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8720 SW MAPLE COURT pnoo oldew MS AZL9 t 0 U CD a a m oc g cn N r c m 8720 SW MAPLE CT 00 i u r i O F3 CIO 1 O a o , O L b V •� M o m c c � O U IJ � FROM- : OWENWEST ELECTRIC FAX NO. : 503297637.1 Dec. 15 2000 09:49AM P1 CITY OF TIGARD ' 13125 S.W. HALL BLVD. UUU TIGARD, OR 97223 IMPORTANT PERMIT NOTICE OWEN WEST ELECTRIC 8310 NW REED DR PORTLAND, OR 97229 Electrical Signature Form Perrnit#: MST2000-00475 Date Issuea, 12/13/00 Parcel: 1,6119AA-MRF16 - Site Address: 08720 SW MAPLE CT Subdivision: MAPLE RIDGE ESTATES Block: Lot: 016 Jurisdiction: TIG Zoning: R-12 I Remarks: S/F-A PATH 1 Your company has been indicated as the electrical 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 r d return this Electrical Signature Form prior to the start of the work to the address above,ATTN: Building rept. No electrical Inspections .will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: WINDWOOD HOMES, INC. OWEN WEST ELECTRIC 12666 SW NORTH DAKOTA 8310 NW REED DR TIGARD, OR 97223 PORTLAND, OR 97229 Phone#: 803-625-6526 Phone #: 297.6315 Req #: Lw 00029492 SUP 28633 CA. !LE 28-3880 AN INK SIGNATURE IS REQUIRED ON THIS FORM m , W XA-49--n—Irf-A -r Signature of Supervising Electrician If you have any questions, please call (503)639-4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE JIM'S PLUMBING PO BOX 7160 ALOHA, OR 97007 Plumbing Signature Form Permit #: MST2000-00475 Date Issued: 12/13/00 Parcel: 1 S135AA-MRE16 Site Address: 08720 SW MAPLE CT Subdivision: MAPLE RIDGE ESTATES Block: Lot: 016 Jurisdiction: TIG Zoning: R-12 Remarks: SIF-A PATH 1 Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: WINDWOOD HOMES, INC. JIM'S PLUMBING 12655 SW NORTH DAKOTA PO BOX 7160 TIGARD, OR 97223 ALOHA, OR 97007 Phone #: 503-625-6526 Phone #: 649-4034 a. o�c Reg #: p M 71860 34-186[)b FIS m AN INK SIGNATURE IS REQUIRED ON THIS ORM W J X_ Signature of At&6rizedfumber If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD BUILDING INSPECTION DIVISION MST ACPO .GU 2f-Hour Inspection Line: 639-4175 Business Line: 639-4171 ' 2 BUP Date Requested ,/—� AM PM BLD Location 9,72c, -5L j h'I.f h/✓ cl Suite _ MEC Contact Person Ph PLM 'or.,actorPh SWR Tenant/Owner ELC Retaining Wall ELR Footing oundation Access: / FPS Ftg Drain � SIGN 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: PART FAIL _ Post&Beam - Under Slab Top Out — Water Service Sanitary Sewer Rain Drains in PART FAIL Post&Beam - -- --� Rough In Gas Line --- -- Smoke Dampers n - PART FAIL CTRICAL -- - — IL Service Rough In N UG/Slab _- Low Voltage Fire Alarm _ J Final m PASS PART FAIL SITE JBackfill/Grading -- — --- Sanitary Sewer Storm Drain ( ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply line ( ]Please call for reinspection RE: ( ]Unable to inspect-no access ADA / A roach/Sidewalk Other Date /_ 1sLl�Inspector r Ext Final PASS PART FAIL DO NOT REMOVE this Inspection record from th Job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST Z�G e 24-Hour Inspection Line: 639-4176 Business Line: 639-4171 BOP Date Requested—2- Z -7 AM PM BLD A. Location "9'74 Le c� Suite ;MEC Contact Person Ph M Contractor L i ;...-�- 4, "'L'L� / Ph10 BUILDING Tenant/Owner _ #_LC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: SGN Slab Post& Beam SIT Ext Sheath/Shear Int Sheath/Shear Framing — Insulation —' Drywall;veiling Firewall Fire Sprinkler / Fire Alarm Susp'd Ceiling Roof Misc: Final ^ PASS PART FAIL PLUMBING Post&Beam Under Slab Top Out — — Water Service _ Sanitary Sewer - — Rain Drains Final -- — �— PASS PART FAIL _ MECHANICAL Post& Beam — Rough In Gas Line -- Smoke Dampers Final — PASS PART FAIL IX. Service Rough In f' UG/Slab N Low Voltage Fire Alarm m :)PART FAIL __— � SITE _-- - W —� Backfill/Grading —— ----- _ Sanitary Sewer Storm Drain [ ]Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( ]Please call for reinspection RE: _ Unable to inspect-no access ADA / Approach/Sidewalk OtherDate Z �7 �' Inspector ! `' Ext Final PASS PART FAIL DO NOT REMOVE this Inspection record from the job site. • CITY OF TIGARD MASTER PERMIT PERMIT M MST2000-00475 DEVELOPMENT SERVICES DATE ISSUED: 12/13/00 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 SITE ADDRESS: 08720 SW MAPLE CT PARCEL: 1S135AA-MRE16 SUBDIVISION: MAPLE RIDGE ESTATES ZONING: R-12 BLOCK: LOT:016 JURISDICTION: TIG REMARKS: S/F.-A PATH 1 BUILDING REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 13 FIRST: 956 al BASEMENT: of LEFT: 0 SMOKE DETECTORS: Y TYPE OF USE: SFA FLOOR LOAD: 40 SECOND: of GARAGE: 228 of FRONT: 10 PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: of RIGHT: 3 VALUE: $87,67900 OCCUPANCY GRP: R3 BORM: 2 BATH: 2 TOTAL: 95000 of REAR: 15 PLUMBING _ SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 2 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB13HOWERS: 1 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<100K: I BOIUCMP<3HP: VENT FANS: 2 CLOTHES DRYER: 1 GAS FURN>000K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVF-S: GAS OUTLETS: 1 ELECTRICAL_ RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS _MISCELLANEOUS ADD'L INSPECTIONS tono sr OR LESS: 1 0 200 amp: 0 - 200 amp: WISVC OR FDR: 1 PUMPORRIGATION: PER INSPECTION: EA ADO'L SOOSF: 1 201 400 amo: 201 -400 amp: 1st WIO SVCIFDR: 00 SIG;..CC::IN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 600 amp: EA ADDL OR CIR: SIGNAUPANEL: IN PLANT: MANU HMISVCIFDR: 601 - 1000 amp: 6014a.'05-1000w MINOR LABEL. 1000+amptVall PLAN REVIEW SECTION Reconnect only: >=4 RES UNITS: SVC/FDR>=225 A.: >600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL _ AUDIO A STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER- HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMFNTATION: MEDICAL: OTHR: HVAC: DATA/TELF COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Contractor: TOTAL FEES: $ 4,320.49 Owner: This permit is subject to the regulations contained in the WINDWOOD HOMES.INC WINDWOOD HOMES INC Tigard Municipal Code.State of OR. Specialty Codes and 12655 SW NORTH DAKOTA 12655 SW NORTH DAKOTA all other applicable laws. All work will he done in TIGARD,OR 97223 TIGARD,OR 97223 accordance with approved plans. This permit will expire N work is not started within 180 days of Issuance,or if the work is suspended for more than 180 days. ATTENTION Phone: Phone: 780-4375(M) Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Rens: LIC 50198 forth in OAR 352-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to / OUNC by calling(503)2461987. I 5fs3-��/Q PY� REQUIRED INSPECTIONS I Erosion Control Insp 8, Post/Beam Structural PLM/Underfloor Electrical Rough In Gas Line Insp Rain drain Insp Grading Inspection Post/Beam Mechanica Mechanical Insp Framing Insp Gas Flrepiace Water Line Insp Sewer Inspection Underfloor insulation Mechanical Insp Shear Wall Insp Insulation Insp Appr/Sdwlk Insp Footing Insp Crawl Draln/Backwater Plumb Top Out Exterior Sheathing Insl Gyp Board Insp Backflow Preventor Foundation Insp Footing/Foundation Dr; Electrical Service Low Voltage Firewall Insp Electrical Final Issued : permittee Signature Call (503)639-4175 by 7:00 p.m.for an inspection needed the next business day CITYOF TIC-ARD SEWER CON NECTIONPERMIT_ DEVELOPMENT SERVICES PERMIT#: SWR2000-00327 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 12/13/00 SITE ADDRESS; 08720 SW MAPLE CT PARCEL: 1S135AA-MRE16 SUBDIVISION: MAPLE RIDGE ESTATES ZONING: R-12 BLOCK: LOT: 016 JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SFA NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarkr: Sewer connection for new SFA. Owner: FEES _ WINDWOOD HOMES INC. Type By Date Amount Receipt 12655 SW NORTH DAKOTA _ TIGARD, OR 97223 PRMT CTR 12/13/00 $2,300.00 27200000000 INSP CTR 12/13/00 $35.00 27200000000 Phone: 503-625-6525 Total $2,335.00 �^ Contractor: Phone: Reg#: Required Inspections Sewer Inspection I This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 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 distance given. If riot so located, the installer shall purchase a"Tap and Side Sewer' Permit and the Agency will install a lateral. 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 by calling(503) 246-1987. Issued b t 9 Permittee Signature: Call(503) 639.4175 by 7:00 P.M.for an inspection nee next business day 10'09,00 MON 08:53 FAX 503 SIR 1960 CITY OF TICARD Q003 B'� uildingftrmitApplication City of Tigard Daterecrived:/,16fzl Petrmil no.:�/r7� QOL%' Pity of 7idarr! Addmss: 13125 SW Hall Blvd Tigard.OR 97223 Pmjtcvsppl=ao.: —." Phone: (503)639-4171 Deft issued: By: Rtxxiptno.: Fix: (503)598-1960 /r 20-" -e'7( '7 1 cmflbno, � Paymenttype: Land use approval: , 1&2 family:Simple complex: i�h 2 family dw-Aing or accessory 0 Commr—iol/induxtrial ❑Mul i-tinily �w conpna:tiou ❑1DwaoUtian ❑AddidoWalterr tontreplacement ❑Tecartt improvement 0 Fite upttrAwa{arm O Othu-. —_ ^ =10111111 31311111LEIRSE1111 Job address: JD'," -5'1- a It Ct _ .no.: suite no.: Lot: 14, 1 Block: _ Subd{v,aiou: /I7 4P,GAT,4jgQ Tu map/taa loVaocamt no.: /S/ d iQ / /- acme: ;6r -Ipr � yt'XJ - Descrfptioa and locatlao of wotk on pts Vises/special cootlidons:_ Ajink- ttrJ'CAd i eu/ ACr..e dam__ Name; Mailing wid eas: /�j S--s- dy�y �¢ A 1!2 hm y dwelftlt City: tete ZIP 0.72Valuation of watt.............................--........ _ 81 Fhoae: Lpas' _/ lrrtlall: No.of bedrootrtslbslha...r............r... .......... _�_. Owners /r"L /f S Total number of floors............... Fhe e ' : New dwelling area(sq.@.) ... _ — NNE (Iaraee%arport area(sq.ft)....... ........... 2 Z --- Coveted area( R ' Name:�;�/1D Fosq. a... )....,r ................ addtesa: ,6'"Air- City: Deet suns(p.ft.).............._..'................. City: I*A C— `tato: ZIP: Other structure area(sq.ft. ... ........... Phone: Fax: E-nail: Ca111s f tustst1a1N1•IM'la�l�Z Valuntion of work......................................- $_ Business name- :",a7 Existing bldg.arra(sq.ft.) ..................._.....Address- "167 bldg.area(sq.ft.)................................ City: _� — .tato: ZIP: Number of stories........................................ Phnae: aeFax: Email: -- Type of construction.................................... CCB m.: __—LQ'G Occu{uncY!R►wp(s): ExiNew.New: City/metro 11t.no.: I'leficet All contr ctnn and eob=111 tors ate sequined to be 111"med with the Oregon Co sellm tion C_oalractton Bond under Nave: �!r _ provisions of ORS 701 anti may be required to be licensed in the ..Address: �, tJ jurisdiction where work is being petfo awed.If the applica�t is YCh !tate: exempt from licensing,the following moson applies: Phone:11 Fax: I E mail: — — Name Q ce--lleact Kaes due upon appiicatiofa................. ..... — _ Address: �. /�—�� � Date received: City:_ ZIP.' -WL�2-dy Amount received............._..........................S _ Fax: s91 E-nail: Please refer to the schedule. I hereby certify I have read and examine I this apfrlicadon and the rur as paam assn aster cnl&pe.0 eau jtrfdnfar ter user rb..rta attached checklist.All provintmut of law acrd ordinances governing this v Vire ❑Mut&Cwd work wig be complied with,whetter ape Lifted herein or not. /',/ CNAt end Authorhzd siP.�m. _ - ��r �mdinTatrr.Moaasen&mm Print name: —' — ; �n ASM Notice:Tale permit application expires if a p armit is not obtained within 190 days after it has been accepted a complete 4eara19 005COM 10 09 00 14O\ 08:55 F:1X 503 598 1980 CITY OF TIGARO Z005 Mechanical Permit Application Uatereceived:in m Permitno.:/y_�7gp- "17-5 M. City Of Tigard Project/appl.no.: Expiredate: CiryofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 '- Phone: (503)639-4171 Jute issued: _ By: Rex:eipt no.: Fax: (503)5911-1960 -20-`TJ -L993.=, Case file no.: Pnyment type: Land use approval: _ Building permit no.: L?18r 2 family dwelling or accessory, U Commercial/industrial U Multi-family O Tenant improvement (]19ew construction U Addition/alteration/replacement Q Other. Job address: 0 .5(y /, brdicate equipment quantities in boxes below.Irsdicaee ttte dollar Bldg.no.: Suite no.: value of ill mechanical materials,egwipmeat,labor,overhead, Tax ma tax InVaccount no.: _ptrofit.Value$ -- Lot:1 Block: Subdivision: • p4.CA;'Q 4d *See checklist for important application information and Project name: /11,41.0jltrisdiction'e fee schedule for tnsidential permit fee. City/county: I ZIP: _ y 72.).-S Description and location of work on premises: 01:4. Fee(aa.) Teed Est date of completionftnspectkm: W RaL ady Aa. Tenant impmvement or change of use: Air unit CFM to existhig space heatui or conditioned?Q Yrs p No Wcondluaniial-r(site 111t0.requ-tt Is existing apace insulated?U Yes .0 No i ATretadon to uxwtt nvn''stn _ Business name: t.r State boiler permit no.: L_ C':' ;fdAk 1 �G-- - HP Togs Bn1/H Addttas ��-# :)�- ,:_, ^i;•iG :/tCJro a Nt - smn uct.mtors Ci - ,.} 'i i'r State: ZIF'; , :1. eat s m reolu Phone: �.+o5'-tam.• =Pax: -mail: Installkeplace umace76urner- Including ductwork/vent liner U Yes U No CCB no.: �� - -- n epIRWrefocateheamn-wspett , City/metro lic.no.: .vat,or floor mounted Name(please print): than - r /� Ahsonption units BTU/FI Name: /G r�rL i�f1.�� to " Chillers HP Address: /y�yy 4-P Com resras Fit' --- a sat and City: $/rdr lam-- State: ZIP: Appliance vent Phone: /,�-mb►- Fax: E-mail: !Mrexhausi s,Type. res. a azmat hood fife suppression system Name: i L. Bxhnuat fsn evhh dtt4le duct(bath fans) Mailing address: ,f , ,-, * uaa�emspot not beating or City: `;y Fit C State;'7� ZIP ^ ) 1 r.a gym`oma wawoors(up ro a LPG NG Oil E-trail• over ets --` � require ) (r Names Number of outlets M-M awed iwR-Ki we Address: _ r j `-- --- Deccxativeflreplace City: State: ZAP. fi°v _ Tnso dslo — Phone: Fax: E-mail: - imt ""°"'ve J m Applicant's _ signature: -. -- Dam: Name(print): -- — --- — W Permit fee................ Q Ys .....S -- .J Nur Visa I]M Iuti7dQ araorepe aedie cam please utr iWirfctlon for mere MAWM uao. Notice: ibis permit application Minimum fee................S rerCarJ expires Ifa permit is not obtained Crdi�cart m�uitrx:_ / / Plan review(at 9F) S Paper, within 190 days after it has been State TOTAL....................... �surc{,, e......... S surcharge891 --Wane nl cc m Lhown nn card accepted as Complete. . )•... s .............S �__ C ttMm A.1 441l-017(araaCr M 10 OA 01) 40\ 08:54 PAC 5103 5198 1960 CAT) 01- TICARD Q004 Plumbing Permit Application Dal-received: ) Permltno.:/'.+c 7.-er,?- ;/7 City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,'figanl,OR 97223 City oJ'I rgard phone: (503) 639A 171 Project/appl.no.: Expire elate: Fax:(503) 598-1960 -S'&7A r9"7)-/`0 1,VDate issued: -��_ 7 By: —LRece.Fa no.: Land use approval: Case Cde no: Payment type: "C01 R 2 family dwelling or accessory O CommerciaUnduatrial 0 Multi-family U Tenant improvement U New cunsttuction U Addition/alteration/replacement U Food service U Other Job address: 7,)0 -5,J /),?a9N" D rri Nos Qt . Fee ea. Tow Bldg.no.: Suite no.: r�1-od'- a r. Tax map/tax lot/amount no.: / " 3, r. , (Sr )IMA.Isreaehttti�areeliow) /,� 3�7 "'v!', c /_ SPR(1)bath L,ot Black Subdivision: - ;is FIR (2)bath -- Project name: j LYS. - S (3)hath City/connty: r .+/tl:1 ">w ZIP: yy„z 3 additional ba -rotten ' Description and location of work on pmmises: � Sltett>titltiea: 7 Catch buinlarea drain Est.date of completiomfinspection: a inelfrench gain Footing drain(no.tin.It) Manufactured home utilities Business trent: _ 7ri�> f��Q _-- an oles - Address: +% Rain rain connector City: /1s__j`- ZIP; r-,I.- Sanitary sewer(no.lin.ft.) Phone: G - 3 Fax: A Email: Stam sewer(no.lin.ft.) CCB no.: -1I j / (-, Plumb.bus.reg.no: '<< =/ o r ater service(no.Lin. t (ratty/metro lic no.: r?ci r^f_- /o 3,J" FMtre o !fame Contractor's representative signature: �.C,r(-___ Absorption valve —_ Print name: i� /� j;�y' D : /�,', TG Back o p� om w preventer Backwater valve Name: (3i / 7':. Address: r" d i Dis washer --- Drinking fountain(s) City: ,-1 r: .tiL State: jt qlP �'O[ Fiject sump — Phone: c LAJ ji u: _, E-mail: � anvon tank ------- 1 set Name(print): r_s n :+, ;n�-j �:L L, Floor nor aiUs/bub (larb die ,al Mailing address: j ) 5 ,tom .'7i rt4" Hose Bibb — City: �, Phone: ' ,�,,-.:�.�4 Fax: � 'ZZ E-mail: Inte�r/grease trap (honer ittstallation/residential mainumance only: The actual installation 'mer(s) d will he made by me or the maintenance and relatir trade by my regular Root'drain(commercial) fY employee on the property I own u per ORS Chapter 447. Sr (a),hasin(s),lays(s) NOwner's signature: Date. I „ S_smp �— llkxnmmml Tubs/shower/shower pan-- Name:_ Unna! =j --- --- — Water c oset _� m Address: _ Wnterheater (� Uty: Start: ?IP: r - _ -- lL Phone: Fax: i-- �E-mnil:-- — - - Total J _Not an Ia Wkdom aoori cmhr,.a,,rtem cad)arta&*%rat mrar tnhmwdML Minimum fee................$ Notice:This permit application U vias U MwW-Wan! _Plan review(at %) $ expires if a permit is net obtained --- — CwWt cad number._ 1— within 180 days it,,it has been State surcharge(8%)....$ _ TOTAL Name at cardhnldw n atrrnn ere tie&card accepted M complete. $ Canlhof&r ilpwure -- — Amuat 440a616(6i0a'CnM) 10'09 00 MON 08:56 FAX 501 598 1960 CITY OF 'TIGARD Q006 Electrical Permit Application I'� . Date received� i it i-) Permno.:/, City of Tigard pinajecdappl.no.: Expire date: Cary nrTigard Address: 13125 SW Hall Blvd.Tigard,OR 97223 Date iisued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 �W"e2¢p•O _M?-27 Cam filen': Nyrneattype: l.uld use appmval: 1<]'I dr 2 family dwelling or accem" 0 Commeteia>rndustrial Q Mufti-family O Tenant imptvvernent Q blew construction U Addition/alteration/replacement U Other:_ U Partial Job address: .t 0 S61 /MOO Bldg.no.: Suite no.: ITu maphax lot/anootmt so.: I-ot Z6 1 Hkx:k: Subdivision:Project tame: 4-v Description and location of work on premises: FAtimated date of letionAm tion: Job no: rtsra tNtta Buetness name: __ 4 T ea eAd N Addmss: i� J A. NewrMliuliat-itslaartNiltfadblN a«er.e..r.lar�alea.tarerd grw�a. City: I SISWL'MUZIP, q - f3rsvtoeksetdeR Phone: _. `;_ r 7 Fru: —----_ -1 E-mail: _ __ 1000 R a Las 4 r portion CCH no.: =• Elea boa.lies no: _..j /i Pub sq.R u `themot utdtad ,raidentiat 2 City/meter he no.: f �' !'y is Lim:me career-tesidentw 2 Hadi manafactund ham or modular dwelling Signature of supervising eiectrician(required_ Date _u SexvixWY-leeder 2 Sup.elect name(mint): License no:2�pS._`, Msvk w or -retanadea. or relecad". 200 amps or kw 2 Name(print): /, r...t r/) , e'r'. n.t_� 201 to 400 2 Maifin address: e r 401 to 600 amps _ 2 g J it C) Z `�CCr 601 amps to 1000 arnEs 2 City: 1_ State; j -ZIP: Over 11100 amps or volts 2 Phone: (. I Fax:. —A5-4 E-mail: Rommaectonly I Owner installation:The installation is being made on property I own tegmmysm4a taorfmd m- which is not intended for sale,lend;,rent,ur exchange according to IaaIaHlMlta'dleeralm,arrelaeatlaa ORS 447,455,479,670,701. 200 lop atlas 2 1 b am _ 2 Owner's A lure: Date: 401 to tr00 amps 2 ■ramch etteM -Nw,atlleranaa, or extrea il"ret ismak Name: A. Fee for bench cirouits with purclu to of A .mice or feeder fa,each branch circuit _ 2 Cit State: - )IP: R. Fee for branch circuits whhout purcitue - --- of service a feeds fee,fico btancb circult: 2 Ph.Stte: Far: E-mail: EWA additional branch dreuic Mbe.( x feeler as►ddelr ❑Service over 225 ampsrotmmemial ❑Health-care facility Each err hti -AIele 2 U Service over 320 amps-rating of l&2 ❑Hazardma ioation Each sip m ovdine li fhtinS 2 family dwellings 0 Budding aver I0jM square rev four of Signal tirMit(s)of a limited energy Panel, O System o-a 600 volts nominal more resutennal snits rn eche mucturn dteratim or a xatanicno 1 U hu.Ung over three curies ❑FaMem,400 arnim m mote a 1?escri en: O Occupant load over 49 persons ❑Manufactured atruchtte s or RV park Eeelt adiYlawi 1a tredllaa mer Ian al-P mW b my of the alsom ❑F4tteWightingplao ❑(Aber-__T-- Perinspection Sabah --arts of plana wkb my of The aMte. Investigation Ire Ilse above we not applicable to tevronry caNtredlal mrs::e Otho Nd an jrrtidictiom weer crania cask,please cut)eri+detian rar sae hrrnaradna Notice:This permit application Permit fee....................$ ❑Vha ❑MasterCard expires if a perrntt i+not obtained Plan review(b -- %) S Credit card nombe •---- _ __ �__1 _ within Igo days after it has been State surcharge(8%,1 ....S _ t wire. accepted as complete. TOTAL. .$ Name d carrlw�lrler r bnwo on ctedie card 't C'ardhdder signature --- -^Amoom 440-4615 MMCW JAV I � e N Sti M44,411064 d6E LI-014re, l'bo .2 \gym S v wrn M� ,Shy* �FQ 3 fF/63 ZEA3 / v IL F4 — 9./ A51 /1 g h. i N kL180 -,ran 3yh'Y t� J