Permit I y n CITY OF TIGARD MASTER PERMIT
II I a • COMMUNITY DEVELOPMENT Permit #: MST2013 00005
Date Issued: 01/10/2013
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S1106A00400
Jurisdiction: Tigard
Site address: 14100 SW 117TH AVE
Subdivision: CANTERBURY WOODS CONDO Lot: 76
Project: Gorilla Capitol
Project Description: Interior demolition to determine extent of permitting to be required
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
Total 0 sf Value. $500 00 Rear. 0
PLUMBING
Sinks' 0 Water Closets 0 Washing Mach 0 Laundry Trays 0 Rain Drain 0 Urinals 0
Lavatories 0 Dishwashers 0 Floor Drains 0 Sewer Lines 0 SF Rain Storm Sewer 0
Drains 0
Tubs /Showers 0 Garbage Disp 0 Water Heaters 0 Water Lines 0 Catch Basins 0
Bckflw Prevntr 0
Footing Drain 0 Ice Maker 0 Hose Bib 0 Backwater Value 0
Drywell- Trench Drain 0 Other Fixtures 0
Other Fixture Units
MECHANICAL
Fuel Types Air Conditioning N Vent Fans 0 Clothes Dryers 0
Heat Pump N Hoods 0 Other Units 0
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 0 0 -200 amp 0 W/ Svc or Fdr: 0
Ea add, 500 sf 0 201 -400 amp 0 201 -400 amp 0 W/O Svc/Fdr: 0
Mfd Home /Feeder /Svc 0 401 -600 amp 0 401 -600 amp 0
601 -1000 amp 0 601 +amp -1000v 0
1000 +amp /volt 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo N HVAC N Secunty Alarm N Vaccuum System N Garage Opener N All
Other N Other Descnption. Ecompasing N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF 0
Owner: Contractor:
GORILLA CAPITAL INC BELLA PIETRA MARBLE & GRANITE LLC Required Items and Reports (Conditions)
1400 HIGH ST #B -2 3780 BOONE ROAD SE SUITE 3
EUGENE, OR 97401 SALEM, OR 97317
PHONE' PHONE 503- 991 -5024
FAX' 503- 991 -5354
Total Fees: $94 29
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 - •r. - 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 • ENTION Oreg• law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -00 -0010 through OAR 9 • -. • -8090. You may obtain a copy of the rules or direct questions to OUNC b .- �eF 232 1987 or 1.800.332 2344
Issue. =y: / - ', .1 4 Permittee Signe e: �' y � / C���E - .
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 completi • of the project.
Approved plans are required on the job site at the time of each inspection.
Jan 10 13 03:56p Bella Pietra 5039915354 p.1
Building Permit Application i ;
Residential a ∎•.±, , , roll OFFICE l'SF. ONLY
of Tigard �'i�� ved
li
• 13125 SW Hall Blvd., Tigard, OR 97223 JAN 10 201 i DatrlReceiBv_ ���� Permn , „� QOQ�
Plan Review
Phone: 503.7 18.2439 Fax: 503.598.1960 p Other Permit. ,
T 1 G A t; D Ins Line: 503.639 �* r •ate R eadyvtiy ]'LI�s sr See Page 2 for
Internet www.tigard or CITY OF ! TI F oufre tit. erhnd
Supplemental Information
BUILDING DTVIS ON
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
0 New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
® Addition /alteration/replacement ❑ Other, equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® I and 2 family dwelling ❑ Commercial/industrial Valuation: S500,00
❑ Accessory building ❑ Multi- Family Number of bedrooms: 4
❑ Master bulkier ❑ Other: Number of bathrooms: 2
JOB SITE LNFORMATION AND LOCATION Total number of floors: 2
Iob site address: 14100 SW 117 Avenue New dwelling area: square feet
City /State/Z1P: Tigard, Oregon 97224 Garage/carport area: square feet
Suitetbldg /apt. no.: I Project name: 117th Covered porch area: square feet
Cross street /directions to job site: SW Gaarde Street 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 m ap/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.
Minor demolition Valuation: S
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Gorilla Capital Type of construction:
Address: 1400 High Street Suite B2 Occupancy groups:
City /State/ZIP: Eugene, Oregon 97401 Existing:
Phone: (503)805 -7012 Fax:( ) New:
® APPLICANT S CONTACT PERSON BUILDING PERMIT FEES*
Business name: Bella Pietra (wise refer w Voice re8edrtJ
Structural plan review fee (or deposit):
Contact name: John "Chris" Brava/Chaz Anderson
FLS plan review fee (if applicable):
Address: 3780 Boone Road SE Suite 3
Total fees due upon application:
City /State/ZIP: Salem, Oregon 97317
Amount received: /r �� n
Phone: (503) 991 -5024 I Fax: : (503) 991 -5354
E-mail: bella- pietra a@comeast_net Cell: 971 -239 -7389 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and ••.idential prescriptive installation of
CONTRACTOR roof -top mounted Ph . • . Voltaic Solar Pa ystem.
Business name: Bella Pietra Submit two (2) sets of ..f plan with nection details
and fire department ace , . non: • th the 2010 Oregon
Address: 3780 Boone Road SE Suite 3 Solar Installation Specialty ..,e checklist.
City /State/ZIP: Salem, Oregon 97317 Permit Fee (includ=...1 eview
S180.00
and ad - strative - s):
Phone: (503) 991 -5024 I Fax: (503) 991 -5354 State surchare _% of permit f::: $21.60
CCB lie.: 185209 O
Total fee due upon application: 5201.60
Authorized signature: / This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: John Chris B . , , Date: 01/10/2013 * Fee methodology set by Tri County Building Industry
I Service Board
IBuild inglPermits \BUP- RESPemtitApp.doc 02/24/2011 440-1613T(11 /02'COMIWEB)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14100 SW 117TH AVE, TIGARD, OR, 97224
Residential - Master Permit
295 Misc. inspection
03/11/2013 00:00
MST2013-00005
FAIL
1. Provide connection from tongue and groove 2 xs to top plate. In garage. As shown on
page S5.1, detail 1
2. In garage add squash below 4x6 ridge beam above window and add king stud to
window.
3. In garage, install Simpson HU28 at ridge beam on 2x8's rafters.
4. Install pony wall above existing garage garage, rear and right side and drywall.
5 install approved man door in garage
6. Provide blocking on gabled end of garage wall, for sheathing.
7. Complete living room dropped ceiling above kitchen pass through
8. Install 2 2x8 over garage window as shown on roof framing plan
9. Remove all dry rotted top plates, main floor, and replace.
10. Fire stop stair stringers
11. Provide electrical approval. Remainder of job needs to be call in for inspection.
Violation Summary:
Inspector Contractor
-
•
6z®® M CITY OF TIGARD MASTER PERMIT
; a a ' COMMUNITY DEVELOPMENT Permit #: MST2013 -00005
TI G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/10/2013
Parcel: 25110BA00400
Jurisdiction: Tigard
Site address: 14100 SW 117TH AVE
Subdivision: CANTERBURY WOODS CONDO Lot: 76
Project: Gorilla Capitol
Project Description: Interior demolition to determine extent of permitting to be required. 2/7/13, REPRINTED to add
• electrical to scope of work. 2/14/2013: REPRINTED for structural repair plans.
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: 0 sf Value: $6,700.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
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'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 2
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
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:
ALT SF VB R -3 0
Owner: Contractor:
GORILLA CAPITAL INC BELLA PIETRA MARBLE & GRANITE LLC Required Items and Reports (Conditions) •
1400 HIGH ST #B -2 3780 BOONE ROAD SE SUITE 3 -
EUGENE, OR 97401 SALEM, OR 97317
PHONE: PHONE: 503 - 991 -5024
FAX: 503- 991 -5354
Total Fees: $408.13
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 • 52 -001 • 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
–OAP C '9
Issued By: i / � � /��� r� _ Permittee Signature: O XV 41-644/ '/ �`a
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.
FOR OFFICE USE ONLY - SITE ADDRESS: / 4 loo &W 1/ 7 AO
This form is recognized by most building departments in the Tri -County area for transmitting information.
Please complete this form when submitting information for plan review responses and revisions.
This form and the information it provides helps the review process and response to your project.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
•
:. Transmittal Letter
T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: IJ -/ f DA'I
DEPT: BUILDING DIVISION L 0
M� 5 03
FEB 11 2013
� -
_ 5
FROM O ( Z
611 l I CITY O
COMPANY: . /.\ \? 7e\
BUILDING DIVISION
PHONE: (6o ) qq \ 6O2-\ cti 4 z 13ya)
RE: • r A. 411 ��/- - 4 ' i H ' ? -0 00
rte A 4 I ress (Perrriit Number)
I
(l �J
. • the tJ
'roject name or su I 8 'vision name . 1 of num p er � � :Cj
Y
ATTACHED ARE THE FOLLOWING ITEMS:
t� )
Copies: Description: Copies: Description:
Additional set(s) of plans. Revisions:
Cross section(s) and details. Wall bracing and/or lateral analysis.
Floor /roof framing. Basement and retaining walls.
Beam calculations. ;� Engineer's calculations.
Other (explain):
JEMARKS:
rit ` : 3
0 7 ,6
0 aoA/� 6 tE
J �5' -/t1 o 77/
FOR rFTE USE ONLY
Routed to Permi c 'cian: Date: ""Z„. (4.- ' Initials. • :.‘
Fees Due: es ❑ No Fee Description: Amount b ue:
To - Art0 $ Aya • ( /
$
Special
Instructions:
Reprint Permit (per PE): ._ 'es ❑ No Q Done
Applicant Notified: D ate: Initials:
I:\Building\ Forms\ TransmittalLetter- Revisions.doc 05/25/2012 /
Jan 10 13 03:56p Bella Pietra 5039915354 p.1
Building Permit Aalolication Mi- ;
Residential ` J i � r' '
Y , . �I t4l: orr ICU t r
City of Tigard � , Re r 0 / Pencil No: rOOO(i
13125 SK Hall Blvd., Tigard. OR 97223 JAN 10 201 3 5�
'� Phone: 503.718.2439 Fax: 503598.1960 P Other Permit. ,
! 1 C. n ! U Inspection Line: 503.639.4175 �t�t/± ey a RpOy/B MI[ r RI See Paw 21br
Internet www.tigard -or gav C]�[y � 1IGARVlmfsdrMtthod j
BUILDING nNISION 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
Additian/aio ration/replacement ❑ Other equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on tins application.
® 1 - and 2 family dwelling CI Contmerc inn du atrial Ye/Nation: $500.00
❑ Accessory building ❑ Multi - family Number of bedrooms: 4
❑ Master builder ❑ Other: Num of bathrooms: 2 •
JOB SITE INFORMATION AND LOCATION tel number of floors: 2
Job site address: 14100 SW 117 Avenue New dwelling arcs: square feet
Citv/State/Z1P: Tigard, Oregon 97224 Garage/carport area: square feet 1
Suitribldg /apt. no, I Project name: 117th / Covered porch area: square feet
Cross street/directions to job site: SW Gaarde Street Deck mem square feet
Other structure area square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: I lot no • Permit fees" are based on the value of the work performed.
Ta m ep/parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materiels, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Minor demolition Valuation: S
Existing building area: square fed
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of states:
Name: Gorilla Capital Type of construction:
Address: 1400 High Street Suite B2 Occupancy groups:
City/State/ZIP: Eugene, Oregon 97401 Existing:
Phone: (503)805-7012 Fax: ( ) New:
all APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES'
rem Business name: Della Pietra (Remo
Contact name: John "Chris" Bravo/Cbaz Anderson Structural plan review fee (or deposit):
Address: 3780 Boone Road SE Suite 3 FLS plan review fee (if applicable):
City /State/ZIP: Salem, Oregon 97317
- Total fees due upon application:
Phone: (503) 991-5024 ( Fax :: (503) 991 -5354 Amount received: t�9 , / 9
E-mail- bend.- pieera®comeastnet Cell: 971- 239 -7389
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR - Commercial and ••_'dentin) prescriptive installation of
roof -top mounted Ph . Voltaic Solar P:„ ystem.
Business name: Bella Pietro Submit two (2) sets of , . f plan ' . aims details
and fire department ace=,. lon: th the 2010 Oregon
Address: 3780 Boone Road SE Suite 3 Solar installation Specialty • checklist.
City /State/ZIP: Salem, Oregon 97317 Permit Fee (includ' • ' ew
and • . strative - s): 5180.00
Phone: (503) 991 -5024 I Fax: (503)991 -5354
State stu+cltarro of permit f.. : $21,60
CCB 1X.:185209 / AI 3
Total fec due upon application: S201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: John Chris B i Date: 01 /10/2013 1 • Fee methodology set by Tri�ommty Building Industry
Service Board
I1Building \Permits'BUP- RESPennIt pp.doc 02124/2011 440-4613T(11 /02ICONEWEB)
'' U CITY OF TIGARD j- MASTER PERMIT
I " COMMUNITY DEVELOPMENT �' ' Permit #: MST2013 00005
O
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 • - , . Date Issued: 01/10/2013
Parcel: 2S110BA00400
Jurisdiction: Tigard
Site address: 14100 SW 117TH AVE
Subdivision: CANTERBURY WOODS CONDO Lot: 76
Project: Gorilla Capitol
Project Description: Interior demolition to determine extent of permitting to be required. 2/7/13, REPRINTED to add
electrical to scope of work.
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:
Total: 0 sf Value: $500.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
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'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 2 i
Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0
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:
ALT SF 0
Owner: Contractor:
GORILLA CAPITAL INC BELLA PIETRA MARBLE & GRANITE LLC Required Items and Reports (Conditions)
1400 HIGH ST #B -2 3780 BOONE ROAD SE SUITE 3
EUGENE, OR 97401 SALEM, OR 97317
PHONE: PHONE: 503- 991 -5024
FAX: 503- 991 -5354
Total Fees: $165.52
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 i e with approved plans. This permit will expire it work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ENTION: Ore n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 01 -0010 through OAR 9 2- -0 0 You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 1987 or 1.800.332.2344.
JIB �
Is ued By: / \ Permittee Signature: Q 0(r ` — Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
i This permit card shall be kept in a conspicuous place on the Job site until completio f the project.
Approved plans are required on the Job site at the time of each inspection.
, _., q,M.: CE
Electrical Permit Applicat FOI(OPI ICI: lisi; ONLY
Received d
City of Tigard DateB : Ab� A Permit No.: r �' , r (� p J
° 13125 SW Hall Blvd., Tigard,OR 972 -3 EB 7 2013 Plan Review
0 . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
I" I G n It D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: kris: iii See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑ New construction j/_ .� Addition/alteration/re p lacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ 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 El Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
ulti- family El Master builder 0 Other: less
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 ", "I -2 ", "l -3 ",
Job no.: Job site address: /4 /O 0 11 7 E 19 tJ e 100HP or more. occupancy.
❑
0 Six or more residential units. Recreational vehicle parks.
City/State/ZIP: J j,, be 0 ❑ Health -care facilities. ❑ Supply voltage for more than
` ❑ Hazardous locations. 600 volts nominal.
r te/
Suite/bldg. /apt. no.: Ofe. Project name: ❑ Service or feeder 600 amps or more.
/ FEE SCHEDULE
Cross street/directions to job site: ✓ �4 i Ro Description I Qty. 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
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
'/�
Limited energy, multi - family 75.00 2
(/N 0 i � l- )' `4 4 4 Z 0 is" 1 /2 eAcv: J residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
C t e 4 -/tr - UtY. 1�d2 ('o,c / /ekichL(e /ce e_ i 200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
ty relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per 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: (kl.! 2_ t r l� TS q) 0 - N P VLS B. Fee for branch circuits without
L service or feeder fee, first C
Contact name: V ` ` L ` t , ` � Ue _� _ oa k � f c( branch circuit 56.18 2
1Y_ " Each add'I branch circuit / 7.42 7. / Q. 2
Address: I CQ S Z 1 b4 (/4�l (nib 6 . f Miscellaneous (service or feeder not included)
l Each manufactured or modular
City/State /ZIP: SLA ( wt. (94) 01 ' j O \ dwelling, service and/or feeder 67.84 2
Phone: (, 65) 12 2_764 3 Fax: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: 1.1A5 At 50 � panel, alteration, or extension. Page 2 2
V ` Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) 1(4( ( Fax: ( I l 4 W / 3 Inspections for which no fee is 90.00 / hr
?
1 / / specifically listed (%z hr min)
CCB Lic.: I t 0 0 Electrical Lic. (�_5 f 5 Suprv. Lic.: v '5 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �P� {{""��__ Subtotal: ( 7 t )
7C Plan review (25% of permit fee): -
Print name: C � (2113 �v eg A rLt is-f Date: 14 1, 3 State surcharge (12% of permit fee): -- 7•626
Y` r TOTAL PERMIT FEE: 7 / . ., 3
Authorized signature: This permit application expires if a permit is not obtained within 180
�(
days it has been accepted as complete.
Print name: fAS IA 7S .) � Date: • Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 07/01 /10 440- 46IST(11 /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:
❑ 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 $75.00
system
(SEE OAR 918- 309 -0000)
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*
p 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 \Permits\ELC- PermitApp.doc 07/01/10
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14100 SW 117TH AVE, TIGARD, OR, 97224
Residential - Master Permit
299 Final inspection
2013-11-19 00:00:00
MST2013-00005
PASS - C of O
Corrections from report dated 10-10-13 completed.
Violation Summary:
Inspector Contractor