Permit Ifi q CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit if: MST2015-00017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/23/2015
Parcel: 2S102CB03800
Jurisdiction: Tigard
Site address: 9975 SW GARRETT ST
Subdivision: FREWING'S ORCHARD TRACTS Lot: 11
Project: MILLS
Project Description: Upstairs bathroom and walk-in closet expansion.
BUILDING
Floor Areas Required Setbacks Reauired
Stories: 3 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: $7,000.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 1 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'I 500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O SvclFdr: 1
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:
MILLS,DOUGLAS S&JEANNE OWNER Required Items and Reports(Conditions)
9975 SW GARRETT ST DOUGLAS SCOTT MILLS
TIGARD,OR 97223 9975 SW GARRETT ST
TIGARD,OR 97223
PHONE: PHONE: 503-297-3503
FAX:
Total Fees: $465.02
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. NTIO : •egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 1-0010 through O•- • -0* -00'1... You may obtain a copy of the rules or direct questions to OUNC by calling *3.232.1987 or 1.800.332.2344.
I .1
A ��� ��
Is ued By: t Permittee Signature: ���
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.
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 all subcontractors who work on the structure must be
-licensed with the Construction Contractors Board.
r
will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
j)vier.,L)4 5 s c off 0/1' .5
Print Name of Permit Applicant
F h , .2o/6—
Signature of Permit Applicant Date
Permit#: HeYrde(5- 0061 7
Address: 1 7.75 511-) coAi2,Q4.7r
012 97 .25 " 7:,r� ,;_
Issued b ate: c43//05-
This Copy for Permit Offices
Building Permit Application
VA.Residential �� �� II)KUIIit I I S1 1/\I l
City of Tigard Received
9 2015 DateB : 0 ," Permit No.:m r.a .
:� 13125 h n SW Hall Blvd.,Ti Fax: 503 98.19 Plan Re `, ran=� Phone: 503.718.2439 Fax: 503.598.19 E8 �u p��g : / Fag, Other Permit:
f I c.n It h Inspection Line: 503.639.4175 I\�i`T�!* ��jj Date Rea :y: See Page 2 for
Internet: www.tigard-or.gov CON NISIoh' Notified/method: a' I9 <��� Supplemental Information
i1 6% a
TYPE OF REQUIRED DATA:I-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.
❑ 1-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: 4:194'.,r 4:194'.,r s'f E,4 6Q r ri f f S'17 New dwelling area: square feet
City/State/Z1P:711 Got./t.), iZ C3 J 2.2—.-1 Garage/carport area: square feet
Suite/bldg./apt.no.: `�I Project name: X1/1/[r L s Covered porch area: square feet
Cross street/directions to job site:
'' +,L Deck area: square feet
JR r e Sl• Q.c- ‘).o._47,4,e F 1 v.,t1 Cg el.1�, Other structure area: square feet
1 REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
f Valuation: $
&XP a K at u piaL t✓--f �a roo Y--1 '4- Wet ix x-"1 Existing building area �r -square feet
C los `
New building area: square feet
SPROPERTY OWNER I ❑ TENANT Number of stories:
Name: et`-/-01-S St-077 inr 1.--5 Type of construction:
Address: et 943— 5 co G,,t44& T. Occupancy groups:
City/State/ZIP: 7 tG.4 ij i OP., 9 ZZ 3 Existing:
Phone:(563)297..3 03 Fax:( ) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: t?lmere erWIaxh )
��'� as ci 2'1ft-- Structural plan review fee(or deposit):
Contact name:
FLS plan review fee(if applicable):
Address:
City/State/ZIP: Total fees due upon application: fit?,ti
Phone:( ) Fax::( )
Amount received: lit 7/i
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Ape_i___ Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: Total fee due upon application: $201.60
Authorized signature: 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:1,0 GC '5e-.a `�S Date: /'4/i Service Board
1:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLY
Received
City of Tigard
IN
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By
Phone: 503.718.2439 Fax: 503.598.1960 Associated permi t,
T I G A R D 24-Hour Inspection Line: 503.639.4175 ❑ Electrical [] ❑ Medianical
Internet: www.tigard-or.gov ❑ Other
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 e,i `I)
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.
11 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.
JLIRiSDI("I'ION;1L 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 Items 16, 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 440-46131(11/02/COM/WEB)
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
Received
City of Tigard DateBy: Permit No.:
III - n 13125 SW Hall Blvd.,Tigazd,ORPhone: 503.718.2439 Fax: 503.5 960 Plan Review
+G Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Q 1 1 Date Read B Juris: H See Page 2 for
T I G A R D Internet: www.ti ard-or. ov pp -� Ready/By: g
g g �* Notified/Method: Supplemental Information
TYPE OF WORK �,tjt+0 FEE* SCHEDULE
❑New construction ❑ r� , . olsio For s,eciai in ormation use checklist.
Descri s tion =PM Ea. Total
❑Addition/alteration/replacement r l t T.I . New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ 1-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
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9t a� sw c A-R.RL--I r 5-7-7 Catch basin or area drain 18.76
City/State/ZIP: _ Drywell,leach line,or trench drain 18.76
y / ,„4/2b Olt 4=77-2_2-3 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: m i,t-C-5 Manufactured home utilities 50.03
Cross street/diredions to job site: P,G,,cI,1,64.„7, ccti vd\ 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer _ 31.27
DESCRIPTION OF WORK Backwater valve 12.51
L J /) Clothes washer 25.02
�X Pat Lt,s /a rs Lek%re Dwk 1-- Wo(L ` 1t"1 Dishwasher I 25.02
Cl as'e`t' Drinking fountain 25.02
Ejectors/sump 25.02
ler PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: t-l04/4S SC°Tr r L C. s Fixture/sewer cap 25.02
t
Floor drain/floor sink/hub 25.02
Address: �R�s_ �� e rrt� S'>�t Garbage disposal 25.02
City/State/ZIP: ,r ygrc Gg._ 9 ? 2 2 3 Hose bib 25.02
Phone:(553) a9'3-3 (Q '. Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: � �1Q'-S �QO✓� Medical gas(value:$ ) I Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory I 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: 0 LA) vi Qv- Water piping/DWV 56.29
Address: Other: I 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 ,
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: I; TOTAL PERMIT FEE
Print name: !AA Date: This permit application expires if a permit is not obtained within 180 days
�6tt(�Ll�S S�O T�f//I;_z. �9r�� after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:'Building\Pennits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/O2ICOM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee:
Footing drain-1 0 100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52
Storm&Rain Drain-1st 100' 62.54 Valuation: Permit Fee:
$1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
Qty. Fee(ea) Total each additional$100.00 or fraction thereof;to
Other Inspections or Fees and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
(minimum charge-1/2 hour) each additional$100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that 1
Work Performed: Capped Added Relocate �p y
❑ Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool
Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure
Drive Stall as defined in OAR918-780-0040.
Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities.
Dishwasher: -Commercial CI Any multipurpose fire sprinkler system.
-Domestic CI Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eye Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
Isometric or Riser Diagram
-4" ❑ Isometric or riser diagram is required for new buildings
-Car Wash Drain
Garbage -Domestic non-food that meet the qualifications above.
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -LavBar non-food related _
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet plumbing permit can be issued.
Urinal
Other Fixtures:
I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2
Electrical Permit Application FOR OFFICE USE ON I 1
�City of Tigard Cit
`�.% Received
y Permit#:
13125 SW Hall Blvd.,Tigard,OR 97223 Skt Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 1Q1 Date/By: Related Permit#:
Inspection Line: 503.639.4175 ` early Date/By: lurir: 65 See Page 2 for
I I I:I) Internet: www.tigard-or.gov C�'" Win' oti d/Method: Supplemental Information
TYPE OF WORK rev V� 4�}01O PLAN REVIEW
❑New construction ❑Addition/alteration/rep)a 00♦ 6 1'� Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: t, it ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
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
Job#: Job site address: ` � ❑Addition of new motor load of system.
_ C 9'.c S Gt/ Ga r r e � S1 100HP or more. ❑"A" "E" "1-2" "1-3"
City/State/ZIP: 7� p ❑Six or more residential units. occupancy.
ty 1 q../�L j ! Z 3 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: n,IILLs ❑Hazardous locations. ❑Supply voltage for more than
I t ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: Pac i VI�ri t,l7 (cif w 1 FEE SCHEDULE
J Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel i4: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above t
p af.sp/ +-t P �a r`S Lai-4r C O v■ 1-- q Jq 1�_Ivi C( OSe�t Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
Ai PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:boa Gi.A.s S,0. - /7-7 i 1-4- 5 200 amps or less _ 100.70 2
Address: 9q � 514 G.c r 2. l s:? - 201 amps to 400 amps 133.56 2
_ ` 401 amps to 600 amps 200.34 2
City/State/ZIP: I t js jl►� c k q 4 Z'l-3 601 amps to 1,000 amps 301.04 _ 2
Phone:(5'63)zei 4.3 O 3 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: i�/jprlit �yy�,/• ea m relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchan e according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature. 6 Date: Z! / 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: 901 t2 a S ba Ut-42 _ above service or feeder fee,
each branch circuit 7'42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first I 56.18 sz,, 11 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 11LAJ Y\ 'e__-\ Sign or outline lighting 67.84
- 2
Address: Signal circuit(s)or limited-energy El See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(I hr min) 66.25/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(/2 hr mm)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 57, i.
Print name: Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): t'7'>
Authorized signature: TOTAL PERMIT FEE: 5 G� 1 A
ASO
- This permit application expires if a permit is not obtained within 180
Print name: Dat G i° 5"G e or-ni r r�s Date:it/9//I- days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 04/21/2014 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Renewable I Qty. Each I Total I
�' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva orless 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener*
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
y • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I\Building\Pennits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9975 SW GARRETT ST, TIGARD, OR, 97223
Residential - Master Permit
299 Final inspection
PASS - No C of O
MST2015-00017
David Young
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9975 SW GARRETT ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Master Permit MST2015-00017
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9975 SW GARRETT ST, TIGARD, OR, 97223
Residential - Master Permit
399 Plumbing final
PASS
MST2015-00017
David Young
Violation Summary:
Inspector Contractor