Permit 1
ECE E1 f�
Electrical Permit Applicati FOR OFFI( I I 'I 10,1 )
Cityo T Tigard MIS 1 3 2021 Received 57X '1`C
• 131 SW slat Blvd.,Tigard,OR 97223 Ded°�r' SS
�� a. Amne: 503.7182439 Fax 503.598.196E Pm Revs. Related radii a:
(�T r tr
TIGARn Inspection Vim. 503.639.I175 �+` ",@r,,r ttly D�flly: aim I lit Set►gar2 Far
Internet www.ttgardorgov gps��/� ONG fie.LMdad: S.pplse.i lI.f.r..fin.
E OF WORK li`�' PLAN REVIEWof
pla
❑New construction Addhiotdahetation/replattrtlent Pleas Se check feeder
dimder wvh(rasa t j see Bud ingems dime Ot
❑Demolition 0 Other: 0 service teeerr 400 amps o or more 0 Balking osa dime aaiu.
of ere the amelabb huh.,.reel 0 Muiow add boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps a ISO volts or O Floabor buildings
I-and 2-family dwelling 0 CommerciaYindusbial 0 Accessory building less to ground,a e l4 o Commercial-um.graa,nt
amps for all other inraaatiau buildings
❑Multi-family
0
Master builder 0 Other: O Fire pump. O Inaallamn or 150 KV A a
JOB SITE INFORMATION AM)LOCATION O E :ao en,system lager sepaaety derived
,, I O Additimn of new mesa hwd of sraem
Job N: I lob site address 7 1 law 5 S��Qln� ',..ter r orore O•A-.`8-,-I-1'.-1-3-.
City/Statt/ZIP: �•,A�]^''f Osixammrc residential units
O a vehicle parks
\\a� s' / L+�� O Iferlhou facilities
Suitc/bidgJapt.0: U pmjai mane: 0 Haamm location. 0 Supply wuaae for move than
O Service ur feeder 600 amps ormore f00 volts mmm
Cross Sheel/directions to job site: FEE SCHEDULE
onerlpni. I Ott. I Cod I Tax I •
New residential single-or multi-family dweliwg..it
Subdivision: I Lot N: Includes attached garage.
1,000 sq.R or less 168.54 4
Tax Itmptpatccl N: Fa acid's 500 sq.R or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 7500 1 2
���rs)$e /�2yvCn .may, (2 -ter (with above sq.ft.)
1-1,..Yt,O�. /may/�(JW/� VC, `V SdT i \vl�� Limited mergy,multi-family
//L•S �1r (4.1e 2
residential(with above sq.D l Sec Pug 00 2
0 PROPERTY I 0 TENANT residential
ble Energyera O
Services or feeders iastaWtion,alteration,amYar reloeasiw
Name: 200 amps or leas 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.01 2
Phone:( ) Fax:( ) Over 1.000 amps or volts 55226 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 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 ampere 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT I 0 CONTACT PERSON Branch circuits—new,alteration,or extension, panel
7 A.Fee for branch ruarits with
Business nano: aces ��, f Ifi above fee, 7.42 2
each ircuit
Contact name: •` +�,s �1/► Q..� B.Fee for branch circuits wNAad
service or feeder fee.fast
Address: St^ Yt, /Cr�1al�`t•�, ^]V, 1-. brands Main 56.1a 2
CitylState/7IP: _W,� 0(2--- v 9 7 z 1 4 Each add'I branch cirevit 7 42 2
Phone:� 2 s J ) ��. "3.1 Each Miscellaneous(seeel rim duor feeder not included)
1/O_LwJ,ali Fax:: Each mmnfedurod«modular
�
dwellingservice and/or leerier 67.84 2
Email: � 1] �'S 10-�f'prtf t •en-OMReconnect only 67.84 2
CfOR Pump or irrigation circle 67.&1 2
Business name: Sign or outline righting 67.84 2
Signal circuit(s)or limited-energy 0 See Paget 2
Address: panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(I far min) 6625/hr
Phone:( ) F :( ) Investigation(l lu min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Email: inspections for which no fee is
CCB Inc.1 �bgr,� Glatrical Lit ,' Suprv.Lie.:� S
specifically listed OS hr min) 911.00/hr
ELECIR1CAl. PERMIT FEES
Su Electrician signature,req Subtotal:
Print name:
name: Me. s pes. Date: )C / 12,�Zj� ❑Plan Review Required(12%of permit fee):
W / State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
n Tice perch application empires if permit is am obtained within 190
fl Print name: TDe S Date: $ 12 j on 24 d after it bar been amd aspicomplete
LLLL • Numbs of invasions allowed per pawn
1 dlddeiraitidELr_paaaAepFmA_F doe Rev aril 70015 440-16157(11A CnINa'®
CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2021-00055
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/22/2021
TIC;; I+.C7 9 Parcel: 2S104AA08000
Jurisdiction: Tigard
Site address: 12665 SW KATHERINE ST
Subdivision: BELLWOOD NO.2 Lot: 105
Project: Loewer
Project Description: Kitchen remodel and add one window
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $17,400.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckfw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 10
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:
ALT SF VB R-3 0
Owner: Contractor:
LOEWER,ERIC MICHAEL NORTHLAND DESIGN&BUILD Required Items and Reports(Conditions)
12665 SW KATHERINE ST 20000 SW CAPPOEN RD
TIGARD,OR 97223 SHERWOOD,OR 97140
PHONE: PHONE: 503-380-6251
FAX: 503-625-4838
Total Fees: $832.50
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: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 952-001-0090. u may obtai copy of t les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: .-t _ Permittee Signature: Vii?‘e-7/ 17
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.
Building Permit Application ' r 10121
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard ie0h70zi ,Date/B2 de-- Permit No.: ' tS
T204l^O00S5
r 13125 SW Hall Blvd.,Tigard,OR 97223FEB12021 Plan Review / 1 •
� �+ 8 Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Z�
lit !,Ci Inspection Line: 503.639.4175 Date Ready/By: J-' Ed See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD ified/Method/ , Supplemental Information
DUILDIN D •► i ' ice` "
;ii 777'7r .'re
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
11: Addition/alteration/replacement ❑Other: equipment,materials,labor overhead,and the pr i for the
i ' " ' - work indicated on this application. /
1-and 2-family dwelling ❑Commercial/industrial Valuation: $
0 Accessory building El Multi-familyNumber of bedrooms:
�4, ❑Master builder 0 Other: Number of bathrooms:
/ �r
` ,� ,t ,,,/, " ,_ Total number of floors:
Job site address: i a 6p Cu s- aw (n-f 0� . ��- New dwelling area: square feet
City/State/ZIP: I i g o D R `i 7 a a3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: /^b — Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
K(TGL1,c. _ rt.wcd-ct .Q ) «Gck olA-_ L..,'tl�-url"c
Existing building area: square feet
New building area: square feet
t ,.
�1 PROPERTY OWNER: ❑ TENANT Number of stories:
Name: Ey,- LD eta�r. Type of construction:
Address: 1 a(r Co S W 4a¢L..,y, S-f- Occupancy groups:
City/State/ZIP: b y y-a i 0 e. Q)2 a 3 Existing:
Phone:( ) Fax:( ) New:
► APPLICANT E : ❑ CONTACT PERSON BUILDING PERMIT FEES*
-=Ally
/— ( �+ t(1� �
Business name. ,/(%.. (-:(4,ici14d C.0ujlYL()�JK (!Mo( y[l/S n , I vtC . view lee(or fee sit): te)
�. Structural plan review tee(or deposit):
Contact name: Q nun -t-L1
._------._--------
�Otioo S.L/ Ca rlyd c K IZ� FLS plan review fee(if applicable):
Address:
Total fees due upon application:
City/State/ZIP: S L rtdved.ck. y O Q Q 7<cf.0
Amount recei\ed:
Phone:(6n0)) a a.) - 4 a Q q Fax: :( ) — —
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
bn`a�l3'f{-II- l= vtor�(a11d btu(d� cow,
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
AIDc L Cd Submit two(2)sets of roof plan with connection details
Business name: dot y , y=t( �j� c�yc� �St� ,1VtC.
S and fire department access,along with the 2010 Oregon
Address: O10000 'LJ C,ffepC� led Solar Installation Specialty Code checklist.
City/State/ZIP: trwppd t 69 Q?[ Y 0Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(60)aa-) _Gjai li. Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: lO it 810 Total fee due upon application: $201.60
Authorized signature: id.......„..
Z-----
( This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Lii` Fee methodology set by Tri-County Building Industry
Print name: R,,,,,,_ P4 !I Date: a`{Q`a' *Service Board.
1:ABuilding\Permits\BUP-RESPennitApp.doc 02/24/2011 440-4613T(11I/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Cityof Tigard Received Permit No.: •
g Date/By:
IN ■ 13125 SW Hall Blvd.,Tigard,OR 97223 Associated permits:
C Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 El Electrical ❑ Plumbing 0 Mechanical
T IGARD
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW N t',, No "s',"
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ I m
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ii
3 Verification of approved plat/lot. ❑ 0 a
4 Fire district approval required. Name of district: . ❑ ❑ ,2r
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ Z.
6 Sewer permit. ❑ ❑ 13
7 Water district approval. ❑ 0 8
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ E
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ (0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 0 ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ 0 ❑
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. 0 ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ 0
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ 0
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ 0 ❑
architect licensed in Oregon and shall be shown to be a',licable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". 0 ❑ 0
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ 0 ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ 0
riand protection measures must be drawn to scale and must include the project arborist's signature of approval.
t' 30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ 0 ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
if on a lot of record approved prior to September 9, 1995.
i
t 1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
i
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit No M sr262.14co ve.S
111 tr 13125 SW Hall Blvd.,Tigard,OR 9722 EC E IVE D Date/By:
Plan Review
Phone: 503.718.2439 Fax: 503.598.19 0 Date/By: Other Permit:
C 1 c P t1 Inspection Line: 503.639.4175 $ ���� Date Ready/By: Juris: M See Page 2 for
Internet: www.tigard-or.gov FEBD Notified/Method: Supplemental Information
r • A •a
s- `t' =' �`" � Mechanical permit fees*are based on the value of the work
❑ New construction Addition/alteration/replacement performed. Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION
r"11-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION �g",` Heating/cooling:
'I1
Air conditioning 46.75
Job site address: Il a 6c4s - S Li lt�jcf�e vl l u. S f) Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Aare ®2 q?Q a 3 Furnace 100,000+BTU(ducts/vents) 54.91
I / Heat pump 61.06
Suite/bldg./apt.no.: Project name: Ott.t.L.tr Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
_ < ; ! Gas fireplace/insert 33.39 '
l [� idie L Flue vent for water heater or gas
e X Gas LIw&_ "[7rr u!� rcwKC,, t i UfitiLf fireplace 23.32
i�h 11e kart art vv Log lighter(gas) 23.32
Vl Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
IA PROPERTY OWNER _ Y 1 LI TENANT Environmental exhaust and ventilation:
Name: Cr1Z G Range hood other kitchen
^ equipment I 33.39
Address: 1 OCte(Q S(-..) /Caf VI Sf Clothes dryer exhaust 33.39
City/State/ZIP: d , De q?as 3 Single-duct exhaust(bathrooms,
(ya t, toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
7 Other:2, r 1 a a , 23.32
wifxgrmaffakomoistil,/ � I �_-I mod`" Fuel piping:
Business name: �I/0 ` C / ,6 J� p p 1
r' a kl � Qhd.( (� S k -LCtCe $14.15 for first four;$4.03 for each additional
Contact name: iZ W C I. . ✓'-- Furnace,etc.
Gas heat pump
Address: aa�®o St,/
ot2 "` Wall/suspended/unit heater
City/State/ZIP: S Lc r•w.ryk 1 61a Q'7 t 4 O Water heater
Phone:(40)) a a-i-Q,2 Q Fax: :( ) Fireplace Range (
E-mail: b eta t,\ . 41.Y Q i lqI I i/d r CD tom-. Barbecue
d t 1%% !>f /, Clothes drier(gas) -
Business name: N \ ` Other:J,� /1
J�\V 5 CK♦ I il9 at"Co( C-0d1? MECHANICAL PERMIT FEES*
Address: a.a?' I,r- SPre.446,Yirf Subtotal
City/State/ZIP: hje��- 4.4, LA.,� O jZ 9?O(;, Minimum fee p p ($90.00)
I Plan review(25%of permit fee)
Phone:(CO 3 ) SS? e'c ?,f- Fax:( ) State surcharge(12%of permit fee)
CCB lie.: L Ot r 3 a TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
(� / days after it has been accepted as complete.
Authorized signature: C l�ir— 6, / T * Fee methodology set by Tri-County Building Industry Service Board
Print name: JG Ck 4/n Date: (S7d
C\Building\Permits 1MEC_PermitApp_0401 13.doc 440-4617T(It/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including.
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Pennits\MEC_PermitApp_040113.doc 2
{
Electrical Permit Application_RECEIVED FOR OH ICE USE ONLY
City of Tigard ��j{ Received ,A 1202k 00 S5
Permit#: (J(JV 7
w 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
N Phone: 503.718.2439 Fax: 503.598.1960 Date B FEB 18 2021 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: BI See Page 2 for
1 1 t;.\P.C) Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
; r ,# ,rP xr�', xr .. «;Cr- aY" !'S "x w €r,ae ..uvaa - q
lai
❑New construction Pi Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
s ,* ,,,.1 gar a J +.i ' r exceeds 10,000 amps at 150 volts or 0 Floating buildings.
.xna„,..,:.::�x9�x1' � ra,�eaas. .a �..,,..,, .:.: .: ..€... � .„, rts� d io
P: 1-and 2-familydwellingCommercial/industrial less to ground,or exceeds 14,000 ❑Commercial-use agricultural
0 ❑Accessory building
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
4r pad ramr }se✓.w.', ere"' '"'!/'- rf may r'3 ll t�i
0, 7 °> a 5 , a .r i I 0 Emerency system. larger separately derived
Page r ,.xi z va.v ttar. r;>.a.z nrA'
(t� U 4. 6,i /( cf kattlAtial ❑Addition 0H of new motor load of system.
Job#: Job site address: � tooHP or more. ❑"A",°•E","t-2","l-3",
occupancy.
Six or more residential units, P Y
City/State/ZIP: "4u reA ' R 27 a a 3 ❑Recreational vehicle parks.
U t 0Health-care facilities.
Suite/bldg./apt.#: 1 Project name: L6 et,✓te✓' ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: r`''fryff r ''AlL
N;k ..si i e$3
Description Qty. Each Total
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#:
;a. % ^ ,:.,xf;. .... Ea.add'I 500 sq.ft.or portion 33.92 1
a .:aZ �� •`sa , a+x;'3`1r t �:= :;r Limited energy,residential
°r�� %�,bR��l%'�i��'t / (with above sq.ft.) 75.00 2`� Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
* ..;. Renewable Energy ID See Page 2
�x'td --., •�.k-''� d `� ad r: �d ,.::.`G= ate:^ Services or feeders installation,alteration,and/or relocation
Name: Er.r C. Lo e .t vs 200 amps or less 100.70 2
Address: 1 a ct(Q- J v K,f rl'� l� 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/Z1P: 1 184
ro( 1 l0 z q?a .3 601 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
2 x , no ,,,f,,..4 , ,c, rp ~ r¢ rr, 4 ., ;,, Branch circuits—new,alteration,or extension,per panel
,/� CoA.Fee for branch circuits with
Business name: i 6r1' la( C k3 UK 4(.4(,{ at j(�ti 1 �'kc , above service or feeder fee, 7.42 2
each branch circuit
Contact name: s„.a L Lr t.,.r B.Fee for branch circuits without
service or feeder fee,first
Address: 6.18 2
0�0000 .t,/ CoO tvel cc__ R d branch circuit
City/State/ZIP: r LA,J 1 0 R, q7((to Each add'l branch circuit CI 7.42 2
p Miscellaneous(service or feeder not included)
Phone:((a0-)) p1a� crag./L/ Fax: :( ) Each manufactured or modular 67.84 2
t,f fE fide 1d dwelling,service and/or feeder
Email: rtpt.. r o l L(t CC".
Reconnect only 67.84 2
drANKNOLISZNEC �a�i�'^ram� 1 i
iemu.. ,:.ar . f ..,, k ,,,..;a,y,„ ;°.,...f a, wa✓ , et Pump or irrigation circle 67.84 2
Business name: Ca,i i,,` de Z_ Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: pc, 16x 26 so panel, See Page 2 2
g panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: t( d
R. ?� ( Additional inspection(1 hr min) 66.25/hr
Phone:(6-03) 4 3a t(¢0 0 Fax:( ) Investigation(1 hr min) 90.00/hr
S jJ Industrial plant(1 hr min) 78.18/hr
Email: COP4Kt K / re t ce-.0(9Hq
inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: s.ecificall listed(Y2 hr min)
l q l3 C� �o c p e .,< ., a, C
Suprv.Electrician signature,r required:L �. / Subtotal:
Print name: Chad Car-f ov. Date: a/s/a( ❑Plan Review Required(25%of permit fee):
!!! State surcharge(12%of permit fee):
Authorized signature: U. TOTAL PERMIT FEE:
(
l This permit application expires if a permit is not obtained within 180
Print name: C_kaol Ca r�olA Date: a/s-/a.' days after it has been accepted as complete.
* Number of inspections allowed per penult.
I:\Bulkimg\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(t1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
rrAT17774s' � a1, �' <rirf FLEE SCHEDULE
Description Qtv. ach I tidal
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
U Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ H• eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
'1,EVitir FEES
COMMERCIAL WORK ONLY:
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
n A• udio and Stereo Systems
Boiler Controls
n Clock Systems
❑ D• ata Telecommunication Installation
❑ Fire Alarm Installation
n H• VAC
n Instrumentation
Intercom and Paging Systems
n L• andscape Irrigation Control*
Medical
n N• urse Calls
n O• utdoor Landscape Lighting*
(1 P• rotective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015