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Permit /- t, .�' MASTER PERM1 006.00126 T CITY OF TIGARD PERMIT #: -= L,, _ DEVELOPMENT H PMENg Tigard, DATE ISSUED: 7/6/2006 -639 -4171 PARCEL: 25111 CB -01309 SITE ADDRESS: 14865 SW 104TH AVE ZONING: R -3.5 SUBDIVISION: DEL MONTE SUBDIVISION NO.2 LOT: 018 JURISDICTION: TIG Project Description: New bath, laundry area. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: s1 BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: VALUE: 1,800.00 OCCUPANCY GRP: R3 BDRM: 1 BATH: TOTAL: 0 sf REAR: PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: 1 FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 2 W00DSTOVES: 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/O SVC /FDR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: r' S 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 ARENSPC OCC: ELECTRICAL - RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO & 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 6 SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other MAUREEN OLBRICH KAIZEN HOME IMPROVEMENT applicable laws. All work will be done in accordance with approved 14865 SW 140TH AVE 815 NW NAITO PKWY # 317 plans. This permit will expire if work is not started within 180 days TIGARD, OR 97224 PORTLAND, OR 97209 of issuance, or 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 Phone: 503 372 - 9828 Contact #: PRI 503 248 - 2033 of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1 -800- 332 -2344. Reg #: TOTAL FEES: $ 336.87 REQUIRED ITEMS AND REPORTS Issued By : 4 Permittee Signature • %� ,,,� .... >�� ____ . 7 Jil■ 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. o, Building Permit App E N ti' FOR OFFICE USE ONLY a Received ,( City of Tigard Date /By: ( 7p 1 Permit No. , Tigard, OR 97223 - 4 13125 SW Hall Blvd., Ti g Plan Review '4%1V i , a , CD _ Other Permit: I Phone: 503.639.4171 Fax: 503.598.1960 MAY 2 5 2 0 DateB Inspection Line: 503.639.4175 ;,_ Date Ready :y: ® See Attached Checklist for Internet: www.ci.tigard.or.us Notified/Method: 7 3 2b �� I (( Supplemental Information CITY OF flUARD s ,t M ta v\ ✓-e „- T14-0W ORK) l/ ti NTO REQUIRED DATA: 1- AND 2- FAMILY DWELLING 1 ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Et Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ ® 1- and 2- family dwelling ❑ Commercial /industrial / 'S'd ' ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE IN AND LOCATION Total number of floors; ` � dwelling } - Job site address: l y (^ S.� I I l• t 1 ' - : A v L New dwellin area: square feet City/State /ZIP: — T t ` c ,,,,j_ ? f) ,,_ I C 9 1 2-1-y Garage /carport area: square feet Suite/bldg. /apt. no.: ` Project name: Covered porch area: square feet Cross street/directions to job site: �(e.. — 9 t J . . 1 _ , C e , r , t ._ ?r 1, , c,i 1oS / Deck area: square feet Q■ t, / h, — n)-, I C) (-, /gyp, ) Le 4 r s, S I,' Dc L ) `I 0 ,,,k_ / Other structure area: square feet L(- -4— 1 0 y “` d ,`4, REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: 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. � —i / Valuation: $ /�+ "Y - (41'C [4 t,i o) , --1 / .l u .%G'v 6 vC y g L - 1"F S ,-. C: c <- ,�, \ 1 7 t, I _ Existing building area: square feet L, , .l-C ...,t.: Rc ..tout tc,v.t av-. Ci'v- - e � c)<.- k.i '1-ct.0 r. J New building area: square feet IR PROPERTY OWNER ❑ TENANT Number of stories: Name: I GiSJV'Cc:�. f 64 v►j P 6 ' , a.• Type of construction: Address: I y ' (ekt A Occupancy groups: Sb � I P Y City /State /ZIP: To r vZ\ (5 (Z C1 :>' 2:b.b Existing: Phone: ( eV - C1' g 2 Fax: ( ) New: ❑ APPLICANT ❑ CONTACT PERSON . NOTICE Business name: Ket .-e , , 4 ,, 1 v., ) „ `, , ,, i- All contractors and subcontractors are required to be Contact name: �f, licensed with the Oregon Construction Contractors Board t 1 / ''i I--c, ' 7 under ORS 701 and may be required to be licensed in the Address: U t S 7 t. Vim i { 4-o I L.— c S' L, / �-, ?_ (v jurisdiction in which work is being performed. If the City/State /ZIP: `� y I �, t (Z r LO n a pp pP l icant is exempt from licensing, the following reasons y: Phone: (5,) - k,) y� - jo S 2 ) Fax:: ( ) E -mail: 11 (- b:, ..vic i .,t .- v ..,4. ( n ' CONTRACTOR Business name: Kfit .L ‘,.,` 1 }-Ir, r -� I , , ,rv-' s r `{- BUILDING PERMIT FEES* Address: $ 1 rl tc1 1N),..t, ) ti k,,,,„ S v " - 1 .k-< 314 Please refer to fee schedule. City /State /ZIP: 1) j ( • ) C� (� iJ S ': L Ln Fees due upon application q ., (3 Phone: (S'u ",) ay 5'-- an 32? Fax: ( ) Amount received t CCB lie.: j 5 7'i ZS e1� 3` 7 O g e Date received: 5' 2s a ( �/ Authorized signature: i %.... ��. (_ � This permit application expires if a permit is not obtained V within 180 days after it has been accepted as complete. Print name: M. C \V Y e P ON b r I e_ h Date: - 4j \ 2� \ 1 . , b * Fee methodology set by Tri -County Building Industry Service Board. ' Plumbing Permit Application FOR OFFICE USE O:NLY City of Tigard Received Perm N it ! c^d -, Date 13125 SW Hall Blvd., Tigard, OR 97223 Review Plan view M Plan Re Phone: 503.639.4171 Fax: 503.598.1960 onnii lid A„,,, i � Date /By: Other Permit No.: 24- Hour Inspection Line: 503.639.4175 ,,7 1.... Date Ready/13y: Juris: RI See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. 1 Total [ . Addition/alteration /replacement El Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 a 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building El Multi-family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: I Li g5 S W 1 04 i t„,,, Catch basin or area drain 16.60 City/State /ZIP: I i a 4 9 L Z4 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: ) I Project name: Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: - b 2 _ G1c� h) a�tf ev 4,., vti L,,t t� (Wer9 Manholes 16.60 Rt��t,� t n, O ( -) �-Q 0-, Bw Dtflo,n `J r- 1 Rain drain connector 16.60 Li F 4. etv J 0 q J 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.: Absorption valve 16.60 . L (� DESCRIPTION OF WORK Backflow preventer Page 2 c hPc. {�. ' )� c7�t Imo•++ X , u h J ✓ � o v_ e, 1 a � c...Fa I- 5 C, i ,, Backwater valve 16.60 1 n dJ ^ �J/ ' e l Clothes washer / 16.60 \\ 6 i+�.yn4 . ' e X Ovs4 A tin L VLt r.. K c. T Gwti K.! Dishwasher 16.60 rg. PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: H a t re e vl 4,-' 6 O 1 brr c .-s Expansion tank 16.60 Address: I4 0 S S � I � 04 A , Fixture /sewer cap 16.60 City /State /ZIP: -- T. , to ( 4 . 4 - 2 _,, Floor drain/floor sink/hub 16.60 Phone: (5103) 3 t � Z _ e g g 2s Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: V .ct i..ee4n r I , v� Interceptor /grease trap 16.60 - Contact name: K •e 711 .1 Medical gas (value: $ ) Page 2 Address: S I S x w !' tt : 6 P Iz c) '1 Primer 16.60 City /State /ZIP: 6 v(Z Roof drain (commercial) 16.60 - , Phone: (Svc ) ,?if ti - '3 3 Fax: : ( ) Sink /basin/lavatory 16.60 +, Tub /shower /shower pan / 16.60 E -mail: i . -G El t�� k l rpm J (0-1,,,.- Urinal 16.60 ` CONTRAC OR Water closet / 16.60 Business name: E ,, r\ey; fi U i„t 6 inn r ` Water heater 16.60 Address: p p; .So k' 2...2) <a S - Other: Subtotal City/State /ZIP: f i a ,,, Q. l )-. p, l4 2-6 I - 39 R Minimum permit fee: $72.50 Phone: S 0,-; ) b l{ ._ 4 181 Fax: ( ) Residential backflow minimum permit fee: $36.25 7 a CCB Lie.: 18 Plumbing Lic. no.: Plan review (25% of permit fee) �� State surcharge (8% of permit fee) , Zd Authorized signature: l TOTAL PERMIT FEE Print name: � r 1�v�.e t_� e , b r, ,__1,-,_ Date: 6\2:5 \ d This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site'UtilitieS Qty. Fee (ea)' . Total Square Footage: Permit `Fee: Footing drain - 1' 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00 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 . Valuation: Permit Fee: 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 Fixture or Item Qty Fee (ea) Total additional $100.00 or fraction thereof, to and 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. Fixture Work: Plan Review for Complex Structures Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. accurately report fixtures could result in increased sewer fees *. Please check all that apply. `Quantity by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing. ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi /Whirlpool providing services to human beings. Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service - Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor/Water Aspirator are being installed for the food service area. Dishwasher - Commercial ❑ Any new residential building containing three (3) or more -Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system. Eye Wash Floor Drain/sink - 2" 3 » Submit 2 sets of plans with any of the above. - 4" Car Wash Drain Isometric or Riser Diagram • Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings Disposal -Commercial three (3) or more stories in height. - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor • *Note: If the fixture work under this permit results in an Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. Mechanical Permit Application ° FOR OFFICE. USE ONLY City of Tigard Date/13y: Review Permit N Received Other Perm1 Y 1 it: f / / l 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 /ramr Illr' Date/By: Inspection Line: 503.639.4175 1 Date Ready/By: Juris: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ' Mechanical permit fees* are based on the value of the work CI New construction I.Addition/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* 0 I - and 2 family dwelling ❑ CommerciaUindustrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: / hl N � Air conditioning or heat pump 6 L (� 4 f T✓ (requires site plan showing placement) 14.00 City /State /ZIP: -i �Q 0 (� C i-Z Z�. Furnace 100,000 BTU (ducts /vents) 14.00 l ) 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: C) di - Ici 6,) 40 C rd - fv ( r . L (�` BPS i) Duct work 14.00 Hydronic hot water system 14.00 P t2 d)') � D � Av-e I Le- ( "`(- �� Si •) P I 0�" ( / h b f l Residential boiler (radiator or � Li l fi A hydronic) 14.00 ' r "'i A-)- ( l ', "�' Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Flue /vent for any of above 10.00 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 1 )6..141.0-00,- Gas fireplace 10.00 1 -P.cif s- ) (a. v ■� atv� a u rc� -.e )- .S i c fu.. Flue vent for water heater or gas 1/45 \tom /� 1 ( n fireplace 10.00 A 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: C Ct i (■,, { , L O Environmental exhaust and ventilation g / -< ' Range hood /other kitchen Address: q C+ ICS S 1.,:s? 1.,:s? (0 t l f equipment 10.00 City/State /ZIP: �t - C) (Z s '4- .2.-.2....:"( Clothes dryer exhaust ( 10.00 Single -duct exhaust (bathrooms, Phone: ( SCE) 3 .,_ . g Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: K I Z-F 4,.€ I 14 ro��-F t ,,, "` i �J Fuel piping Contact name: 6 et oY. t h7� $5.40 for first four; $1.00 for each additional �. Furnace, etc. Address: 1 S 3 l�( , �d . c. S `' �-� S (- Gas heat pump City /State /ZIP: `��,.kt 0 (L 0 9 •i Z 9 Wall/suspended/unit heater Phone: ( S�) 1 b_)o' �) Fax: : ( ) Water heater \ Fireplace E -mail: )„ L 1 " (<, r ,Ze �f `-' Lio✓. .e (L� _ 1T v ,--,,,..0 C 0'uA Range CONTRACTOli_ - Barbecue Business name: J [ I Clothes dryer (gas) I sE ` Cr". 1 d -.(% I / ,----(.= .. Other: Address: v ( r j ; j y > `) c: , y (�" ,. U • �� %0 • l,T ` MECHANICAL PERMIT FEES* City/State /Z1P: t 1 ] E � I c�- • Q ©St_ � 61,i L� Subtotal ) . L Minimum permit fee ($72.50) - 7 7 , SZ) Phone: (c0-7,) I 6)- :D..0. it? 7 Fax: ( ) Plan review (25% of permit fee) CCB lic.: ( S C - 1" Zj State surcharge (8% of permit fee) C ,% C) TOTAL PERMIT FEE Authorized signature: �� " \(..---.._ This permit application expires if a permit is not obtained within 180 n days after it has been accepted as complete. I Print name: `V \��`' �.e yl 0 1 b r t c _` \ I Date C k 2 \ b o I # Fee methodology set by Tri- County Building Industry Service Board 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 12/03 2 Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Received Date /By: Permit No\v 4 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /r,� Phone: 503.639.4171 Fax: 503.598.1960 t 'd� i ll � I- Date /By. Other Permit: Inspection Line: 503.639.4175 'IL Date Ready /By: Juris. ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ® Addition/alteration /replacement Please check all that apply. ❑ Demolition ❑Other: ❑Service over 225 amps, comm'! ['Hazardous location ['Service over 320 amps - rating DBuildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential _g 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION - DEgress/lighting plan RV park Job no.: Job site address: 0.46.,,s- s w 0 4 44 -A y , ❑Health -care facility ['Other: Submit 2 sets of plans with any of the above. City/State /ZIP: ` e elc4 y) go _ C.� ' Z2;2-4 The above are not applicable to temporary construction service. J Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE * . R . Description I Qty. I Fee. I Total Cross street/directions to ob site: single- or multi-family dwelling ��'"l �l� .' ✓ k1e.g� New residential sin g Y g unit. Left- r^ Includes attached garage. g - lei 'l7� E, I C C�AN L e -c e.Fi a�, Si.-'; f )10 h 0.,- ) L.,,/00- 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 • Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular /' (� r1 dwelling, service and/or feeder 90.90 2 l Ie u� Li (for -, r Oa.t;.' Q Cw't°c. Cl ,/CS 1 /� 5 n 04 (v I I-s- Services or feeders installation, alteration, and /or relocation 6 ;t It-e v�F Pa rtQu ` ctt t-c,, lY u- r' L..c 200 amps or less 80.30 2 ig PROP OWNER 1 i ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: I t^r.64-, i eiA Q f bt L 601 amps to 1,000 amps 240.60 2 Address: 1(1 ' ( � t- w 5 ` C , `t c`�t,� Over 1,000 amps or volts 454.65 2 7 ('� Reconnect only 66.85 2 City/State /ZIP: , C& r 0 y(. 9 I-Z2-1- Temporary services or feeders installation, alteration, and /or Phone: ( 1) 2_, _9 )._ 2000 0 amps R Fax: ( ) relocation 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 600 amps 133.75 2 Owner signature: Date: Branch circuits new, alteration, or extension, per panel ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with ` service or feeder fee, each 6.65 2 Business name- C/ wt (- l tc.. ✓"rs_, t w. Oro ve.v . ' branch circuit � , B. Fee for branch circuits Contact name: , < _k I k o �. f .,,.-, without service or feeder fee, ) O first branch circuit / 46.85 2 Address: 1 i . \ ,) N k S .3 I - Each add'l branch circuit 6.65 2 City/State/ZIP: ) Miscellaneous (service or feeder not included) Fax: : Pump or irrigation circle 53.40 2 Phone: (�u �4 J � ' t ' 3 ( ) Sign or outline lighting 53.40 2 E -mail: ..,-4c Ce ICA i .La- tn,p (,v r'- r✓1, C.,.ryv`. Signal circuit(s) or limited- ' CONTRACTOR energy panel, alteration, or \� 1 \ - extension. Describe: Page 2 2 Business name: ? t✓ \ � \ ci v W `c\ t. cr S ;i Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City/State /ZIP: Investigation per hour (l hr min) 62.50 Phone: ( ) Fax: ( ) �- yl ry , - 9 6 51 Industrial plant per hour 73.75 l. ELECTRICAL PERMIT FEES* CCB Lic.: Electrical Lic.: Suprv. Lie.: Subtotal (Q (p , Cb 0 Suprv. Electrician signature, required: Plan review (25% of permit fee) State surcharge (8% of permit fee) 5 . > 4 Print name: Date: TOTAL PERMIT FEE 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: * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. 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* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) 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 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE PACIFIC NORTHWEST ELECTRIC INC 16200 WIDMAN CT OREGON CITY, OR 97045 Electrical Signature Form Permit #: MST2006 -00126 Date Issued: 7/6/2006 Parcel: 2S111 CB -01309 Site Address: 14865 SW 104TH AVE Subdivision: DEL MONTE SUBDIVISION NO.2 Block: Lot: 018 Jurisdiction: TIG Zoning: R -3.5 Remarks: New bath, laundry area. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: MAUREEN OLBRICH PACIFIC NORTHWEST ELECTRIC INC 14865 SW 140TH AVE 16200 WIDMAN CT TIGARD, OR 97224 OREGON CITY, OR 97045 Phone #: 503 - 372 -9828 Phone #: 503 - 657 -1188 Reg #: ELE C6 LIC 162893 SUP 5089S AN INK SIGNATURE IS REQUIRED ON THIS FORM X . ature of Supervising Elec If you have any questions, please call 503.718.2433. ' _ - -.' CITY OF ' :. ��n m n n�vu TIGARD . . � BUILDING DIVISION PERMIT k | ~~~~^~~~~^^~~° ~~^~^~~^~~^~ #: °'2006'00126 | 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7y6/2006 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 *.S0w�� ^��. INSPECTION WORKSHEET FOR DATE: i1/2OY2OO8 TIME: 7:01AK4 —pAGE: 12 SITE ADDRESS: 14865EW104THAVE CLASS OF WORK: SUBDIVISION: DEL MONTE SUBDIVISION NO.2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH . DESCRIPTION: New bath, laundry area. 7/24166 Added (2) branch circuits & ejector pump in crawl space. OWNER: OLBRICH, MAUREEN PHONE #: 603-372,9828 CONTRACTOR: KAIZEN HOME IMPROVEMENT PHONE #: 503-248-2033 Inspection Request Scheduled For: Date: 11/20/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message . 299 Final inspection 040049-01 503-939-9092 Y Corrections/Comments/Instructions: � � (��/ /-1w)/4L- Ai~/A z- (�'14.'e b�� . �� - Y�— aCe v ��N� — , '� ~ . ~ ) ""�� ^' ' — �_ -To' t �� ~ �� _ -' ._� 'Z ^ ' . PARTIAL APPROVAL ri CANCEL I I NO ACCESS FA|L -- 0 CALL FOR INSPECTION H | /\DDDDONAL FEES ASSESSED Inspector: Date: ^ne-, Phone #: (503) 718- • ^.. . _ _ �� ` CITY ��U�� - ,, ��n w w OF m n��mno�� . ^ ' � BUILDING DIVISION ~�~~"~~~�,,~=° ~~,°"~~"~~,~ PERMIT #: hM81�OD��QO12G 13125 SW Hall Blvd., Tigard, OR 97223 ( ' • PER /�� DATE ISSUED: 7/6/2006 �� Phone: (503) 639-4171 4701 0901 I 1 ff. Inspection Requests (24 Hrs.): (503) 639-4175 v�A '11., INSPECTION WORKSHEET FOR DATE: 10300006 TIME: 7:05AM PAGE: 13 SITE ADDRESS: 14865 GW104TH AVE CLASS OF WORK: SUBDIVISION: DEL MONTE SUBDIVISION NO.2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH . DESCRIPTION: New bath, laundry area 712406: Added (2) branch circuits & ejector pummp in crawl space. . OWNER: OLBRICH, kAAUREEW PHONE #: 503-372-9820 CONTRACTOR: KAIZEN HOME IMPROVEMENT PHONE #: 503-243.-2033 Inspection Request Scheduled For: Date: 10/30'2006 Pour Time: Code # Inspection Description Confirm # Contact # Message ' Mechanical ewhsmico|fioa} 039011-01 503-939-9092 N 9�� Corrections/Comments/Instructions: . . ■ APASS . 0 PARTIAL APPROVAL ri CANCEL 0 NO ACCESS | I FAIL I I CALL FOR INSPECTION �� ADDITIONAL FEES ASSESSED ' ' / / �� ~~� ^�'n��' -�� k / � � ~ Inspector: ^��1 �^.~ i Date: c� Phone #: (503) 718- -A / ^ IdAtti _ .` ^ '^ — ____ _ -- CITY OF °' � ^` . ~ ��nn m ��u TIGARD . BUILDING ~~"°"~,"~~.. ��U�� DIVISION ��UU ' PERMIT #: MST2006-00126 13125SVVHoU . , ^ Blvd., OR DATE ISSUED: 7/6/2006 Phone: (503) 639-4171 Inspection Requests (24Hroj:(5O3)830'4175 =8��'NI. INSPECTION WORKSHEET FOR DATE: 1026/2006 TIME: 7:04AM PAGE: 14 gu4b"c,/4 / , )ku�mg SITE ADDRESS: 14866SW1[4THAVE CLASS OF WORK: SUBDIVISION: DEL MONTE SUBDIVISION NO.2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH ' DESCRIPTION: New bath, laundry area. 7/24/06: Added (2) branch circuits & ejector purnpin crawl space. OWNER: OLBRICH, MAUREEN PHONE #: 503-3119828 CONTRACTOR: NAJZEN HOME IMPROVEMENT PHONE #: 605'248'2033 Inspection Request Scheduled For: Date: 1026/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 038800'01 503-939-9O92 N • Corrections/Comments/Instructions: . • PASS . PARTIAL APPROVAL n CANCEL I | NO ACCESS ri FAIL I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: e1 Date: Phone #: (503) 718- CITY F TI AR D l�v -103- n�� /01,0- ® G t. BUILDING DIVISION PERMIT #: MST2006.00126 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/t3/2006 Phone: (503) 639 -4171 u'�Nlu , bli�IG�iIIi Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/25/2006 TIME: 7 :04AM PAGE: 42 SITE ADDRESS: 14665 SW 104TH AVE CLASS OF WORK: SUBDIVISION: DEL MONTE SUBDIVISION NO.2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH DESCRIPTION: New bath, laundry. area. 7124106: Added (2) branch circuits & ejector pump in crawl space. OWNER: OLBRICH, MAUREEN PHONE #: 503.372 -9828 CONTRACTOR: KAIZEN HOME IMPROVEMENT PHONE #: 503. 248.2033 Inspection Request Scheduled For: Date: 7/25/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 033657 -02 503 - 939.9092 N Corrections/Comments/Instructions: r /1 iUf.i.I l ,A1 _ _ " i A JP Jr • 41 w % / . //i. / tI fr' 0 Law ( -e-id- 117 P All t \A - I r tij 4 ) J # I /, , • ce ouvv-ek - ))/011V-0 r W Lott(' 1 - fe ' PASS ri PARTIAL APPROVAL Ti CANCEL NO ACCESS n FAIL n CAL OR INSPECTION n ADDITIONAL FEES SSESSED i Inspector; ��" ' D ate: 4eone #: (503) 718 - ` tit CITY ��U�� ' `^' . s. ' ��m n m ��m o o��a�� . BUILDING K�U��U��U��N� � DIVISION PERMIT #: MST2006-00126 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7y6/7006 Phone: (503) 639-4171 Inspection Requests �4Hmj (503) =&�@� Hrs.): °� INSPECTION WORKSHEET FOR DATE: 9/11/2006 TIME: 7:00AM RAGE: 23 SITE ADDRESS: 14866SW CLASS OF WORK: SUBDIVISION: DEL MpNTE SUBDIVISION N().2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH DESCRIPTION: New bath, laundry area 7/24/06: Added (2) branch circuits & elector pump in crawl space. OWNER: ()LBR|CH.MAJREF_N PHONE #: 503-372.9828 CONTRACTOR: KAIZEN HOME IMPROVEMENT PHONE #: 583 . Inspection Request Scheduled For: Date: 9111/2006 Pour Time: . Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 036316-01 5O3-939-9092 N Corrections/Comments/Instructions: ( � / ' .,_ .,/ . 0 - " /2. . g ~^SS H PARTIAL APPROVAL [ CANCEL | I NO ACCESS FAIL � CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED . ��l ~�^� ril \ 7 � / �� Inspector: �� Oate� ' Phone #� (SO3> 718' ' ~ ~ ' ' - ~ -- ' ' CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006-00126 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/612006 Phone: (503) 639- 4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/24/2006 TIME: 7:01AM PAGE: 31- SITE ADDRESS: 14865 SW 104TH AVE CLASS OF WORK: SUBDIVISION: DEL MONTE SUBDIVISION NO.2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH DESCRIPTION: New bath, laundry area. OWNER: OLBRICH, MAUREEN PHONE #: 503 - 372 -9828 CONTRACTOR: KAIZEN HOME IMPROVEMENT PHONE #: 503 -240. -2033 Inspection Request Scheduled For: Date: 7/24/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 033669 -02 503 -624 -4880 Y Corrections/Comments/Instructions: /I 'ASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS • FAIL fl CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED i 'v wk - e .--- �Inspector: Date: P Phone #: (50 718- • CITY OF TI•GARD . BUILDING DIVISION #: MST2006.00126 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/612006 Phone: (503) 639 -4171 irtit i Ispection Requests (24 Hrs.): (503) 639 -4175 l l.. INSPECTION WORKSHEET FOR DATE: 7113/2006 TIME: 7 PAGE: 31 SITE ADDRESS: 14865 SW 104TH AVE CLASS OF WORK: SUBDIVISION: DEL MONTE SUBDIVISION NO.2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH DESCRIPTION: New bath, laundry area OWNER: OLBRICH, MAUREEN PHONE #: 503 -3 ? -8828 CONTRACTOR: KAIZEN HOME IMPROVEMENT PHONE #: 503-248 -2033 Inspection Request Scheduled For: Date: 7/13/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 315 Post/beam plumbing 03305D -01 503 - 624 -4880 Y Corrections /Comments /Instructions • • ..0(7/"1"Thae i i.:) M 6V %_i ce - -- alWr SS ❑ PARTIAL APPROVAL ❑ CANCEL I l NO ACCESS FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: v Date: ' / l Phone #: (503) 718- -1.3/ y am - . CITY OF TIGARD . BUILDING DIVISION PERMIT #: MST2006 -00126 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/612006 Phone: (503) 639 -4171 /mmotiv Inspection Requests (24 Hrs.): (503) 639 -4175 - ° ='I �.. INSPECTION WORKSHEET FOR DATE: 7/2612006 TIME: 7 :07AM PAGE: 5(3 SITE ADDRESS: 14865 SW 104TH AVE CLASS OF WORK: SUBDIVISION: DEL MONTE SUBDIVISION NO.2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH DESCRIPTION: New bath, laundry area. 7/24/06: Added (2) branch circuits & ejector pump in crawl space, OWNER: OLBRICH, MAUREEN PHONE #: 503- 372.3828 CONTRACTOR: KAIZEN HOME IMPROVEMENT PHONE #: 503- 248 Inspection Request Scheduled For: Date: 7/2612006 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 033762 -02 503-939-9092 Y ZbA _ 1 �suir- n�k.. Corrections /Comments / Instructions: s f: PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: / �� Date: 7-22- Phone #: (503) 718 - CITY OF TIGARD . . a. BUILDING DIVISION PERMIT #: NIST2006M0126 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/0/2005 Phone: (503) 639 -4171 : �a4Nu�1g l Inspection Requests (24 Hrs.): (503) 639 -4175 _..._... "__.. INSPECTION WORKSHEET FOR DATE: 7/26/2006 TIME: 7:07AM PAGE: 51 SITE ADDRESS: 14865 SW 104TH AVE CLASS OF WORK: SUBDIVISION: DEL MONTE SUBDIVISION NO.2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH DESCRIPTION: New bath, laundry area. 7/24/06: Added (2) branch circuits & ejector pump in crawl space. OWNER: OLBRICH, MAUI EEN PHONE #: 503. 372 -9028 CONTRACTOR: KAIZEN HOME IMPROVEMENT PHONE #: 503 -246 -2033 Inspection Request Scheduled For: Date: 7/26/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 615 Mechanical rough -in 033762 -01 503. 939.9092 N Corrections /Comments /Instructions: A, ; (JA- - 6 7 j R-^€ ' ,,,° -Fr.° t 77 -' 'S • PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I I FAIL . I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: Date: 7 -2.6 Phone #: (503) 718 - - 7-` <- CITY OF TI•GARD . BUILDING DIVISION PERMIT #: MSI`2006.00126 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/20116 Phone: (503) 639 -4171 /Omurdpip,��'��III Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/25/2006 TIME: 7:04AM PAGE: 43 SITE ADDRESS: 141365 SW 104TH AVE CLASS OF WORK: SUBDIVISION: DEL MONTE SUBDIVISION 140.2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH DESCRIPTION: New bath, laundry area 7/24/06: Added (2) branch circuits & ejector pump in crawl space. OWNER: OLBRICH, MAUREEN PHONE #: 5Q3- 372•982t) CONTRACTOR: KAIZEN HOME IMPROVEMENT PHONE #: 503-248-2033 Inspection Request Scheduled For: Date: 71251 1006 Pour Time: Code # Inspection Description Confirm # • Contact # Message 615 Mechanical rough -in 033667-01 503 -938 -9092 N Corrections /Comments /Instructions: � � - - ' /-4 ff�4 r C �,�¢C/` • fr' % 1 • -T ✓- //6 �� ✓ ar ��i C/-/C/ �;, / G/ j L �c . G'/•r -Lt ❑ PASS n` PARTIAL APPROVAL n CANCEL ❑ NO ACCESS IL n LL F R INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: , . Date: 7 —'"-- G Phone #: (503) 718 -5,,� CITY OF TIGARD . .. .. . . ,, A BUILDING DIVISION PERMIT #: MST7006-00126 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/1006 Phone: (503) 639-4171 /411 NA Inspection Requests (24 Hrs.): (503) 639-4175 ,T. 14' ''--. V INSPECTION WORKSHEET FOR DATE: 7/26/2006 TIME: 704A1v1 PAGE: 41 SITE ADDRESS: 14865 SW 104TH AVE CLASS OF WORK: ) SUBDIVISION: DEL MONTE SUBDIVISION NO.2 LOT #: 018 TYPE OF USE: PROJECT NAME: OLBRICH DESCRIPTION: New bath, laundry area. 7/24/06: Added (2) branch circuits & ejector pump in crawl space. OWNER: OLBRICH, MAUREEN PHONE #: 503-372-9828 CONTRACTOR: KAIZEN HOME IMPROVEMENT . PHONE #: 603-248-2033 Inspection Request Scheduled For: Date: 7/25/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message ' 275 Framing 033657-03 503-939-9092 N Corrections/Comments/Instructions: ";- .--, G. - 5 . • ' 5 . , . —1,',.-A—, _ 7 ---_-/ - A P ,,....27- n PASS 17%1 APPROVAL E CANCEL III NO ACCESS I I FAIL I I CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED Inspector: .--... I Date: - 7.---:S ----- exf , ' Phone #: (503) 718- . _