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12980 SW MORNINGSTAR DRIVE Ha ad1SONINaOA MS 08626 a ce Q cn 0 Z Z cr 0 3 cn ID co N r 12980 SW MORNINGSTAR DR WASHINGTON COUNTYRESTRICTED Depertmr+nt of Land Use se&Transportation 155NElectrlcallnsstAvenSection ELECTRICAL ENERGY 155 Naf:h First Avenue,Ai350-12 Hillsboro, Oregon 97124 APPLICATION Information: (503)503)640.3470 Fax: (503)693-4412 PLEA S�E PRINT Piense cAplete . . . Permit No. 1. Location of Installation Date C) 1-3_ 7 Address- l 2-ti qo _.5-z kUr_�%' _� �r . City- T`.G' _ Zip CodeJ.__ 4. TyF of work: Map No. ;Z 5101PD AT Tax Lot 60 _ RESIDENTIAL Restricted Energy Fee $40,00 Thomas Map Book: Page _ Section (for all systems) Check type of work involved: Directions _ Audio and Stereo Systems" CommerciLl ❑ Residential ® Burglar Alarm Telephone Systems' Tenant Name r Garage Door Opener* (if cor il) _-_— — - Fire Alarm Heating,Ventilation and Au Conditioning Systems" 2. Cc ,ractor application: Vacuum Systoms• Other Electrical Contractor_—____�� _________._ Address _ COMMERCIAL Fee for each system $40,00 City_ ----- State._ Zip _-- (see OAR o16-260-260) Date Job Number _ Check type of work involved: Property Owner Contractor's License No. Contractor's Board Reg. No. Boiler Controls Clack Systems Phone NO. - Data Telecommunications Installations Fre Alarm Installation 3. Owner application: HVAC Q�pv��yyyq �_ 1 $SInstrumentation Print Owner's Name hotie No, Intercurn and Paging System is is _toQ ��u�lb� �, *-74 Landscape Irrigation Control* dre /� 7 ,, Medical oY&4 _—At, __ Z��1 Nurse Calls city Stats Zip w Outdoor Landscepu Lighting* This permit Is Issued under OAR 918-320-370. The applicant agrees Protective Signaling to make only restricted energy Installations(foo volt amps or less) Other under this permit and to do the following. — --- -- t. Only use electrical licensed persons to do Inrtallat.ons where 4. required. (Certain residential and other transactions are exe,npt Number of Systems from licensing. These have asterisks("). All others need Ilcens- F- ing.) N Z. Call for an Inspection when all the Installations under:his permit 'No licenses are required. Licenses aro tr wed fore!;other installations. are ready for Inspection. 3 Purchase separate permits fnr all Installations the',are nat ready 5. Fees for inspection when the inspector Is out to Inspect under this 6—/0. d permit. Enter fees $ m 4. Assume responsibility for assuming that all corrections required by the Inspector are done,and (r�� W 5. Assume responsibility fvr calling for a final Inspection when all of 5% Surcharge (.05 X total above) $ J the corrections are completed. The person signing this permit must be the applicant or a person Trust Account $ authorized to bind the applicagt. Signature — — —l�—/�---- �--_- ------- Tota) $ Authority if other than applicant This permit becomes null and void if the work authorized by the permit is not commenced within 190 days from date of Issuance For inspections call of such permit or If the work authorized Is suspended or abandoned 640-3561 or 693-4415 at any•Ime after work Is commenced for a period of t so days. Electrical Permits are non-refundable and non-trensferable. 24-hour recorder, one working day In advance of reed BL24 1 t 4 SEWER CONNECTION CITY OF TIGARD PERMIT PERMIT #. . . . . . . s SWR95-0207 COMMUNITY DEVELOPMENT IJ1}NT DATE ISSUED: 0b/13/95 13116 8W Hall SNd.Tigard.Oregon 972230109 (ON)0.14.4171 PARCELS 2S104DD-004"3e SITE: ADDRESS. . . : 12980 514 MORN I NGSTAR DR SUBDIVISION. . . . : MOUNTAIN HIGHLANDS 7.ONINGs R-4. 5 PD BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . ..003 ------------------------------------------------------------------------------------- TENANT NAME. . . . . : USA NO. . . . . . . . . . : F I X TUP.E UNITS. . . s CLA`;S OF WORN,. . . :NEW DWELLING UNITS— el TYPE OF USE. . . . . :SF NO. OF' BUILDINGS21 INSTALL TYPE. . . . :BUSWR IMPERV SURFACE. . : : sf Remarkss PATH I Owner: ______.___.___._.____._._.__._______._____._____._________..____.— FEES __-- PHONEGAVANH MANYRATH/USSAH type amount by date recpt 15864 NW WEST UNION RD PING PRMT $ 2200. 00 JD 06/13/95 95-266683 APT # 76 INSP 11 35. 00 JD 06/13/95 95-266683 PORTLAND OR 97229 Phone #: 690--4058 Cont Tact or: —___--_____.____.___------------ CONTRACTOR NOT ON FILE Phone #: >ti 2235. 00 TOT4L Rey #. . : -------- REQUIRED INSPECTIONS -------- This Applicant agrees to comply with all the rules and regulations Sewer Inspection of the Unified Sewage Agency. The permit expires IN days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement _ given, the installer shall prospect 3 feet in all directions from the distanc, given. If not so located, the installer shall purchase a "Tap and Sias Sewer" Permit and the Agency will install a lateral. Permittee S: gnature : IL Call for inspection - 639-4175 F- N m w 3 1 Hca. � ooh ,2� S Residential ljuetding Permit A-VR cation Sl City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 (593) 639-4171 Jobslte Address: 12i S O 50.) N1vv lkk-Al�r �r• s's'ssao T � Office use Q� Subdivision: Mow�k��.\ N�a�lav ,� of Valuation: - 12 �s 07 MCI` Contact Date Initials / / Result Planck/Rec * New Construction Only: (Square Footage) Permit# &j s/t2- o 01 /!9_ House: ;&ja Gorage: _ Reissue of_ -t. * talk= Map &TL* Z- 5 1070 P - i. ,Z Zone Corner Lot? (Y) N Flag Lot? Y N Plat*-0 Z � . Owner: k/ AisskAuorovals Required Planning Setbacks --Solar✓©1� Address: t S� ti' 6`} � V41iu►� Engineering `7 4 r 10. 0�- 17 Other r_ Items Reaulred Phone: qcnx __ ��i Subcontractors *V Contractor: U►"1 Truss Details Address: � � Other �� x') Notes Phone: j 4503 405A Contractor's License * (attar copy o,current Oregon license)\ Contact Name: _ & Qg 0'0y'�. 4t- ) Contact Phone: L riO3 L bzb 5 Zq _ CL Subcontractors: Architect/Engineer: . iAfnfayJ _ e-%14 H rn Plumbing: Address: -� Mechanical: m (attach copy of current OR Contractor's License) � Phone: L 1 J JOB DESCRIPTION: � di r. e,- too V4 Applicant Signa iare Applicant Phone number Received by: �,�_ Date Received: M:14y1MMVwy� Permit * Account Description Amount Amt. Pd. Btal- out /Y13f�rJ O / Bldg. Permit _...� g (BUILD) Plumb. Permit (PLUMB) Mech. Permit (MECH) �- State Tax (TAX) Bldg: Plum; Mach: A -L I Plan Check LANCK) Bldg: 2 ? Zov Plumb: Mech: //• 2 N 0.20 Sewer Connection (SWUSA) W Sewer Inspection (SWINSP) Parks Dev Charge (PKSDC) -5vel Residential TIF (TIF-R) Mass Transit TIF (TIF-MT) Commercial TIF (TIF-C) Industrial TIF (TIF-1) Institutlona! i IF (TIF-IS) Office TIF (TIF-0) a Water Quality (WQUAL) /�!i ✓ N Water Quantity (WOUANT) Ud / ar i✓ LFire Life Safety (FLS) m Erosion Cntrl Permit (ERPRMT) �v s/ r (� --✓ W I . Erosion Planck/USA (ERPLAN) 1.ILLo": Erosion Planck/COT (EROSN) r TOTALS: Permit#: MST Q 5' 0.011 Address: _ 59(alf AW 1U * 7� Por1'la� , 72.ZX� Issued by: Date: Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 70.1.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for resident al building, electrical, mechanical, and plumbing permits. Licensed architcct and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure. (� 2. 1 understand that I must register as a constriction contractor if the structure is sold or offered for sale before or upon completion. U 3A. My general contractor is _— U (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR i 3B. I will be my own general contractor. a p� If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors N Beard. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the .� name of the contractor. m W I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. VT q,4 V (Signature of permit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) information Notice to Property Owners About Construction Responsibilities Note, this I►1l0rr►nation Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5). if you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure,you will,in most instances,be ruled to be an employer and the people you hire will be employees. As the employer,you must comply with the following: Oregon's withholding tax law: As an employer,y:ou must withhold income taxes from employee wages at the Jme employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information,call the Oregon Dept.of Revenue at 945-8091. Unemployment insurance tax: As an employer,you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information,call the Oregon Employment Division at the Department of Human Resources at 378-3524. Workers'compensation insurance: As an employer,you are subject to the Oregon Workers'Compensation Law,and must obtain workers'compensation insurance for your employees. If you fail to obtain workers'compensation insurance,you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers'Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S.Internal Revenue Service: As an employer,you must withhold federal income tax from employees'wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information,call the Internal Revenue Service at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project,you are responsible for resolving any failure to meet code requirements chat may he brought to your attention through inspections. a Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools,paint overspray,water damage from pipe punctures,fire,or work that must be to re-done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. m WExpertise: Make sure you have the expertise to act as your own general contractor,to coordinate the work of rough-in and finish J trades,and - otify building officials at the appropriate times so they can perform the required inspections. If you have L anal questions,write or call the Construction Contractors Board(PO Box 14140,Salem,OR 97309-5052, 5031378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem. prop-own.pm4 1/94 Community Development ELFCTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. Tigard, OR 97223 Planck/Rec. #_ Permit # Phone (503) 639-4171 Date ISSu d =' FAX (503) 684-7297 Issued by CITY OF TIOARD ^ TDD No. (503) 684-277, Inspection (503) 639-4175 i 1. Job Address: p 4. Complete Fee Schedule Below: Name of Development_ Number of Inspecidone per permit allowed Address bf►11y�5�b,✓ �r- Service included: Items Cost(aa) Sum City/StatelZip ti4 n 4a. Residential-per unit 4 T—� 1000 eq It or less 1111000 Name (or name of business)--- Each addtronel 500 aq n or �— portion thereof 82500 Commercial❑ Residentia!© Limited Energy $2500 _ Each Msnurd Home or Modular 2 owe"Service or Feeder IN 00 2a. Contractor Installation only: 4b.Services or Feeder Inslallation,allerdion or rekestion2 00 Electrical Contractor_ 2amps or lees $e0 00 2 Address 201 amp@ to 400 amps $e0 00 _ 2 401amps 10 000 amps $1x000 2 e City StatZip 001 amps to 1000 amp Illwoo 2 Phone No. Over 100n amp or volts $34000 � 2 Contractor's License No. Revonned only VA o0 Contractor's Board Reg. No. _ 4c.Temporary Services or Fssde►e Installation,alteration,or relocation 2 Signature of Supr. Elec'n 200 amp or Was $6000 2 License No. Phone No. 201 amp to 400 amp $7500 2 401 amp to 000 amp $10000 Over 000 amp to 1000 volts -- 2b. For owner installations: see`b•above 4d.Branch Circuits Print Owner's Name jLo he 4,(1da h ✓�\ New,alteration or extension per panel Address uJ \tY\ 1} 7 1, a)The tee for Manch circuits w1M City r tate Zip j 1C p'�"a@a Msow ke or beater be. 2 Eadi Manch drain _ Sri 00 Phone No. 1 612-— b)The fee for branch nrw%ts wlNtrwf The installation is being made on property I own which is Putin..s,o►*Wyke or lr+dw be. 2 not intended for s le lease or rent. Feel brant:"drat $9500 2 I" f, Each ar)tltioretl branch drwB u•Qy Owner's Signature X11 t 4e.Miscellaneous (Service or feeder not included) 2 3. Plan Review section (l/required): Each pump or irrigation circle $4000 2 Each sign or outline lighting $4000 Signal circult(s)or a limited energy 2 Please check appropriate Item and enter fee In section SB. panel,snare ien or extension $40.00 4 or more residbntial units in one structure Minor I_shole(10) $10000 d Service and feeder 225 amps or more System over 600 volts nominal 41.Each additional inspection over N �_Classified area or structure containing spacial occupancy the allowable In any of the above AS described in N.E.C. Chapter 5 Per Per hour hour inspection $95 00 _ $95 00 J Submit 2 sets of plans with application where any of the above In Plant 26500 m apply. Not required for temporary construction servioes. 5, Fees: So. Enter total of above fees $ NOTICE 5%Surcharge(.05 X total fees) $ ry ) PERMITS BECOME VOID IF WORK OR CONSTRUCTION subtotal S AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Sb. Enter 25%of line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sec 3) $ _ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS subtotal $ COMMENCED. 11 Tnlst Acr otint 4 $ Balance Duo $ d� . ..n,N.rr IVP /-