Permit CITY OF TIGARD MASTER PERMIT
m COMMUNITY DEVELOPMENT Permit#: MST2013 -00016
T l G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/06/2013
Parcel: 2S104CA06300
Jurisdiction: Tigard
Site address: 13256 SW HILLSHIRE DR
Subdivision: HILLSHIRE Lot: 63
Project: Flake
Project Description: Finish previous unfinished basement, including some additional crawl space.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 1690 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: 1690 sf Value: $108,971.00 Rear: 0
PLUMBING
Sinks: 2 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 2 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs /Showers: 1 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: 1
Other Fixture Units: sump
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 1
Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1
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: 9
Ea addl 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 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:
ADD SF VB R -3 1690
Owner: Contractor:
FLAKE. JEROME 8 JANEEN OWNER Required Items and Reports (Conditions)
13256 SW HILLSHIRE DR
TIGARD, OR 97223 •
PHONE: 503 -502 -4369 PHONE:
FAX:
Total Fees: $4,585.15
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 OA 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
IA Issued By: hit ia-1-- Permittee Signature: _
Call 503.639.4175 by 7:00 a.m. for the next available inspection d e.
This permit card shall be kept in a conspicuous place on the Job site until co letion of the project.
Approved plans are required on the job site at the time of each inspection.
!J
I
Property Owner Statement •
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing 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 a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
//✓r 77 Ate__ or
61"9 ' I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
•
Ai r ame of Permit Applica
10 0F1. nature of Permit Applicant Date
Permit #: H 45-1 13 -ct:50 /(o
Address: ( ..J W-1 U-5/fi 6
6a2 97..3
' ( :
Issued by: Date. i I .3
This Copy for Permit Offices
•
'Building Permit Application
Residential O1t •OIC USE OI. ... ..
. . ... . ...
.. .,•. .. ,...•• • FFFE SNV : . •• R CE IV� Re ccncd
City of Tigard m Permit No.: N / [ /
lik `J g Datei
13125 SW Hall Blvd., Tigard, ORS fl 23 8 2 013 Plan Revi 7 1�T '
�J 1 -• • Other Permit - O .
Phone: 503.718.2439 Fax: 5035181960' Dat e/B : 4�ra
.TIGA i• In' spcetion Line: 503.639.417 : A Dale Ready : . • Juris: 0 See P_age'2 far' s
Internet: www.tigard- or.gov � ITYOFTIG�RD Notifie ethod: `� _j /3,' Supplementallufarmation
•
• ®1)ILDfNGDIVISIO��i - ?- W .,
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", ' - . _ % 'rT' . . - .. R'ORK T. _. ? r ` _ t - • . RE
. QUIRED DATA: l- Ar" DIY FAATI I : . \ FLUNG i
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❑ 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/replaccmcnt ❑ Other: equipment, materials, labor, overhead; and the profit for the
•„; -; • -•'' _ ,;. _ ''..z-.---'--
z - CATEGORY •.O
-'=�_;''' P =- _ ' work indicated on this application.
f ; ' ,. <„ ^_ ;., t " F,CQNS ?RUCTIO -, F ` �. r '-•-
a r :- ,,a Valuation: • $ ( /
e' 8 , q? /
® I= and 2 family dwelling ' ❑ Commercial /industrial . •
❑,Accessory building ❑ Multi - family Number of bedrooms: 1
El builder ❑ Other: Number of bathrooms: 1
AND C
=, • = :JOB' Sl "GF IION: LO ATION ..�, + a Total number of floors: 1
Job site address: 13256 SW H illshire Dr. New dwelling area: /6elD square feet
City/State /ZIP: Tigard, OR. 97223 Garage /carport area: square feet
Suite/bldg. /apt. no:: Project name: Fivii94141eselwnt ! - 1 . 4 k £ Covered porch area: square feet
Cross street/directions to job site: Wilshire Dr. and SW Westridgc Terrace Deck area: square feet
Other structure area: square feet
REQUIRED;DaGAi ;COAL \TF.RCIAti= lSE.,CHEChI1ST' ;
Subdivision: Wilshire I Lot no.: Permit fees* are based on the value of the work performed.
map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
Tax
s _
- "
_ equipment, materials, labor, overhead, and the profit for the
ijai: - ; , y .3 . 7 .1 t:4s.V. - I r - , .:: =f .' .,
z, :. ;,,DESt_'RI'PTION-.. •' URIC F _�_ t -" ° r:' wor i n di cate d on t app
Finish unfinished basement, including flooring, sheetrock, painting/texturing, Valuation. $
Millwork; tiling,.eahinets, counter tops, doors. • Existing building area: square feet
. New building area: square feet
.. PROPERTY'- O ., "r; k :'❑:'l'ENANT ;:? c + '. - rn Number of stories: -
Name: Jerome and Janeen Flake Type of construction:
Address: 26002 NE 10 Street _ Occupancy groups:
City /State /ZIP: Camas, WA. 98607 ' Existing:
Phone: (503)502 -4649 . Fax: ( ) New: . •
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- ; APPICA'N'E - ,_ - , q CONTIGIY - • "
PE �`i' - _i..„: ' .BUIGDII\IIT�FEES- ar '_ ,y
Business name: -. = - -- s ;(Pleas fer'.? fees >• =u "'.,
Structural plan review fee (or deposit):
Contact name: Jerry Flake
Address: 26002 NE 10'" Street FLS plan review fee (if applicable):
City/State/ZIP: Camas, WA. 98607 Total fees due upon application:
Phone: (503) 502 -4369 Fax: : ( ) Amount received: $75
O'l't) JAL OR'PANEI:L:S fE I s '
E-mail: maijFlnl:e @gte.net i :.:< .��. :_
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,�•; ;-,_ r ,� x ,. : .. t _ ";;;1; ;, - r 1 _ Commercial and residential prescriptive installation of
r
t r _ •: 'f : „ ,: ;'.r ` l` : _ i •
••,i a .- roof -top mounted Photovoltaic Solar Panel System.
Business name: Y C 'el 0 F Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: Solar Installation Specially Code checklist.
City/State/ZIP: Permit Fee (includes plan review 5180.00
and administrative fees):
Phone: ( ) Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lie.: Total tee due upon application: . $201.60
Authorized signature: o This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:.ferome Fla Date: 1 -14 -2013 * Fee methodology set by "1'ri- County Building Industry
Service Board.
I`\ Building \Pennits\BUP- RESPerrnitApp.doc 02/24 /2011 440- 4613T(1 l /02 /COM/WEB)
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•
Plumbing Permit Applicatio
Building Fixtures JAN 2 8 2013 FOR OFFICE USE ONLY
cet� ed
City of Tigard Da eive I . : 3 - Y / 3 Permit 1,150 S7 7 1.3 -OW I •
13125 SW Hall Blvd., Tigard, OR 972 1 TY OF TIGARD Plan Revic \ f� r .
Phone: 503.718.2439, Fax: 503.598. �1 -1 Date/By: +�T�V `Pt 3 Other Permit 1� a _ o
TI GA RD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: .- / � / Juris: ' l0 See Page 2 for
Internet: www.ngard Oi.gov t.ori£ Cr' ed/Metfpd: S Supplemental Information h on
- •r -•r w }, ..: ; , � E * S Ems`' • ''' : _ , ,-.•.' ri1.7.r T• .: ' , .WORK~ t. ,.t ( s _;;,i,,, *' ltiJ ; i; - '1,' , „' CHEDUL ', I .:'..
3 .. _ .. :. v ,� 1 - . - r_k- �- c,, -,_, ..a�r ,..,�.: ,;.J-,,,.... ,w ., i..<�,...rJe -.,.. �:.:.,�. �.- .n . •
❑ 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)
�= :. °fix`" SFR 1 bath 312:70
'a te ' - ,, ; ;, : :..,
. - - - _��*���TECORI's:OF- CUNSTRUC7'fO \:�_ ��� �3: =.: . ( )
® I- and 2- family dwelling ❑ Commercial /industrial
SFR (2) bath 437.78
. SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2
}`,: r- s W JOB SH EvilYFOR1ILATION `AND_ L'OG;I kr R ;; Site utilities:
Job site address: 13256 SW Hillshire Dr. Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
- City /State/ZIP: Tigard, OR. 97223
Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: I Project name: Finish Basement Manufactured home utilities 50.03
Cross street/directions to job site: Hillshire Dr. and SW Westridge Terrace Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) . Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Hillshire Lot no.: Fixture or item:
Tax map /parcel no.: Backtlow preventer 31.27
- r - r ,.. •,: - r t d; tt�; -'-; � :m Backwater valve 12.51
... z;�t-:•...11'wa1el DE$, • ... .i01 QF _,, C- 1RK : A , : - .:€v�: ' -' �T3° r s , ii'
Clothes washer 25.02
•Install copper piping to supply hot and cold water to full bath, wet bar sink, Dishwasher 1 25.02
and wine cellar sink. Install PVC drain and vent pipes for full bath, wet bar Drinking fountain 25.02
sink, and wine cellar sink. Install sump pump for basement sewer. Ejectors /sump I 25.02
fit -FE Ctrs+ - `~ a T ' " Expansion tank 12.51
I
;" ••. ®.; <,BROPERT'�;OWNER „. �w ° ^� ° __i ;TENANT "
Name: Jerome and Janeen Flake u Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 26002 NE 10 Street
Garbage disposal 25.02
City /State/ZIP: Camas, WA. 98607 Hosc bib 25.02
Phone: (503)502 -4649 Fax: ( ) Ice maker 12.51
KA' `s," ,- `h.®` _ E` ;y'` ;;,-,; = ®i. CONT$CT; PERSOD `=" ' .7_ Interceptor /grease trap 25.02
Business name: Medical gas (value: S ) Page 2
Primer 12.51
Contact name: Jerry Flake
Roof drain (commercial) 12.51
Address: 26002 NE 10 Street -
Sink/basin/lavatory 4 25.02
City /State /ZIP: Camas, WA. 98607 Solar units (potable water) 62.54
Phone: (503) 502 -4369 Fax: : ( ) Tub /shower /shower pan 1 12.51
E -mail: jfiake @gte.net Urinal 25.02
rr .c. - • - r °=:CQNTRAC TOR': a>s. - - � -. •= -,o-: 07, Water closet i 25.02
,. ,..„ ^- . :3.,sa,i..,,....,., -. -.•_::_,4:, n r �i: z : G: r:. ;1.•._' Water heater 37.52
Business name: OM lv e/ Water P 1 P in WV 56.29
Address: Other: 25.02
City / State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lie.: Plumbi g Lie. no.: Plan review (25% of permit fee)
State surcharge (12% of pennit fee)
Authorized signature: C TOTAL PERMIT FEE
Print name:. l ( � �o D ate:
This permit application expires if a permit is not obtained within 180 days
� otter it has been accepted as complete.
'Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits\PLMU- PemdtApp.doc 10/01/09. 440- 4616T(10 /02./COMM'EB)
Mechanical Permit Application - k • FO R OFFICE USE ONLY - • -
�d,
'. City of Tigard • :i�' Received if i3 PermitN 1�STX07 -6 b /l0
71 S 13125 SW HalI'Blvd., Tigard, OR 9 ,2 •• � � � , . Plan Review iv., 1 .. / Oth Per m �Jn , �
. Phone: 503.718.2439 Fax: 503.59''.1'' . 8 DateBy: L'71� d`h / �
�a.000�
'TIGARD ,inspection Line:. 503:639.4175. JAN 2 8 2013 Date Ready/By: y: iun 1 ® See Page 2 for
. Internet: www.tigard or.gov Notified/Method: s• Supplementallnformation
sll 7
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_ - _ . --11.1'.:f c - _ -- ,_ - ' _ - "!t -: C :.Fh.E "SCHP.`D ULiE "- USE GHECI�LIST,-: '
- � - 5i ��•.. G DIVIIOK,�� ��" Mechanical permit fees* are based on the value of the work
❑ New construction ® Add ition/alteralton/replacemen performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: - ' mechanical materials, equipment, labor, overhead, and profit.
•� � .�,.- Value: $
s , . °` CATEGORY' •OF CON5TRUCTION } a: w,° s :,, « f"
' .,--...-,-,,-_-,•,::,...,,;,:_,:,:,.,f,...,;-:•-,...,,: �� --\,_ � _- �, RF. SIDE�NTIA LiEQUII'IVIF.,VT /,S]SGEMSaFEES; „ =i ■_.,
• ® I. and 2- family dwelling ❑,Commercial /industrial ❑ Accessory building • For. special information use checklist.
• ❑ Multi- family . - . •Master builder : ❑ Other: Description I Qty. I Ea. I Total
Si ''t:,4_.: ?-t '.IOR SiTF:r-i\ :-r- ::- ..-,— °T•';-T'.:: Heating /cooling:
xa '.L:' y: _ -- FOlt�11- .
- - - - ArU'LnFATIOV >'t; #�.w".a z., ";F
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., _ ... __ -,..- ..n _ ..._ . -- --- � .�- -- ..•'t7-.::.'" Air conditioning •
Job site address: 13256 SW' Hillshire Dr. (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: Tigard, OR. 97223
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Finish Basement Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Hillshire Dr. and SW Westridge Terrace Duct work ( 23.32
Flydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Hillshire Lot no.: Flue/vent for any of above 23.32
' Other: - - 23.32
Tax map/parcel no.: Other fuel appliances:
, -- -. �° - 'd _ �''DF.SCR1Pi' _ 1 — ; ,. ; ' n t Wat heater 23.32
Gas lireplace/insert / 33.39
Flue vent for water heater or gas
fireplace 23.32
Log liehter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
i y ^' `
;:;r : Chimney /liner /flue /vent 23.32
®�PRQPERT�]�`��QWi\rE'R�'? : ....' - • -- X7:3. �(]. �_rENi�I�1C�::: "r:� ;�+ +�;_�-i �.:
a- Other: 23.32
Name: Jerome and Janeen Flake Environmental exhaust and ventilation:
Address: 26002 NE 10 Street Ranee hood /other kitchen
equipment 33.39
City /State /ZIP: Camas, WA. 98607 Clothes dryer exhaust 33.39 .
Single -duct exhaust (bathrooms,
Phone: (503)502 -4649 Fax: ( ) toilet compartments, utility rooms) 1 23.32
.- +. ::, tea- `- �; •,,,.'. - n-.
; i ' u ;; : r. , : _- z ®� APCLICA�1 . ` � . � - - , ®'COnTACT i �"R Anic /crawlspace 23.32
Business name:
Other: 23.32
Fuel piping:
Contact name: Jerry Flake $14.15 for first four: $4.03 for each additional
Address: 26002 NF. 10 Street Furnace, etc.
Gas heat pump
City/State /ZIP: Camas, WA. 98607 Wall /suspended/unit heater
Phone: (503) 502 -4369 Fax: : ( ) Water heater
Fireplace t'
E-mail: jFlake(a�gle.nel Range t
-,-: •-1:: W ca0 •1- 1t.T:';7. • _ 1 A o :. •. r' - - -9 ;•': - _, . --1 ;te,i=
.•: :,,us , t.. -'� •: - -. . .;s (r: ,- GON .H.:..:,: ,! - , Barbecue
• Business name: )/ p'�ki el.__ - Clothes dryer (gas)
/�` Other:
Address : _._. °, ,_ -
s �: yr �:: �: N1EGH; 11�; I_ Ga_ tiPERNII _TFEES, *�;< .
City /State /ZIP: Subtotal
Minimum permit fee ($90.00)
Phone: '( ) Fax: ( ) Plan review (25% of permit fcc)
CCB tic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized Si gnature: days after it has been accepted as complete.
Print name: Jerome Fla e - Date: 1 - - 2013 • Fee methodology set by'I`ri- County Building Industry Service Board
•
I: \Building \Permits \MEC- PermitApp.doc 03/07/12 440 -4617T (I I /02/COM/WE13)
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Electrical Permit Application I -- - . 1.012 OFFICE USE ONLY. - -
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City of Tigard -- i, 4 :v: .
1 %ed y e).s i t 3 . . .
Pennit No.://,.e.T.301. --,
. .......
:.- - - - - i3125 SW HA Blvd., Tigard, OR
Illit 598.1960 N 2 8 2 013 Plan Review bil.q.., .
czYLO 1 3. • Other PerMi„ i --
/...0e/i •
503.. - JA . Date/By:
..
. ' `.;... •'' '... 'Inspection Line: 563.639.4175
'4_ Internet • Dam RcadY113);' eP/SII. - .. Juri,: • ' El .See Page 2 for :: •
Internet: www.tigtird CITy OF TIGARN NotifiediMethod: -t • ?7G. .... Supplemental Inforniation '-
- . .
18,/i, i;, G ::'.:', •
E3 New construction E Addition/alteration/replacement ' ' _ Please check all that apply (submit 2 sets of plans whiams checked below):
• 0 Service or feeder 400 amps or more 0 Building over three stories:
• .,.0 Demolition .. ' . . ' - : .:1:10- . . Other: . . .. where the available fault 0 MatinaS and boatyards. •
. . ' ••
exceeds 10 000 0 am s at 150 volts or floating buildings
-': ,,,°q'i: '. `■'';:,..-,15 - z,-,IL ' '4 .cosisYRu ,:" --. i,:,, . , P 8 . g .
'''' -'` ' '''''' r. ' ' ''''' '' ' ' ' 4 r .' ' . ' - ' '- ' ' ' ' ' ' . • less to ground, or exceeds 14,000 0 Commercial-use agricultural .
•
. . . 0 I- and 2-family dwelling . 0 Commercial/industrial 0 Accessory building amps for all other installations. . ' buildings.
1:1 Multi-family -. El Master builder 0 Other: - El Fire pump. '0 Installation of 75 KVA or • . .
- • . -- • • - 0 Emergency system, larger separately derived system.
i.10B:' SITE INFORMATION AND LOCO 0 Addition of new motor load of
100HP or more. occupancy.
Job no.: Job site address: 13256 SW Hillshire Dr.
CI Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, OR. 97223 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: Finish Basement CI Service or feeder 600 amps or more. •
-' +' ''.". --'-:;7-'•': - ..''-: - . ' ", 1" :t - T;., 1 -3 1 - '0 0fi5,* } IEBV: 111. : - .4 - i
Cross street/directions to job site: Hillshire Dr. and SW Westridge Terrace Description 1 Om I Fee. 1 Total I
. New residential single- or multi-family dwelling unit.
Includes attached garage. •
Subdivision: Hillshire Lot no.: 1,000 sq. ft. or less I:P"' 168.54 4
Ea. add'I 500 sq. ft. or portion _ .. . 33.92 1
Tax map/parcel no.: • . Limited energy. residential
,
,
'' .. 75.00 2
')''?' '' ' '''''''''': Wi:iiiiee' ' ,, t,;:-:=''- c (with above sq. ft.) - - -
: !.;::....: -, ..:. ., - . ' ....„-'e.z.,...,. -:4 ',
Limited energy, multi-family .
' . '
Wiring of basement being finished.. •
- . • • • residential (with above sq. ft.) - .
75.00 2
. . _ . . Services or feeders installation, alteration, and/or relocation . ' • - . .
•
. •
. .
, . . ' 200 amps or less - 1 . 100.70 2
• ' " . .... . •
:- . 2( ;L4it ;'2•24IitiiiIiiii?; Iti.SiNhil:L 1 :':;:;:- 1:r 'I'EN.kNT '7_1.'±-1..;a5;._ 201 amps to 400 amps 133.56 • 2
401 amps to 600 amps 200.34 2
Name: Jerome and Janeen F lake .-
601 amps to amps 301.04 2 11
Address: 26002 NE le Street Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: Camas, WA. 98607 • relocation . .
Phone: (503)502-4649 • Fax: ( • ) 200 amps or less 59.36 I
201 amps 10 400 amps 125.08 ' 2
Owner installation: This installation is being made on property that I own which is not
•
intended for sale, lease, r , or - ch. e , 401 amps 10 599 amps
.: srding to ORS 447, 449, 670, and 701. ' 168.54 2
.10 Branch circuits — new, alteration, or extension, er panel
Owner D3itit-'-/"/ A. Fee for branch circuits with•
''.-- r. ---.•".'''''' ': tU --k . .. r ' E); C6Nt ptiisoNf..."::', above service or feeder tee, 9 7.42 ' 2
each branch circuit
Business name: B. Fcc for branch circuits leirhour
service or feeder fee, first
' .56. 18 ?
Contact name: Jerry Flake . . . . branch circuit
- • Each add'I branch circuit . 7.42 ' . 2
Address:.26002 NE 10 Street . . Miscellaneous (service or feeder not included)
• Each manufactured or modular •
- • City/State/ZIP: Camas, WA. 98607 • . 67.84 2
dwelling, service and/or feeder
Phone: (503) Fax: : ( ) Reconnect only .67.84 . . 2
Pump or irrigation circle 67.84 2
E-mail: jflake@gte.net _ . _...... • Sign or outline lighting 67.84 /
=,
- - 1: . .. ,- '',.:•7,•-'•:-'. - . , ' , ".•' , 7-' 7 ,-°:toistkk€I.Tco.gri:7 =. '2: ': ,:::, - ": :' j-: S ignal circuit(s) or limited-energy
Business name: 010,3€4 panel, alteration, or extension. .Page 2 2
Each additional inspection over allowable in any of the above ,
Address: . Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: . . Investigation (I hr min) 66.25/ hr •
• Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
90.00/ hr
specifically listed (V: hr min)
CCB Lie.: Electrical Lic.: Suprv. Lie.: - .:.&"!•4.f.iii::::2,74F,F;ECT R 1(4 1,,,j). ERtvirit
Suprv. Electrician signalure. required: Subtotal:
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): .
. e ToTAL PERMIT FEE:
Authorized signature: ,. .
. . ' -This permit application expires if a permit is not obtained within 180
days after it has been accepted
Print name: Jerome F --
ke ---------- -Pate:_k) 4 13
-. ,.• Number of inspections allowed per permit. as complete.
1:111oildineermits \ ELC-PerrnitApp.dot 07/01/10 440-4615T(1 I/OS/COM/WEB
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