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Permit �rx q A 1 1 0 --- P ii aA „, c ‘ t C42;± • C CITY OF TIGARD MASTER PERMIT COMMUNITY DEVELOPMENT Permit #: MST2010 00117 . Date Issued: 07/21/2010 TiGAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103AC01200 Jurisdiction: Tigard Site address: 11385 SW FONNER ST Subdivision: ERVIN /STARK PARTITION Lot: 0 Project: McVicker Project Description: Garage conversion. 8/3/10, changing electrical contractor, adding feeder and 4 additional branch circuits. BUILDING Floor Areas Required Setbacks Required Stories: 1 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: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $15,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'I 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 add Br Cir: 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 • . ELECTRICAL - RESTRICTED ENERGY SF Residential Audio 8 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) MCVICKER, KEVIN S 8 HOME RESOURCES UNLIMITED INC MCVICKER, REBECCA M, 11385 294 NW 2ND AVE #412 SW FONNER ST CANBY, OR 97013 TIGARD, OR 97223 PHONE: PHONE: 503 - 263 -1976 FAX: 503- 263 -0067 Total Fees: $973.71 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. AT . gon law requires you to follow the rules adopted by the Oregon Utility Notification nter . Th rules are set forth in OAR 952 -0 -0010 through OA 52 -0 -010 You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 . 6 1.8 32.2344. Is ued By: L. Lk? �� Permittee Signature: J� *.. CITY OF TIGARD MASTER PERMIT I . '. COMMUNITY DEVELOPMENT Permit #: MST2010 00117 G A D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2010 cam ,,, a a er..-, ,,t. Parcel: 2S103AC01200 Jurisdiction: Tigard Site address: 11385 SW FONNER ST Subdivision: ERVIN /STARK PARTITION Lot: 0 Project: McVicker Project Description: Garage conversion. BUILDING Floor Areas Required Setbacks Required Stories: 1 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: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $15,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: ' 0 SF Rain Other Fixtures: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 1 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 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 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 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) MCVICKER, KEVIN S & HOME RESOURCES UNLIMITED INC MCVICKER, REBECCA M, 11385 294 NW 2ND AVE #412 SW FONNER ST CANBY, OR 97013 TIGARD, OR 97223 PHONE: PHONE: 503- 263 -1976 FAX: 503 - 263 -0067 Total Fees: $844.31 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speci= Codes -n• 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 H of s • - nce, i r work is suspended for more the 180 days. ATTENTION: Oregon law requires you to foil • •- -s adopted by the Oregon Utility Nojifica'• e 4 Those rules are set forth in OAR 952- 001 -0010 through • ' R 952 - 001 -0100. You ay 0 ain a cop 'Tr- rules or Mr- l uestions to OUNC by call ng 1 47-17' • or 1.800.332.2344. L , / ''/ Issued B ` �` ` - e rmittee Signature: _9 C ' Bbildin ' Permit Ai . lication S ■4.' Rec eived City of Tigard Permit No.: N tY g D IeLB : � � Ate/ � � ° . , 1 11111 II ° 13125 SW Hall Blvd., Tigard, OR 97223 + i ` Plait R ., - . , -wt. ` i Other Permit: •. Phone: 503.639.4171 Fax: 503.598.1960 1 i � t e Da {'rA 7 ( 1� ` r I G n' it b. Inspection Line: 503.639.4175 Date ReatI By: .. lulls. ® See Page 2 for Internet: www.tigard-or.gov JUL 0 9 1 1 o i ied/Method: / , LEI NI r Supplemental Information ' - TYPE OF WORK - •CITY o :F , r I( AR - . REQUIRED DATA: 1- AND.2- FAMILY DWELLING ❑ New construction ❑ Demolitio @UELGjNG QjvISIo, Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ' [ddition/a1terationlrepiacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATE GORY 'OF CONSTRUCTION - work indicated on this application. Valuation: $ 9w 1- and 2- family dwelling ❑ Commercial /industrial 1 coo �� ❑ 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:k 1 392 SW Fo N N 4,2 New dwelling area: square feet City /State /ZIP: T ) 4 O2 5'2 2_2_, \ Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: nits._ v i (k�L 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. t� Cep l n "GAY A--yt Valuation: $ Existing building area: square feet New building area: square feet '0 PROPERTY OWNER •.. ❑ TENANT ., ' Number of stories: Name: Type of construction: Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: ® APPLICANT' ., . ❑ CONTACT;; PERSON . - • . ' - . t,-' 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: F ax: applicant is exempt from licensing, the following reasons apply: Phone: ( ) :( ) E -mail: 7A k..€ 94V- vhl Coq Q. 8( d 6 I C.A Vh . ,CONTRACTO . . ' .. Business name: M r Z j4C . BUILDING-PERMIT'FEES* . B ' • ��rtac� S (,rN'L , f/ d Address: 2� 4) Z4_ Av k _. (Please"rejeitojeeschedule) City /State /ZIP: cA A, 67e a /3 Structural plan review fee (or deposit): h / I FLS plan review fee (if applicable): Phone: (S03) 3(0 — Z Fax: (Sti) 2 — 03 t-2 CCB lic.: t ( Total fees due upon application: , S ( 9..0 ount received: Authorized signature: �Ir Si fv\ This permit application expires if a permit is not obtained (� (y U i within 180 days after it has been accepted as complete. Print name: �[ 1 ' / (, J 54�� ti D ate: 9 ` ? —( t *Fee methodology set by Tri -County Building Industry Service Board. I: \Building\Permits\BUP -COM PermitApp.doc 10/01/09 440- 4613T(11/02/COM /WEB) 1 1114 Building Division Accessibility: Barrier Removal Improvement Plan • `TI REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241. (1) Every project for renovation, alteration or modification to affected buildings and related facilities shall be made to insure that the path of travel to the altered area and the restroom, telephones and drinking fountains are readily accessible to individuals with disabilities unless such alterations are disproportionate to the overall alterations in terms of cost and scope. (2) Alterations made to the path of travel to an altered area may be deemed disproportionate to the overall alteration when the cost exceeds twenty-five per -cent (25 %). VALUATION: Total of all renovation, alteration or modification being done, excluding painting and wallpapering: [1] $ MULTIPLIER (25% barrier removal requirement): x .25 TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given to those elements that will provide the greatest access. Elements shall be provided in the following order: (a) Parking $ (b) An accessible entrance: $ (c) An accessible route to the altered area: $ (d) At least one accessible restroom for each sex or a single unisex restroom: $ (e) Accessible telephones: $ (f) Accessible drinking fountains: and, $ (g) When possible, additional accessible elements such as storage and alarms: $ TOTAL (shall equal line [2] of Valuation Computation): $ I: \Building \Permits \BUP -COM PermitApp.doc 06 /25/08 Electrical Permit Application , x ,- a1mc�r► ►c�1 4; ry�4,4", '7. y y ..., C of Tigard O reitlY: Q Plan Permit No.:' / 'S� p Z0/O eel/ 7 13125 SW Hall Blvd., Tigard, OR 97223 ` \ Other Permit: t ` - 1 7:' Phone: 503.639.4171 Fax: 503.598.1960 � w a • Inspection Line: 503.639.4175 • �C� °Ddt`' l y � ity: me / ' ®See Page 2 for • 11 1 6 ' ; , A R' 1 7 \ ethod: Supplemental Information • ,„ • ; ; Internet: www.tigard or.gov '� ��, ' TYPE .OF WORK v. _ PLAN RE VIEW , ` ❑ New construction ❑ Addition /alteration/replacementV 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 - ", "1 - ", Job no.: Job site address: i 1 - ' , - f -v Six or or more r es. occupancy. ?j Y►o! f \/�,Q 0 or more residential units. 0 Recreational vehicle parks. City/State /ZIP: 77 2 972 23 ❑ Health -care facilities. ❑ Supply voltage for more than 9 2 C V ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: / Project name: in F k A 61K, ❑ Service or feeder 600 amps or more. "FEE SCHEDULE Cross street/directions to job site: Description I ow. I Fee. 1 Total 1 • . New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 67.84 2 • DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 67.84 2 Se OA o 1 6z 1 , (la L residential (with above sq. ft.) ` - 1 /L Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ROPERTY OWNER" -' .. I "❑ TENANT .. 201 amps to 400 amps 133.56 2 / 401 amps to 600 amps 200.34 2 J Name: 0 , v.■, /1 gip/ 4 44 _ 601 amps to 1,000 amps 301.04 2 Address: / 3 rc ' S Lt. F04 l J . Over 1,000 amps or volts 552.26 2 / Temporary services or feeders installation, alteration, and/or City/State /ZIP: - T - 4 1‘ 9 -A O 2 / p� ? Z 2 3 relocation 'O Phone: (, 1-/‘ lA -- 3 11‹.-c I Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease t, or an e, according to ORS 447 and 701. Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with «APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit , Business name: ri g /t/ / B. Fee for branch circuits without service or feeder fee, first 56.18 i st , te 2 Contact name: branch circuit C2 Each add'I branch circuit _a 7.42 22.. 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67 84 2 ty dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy • Business name: / panel, alteration, or extension. Page 2 2 {yl Each additional inspection over allowable in any of the above Address: 0 ( �� VV Additional inspection (1 hr min) 66.25/ hr City/State/ZIP: Investigation (1 hr min) 66.25/ hr ty Industrial plant (1 hr min) 78.18 / hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (Y: hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: " - ELECTRICAL PERMIT FEES Subtotal: 1 , 4.4_ Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): It i 4- TOTAL PERMIT FEE: e, 7 , CU� Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. I: 1Building \Pamrta\ELC- FamilApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB Mechanical Permit Application , r c l usi c)w � ° . °I �IZCiirl , . City of Tigard s. DateB N Plan Rev Permit . • ( y� / ' /1 ° 13125 SW Hall Blvd., Tigard, OR '7' • z a 'N 1 y ' ew d o�/ V I N i :: ' . Phone: 503.639.4171 Fax: 503.59$.1 0 9 1-� Other Permit: DateBy: 116 ;, it Di Inspection Line: 503.639.4175 0- �Q Date Ready/By: EN El See Page 2 for Internet: www.tigard-or.gov \ CC. ��! \�\ ®� Notified/Method: Supplemental Information TYPE OF WO � ,,m . COMMERCIAL FEE* SCHEDULE •USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction l tddition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* - 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total . . JOB SITE INFORMATION AND LOCATION • . - Heating/cooling Ai Job site address: 113 Sc 5w TOW � (requires N ste pl site plan showing placement ) 46.75 City /State /ZIP: --'' 51. (2. .. 0 - g.._ Y)2_23 Furnace 100,000 BTU (ducts /vents) 46.75 II �1� Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: in Y v I e Heat pump 61.06 Cross street/directions to job site: Y Duct work 23.32 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 Subdivision: Lot no.: Other: 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK. • Water heater 1 23.32 Zr Gas fireplace 33.39 . y✓1:9 dt-,( �f32a1, 4 Flue vent for water heater or gas / fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 Chimney /liner /flue /vent 23.32 - p, PROPERTY OWNER '0 TENANT Other: 23.32 Name: \Acc V ,' n/ fb C V( CSC Environmental exhaust and ventilation Range hood/other kitchen Address: `\ 3 s-c., S W I O N ty F I f2_ equipment 33.39 City /State /ZIP: AIt 6(1 9 7 2Z 3 Clothes dryer exhaust 33.39 /` l Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) ! 23.32 ;32- • 71 APPLICANT '. :EP CONTACT PERSON Attic /crawlspace fans 23.32 Business name: Other: 23.32 Nel Rt c $ (A N` / M 1 . 'f(a T VI 'C Fuel piping Contact name: / ik, o f / $14.15 for first four; $4.03 for each additional Furnace, etc. Address: 29 y N L Z ~ a A G as heat um p �� pump City /State /ZIP: --fir - i3 v Q Q_ 1 7 o - /_3 Wall/suspended/unit heater Phone: ( ) '�j 0 .- V)� Z Fax: (J ) 2 C,3 » 7 Water heater ' / 4- 5 J` / 1 Fireplace E -mail: C�G VE' / E (dot,/ 6y @ ''&0 • C-D1"'N Range . CONTRACTOR . - . - Barbecue Business name: Clothes dryer (gas) Other: Address: $ Pc ON (J 4_ MECHANICAL PERMIT FEES* ' City /State /ZIP: 1 " Subtotal COO .77 Minimum permit fee ($90.00) 7,q , zi Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: ) S ' ' C i State surcharge (12% of permit fee) 6 . TOTAL PERMIT FEE 1 I 80 This permit application expires if a permit is not obtained within 180 Authorized signature: �; days after it has been accepted as complete. Print name: y i j L) 5f _ Date: �� 5 10 * Fee methodology set by Tri County Building Industry Service Board 1.\ Building \Permits \MEC- PermitApp.doc 10/01/09 440-4617T(11/02/COM/WEB) 4 a h 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\Permits\MEC- PermitApp.doc 10/01/09 2 Plumbing Permit Application Building R ECEIVET . :I,' Jl wilding Fixtures J ` ;( _uI I (• I I tiI () N Il "y *& , a a "''q:`»;,. Cl of Tigard Received City g f � . Permit No/Lf�P 1, DO // 7 A v 13125 SW Hall Slvd., Tigard, OR 97223 JUL 0 9 2010 p Review li $ - Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit No.: .4. ' Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: ® See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISIO 0 0 Jr v Supplemental Informa TYPE OF WORK FEE* SCHEDULE: - , ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. _ Total la 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: Catch basin or area drain 18.76 Job site address: I (3 56) 7- o N N ire Drywell, leach line, or trench drain 18.76 City/State/ZIP: - 6,444 0 % ) Z V Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: VI c ‘<fizR Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _J Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 jai 0. 4.RA, (C Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 . 01-PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 / Fixture /sewer cap 25.02 Name: 1 ^ �V i v` OA C l/i(t¢ Floor drain/floor sink/hub 25.02 Address: /1 3 8-<- 5 Ai FO n $16Y Garbage disposal 25.02 City/State/ZIP: r. 0 9) 2 2 3 Hose bib 25.02 y e Phone: (503) 6 - 3 t/( Fax: ( ) Ice maker I 12.51 l� ❑ ! APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: K----- Medical gas (value: $ ) Page 2 1i Primer 12.51 1 Contact name: P Roof drain (commercial) 12.51 Address: Sink/basin/lavatory Z__. 25.02 60, t# City/StateJZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 1 12.51 r2.-.6( E -mail: Urinal 25.02 Water closet 1 25.02 2_5 0 CONTRACTOR 0 Water heater l 37.52 37,..5 L Business name: Water piping/DWV 56.29 Address: 001/4) Other: 25.02 / City/State/ZIP: Subtotal l 37160 Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) l /0,5" Authorized signature •� TOTAL PERMIT FEE / 14 v 1 f Dal This p ermit a expires if a permit is not obtained within 180 days Print name: /4 V jGv' - f - . after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I:\Building\Permits\P1.MU- PermitApp.doc 10/01/09 440- 4616T(10/O2JCOM/WEB) 08/01/2010 19:20 5037' D CASCADE ELECTRIC PAGE 01/01 Electrical Permit Applicatio l O Iz O1 l I( 1. t 1. i AUG 2010 City of Tig> I'd D PYamitlta.: 13125 SW Hall 131vd., Tigard, OR:9774 ;" : : ;, �;_, a Review Other Permit Phone: 503.639.4171 nor 503,1960 .1960', -, ., 1)atd13 , i (c; A u r Inspection Line: 503.639,4175 -' - - •, ' ' , . • Date Ready/By ......._ ... —_. kris: B Sec Page 2 for Internet: www.tigard_nr.gnv 1QotifiedlMGhod .: b1 luJorzaatien ,...., s.•., - ...r -,: ... .,.... ... ,._,a;. ,,,.• - ,:,.�,,.... ,,c ,,. + . ; .. i < ' -lr `1p" irb . J i.,. '.':: - •.Y "7. .;'PF, '!i't Vin. . +l'i ❑ New construction Addition/alteration/replacement Please ' oi t a pply ( a sets of plies wry checked belo ❑ Service or fader 400 amps or more 0 Baddi ng over three stories. ❑ Demolition ❑ Other: where the available fault commit ❑ Marina and boatyards. y, +r Y ` . , C r,, , V t> ;:: '', t 0 f. v a ,. • c t : Is e i } t . '"'"1 ./•1' : ,r ° ! \ , , . , '!'' exceeds lU 000 amps 1 t 0 volts or ❑ Floating b,zfl4tngs ' \ less to !?,m or exceeds 14,000 ❑ Commercial -use agr cuhural 0-1- and 2- family dwelling D Commercial/industrial Q Accessory building amps for all other installations. buildings. ❑ Multi- Iarady 0 Master budder 0 Other: ❑ Fie puinp. CI /mediation of 75 KVA or �{f; C3 Pm«a�Y gym- larger separately derived system. 4 , r :'::' i"d r^ t ! ` � ; n t a ' 4 r `. A' ❑ Addition anew motet load of ❑ "A", "E^, "1 -7 ", "1 -3 ", Job site address: 1 � i IOOHPormore. • Job no.: I 134)5 5t..3 t^8hlneQ ST, oSixamro.G c.w.o.,.it,. ❑ Recreational y olepates. City /State/ZIP: , a • C( 127. 3 0 roc 11 . u mote than . Suite/bldg./apt. no.: Project name: 0 Se vrce or feeder 600 amps m wore. Cross street/directions to job site: Description i 04• l r.. t Tour l J New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: , Lot no.: 1,000 sq. ft or iess 168,54 — 4 Fn. add'I 500 sq. ft or portion 3392 t Tax map /parcel no Limited energy, rside:matt �-"`,.` a ? a t , r { \�,�,,�� tt , o\'n [ i r 75.90 2 2.,:,..:42..>,;,,f1.:7.,,, : 16 ' , :i l A , I d : :', ick,;1 771'F. V r � "� . y I.� f i Y �� . r Y . � �, , • (with above gift) ,.'. rr � . __ .',':11o: ;w. P ., . . . t' vl Limited energy, nab-family 75.00 2 0 eed k 4c AI4...r -e-l�e 1 U n residential (with above sq. ft) Services or feeders installation, alteration, and/or relocation ter c \- )'Y, ^ 2 / O — 0011-7 200 amps or lees j V 100.70 2 amps r , 1 1! + ti g r = 4 ''''' 2 ,� r d f u '.V fr- v' „ i l '.. . ,. ( q ;;yw 201 atwl s to 4 00 133.56 401 amps tv 600 maps 20034 2 Name: lD -co A a} 1 601 amps to 1,000 maps 301,04 2 Address: Over 1,000 imps or volts 552.26 2 - Tempo' rary services or feeders installation, alteration, and/or City /State/ -rY: relocation Phone: ( ) Fax: ( ) . 200 amps or less 59.36 1 Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2 intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 - 401 to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date A. Fee for branch circuits with '': •.�; %y' . a ?/ �� z.. 4� u 1 ,�,55,, . • , 5 a ! : f 3 - - \ f F above savice or feeder fee, „9..... . 7.42 2 Y\ •;: r � k� r ,. ,•'.'= ^i • . , .v' ,. - 1 %, \ .,• . 4: •` k- • v . . ' u y . 'Fx. , '2. , ;: , .7: c,., each branch circuit Business name: ' - e. f_t.�c- r B- Fee fur branch circuits without `_ e service or tbednr fee, first 5618 2 Contact name: )Al /� t,�'c_'_ k,to 1..1.s branch circuit Each add'I branch circuit 7.42 2 Address: 150 1J' • r - S . Miseellaneoas (service or feeder not included) y /State/Z1P: Each mamrfactured or modular 67,84 2 Cit loo r 1 `o,, c1 Oa_ _ 9 2 . 3 0 dwelling, service and/oir feeder _ _ Phone: (503) e % — l'3 c) 1 I Fax:: (5O3 )1 b cf ! t 3 3 0 Reconnect only 67.84 " 2 9( Pump or litigation circle 67.84 2 E Signor outline lighting 67.84 2 •, ^ , r ti'r 7 "- 'r 1,. y ` ;'; 1 ; • 4 . r'3t R.: � , .e ''.fgf ;., 1r i t ,•.. a t . , t Signal CITCU.t(8) or limited -eVet r Business name: C ( 7, c ,.., �- t e_ panel, alteration, or extension. Page 2 2 �k Each additional inspection over allowable io arty of the above Address: 1 5OSS N €., are eJ °,..- 5A- Additional iwspe tion(1 ' 6625/ hr I I City /Statc /7.,1P: 0 IL. c t 12 (� Industrial (1 hr min) 66.25/ hr Iridastital plant (1 hr min) 78.1S/ hr Phone: (5 91 , — 10 Fax: (503) ) ( / q `ID Inspections for which no fee is 90.00 / br r specific, listed (K hr mini) °.: 1 (fl 1 (v( Electrical tic.: t / t q - ! ; , •�. ' ti 'r' , off � \ � CC Bi Suprv. Electrician signature, required: - " i" Ailliiii1111111111 Subtota1: 7/ .,.---/ P lan review (25% of permit tee): —�)— Print name: n i i Chat , , (c, [ u 5 Date 1 /j- I v State surcharge (1 Z% of permit fee): / '1 • Sf (� r 1 v ' TOTAL PERMIT FEE: _ l 9. V!.) This Authorized Signature: application expires if is obtained within 180 m t _. 1 ` L permit pP permit n days - Print name: t t'F e / .I F 1I t V"1 7 3 p , O aRer it has been accepted as complete. Date: - - � - - - - -° - -- - - -:. 07/15/2010 15:10 5035981960 //��C��ITY OF TIGARD PAGE 01/01 .k Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential budding, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date 1 will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. Or 1 will be performing work on property 1 own, a residence that I reside in, or a residence that 1 will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who licensed with the CCB and will immediately give the name of the contractor to the office _ issuing this Building Permit. 1 have read and understand he information f ormatlo this homeowner to Homeowners About Co statement is truce Resibilities, and 1 hereby certify the 1 C I. ' r nt Name of P = .t Applicant • /� - 77( 7 M :nature of Permit Applicant Date Pent* #: M 5-TPO 10 -- 00 I - 1 - 7 .. Address: • -1 13 W Si.l - j-zmnK.s' s Issued by: 'J I. Date: 7 /i?-I IO This Copy for Permit Offices 4