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Permit (52) CITY OF TIGARD MASTER PERMIT `.. '= COMMUNITY DEVELOPMENT Permit#: MST2016 00331 T f G Awn 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/26/2016 Parcel: 1 S135DC00900 Jurisdiction: Tigard Site address: 11930 SW LINCOLN AVE Subdivision: TIGARDVILLE PARK Lot: 8 Project: Nyounai Project Description: Add(1) bedroom&(1)bathroom to unfinished basement. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 1 First: 0 sf Basement: 257 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 1 Third: 0 sf Right: 0 Detectors: Yes Total: 257 sf Value: $10,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 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: 1 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 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn>=100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0 Ea add'500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 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-3 257 Owner: Contractor: NYOUNAI,DANIEL DANIEL NYOUNAI Required Items and Reports(Conditions) HERRERA-LATORRE,MARIA 11930 SW LINCOLN AVE IMMACULADA TIGARD,OR 97223 6100 SW TAYLORS FERRY RD PORTLAND,OR 97219 PHONE: 503-892-9009 PHONE: 503-892-9009 FAX: Total Fees: $963.80 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 day . TEN • ,: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 9 -001-0010 through••R• -#.1# ._ii'__ t_A1' 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or .800.332.2344. I -ued By: )\,-..k..._ Permittee Signature: Itikik.,t_4_ A �-"Call 503.639.4175 b 7:00 a.m.for the next available ins ectioo daA te Y inspectio 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. G Ti A t7f •v l ` , yGTUN CS / Building Permit Application 3P2� - .. Washington County Phone: 503-846-3470, Fax: 503-846-3993, Inspection Request: 503-846-3699 °REG& 155 N. 10 AV, Suite 350, MS 12, Hillsboro, OR 97124 www.co.washinaton.or.us Land Use Approval: PNroject# yo7�d( Permit# J'-/ j o 33/ TYPE OF WORK �• °'�i+J, IV (' REQUIRED DATA: 1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition AUG 1 1 7 2016 Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Additi /alteration/r placement ❑Other: 1-* -- equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUC t t ��p� �GARD work indicated o this al,lication._ 4-/.,. �1-and 2-family dwelling ❑Commercial/industrial DIVISION Valuation '�" i Z,� UC,p,cis 1,0DOa ElAccessory building ❑Multi-family Number.of bedrooms: JOB SITE INFORMATION AND LOCATION Number of bathrooms: I Job site address: 1 e v i 1 �� - Total number of floors: S /� New dwellingarea: square feet City/State/ZIP: -r hAi , �•lav, �!,,• q Suite/bldg./apt.no.: — (%' Garage/carport area: j� square feet e9 Project name: (1z � Cross street/directions to job site: ' ws + 1-1A.1-1- t ���t Covered porch area: C/ square feet �*�� `� Deck area: square feet l ' Plan No. -�— ( �r) Other structure area: square feet Reissue: Yes[ ] No [) Subdivision: Lot no.: REQUIRED DATA:COMMERCIAL-USE CHECKLIST A Permit fees*are based on the value of the work performed. Tax map/parcel no.: 4 Indicate the value(rounded to the nearest dollar)of all DESCRIPTION OF WORK ��,,- 1i . equipment,materials,labor,overhead,and the profit for the A•10^ ,/ � �r fiti,�\ork indicated on this application. At�� ) 'l ,O ('N ,0t.. ion �W `A ti 4 1 A1-2 ���++ Existin: - .ilding area: square feet l�' I 9 A PROPERTY OWNER 0 TENANT New building \ Name: A* _ 7A 4 Pi.� �(( ' square feet � �lJg�I Number of stories:ories: Address: & 00 '&,,, ---' t � Type of construction: City/State/ZIP: o fiL j�a �` . -1 i oda + Occupancy groups: Phone:( 1,7 , 1 2 , 10,01 Fax:0">C13)04l41 e l4t4yT1I'Ziel) Existing: APPLICANT CONTACT PERSON New: Business name: t l'� lel--`t�lei 1-Ai � -t VL_ NOTICE Contact name: i1 1 1 �1dt it A 1 All contractors and subcontractors are required to be Address: �V 6 JJ�� !� {(�� licensed with the Oregon Construction Contractors Board I i© /AVj4 T,A /tie'1�/ M under ORS 701 and may be required to be licensed in the City/State/ZIP: i Oyri-1 A } _ jurisdiction in which work is being performed.If the Phone:(-� p `1 Z ,100,01 /Fax::(V-AO" v,` d 1' ' applicant is exempt from licensing,the following reasons ,�{ a.el E-mail: r 1 Ogg .4/14i i y CONTRACTOR Business name: '7tA'01_ GU iBUILDING PERMIT FEES* Address: 0 at, y W. -� '" r , Please refer to fee schedule — City/State/ZIP: fef1-1-A �� o' Fees due upon application $ Phone:('3 eb� /�+ rl4G1� / Fax:(*)•- p24/1---/-.±1_11�1�( ,ph-j- i ) Amount received Si/I/6,77 CCB lie.: � � i (` 1 T Date received: Eng -er: , 1\400e741,vflt,t 2 d 11'' I ` This permit application expires if a permit is Address: Address: 'P QJ,�{+ �YI ,,,41 not obtained within 180 days after it has Phone:( ) Phone:( 009 11,;9K / e ►'�(been accepted as complete. Email: li il: ,-..�.G.--- * Fee methodology set by Tri-County Building AuthorizedIndustry Service Board signature: , .j1 liyPrint name: .tf'�� r}JA f AI Date: t ,1l 440-4613T(8/06/COM/WEB) vim' k Mechanical Permit Applic FOR OFFICE I SF O11.1 Cityof Tigard �E ReceiDate/Byved g : Permit No.:t...4.57- /&_0033 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 1111 I Phone: 503.718.2439 Fax: 503.598.19 U G 17 2016 Other Permit: Date/By: TIGARD Inspection Line: 503.639.4175 Date Ready/By: Jails: gl See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information BUILDING DIVISION T OF WO, COMMERCIAL FEE* SCHEDULE—USE CHECKLIST= Mechanical permit fees*are based on the value of the work ❑New construction 74 Additi,n/alteration/r-. acement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition • •t er: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION • RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: t\ Air conditioning 46.75 Job site address: 1 I G.j �r SI -1---k���-� A�`� Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: "r I I6.A-K.17/ v Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: ----�� Project ame: 1,t *S J� Duct pump 61.063 '`ty IVz\� � \. Ductwork 1 23.32 2.3r3-4f Cross street/directions to job site: rn r Vkl • RAU' .fit>* 1-e Hydronic hot water system 23.32 `�r • Residential boiler(radiator or �.VI ' -41.1�%l - AN be> 1 �; 'r' hydronic) 23.32 [J p 1 Unit heaters(fuel-type,not electric), /v n, Aki-L 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 op,. ' DES,IRIPTION )F'WORK Gas fireplace/insert 33.39 If. �/� ` r, Flue vent for water heater or gas ' ` -\i�J N`. ` NI,r fireplace 23.32 X( .1-,) '. 1 v +J A'� "A l Log lighter(gas) 23.32 J t� Wood/pellet stove 33.39 '�� ��M (X i 9„) &M ' A Wood fireplace/insert 23.32 414 iN y�-�'' Chimney/liner/flue/vent 23.32 I l Other: 23.32 COYER OWWNER ' , fl°TENANT ` ''''?"'t Environmental exhaust and ventilation: Name: - A i L- 1-g'/c 1\ A'I Range hood/other kitchen /_ ���IA j 1 equipment 33.39 Address: ( 9 67 1C V • • A -� 611-54;''' � --17- Clothes dryer exhaust 33.39 City/State/ZIP: •'�`'rT'L/\ c7 � � Single-duct exhaust(bathrooms, / 1 toilet compartments,utility rooms) 23.32 Z'3, a Phone:lx j?� ibl, .. ' `fQ el Fax:( (- 1�f 1211) Attic/crawlspace fans 23.32 A-APPI.IC , 'g .AP. PLIC. .414. t CI�)�i�,CT I?!ERSON Other: 23.32 p ev D� r(i",,-fr" Fuel piping: Business name: •_- $14.15 for first four;$4.03 for each additional ter"'j-1 dl�L Contact name: ..c7/411' 'N! ijA( Furnace,etc. Address: i.e/e, ' ' ' ,j�i y`, 1 Gas heat pump ''Y" ° `\ y Wall/suspended/unit heater City/State/ZIP: 1 �y i Water heater Phone:(G 3.) 1,Z..,�el© �) Fax::003) (1121 1) Fireplace Range E-mail: Barbecue CONTRACTOR- :. Clothes dryer(gas) Business name: 17 ", �Y• l")1-1,01\1 Other: /- ` \� (� 1 v t +y, .�� MECHANICAL PERMIT FEES* Address: V�I fide) `' t TA,i- '& "f J '(`4�. Subtotal 41(o e Minimum ' ',0— City/State/ZIP: yf� permit fee($90.00) l ` v ► ' Plan review(25%of permit fee) 22,'5= Phone:(GJ� ) �l�� Fax:(503) 2��, State surcharge(12%of permit fee) I I CCB lic.: TOTAL PERMIT FEE ‘•-4 •••"--- This permit application expires if a permit is not obtained within 180 Ge a /} days after it has been accepted as complete. Authorized signature: l/��� * Fee methodology set by Tri-County Building Industry Service Board Print name: SAI I'1 1\141 NIA\"' I Date: £ ' , 1 651 B \P \ 1:\ uildingermitsMEC`_P`lermitApp_040113.doc 440-46171(11/02/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 $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $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. I:\Building\Permits\MEC_PennitApp_040113.doc 2 Tlo A=r-� . 'i< - 4�< Ele(trical Permit Application N 57-c96 /Co-0033/ Washington County,155 N.1st AV,Suite 350,MS 12,Hillsboro,OR 97124, ()RE„ Phone: 503-846-3470,Fax: 503-846-3993/lutbldg@co.washington.or.us get Inspection Requests: 503-846-3699/wwwwashington.or.us/piro TYPE OF WORK j''1EivEL) PLAN REVIEW ❑New construction :+ 'dditio /alteration/r placement ❑Other: • Please check all that apply: A t ❑ Service or feeder 400 amps ❑ Hazardous locations G1 7 2016 or more where the available Service or feeder 600 amps or more CATEGORY OF CONSTRUCTION/^r+ fault current exceeds ❑ Building over three stories V 0 Ti 10,000 ampsat 150 volts or AL 1-and 2-family dwelling ❑Commercial/industrial a �� ❑ Marinas and boatyards Wire;I i . ,� less to ground,or exceeds ❑Multi family ❑Master builder ❑Other: SION 14,000 amps for all other ❑ Floating buildings JOB'' SITE INFORMATION AND LOCATION installations. ❑ Commercial-use agricultural buildings 1-t iN ee"1-K ❑ Fire pump ❑ Installation of 150 KVA.or larger Job no.: r- Job address: O `�Q f x ❑ Emergency system separately derived system CI Add'tion ofnw motor City/State/ZIP: "—I �, <tj ,3) load of 100HP or more ❑ "A,""E,""I-2,""I-3"occupancy ❑ Recreational vehicle parks Suite/bldg./apt.no.: — Project name: t /c'-JN t I t< ❑ Six or more residential units ❑ Supply voltage for more than F-14e'A1 (7< 4 1 �� y ' \r ❑ Health-care facilities 600 volts nominal Cross street/directions to job site: IGV {� I�{� ( 7� FEE SCHEDULE 1 ¶ ' - . -j tV �:� } Nig.,.. i{'/ALL Description Qty. Fee Total * Subdivision: Lot no.: Residential single-or multi-family dwelling unit. Includes attached garage, Tax map/parcel no.: 1,000 sq.ft.or less 'rer'efr="" 4 DESCRIPTION F WORK Ea.add'1500 sq.ft.or portion 47.00 (,..:1‘1..r.. ) N 7!�).1,,,,,o,,_ i ea !/ A `,.N /r .) 1d� '"a Limited vergy,residential 107.00 2 Il ���7f` . (with above sq.ft. s Limited energy,multi-family � ��� residential(with above sq.ft.) 107.00 2 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation I+� / t t 200 amps or less 107.00 • 2 Name: � � '.7 rte t 201 amps to 400 amps 161.00 2 Address: i. i e,e) ',V T -e KY . 401 amps to 600 amps 214.00 2 601 amps to 1,000 amps 321.00 2 City/State/ZIP: L '\''''2- r , rOver 1,000 amps or volts 642.00 2 Phone:(-,„.:7`1), �el Z . 4161 e Fax:()% 1y- 241,4 if el y4°11:21 1' Temporary services or feeders instatlat aiferatio or relocation Owner installation:This installation is being made on residential or-faun property owned by me or a member of 200 amps or less 4 'n i 7____ my immediate family. This operty is not intended for sale,exchapgopotrant.(ORS 479.540(1)and 479.5601(1). IL 1t. L 201 amps to 400 amps 161.00 2 Owner signature: ..r.:� 1 ...AI tit-,----- Date: 401 amps to 599 amps 214.00 2 A APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension per panel ' u., _ A.Fee for branch circuits with Business name: '1%2A tv ..p.-i.- lV'y Cly iii 4:( aj-- ' fil-i(iKr. above service or feeder fee, •�NG&i1 each branch circuit —[64. 2 'fit t1 Contact name: °.- lCJ' ' 1' B.Fee for branch circuits �j without service or feeder 107.00 Address: 6 j Gi® //, , -TAyi- / ..5,-, /t `� .1-<457 fee,first branch circuit 2 City/State/ZIP: ei,, w Y "i =�Cy„9 Each add'!branch circuit 9.50 e' Miscellaneous(service or feeder not included) Phone:(r-iG: bel 2, , el ele el rFax:eL�7;tv�) 0 t 1) Each manufactured or modular rr''jj // '-t dwelling,service,and/or feeder 113.50 2 E-mail: V 5 �-�c�t � I Reconnect only 107.00 1 CONTRACTOR tPuPump or irrigation circle 107.00 2 .� Business name: t-'1/6‘11"+ ..' .0.1.- f/i 'i_li'e, Sign or outline lighting 107.00 2 N VeiLIIA 1 Signal circuit(s)or limited- Address: &I f3© 0.., I xly �A�/�' ''�.� `� ..517, energy panel,alteration,or 107.00 / ( I extension.Describe: City/State/ZIP: e, " :-T-, � 2 / Each additional inspection allowable inan of the above Phone: (I;rs`��- �l z, .Gi ere,),/ Fax:( 63 ) z�tel,`(ii \�i�t� � y 1 Per inspection 107.00 E-mail: CCB lic.no.: Investigation fee(See compliance) •. Electrical lic.no.: City or metro lie.: Other: Supervising electrician e1-7, ELECTRICAL PERMIT FEES t- signature,required: "14 Gam" Subtotal E' ;/11,1, Date: L'� . t Plan review(25%of permit fee) • Print name: H �>;` ,,,i State surcharge(12%of permit fee) 77t%t,.— signatur : CD C _ ��0`�-- TOTAL PERMIT FEE Ld 1 , " signature: L IThis permit application expires if a permit is not obtained Print name: 2 \ e 1 Date: F. 3- 14/ within 180 days after it has been accepted as complete Number of inspections allowed per permit. Revision 6/13 1 'TIS, ,�.�GTON,oG Plumbing Permit Application 3�2� Washington County www.co.washington.or.us Inspections: 503-846-3699/www.co.washington.or.us/piro 155 N. 1st AV,Suite 350-12 Phone: 503-846-3470 Email: lutbldg@co.washington.or.us ,,1111.' Hillsboro,OR 97124 Fax: 503-846-3993 OREGoN Project# Permit# H'- --,9-63,/ -.0033, TYRE QF WOE# �e FEE*SCHEDULE,, _ e_. ▪New construction ❑Demolition For special information use checklist. -Th.' ��, G 1 2016 Description Qty. Ea. Total Addtio alteration/r placement ❑Other: New 1-2 family dwellings(includes 100 ft.for each utility connection) CATEGORY OFONSTRUC�TTIONT�/�OF t,� TIGAR SFR(1)bath 369.75 141-and 2-family dwelling 111Corh�YlettDl,NGi D!VfS10N SFR(2)bath 474.75 ❑Accessory building ❑Multi-family SFR(3)bath 577.75 ❑Master builder ❑Other: Each additional bath/kitchen 102.00 Fire sprinkler(# sq.ft.) By Sq.ft. JOS SITE INFORMATION AND LOCATION Site utilities Job site address: t 1 t1 '776, Gam,V_ :,AN 6-7.,-t._ A'Nom' Catch basin or area drain 16.75 City/State/ZIP: T( �`"' H ,cJ r V V e,�?� 2, T Drywell,leach line,or trench drain 16.75 Suite/bldg./apt.no.: Project name: (11-2 ) Footing Drain(each 100'increment) 49.50 Cross street/directions to job site: G+ Manufactured home utilities 112.50 Y i �m �` l""` ' Manholes 16.75 re" `�A f r L I -- F\Y" 0,, <1'7L.1 P- 1\i 1 Rain drain connector 16.75 F.1‹.6)M tkALL Sanitary sewer(each 100 ft.):#of ft. 49.50 Subdivision: Lot no.: Storm sewer(each 100 ft.):#of ft. 49.50 Tax map/parcel no.: Water service(each 100 ft.):#of ft. 49.50 DESCRIPTION OF W "Vf. (G�INe) 'rte. e1 i' ' �h� �101\t Fixture or item fes' ^j►'rL J� t_z Absorption Valve 16.75 ( ' W..4-. /1 0 i /(1) Backflow preventor 16.75 Backwater valve 16.75 Clothes washer 16.75 1; PROPERTY OWNERNANT Dishwasher 16.75 1� F [l . ... Drinking fountain 16.75 Name: � r LI V , /C `j Ejectors/sump 16.75 Address: 611 4:\'11 y j -IA A}/1- ' °' Expansion tank ( v_.‹.9 16.75 City/State/ZIP: f i A ef� ' ' Fixt,r/s wer cap �'..0 {A` P 16.75 Phone: -G %- Fax: G' Floor drain/ oor sink/hub V� 16.75 APPLICANT PERSON' Garbage disposal 16.75 Business name: A L'r , •'t .� Hose bib 16.75 -."..2e--4� .- Hydroponic piping system 16.75 Contact name: .0...\1\1 1. rty r Y wr Ina maker 16.75 Address: 1 �� � �'�/t -r Kt? Interceptor/grease trap 16.75 City/State/ZIP: trt;.�•�� ��� e!��6 Medical gas(value: ) By Value �" �" � Primer(s) 16.75 Phone(Q2^1i<slye� her Fax: ( (�l�i Residential Re-pipe:3600 sq.ft/less 107.00 E-mail: 2-4i4 '411 41 Residential Re pipe:3601 sq.ft/more 161.00 CONTRACTOR toi Roof drain(Commercial) 16.75 Business name: 1,r--,,L., t\1''/C'i...I , ry ti j�� +' Sink bas' lavato 16.75 1 ,t=om k� . Address: � � M v �,STA( �j Tub/ower/s war pan i 16.75 City/State/ZIP: •'�4-' i�rlf��'` l it sinal _ 16.75 Phone:(r-.7'‘''- ) c 016.-(,,,,el Fax:( '`� �� Water closet f.0 �IV 14 ` 16.75 G'� 1 ( Z Water heater 16.75 CCB lic.: Lic.no.: erg- • Other: 5 ,,,,,_____,e( Subtotal 7.00 Authorized signatu�ry l�✓<� •�� inimum p rmit fee $107.00 - i Print name: ,}3 t ,,,. '4.;)1 A t Date: , .y . l 4' Plan review 5%of permit fee) $.?�T7,: This permit application expires if a per t is not obtained within 180 days after it has been State surcharge(12%of permit fee) $ 4e,i accepted as complete. *Fee methodology set by Tri-County Building Industry Service TOTAL PERMIT FEE $ t ,m `.-' Board. S:\FORMS\July 2013 forms/Plumbing Permit Form rev 06-13.doc Property Owner Statement q /V� Regarding Construction Responsibili ' rvo Z015 /�,, fri Oregon Law requires residential construction permit applicants who are not licensecrw i, rib Construction Contractors Board to sign the following statement before a building permit can 15 IS/ON 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. 1► ., or I 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. DkAPE4 N Y° ( A114-1 Print Name of Permit Applicant 7//to Signature of Permit Applicant Date Permit#: u`15f 0611-0—CO 3-7Jl Address: I 19 L e-44v CI-A1 Q--- . '' Vi , 0E 9 729-3 ituyav� Issued by: 9e.?!i4 Ric-D. Qi�e'y`"'.. ,e (-VS: This Copy for Permit Offices 11-10-'16 14:04 FROM- E ' " T-009 P0002/0002 F-040 Electrical Permit Application�OV 1 o 2016 FOR OFFICE. USE ONLY CI O Tigard ItkCdivdd Perm"'City f �$ DatalB vd �/ 5To'�d/!p-�33 o - n 13125 S W Hall Blvd.,Tigard,Oltl9 i 7 O TIC C A R plat Review Phone; 503,7182439 Fax: 503.3398 lybb Date/B : Related Permit#: Inspection Line: 503.639,4175 BUILDING DIVISIONReadyDaleiny: runs: P1 SeePage2 for T I G AR D Internet; www.tigard-orrygov�y Notifiod/Method: Supplemental Information t ❑New construction ©Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wlitems checked): ❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories. . 7. where the available fault current D Marinas sod boatyards, - - exceeds 10,000 amps at 150 volts or 0 Floating buildings. El 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑Multi-family ❑Master builder ❑Other amps for CA1 allOther installations. buildings. ❑Fire pump. ❑Installation of 150 KVA or •:JOE,SITE JNEOi2WTON"AND LOO -:I - ❑Emergency system. larger separately derived Job ft:76179 Job site address: 11930 SW LINCOLN AVENUE ❑Addition of new motor load of system. 100HP or more. ❑«A""E","1_�„"1-3" City/State/ZIP;TIGARD,OR 97223 0 Six or more residential units. occupancy. —Suite/bldg./apt.#: Project name:NYOUNAI RESIDENCE OHazardoare facilities. 0 Recreational vehicle parks. ❑Hzardous 100511005. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: ., ,#,. :SCHEb?()L E Description I Qty. I Each I Total f New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 ' DE CRIPTv*i:OF w ,.77:777 F.a.add'I 500 sq.ft,or portion 33.92 1 PLEASE ADD FRAHLER ELECTRIC ON THE ELECTRICAL PERMIT Limited energy,residential 75.00 2 #2016Q0331, (with above sq.ft.) Limited energy.multi-family 75.00 2 WIRING IN BASEMENT BEDROOM AND BATHROOM residential(with above sq.ft.) -: Renewable Energy O See Page 2 D - ,PROPERTY QW "ER • .,D-;TENANT.. • Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100,70 2 201 amps to 400 amps 133.56 2 Address: 401 amps to 600 amps 200.342 City/State/ZIP: . 601 amps to 1.000 amps 301.04 2 Phone:( ) Fax:( ) over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: 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 exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature; Date: 401'amps to 599 amps 168.54 2 t Branch circuits,new,alters loll,or extensions panel ❑:A,t?I'I.1(CAIV'1'' �.: . .;�],CUNTAC'I';,PERSDi!7 A.FCC for branch circuits rvirh _ Business name: above service or feeder fee, each branch circuit 7'42 2 Contact name: B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: 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 67.84 2 dwelling,service and/or feeder Email: Reconnect only 67.80 2 COIQTRACTOR Pump or irrigation circle 67.84 2 Business name:JRA INC.dba FRAHLER ELECTRIC Signor outline lighting 67.84 2 V Address: 11860 SW GREENBHRG ROAD Signal circuits)or limited-energy 0 See Page 2 2 panel,alteration,or extension. City/State/ZIP:TIGARD,OR 97223 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)639-4627 Fax:(503)639-4673 Investigation(1 hr min) 90.00/hr Email:sandyl}ahlereIectric.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is CCI3 Lie.: 197172 Electrical Lic.; C861 Suprv.Lie.: 51105 specifically listed(54 hr min) 90.00/hr Suprv.Electrician signature,required:4; ,`':...r., ) :ELECTRICAL'PERMIT,^FEES �/ r" Subtotal: Print name: ADAM ETHERINGTON Date: 11/10/16 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 Print name; Date: days after it has been accepted as complete. r.lBuildingParmits1ELCfcrmirApp_aR saa.doe are 06/17/2013 440-4615't(1l/ostat/Wan 11-10-'16 14:04 FROM- T-009 P0001/0002 F-040 , FRAHLER ELECTRIC COMPANY 11860 SW GREENBURG ROAD,TIGARD, OR 97223 PHONE(503)639-4627 CCB#3.97272 FAX TRANSMITTAL FAX (503) 639-4673 DATE /'/ _ G, - RECEIVING FAX NUMBER5o3 -.49 '7l9t O - RECEIVING LOCATION (',c -� a'f j arca • PERSON SENT TO aroz-c5/0P,r 2 /f SENDER calndy licurri.5611 NUMBER OF PAGES ca-- (including transmittal) SUBJECT Aqui,ui, Fr-6 r E/chic Jame l pp cinfh- d/63 3 a MESSAGE 744 .lib inQ,47dcr) ;P 47tre i s In Ptirc/ .. -a-r c r1- . 0- z,t) ;///oaj vreG2-c' .t (wed . ._ 'S;7.14":44/1 COMMENTS �.s�ta-� �,i � C 0 C "LC-' , a_ei !/ lSl4, COMMERCIAL * RESIDENTIAL SERVICE * INDUSTRIAL* SOLAR ENERGY City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT .1 i ! =. �� Re uest for Permit Action l( T I G A R D 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •www,tigardr i.g•1v CI TO: CITY OF TIGARD )Ari , Building Division (1 - I I% $f 13125 SW Hall Blvd.,Tigard,OR 97223t it`' Vii.' Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: 1 Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) e ,(� Mailing Address: rid' c /G Q1%! City/State/Zip: �i' C ty/S /Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑__,/ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). -3ll REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel pen iit). Permit #: j"YfS7' 0I!o --60.3 3 1 Site Address or Parcel#: / I 9.3o SL-J L.neobn Project Name: , Subdivision Name: �+ Lot#: EXPLANATION: • Fr-r'4/e.r- E6c iG Z re, ,r:2 r-►(p_ trIA. ' Signature: Date: (1/1 5/< Print Name: P tVitL- U ��—t Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date /1 /S/to B. Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_092314.doc 13125 SW Hall Blvd. Tigard, OR 97223 City of Tigard Location: 11930 SW LINCOLN AVE, TIGARD, OR, 97223 Record Type: Residential - Master Permit Inspection Type: 199 Electrical final Result: PASS Comments: Violation Summary: Inspector Tel: 503.718.2439 Inspection Date: Record ID: MST2016-00331 Inspector: Jeff Grove Contractor