Permit ' (//°49 )-e. F.,4 a g /, —,u.. r,L ,
CITY OF TIGARD MASTER PERMIT
; . • COMMUNITY DEVELOPMENT Permit#: MST2009 -00164
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/14/2009
Parcel: 2S104BB01800
Jurisdiction: Tigard
Site address: 14306 SW WINDSONG CT
Subdivision: Lot: 0
Project: Signh
Project Description: Convert enclosed patio to habitable space. 12/10/09, adding additional branch circuit, for a total
of 3. -
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: NO
Total: sf Value. $3,500.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays. 0 Rain Drain* 0 Catch Basins: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckflw Prevntr. 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans* 0 Clothes Dryers: 0
Heat Pump. N Hoods: 0 Other Units: 0 _
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less 0 0-200 amp: 0 0-200 amp: 0 W/ Svc or Fdr. 0
Ea add') 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') 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)
SINGH, BALWINDER & OWNER
KAUR, HARCHARAN, 14306 SW
WINDSONG CT
TIGARD, OR 97223
PHONE: PHONE*
FAX
Total Fees: $217.19
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 throunlLOAR 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: ki
C Permittee Signatu
CITY OF TIGARD MASTER PERMIT
0 • COMMUNITY DEVELOPMENT Permit #: MST2009 -00164
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/14/2009
Parcel: 2S104BB01800
Jurisdiction: Tigard
Site address: 14306 SW WINDSONG CT
Subdivision: Lot: 0
Project: Signh
Project Description: Convert enclosed patio to habitable space
BUILDING
Floor Areas Required Setbacks R
Stones: 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: No
Total: sf Value: $3,500.00 Rear: 0
PLUMBING
Sinks 0 Water Closets: 0 Washing Mach: 0 Laundry Trays 0 Rain Drain: 0 Catch Basins: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures 0
Tubs /Showers: 0 Garbage Disp. 0 Water Heaters: 0 Water Lines: 0
Drains: 0
Bckflw Prevntr: 0
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers. 0
Heat Pump N Hoods: 0 Other Units 0
Fum<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets 0
Fum > =100K• 0
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less. 0 0-200 amp 0 0 -200 amp: 0 W/ Svc or Fdr. 0
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! Br Cir:
601 -1000 amp: 0 601 +amp- 1000v 0
1000 +amp /volt 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio 8 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)
SINGH, BALWINDER 8 OWNER
KAUR, HARCHARAN, 14306 SW
WINDSONG CT
TIGARD, OR 97223
PHONE: PHONE
FAX
Total Fees: $208.88
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 h gh OAR � 9 � 52- 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: Q.L lQ 1. / J ;AZ Permittee Signature: `
` Electrical Permit Application FOR OFFICE usr ONLY
Received
City of Tigard Recei : Permit No 1 O — dui ,
q 13125 SW Hall Blvd Tigard, OR 97223 Plan Review
III C Phone. 503.639.4171 Fax: 503.598.1960 Date/B Other Permit
I'I( ; Alt0
Inspection Line 503.639.4175 Date Ready/By. Juris ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method. Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction ❑ Addition/alteration/replacement Please check all that apply (submit 3 sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Conimercial/industrial ❑ Accessory building amps for all other installations buildings
El Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately denved system
❑ Addition of new motor load of ❑ "A ", "E ", "I - "1 - ",
Job no.: Job site address: /q3p to aco Lc) /1JDo ^- ( IOOo m o o r occupancy
L7 ❑ Six or re residential units. ❑ Recreational vehicle parks
City /State /ZIP: ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: n, 6 fF ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I (Ny. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33 92 l
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
.// 14--/--/o 1 , e Limited energy, multi - family 67 84 2
61 0 A 4T C,i)ee - b . / ' t7744. E residential (with above sq. ft.)
�� G Services or feeders installation, alteration, and /or relocation
d C 200 amps or less 100.70 2
I
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: "Z L /A.) , /t )D f/Z . (51,1 401 amps to 600 amps 200.34 2
^�_ J 601 amps to 1,000 amps 301 04 2
Address: 7i.-i >` /q 097 fit/ E Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59 36 1
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
Branch circuits— new, alteration, or extension, el' panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, / 56.18 2
first branch circuit
Address: Each add'I branch circuit a 7.42 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: �O .l F H7 fG f 6 , 7 - 2 I ,�V Signal panel, or limited -
energy panel, alteration, or
Address: / / g 6 /. e » , Tg,9 - - • , extension. Describe: Page 2 2
City /Statc /ZIP: tkpodb 61_4 d Ai pra 9 70 7 ( Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: ( ) Fax: ( )
Investigation per hour (I hr min) 66.25
CCB Lic.: / 7VA 7 /A O / Electrical Lic.: tog 5 Suprv. Lic.: 5oA06— 5 Industrial plant per hour 78.18
e_ l t S� ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal•
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 \Bu Iding\Permits\ELC- PermitApp doc 10/01 /09 440.4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r RESIDENTIAL WORK ONLY
Fee for all residential systems combined $67.84
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 $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems •
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations -
I \Building\Pormits\ELC- PermitApp doe 10/01/09
Dec, 10 09 08:58p Doright Electric 503- 982 -0042 p.1
Electrical Permit Applies ' ,,,' CEDE
1•,;It err! It t: t 6 .1 Il•.l '1
City of Tigard
• 13125 SW Hell Blvd. Tigard, OR 9'273 Mee I . III 4....* !
P'hrmti 503.639 Fes. 503.59Cj 1 1 2009 amre • oilier Ptw
t . e ■ Inspection Line. 5 r)ae ReadyAay: lien: Per P 2 per
Internet: wwev.tiWard.ot.gov QF TIGARD Notified/Method: sap Pkirental labrmeties •
'• '.'s.. . GD' I - •.,, : ;; ;; : ' • ;•' -
❑ New construction ❑ Addiban/alterationfrepineetaati Rene c cck ell that (I01•0- ebmitl Lien efplans w hemp chcelmd bele.);
I a Service or feeder aoc cave et mere ❑ gtulrlina cries stories,
El DeRt011ti0tl ❑ Other,
1. � .bole the avtilahle fault corn ❑ Mmretn mod boatyards.
IIRIJ� . 1 - . •. • ' . • caoeeda 10,000 amps at 150 volts or D Meting bofldiess.
CornmerciaVindostrial ❑Acr.gory b budding �1 km* firmed. ren e rmteeeds1e.000 ❑Commercial-um ows a�it,rit.,Al
❑ I. and 2-family dwelling Q �� � amp for all other httdallp�em, Widows. Multi- family 0 Mesta builder ❑ Other: 0 rirc pump. ❑ taslalilatorl of75 i .Vn or
: ' §fig: �d 'OCA1791t1 - . • 0 y m wee* rmrndeh dn:.en rysrem •
❑Additionefnewmotortered a n'•.'E'. "1- 2 - . °1J
Job no.: I Job she address: f i0 (� /� � t iil ( >L f .- tam-- ,a e�yutey-
y 7 13 Six of mote reaideatiel roils, ❑ Rum:rota' vet t* parks.
City/Statc/Z1P: ❑ r incite facilities. ❑ SupPl7 ' for mere dlne
❑ menratous leant**. ter. 600 vc Id nom*!
S uite/bldg./apt no.: Preloctname: / 6* ❑Servicea minas ormare.
Cross stlict/directrans to job site ., '
1: nyinrton f Qcr. 1 yrs i Tad I •
New residential single• or math - Family dwelling onit
include% Moulted enrage.
Suhdivision: Lot no. 1.000 S. ft or less
168.54 4
Tax map /parcel no. E f add 'I 500 sq or portrdn 33.92 1
1- imited energy. rest dental 1 2
ti ISSilif 19 V '' " - 1 h it) ' 67.8d
�; ) -1 fait above n
6 , - 7-_ , , f T� J`".11/./ � �0 44 i Limited clergy, rot/Ili-family , ` ti
• y: %c : i...- 6.. 1 --- _ _._ � ...: �>>ii : + ^, __.:. '•Weser. .� :. l.. �t tC6 :: i
_ - - - _ - _� -. / ....... -.- —�� -�- 1 il m■ :1 =K3 1 . Inn -- • , . • •
•
,.. .. ..jt. .. .� 1, _ - _ .. __. ____ . .- . __ .. -.
-- -- -- - - - -• .J
. .... . .----- ----- ..... . . -
•
- r --. .._
■
•
I
Electrical Permit Application FOR OFFICE USE ONLY
0 ce
DaiByd '1 " ` 1 CJj • 001 Ic i"
City of Tigard Received Permit No..
13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit:
® Inspection Line: 503.639.4175 Date Ready/By. its El See Page 2 for I Internet: www.tigard - or.gov Notified/Method Supplemental Information -
TYPE OF WORK PLAN REVIEW
❑ New construction ?Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below).
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
Y i 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: 14 30 6 • Six or more more occupancy
30 (soak (' d '�' 1 "\ v ` ' 0 or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: �J ❑ Hcalth-carc facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: Project name: i(� n h ❑ Service or feeder 600 amps or more
` (.J FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
Ncw residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family -kid I Ail of (2) 1otranC, r1 residential (with above sq. ft ) 75.00 2
Services or feeders installation, alteration, and/or relocation
€N r . t.{ AA\ S _ 200 amps or less 80.30 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106 85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
(Q Branch circuits — new, alteration, or extension, per panel
Owner signature: ��a Date: J) f) 9 A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85 2
first branch circuit
Address: Each add'I branch circuit 1 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date:
Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I \ Building \Permiis\ELC - PennitApp doe 05/23/06 440- 4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
E l Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
E l Nurse Calls
El Outdoor Landscape Lighting*
E l Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I. Building \Petntit■ELC- PeunitApp.doe 03/23/06
Building Permit Application RECEIVE Commercial
RE
' CEIVE IY)R OFFICE USE ONLY
City of Tigard Received
III AUG 04 200' DateB • \_. PermitNo.. MRZO ,r0
• 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review, �IR�
Ill Phone 503 639 4171 Fax 503 598.1960 Date/B ili i Other Permit.
I C; It n Inspection Line' 503 639 4175 CITY OF TIGA' II Date Ready : y' G 63 See Page 2 for
Internet. www tigard -or gov BUILDING DIVISI 11 0 tified/Method 6 • 2. O O. t d ti Supplemental Information
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
ddition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
� CATEGORY OF CONSTRUCTION work indicated on this application.
K and 2- family dwelling ❑ Commercial /industrial Valuation $ 500
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms I
JOB SITE INFORMATION AND LOCATION Total number of floors.
Job site address: 1366 S CdA so4/h C, New dwelling area. / 27 square feet
7 City/State/ZIP , 4-2L) £) Z l Garage /carport area: square feet
7 '�� / ( ,
Suite/bldg. /apt. no. Project name. eomerf=/ A.' C.a 4 Covered porch area: square feet
Cross street/directions to job site: 5) W i /1/25A(C ,. /2../.e.e,y Deck area: square feet
I
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
r
g 67 ' SY c (°/J Glo.re' ,eX/ST7yb Cove�C2v Valuation: $
1 70 ( Existing building area V square feet
New building are ! square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: fl/ 5/4ch Type of construction:
Address: *306. &,,,.. w // j / f( CT', Occupancy groups:
City /State /ZIP: 776A/eV Ore_ 9Rz3 Existing:
Phone: (513 ) L � • Z O7 / Fax: 6)3 ') 35 2 /(J '/ Z New:
•
*APPLICANT ❑ CONTACT PERSQN NOTICE
Business name:/ / / tie Q-C /4f/0 ACA t. C A ' -` All contractors and subcontractors are required to be
Contact name: ,4- . j f a le�f�C licensed with the Oregon Construction Contractors Board
` under ORS 701 and may be required to be licensed in the
Address: 775u 7/ jurisdiction in which work is being performed. If the
City /State /ZIP ,,�/ �z Or_ � Z 0 _z applicant is exempt from licensing, the following reasons
apply:
Phone (5; G tf s X165 Fax:: J3) Z /- ; / 5
E-mail. A:) / - - 41/dr - 613,1)
CONTRACTOR
Business name: C ivre. - BUILDING PERMIT FEES*
Address: (Please refer lo 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: COQ QQ
Authorized signature ) I
C/0 /44� Amount received: 1� /V • C_JC..f
���� �� This permit application expires if a permit is not obtained
AA � '� " I ^ within 180 days after it has been accepted as complete.
Print name: j - Date: 02 /3 V, y * Fee methodology set by Tri -County Building Industry
...�i r I' �
Service Board
I. \Building\Permits\BUP -COM PermitApp doc 2/23/07 440 4613T(I 1 /02 /COM/WEB)
,
° Building Division
Accessibility: Barrier Removal Improvement Plan
TIGARD
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty -five per -cent (25 %).
VALUATION: Total of all renovation, alteration or modification being done,
excluding painting and wallpapering: [1] $
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains: and, $
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
I. \Building \Permits \BUP -COM PerrrutApp doc 06/25/08
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
e gi 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.
P i. 44— t,0IAJDEms- Srt.)c,A-r
Print Name of Permit Applicant
�r4a' O R - 1 14 -1 0 S'
Signature of Permit Applicarir Date
Permit #: rn5T2ecq • COl 6 l �
4
Address: 3 cD (D (1 r C: 5717/ J
V amour,
1 '0 C a rd 02 4 _7 223 t :�,.,,.
Issued by: Date: 0 ' ` 0 9 r` i'�
Y I
This Copy for Permit Offices