Permit CITY OF TIGARD MASTER PERMIT
° COMMUNITY DEVELOPMENT Permit#: MST2013-00156
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/08/2013
Parcel: 2S110BA04000
Jurisdiction: Tigard
Site address: 14380 SW MCFARLAND BLVD
Subdivision: SHADOW HILLS Lot: 25
Project: Jenkins
Project Description: Remodel two existing bathrooms. Change closet opening to existing master bath.
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: 1 Third: 0 sf Right: 0
Detectors: Yes
Total: 0 sf Value: $20,000.00 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: 2 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: 2 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 Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add9 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:
JENKINS,ROBERT EBEN& HORIZON NORTHWEST INC Required Items and Reports(Conditions)
WENDY MK 6950 SW HAMPTON ST
14380 SW MCFARLAND TIGARD,OR 97223
TIGARD,OR 97224
PHONE: 503-639-5725 PHONE: 503-319-5878
FAX:
Total Fees: $923.12
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. ATT- ' •1: : -.on law requires you to follow the rules adopted by the Oregon Utility Notification ter. Those rules are set fo h in OAR
952-001 .010 through OA 152-I• -00.0. You may obtain a copy of the rules or direct questions to OUNC by calling 503 "87 or 1.800.33 4.
Issued =
Y• I Permittee Signature: i//i.. /. ,
Call 503.639.4175 by 7:00 a.m.for the next available Inspection de
This permit card shall be kept In a conspicuous place on the job site until comple on of the project.
Approved plans are required on the job site at the time of each inspection.
•
Building Permit Application
Residential RECEIVED FOR OFFICE USE ONLY
■
/_ Permit No.:
City of Tigard �I Inl f DateBea (L At'D Mira
W3 i/3 5■
° 13125 SW Hall Blvd.,Tigard,OR 97223 UN .� 20,3 Plan Review
' Phone: 503.718.2439 Fax: 503.598. 60 Date/0 : A`' 1 11II (.3 Other Permit:
Inspection Line: 503.639.4175 CITY OFTIGARD Date Rea.y:5;: furls: ® See Page 2 for
r��� BUILDING DIVISION Notified/MeetthhoodO 7 ,'' ,P Supplemental Information
Internet: www.tigard-or.gov ` � R PP
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
Addition/alteration/replacement ['Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ o�•CO
5(1-and 2-family dwelling El Commercial/industrial r
ID Accessory building ['Multi-family Number of bedrooms:
1:1 Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: /4,3 s'u),. n G f-gYiQ,l,1d F kei, New dwelling area: square feet
City/State/ZIP: • !'���/ 0 I �'7 Z� Garage/carport area: square uare feet
Suite/bldg/apt.no.: (-1
Project name: Covered porch area square feet
Cross street/directions to job site: A.(0 6j4�, 4,J G f=„/V1ersid Deck area: square feet Q J L
A5 Ih76( ■ Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 1 Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: �s'I��rJ [ �(� Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESSCRIPTION OF WORK work indicated on this application.
Rd I ET: to t tiq kt4a S'r�/ 1�E k -F' ha i.� 11 ail k. Valuation: $
2vvn0 � J ( r_ �
C ail J /cjrc 1 AOvCrKull a & crr-St Wt�l.SfrV t Existing building area square feet
L%IOSvVV,t+ New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: Q, l at id Ccie-t �.,' c - .1 -1t:Lc Type of construction:
Address: ,c Gtr t fA q t9iYi-P, Occupancy groups:
City/State/ZIP: Existing:
Phone:(g,))) 62 m_ 5 r] 5- Fax:( )
New:
APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* '
Business name: ��� ^ I (Please refer to fee schedule)
`tTCJ��20)1 r 1`t lt,U � .. ..,1,46.../ Structural plan review fee(or deposit):
Contact name: D-e_b1Ll•ts b(v e-( -
_FLS plan review fee(if applicable):
Address:
��, (5-1-„t/ p s�{ Sf't f �/ Total fees due upon application:
City/State/ZIP: ,...4 , 9 C ' • ,— —
_ Amount received: O ys. O
Phone:(6-) 31 7 / Fax: :( ) q , ----74-6,
E-mail: 6/�`,�d /1('] G c:� wr z� • v'�I PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commer '•l and residential prescriptive installation of
CONTRACTOR roof-top mou Photovoltaic Solar Panel S .
Business name: �f � s f„Q(�� Submit two(2)se •f roof plan with c P ection details
ICJ and fire department ace-. alon: , the 2010 Oregon
Address: Solar Installation Special •.•• checklist.
City/State/ZIP: Permit Fee(in •i es plan re - • $180.00
. • .dministrative fees):
Phone:( ) Fax:( ) State • arge(12%of permit fee): $21.60
CCB lic.: ti 6 31 S
Total fee due upon application: $201.60
Authorized signature: ,/ This permit application expires if a permit is not obtained
ie
r•1 within 180 days after it has been accepted as complete.
Print name: 0(�(l.t l - e_\ Date: s— /3 *Fee methodology set by Tri-County Building Industry
Service Board
I:\Building\PermitskBUP-RESPermitApp.doc 02/24/2011 44046131(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
g Date/By: Permit No.:
1114 q 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
T I G A R D 24-Hour Inspection Line: 503.639.4175, 0 Electrical 0 Plumbing 0 Mechanical
Internet: www.tigard-or.gov ❑ Other:
TFIE 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.
I I 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-ft. 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 Ore:on and shall be shown to be applicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)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 Items1 6, 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 trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature 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-RESPermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
G&B Plumbing&Sons,Inc 503-925-1707 p.1
Plumbing Permit Anplicatio(g� EWED
Building Fixtures FOR OFFICE; 1 SF ONLY �1
City of Tigard JUN 6 J:' Da e/Bya Permit NO: )1101/91 Zj-1 17-(09
III a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
2 • Phone: 503.718.2439 Fax: 503.591 OF Other Permit No.: ".
Inspection Line: 503.639.4175 TIGARD Dam/By:
"I I G.\I.D Doc ReadylHy: foes el Set Page 2 Poe
Internet: www.tigard-or.gov RIJILDINGDIVISION NoIifiedRuled�od: _ Supplemental Information
TYPE OF WORK FEE' SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description t Qty. I Ea I Total
,'Addition/aberation/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for eadl utility cormection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
'and 2-family dwelling ❑CommerciaVndustr®1 SFR(2)bath 437 78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
' Each additional bath/kitchen 25.02
El Master builder ❑Other: Fire sprinkler( sq.ft.) _ Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ±"1 C 1 '" • Catcb basin or arca drain 18.76
�� rQ I} Dry�vcll,leach line,or trench drain 18.76
CitylStatcrLLP: /-) "?.
fl C= / Footing drain(no.linear ti.: ) Page 2
--Suite/bldg./apt no.: r Project name: Manufactured home utilities 50.03
Cross street/directions to job site: (, I; i i;/:t,L C "L i-1.1 (p.`1 .j`, Manholes 18.76
,/' ' Rain drain connector 18 76
72 C" i't-'tic::iii h..i/'f '
Sanitary sewer(no.linear ft.:_____) Page 2
Storm sewer(no.linear II.: ) Page 2
Water service(no.linear 1L: ) Pagc 2
Subdivision: 5I4„/41JId f.!'/i; _ Lot no.: Fixture or item:
Back flow prtisen
ter 31.27 nap/parcel no.: ." . //p h r�i d
DESCRIPTION OF WORK Backwater valve 1251
(� • I { •[ !!�� Clothes washer 25.02
l��i��y'\ Ftc, t1 G :(�i.f..[t 4•- �'c<< L".Z tt t Dishwasher 25.02
-1'14 40�' c I p - •ifrziasC t , I/Leid ,)-eta/se ll Uzi I1 ej; Drinking fouruain 25.02
Nrege- --1�P-}f' Ejectors/sump 25.02
•1 PROPERTY OWNER I ❑ TENANT Expansion lank 12.51
Name: Fixture/sewer cap 25.02
='h'�' �� 5� �� 1�t Floor drain/floor sink/hub 25.02
Address: ii /t f7( l /
j . �n 1 i/� >��j'/!: •(�� f^II�f • Garbage disposal 25.02
City/State/ZIP: 7i ii fi if/ /r ('.) )?'/ Hose bib 25.02
P h o n e:( .: ) -t/J!�-.5-3 J';7 Fax:( ) Ice maker 12.51
V APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: / ,{ ' t --Fit Medical gas(value:S ) Page 2
iii- I`I-.7,:11 j�/L r fte (I C c':� r r Primer 12.51
Contact name: 1)f itt.rl] lA{1(4c.-1
Roof drain(commercial) 12.51
Address: 6";</.5-Z S L[- 171;7i;11) -777 <i f.t. :34`J Sink/basin/lavatory 25.02
City.SWle/ZIP: ,lt if( ( k /c7)1_7 %_� Solar ones(potable water) 62.54
Phone:(-;;1•)) - !J2,,1 1 - ti )c I Fax::( ) Tub/shower/shower pan i 12.51
E-mail- I J [� ) '' c /- F Urinal 25.02
X4%1 Lid,I -f J e(i"ry9ii 1 t-?r1 Water closet 25.02
I CONTRACTOR Water heater 37.52
Business nitene: �'-f'1''l �v,�:,�:„ j °- o� / -
Water piping/DW V 56.29
Address: el• /C•K G'� `
Other: 25.02
City/Slate/ZIP: e j, PPrki Die- Subtotal
Phone:( ' 1 ( 1 Fax:( tq 2 'J t -/c) Minimum permit fcc: 572.50
��� to - Lt S � � S -
-, Plan rcvicw (25%of permit fee)
CCB Lie.: «4 3`1..2, /%.g//y Plumbing Lie.no.: P.6 b) y -
".1f/l/y State surcharge or/.of permit ice)
Authorized signature:
TOTAL PERMIT FEE
Print name. it " _ I Date: Iii~- r This permit application expires if,permit is not obtained within 18D days
� after it has been accepted as complete_
"Fee methodology set by Tri-County Building Industry Service Board.
I:lauildina'Pemuu1PLMU-PemutApp.doe 1010 609 440-4616T(IOIO2/COM/WEB)
•
i
•
Mechanical Permit AnalitCWED rr n: c;r r i c i. r z,:r. !.
•
City of Tigard w3uaitria: ifp'b /5-",,
13125 SW Hall Blvd.,Tigerd.OR 972 '
r Phone: 503.718.2439 Fax 503.59S 0 2 U LU13 Omer Pamir i
,- inspection Liar. 503.639A175 tan Ready/By::: Aoic ®see Page 2 for j
Hdeinci www.ugard or.gov CITY OPTIGARD � Supplements!latareeallao
.
... . . ..:::
„_•'...-:::7--.-:.:.!:::',.-;-:,-::•,- _ _ .
,,.�;i•.=': .-J: .: Mechanical'paadt fees"me based oaths value olds watt
0 New construction ❑Addition/alteration/replacement perform!.Indicate the value(roinded to the neare t dolla3)of all .
❑Demolition • ❑Other: me l s,.e pn nientL labor,overhead,aid profit
•
X1-and 2-fmo,ily dwelling ❑Commercial/iinduSutel ❑Accessory building . - Forspeciali tfo oration use-dr.ir d&
❑Multi-family ❑Master builder ❑Other. Description I Qty. I Fes. I Total j
-
Air condrtioninB _46.75
Iob rite address /'1 WV era /n Ci.•U Od R/J(' . Fantail 100,000 BTU(daadvmns) 46.7$
City/State/ZIP: — - 0 . yejzy Fwvace 100.000+BTU(d ems) 34.91 •
•Su 1dglaprt n0.: `' ProleU11`name: `�`/// Heat pump 23.06•
f (� Deetvrotlr 2332
•
•
•
C�resa s7reet/directiotm to job/site ��g/ u/�1 IdGiM"IA.f�< IC.oOiG� Hyaronic hot waua sysum 23.32
• • e Fall�4( . u4` . 6odw(r8gdator ar 2332 •
. Ua lthaters(fuskype,not el Mc),
• • io-wall,induct:suspended.etc: . 46.75 .
Fluevent for any of above 2332
.Other Subdivision: ,S h d /f,BLS Lot o_n 2332 '
Other the t
•
Taxmapfparcelna: .25 f1Q 61 14 Water heater 2332
_. :,.. ,:=_::r._;:=.:- ,...:.,...-,. :,-:_:-_::,:.-. . ...::. ....:... 3.39
__ Gasfireplacduract
:. . 4oD):p :Wl1[
. . FhmvetQ:Pot watsrhearerorgs
•
v - t%S .,
tireplaoe 233z
Lon ter in (qtw) 2332. .. r
Wood/pelletsnue •. 3339 '
- Wood&eptmdinsert 23.32
. t3rnnneynu/veet°
4: :_ _.. 23.32
s1 :ii ,` �� :° Eavlranmeulal.eslaugnad wcelHatloe:.
Namm 0 Lta (4 T t .174* k i ?c i haodl�arbtchen .
' ,equipment . 3339. .
- Address: law .� t'-1 LfIa4.4 tt4 . t;lalhoadryer ochanst . . 3339
Ciry : - .a .p
... S ngla t Wield(b ,
mita tildy ttoa�
) . . 2332 . .
Phone( 6,, . fns . II
. ... .
- - = 23 32
.. _:. .:fir, ,.' _
_ ..,.
Husiness.oame. Fad 0101211.
v17 �D,Arrtt 1I� i'1 51415 for fleetboar;S4A3 foreufiadditlaal
Contact name: .p�yyrll.5 , 4 4 F'e.tt
ass.heetpuaw
Address: .6:Y. 296 4 z4"J , w mrmrt.lieater•
C3tAtatel�P: G' 2-23 Water heater
Phnom( a i5D I fax::(4P3) q -14f&I F11epla°`
Rm►ge
E-mail: • r,e i"1 -, • ->l.l Barbecue- : ;yama:_ ::i_ 4 u .. f_� :.,_:'ail ; s• < .
( )
Busneas.na P rarAi Wes., pt n ° ga
Address: qq we ( o ax
Subtotal.
ty/Sfate�P MinimumpentM fee(59000)
Ci
('�Dir'f-l Q i 1 Plan review(2356 of perailt.fee) . .
Phone:( )7g( 4522 I Fax:(9) )78ti 3g32 Staesurcharge;(12%ofpetmirti:a)
CCB lie.: 59 3 g . - TOTALFERMIT FEE.
Th peradi epiniaesn apbes Ifs perurhlb net ebpraed wttio 180
daysitter.it h Mona+meapeed as complete.
Authorized signature a A • Fee methodology son by Tell-Calmly Boding Bavica Bored
Print name .4I 11 . 'J _. Date: , _
r: ow313dso 4a4617r(UIDSp IW!$)
Electrical Permit A licati CEIVED FOR OFFICE t.SE ONLY
City of Tigard Received l/ �"2./Q-0:)/56:7
a.m. Permit No.: G pc/r✓
• 13125 SW Hall Blvd.,Tigard,OR972J3'' 2 6 �U 2e1(3 Plan Review
B Phone: 503.718.2439 Fax: 503.598.x9 1 Date/By: Other Permit:
111,A 1L L) Inspection Line: 503.639.4175 Date Ready/By: lens. ®See Poge 2 for
Internet www.tigard-or.gov CITYOFI'IGARD Notified/Method: Supplemental Information
TYPE ataialVGDIVISION PLAN REVIEW
❑New construction ddilion/alteralion/replaCemCM -Please check all that apply(submit a sets of plans /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
" J-and 2-family dwelling ❑Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A""E" "I.2""1.3"
Job no.: Job site address: 142 ��jj, t nn JJ 100HP or more. occupancy.
/ $L ��� /d� ���whifA�Ti ❑Six or more residential units. ❑Recreational vehicle parks.
City/StatefZlP: ✓/Cud} /'l ` (/-q 2 L ❑Health facilities.
❑Hazardous locations. 0 Supply voltage for more Ihan
600 volts nominal.
Suite/bldg./apt.no.: ` Project name: ['Service or feeder 600 amps or more.
� ( � FEE SCHEDULE
Cross street/directions to job site: ^`TL q q I_ fr Description J Qty.7 Fen 1 Total 1
tt (.� �,�6't l.�l ��4,� L 1C 1 It-
� I New residential single-or multi-family dwelling unit.
/V e 12 Li d// A b'e f. Includes attached garage.
Subdivision: Lot no.: 1.000 sq.ft.or less 168.54 4
Tax map/parcel no.: a„5 I I,L' gi -& 4-tL7 Li Limited energy,sq.esdeponion 33.92 I
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.fl.)
� ( ,p p /
Limited energy,multi-family
75.00 2
4fP/T `PIA'( f'1 CJdC•' �(I,+ /I.:f..5� f�di i LJt p1.11 11/i�G O� residential(with above sq.R.)
I' !1 Renewable Energy ❑ See Page 2
'��!'k I t/ !,:..i5 Services or feeders installation,alteration,and/or relocation
G.PROPERTY OWNER I ❑ TENANT 200 amps or Ims 100.70 2
Name: Q /
201 amps to 400 amps 133.56 2
•.J 1 ti., el//{I / \l"-C 4 I kit/LS 401 amps to 600 amps 200.34 2
Address: t 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:1_5-..5) �r ') I ( ) relocation
C�t'a(-`� / ST Fa` 200 amps or less 59.36 r 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
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
O.APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: .0-6,ke-c-2.(-11 6J. 1,i),Z='m- L7/ each branch circuit
B.Fee for branch circuits without
Contact name: f service or feeder fee,first
�C��l.i xt S 11th Yr>� ,,!!'' - branch circuit ) 56.18 5,4 1 g 2
Address: y, , (l/) ,1"' ', r : >L r '/ Each add'l branch circuit j 7.42 -7.)i-/Z 2
City/State/ZIP:/$tale/""/..IP: 0 Miscellaneous(service or feeder not included)
ty r e a'a4 i 'r `i?27?) Each manufactured or modular
Phone:(51.„?) 4 dwelling,service and/or feeder 67.84 2
) 31tY__ ''O, Fax::(5;3) �1,s--7` t
Reconnect only 67.84 2
E-mail: �11 Mt'/ yj') ci-!alit ,51- tier Pump orinigmioncircle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: 0.0 ,ea •LL Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: /1,/id ,L Each additional inspection over allowable in any of the above
City/State/ZIP: / Additional inspection(I hr min) 66.25/hr
�-6 ''7t C 6Jv,`C, C R �)//(v Investigation(Ihrmin) 66.25/hr
Phone:(,0 ) ?)57,6,/ 3 5 D Fax:(507 357- q/5 9 Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.:3 5-7&3 I Electrical Lic.3 -//8)C._. I Suprv.Lic.:33 `s specifically listed(%r hr min)
j ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 63,be2
Print name:`G n r Date:6 5--i Plan review(25%of permit fee):
m/ State surcharge(12%of permit fee): 'T'[.,1,.
Authorized signature:cc)OVP2 7 - 7 TOTAL PERMIT FEE: '7)).ZJz
Print name: /� , 3 This permit application expires if a permit is not obtained within ISO
0i,1 (2, . O t I'd er Date: (C/-� days after it has been accepted as complete.
• Number of inspections allowed per permit.
I'13uildinglPcrmiu`ELC PermitApp_ELR EREdoc Rev 051212013 440-46151(11/05ICON/WES
CITY OF TIGARD
BUILDING DIVISION PERMIT#:.P-t �i3�tbsSfo
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171 ,,�11 �r�
Inspection Requests (24 Hrs.): (503) 639-4175 . ':!+� °'I I..
•
INSPECTION WORKSHEET FOR DATE: ``/!So TIME: ll,'417 PAGE:
SITE ADDRESS: 1/330 SGT Nfit ,f,701 6(l/, CLASS OF WORK: •
SUBDIVISION: LOT#: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: • PHONE #:
CONTRACTOR: • PHONE #:
Inspection Request Scheduled For: Date: a//r`!T Pour Time:
Code # Inspection Description Confirm # Contact # Message
•
• gt/�Zbr cis? —
•
Corrections/Comments/Instructions:
•
•
posfi_ 1(60,
f rev
PASS ❑ PARTIAL APPROVAL ❑ CANCEL • ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector � Date: ////..51/ Phone #: (503) 718- a7.U630