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ELECTPERMIT
CITY' OF TIGARD PERMITRICAL#: ELC96-0502
COMMUNITY DEVELOPMENT DEPARTMENT DnTF ISSUED: 0*7/30/96
13126 SW Hakll Blvd.Tigard,Oregon 97223e8199 (503)639-4171
PARCEL: 1,5135DC-08300
_'31TE ADDRESS. . . : 11730 SW GREENDUI<u kl)
'3UBDIVISION. . . , t MLP940007 ZONING:R-4. 5
IkLOCK. * Is I-OT. . . . . . . . . . . . . 1001
1--Ir,o,jec;* " ' " ' *,
Description: FIRST BRANCH CIRCUIT FOR GARAGE ADDITION
UNIT------ ---TEMP' SRVC/FEEDERS---- -----MISCELLANEOUS-----
1000
----MISCELLANEOUS——1000 SF OR LESS. . . . : 0 0 200 amp. . . . . . . .. 0 PUMP/IRRIGATION. . . . : 0
EACH ADD' L 500SF. . . 1 0 _01 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0
LIMITED ENERGY. . . . . : 14) 401 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : in
MANF. HM/ SVC/FDR. . .- 0 601.4-amps- 1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
----SERVlCE/FEEDER�--------- ------BRANCH CIRCUITS------ -----ADD' 1_ INSPECT I
0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
201 - 400 amp. . . . . . : 21 1st W/O SRVC OR FDR. : I PER HOUR. . . . . . . . . . . 0
401 - 600 amp. . . . . . : 0 EA AD1)' L BRNCH CIRC: 0 IN PLANT. . . . . . d . . . . : 0
b01 - 1000 amp. — , . : 0 -.-__...________--.-__-PLAN REVIEW SECTION--------
1000+ amp/volt. . . . . : 0 )-4 RES UNITS : ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR 223 AMPS. . : CLASS AREA/GPEC UCC. :
Owner: FEES _-----__---_
JEANIE CRAFT type a fn 0 IJ n t by date r-ec pt
11730 SW GREENBURG ROAD PRMT $ 35. 00 JMH 07/30/96 96--28,2314
5PCT $ 1. 75 JMH 07/30/96 9 6-LL'8 23 14
T'IGARD OR 97223
Phone #:
Contractor-:
OWNER 36. 75 'TOTAL
REQUIRED INSPECTIONS
Ceiling Cover- Elect' l Service
Phone SEE ABOI'i_- Wall Covet, Elect' 1 Final
Reg #.
This permit it issued subject to the regulations contained in the
mi-
Tigard Municiril Code, State of Ore. Specialty Codes and all other �;tt'e*e' SigntUV,e
applicable lain. All *&0 sill be done in accordance with `/ �� sU VJ(,'r l_.-'
ap,irovtd plans. This pL-rrit will expire if work is not started
within 181 dale of issuarce, or if work is suspended for more
thin 180 days. IWSUed By
INSTALLATION ONLY-----
The installation is being made on pt-op r- y I a which is not intended for
gale, lease, or- t-ent .
UWNERIS SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONL
SIGNATURE UP SUP-�. CIN- DATE-.
LICLNSE NO
Call for- inspection�- 639141
Community Development ELECTRICAL PERMIT APPLICATION
1T g3125 SW lard OR97223 Permit # L``
_ Date Issued _1 . 9E: ~�
Phone (503) 639-4171
FAX (503) 684-7297 r q,
CITY OF TIGARD TDD No. (503) 684-2772
inspection (503) 639-4175
1 Joh Address: 4. Complete Fee Schedule Below.
Name of Development 1 M- Q �_— _ Number of Inspections per permit allowed
Address���0_ W-6, Qt's Service included Items Cost(ea) Sum
City/State/bp.-7 4a. Residential -per unit
d 1000 Sqft. or less $11000
Name (or name of business) yrt � __ f Each addnereof Eso(,eq h or
t portion thereof 00
Commercial Residential I Limited Energy $2500 _
Each Manuf'd Home or Modular
Dwelling Service or Feeder $6800
2a. Contractor installation only:
4b. Services or Feeder
Installation,alteration,or relocation
EI@CtrICSI riUntraCtor2DO amps or less $80 �. 2
Address _ 201 amps to 400 amps $8000 —,� 2
City J _- State__ Zip. 401 amps to 600 amps S12000 2
801 amps to 1000 amps $18000 2
Phone No. _ Over 1000 amps or volts s34D oo 2
,lob NO. � Reconnect only _ $5000 2
contractor's license NO.-------- __ - 4c. Temporary Services or Feeders
Contractor's Board Reg No _ Installation allrrabon or relocation
Signature of Supr. Elec'nI 200 amps or less _-- z
License NO. phone NO. $75 201 amps+o 400 amps �- 00
.«. - -- --- 401 amps to 600 amps �_ 37500
Over 60o amps to 1000 volts $10000 --------
2b. For owner installations: ger h..above
4d. Branch Circuits
Print Owner's Name.. &_ _- New.atierabon or extension per pane
AddressDI �_J��_�.A .'l a)The fee for branch circuits with
City_ _ Stat 1p Z:l purchase or service or feeder fee.
`,' _ '/ Each branch circuit s`on _
Phone lL...__.S_ _`��_-�__ b)The fee for branch clrcults without i
The installation is being made on property I ow which is _ purchase of service or seder Ise. (:2-1
First branch circuli $3500 )_
not intended for s I ase ant Each additional branch circuit 4;011
Owner's Signature _ =. I 4e. Miscellaneous
(Service or feeder not included)
3. Plan Review section (if req ired): Each pump or irrigation circle $4000
Each sign or outline lighting $4000 _
tdignal circuit(s)or a limited energy -
Please check appropriate Item and enter fee In section 58 panel,alteration or extension $40 00
4 of more residential units to one structure Minor Labels(101 $1e0 DO
Service and `eeder 225 amps or more
System over 600 volts nominal i 4f. Each additional inspection over
a
Classified area or structure zontaining special occupancy the allowable in any of the above
Pis described in N E.C. Chapter 5 for inspection —� $35 On
per hour $551X)
In giant S55 CX) —_-�-
Submit 2 sets of plans with application where any of the above -"
apply. Not required for temporary construction services 5. Fees:
—
5$. Enter total of above fees a .tom
15
NOTICE 5%Surcharge (05 X total fees) g
PERMITS PECOME VOID IF WORK OR CONSTRUCTION Subtotal g
AUIHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF fib. Enter 25916 of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required (Sec.3) g
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED Trust Account N
Mm xlq
[Balance Dtie $
Permit tl:
I1730 51�tJ -
-�ddrrss: _
Issued by: t7 Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
;Pule: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cank; 111ho are not registered with the Construction Contractors Board to sign the
/idloit ing stateniv tit he/bre a building perrrrit can he issued. 77tis statement is required
fin' resiacutiai building, electrical, rnechanical, and plumbing per snits. Licensed
architect and engineer applicants, exempt fi-om registration under ORS 701.010(7),
need not suhrrrit this statement. This siatenient hill he filed with the permit.
Fill in the appropriate blanks and initial boxes 1 ano 2,and either box 3A or 3B:
A1. 1 own, reside in,or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
U 3A. My general contractor is_..___—_----------- -_-.- ------- -- — — ---—
U (Name) Contractor regis. #
I will instruct mN general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
{ 313. 1 will be my own general contractor.
III hire subcontractors. I will hire only subcontractors registered \\ith the Construction Contractors
Board. lfl change m} mind and hire a general contractor. i %%ill contract ssith a contractor ssho i
registered with the CCB anti will immediately notify the office issuing this building permit ofthr
name of the contractor.
herrh,i certif,i That the abo%a information is correct and that I IcIN e read and do understand the Information
Notice to I'rirfoeriN Omners about (construction It psponsibilities o:1 the rc%erse Side of this form.
tfiignatur ofp rrnit a plicant) (Date)
(1171ite coliv to is.%rring agent}.pertnit file.
pink cohi,to applicant)
Information Notice to Property Owners
About Construction Responsibilities
4u1,�. Ilrn /N/i'l,W4 /frill Vwl( r' to Ih'(lpe'rit l h lwl'v +rl 11,"p(ill vrhililie.%
it os I/t'6</11�tr'c�Ohl //!�' ( rNJ.1'NY!(l.,N7 ( Nl7l/'(J. tejt'.� flo,in/1+1(lk it',Itill, c ,t 11/(
It \t'll :IIs.I �!I_' ;I'•\1'111 \\II �I i;I Jk'1.�i Its �'It ,11111f ,1 I Ili\ lit Ill Ik:(II IIIal,l'-1 llh.,Ial II itl1 '11)prlt\.'mcl I I Ill an CM,.ting sti tielure„
\(111 Call illy\flit nlaw, 1 lobIl'lll,I", I)CIIIL' a\\ 11'4; "i 1111' i 11, 11 II?',I C'IN II`•I1+111111';;11111,lll';IJ+!t CUi'll'l'I'll.
EMPLOYER RESPONSIBILITIES:
If �++11 Inrc periow, m)l regi.,teud \\1111 ;Ill. ! '-I! -iIIli.lit ill if't,1i11,it I It . 11—11,1 I,I Litt I;ii1111 111 ',IIll aI'll ICI illh (lt' assisting i1I the
k:,'ll`,trn,litin or nnpr(lvenlcnt n1':1 re,identi,ll •irn(ill re.ii oil\t-i11. Ili mo-,i instant C, I)c l•ulca h1 ht:an enlPlover and the people
\iul 1)1I-C t\ill be einplovee>. A<,Itie emploi,e'r. \'t,u lrintit con ilil \t ith the filllm,\ita,-,'
Oregmi's%%ithhnidingtax hm: Asallvill Plot,cr,,,ouulust\k'ithholdincomeIll vesIromemplo\ccNvngei:atllit.time employees
art.!paid. ),(it, t\ill he liable fill'lite tax paNtrients e',en tt ;un don't actually wldihl,.tld the tai from v1,ur eniplo,ices. I'nr more
infurnmiion.call the(itcgon I)l'pl tit kcrcnuc at tt-I -8u9I.
[fnemplovment instu tinct tai: 1,,an emplot,et,Attu arc reciuirell t(,pa\ ;1 tax tin'urnmpluytnent iilStlr1111Cl:purpose,kill the
+tine,of .111 Clnployecs. Fln llitllC Information.call the Orcgon I mplvt mQjil Uepartanc-,i at 378-3524.
Workers'compensa►tion incaralnee: A an enlpin\cr. foil are suhjW It,the 01V,e (In Wo,-KCI titnpela ;llfurl I_aa,and fnnst
obtain\\(it'l urs'Ce,I1lpew,,ilittit ill',Ilr:lnl.e sur k,(till cmploi,'ee`. 11".ou('811 t,,(+hl;lln ,%orkers't't mpen.>ntion im,;ilrilnce tail Ina.
he•,11111v t it perlahiC,and\\ill h(•hilhIC ti'rall rlvul Cr1;1-,it onvol,\oil!llnitlo\e' ,I,inured lin tl�t-lith. I or mitre infol llwlion.
call the Woikvrs'Compcnealion Division at the 0epartincnt ol'Colisumel ;arid litawincss tierviCes mo -15-7989
l .`.internallir't'enuc'tiers .c: A-allenlplu\Cr,ttllrfTlllSt\\Ilhht)Idte(Irrolrncivalcta* fittnaenlplit\el \\a.1,e, 1'.1(1\\iiihr
liable I'll the IAX pad meat C\ •Il 11 \ ,it di(in l arhlall. `.\ilhhold the tai;. I (+r marc inh+rmatirin,call the llUCH)al Re\erlur tier\ile
at 1 -90i1-829-1040,
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Codtcntnpliltnce: \,IlleItCrI111l1101d;rIli[ Ihl,ill,'ICCI.\iMmcR",pi,ii-ihl;I `i rv.,`I11111':111\ 11i,llilt:lkinl('Cl, OdC!'t`killlicll,t'ill .
Thal lTta1 he hlollallit 14r iiottr atlentlorl thrott{!h (Iltiht' lion-.
I,iahihh and projilem damage ltisurance: ( ttlllatl \tail! Ill,lirarlCl' t::t'll;10,l'C It ,1111;1\t'jdk -,111,110 III,1n,111k l i 1.1C I'
UCltl('111";11111(Illll-sioll,Stich a, tillling look, paint t+1er'.Itl;l\. \t;ltt:t 'hill;l t_ irkill) plpi Ill Iilltill c"', IitC. lit'`: Il!:!! IIIU'I hC
rC-d(ItIC.
1 deet' to MAe sure Noll h;l\c,lllfirient tittle t1 <urer•t i';c\, urefnillrtcl:,.
l lllt.'1(150: 11111kk''-ill C\"11 k1\c 111-: :"pt•1lot lk,1;1`•\,-tit l+',\It`lelll:l;)l.. .'10100,tut.tt`l 1 t,41111WAC(11C\tial 01 lllll.'.II 111;11!;1 i!I11,11
iiiidet.S111d t(t nl!lil'\-hua141111v tit fIClok tit the rppropriate times sol they con perlilrm the reciuirell in petIions. `
i t I'll ll,lt c ;Ikldlnllnll klil("i n• \\rite lir c;ill flit( tm,irtit ii!+n t,i ml m�ler, lit,,ard i l'() it `x {11(!. ls,llt m.t IR t)..'tilt'. .tl
8. 1621), 1 lie 1311arti it '00 `-`llllurr '-,I. A'I 'vuitc (UII. in tiillem.
1 'll
CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.81Do (503)830-4171
t
Residential Building Permit Application �0
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address: 1
Office Use Only
Subdivision: 4�; �- /� �l y" C�G�� � Lot #�l
valuation: _ yy '�� r' Contact Date _ / / _Initials
,r-f— Result
Planck/Rec # �� - .�� •'�
New Construction Only: (Square Footage Permit # /n s 1.5
House: Garage: fZXQ I lj IYO rto-t- Reissue of
Map & TL#
Zone 11?
�+;�
Corner Lot? 1Y` lrJ Flag Lot? Y N Plat #
Owner: N T Lin �o_ (�f T _ Approvals Required
Planning Setbacks ��_ Solar
Address; Engineering ,
Other
Items Required
Phone c
Contractor: Subcontractors
�uy.U��� --- Truss Details
Address
Other
,�,,,,, u�. a n��..
Notes
Phone
Contractor's License # __ ---- —
(attach copy of current Oregon license)
Contact Name
Contact Phone _l _
Subcontractors: Arch itecUEngineer:
Plumbing: _ _ _ Address:
Mechanical
(attach copy of current OR Contractor's License)
Phone:
JOB DESCRIPTION:
App antsig6atu'rW
(� - Applicant Phone numoer
Received by: ��k� �� Date Received _4
H W�e}rylrrapp
Permit # Account Description Amount Amt. Pd. Bal. Due
hlsttiu 1. Bldg. Permit (BUILD) Al/,
Plumb. Permit (PLUME) _
Mech. Permit (MECH)
State Tax (TAX) • 2
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWItJSP)
Parks Dev Charge (PKSDC)
Residential TIF (11F-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (TIF-O)
Water Quality (WQUAL)
Water Quan"ity (WOUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ENPRMT)
Erosion Planrk/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS:
Permit #: M51
Address: -7-71
1 i�l issued b ` ' ) Date:
/gg9 _
Statement- Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect am/engineer applicants, exempt ff•om registration under ORS 701.010(7), i
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
(� 1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold of offered for sale
before or upon completion.
❑ 3A. My general contractor is
(Name) Contractor regis. #
1 will instruct my general contractor that all subcontractors who wort:on the structure must be
registered with the Construction Contractors Board.
DR
LTJ 3B. 1 will be my own general contractor.
If I hire subcontractors, i will hire only subcontractors registered with the Construction Contractors
Board. if I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify thut the above information is correct:end that I have read and du understand the I nUormatio n
Notice to P iperlyners�out C st ction Responsibilities on tr►e reverse side of this form.
11U'4k
(Signature ofmit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
Aboui Construction Responsibilities
Now: I/n.r itiformation Notice to Property Owners abort Constrm bort Responsibilities
Drax de'crlope°d by the C'on.ctruction Contractors Board it accordance with ORS 70/.05(5).
If you are acting&,your own contractor to construct anew home or make a substantial improvement to an existing structure,
your can prevent many pmblvais by being aware of the following responsibilities and areas of concern.
EMPLOYER RESPONSIBILiTIES:
If you hire, persmts not registered with the Construction Contractors Board to do labor 41 constructing or assisting in the
conslruCtiOn or improvement ol'a residential structure,you will, in most instances,be ruled to be an employer and the people
y•r.r 1-11-C %ill he employees. As the employer,you must comply with the following:
Oregon's withholding tax law: As an employer,you must withhold income taxes from employee wages at the time employees
are paid. Your -.rill he lial le:for the tax payments even if you don't actually withhold the tax from your employees. For more
information,call OW c)regoo r)ept.ref Re venue at 945-8091.
Unempio►yment insurance tax: ;I,s an entpluyrt, N(at ML required to pay it tax for unemployment insurance purposes on the
wages of all c aiployee.s. For more infornia(ion, :all the Oregon Employment Division at the Department of Hrtman Resources
at 378-3524.
Workers'compensation insurance: As an employer, you arc subject to the Oregon Workers'Compensation Law,and must
obtain insurance for)our employees. If you fail to obtain workers'cornpens:''on insurance,you may
he sul,j,,ct to penalties and .gill he liable for,ill claim cost.if one of your employees is injured on the je,r. For more information,
call the �N,or!:rrs'Compensation Division at the i7epartment of Consumer and Business Services at 945-7988.
U.S. Internal Revenue Service: As an employer,you must withhold fecderal income tax from employees'wages. You will be
liable I�rr the tax payment c�cn if veru chdn't actually�,,ieIll old the tax. For inure information,call the Internal Revenue Service
at 1-800-829-1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Cadecompliance: As the permit holder for this project,you are respon:ihle for resolving any failure:to meet code requirements
that maty he hrought to your attention through inspections.
Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
acctd its and omissions such as falling tools, paint overspray,watcr damage from pipe punctures,fire,or werk that roust be
re-done.
f
'Carne to supervise ernplovees: Make sure you have sufficient time to super,use your employees. ;
Fxpertise: Make sure v,�u have the expertise tri act as your own general contractor,to coordinate the work of rough-in and finish
trades, and to notify building officials at the rippropriate times ao they can perform the required inspections.
If you have additional questions,write or call the Construction Contractors Board(P0 Box 14140,Salem,OR 97309-5052,
503/378-46211. The Board is located at 7M.inrnmer St. NE Suite 30), in Salem.
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