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Permit Q_ e,p (i 11 --_ILci -+ a c c 0 O c oL ►-Y,. p. cQ-e. r. CITY OF TIGARD MASTER PERMIT 111 '' . 2 : COMMUNITY DEVELOPMENT Permit #: MST2009 -00128 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/10/2009 Parcel: 2S 111 CB01735 Jurisdiction: Tigard Site address: 10310 SW HOODVIEW DR Subdivision: Lot: 0 Project: Switzer Project Description: Bed /bath remodel. 7/27/09 ADDED (1) 200 amp serivce/feeder. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement 0 sf Left: 0 Parking Spaces: 0 Height. 0 Bathrooms: 0 Second: 0 sf Garage. 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors Yes Total: sf Value: $10,02100 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL • Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 1 Furn<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. 1 0 -200 amp: 0 W/ Svc or Fdr: 6 Ea add'I 500 sf: 0 20 1 -400 amp: 0 201 -400 amp: 0 1st W/O Svc /Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'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 asin N Other: N Other Description: Ecom P g BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: Owner: Contractor: Required Items and Reports (Conditions) SWITZER, KRISTEN C & CARL R OWNER 10310 SW HOODVIEW DR TIGARD, OR 97224 PHONE: PHONE FAX: Total Fees: $681.87 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 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: c/ /✓ Permittee Signature: am'` -'`� 01 l V\ n.( - -TA t* -CITY OF TIGARD MASTER PERMIT ✓'_ COMMUNITY DEVELOPMENT Permit #: MST2009-00128 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/10/2009 T1 ARLD' Parcel: 25111 CB01735 Jurisdiction: Tigard Site address: 10310 SW HOODVIEW DR Subdivision: Lot: 0 Project: Switzer Project Description: Bed /bath remodel. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement. 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors' Yes Total. sf Value: $10,021.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach. 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 2 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Natural Gas Heat Pump: N Hoods: 0 Other Units: 1 Furn <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 add'I 500 sf: 0 20 1 -400 amp' 0 201 -400 amp: 0 1st W/O Svc /Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add'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) SWITZER, KRISTEN C & CARL R OWNER 10310 SW HOODVIEW DR TIGARD, OR 97224 PHONE: PHONE FAX: Total Fees: $591.93 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 -0100. You may o tain a copy of the rules ules or direct questions to OUNC by ca. n. .1 .246.6699 or 1.800.332.2344. Issued By: 1 &�Q �+ Permittee Signature: _ %41 _ 4 ii If v `¢ Building Permit Application Residential" RECEIVED FOR O FFIC EU S E O N L Y C of Tigard �+ Date /88 Permit No.: M .t! Q 2oO' a n 1 3125 SW Hall Blvd., Tigard, OR 9722 0 2009 Plan Review- i�Q1' Oth er Permit: wv Phone: 503.639.4171 Fax: 503.598.1 N 1 Date /By:% / TIGARD Inspection Line: 503.639.4175 Date Redd : orris: ® See Page 2 for Internet: www.tigard - or.gov CITY OF TIGARD Notified /Method: Supplemental Information BUILDING DIVISION TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all 0 Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 0 I- and 2- family dwelling ❑ Commercial /industrial Valuation: $10,021.00 ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: 1 JOB SITE INFORMATION AND LOCATION Total number of floors: 0 Job site address: 10310 SW Hoodview Drive New dwelling area: square feet City/State /ZIP: Tigard Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Switzer Bed/Bath Remodel Covered porch area: square feet Cross street/directions to job site: SW Kable Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL - USE CHECKLIST Subdivision: HOOD VIEW NO.2 Lot no.: 34 Permit fees* are based on the value of the work•performed. Tax map /parcel no.: 2S111CB01735 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. Convert a family room into a master bed/bath /closet. Valuation: $ Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: Carl & Kristen Switzer Type of construction: Address: 10310 SW Hoodview Drive Occupancy groups: City /State /ZIP: Tigard, OR 97224 Existing: Phone: (503) 201 -7078 Fax: ( ) New: ® APPLICANT ® CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: Carl & Kristen Switzer licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 10310 SW Hoodview Drive jurisdiction in which work is being performed. If the City /State /Z1P: Tigard, OR 97224 applicant is exempt from licensing, the following reasons apply: • Phone: (503) 201 - 7078 Fax:: ( ) E - mail: carlswitzer @hotmail.com CONTRACTOR Business name: (5tA) i\i € f2. BUILDING PERMIT FEES* Address: (Please refer to fee schedule) City/State /ZIP: Structural plan review fee (or deposit): Phone: ( ) Fax: ( ) FLS plan review fee (if applicable): CCB lic.: Total fees due upon application: Amount received: l 1 a 93 Authorized signature: a This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Carl Swi er 1 Date: 6/8/09 * Fee methodology set by Tri- County Building Industry Service Board. I: \Building\Pennits \BUP -RES PermitApp.doc 11/6/07 440 4613T(11/02/COM /WEB) ', M Permit Application FOR OFFICE USE ONLY Rec-'ved City �f Tigard 1 ,�,,.y: Permit No.:A Tame_ a I a-� II - 't 13125 SW Hall Blvd., Tigard, OR 9722 RECE a. ! Phone: 503.639.4171 Fax: 503.598.1960 a evrew Other Permit: Date(By: TIGARD Inspection Line: 503.639.4175 /� tt Read /B : Juris: www.tigard- or.gov JUN 1 0 y y Supplemental See Page 2 for Nb'tified/Method: Supplemental Information TYPE OF WORK CITY OP TIGARD COMMERCIAL FEE* SCHEDULE - USE CHECKLIST BUILDING DIVISION ❑ New construction ® Addition /alteration /replacement Mechanical permit fees* are based on the_alue 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* 0 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Air conditioning or heat pump Job site address: 10310 SW Hoodview Drive (requires site plan showing placement) 14.00 City/State /ZIP: Tigard, OR 97224 Furnace 100,000 BTU (ducts /vents) 14.00 Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: Switzer Bed/Bath Remodel Gas heat pump 14.00 Cross street/directions to job site: SW Kable 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 Flue/vent for any of above 6.80 Subdivision: HOODVIEW NO.2 Lot no.: 34 Other: 10.00 Tax map /parcel no.: 2S111CB01735 Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 Convert a family room into a master bed/bath/closet. Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) ( 10.00 16 CO Wood/pellet stove 10.00 Wood fireplace /insert 10.00 ® PROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 10.00 Other: 10.00 Name: Carl & Kristen Switzer Environmental exhaust and ventilation Address: 10310 SW Hoodview Drive Range hood /other kitchen equipment 10.00 City/State /ZIP: Tigard, OR 97224 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (503)201 -7078 Fax: ( ) toilet compartments, utility rooms) 1 6.80 6.80 ❑ APPLICANT ® CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: Carl & Kristen Switzer $5.40 for first four; $1.00 for each additional Address: 10310 SW Hoodview Drive Furnace, etc. Gas heat pump City/State /ZIP: Tigard, OR 97224 Wall/suspended/unit heater Phone: (503) 201 -7078 Fax:: ( ) Water heater Fireplace E -mail: carlswitzer @hotmail.com Range h / �/ CONTRACTOR Barbecue Business name: /T ) 1 A) E Clothes dryer (gas) /` // ( Other: Address: MECHANICAL PERMIT FEES* City/State /ZIP: Subtotal Minimum permit fee ($72.50) 72 Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lie.: t? State surcharge (12% of permit fee) i� r 70 TOTAL PERMIT FEE x/- Authorized signature: NA0 , ( This permit application expires if a permit is not obta withi 0 \ \ \\ days after it has been accepted as complete. Print name: V 1) ( Date: * Fee methodology set by Tri- County Building Industry Service Board l:\ Bui lding\Permits \MEC- PermitApp.doc 01/19/07 440 4617T(11 /02 /COM/WEB) Plumbing Permit Application Building Fixtures , ' `. FOR OFFICE USE ONLY City of Tigard Received 131 25 5W Hall Blvd., Ti ard, OR 97223 Date /By: Permit No.: I aov y- (vas ' � g Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.: Date/By: TIGARD Inspection Line: 503.639.4175 Date Ready /By: /uris: ® See Page 2 for Internet: www.tigard - or.gov Notified /Method: Supplemental Information � � � TYP e E OF WO . � r`t 1 '__' , ' �`i. ' "" r FEE * LE a -A it , . , _ - , - . e � *,, ,� _.. _ . A�a, iidq: : .. ._ ,.ze '_- . ;„ i : - - � i _ , _ „� , -, tea.,.. _ F .f,: °2 M . �..s:91 ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total ® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) i. i;i'gt i ' CATEGORY OF CONS:TR G TION : t _ 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 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: �a3� r Fire sprinkler ( sq. ft.) Page 2 �A_F i l a JOB SI' I'E °� INFOR1/FtATIQ N A ND I:OCA 1 y„ " w „.0 Site utilities Job site - address: 10310 Hood -View Dr Catch basin or area drain 16.60 City /State /ZIP: 97224 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: 1 Project name: Switzer Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: SW Kable Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: _) Page 2 Fixture or item Tax map /parcel no.: . � . Absorption valve Ab orpC I 16.60 O x DES CRIPTION OF W : OAK - 4 1 :, . 6 3 ' ;�1 , Backflow preventer Page 2 Addition of one Master Bath with one water closet, two lavatories, one mud -set Backwater valve 16.60 shower, and one Jetted type tub. Clothes washer 16.60 Dishwasher 16.60 „ tl fs- "% ®` -1 ,or EIt " ry , 1 ,, ,TENANT Drinking fountain 16.60 " '° Ejectors/sump 16.60 Name: Carl Swtizer Expansion tank 16.60 Address: 10310 SW Hood View Dr. Fixture /sewer cap 16.60 City /State /ZIP: 97224 Floor drain /floor sink/hub 16.60 Phone: (503) Fax: ( ) Garbage disposal 16.60 - s..x ` >`�i;P -,vi d z way Hose bib 16.60 a ` AP EICANT , _ CONTACT PERSON .. . 16.60 Business name: Oasis Plumbing Inc Interceptor /grease trap 16.60 Contact name:.lason Medical gas (value: $ ) Page 2 Address: 11177 S Allen Ct Primer 16.60 City /State /ZIP: OregonCity Roof drain (commercial) 16.60 Phone: (503) 557 -5555 Fax: : (503) 2010165 Sink /basin/lavatory 2 16.60 $1 , Tub /shower /shower pan 2 16.60 "V) 1_,0 E -mail: jason @oasis- plumbing.com Urinal 16.60 ,_.,, .,, .� ,,� -: .. .._ - ...,..� �� ter..; : -- ,.� , . :( a . .tin.- +xbr ONT ICT R r ti, gat,. F , 6, m: „, A. , Water closet 1 16.60 l (0 • (0 ) Business name: Oasis Plumbing Inc Water heater 16.60 Address: 11177 S. Allen Ct. Other: City /State /ZIP: OregonCity Subtotal ( 1 . 4 ,..t �� Minimum permit fee: $72.50 Phone: (503) 5575555 Fax: (503) 2010165 Residential backflow minimum permit fee: $36.25 Plan review (25% of permit fee) CCB Lic.: 169234 ,. Plumbing Lic. no.: PB -96 State surcharge (12% of permit fee) ct, Authorized signature: Ii Li TOTAL PERMIT FEE 77,e9 C' Print name: Jason T ce Date: 06/08/2009 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. I \ Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T( I 0/02/COM/WEB) :=s Electrical Permit Applic4. 11� Received City of Tigard Date/By: Permit 240.//(9 i • 13125 SW Hall Blvd., Tigard, OR 8�7 3 Plan Revie ' _ � � Phone: 503.639.4171 Fax: 503..4) 1t 6 . 2U' Date/Bv: Other Permit: l_l.t.. R. a Inspection Line: 503.639.4175 p Date Ready/By: writ RI See Page 2 for Internet: www,tigard or. gov OFTIGAR� Notified/Method: Supplemental Information :Fro ,r,F ,, 'U.:: :` - p '" � -' - r Print name: , r L -. a ttr. _ ' n A*0. ut - � +FR � f w • u . ❑ New construction IS] Addition /alteration /replacement ❑ Demolition ❑ Other: -- y'- ... ' e: Vie. ,x , ;,t 5 .,•�, . s u - , .. Please check all that apply (submit a sets of plans w/items checked below): ., P - +' ,. . =1)ZI .r R+ §t6, - = ..�� ttt�t .. ;,�;r<:: -�,.�, i�� 0 Service or feeds 400 amps or more ❑Building over three stones ; $,I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building where the available fault current ❑ Marinas and boatyards. ' ❑ ❑ Master builder Other: exceeds 10.000 amps at ISO volts or ❑ Rooting buildings. Multi-family ❑ leas to ground, or exceeds 14,000 ❑ Commercial -use agicultural a [ i an ,'d amps for all other inslaltaz7ans. buildings. . '� e + ` k ' - --- ' * T e �� ,- 1 l ` a ' ' ❑Fire pump, ❑ Installation of 75 K VA of lob no,: lob site address: �`O SW •A UI • l ❑ Emergency system. larger separately derived system. - ❑ Addition of new motor load of ❑ "A ", "E ", "1.2 "I d City /State/ZIP: 1 ,�.(, ¶ 7-ZZL 100HP ormare occupancy. ❑ Six or more residential units ❑ Recreational vehicle parks Suite/bldg. /apt. no.: Project name: �wl1zP� 6LIr ' bee � ❑ Health-care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal I 4 Cross street/directions to job site: 1 1-e I t I ❑ Service or feeder 600 amps or more. S W Ka Deen o -e M ._ ,,.,. pttan Qty Pee. Tow Subdivision: p UleL4.) 2 Lot no.: ! Z New residential single- or multi - family dwelling unit. l Includes attached garage. ' Tax map /parcel no.: 2 s I c 1,000 sq, ft. or less 145.15 I 4 '... r, 4 7- r s ,, _Y a Ea add'I 500 sq. ft. or portion 33.40 I Limited energy, residential NM Vid 1 MILLI VONA I Vi j ioeC C7 �- C/GSe. (with above sq,R,) 75.00 2 Limited energy, multi - family 75.00 , 2 residential (with above sq. ft.) 4. 4 r ( �+ t r '=� ii el Services or feeders installation, alteration, and/or relocation 200 amps or less 1 80.30 1Q 2 Name: C (t, Vt A �/� 4 z vi VI ' 1,&)1 1--z Piv 201 amps to 400 amps 106.85 r I 2 14-0--06 Address: 1 031 D S W 401 am to 600 am 160 2 { � 601 amps to 1,000 amps 240.60 ; 2 City/State/ZIP: T 15 (, 60, e1 1 U 2 l ZZ L � Over 1,000 amps or volts 454.65 , 2 Temporary services or feeders Installation, alteration, and/or Phone; (�) 2 -(� �J1 Fax: ( ) relocation Owner installation: This installation is being made on property that I own which is not 200 amps or less 66.85 ' I intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 201 amps to 400 amps 100.30 ' 2 Owner signature: Date: 401 amps to 599 amps 133.75 • 2 - new, alteration, or extension, per panel ' ,, '4 ; 41 ' - 1 ,, i .4 , Ts - r � v c y a � Branch circuits W � - t �. _ . -.at; ..._ � g� __ • _ . t T ., A. Fee for branch circuits with Business name: above s rent h c or feeder fee, 6 6.65 39, 2 Contact name: CCM 6 KVI S V/in )1.0\ � v B. Fee for branch circuits Address: i 0310 w �a V 1'�/ - 2 without branch service c ir u feeder fee, • Y first branch circuit 46.85 2 branch circuit 6.65 2 5r c I /13-zZI-I J Each add't _ City /State2IP:�� (5 t� I 1 M11seellaneous (service or feeder not included) Phone: G' Fax:: ) Each manufactured or modular (5(,� 2_°,-- 1 �� ( J ( / CO ,' �t dwelling, service and/or feeder 90,90 2 E -mail: COL VI ' 1 1' y (] A ttI In V ` Reconnect only 66.85 ! 2 F _- t . ,, ° ` 1 44U%`;11. - LL g a . �i : #6 = F -___ °-.. ::° Pump or irrigation circle 53.40 2 Business name: S(,� H f r �T I eG"7 - te i G 4 rZ , Sign or outline lighting G (J 53 40 2 n /� Signal circuit(s) or limited - Address: Q c' /l/ p ,s� Ave A ^ . 5 energy panel, e��hation, or extension. Page 2 2 City/State/ZIP: UPC. hr.() Ae t ve n . W . 86 6 1 Each additional Inspection over allowable in any of the above e r' Phone: v o .5-19_ 8J Fax: ( 360 ) Cn9 H - , 912 8 Per inspection 62.50 CCB Lic.: / 725(49 Electrical Lic.: C 2 3 O Suprv. Lie.: Investigation per hour (1 hr min) 62.50 - Industal plant per hour 75 Suprv. Electrician signature, required: 01/ "'�"` ; ;rte ri . -; n:�; = Subt 1, Z.Q , 2 Print name: �� 2 - j I- ,,,,,,2 £ . tC Date: e if C � j Plan review (25% of permit fee): `' 11 t State surtht7rg o o permit fee): '4 47 Authorized signature: SE-Q a Hci (0 y ,, A RN4 4•Cii • ` TOTAL PERMIT FEE: '2.. MEN 1 . tauildis5\PermitaELC- PermitApp doe 0503,05 440.4 1 Ir05.'COMPWEa illi 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 0 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. t v!sbi S Name of Permit ' •plicant . % , IA iikl.lai L [1616 01 100 Sig -44 of Permit Applica v Date Permit #: i(lagZ ? nog • C) ®(Z !1 Q F • Address: leg /6 6W �lit `G�1 ,,:#7-':',- � � 2 02_ 'I 7 ` . r .,.r, +r�ti �: Ti; • Issued by: Date: F This Copy for Permit Offices