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Permit 4 ' CIT Y OF TIGARD MASTER PERMIT ,'Ili - .' :•; .. COMMUNITY DEVELOPMENT Permit #: MST2009 -00208 ' :T t GA.R 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11 /06/2009 Parcel: 1S136AD03400 Jurisdiction: Tigard Site address: 6918 SW PINE ST Subdivision: Lot: 0 Project: De Bauw Project Description: Add 1162 sq ft garage addition and 400 sq ft covered porch. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 16 Bathrooms: 0 Second: 0 sf Garage: 1162 sf Front: 20 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: Yes Total: sf Value: $53,950.82 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 1 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add! 500 sf: 0 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea addl Br Cir: 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: Owner: Contractor: Required Items and Reports (Conditions) DEBAUW, JEFFREY PAUL 1 MST Ersn Cntrl 503 - 681 -4444 6918 SW PINE ST TIGARD, OR 97223 PHONE: PHONE: FAX: Total Fees: $1,614.87 This pennit 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 throug1 OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. ` Issued By: � � � � _ _ 1 , Permittee Signature: / �� ! 99 Building Permit Application RECEIVED j� �.ILJCEi Y E� : � " r ,,mn i -, rr . 19, t i n. �F F. U + s1, 7 ) , M , r , ,11 i t � . Residential � � „ ' 1� 4 w g q , ' I OR f )I 1,1 C I SI nN l l i P 1, �' i r ii, , °_i_id,. -� 110 iF o:Ala _ adti1 �: /T, :, . hi k e a +p i I+ V ;.'' t. ± ”' City Of Tigard Recei eived _ -.w. ' Al Permit No.: a • • r i U O dO • 14 13125 SW Hall Blvd., Tigard, OR 97223 0 r. T 2 7 2009 Plan Review �� 0 Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: 1 C; A' R G) Inspection Line: 503.639.4175 Date Ready/By: ® :1 _ See Page 2 for i ,] Internet: www.tigard- or.gov CITY OF DIVISION Notified/Method: Supplemental Information DIVISI BUILDING ON TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. dwelling Valuation: $ 1_} _: E' 1 C_7! ❑ 1 - and 2-family g ❑ Commercial /industrial ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: ' JOB SITE INFORMATION AND LOCATION . Total number of floors: Job site address: ‘e 1 g 5u.; PZv e 5 7 New dwelling area: square feet City /State /ZIP: 7-l5a y al (21 �' 7 2 3 Garage /carport area: II (02 square feet Suite/bldg. /apt. no.: J Project name: lae_ ) 3a IA It/ Covered porch area: L4 (DO 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. • P d „1 ■ 1 (0 2 C# , q{Q _ d - vi on Valuation: $ l a no 400 C V e Q ervc h • Existing building area: square feet New building area: square feet .❑ PROPERTY OWNER - ❑ TENANT Number of stories: Name: L. FF '1i, -e._ 13 u ee re, Type of construction: Address: & 7 / y S (!_, /-9/ „1 e 5 r. Occupancy groups: City /State /ZIP: aV( Existing: Phone: 5,0 3 ) 'r or ._L Fax: ( ) New: ❑ APPLICANT • ❑ CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address. jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail: • CONTRACTOR Business name: BUILDING PERMIT FEES* / (Please refer to fee schedule) . Address: City /State /ZIP: ow � r Structural plan review fee (or deposit): /_i ci3 . 71 FLS plan review fee (if applicable): Phone: ( ) Fax:( ) CCB lic.: Total fees due upon application: Amount received: Authorized signature: This permit application expires if a permit is not obtained ��/�j within 180 days after it has been accepted'as complete. Print name: / �` /! pi/ D ate // ?_ 7 Q4” * Fee methodology set by Tri- County Building Industry Service Board. I: \Building \Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11 /02 /COM/WEB) Building Permit Application Checklist One- and Two-Family Dwelling HOR OIi l USE:,oN ..X ;.t llt' �r Received City C • of Ti Date /n Permit No.: ,, n 13125 SW Hall Blvd., Tigard, OR 97223 y e a 0 Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 n • 24- Hour Inspection Line: 503.639.4175 El Electrical El Plumbing 12 Mechanical iI I A' R[�l er ; Internet: www.tigard - or.gov ❑ Other: 1 �,.�. U... , t r ;F. F ., .. , , �. -.- r :, ; M.... i ,,.. V a r ��' k { + a1 ', �s?` \r�..V/ lifir ifoliq WIN E1 -cAlit .R gUilitD. i514 L- ! Ei I Wlii ' "47 T "'" - o / ..�„ 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ 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 ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ 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- ❑ ❑ ❑ 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. ❑ ❑ ❑ 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 ❑ ❑ ❑ 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 ❑ ❑ ❑ over 10 feet long and /or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ 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 ❑ ❑ ❑ architect licensed in Ore Lon and shall be shown to be applicable to the •ro'ect under review. v I n�pi t s.-- a s r I . : '�' +., ti .;I artiaF JRIS' D1e 1 I ON : PLC II ICS + t�.� .,� �� s� �' rt �. �.. ,,� 1. r _ / ,� F �3�u� l ► ; ., ,t r +3 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 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. ❑ ❑ ❑ 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 ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre- Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. I:\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440- 4613T(11/02/COM/WEB) Plumbing Permit Application RECEIVED • ED ,, u ,lyi'Iti4+ ,, i+,lP' + d , t 1,1 tl r ' ,, P er J�F S i ih dF „ 7 &1t ,�.4 � I . , i 1! � l ., Building Fixtures 11 -$ wti „ F,ii ° „ oRI ICI USI IONI 11 +a + II, � n q ,� iiit+11 "rlalgA:�#�V aura .. �; � L., 0 I.,x.x .�i i �44,LIE k 1 �� :ii , r j q City of Tigard DEew Permit No.: 13125 SW Hall Blvd, Tigard, OR 97440V 0 5 2009 P � �� C Other Permit No.: Phone: 503.639.4171 Fax: 503.598.1960 DateBy: r'' "`'+ "' IM, t Inspection Line: 503.639.4175 �+�/ I,l G n R D) CITY S OF TIGARD Date Ready/By: Ions: ® See Page 2 for ....01t. , ,.1awl Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WXDING DIVISION FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) • CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 • JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 6 9'7$" /-ice c- -- Catch basin or area drain 18.76 City /State /ZIP: �ye /if C 01727- 3 D oting leach line, or trench drain 18.76 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: )).( 3 W� Manufactured home utilities 50.03 . Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.:59 f / Page 2 C Z Water service (no. linear ft.: ) Page 2 Subdivision: 1 Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 . DESCRIPTION OF WORK - ' Backwater valve 12.51 Clothes washer 25.02 «`� yryl-/ // \ ( Dishwasher 25.02 »' ' PO t- 2» a 6A-1 a 4.4 Drinking fountain 25.02 A / Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT • Expansion tank 12.51 ",.e Fl- I)--e- r3 a 4.-t ,-(--Y Floor drain/floor sink/hub 25.02 Fixture /sewer cap 25.02 Name: ` Address: 1 L (a ! �� l KY /-1 Garbage disposal 25.02 City /State /ZIP: 17._ 4Y'( , it � �� 3 Hose bib 25.02 Phone: ( 23) q T , 4/ 5 t Fax: ( ) Ice maker 12.51 . ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 City /State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: Water piping/DWV 56.29 Address: /� Other: 25.02 City /State /ZIP: / J / Subtotal r " i Phone: ( ) `/ Fax: ( ) Minimum permit fee: $72.50 I • C((,,, CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) 8, Q Authorized signature: �G(/��-" TOTAL PERMIT FEE Q ( r I Print name: ,re f . 6a u it/ Date: 7� �� This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. : \ Building \Permits\PLMU- PermitApp.doc 10 /01 /09 440- 4616T(10 /02JCOM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total ' Square Footage: Permit Fee: Footing drain - 1' 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $ 169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Storm &Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Inspections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to p and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees * . Please check all that apply. Quantity, by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure -Tub/Shower as defined in OAR918- 780 -0040. Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities. Drive tall ❑ Any multipurpose fire sprinkler system. Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040. Dishwasher - Commercial Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash Isometric or Riser Diagram Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. Car Wash Drain Garbage - Domestic Disposal - Commercial - Industrial Comments regarding fixture work: Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial *Note: If the fixture work under this permit results in an - Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be aid before the Washer - Clothes p Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: 1:\Building \Permits \PLMF - PermitApp.doc 2 • ikw , �� t k C_ s , 71 , 1r i -, rr , E nn � i, ��tl, • Iha ( 1 1 I ra ,� �(: Electrical Permit Application �) , � , Ic 4 ' 4�,1q:h�l oI o� El e.PUS ION Il',11•. I s I �1 CEWED ,, trrt � ' ± ,.. r;,, ,�s l,„,„:4,q,,k,'M1Ms .„,, ZI' „i , ,,4 i �,y "Ih ' ,.,, „, mi191 11n41 ' 1� �l OfTI aC(I iii ! Received Permit No.: Gr/ o9 . D al `.1 g Date/B 1 ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 1 C Other Permit: P hone: 503.639.4171 Fax: 503.598.196° NOV : Ins ection Line: 503.639.4175 NOV 0 5 2009 Date Read /B Juris• F 1 C A •t 6, P Ready /By: H See Page 2 for i .:; Irv, Internet: www.tigard - or.gov Notified/Method: Supplemental Information 1 TY OF TIGARD TYPE OF DING DIVISION PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or . JOB SITE INFORMATION ,AND LOCATION ❑Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ", Job no.: Job site address: f .- 7 100HP or more. occupancy. 6 gl �(5 / ❑Six or more residential units. ❑ Recreational vehicle parks. Cit /State /ZIP: Ay 7 a ? ❑ Health -care facilities. ❑ Supply voltage for more than y y J 600 volts nominal. ❑ Hazardous locations. Suite/bldg. /apt. no.: Project name: `--r4_ 6 � t+v -h" .� n ❑ Service or feeder 600 amps or more. �/�/ FEE SCHEDULE Cross street/directions to job site: Description I Qtv. 1 Fee. 1 Total 1 New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. 0.) Limited energy, multi - family � J/ d „�� ~� residential (with above sq. 0.) 75.00 2 ✓O `` Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 Name: ✓ e f F ...e 1L- a IA w 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: G( L ( 5 W � n a) 57` Over 1,000 amps or volts 454.65 2 City /State /ZIP: 11,3a V�( � 2 � � q '7 3 Temporary services or feeders installation, alteration, and /or J relocation Phone: (503 ) er 2 R _t{ 5el4 Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, r• nt, 9 •xch /according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 • 2 Branch circuits – new, alteration, or extension, per panel Owner signature: eUllis Date: //..- .5”- a 4 A. Fee for branch circuits with ❑ AP V I A T I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, ` Contact name: first branch circuit — i 2 Address: Each add'I branch circuit 1 6765 42._ 7. 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: Signal circuit(s) or limited - energy panel, alteration, or Address: extension. Describe: Page 2 2 City /State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: & . ‘., 0 Print name: Date: — State surcharge (12% of permit fee): `j t � � j Authorized signature: TOTAL PERMIT FEE: 7 "Z 3 This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. • Number of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: . Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n B • oiler Controls • n Clock Systems ❑ Data Telecommunication Installation • n Fire Alarm Installation ❑ HVAC ❑ Instrumentation F7 I • ntercom and Paging Systems n L • andscape Irrigation Control* ❑ M edical n Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: 03/23/06 RECEIVED . . . r ' : . CITY OF TIGARD )1 5', ze,/ -1--- so 4 i - - - -- R! Ill DING DIVIS;ON ,„, 4 6 . n wo a+ • • a • • — . 0 )(--*- .NT w . e Ne -, x x tiz K. ,c --- - ...--- q O _ . • Atrick4.__ ____ 1 4Ni&ke.;M__ _ __ - 171 \‘‘ \ s N` - 4 ---- Vl p - =f.. - - _ • Zik.* ' ) 4 0 *4 czai4TitioL - , X.. \ 4' e • \,. s 1 1 4L -• .,:lizia." _____ \,\, y il t --.7- . ; Ai \ /-44 i' 1 fi_ \ \ , i A r.,-ApV-141P-F Au rO • ' :\ \ ,\\\ . • ""' ,- • , loae 00 1 i , \ . Q \ • i , _ _ • -- 4 ...;• . --- Rck - m - lawto.t.4 4 " • • 101 ,e) - - • — . - . A 1.• 1 .0... e4t•le---_-. r :, .• , ,.., II ._., i . -- - 14 -,„. ze) e)il- ple- ---45-1-rpel4 i -,c p.-.,.• „AL----R--t-r9lep- -- -- - vormi -Iii , arm__ I: --- • 34 -14c—t-s-f.> CITY OF TIGARD - SITE PLAN REVIEW • BUILDING PERMIT NO.: MSTZO PLANNING DIVISION: Required Setbrks: a Approved ❑ Not Appro Side: Street Side: l Front. d'" Garage. R . — Visual Clearance: Approved ❑ Not .\pier "" IZ S Maximum Building Height .311 feet CWS Service Provider Letter Required: 0 Ye:: ' g .w I T _. __r / /0? ENGINEERIN D EPARTMENT: o nv- Approved Actual SI pe: �� App ved 0 Not Approved - Site PIa �pproved Ott A p roved By: Date: Ld 2g ts ? Notes: / I CITY OF TIGARD - SITE PLAN REVIEW r BUILDING PERMIT NO: m n 2cog , Qn7 Street Trees: (/Approved ❑ Not Approved Protected Imes; Approved 0 By: Notes: / Jac`Jl?c Date: / y re N