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CERTIFICATE OF
C4TOCCUPANCY
OFTIGARD PERMIT 0. . . . . . . MS795-0241
COWW DEVELOPMENT DEPARTMENT DATE ISSUED: 01/26/96
ISM SW HO OW.T*wd.Omw OTM*4109 (5"82&4171
PARCELS 29104DC--08100
SITE ADDRE!:iS. . . r 1:3173 SW MORNINGSTAR DR
SUBDIVISION. . . . t MORNINGGTAR ZONINSiR--4. 5 PD
BLOCK. . . . . . . . . . I LOT. . . . . . . . . . . . . 1018
CLASS OF WORK. aNEW
TYPE:: OF UGF. . . t SF
OCCUPANCY GRP. t*600P
OCCUPANCY LOAD t 2
Remarkst PATH I
Owrterr _-----_-_-___----.._-----__..._-_----.. .� $
DWIGHT PETERSON
P 0 BOX 1488
WILSONVILLE OR 970'70
Phone #o 503-590-9207
Contract or t
R EDWARDS CONSTRUCTION CO.
6800 SW 105TH
BEP�'E:R"CON OR 97006
Phone Mt 643•-4350
Re!1 #. . t 55784
'this C:ertific,ate tlrNnts occupancy of the above refei,enced building or portion
thereof ;and confirms that the building has been inspected for compliance with
the State of dr•egon Specialty Codes for the group, occupancy, and use under^
which the ref re -ed permit was issued.
g(JILDING INSPECTOR BUILDING OFFICIAL J
a
e..
POST IN CONSP I'CUOUS PLACE: x ';
411 n a!
N:
3
0
Ll
a
D I TY OF T I G A R D ELECTRICAL HERMIT
PERMIT 0: ELC95-00249
DEVELOPMENT SERVICES DATE ISSUED: 8/29/95
13125 SW Hall blvd.,Tigard.OR 97223 (503)639-4171 PARCEL: 2S104DC-08100
SITE ADDRESS: 13173 SW MORNINGSTAR DR
SUBDIVISION: MORNINGSTAR ZONING: R-4.5
BLOCK: LOT: 018 JURISDICTION: TIG
Prolect Description: Residential 4,000 sq ft.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS MISCELLANEOUS _
1000 SF OR LESS: 49 0 - 200 amp: 0 PUMPlIRRIGATION: 0
EACH ADD'L 500SF: 6 201 - 400 amp: 0 SIGN/OUT LINE LTG: 0
LIMITED ENERGY: 0 401 - 600 amp: 0 SIGNAL/PANEL: 0
MANF HMI SVC/FI)R: 0 601+amps-1000 volts: 0 MINOR LABEL (10): 0
SERVICEWEEDER BRANCH CIRCUITS _ ADD'L INSPECTIONS
0 - 200 snip: 0 W/SERVICE OR FEEDER: PER INSPECTION: 0
201 - 400 amp: 0 let W/O SRVC OR FDR: 0 -R HOUR: 0
401 - 600 amp: 0 EA ADD'L BRNCH CIRC: 0 it, -:ANT: 0
601 - 1000 amp: 0 PLAN REVIEW SECTION _
1000+amp/volt: 0 >-4 RES UNITS: >600 VOLT NOMINAL:
Reconnect onl : 0 SVC/FDR>¢225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
METZGER ELECTRIC INC
8780 SW LEHMAN ST
TIGARD, OR 97223
Phone: Phone: 244-9025
Rey fit:
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRMT TMP 12/18/95 $260.00 95-269883 Elect'I Final
5PCT TMP 12/18/95 $13.00 95-269883
Total $273.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws.
L All work will be done in accordance with approved plans. This permit will wore if work is not started wknin 180 days of issuance,or Nwork is
C suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rubs adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-00 -0010 through OAR 952-001-0080. You may obtain copies of these rules ordirect questions to OUNC at(503)
0
246-1987.
3 PERMITTEE'S SIGNATURE 'f ISSUED BY:
0 ,
9 OWNER INSTALLATION ONLY
The installation is being made on propk- own which is not Intended for sale,lease,or rent.
OWNER'S SIGNATURE: _ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: _ DATE-
LICENSE NO:
Call 639-4175 by?:00pm for an Inspection the next business day
ELECTRICAL PERMIT-
CITY O F T I GARD --
RESTRICTED ENERGY
DEVELOPMENT SERVICES _RMIT 0: ELR95-00161
13129 SW Hall Blvd..Tigard.OR 97223 (5031639-4171 nATE ISSUED: 10/10/95
SITE ADDRESS: 13173 SW MORNINGSTAR DR PARCEL: 2S104DC-08100
SUBDIVISION: MORNINGSTAR ZONING: R-4.5
BLOCK: LOT: 018 JURISDICTION: TIG
Prolect Description:
A.RESIDENTIAL_ B.COMMERCIAL
AUDIO S STEREO: X AUDIO&STEREO: INTERCOM b PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE Al PQM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL 9 OF SYSTEM
Owner: Contractor:
H S I SECURITY SYSTEMS INC
3424 NE 35TH AVE
PORTLAND,OR 97212
Phone: Phone: 287-4604
Reg 0:
_ FEES Required Inspections;
_Type By Date Amount Receipt Elec"1 Final
PRMT TMP 12/29/95 $40.00 95-271462
5PCT TMP 12/29/95 $2.00 95-271462
Total $42.00
---------------
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 law
requires you to follow rules adopted by the Oregon 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 or direct questions to OUNC at(503)
246-1987. l
Issued by �I L,,,t Permittee Signature
j 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;
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:_
LICENSE NO:
Call 6394175 by 7:00 P.M.for an Inspection needed the next business day
PLUMBING PERMIT
-C17Y OF TIGARD DATE PERMIT ISSUED:�06/15/955-0241
6/15/953-0241
COMMUNITY DEVELOPMENT DEPARTMENT
13125 BW Nob Blvd.Tga►d,Oregon 97223.6199 (503)6 4171 PARCEL: c S 104DC—08100
SITES' ADDRC.S:3. . . : 1317:7 SW MORNINGSTAR DR
SUBDIVISION. . . . : MORNINGSTAR ZONING: R-4. 5 PD
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . ..018
CLASS OF WORE:. . :NEW GARBAGE DISPOSALS. . : l
TYPE OF USE. . . . :SF WASHING MACH. . . . . . . 31 BACKFLOW PREVNTRS. . : 1
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . . CO TRAPS. . . . . . . . . . . . . . :0
STORIES. . . . . . . . :2 WATER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . :0
FIXTURES --- -- - ------ LAUNDRY TRAYS. . . , . : 1 SF RAIN DRAINS. . . . . : 1
SINKS. . . . . . . . . . : 1 GREASE TRAPS. . . . . . . :0
LAVATOR I ES. . . . . :4 OTHER FIXTURES. . . . . :qj
TUB/SHOWERS. . . . : SEWER LINE (ft) . . . . :0
WATER CLOSETS. . :3 WATER LINE= (ft ) . . . . : 100
DISHWASHERS. . . . : 1 RAIN DRAIN (ft ) . . . . :0
Remarks : PATH I
OWNER: -- -------------------------- ------_---------__
DWIGHT PETERSON TIF $ 1550. 00 JD 06/15/95 95--266810
P 0 BOX 1428 SWM f 180. 00 JD 06/13/95 95-2266810
SWM $ 100. 00 JD 06/15/95 93-266810
WILSONVILLE OR 97070 BPRT $ 698. 00 JD 06/15/95 95-266810
Phone #: 503--590--9207 BPLC $ 433. 70 SW 06/08/95 95--26652.2
B5PC f 34. 90 JD 06/15/95 95-:2.66810
f='lambing Contractor:-_-_----_._-__-_ PARK f 500. 00 JD 06/15/95 95-266810
MPRT $ 45. 00 JD 06/15/95 95-266810
Name :_ MPLC t 11. 25 JD 06/15/93 95 -266810
Addr-•e s s :_ _ �_. M5PC $ 2. 25 JD 06/15/95 95-6:66810
City: Prinv3LAestate : 30TH $ 225. 00 JD 06/15/95 95 -266810
Zip:_ , Phone#: P5PC 6 11. 25 JD 06/15/95 95-266810
Reg #: � C�0,1_tit_ -'1PQ Additional fees not shown here. . . . . . . . .
---- --- REOU I RED INSPECTIONS
--- - -This permit is issued subject ti ;he reg-
ulations contained in the Tigard Municipal Footing Insp Insulation Insp
Code, State of Ore. Specialty Codes and all Foundation Insp Gyp Board Insp
other applicable laws. All work will be done Post/Beam Struct Rain drain Insp
in accordance with approved plans. This Past/team Mechan Water Line Insp
,permit will expire if work is not started Crawl Drain Water Service In
within 180 days of issuance, or ifwork is Plm/,andslab Insp Appr-/Sdwlk Insp
=-,uspended for more than 1817, days. PLM/Underfloor Mechanical Final
Mechanical Insp Plumb Final
Plumb Top Out Building Final
framing Insp Erosion Control
Fireplace Insp
Gas Line Insp
authorized Plumbing Contractor Signature
Call for inspection - 639-4175
Contractor Notes :
MASTER PERMITM
PERMIT #. . . . . .. .. a ST95--0241
'COMMUNITY DEVELOPMENT DEPARTMENT TE ISSUED: 06/15/95
17126 SYN Hall Blvd.Tigard,OrsW 9722n•6190 (603)639.41?1
PARCEL: 2S 1O4DC--O81OO
SITE ADDRESS. . . : 13173 SW MORNINGSTAR DR
SUBDIVISION. . . . : MORNINGSTAR ZONINGS R-4. 5 PD
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :O18
------------------- ----------------- BUILDING
REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . :O Sf
CLASS OF WORK. :NEW BEDRMS:3 BATHSt3 GARAGE. . . . . . . . . . t465 sf
TYPE OF USE. . . ;SF FLOOR AREAS-- - ---- - - - REQUIRED
TYPE
---
TYPE OF CONST. :SN FIRST. . . . : 1581 sf L.EFT. . : 1O ft RIGHT. :20 ft
OCCUPANCY GRP. :R 3 SECOND. . . : 1476 s f FRONT, i 2 O ft REAR. . :35 ft
STORIES. . . . . . . ..2' FINBSMENT:O 5f REQUIRED---------------------
HEIGHT. . . . . . . . .
-------------•------
HEIGHT. . . . . . . . :28 ft TOTAL-------:3057 s f SMOKE DETECTORS. :Y
FLOOR LOAD. . . . :4O psf VALUE. . . . . 2O5232 PARKING SPACES. . : 1
Remarks : PATH I
-------------------------------------- PLUMBING -._--_--.-__----_____-___---.-_-_------
STNKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . : 1
LAVATORIES. . . . . :4 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUB/SF1OWERS. . . . :3 LAUNDRY TRAYS. . . : 1 CATCH BASINS. . . . . . . :0
WATER CLOG!ETS. . t3 SEWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . :0
DISHWASHERS. . . . : 1 WPTER LINE (ft ) . : 100 OTHER FIXTURES. . . . . :0
GARBAGE DISP. . . il RAIN DRAIN (ft ) . :0
WASHING MACH. . . : 1. SF RAIN DRAINS. . : 1
MECHANICAL - -__- _-_-_--.-_._______._____-.__.____ FEES
FUEL TYPES------------- UNIT HTRS. . cO type amount by date recpt
/GAS/ / / VENTS . . . . . :0 TIF t 1550. 00 JD 06/15/95 95--266810
MAX INPUT:O BTU VENT FANS. . -4 SWM t 180. 00 JD 06/15/95 95--a6681O
TURN < 1O0K . . :0 HOODS. . . . . . : 1 SWM ! 100. 00 JD 06/15/95 95-266810
FURN ) - 1O0K . . : 1 WOODSTOVES. :O SPRT f 698. 00 JD 06/15/95 95-266810
FLOOR FURN. . . . :0 CLO DRYERS. : 1 BPLC f 453. 70 SW 06/06/95 95-266522
BOIL/CMR ( 3HP:0 OTHER UNITS: 1 B5PC f 34. 90 JD 06/15/95 95--266810
GAC OUTLETS: 1 PARK $ 500- 00 JD 06/15/95 95--266810
Owner: - - -._-_.__.__________________.._-___._..__.MPRT i 45. 00 JD 06/15/95 95-266810
DWIGHT PETERSON MPLC f 11. 25 JD 06/15/95 95-266810
P 0 BOX 14E8 M5PC $ ?. 25 JD 06/15/95 95--266811
3BTH ! 225. 00 JD 06/15/95 95-266810
WIL50NVILLE OR 97070 PSPC $ 11. 25 JD 06/15/91 95--266810
Phone #: 503-590"9207 EROS $ 88. O0 JD 06/15/95 95--266810
Contractor.: _.—_--_.----_—_---_____.—_--__--_-_ERPC E �' l. 60 JD 06/15/95 95-266810
R EDWARDS CONSTRUCTION CO. ERPC It 243. 6O JD 06/15/95 95--266810
61300 SW 1O5TIl
g. BE'AVERTON OR 97008
Phone #: 643-4350
U) Reg #. . : 55784
Y -__s--3956. 55 TOTAL ----- --
5 This permit is issued subject to the regulations contained in the — REQUIRED INSPECTIONS —
Tigard Municipal Code, State of Ore. Specialty Codes and all other Footing Insp Plumb Top Out
applicable laws. All Mork will be done in accordance with approved Foundation Insp Frr.m i ng Insp
plans. This permit will expire if work is not started within 188 Post/Beam Str-uct Fireplace Insp
days of issuance, or if work is suspended for more than 188 days. Post/Beam Meehan Gas Line Insp
Crawl Drain Insulation Inco
F.lei-mitt: ee !nature- _ Pilin/undslab Insp Gyp Board Insp
' PLM/Under•fIoo►- Rain drain Insp
Issued e Mechanical Insp Water Line Insp
Call for inspection - 639--4175
—r� SEWER CONNECTION
•`G11Y oF TIGARD PERMIT
PERMIT M, , . . . . . s sWR95-0237
COMMUNITY DEVELOPMENT dLfNT DATE I SSUED s 06/15/95
MH aW H&N 9wd.Tiowd,arao" 97W*11109 ON)6784171 PARCEL t 2S 104DC-08100
CITE: ADDRF_SS. . . : 13173 SW MORNINGSTAR DR ZONING: R-4. 5 PD
SUBDIVISION. . . . : MORNING[,TAR
L;LOCK . _. ' --- ----------------..__` s 018
__—___-- ------_.__________-------- ._—_—__
TENANT NAME. . . . . a
USA NO. . . . . . . . . . : FIXTURE UNITS. . . a
CLASS Of . . . . . . :NEW DWELLING UN I TS. . s 1
NA. OF F�UILUING5a1
TYPE OF USE. . . . . sSF
INSTALL TYPE. . . . sBUSWR IMPERV BURFACE. . e ssf
Remarkss PATH I
Owner: -------------------------------------------------------
FEES -----_---------.
DWIGHT PETERSON type amount by date recpt
P 0 PDX 14'9 PRMT f 2200. 00 JD 06/15/45 95-266810
INSP $ 35. 00 JD 06/15/95 95-266810
WILSONVILLE OR 97070
Rhone #a 503--590-9207
Contractors
CONTRACTOR NOT ON FILE
------------------------------------
Phone #: # 2235. 00 TOTAL
Reg #— i
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 198 days from _the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guar;,ntee the accuracy of the
side sewer laterals. if the stover is not lacatvd at the measurement
given, the installer shall prospect 3 feet in all directions from -
tke distance given. If not so located, the installer shall purchase —
a "Tap and Side Sewer' Permit and the Agency will install a lateral.
s
C—
I ss1_ied _-
- J
Call for inspection — 639-4175
Rr
/ALO
�h
Residential SM11dina Permit Aoalication
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(593) 639-4171
Jobslte Address: '•� Sw (V�ww c�»�e. �l'►►w
/Subdivision: Mocww ,cYrM. 2 Lot* L is QMN Use Only
r Contact Date I I Initials
Valuation: Result
PlancklRec*�g.JE1 t _
New Construction Only: (Square Footage) PermR# M►�tf�d.]T�
House: 'bosl Garage: _6! Reissue of
Map 3 TL* 7 S)) — IQQ
Zone
Cojner Lot? Y Flag Lot? Y � P* - 44 1t
Owner �w►(.w� �P err ins,ems _
Planning Setbacks v v Solar
Address: V60 x 142 d Engineering
W t-s c.,v.,i,w C,* W , "1'Z taZ 0 Other
Phone: ( I. ,�) S90-y4.c1 KM
Contractor: Subcontractors
Truss Detaits
Address: 'S!o'1 fS Nw 1�3"=' `(�� Other -
Pone: yL p ) _�¢4 3-:5 'S 5.0
Contractor's License
fattarh copy of current Oregon license)
Contact Name:
Contact Phone: L (o-S- S917—
Subcontractors: Aruhltect/Engineer.
OC
H
rn ""Plumbing: CAN AA`f ��+ _�^��-_- Address:
✓Mechanical: - 'amu -�'c w�-• _�- u:..a,n�w.a� cam. 9?tZ-'3
�f (attach copy of current OR Contractor's License)
t9 Phone: ( So3) &40 - 6 no&
W T
J
JOB DESCRIPTION:
Applic nt Signature Applicant Phone number
Received by: Date Received: (0 8-1:1
M11oomieYNp
Permit d Account Description Amount Amt. Pd. Bal. Dw,
Bldg. Permit (Buil.D) °of
Plumb. Permit (PLUk4B)
Mach. Permit (MECH)
State Tax (TAX) G/!l• c '' /
Bldg: 3e- a /
Plumb: yifc.s,
Mecfo:," f
Plan Check (PLANCK)
Bldg: U �
Plumb:
Mach: �f ► /
,5c'k ff-v a 3) Sewer Connection (SWUSA) _
Sewer Inspection (SWINSP) 3
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit SIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-I)
Institutional TIF (TIF-IS) -
Office TIF (TIF-0)CL
Water Quality (WOU ) ,
Water Ouantity ( UANT)
m
Fire Life Safety (FLS) �-
w Erosion Cnt ormit (ERPRMT)
J
Eroslo Ianck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS:
Solar Balance Worksheet
Address, 12 13 ty rinrnQ114n-A—
Box A calculations : North-South dimension for the lot. Box A:
This dimension is determined by finding the midpoint of the
North lot line and drawing an intersecting line perpendicular
to that point. . Measure the distance from the midpoint of the
Horth lot line to the South lot line along the described line.
Ig � ft
Box B calculations : Shade point height from your structure. Box B:
1 . Determine whether measureme«ts will be based on the peak
or eave of your structure . The orientation of the ridge
is also important . Which
la: If the roof line runs North-South, measurements will bit describes
based on the peak of the roof . your lot?
ib: If the roof line runs East-West and the roof pitch is less (Circle one)
than 5/12, measurements will be based on the eave. CC lc: If the roof line runs East-West and the roof pitch is 5/12 la lb
or steeper, measurements will be based on the peak.
2 . Measure change in elevation from front property line to
finished floor elevation. q.5ft
3 . Measure distance from finished floor elevation to the
affected peak/eave . Z
_ ft
4 . If the roof line runs North-South, deduct three feet .
If the roof line runs East-West, deduct nothing.
- - ft
5 . Subtract one foot for each foot of difference in elevation
from the front property line to the rear property line, if
the lot slopes up from the front to the rear. If the lot
has no slope or slopes up from the rear to the front, ft
deduct nothing.
Massa:ase
6 . Total figure for box B:
ft
Box C. Distance to the shade reduction line. Box C:
0.
a 1 . Measure the distance from the North property line to the
foundation. _ / 9 ft
�j 2 . Measure the distance from the foundation to the affected + j ft
peak or eave .
t7
MszMssmasaz
3 . Total figure for box C:
ft
H!\LOGIN\DSTS\SOLARCR
Y
Solar Balance Point Standard
fox A. North-sou
t
h
dimansion for your lot fox 8. Sr height E your structure
I 1 a feetENID
fox C. Distance to the shade reduction amine
9=1 ) Fast
Distance to
shade 00+ 95 90 85 80 75 70 65 60 SS SO 43 40
reduction line
from northern
lot line in feet
70 40 40 40 41 42 43 44
65 38 38 38 39 40 41 41 43
60 36 36 36 37 38 39 40 41 42
55 34 34 34 3S 36 37 38 39 40 41
so 41__
45 30 30 30 31 31 31 34 35 36 37 38 39 40
40 28 28 28 29 30 J 32 33 34 3S 36 37 38
35 26 26 26 27 28 29 30 31 32 33 34 35 36
30 24 24 24 25 26 21 28 29 30 31 32 33 34
25 22 22 22 23 24 2S 26 27 28 29 30 31 32
20 20 20 20 21 22 23 24 25 26 27 28 29 30
15 18 18 18 19 20 21 22 23 24 2S 26 27 28
10 16 16 16 17 18 19 20 21 22 23 24 2S 26
5 14 14 14 15 16 17 18 19 20 21 22 23 24
L Box "D" Maximum allowed shade point height 2 feet
2
login\v1o1•\solaRbal
s
a
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec #
Permit #t t-'i..C.95 - bz q
Phone (503) 639-4171 Date Issued S
FAX (503) 684-7297 Issued b
CITY OF TIOARD TDD No. (503) 684-2772 y
Impection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below.-
Name
elow:Name of Development Lill 6 H�1%A3 S_(4 t— Number of Inepecdons per permit dlewsd
Address 1 7� 1"1 f)r, service hwktded: Items Gat") sum
city/state/zip -Tt.Qa rA . b r- k Reedal-per anti
10041 w n.or less 1_ $110,00 00.00
Name (or name of business).a C 1 =�rrss►. MWW 5W'4 " or11W 11".00
Commercial❑ Residential 1MnNid FMW 06.00
Earn Marad'd Homo or Modular :
Dao&q SoMm or Fiodar "6.00
2s. Contractor Installation only: 4b.s.rvion or Feelere
Irrtdlalbn,aMaratbn,or robatbn 2
Electrical Contractor ,.c 200 amps or ion $10.00
Address tot amps to 4410 amps 00.00 2
Ci "t i,as r State r Zi b1 o'"P'to°00 ampo $120.00 2
city .� 3z_ P 1411 r"Ps w loco amp. $110.00 — 2
Phone No:-' y - -70 a tsar 1000 anpo or votes 1110.00 '- 2
Contractor's License No. 3 4 Raconnad nr4 NO=
Contractor's
---
Contractor's Board Reg. No.. C_ 4 $o.Temporary Be@vloss or Feeders
IntaNelion,aMorMlon,or reloeak n 2
Signature of Supr. Elec'n 200 r"Ps or loos $141.00 2
License No. 3 l 5 Phone No a uu _ 201 iipip"10 400 irnp" 41n.00 2
401 amto 100 Wnpa $100.00
Oro,100 amp to 1000 volts
2b. For owner Installations: "o W obar�.
Print Owner's Name Nor Branch
Mer0ionCircuits
oftneion pot pond
Address a)Tho las 1a brand+drones aiMt
City State Zip Eadr banchaakor easier vow 2
1z 30
Phone No. b)The he for hr.naf,arouft aWe-,!
The installation is being made on property I own which is Fpurvf�of ns brand, exWnircull w hodar ba.
not intended for sale, lease Of rent. 1135.00
Each add,tlorul to-nd,dm* $100
Owner's Signature 44L filiiecallaneous
(service or liseder not included) 2
3. Plan Review section (lit required): Each purM or I"Io""0n c*da -- sHo 00 2
Each sic"or outna Ifo" W.00
BOW dreW(a)or a Wed*now 2
Plates check appropriate Item end enter tee In section so. panel,ausranon or edension
4 or more residential units In one structure Miner LW*b(10) $100.00
L Service and feeder 225 amps or more 41.Each additional fropectJon over
-System over 8,00 volts nominal
C ng I paw, the allowable In any of the above
Cla,,silied ens or structure containing occupancy
0 ss described in N.E.C.Chapter 5 Per I"p"so" 1131.0o
Por haw 111100
3 submit 2 sets of plana with application where any of the above In PMnt $16.00
apply. Not required for temporary construction ssMoee. 5 Fees:
sEnter total of above hes s S,pts
a
u NOTICE 5%Surcharge(.OS X Wall hes) $ S
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 1111d" l :
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF sb.Enter 25%of lira A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan RevlR"'if requki d(Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS subtotal :
COMMENCED. ❑ Trust Account# $
Balance Duo
r' CITY OF TIOARD sWLIDOG INSPECTION NOTICA
inspection Line (Rec-O-Phone):839-4175 Business Phone: 8394171
r
Inspectbf/.
Footing Susp. iling Spink. Rough-in Appr/SdwIk
Foundation P . Underslab Mach. Rough-in Fireplace
oat/Beam Stru Plbg. Top Out Elec. Rough-in
Post/Beam Mach. San. Sewer Gas Linel
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Underfir. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: , Time: AM � PM
L,
Address:
Builder: Permit A:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ' / ? Z"
t
m(A
k " TV
IL
Inspector: Date:O&kt Zb ti I
ROVED -_DISAPPROVED APPROVED SUBJECT TO ABOVE
�� _Call For Reinap.