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Permit 11111 CITY OF TIGARD MASTER PERMIT #: MST2009 -00138 . n Permit COMMUNITY DEVEL OPMENT TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/23/2009 Parcel: 2S 111 AA06000 Jurisdiction: Tigard Site address: 14315 SW 90TH AVE Subdivision: GREENSWARD PARK NO. 2 Lot: 46 Project: Orchard Project Description: Add 307 square feet habitable space. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 306 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 12 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $31,196.70 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 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: Bckfiw 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 Srvc /Feeders 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 add'' 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 Ecom asin N Other: N Other Description: p g' BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) ORCHARD, SHAUN F & SHELLY PROJECTS PLUS LLC 14315 SW 90TH AVE 10855 SW SUMMER LAKE DR TIGARD, OR 97224 TIGARD, OR 97223 PHONE: PHONE: 503 -816 -6900 FAX: Total Fees: $1,284.24 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 t •ug 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. j Issued By: �� alt.. I ! L Permittee Signature: . - .40 AA a . • Buiididg Perfnit Application Residential RECEIVE a FOR OFF Icf l 5E 0\1 1 14 City of Tigard JUN 2 5 2009 Recei Permit No.: ' r l z . • , 4� • 13125 SW Hall Blvd., Tigard, OR 97223 Pl : g g Pl an Revie � q Phone: SW 503.639.4171 Blvd. Fax: 503.59 97223 DateB ' ` et aLer Permit: it TI GA R D Inspection Line: 503.639.4175 CITY OF TIGAR I ate R=- : y: ® See Page 2 for Internet: www.tigard or.gov BUILDING DIVISII) otfed/Method: IMM Supplemental Information TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. ® Addition/alteration/replacement ❑Other; Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ r3 , 9 , 7 j ❑ Accessory building ❑ Multi - family Number of bedrooms: 0 ❑ Master builder ❑ Other: Number of bathrooms: 0 JOB SITE INFORMATION AND LOCATION Total number of floors: 1 Job site address: 14315 Sw 90th New dwelling area: 306.7 square feet City/ State/ZIP: Tigard Or. 97224 Garage /carport area: 0 square feet Suite/bldg. /apt. no.: Project name: Orchard addition Covered porch area: 0 square feet Cross street/directions to job site: near Greensward Ln and 90 street Deck area: 0 square feet Other structure area: 0 square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: 2S111AA06000 Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Add a one story addition to the existing living room Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: Shaun & Shelly Orchard Type of construction: Address: 14315 Sw 90th Occupancy u P Y gTO s: P City/State/ZIP: Tigard Or. 97224 Existing: Phone: (503)684 -6977 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 applicant is exempt from licensing, the following reasons City/ State/ZIP: apply: Phone:( ) Fax::( ) E -mail: CONTRACTOR Business name: BUILDING PERMIT FEES* Address: (Please refer to fee schedule) City/State/ZIP: Structural plan review fee (or deposit): 4 ..1 0, 0 I Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lic.: 440 13 1 `z 2 . 5- Total fees due upon application: Amount received: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: K b T r rte/ Date: 1/7..4(1:›5 * Fee methodology set by Tri -County Building Industry Service Board. l:\Building\Permits\BUP -RES PermitApp.doc 11/6/07 440- 4613T(11/02/COM/WEB) • Building Permit Application Checklist One- and Two - Family Dwelling FOR t)1 11(1 I ■I ()NI \ City of Tigard Received perm it No.: IN 1 3125 SW Hall Blvd., Tigard, OR 97223 Date/By. ■ Phone: 503.639.4171 Fax: 503.598.1960 Associated Permits: 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical T16ARD Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEM~ ARE. RE:Qt IREI) FOR I L:k\ RFAIENN v es `I) . k 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • :4 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ El 4 Fire district approval required. Name of district: . ❑ ❑ El 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ 6 Sewer permit. ❑ 0 ❑ 7 Water district approval. ❑ 0 0 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 I. Ef ❑ 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 121 ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, D ❑ ❑ 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 ion and shall be shown to be a pplicable to the .ro'ect under review. .I( R1SI)lC I IO \.AI. SI'1.CII IC' 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17". ❑ 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. ® ❑ ❑ 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, ❑ Q El and protection measures must be drawn to scale and accompanied by 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. 1:\ Building \Perraits\BUP- RES- PerrnitApp. 03/21 /06 440 4613TO 1 /02/COM/WEB) Mechanical Bermit Application FOR OFFICE USE ONLY El City of Tigard Received Permit No.: Vt J 2 t , co l ..i 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: CM Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ New construction ❑ Addition /alteration/replacement Mechanical permit fees* are based on the value of the work 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 I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: l IA 'S C IO"' \ Air conditioning or heat pump (requires site plan showing placement) 14.00 City/ State/ZIP: Furnace 100,000 BTU ( ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: Lot no.: Flue/vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 Flue vent for water heater or gas VC c ( d 1 fireplace 10.00 t i' Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 ❑ PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 10.00 Other: 10.00 Name: Environmental exhaust and ventilation Address: Range hood/other kitchen equipment 10.00 City/State/ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, eta Gas heat pump City/State/ZIP: Wall /suspended/unit heater Phone: ( ) Fax :: ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: M � J `� • $ 9 j V Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City/ State/ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) �` Plan review (25% of permit fee) CCB tic.: 1 1 2 9 5 q, t V State surcharge (12% of permit fee) ` / / TOTAL PERMIT FEE K Authorized signature: ,i � This permit application expires if a permit is not obtained within 180 / _ / days after it has been accepted as complete. Print name: �� I c e v �/ Date: 7/2,..t AP i * Fee methodology set by Tri- County Building Industry Service Board B \ N I:\ uilding PermitsMEC- PermitApp.doc 01719 440.4617T(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I: \Building\Permits\MEC- PermitApp.doc 01/19/07 2 Plumbing Permit Application FOR OF 1: it 1: 1SE ONI.A 13125 of Tigard Receive pit 812 t t . Gage `'� ll Date/By. PermitNo.: OG� 11 11 • 13125 SW Hall Blvd., Tigard, OR 97223 = Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date By: Other Permit No.: Ti G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris R3 See Page 2 for Internet: www.tigard- or.gov Notified/Method Supplemental Information , TYPI�';OF WORK '' '' , - rEE* SCL1I DIT E ❑ New construction ❑Demolition For special information use checkl Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) ' ; CATE't 012'3' 'f1-F. ONSTIZIJCTIO)N SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2 i lt')C?e 1FO1M1 i111ON ANti t CATION ' Site utilities - Job site address: ILA Z i 9 OA- h Catch basin or area drain 16.60 City /State /ZIP: l Drywell, leach line, or trench drain 16.60 Suite/bldg./apt. no.: I Project name: Footing drain (no. linear ft.: Page 2 Cross street/directions to job site: Manufactured home utilities 110.00 Manholes 1 6.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: Page 2 Fixture or item Tax map /parcel no ,� at -- -- Absorption valve 16.60 ,, - -' >, _ - �.� - �. �; Backflow preventer Page 2 Backwater valve 16.60 -h. c( d ( .4 c ^ Y - Clothes washer 16.60 v Dishwasher 16.60 a� ; v� .t g * a ,. Drinking fountain 16.60 E /sump 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City/State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 C1,t -e s' ,. , ' � , 1� lee ma b 16.60 Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 1 6.60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: (4/'�} � � fY Urinal 16.60 -._ Water closet 16.60 Business name: S 1,..„6,_,,,,„, F- tr-c � ti Water heater 16.60 Address: / L7 ? l S .c t� (if) >� Other: City /State /ZIP: J o i 57 2 z q Subtotal �� y Minimum permit fee: $72.50 Phone: (soy) ti R 4 _ ( > Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) k Authorized signature: ..),41114,00.7 , r D�f TOTAL PERMIT FEE Print name: Li Lz r D � / ar Date: 7_ 2 z _Of This permit application expires if a permit is not obtained within ! n 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1: \ Building \Permits\PLM- PermitApp.doe 12/27/06 440- 4616T(10/02 /COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: sit ties - Qty. Fee (ea) Top 11 Square Footage: Permit Fee: Footing drain - 1 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 + Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each F ee I) Toil w additional $100.00 or fraction thereof, to and lxtt �bl including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", . � {yr' ! 6iii lnstaIlations 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 (Fixture) Work'P rfoe , ❑ Any new commercial building with water service 2" and Fixture Type Rep jeue:`". greater, except systems designed and stamped by licensed Previous Capped Added lxisting engineer. Baptistry/Font Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure Jacuzzi/Whirlpool 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 NV * ^� ° .s• mt Floor Drain /sink - 2" ❑ Isometric or riser diagram is required for new buildings 3 that meet the qualifications above. -4" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an - Bradley uner p - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: is \ Building \Permits\PLM- PermitApp.doc 12/27/06 Electrical Permit Application FOR OFFICE USE ONLY 11:9 City of Tigard Received Permit No.: ms - A s 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review Other Permit. Phone: 503.639.4171 Fax: 503.598.1960 DatelBy: ® Inspection Line: 503.639.4175 Date Ready/By: Ms: SI See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK 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 JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", `B ", "1 -2 ", "1 -3 ", Job no.: Job site address: } IOOHP or more. occupancy. '� O� ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: - Description I Qty. i Fee. I Total 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'1 500 sq. ft. or portion 33.40 I Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family 75.00 2 AA residential (with above sq. ft.) aj \ j 0 I\ Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City /State/ZIP: 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 I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration , or extension, per panel A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: f 2 ee for branch circuits without service or feeder fee, ( 46.85 2 Contact name: first branch circuit Address: • acli add'I branch ci? trit - a 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: Each manufactured or modular dwelling, service and/or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 `` ` Signal circuit(s) or limited - Business name: L K t (e c T e: C- energy panel, alteration, or x Address: ( (Z Z s E s 4 t.... extension. Describe: Page 2 2 Ci / State/ZIP: Each additional inspection over allowable in any of the above 0a_ to A. S [ w s ) D et 7Ds Per inspection 62.50 Phone: (77 f) 5 Fax: ( t 0 3) 6 3 3 b 3' l 3 Investigation per hour (1 hr min) 62.50 CCB Lic.: is '7 3 a Electrical Lic.: !/ S L /f�' Industrial plant per hour 73.75 JJ p , t n — / , �V ELECTRICAL PERMIT FEES Suprv. EIectriclan signature, required: / ,46.115: Subtotal: Plan review (25% of permit fee): Print name: r 2 rr y Ai , Date: 7 ' �� q r 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: L, ✓ i ` � .. - - Date: 2� j .0 9 days after it has been accepted as complete. ' Number of inspetions allowed per permit. I:\Building\Permita\ELC-Porm p.doc 05/23/06 440- 4615T(1l/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 n Garage Door Opener* ❑ 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 ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ 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:\Building\Permits\ELC - PermitApp.doc 03/23/06 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 building, 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 I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I 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 is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. �• �.� O Print Name of Permit Applicant Signature of Permit Applicant Date Permit #: [°3CZCyS - 00 &g 435 9 0 4 Address: �" Q • ** *.ti ! n Issued by: Vt\ Date: � n[� ° 3 This Copy for Permit Offices WOOD FENCE '4 ∎ % f ' y - - - -- 0 - -CT - • - • • - • - • - • - • - • - • WATER METER n m GAS CONTROL _ _ _ _ _ _ REJIV E ED .! PROPERTY LINE — — O — — — — — — — — — — — — —.— — —. —._ — — —. —.— — JUN 252009 � � FTe�RD CITY 0 / ' Ilo'-'' — BUILDIN IVY '_ 0 ■•5 . 20' -0" 4' -II 3/4" / ∎∎• • ♦ V♦ . , I ,� � � SET K ott: ■ -1-. ' S\ i I ■ HOUSE A EDITION 3( 5F� • I • --0 S �i��1' �� 7 � � � � � � � � � j � j � j � j 4 03 I )3> 4 . � 4 c c (..sQ) . / � � � � � �� Al_ I • � I I � • I � • EXIST CONC. PATIO • I � \ c, • 06 0 u e m ZI1 4- 6' O n a HYDRANT Lo '" V l� _ ' ` ` • ' . te 4/.7. y9! l) 54.0(4-A,1 4074 1 5 O , // • CITY OF TIGARD - SITE PLAN REVIEW , BUILDING PERMIT NO.: (Y FT 2 (Dog - L( PLANNING DIVISION: CITY OF TIGARD - SITE PLAN REVIEW Required Setba DIVISION: [r Approved ❑ Not Approved BUILDING PERMIT NO: yy\nv 200q • OCl Side: . 5 Street Side: � -- i Front. rage: . Rear: 1 5 garage: G // Street Trees: LIB" roved ❑ Not Approved K `' Visual Clearance: ved ❑ Not Approved Protected es: WApproved Not pproved Maximum Building Height / feet BY: � Date: / 7 ( CWS Service Provider Letter Required: ❑ Yes Nc , Notes: �°- �ie / B : 4/ Date: l ❑ 0 Received ce �� /�� /� ENGINEERING EPARTMENT: Actual Stope :_.L% Approved ❑ Not Approved / �z j� -- 1�� Site Pla : Approved ❑ Not Approved 1,,r G `aJ By: �L. Pii i� Date:h� ---9 ei il-(44velvi-s d /Aid #7,49:" /1~1 BY: a put att,e,.-- •4. I