Permit GA D MASTER PERMIT
CIT OF TI
PERMIT #: MST2005 -00137
,, } I DEV OPMENT SERVICES - DATE ISSUED: 4/18/2005
"s,�l. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 103AB -00404
SITE ADDRESS: 11305 SW WALNUT ST ZONING: R - 4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Interior remodel. 4/20/05: Adj.to mech:owner's scope of work: (5) fans, gas stove, water heater &
dryer. 5/3/05: Added water & sewer lines(8725105, chg ELC Work t� 2;040 sgrft-11eede in •J
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT' sf LEFT: SMOKE DETECTORS: V
TYPE OF USE: SF FLOOR LOAD. 40 SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THRD sf RIGHT.
VALUE: 2 00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR:
PLUMBING
SINKS: 1 WATER CLOSETS' 3 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: TRAPS*
LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 130 SF RAIN DRAINS: CATCH BASINS
TUB /SHOWERS. 3 GARBAGE DISP: 1 WATER HEATERS. 1 WATER LINES. 120 BCKFLW PREVNTR. GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 5 CLOTHES DRYER: 1
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 2
MAX INP: btu FLOOR FURNANCES• VENTS: WOODSTOVES: GAS OUTLETS:
ELE TRICAL — Th
'
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
10D0 SF OR LESS: -1/ 0 - 200 amp: 1 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION'
EA ADD:L3 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FOR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp' 401 - 600 amp: EA ADDL BR CIR• 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 AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY}
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO 8 07 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 # SYSTEMS:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Munlapal Code, State of OR Specialty Codes
HARRIS,SEAN & JAMIE OWNER and all other applicable laws. All work will be done in
• 11305 SW WALNUT ST accordance with approved plans. This permit will expire
TIGARD, OR 97223 If work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules
Phone: 503_591_1337 Phone: 503 624 - 5499 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 of these rules or
Reg #: direct questions to OUNC by calling 503 - 246 -6699 or
TOTAL FEES: $ 1,123.68 1 -800- 332 -2344
REQUIRED ITEMS AND REPORTS
I
I sued B : I,' l' ,„ _ I _ , , Permittee ; ignature : 1 -_ i !' ,A - Al
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that busines- day.
This permit card shall be kept in a conspicuous place on the job site un • ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
CITY TIGARD • MASTER PERMIT
PERMIT #: MST2005 -00137
yid DEVELOPMENT SERVICES DATE ISSUED: 4/18/2005
'� °- . 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 103AB -00404
SITE ADDRESS: 11305 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: See mec2005 -00165
BUILDING
REISSUE CUSTOM STORIES* FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK' ALT HEIGHT. FIRST: sf BASEMENT. sf LEFT. SMOKE DETECTORS. Y
TYPE OF USE. SF FLOOR LOAD' 40 SECOND: sf GARAGE' sf FRONT: PARKING SPACES
TYPE OF CONST 5N DWELLING UNITS THIRD. sf RIGHT.
VALUE 2 00
OCCUPANCY GRP' R3 BDRM: BATH* TOTAL* 0 of REAR:
PLUMBING
SINKS. 1 WATER CLOSETS. 3 WASHING MACH 1 LAUNDRY TRAYS. 1 RAIN DRAIN' TRAPS
LAVATORIES' 3 DISHWASHERS. 1 FLOOR DRAINS. SEWER LINES: SF RAIN DRAINS: CATCH BASINS
TUB /SHOWERS 3 GARBAGE DISP: 1 WATER HEATERS. 1 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS.
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP• VENT FANS. CLOTHES DRYER.
FURN > =100K: UNIT HEATERS: HOODS' OTHER UNITS.
MAX INP. btu FLOOR FURNANCES VENTS' WOODSTOVES GAS OUTLETS'
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS' 0 - 200 amp• 1 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 SIGN /OUT LIN LT PER HOUR.
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp EA ADDL BR CIR SIGNAL/PANEL 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 AREA/SPC 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
HARRIS,SEAN & JAMIE OWNER applicable laws. All work will be done in accordance with approved
11305 SW WALNUT ST plans This permit will expire if work is not started within 180 days
TIGARD, OR 97223 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
of these rules or direct questions to OUNC by calling 503 - 246 -6699
Phone: 503 - 591 -1337 Phone: 503- 475 -3180 or 1 -800- 332 -2344
Reg #:
TOTAL FEES: $ 645.57
REQUIRED ITEMS AND REPORTS .
1_...
Issued By : �I �i1A Permittee Signature :��rv
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.
Building Permit Applica i ,FOR OFFICE USE ONLY
,�a
CEIV� -_ �1.
City of Tigard Date/By �� L/� '� Permit No. , ):21:165--, ad 477
13125 SW Hall Blvd , Tigard, OR 97223 APR 18 21 • Plan Review _ - _
r \ Other Permit L
Phone. 503 639.4171 Fax 503.598 1960 `' ` 1(G�I' DateBy:i QQ
Inspection Line 503 639 4175 el • Date Ready/By Juns 0 See Attached Checklist for
Internet www ci tigard onus CITY OF TIG r
1 Notified/Method. I . I (1. 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
[IAdditio alteratio eplacement ❑ Other equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Rf 1 -and 2- family dwelling Valuation $ ' j; 4 (/ 500
❑ Commercial/industrial
111 Accessory building ❑ Multi- family Number of bedrooms: 4
❑ Master builder ['Other. Number of bathrooms: 3
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: I 1 3 r7 10 vocal,, u,{ st , New dwelling area: so Ad square feet (ht, 1 / 1
City/State /ZIP: 'ri q a , l r d , o i . ori-1• 3 Garage /carport area: square feet �'` "" Y�
Suite/bldg /apt no.: Project name: , ` Covered porch area: square feet
Cross street/directions to job site. PftC,t�G r )� (CVAW) Deck area. square feet
Other structure area: square feet
/ REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no : 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.
- V _ I OnQ j � Ck i k . titS Valuation $
` - � 1�1 Existing building area: ' square feet
`A ��; _ s t % t 0- 6 1 New building area: square feet
KPROPERTY OWNER '' \\ -1 ❑ TENANT Number of stories
Name a Q n and �rii')'1 . te) 10.:. f 15 Type of construction:
Address 1$5 \ 2 5 12Lt cr c .k - Rte . Occupancy groups:
City/State /ZIP: z e0 . k _ s.e r n t p9 ..... c\--1_00-4... Existing.
Phone (5/)..) 1"3"5 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: 1 vh e no i i e_r All contractors and subcontractors are required to be
Contact name. licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City/State /ZIP: applicant is exempt from licensing, the following reasons
apply.
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name 0 „, e U t.c e(f BUILDING PERMIT FEES*
Address
Please refer to fee schedule.
City/State /ZIP
Fees due upon application
Phone: ( ) Fax. ( )
Amount received
CCB lic.:
Date received.
Authorized signature C-C/ M_ This permit application expires if a permit is not obtained
�Y within 180 days after it has been accepted as complete.
I
Print name. jr:v:Nm‘E 1-- AV -2-1 S Date. 4 /14 105 * Fee methodology set by Tri- County Building Industry
Service Board
I \Bu iding\Pemnts\BUP- PenmtApp.doc 12/03 440- 4613T(I1 /02 /COM/WEB)
One- and Two - Family Dwelling y
Building Permit Application Checklist FOR; OFFICE USE ONLY
City of Tigard Received
Permit No.
Date/By g
13125 SW Hall Blvd., Tigard, OR 97223 sse Associated permits.
Phone 503.639.4171 Fax 503.598.1960 of
24- Hour Inspection Line 503.639.4175 E• I 1 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www ci.tigard or.us ❑ Other
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No ' N /A''
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 -fl. 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 load.
20 Manufactured floor /roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas -piping schematic is required ❑ ❑ ❑
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Oregon and shall be shown to be applicable to the •ro'ect under review.
JURISDICTIONAL SPECIFICS , ,
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" 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 tree protection measures as required by conditions 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 2
04-18-2005 10:52 TWOBRO PLMG 5034910386 PAGE:1
' ,`i 1
.,!. (z..? P1un ilAng Permit Annlicataon if IN of r u. t : a ; , ,r•: 0.I
City of Tigard 1 #' 2c i
13135 SW Sall Blvd, Tigard, OR 97223
li
Pl an Swim Ogee Potash No
Phone: 503,639.4171 Pax: 503.598.1960 . A Dabli3lo
24- Hour /napalm L Dc 503.639.4175 ....I.l •1 I �_ Dam Reedy/By: rue's lif Boa Page 2 for
internee www.ci.ttgerd.or.ue , Noarieete nhod: sepraem.nat rareraeitfno
TYP'S OF WORK NOP SCEEDIILE
❑ New construed= 0 Demolition for spacial tfb ararion um eitsalrlbt
Desecirlon I . I lie. J Toni
I. �tddttlon /alteratior/fepluaatent ❑ Omer: New 1- 24bmfy dwellings (includes 100 ft kr earl la eonneedon)
CATEGORY OF CONSTRUCTION SF (1) bath 249.20
fie d 2.6zoily dwelling ❑ Conunerchellndustdid ,3Pk (2)) bash 330.00 SPR ❑ Accessory building Q Muni Amity (3) , 399.00 - • , Sect additional batDAdalim 45.00
❑ Master bizi1& 0 Other: pie aponlder (_.-_ eq. It) Page 2
rOB SITE INFORMATION AND LOCATION She utilities '
P A P • . 'l. ' Bl r.lg Catch bed% er etta drain 16,60 '
City/Statd7.>P: 1 ilffiralit prywell, teach line, ortranob drain 16.60
Svaterbidg.leptno.; Project none:
Footing dtaift(ltD.lirwsR:�,} Pagc
Meaetratured home utilities 110.00
GYoea efreeddheotiona to job sire: t w .. Manholes 16.60
+ 16.60
' Etein drain connecter
Sanitary sewer (no. linear tt:.J Page 2
Storm ems (co. linear fl.:.- ..,...) Page a
Water service (no. linear fi: _J Page 2
Bubdtvieina: -
'ktnture or item
Tex rasp/parcel no.: Ab6QTption valve 16.60
r DESCRIPTION OP WORK Saddlew ptavetdcr P
i L_ _. �.• F ILL ` / !A ir _ `_� S eckwetavelve 16.b0
1 moo= washer 16.60
. was ' 16.60
Drinking fountain 16.60
0 PROP1aRTY OWrfiR J ❑ TENANT iij/eung, 16.60
Name: Expaasioa leNe 16.60
Addreee: Phomghea fie 16.60
City/State/ZIP: Floor dtaiefittor *Muth _ 16.60
Garbage disposal 16
Phone: ( ) Fax: ( ) Hose bib 16.60
❑ APPLICANT ' ❑ corium PERSON Ia taw 16.60
Business name: interceplorfgreaee asp 16.60
Contact Hama Medical gas (velum $ ) Pegs 2 ,
Address: Primer 16.60
Roofdmin(coro:imalal) �� 16.60
Cit $&ewb.de/avatory 16.60
Phew ( ) • Fox : ( ) Z5m/rhonaf/shoa.rpan 4 16,60 • Primal 1,1final 16.60 • CONTB ACTOR Watat closet 16.60
. - Water hinter 16.60
Business name: 10 i s f...l n) ,r •• A -Nis o, I ' OfAer
i� �[tIRM - I n bltbm�i ~
City/State/2 : C. le, •, N., . � •f 4 -- l.i Waimea' $92.10
NCIiW A s M� Reddentielbeolellow:wh ine= pemitti.: $36.25
I.. no.: ' ���}. Plea review x596 of pemt{t lbe)
CO3 Lie.: i� 'ZS/ �/ Plumbing - 7 Stets sneehase (896 of pecan fee)
Authorized signature ` /" TOTAL PH1 T MI
Print name: r Date: 1-{ I " c This permit application ft•apermit1snot obtslna0witrun•
`ayµ. �;+ ✓�- - 3 160 days alter it has bean accepted es template.
*Pee taathodology set by Tri- Count/ Building !Mum/ Service Board•
tnButwl do% uvoI aeo.onerpemicO dawiso)
04 - 18 - 2005 10:48 TWOBRO PLMG 5034910386 PAGE:1
Electri P erm it A pp li ca ti on r , ' , .1,.)l."./.,47,0:4•.',',:,,,1,.;''''
,� FOROF USE ON L ' Y'' �� ' ' a
--- /^(� r �f
City of Tigard
Date/By Penult Ndl�l { J g c' Vj5
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review / l �
Phone 503 639 4171 Fax 503 598 1960 . f 1, i ( - Date /By Other Permit
Inspection Line 503 639 4175 ;,,_!�- e. , Date Ready /By lens ® 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'I ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi 0 Master builder 0 Other:
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no : Job site address: 1 1305 Cik j VV(.tjj',tj 51.-- ❑Health - care facility ❑Other
Submit 2 sets of plans with any of the above
City/State /ZIP "\'' l OE �. 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: J I'W v1 � a
Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total ""
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.. Ea. add] 500 sq. ft. or portion 33.40 I
Limited energy, residential 75 00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder _ 90 90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less f 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax:( )
200 amps or less 66.85 I
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 - near, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each ZQ� er 6 65 2
Business name branch circuit
B Fee for branch circuits
Contact name without service or feeder fee,
each branch circuit 46.85 2
Address: Each add] branch circuit 6 65 2
City /State /ZIP Miscellaneous (service or feeder not included)
Pump or irrigation circle 53 40 2
Phone: ( ) Fax::( )
Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
1- ��J1.OL.J extension Describe. Page 2 2
Business name C�1gt.f C -
Address: 2 2 .tx "wCV._.V\al , Each additional inspection over allowable in any of the above
Q Per inspection 62.50
City /State /ZI P:J 1� - Q , Da_ - 1� 12. Investigation per hour (I hr min) 62 50
Phone (�j' 5 ) UR 1' Fax ( 5D?�) 1 � - 1� ' lndustnal plant per hour 73.75
// ELECTRICAL PERMIT FEES*
CCB Lic.. Electrical Lie.: Supry Lie Subtotal
Suprv. Electrician signature, required. Plan review (25% of permit fee)
Print name: Date State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature This permit application expires if a permit is not obtained nithin 180
days after it has been accepted as complete
Print name Date. • Fee methodology set by Tn- County Building Industry Service Board
"• Number of inspections per permit allowed
1 `Buddm.`Pemuts\tI.C- Pemut 1pp doe 1103 440- 4615T(I0,02 /COM /WED
Electrical Permit Application - City of Tigard r •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
•
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
n Other:
COMMERCIAL, WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n 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
\ Building \Pcrnuts \ELC- PcrnutAPP Jac 01103
CITY OF TIGARD
. BUILDING DIVISION PERMIT #: MST2005 -00137 • A
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/18/2005
Phone: (503) 639 -4171 MA
Inspection Requests (24 Hrs.): (503) 639 -4175 ._' -_
INSPECTION WORKSHEET FOR DATE: 8,)/7/2005 TIME: 7:08AM PAGE: 100
SITE ADDRESS: 11305 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HARRIS
DESCRIPTION: Interior remodel. 4/20/05: Adj.to mech:owner's scope of work (5) fans, gas stove, water heater &
dryer. 513105: Added water & sewer lines. 8/25/05, chg ELC work to 2,040 sq ft, 1 feeder in garage &
OWNER: HARRIS,SEAN & JAMIE, PHONE #: 503-591-1337
CONTRACTOR: OWNER PHONE #: 503. 475.3180
Inspection Request Scheduled For: Date: 9/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 015052 -02 541- 617 -9257 Y
Corrections /Comments /Instructions:
•
if-PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: A/272) Date: Phone #: (503) 718- _V2b5±
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005-00137
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/18/2005
Phone: (503) 639 -4171 �mP
Inspection Requests (24 Hrs.): (503) 639-4175 __
INSPECTION WORKSHEET FOR DATE: 9/7/2005 TIME: 7:08AM PAGE: 99
SITE ADDRESS: 11306 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HARRIS •
DESCRIPTION: Interior remodel. 4/20/05: Adj.to mech:owner's scope of work (5) fans, gas stove, water heater &
dryer. 5/3/05: Added water & sewer lines. 8/25/05, chg ELC work to 2,040 sq ft, 1 feeder in garage &
OWNER: HARRIS, SEAN & JAMIE, PHONE #: 503 -591 -1337
CONTRACTOR: OWNER • PHONE #: 503.475 - 3160
Inspection Request Scheduled For: Date: 9/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 015052 -03 541- 617 -9257 N
•
Corrections /Comments /Instructions:
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•
. 1/ 7 .-. "' e / ti ( - ir -2- e I. -7- - - — 1
7 74-44/j2 ,1
•
PASS - IVRARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 7 7ri Date: eir Phone #: (503) 718-
CITYOF TIGARD ' „
BUILDING DIVISION PERMIT #: MST200S -00137
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/18/2005 • -
Phone: (503) 639 -4171 � mayi� l(
Inspection Requests (24 Hrs.): (503) 639 -4175 - _..
INSPECTION WORKSHEET FOR DATE: 9/19/2005 TIME: 7:06AM PAGE: 46
' SITE ADDRESS: 11305 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HARRIS
DESCRIPTION: Interior remodel. 4/20105: Adj.to mech:owner's scope of work (5) fans, gas stove, water heater &
dryer. 513105: Added water & sewer lines. 8/25/05, chg ELC work to 2,040 sq ft, 1 feeder in garage &
• OWNER: FIARRIS,SEAN & JAMIE,. PHONE #: 503 -591 -1337
CONTRACTOR: OWNER PHONE #: 503 - 475 -3180
Inspection Request Scheduled For: Date: 9/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 016016 -01 503-706-6733 N q56i
Corrections /Comments /Instructions:
6 friat/76-14`5 Wi
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1 i ! 4 k '/' i , N A S
1
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/ . -)
•
A N PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
\FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
4 . �
Inspector: ' fIF Date: 7 - ( ( � Phone #: (503) 718-