Permit •
• 'q CITY OF TIGARD MASTER PERMIT
.6 COMMUNITY DEVELOPMENT Permit#: MST2013-00213
T FGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2013
Parcel: 2S102BD02400
Jurisdiction: Tigard
Site address: 12820 SW GRANT AVE
Subdivision: NORTH TIGARDVILLE ADDITION Lot: 40
Project: CAMPBELL
Project Description: Dormer addition only. Exterior footprint is not changing.
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: 272 sf Garage 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 272 sf Value: $95,000.00 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
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
Natural Gas Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K: 1 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- 2 0-200 amp• 0 W/Svc or Fdr: 15
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
Ecompasing: N
Other: N Other Description: P 9
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R-3 272
•
Owner: Contractor:
CAMPBELL,SANDRA RAE WEST COAST CONSTRUCTION Required Items and Reports(Conditions)
12820 SW GRANT AVE 4300 SE ALDERCREST RD
TIGARD,OR 97223 ' MILWAUKIE,OR 97222
PHONE: PHONE: 503-939-1286 -
FAX:
Total Fees: $2,673.00
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 •NTION: Or gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 through OA 952-0 0 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800-332.2344
Issued y: r Permittee Signature: . O_ _ .
Call 503.639.4175 by 7:00 a.m.for the next available inspectlo 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.
Building Permit Application
. Residential *CEIN ED FOR OFFICE USE ONI.,Y
City of Tigard DateBea a p, Permit N°.: T� C)C�
° 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revii I
Phone: 503.718.2439 Fax: 503.598.1960 SEp 3® 2013 DateB : /rat Q in ( � Sher Permit
T I G n K D Inspection Line: 503.639.4175 ��QQ[1 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov O�'I`Cjfu� Notified/Method: }6I17�13 17" Tit Supplemental Information
��tCt```n11410 1510 0 Spakt In R.T`
TYPE OF WOI 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
0-Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Xl-and 2-family dwelling ❑Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: t 2_ 3 2_0 . 'QA-4‘-)`1-- New dwelling area: square feet
City/State/ZIP: ' \CI on 22_3 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: s'Z F Covered porch area square feet .
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Rely)a o t tr u.P el 11A-DE: ROD DzycoRtleil Valuation: $
e--‘fl- ��V p-2 9 Lam), N v, W ( 1 Q Existing building area square feet
J New building area: square feet
J PROPERTY OWNER ❑ TENANT Number of stories:
Name: 'J 2 F P f2o P 02-1-1 6:S Type of construction:
Address: 72 a 5 5 c. , (Tot_ itI.LL I•j) Occupancy groups:
City/State/ZIP: 11012-1-- 912-19 Existing:
Phone:(503) 517 - I g's-7 Fax:( ) New:
EC APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: tni ' co ft .1 Co N 5.7-1214c.:71 0/� (p�aserefertofeeschedule)
Structural plan review fee(or deposit):
Contact name: 2:3. t (LE
Address: 3vO 5 ��CcZ CA?'C FLS plan review fee(if applicable):
�� Total fees due upon application:
City/State/ZIP: pc--(2-1— 9-?z-z-2-
Phone:(5793) 9 " (2-?(o Fax::( ) Amount received:
E-mail: `' ^ PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
ll r°�G`51'�� C� Cow< (ra— Commercial and residential prescriptive installation of
• CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: i(.r.ES°' co A51-- Ce?N IT-2._.m.C-1-1 0 IaI Submit two(2)sets of roof plan with connection details
`� and fire department access,along with the 2010 Oregon
Address: �3O O 5 E V1) 1ZC1Z77 r-'"!/ Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
��Z Z�' and administrative fees):
Phone:(5p3)et-j.:7-_--- t Z- '6 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 18CI 567.3 o2/I a. 1 'w Total fee due upon application: $201.60
Authorized signature: jj (.1 et6t IA 1 z� This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: /Vt. Date: _ fl r [ Service Board
I:\Building\Petmits\BUP-RESPermitApp.doc`02/24/2011 440.4613T(11/02/COM/W EB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received Permit No,:
4 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
' G Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
TIGAR'D
24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
I 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.
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 o1 ❑ ❑ ❑
architect licensed in Ore:on and shall be shown to be a•slicable to the Iro'ect under review.
JURISDICTIONAL SPECIFICS-
23 Three(3)site plans are required for Item I I above. Site plans must be 8-1/2"x II"or 11"x 17". ❑ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
25 Buildingplans 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 I/02/COM/WEB)
•
_ 4 -_
Mechanical Permit Application Received
FOR OFFICE USE ONLY
jig u City of Tigard Date/By: Permit No.: t. i I 13125 SW Hall Blvd.,Tigard,OR 97OWED , `
° 2013 Date/By:Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960
T I G A K D Inspection Line: 503.639.4175 CEP 5® Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov J Gia AA,, Notified/Method: Supplemental Information
�` 91,11)1�IS1G1` COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
TYPE OF WD�1`t
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
)] I-and 2-family dwelling ❑Commercial/industrial ID Accessory building For special information use checklist.
'0 Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: l2 '2c2 St") 6(R T Fumace 100,000 BTU(ducts/vents) ' 46.75
City/State/ZIP: 1-1 CD Cr) 22 Furnace 100,000+BTU(ducts/vents) 54.91
5 Heat pump _ 61.06
2_ '
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic 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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
' DESCRIPTION OF WORK Gas fireplace/insert 33.39
}} /� Flue vent for water heater or gas
IQ , __.) v/ S c -ii C t kJ 1 uvr_k61-c fireplace 23.32
(
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: S 2r- p az e ez'(1 es Range hood/other kitchen
Address: '72 l 5 ti
equipment 33.39
S ���� ��L ( t I�� �-� Clothes dryer exhaust 33.39
City/State/ZIP: P D ) 7 ci—7 2- I, Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503) 5'--1---/--- ) 2s5--) Fax:( ) Attic/crawlspace fans 23.32
N.APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name: /1 0C�ejS '�,/v( t-G���) (� $14.15 for first four;$4.03 for each additional
Contact name: _l_f��1�e_'7' N 12Z( �/ Furnace,etc.
Address: ' 3"g) 56- I 7-i Cr Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: iitt0eir D s Ci l OE9 Water heater
Phone:0-03 ) 233 3137 Fax: :( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: f5(A pSe"T I I G - b..) -.f C,Q0�-jam} Other:
p ,a ,�-C MECHANICAL PERMIT FEES*
Address: 13 p 7 ,a ("1' C-1- Subtotal
City/State/ZIP: n 5C �I s O 17 s ci' Minimum permit fee($90.00)
Phone:(5.D3 ) t 3 3 - 3 (22 7 Fax:( ) Plan review(25%of permit fee)
State surcharge(112/2%o of permit fee)
CCB tic.: tI t 7 q 75 (-7/15-' TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Authorized signature: R5- I°j►qtav I(ZG • Fee methodology set by Tri-County Building Industry Service Board
Print name: r Date: et.(-3,30
I:\Building\PermitsMEC_PermitApp_0401I3.doc 440-4617T(I1/02/COM/WEB) .
Mechanical Permit Application City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee.Schedule:
:total Valuation: Permit fee:
$0.00 to$500.00' Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00:
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional.$100.00 or
fraction thereof,to and.including
$10,000.00.,
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00.and
$2.54 for each additional$100.00 or.
fraction thereof,to and including ` r =
$50,000.00.
$50,000.01 to$100,000.00 $1,363:71 for the first$50,000.00 and
$2.49for'each additional_$100.00 or
fraction thereof,to and including V ''
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000:00 and
$2.92 for each additional$100.00 or
fraction thereof. .!
Note: All new commercial buildings require 2 sets of plans. .
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1:\Building\Permits\MEC PermitApp_040113.doc 2
°Oct b2 13 03:55p RJ Ma 14 0 11 FIn 5035130158 p.1
Electrical Permit Applt anon FOR OFFICE USE ONLY . •
City of Tigard OCT 2 ?;": ; 1;,, b\h) Received O y Penult to.: /I ..
- - Date/By: l i ' Lh�v '�/3' 3
13125 SW Hail Blvd.,Ti° ,. : •,':-1
• 0 Phone: 503.718.2439 l� 5 3.'918 A !N:.. 11 o- 7� Plan Review eW OtherPenm,
Inspection Line: 503.6�g1 f lit I r. `„• Z t.J `-t3 Date Ready/By: luris: ® See Page 2 for
fIG�Rll ".go��
Internet: �awvv.tipard or.gov `,Ryl Notified/Method: Supplemental Information
TYPE OF WORI '�,UY ” �Sv��1`d PLAN REVIEW .
New construction S""'n Please cheek all that apply(submit 2 sets of plans w,items checked below):
❑ ❑Addition/alteratioprrefiT Bement
in Service cr feeder 400 amps or more 0 Building over three stones
❑ Demolition ❑Other: where the available Fault current ❑:violinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,C00 amps at I50 volts or 0 Pleating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildines.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of ISO KVA or
❑Am system. ;sager separately derived system,
JOB SiTE INFOR.F[ATION AND LOCATION
❑Addition ition of new motor load of ❑'=A","E","1-2",'l-3";
Job no.: Job site address: (''� ]ocl�Pormore, occupancy
w +Jut) I ❑Six or more residential units. ❑Recreational vehicle parks. •
City'.'StateiZlP: .n 2 z3 ❑Health-care facilities. ❑Supply voltage for more than
(� 600 volts ncm:na).
�f_�'�� (� CI Hazardous locations.
Suite/bldg./apt.no.: 1 Project name: ` 0 Service or feeder 600 amps or more.
L _ FEE SCHEDULE
Cross street/directions to job site: 04-04P here. 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 _ I 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax trap/parcel no.: Limited energy,residental 75.00 2
DESCRIPTION OF WORK (wits above sq.ft.)
/�q , Limited energy,multi-family
1 le—PL �C.� 1.7. 1..jG f-- , 5 L 8 C •1 N` L_- �Q residential(wi:h above sq.ft) 75.00 ''
I / Renewable Energy ❑ See Page 2
15 c.. :`Q (,( -17 --t4 I 15 Services or feeders installation,alteration,and/or relocation
• (.PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
t�
201 amps to 400 amps 133,56 2
Name: S 2_ '' P ees 2 2_. 1�1 401 amps to 600 amps 200.34 2
Address: ---)`Z'rJ 5 v%) -..f -r' 1 [._ ('k-k i.-_ (7-., 601 amps to 1,000 amps 301.04 2
Over 1.000 amps or volts 552.26 2
CityiState/ZIP: Po-v_---1 G-l'"L I Temporary services or feeders installation,alteration,and/or
relocation
Phone:(53) 5 1 l c,5-7 Fax:( )
t f - 200 amps or less 59.36 ]
Owner installation:This installation is being made on property that i own which is not 201 amps to 400 amps I 125.08 2
intended for sale,lease,rent,or exchange;according to ORS 447,449,670,and 701-
401 amps to 599 amps 1 168.54
Owner signature: Date: - Branch circuits—new,alteration,or ex tension,Per panel
A APPLICANT . '' ❑ CONTACT PERSON A.Fee for branch circuits with ,
above service or feeder tee,
7.42 2
Business name: IU Ci t f— 6-,,6-,,-,,-,_j C each branch circuit
+ B.Fee for branch circuits rvirllorrr
f
Contact name: 1.7.1-0- i—{ -�'(�\ ([� service orfeeder fee,list
55.18 2
branch circuit
Address: 1 055 $o) J3 ,Y zD_1 Each add.'branch circuit _ 7.42 2
Miscellaneous(service or feeder not included)
I City/State/ZIP: `,'J [t,-,5 Vj r �� 7� Each manufactured or modular
Phone:i5 3) S'12-7-- 3M eE 2 Fax: :( ) dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail: Pump or irrigation circle j 67.84 r. 2
. CONTRACTOR Sign or outline lighting • 67.84 2
Business name: (..!Q rt e L EC:1 i 6, Signal circuit(s)or limited-energy See
panel,alteration,or extension. _ Page 2 2 -
Address: Each additional inspection over allowable in any of the above
-
CitylState.rZiP: ; Additional inspection(I hr min) 1 66.25/hr
Investigation(1 hr min) 6625/hr
Phone:(5113) 5-12_- 3---1 g 7 Fax:( ) Industrial plant(1 hr min) ! 78.18!hr
' Inspections for which no fee is
CCB Lie.:jqi4 dj$7 Electrical Lie.: 6797 Suprv.Lie.: 97/7 S specifically listed(%hrrain) 90.00/hr
q/24s 7 7 r f j y Id I I lit. ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: /_ Subtotal:
Print name: Date:
Plan review(25%of permit fee):
q A` State surcharge(12%of permit fee):
Authorized signature: L /? ._/'--r TOTAL PERMIT FEE:
a�t•` lTr Li �-
This permit application expires if a permit ix not obtained within 180
Print name: j.,�_s t-I- 1 1e1 Date: days after it has been accepted as complete.
t • Number of inspections allowed per permit.
I'Buildingl Pe•mit'ELC_PermitApp_ELR_EREdo:Rcc05121/2015 445-161ST(II/OS/COM/WEB
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
12820 SW GRANT AVE, TIGARD, OR, 97223
Residential - Master Permit
199 Electrical final
2014-03-28 00:00:00
MST2013-00213
PASS
Violation Summary:
Inspector Contractor
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
12820 SW GRANT AVE, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
2014-04-15 00:00:00
MST2013-00213
PASS - C of O
Violation Summary:
Inspector Contractor
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
12820 SW GRANT AVE, TIGARD, OR, 97223
Residential - Master Permit
699 Mechanical final
2014-04-15 00:00:00
MST2013-00213
PASS
Violation Summary:
Inspector Contractor