADOW ST
SUBDIVISION: THE MEADOW ZONING: R4.5
BLOCK: LOT:013 JURISDICTION: TIG
CLASS OF WORK: ALT �V FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
_ FUEL TYPES — 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTII 15-30 HP: S
LIMIT -
REPAIR :
FIRE DAMPERS?: 30-50 Fir': WOODUNITS
GAS PRESSURE: 50+ HP: CLO DRYERS:
FURN< 100K BTU: _AIR HANDLING UNITS OTHER UNITS:
FURN >=103K BTU: _ �=� cfm:- GAS OUTLETS:
> 10000 cfrn:
Remarks: Exterior A/C unit. Unit must not encroach within 5'side or rear yard setbacks.
Owner: FEES �-
OROTHEA SZYDLOWSKI Type By Date Amount Receipt
0365 SW MEADOW ST f'RMT GEO 8/17/99 $50.00 99-317717
IGARD, OR 97223 513CT GEO 8/17/99 $3.50 99-317717
Phone.503-639-6092 —_ — Total $53.50
Contractor:
p -TEMP HEATING +COOLING
6000 SE EVELYN ST
C LACKAMAS, OR 97015 REQUIRED INSPECTIONS
Misc. Inspection
Phone:650-5014 Final Inspection
Reg N:LIC 000718,'8
ELE 3-374CRE
L
n
ORIGINAL
J
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty
J 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 law requires you to follow rules adopted in the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-001-0010 through OF R 952-001-0080. ';'ou may obtain copies of these rules or
direct questions to OUNC by calling (503)246-9189.
Issue By: � '((_ � Permittee Signature.
Call(503)039-4175 by 7:00 P.M.for inspectloas needed the next business day
Plan Che
e- Jll� � limit-�� -.....w rt'l�Jilri����ln RIC�By
wvi t n i tidal and Residential Data ae�d I
-11LAA410, Chk 97223 Data to P.E.
(503) 639-4171, x304 unto to DST•.
Print or Type PemNt 0 -1
Incomplete or illegible a plications will not be accepted rallied --
Nart+s or Developmerw Fro)ed [?eaplpf16/1 � --�._.._
Table 1A MecharilL Code _ Prloe Amt
Job sheet A hs SOON A Permit Fes � - � 16.00
1) F"urtace to 100,000 STU
Address / 1y _Liu I)� i Including ducts a vents see fowmalts 1,2 6_05
Bldg* Citylstate ir zip 2) Furnace 100,000 BTU+
L inctudtny ducts 6 vsnb ase footnote 1,3 12.00
J- Narne(or nems or bceflnen/ 3) Floor Fumace
Owner li < 1c.. �UI t.0 k I including vent not footnote 1.2 _ 965
Mn"Afton .rr 4) SuKended heater,well heater
or floor mounted heater sae lbotnote 1,1 9.65
- A . 6 Vent not Included In1-Banca- rr* 4.75
csylatets zip errs Cheat ell that apply: - *11110111111,11, Hem
< r m
For Items 6-10,a" or Pianp Cond Qty Price Amt
Nar n ��nasties) IootnotM 11,2
Coin •
6)a3HP;sbsorb unit to
I
Occupant -Mainnq AAdre+s ,00K SM 9.65 9.105
_ - 7)3-15 H ;s or unit
100k to 6008 BTU 11.65
CnyrStete tip Phoma 9)15-30►+P'absorb
unit.5-1 mil BTU 24.15
Contractor Name 9130-50 HP;absorb
unit 1-1.75 mll BTU 1600
A _ , i 10)ySOHP,absorb unit
Prior to permit MaMa Addnse >1.75 mill BTU 00.15
Issuance,a copy E . J t 1 Ak heirWng untt to 10,000 CFM
of ap Ilcenses „ rata hmo 7,UO
are required It C� : „� 12.)Air handling until10,000 CFM+
expired in CUT Const.Cont eo Ue. Exp. ate 11.rS
database 13)Noo-poitsMis*vapor*%coolery
!�rchNect N•"• _ 7.00
14)Vent fan connected to* 1 t��
or Mainng Address _ 4.75
15)Ventilation system not Itchided In
sppllsnce_psmtK 7.00
Engineer cnWSW?* zip Phone 16)Hood served by machsnlcal exhaust
7.00
Describe work to be dome: 11)Oornestic Incinerators - 4
_ 12.00 _
New O Repair O Replace with hire kind Yes O No O t A)Corrmerr:lel or Industrial type Incinerator
Residentfaf Q Commerdat 0 _ 48.28
19)Repair units
AdniG ^*i inMnnetlnn or dee 8.40
criptinn of work:
20)Wood atowa/gse FP/otfwr unKaM,ofhe dryerrbte.
7.00
NOTE: For Cnmrrwdsl pro"only;Unlit over 400 be.require 21;Cine piping one to four outlets
structural pas Coca. Sea footnob 1 3.75
Type of fuel: oh O natural pas O LPO O e(Wrfc O 27More thin r outlet(each) � 75
10. Minitnum Permit"'N$0.00 8U�8T07r►L 0
I wr
hereby acknledge that 1 have read tMs sWpllcatlon,that the Inliormation -_ 7%SURCHAR
N given Is correct.that I am the owner or authorized agent of PLAN R USTO AL
the owner,that plans submitted are In compliance with Oregon State laws Required for ALL coannta►eid permits on
.OT
AL
i Slerrehtre of Owner/Agsnt Date
Other Inspectlom and Fates:
d <� 1. Inspection*or
trhslde of normal buM
shtaee une(rrrinlmern chmrpa•two
W C P ams orte hours) $50.00 per hour
J ` 2. Inspectlorm for which no foe Is"welfleelly Indicated (minlmunt
charge-haN hour) =00.00 per hour
3. Addlreqes
tlonal plan review requited by changes,addMeme or revislona to
Fconotes for cornmerefal projects only:
1. Provide full schematic of existing and proposed gas line and pressure plan(minimum sharps orn•haK how)=00.00 per four
2 Provide drawing%to scale showing existing and proposed mechanlral
units. 'Stall Cenhsetor Roller Certification required
_ - _ -Residential A/C requires of plan showing plecoment of unit
I tmeehperm doe rev 7119M9
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