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Permit
CITY OF TIGARD ELECTRICAL PERMIT 11 4 l , COMMUNITY DEVELOPMENT Permit #: ELC2011 -00512 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 09/16/2011 Parcel: 2S104DC00300 Jurisdiction: Tigard Site address: 13354 SW BENCHVIEW TER Project: GREINKE Subdivision: BENCHVIEW ESTATES Lot: 3 Project Description: (1) branch circuit for sunroom lighting. Contractor: A & J ELECTRIC Owner: GREINKE, MARK S & PAMELA J PO BOX 330 13354 SW BENCHVIEW TER FOREST GROVE, OR 97116 TIGARD, OR 97223 PHONE: 503 - 359 -5891 PHONE. FAX: 503 - 359 -1981 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 09/16/2011 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 09/16/2011 $6 74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 Required Items and Reports (Conditions) 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 -001 -0090 You may obtain a copy of the ru =- • di -Ct questions to OUNC by calling 503 232.1987 or 1 800 332 2344 Issued By: — Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. 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. Sep 15 11 01:50p Leeann Greason 503-359-1981 p.2 . i', ,,\ ., Electrical Permit Application ce.‘,- FOR OFFICE l SE ONE 1 City of Tigard e% r l,'' \\ Received el DaiefRy: it 15 - 71 ryi Permit No t _ ;-=.7.1__C, ;)1) I 1 —4)5 • i • 13125 SW Hall Blvd , Tigard, 01k972:2 ' -k s 'c) , Plan Review 3 Phone: 503.639.4171 Fax: 503.598.1960 ' ,c„:}?"-‘ N,, ADatefBv: Other Permit. T1 Inspection Line' S03,639.41 75 C D C 1 .. \ '''' C. 3°:"" Date Read}/ I 1Z See Page 2 for Internet. v;ww.tigard gov ci A R.D 6 t e • \'''' \ Noll fierPvterhod. . I Supplemental Information .,;- , 4".' - ..‘ t ' 4, .4 ii?dr.41,l;te, :-.W , ■:...:-%. - e-,.-4e-,.i.i , . - .rr.r2,. 'r4:'`e .m.rwo.4. mic...: :45 ,, c....L. , t'r..- El New onstruction „AdditionialterationfIbiement check eck all that apply (submit 2 sets of plans wfiteras checked below): c NiraC 0 Service or feeder 400 amps or more El Building over three stories. p Demolition 0 Other where the available fault current El Mar nas and boatyards. ''' t - itt = ' 4 ' ti ', - -.' • '''=:V...- cii' i ' ' :StIFF , M:Va...,4- exceeds 30,000 amps at 150 volt or 0 Floatiog buildings 'die.4;:ii.::i74-g-i'24 less 173 ground, or exceeds 14,000 CI Commercial-use agricultural - and 2 dwelling D Com merciallindustrial ED Accessory building amps for all other installations buildings. El Multi- family 1=1 Master builder 0 Other: 0 Pic primp. I:I Installation. of 75 KVA or .- ,. t=.=.i•-..1-----. ...,-;,-,-, - system larger separately dend system vc ' ' , . .itTiittiftt'lttah:e13V7iPiIrr '; :: i'P' . 0 Emergency system ;.-7r;: El ' • i :-.t.-: :•---. ,.'.-,-',' ' , --.t . i.- rt. -''oi'':t't .' . 7- '' '". 1 :-.--,L1 '''•=4.- .4_ Addition of new motor load of ID "V, "b"."1-2", "1-3", Job no,: Joh site address: "..7-2-;"--,-..----N "7 0 Siz or more residential units. El 1 00HP or more. ocuripaney. Recreational vehicle parks City/ ,„ Stale/ZIP: - "i ---... a .....c.. D Health facilities 1E15143ply voltage for more than 0 Hazardous locations. 600 volts comical. _ Su iteibldg.tapt. no.: Project name: 1=IService or feeder 500 amps or more. - Mr"i7,:iiirlk'n':':.'f'tfltt4VW-5= __ C ross street/directions to job site: naertinita. Qrv 5 .. New residential single- or multi-family dwelling unit. Includes attached garage. 1,000 sq R. or leAs 1610_54 4 Ski bdiv ision : Lot no.: Ea. add'I 500 sq R. or portion 33.92 1 Tax map/pal eel no.: Limited energy, residential 67.84 2 - L't,.- ' - .g•••• ..A.T._.:2 ‘e, :..,, _tin: eri Limited energy, multi-family 67.84 2 l '"•-....--..?"--. '' ''`-::-..C:72;, -- "C - --. 1 '•-<"-, 11. -- - - -- ---,. " ----. residential (with above sq a.) • Services or feeders installation, alteration, and/or relocation 200 snips or less 100.70 2 f ; i 1", -' 1. - -1: 1 1W - :::il'`I'Miz"MPeri.....A1?-•Vii.imSet."MiTt'likt:17i"11 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 snips 301,04 2 Address: Over 1,000 amps or volts 552.26 2 City/SIDe/ZIP: Temporary services or feeders installation, alteration, a ndior relocation Phone. ( ) Fax: ( ) 200 amps or less 59.36 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel .. A. Fee for branch circuits with '4 .- I TI C I34 ,W1,11rW i IT above servtce or feeder fee, 742 2 each branch circuit Business name: • B. Fee for branch circuits Contact name: without service or feeder fee, N 56.18 -•-j'-‘,.'-1 2 first branch circuit Address: Each add'I branch circuit 7.42 2 Miscellaneous (service or feeder not included) Ci ty!State/ZIP: Each manufactured or modular 67.84 2 duelling, service and/or feeder Phone: ( ) I Fax : ( ) Reconnect only 67.84 2 F-mai I - Pump or irrigation circle 67.84 2 1 ; , ` . " -4;1 'ijCW37,n77. 4 ■71:1 1 gWil-k ' '11:K;F ,..;'' .., „-;4t* Sign or outline lighting 67.84 2 Business name: A&J Electric, Inc Signal circuit(s) or limited- energy panel, alteration, or Address: PO Box 330 extension. Describe: Page 2 2 CityiStaleZIP: Forest Grove, OR 97116 Each additional inspection over allowable in any of the above 1 1 Phone: (503) 359 Fax: (503) 359 Per inspection 66.25 . _ Investigation per hour (1 hr min) 66.25 CC13 Lie : 959 Electrical Lie.: 34 Suprv. Lie.: ' ' - • Industrial plant per hour IIMI 78 18 I Su prv. Elixir iei an signature, required: ‘,....‘_.,./ ' ..i._ Subtotal: - .....„,7; Print name: Anthony Wilson Date. "."-..., jis.,/ \..„....,„,„. Plan review (25% of permit fee): State surcharge CI 2% of permit fee): Author iz .-: d signature TOTAL PERMIT FEE: ' :'-...- Print name: Date: This permit application expires Ha permit is net obtained within ISO days after it has been accepted as complete. ' Number oF Inspechons allowed per permit. I II {1111 : 111- .4 5 crrIll , IELC-I'crm,tAx dun 10,01/09 440-46 ' 5 T(ILVICOMME B LASERFICI IE ELEPHANT m U Z ~ h ' (- W ti '71 INVHd 'JIH 'JTHDL IH'JS` I CITY OF TIGARD MECHANICAL PERMIT • COMMUNITY DEVELOPMENT Perm it #: MEC2011 -00415 Date Issued: 09/16/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S103DB00900 Jurisdiction: Tigard Site address: 13355 SW 110TH AVE Project: CLARK Subdivision: MIRA PARK Lot: 5 Project Description: Installing gas piping for fireplace and range. Contractor: OWNER Owner: CLARK, SCOTT E FAMILY TRUST 13355 SW 110TH AVE PORTLAND, OR 97223 PHONE PHONE: 503 - 504 -2251 FAX FEES Specifics: Description Date Amount Fuel Piping 09/16/2011 $14 15 Type of Use: SF 12% State Surcharge - Mechanical 09/16/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/16/2011 $75.85 Occupancy Grp: Stories: Fuel Fuel Types Gas Pressure: Total $100.80 Required Items and Reports (Conditions) 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 s tarted within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rule \ adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -0: -0090. You may ob.. in a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800.332. 344 Issued By: Permittee Signature: __ y� I 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. Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard �� Date/By ` ® s 1� Per •F f '' " 13125 SW Hall Blvd , Tigard, OR 9722 �, Plan Review Phone: 503.718.2439 Fax. 503 598.1960 k D a Plan Other Permit T I G A R D: Inspection Line 503 639 4175 rP Date Ready/By .tuns El See Page 2 for Internet: www.tigard- or.gov ‘ � ,1 Notified/Method �% Supplemental Information TYPE OF WORK °i d° COMMERCIAL FEE* SCHEDULE - USE CHECKLIST r� `. Mechanical permit fees* are based on the value of the work ❑ New construction Addition /alteration /replilC gfive performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value. $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* '01 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty Ea I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: _ (requires site plan showing placement) 46 75 33 p Furnace 100,000 BTU (ducts /vents) 46 75 City /State /ZIP: � G, IA Z4 0 Z ) 7 _a.3 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: ' l A P C. �� Heat pump �� (requires site plan showing placement) 61 06 Cross street/directions to job site: ?p Z'` ... © 1 , 01 Duct work 23 32 ?p I Hydronic hot water system 23 32 Residential boiler (radiator or hydronic) 23 32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: Lot no.: Flue /vent for any of above 23.32 Other. 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 ` Gas fireplace 33 39 1 N 5-f' O1 LL s G -5 F 1 1 P 1---A L A-- G 63 Zt9 N 6 Flue vent for water heater or gas fireplace 23.32 P 1-) (^ t;. t. Log lighter g g (gas) 23.32 Wood /pellet stove 33.39 Wood fireplace /insert 23.32 PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32 I Other 23 32 Name: S c_sa \1 C--1.--A j2K Environmental exhaust and ventilation: {� Range hood /other kitchen t Address: ` 3S� 3_ 5 \\(,)_\„.1‘‘ I 1 V L equipment 33.39 City /State /ZIP: G AZa 0 '� Clothes dryer exhaust 33 39 Single -duct exhaust (bathrooms, Phone: (Sow _ � ,"/ Fax: ( ) toilet compartments, utility rooms) 23.32 ' APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23 32 Business name: (AA l nr - e - t" Other. 23.32 Fuel piping: Contact name: $14.15 for first four; $4.03 for each additional Address: Furnace, etc Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: 1 Range CONTRACTOR Barbecue Clothes dryer (gas) Business name: 6Skj Other. Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Minimum permit fee ($90.00) 'T() , l'-`-=-' Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lie.: State surcharge (12% of permit fee) / i i , S-0 TOTAL PERMIT FEE ial _S--o This permit application expires if a permit is not obtained within 180 Authorized signature: t� / days after it has been accepted as complete. n Print name: 3 r-'T' € . C' tA -C),-. 4 -46 Date:9 / Q0 Li * Fee methodology set by Tri- County Building Industry Service Board B I \Buildin \Permits\MEC- PermitApp.doc 1 09/09/10 17T (I 1/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and - $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1'\ Building \Permits \MEC- PermitApp.doc 09/09/10 2 • 1 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 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing per mits. 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 a II 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 w ill 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 horn eowner statement is true and accurate. Print Nam of Permit Applicant q Signature of Permit Applicant Date Permit #: Address: 133SS S IIG - r �� : ;j• Issued by: O I Date: This Copy for Permit Offices