Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2020-00060
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/10/2020
Parcel: 25109BB02903
Jurisdiction: Tigard
Site address: 14305 SW HIGH TOR DR
Subdivision: HIGH TOR WEST Lot: 29
Project: HASHIMA
Project Description: 528 sq.ft.detached accessory structure for recreation room including sauna, bathroom and
storage room. WATER METER FIXTURE WORKSHEET REQUIRED PRIOR TO ISSUANCE.
BUILDING
Floor Areas Required Setbacks Required
Stories: 1 Bedrooms: 0 First: 528 sf Basement 0 sf Left 5 Parking Spaces: 0
Height: 11 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 15 Smoke
Dwelling Units: 0 Third: 0 sf Right: 5
Detectors: Yes
Total: 528 sf Value: $64,658.88 Rear: 15
PLUMBING
Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 1
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr. 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywall-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Electricity Heat Pump: V Hoods: 0 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 1 0-200 amp: 0 W/Svc or Fdr: 6
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ADD SF VB R-3 528
Owner: Contractor:
HASHIMA FAMILY TRUST PINEHURST HOMES Required Items and Reports(Conditions)
BY HASHIMA,JASON N&LISA K P.O.BOX 3665 1 Ersn Cntrl 503-639-4175
TRS TUALATIN,OR 97062
14305 SW HIGH TOR DR
TIGARD,OR 97224
PHONE: PHONE: 503-407-1102
FAX: 503-336-0437
Total Fees: $3,873.36
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Ore law requires u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throug 952-00 90. Y ay obtain opy of the s or direct questions to OUNC by calling 503.232.1 r 1.800.332.2344.
Issued By: Permittee Signature: .12'
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ON I.,
Received
I25 W Tigard AE/SOTemit:. /Yt
, ' C13125 SW •Hall Blvd.,Tigard,OR 97223 Dan R : /
C �Ian Review
Phone: 503.718.2439 439 Fax: 503.598.19(>(� I\ /E tugy Related Permit N:
Inspection Line: 503.639.4175 �/ L
TIGARD earlyDate/By: heist 0 See Page 2 for
Internet www.tigard-or.gov �D] Notified/Method: Supplemental Information
TYPE OF WORK 41 v r7 202Q
• PLAN REVIEW
❑New construction X Addition/alleratioll/replacement ,. - Please check all that apply(submit 2 sets of plans w/items checked):
❑ Demolition ❑Other: DIVISION 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
I-and 2-family dwelling ❑Commercial/industrial fl Accessory building Multi-family ❑ Master builder ❑ Other: less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Fire pump ❑ uildlationof ISO KVAor
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:/ y3vS $W L//6H 7Z/Z 04. I00HPormore. ❑'A" "E" 'l-z" "la"
City/State/ZIP: ?7 0 AA.e2 D/t ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt,#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft,or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft,or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
C.td r'a r) / 2 I-r-x 002 C' Ci 4 �" (with above sq.ft.)S f1 N F'Est ar.-r r'T Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT 4m CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
' A.Fee for branch circuits with
Business name: ? fN e H torts 7 //�/D••✓1 t- S each branch a or fe jeder fee, 2 7.42 /(I b ti 2
ciContact name: 2y"") I.A Ai -e G. . d....� B.Fee for branch circuits without
service or feeder fee,first
Address: 16 cs G 7 S G..1 ( S'f" A a r 41/ q/ branch circuit 56.18 2
Each add'I branch circuit 7.42 2
City/State/ZIP:
CA.c is- c S Gv a CUB es,..?
Miscellaneous(service or feeder not included)
Phone:(5 3 q tJ-7_.//p Z. Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: r2,7,A,J. ?sir&'/tU✓e s r-A/D , C S. U S Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 20 S S E C.EGTit r Sign or outline lighting 67.84 2
Address: e nd Signal circuit(s)or limited energy 0 See Page 2 2
2 Cj—7 O 5 1r -7 3 A S Z o 3 panel,alteration,or extension.
City/State/Z[P: Each additional inspection over allowable in any of the above
«t-s 3 o/L 0 f O"{ 9-71 Z 1 Additional inspection(I hr min) 66.25/hr
Phone:(col) (Y2._ 2b0O Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: no 5S EL cc-rib C,+t+r(t£4"."a toM G '?• Ne" ir Inspections for which no fee is
CCB Lic.:lsl 5¢{/ Electrical Lic.:3 t�_ q prv.Lic.:
specifically listed VA hr min)CCB
9000/hr
s
ELECTRICAL PERMIT FFrE.S
Suprv.Electrician signature,required: C..4„.. Subtotal:
Print name: C.4xvi5 p/1;it..1_be* Date: Co/at / Lo7-o 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:.
This permit application expires if a permit is not obtained within 180
Print name: Lk," 5 M\'l, .r✓ Date: r,,,pi/ye 1 e days after it has been accepted as complete.
• Number of inspections allowed per permit.
I'.\Building\Pernlirs\Et.0 PermiIApp EL.R ERE.doc Res 06•'17^01S 440.4615T(II/OS/COM/WEB