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Permit CITY OF TIGARD MASTER PERMIT 111111 , , N COMMUNITY DEVELOPMENT P ermit #: MST2010 00035 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/26/2010 f Parcel: 2S111CA14600 Jurisdiction: Tigard Site address: 9845 SW SATTLER ST Subdivision: Lot: 0 Project: Asbra Project Description: Construct detached 528 sq. ft. accessory structure. 3/11/11, reprinted to add (9) additional branch circuits and replace service panel in main house. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 13 Bathrooms: 0 Second: 0 sf Garage: 528 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 5 Detectors: No Total: 0 sf Value: $20,914.08 Rear: 15 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc!Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 2 0 -200 amp: 0 W/ Svc or Fdr: 15 Ea add 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB U 0 Owner: Contractor: ASBRA, ANDREW J OWNER Required Items and Reports (Conditions) 9845 SW SATTLER ST TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $1,140.92 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 i accordance wi - .proved 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. TENTION: Oregon la • - • re you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0 -0010 through OAR 952 ∎ S i i •/. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332 2344. / A i l� Issu By: 1 __ I . L If .1A_(_,4 Permittee Signature: / Call 503.639.4175 by 7:00 a.m. for the next available inspection date. / This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. : ": CITY OF TIGARD MASTER PERMIT 4. a COMMUNITY DEVELOPMENT Permit #: MST2010 00035 T (GARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/26/2010 Parcel: 2S 111 CA14600 Jurisdiction: Tigard Site address: 9845 SW SATTLER ST Subdivision: Lot: 0 Project: Asbra Project Description: Construct detached 528 sq. ft. accessory structure. BUILDING Floor Areas Required Setbacks Required Stories: 1 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 13 Bathrooms: 0 Second: 0 sf Garage: 528 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: No Total: sf Value: $20,914.08 Rear: 15 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: 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 Srvc/Feeders Branch Circuits • 1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 6 Ea addl 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'I 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) ASBRA, ANDREW J OWNER 9845 SW SATTLER ST TIGARD, OR 97224 PHONE: PHONE: FAX: Total Fees: $953.35 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 0 You c ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Of i l.' y u ` Al ( 1 ,K,(1./ \.3 Permittee Signature: 6 s Electrical Permit Application FOR OFFICE ESE ONE) City of Tigard Date/By: Received No.: -� aOlo ^y 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ✓J IIIIII ' Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: Inspection Line: 503.639.4175 Date Ready/By: luris: ® See Page 2 for T I G A K D Notified/Method: Supplemental www.tigard-or.gov PP lemental 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 ❑ 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: 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: ❑ Health 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 Otv. I Fee. I Total I * 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'l 500 sq. ft. or portion 33.92 1 Tax map /parcel rk: Limited energy, residential 75.00 p,a DESCRIPTION OF WORK (with above sq. ft.) 1) O tt � 14 G, Q/CoAl) Limited energy, multi- family 75.00 2 l giWk CC�� s 40 � QtTit- Nv residential(with abovesq.ft.) n Services or feeders installation, alteration, and/or relocation 4*10441* Y`pTA PA✓�( tt\ �011 td (41^ 200 amps or less 1 100.70 2 2 I ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) 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, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit % , 7.42 2 Address: Miscellaneous (service or feeder not included) Ci /State /ZIP: Each manufactured or modular 67.84 2 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 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr specifically listed (V: hr min) CCB Lie.: Electrical Lie.: Suprv. Lie.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Plan review (25% of permit fee): Print name: I,1),,,oN . 6...I Date: 3( u J I I State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: aed` , j�l— 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. 1: \Building\Permits\ELC- PermitApp.doc 07/01 /10 440- 46I5T(Il/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* I Heating, Ventilation and Air Conditioning System* n 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 ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ 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 07/01/10 Building Permit Application Residential _ "W > �i cii I,IC u c i i 4 ,? `' F . a1 I f s��3i�caF . . y: = a ,;'_ sir ; �., LQ, ;; 5 'z p Received Permit III City of Tigard P Date/I3 : _ . .:l 2 d i co 03S 13125 SW Hall Blvd., Tigard, 0 , F r + \1 -.- Plan Review C Phone: 503.639.4171 Fax: 5045981960 Date/By: �� - a Other Permit: I G i& I Inspection Line: 503.639.4175 R 1 1 2013 Date Ready /By: 2 s: ® See Page 2 for , Internet: www.tigard - or.gov MA Notified/Method. `=7 '0. c� Supplemental Information TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING 0 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- and 2-family g ❑Commercial /indusVial , 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: A s LK S W SkrrLER ST. New dwelling area: square feet City /State /ZIP: .. vkg..1 + 09.. 41-122-74 Garage /carport area: 5 a aPt square feet Suite/bldg. /apt. no.: a A Project name: 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: I Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: 'Q" (�p�' `� Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK 6/4446E) work indicated on this application. cA i o-a �3A i� ms0a.1 • �cra Valuation: $ u. Existing building area: square feet New building area: square feet A PROPERTY OWNER ❑ TENANT _' Number of stories: Name: A A) Type of construction: Address: -1 S45 Sys SIB LE L gt Occupancy groups: City /State /ZIP: 9- 0 6 V123-4 Existing: Phone: ( $b3) Gt51 c a 038 Fax: ( ) New: ig APPLICANT ❑ CONTACT PERSON - NOTICE Business name: Ai/Pit All contractors and subcontractors are required to be Contact name: ps ow 6140V4 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: O ts4 'e+w —curt loNoo .GorN CONTRACTOR Business name: Af f 4. (g4 • NSA BUILDING PERMIT FEES* Address: I (Please refer to fee schedule City/State/ZIP: Structural plan review fee (or deposit): 'S, .5_ Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lic.: Total fees due upon application: Amount received: Authorized signature: �� �p This permit application expires if a permit is not obtained �/ �� �` within 180 days after it has been accepted as complete. Print name: �p ��,� `pj f Date: * Fee methodology set by Tri- County Building Industry Service Bo d. l: \Building\Permits \BUP -RES PermitApp.doc 11/6/07 440 4613T(I 1 /02/COM/WEB) q 7 S 3 Building Permit Application Checklist t s atv One- and Two - Family Dwelling H • iz nl F I C -r Si4ON Ci ty of Tigard Received DateB Permit No 13125 SW Hall Blvd., Tigard, OR 97223 y C Associated permits: Phone: 503.639.4171 Fax: 503.598.1960 24- Hour Inspection Line: 503.639.4175 ❑ Electrical 0 Plumbing 0 Mechanical Internet: www.tigard - or.gov ❑ Other: $ „ r T Hp,ppr O; y, ITEMS VIZE#`KE + lllltl{ UtFOR I'L�flsiYyRF�V1CW k 'Nt1 � Y� 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 Toad. 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 Oreton and shall be shown to be a likable to the •ro'ect under review. i FIURIS IONf1L SPCCII , , -:. �_. ; . ., „ %...._:. 1 .1 $ 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2” x 11" or l 1" 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) 0. R c. n 2 l `c!Fr ,a n t . l4 `w'w�7r H"!"'r N a V '� r Electrical Permit Application , F , .. oR ()� 1 Ic�L.uS c) ,U N ;t, - e " } ,1 i x t :ic 'I Y City of Tigar ‘,..„1/4,,,,,,,.„,,, �� ' Received Permit No.: (�/J /� . , . 13125 SW Hall Blvd., Tigazd,0 7223 x1 0 1'3 Plan Review Date/By: lita Phone: 503.639.4171 Fax: 503.59M* L Date/By: Other Permit: k` :?f�- Inspection Line: 503.639.4175 r Date Ready/By: :Furls: El See Page 2 for ite 1. Gi �BD Notified/Method: Supplemental Information ��, „.� Internet: www.tigard-or.gov ' "� PP r' ' P? 0 l TYPE OF,�IW \GUI '' ' PLAN REVIEW Is New construction ❑ Addition/ 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 ❑ I- 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. p ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: Job site address: 1.2,45 SIN 5k" ` e e. Sr 100HP or more. occupancy. 0 Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: /r� �� ❑ Health -care facilities. ❑ Supply voltage for more than T I l7 I 00,_ Z ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: kik, Project name: ['Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to Job site: 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 energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. 16.) . • // ��^^ Limited energy, multi - family CpIM CA' ,KS6Q,,i �11.. w k, 6 6 residential (with above sq. ft) 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less f _ 10:) ."706(12) 2 +R PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 Name: k,,k) ®` V✓ ke,94 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: (A% II4S '5 Ls g._ Over 1,000 amps or volts 454.65 2 City /State /ZIP: .S, c�� t o'.. QI'1 i " Temporary services or feeders installation, alteration, and /or relocation Phone: (93) 51 — test 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 exc ange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 ll VIA �,, Branch circuits — new, alteration, or extension, per panel Owner signature: O AP V'� Date: A. Fee for branch circuits with 1 . ® APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 each branch circuit 2 Business name: B. Fee for branch circuits without service or feeder fee, Contact name: ` ,V VDU Q first branch circuit 46.85 2 Address: Each add'I branch circuit 6.65 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: ■ 1f 4A, O66fa e, 10A►00_ (,Juh Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: © � N — !1 r, s � e r 1 0 rw�Fl energy p a ne l, a ) or limited- it or (� r V � - i vim+ 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:.. /4 22_ Print name: Date: Plan review (25% of permit fee): State surcharge (12% of permit fee): 1 {7, A? Authorized signature: 1Jy0"1ous„. 0444r, TOTAL PERMIT FEF + f CL b r This permit application expires if a permit is not obtatfied within 180 Print name: 1 ►IDQitw X- Qe 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(11/05 /COM/WEB l Electrical Permit Application - City of Tigard Page 2 Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: • I Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm ❑ 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 ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ 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 1 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. f\v.4 JAf Print Name of Permit Applicant x a ca • C Signature of Permit Applica t Date Permit # : , � 2 C � � C) • Q c)O 5 Address: % L 01/4:0&4 r v t Issued by: ate ' & ( (� This Copy for Permit Offices f- s • . , Ai S • MAR 11 2013 / .---- \ - v - e( ' . -. -..- . _ .. - .. , . gatiS Sw �t - =H�. Si t • : ; !, .,- ; iGARD, ....... . - ... G DIVISION • — - — — • �, ara T ..e N'p; o^ • -I; ; ZtI XZz I . LZ\ C, O./u.9C, , . S Eew 7 l Z tcPe `� le - I /,? = �� 1Q� e I I of less i { Vvp I /5- � ,,, 4 / L c-t S ►,.., :•;• . ' ! i ..' . - ' / n, p R V s4 ,•-• I,/ Qv . A 1 CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO.: u PLANNING DIVISION: Required Setbacks* • QApproved ❑ Not Approved Side: S Street Side: G• age: Rear: Front. - , - Vi NOT : 1 sual Clearance: Approved ❑ Approved Maximum Building Height feet CWS Service Provider Letter Required: D. Yes 1No 0 Received B Date: 1i ENGINEERIN ,EPARTMENT: roved Actual SI'.pe: % 121 Approved ❑ Not App Site Pia (Approved ■ Not Approved B Date: 3 l /6 Notes: 11-e L ch'n`k,..' xv �'✓(.��� CITY OF TIGARD - SITE PLAN laVIEW BUILDING •ERMIT NO: Street Trees: la Approved ❑ Not Approved Protected Tr / 7i a A pproved ❑ 17/Tved Notes: By: /Od ! /.glr Date: /