Permit u q CITY OF TIGARD MASTER PERMIT
IN
PERMIT #: MST2008 -00131
COMMUNITY DEVELOPMENT DATE ISSUED: 9/12/2008
TIG AMY 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103AD - 00104
SITE ADDRESS: 10540 SW ERROL ST ZONING: R -4.5
SUBDIVISION: LOT: 015 JURISDICTION: TIG
PROJECT: OLSON
Project Description: Replace set of 3 windows with 1 slider door. Electrical work to be done under minor label.
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: 22 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: 5f RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf 5,000.00 REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB/SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/0 SVC /FDR: 0 SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601•amps- 1000v: MINOR LABEL:
1000+ amp /volt :
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 8 STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL C SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR Specialty Codes and all other applicable
RODNEY OLSEN A CUT ABOVE EXTERIORS INC laws. All work will be done in accordance with approved plans. This
10540 SW ERROL ST 12985 NW CORNELL RD permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 PORTLAND, OR 97229 if the 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 952 - 001 -0080. You may obtain copies of these rules or direct
Phone: 503 - 639 - 3697 Contact #: PRI 503 639 - 7172 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
FAX 503- 639 -9755
Reg #: LIC 153847
TOTAL FEES: $ 168.13
REQUIRED ITEMS AND REPORTS
(..... ----„,,,
. / r
Is ued By : _ , _ Permittee Signature :4 , V ►, `_
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
of Building Permit Application
Residential FOR OFFICE USE ONLY
City of Tigard 3 ECElV E , i DatefB : $ D �( Perm ; 1 3
v 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 AUG C 2011s Date/By: g � / Other Pernut.
T I G A R D Inspection Line: 503.639.4175
AUG L+ O Date Ready /By: t om' ®See Pa 2 for
Internet: www.tigard- or.gov + '� A D Notifie thod: '0 /, t7b '` A JA 6, Supplemental Information
OF
CITY 1 `„Q { i ARE \) )
TYPE OF p��G DIVISIO / I v 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.
Valuation: . $ t,
Y- l- and 2- family dwelling ❑ Commercial /industrial
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder 0 Other: Number of bathrooms: 3.s
JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: \ VS\-1 c_-.-›vV 'RRO &.--v New dwelling area: square feet
City /State /ZIP: ' -rt 1 `) MI (* t(• Garage /carport area: square feet
Suite/bldg. /apt. no.: r � Project name: Covered porch area: square feet
Cross street/directions to job site: G f1,\AR, J E \ Deck area: square feet
WPt `nU\ ' \ C \{ ` ( ' c- OJ\(1∎ WO \) Other structure area: square feet
• Q •K;j
�, •S ��\ , )-N— C'tOW.- l'N V " WS 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.
`r \ L (.'v\ `> \4 \I O-.11, tPT\r \1.li, ' (k Valuation: $
�A
�� ` Existing building area: square feet
J �C1 l�
New building area: square feet
le PROPERTY OWNER ❑ TENANT Number of stories:
Name: 0 1SYN Type of construction:
Address: \ CTS S'•1 -16Z.0\ S7 Occupancy groups:
City /State /ZIP: c,pf-1 Orl9 a\ 1)13 Existing:
Phone: ( ) 6.300- 36q-1. 1qy_ .)1/4,\u9 Fax: ( ) New:
• ❑ APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: All contractors and subcontractors are required to be
ontact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
4 Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
IN apply:
Phone: ( ) Fax:: ( )
E -mail:
(r, CONTRACTOR
, , Business name: CQA. Aia4Q.. aCkrV > 6 E( reD.P,M4' BUILDING PERMIT FEES*
Y (Please refer to fee schedule)
1 Address: (�.q‘C Na C�CAa\\ �.(1 5� 400 M City /State /ZIP: V (b C \� WI-2V\ Structural plan review fee (or deposit):
'^ FLS plan review fee (if applicable):
V, Phone: ( 61 3) <4 Svb Fax: ( )
CCB lic.: \ W\1 Total fees due upon application:
Amount received: °Z., l , C � 7 /
Authorized signature: �� \ C9( This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: a 1 M ,. 0 \
Date: C�i I l� * 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)
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EI ect_rical Permit Applicati I t i ` �,1 * , ;FOR o F eEmu - , oNLY� �i. 0 '
M , ,,
��• �t.rN F . , .!:
r Received n �/�
" '' City ol Tigard Date /B : , a5 -- 0 v 10 Permit No.: N! r a " /3
y a 13125 SW Hall Blvd., Tigard, OR 97223 AUG 2 5 2008 Plan Review
® #, Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
0 = Inspection Line: 503.639.4175 � TIGARD Date Ready /By: .fur ® See Page 2 for
'1 1 G XR D; r Noti fied Method: f Su lemental Information
* -tea Internet: www.tigard- or.gov CITY ` ' @@ (/�� PP
D��1G
MO .
TYPE OF 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 ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system.
• JOB SITE INFORMATION AND . LOCATION _ ❑ Addition of new motor load of ❑ "A ", "E ", 1 -2 ", I -3 ",
Job no.: 1 Job site address: l D540 �� g26 � 100HP or more. occupancy
❑ Si x or more resi ential units. ❑ Recreational vehicle parks.
City /State /ZIPT CO 0 2 V a_ ❑ Health -care facilities. 0 Supply voltage for more than
t ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or reeder 600 amps or more.
. ./ FEE SCHEDULE , .
Cross street/directions to job ''te: Description 1 Qty. 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
,Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: /' Limited ener 75.00 2
gy, residential
DES ' I' ON OF WORK
(with above sq. ft.)
/ Limited energy, multi - family 75.00 2
i �No 3 Du -nL , , residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
/
/ 200 amps or less 80.30 2
E CPROPERTY OWNER ❑ TENANT / 201 amps to 400 amps 106.85 2
Name: (.2s- O LSo / 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: ( 5L s,....,0 -&-O L 51 / Over 1,000 amps or volts 454.65 2
City /State /ZIP:Tc /1. t 2 . "1" 02.__ C A' / Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) / 200 amps or less 66.85 1
Owner installation: This installation is being made on property that Awn which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 4• 9, i 0, and 701. 401 amps to 599 amps 133.75 2
/ Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. ❑' APPLICANT . ❑ COI<ITACT PERS c. above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, nch circuit 46.85 .g--<-2 first bra
Address: Each add] branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
welling, service and /or feeder
Phone: ( ) Fax : ( ) R onnect only 66.85 2
E -mail: Pum, a irrigation circle 53.40 2
CONTRACT A R 5b - Sign or tline lighting 53.40 2
Business name: _�j t Signal tire: t(s) er or limited-
)�-�`- r t e_ energy pane , • Iteration, or
Address: extension. Des be: Page 2 2
City /State /ZIP: Each additional in 't ection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr :.in) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
/ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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- 46t5T(1I /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:
n Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ 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 Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06
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CITY OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9 t)8 00 "i;i1
Phone: (503) 639 -4171 21 �t10Q3
Inspection Requests (24 Hrs.): (503) 639 -4175 '"'' I-
INSPECTION WORKSHEET FOR DATE: 9/30/2008 TIME: 7 :00AM PAGE: 7
SITE ADDRESS: 10540 SW ERROL. ST CLASS OF WORK:
SUBDIVISION: LOT #: 016 TYPE OF USE:
PROJECT NAME: OL. SON
DESCRIPTION: Replace sot of 3 windows with 1 slider door. Electrical work to be crone under minor Zabel.
OWNER: OLSEN, RODNE`r PHONE #: 503,.639.3637
CONTRACTOR: A GUT ABOVE EXTERIORS INC PHONE #: 503- 639 -7172
Inspection Request Scheduled For: Date: 919012006 Pour Time:
Code# Inspection Description Confirm # Contact # Message
275 Framing 076108-01 503.799 -2448 N
Corrections /Comments /Instructions:
VV O CDv vtr
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: %ZS Date: 30- Se - Phone #: (503) 718- 2%2 3
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: MST7008-00131
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/1
Phone: (503) 639-4171 . --i-i , ilill' ,
Inspection Requests (24 Hrs.): (503) 639-4175 ,-_-_-_.w - - —
INSPECTION WORKSHEET FOR DATE:. TIME: PAGE:
9/29/2008 7:02AM 38
SITE ADDRESS: CLASS OF WORK:
10540 SW ERROL ST
SUBDIVISION: LOT #: 015 TYPE OF USE:
PROJECT NAME: OLSON
DESCRIPTION: Repk sot of 3 windows with 1 slider door. Electrical work to be done under minor label,
OWNER: OLSEN, RODNEY PHONE #: 503
CONTRACTOR: PHONE #:
A WT ABOVE EXTERIORS INC E$03-639.7172
Inspection Request Scheduled For: Date: • 912W2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 076016-01 503-799-2448 Y
Corrections/Comments/Instructions:
1 :ez._ 4.-4
E PAS— Li PARTIAL APPROVAL 0 CANCEL NO ACCESS
FAIL I. CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED
Inspector: , Date: 9------JA?) Phone #: (503) 718- acki