10509 SW NAEVE STREET -
- REVISE FRONT OF GARAGE j0 34'
PER CLIENT, 11/25/01 MSG.
-- REVISE RIGHT SETBACK TO 5'
7 PER CLIENT, 11/29/01 MSG.
NOTE: CENTERLINE CONCEPTS,
SU:IEYORS, WILL PIN ALL EXTERIOR
S FOUNDATION CORNERS AND PROVIDE WOO Iii ssc�dtc�
SUBSEQUENT MORTGAGE SURVEY.
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EROSION CONTROL:
s,Je SCALE D_R__A_ WILTG LOT 23 ERICt�S'ON HEIGHTS
1- PROVIDE 8 MAINTAIN 8`(min) THIS '
7- i S ' GRAVEL PAD & DRIVE UNTIL PERIVANENT S.E. 1Z4 SEC. 10, T.2S., RAW., W.M.
CONCRETE DRIVE IS i.; �'I,ACE.
/ 2. PROVIDE & MAINTAIN SOIL SEDIMENT CITY OF 11GARD
f:.
FENCE AS INDICATED. WASHINGTON COUNTY, OREGON
NOVEMBER 21 , 2001 Centerline Concepts Inc .
DRAWN BY: J[PW CHECKED BY: WGDIII
'CALE 1 "=20' ACCOUNT 115EMAI L CCIEMAILdPA0L. 00M
640 82nd Drive Gladstone, Oregon 97027
M: \MU\L23ERICK 503 650-0188 fax 503 650-0189
NOTICE: IF THE PRINT OR TYPE ON ANY -r I-Ij I ! I I I I I I I I I I I I I ! 1 I 1 I 1 I I I I I I I I I I I I I 1 11_[T -I I I I I 1-fr�rT-r 17111-TTF11 1111 1 1 1 1111 1 11 111 I I I I I I II I f.� I I I I , I I I I 111 .L�_�.�1 f1 r LI-IT-[ I I I I.. r_I I. I I I .r-11 1_j I f_r� l _L_�r. -rrl_ 1 IT[I'l I 111 Jill 11111
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i
10509 SW Naeve Street
ELECTRICAL
CITE( OF TIGARD RESTRICTED ENERGY
ENERGY
DEVELOPMENT SERVICES PERMIT#: ELR2002-00237
13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/31/02
SITE ADDRESS: 10509 SW NAEVE ST PARCEL: 2S110DA-06200
SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5
BLOCK: LOT: 023 JURISDICTION: TIG
Proiect Description: Landscaping lighting
A._RESIDENTIAL_ B.COMMERCIAL
II AUDIO & STEREO: AUDIO & STEREO: !ATERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DA'A/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: X HVAC: PRO'rECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS_:
Owner: Contractor:
CART_ RUGGIERO PROGRASS LANDSCAPE SERVICES
10509 SW NAEVE STREET 29895 SW KINSMAN RD
TIGARD, OR 97224 WILSONVILLE, OR 97070
Phone: 503-320-1009 Phone: 682-6076
682-6076 Reg #: I IC 6136
FEES i Requked Inspections
Description Date Amount Elect'I Final
[ELI'R,\l I J I:LR I'ennit 10/31/02 $75.00
[TAXI 8%,State far 10/31/02 $6 00
Total $8 .00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes
and all other applicable laws All %Arork 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 than 160 days ATTENTION Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0100 You may obtain copies of these rules or direct questions to OUNC at (503)
246-6699
Issued by Permittee Permittee Signature
1
OWNER 114STALLATION ONLY
The installation is being macre on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
COQ TRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. EI_EC'N _ _ _ DATE:
LICENSE NO:
Call 639-4175 by 7:00 P.M for an inspection needed the next business day
Electrical Permit Application
Date received: p OP, Permit no.: ,7a;?.ooa3 7
City of Tigard Projecl/appl.no.: Expire date:
CilyoJTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no,: Payment type:
Land use approval:
TYPE OF '
A I & 2 family dwelling or accessory U Coninictu:d/industnal U Multi-family ❑Tenant improvement
U Ncw construction U Addition/alteration/replacement U Other: _ U Partial
JOB SITE INFORMATION
Job address: ,- ' 'Ve Bldg.no.: Suite no,: Tax map/tax lot/account no.)
Lot: Block: Subdivision: _
Project name: i e-y +e')' Ct 1(' )•script'm and location of work on premises:
Estimated date of c Ietioivinslxclion 'j ej
1 1 ' APPLICATION 1:1 1 S( IIEDULE
Job no: pee Ota.
-- -- — --� _ Description Qw (ea_) torsi nn.bisp
Business name: - -
-, , A New nxidentL•d single or multi family per
G, Address• i rn ft dwellingunil.bulndrsaltaclK•dgarage.
Cit, Ji(L Slate: `' I ZIP: ` J•Q'" - - s•niceinciudcri:
Phot : ' -. 6n Fav'ic,k mail: I Ixx)sq,ft,or lean — --_ - - 4
Each additional 500 sq.fl.or union thereof
4 CCB n0.: _ i e.bUS.tic,no: Limited energy,residential 2
City/metro lic,no.: Limited energy,non-residential _ 2 _
�' 4'` _ 16125 7.- Each manufactured home or nic Jular dwelling
Sign ure of supervising eiec-cion r uired) bele Service and/or feeder _ 2
Sup. 1ecr.name(print): License i Sersicesorfeedem-installation,
alteration orrelocatio r.
PROFFRTV OWNER 20o amps or less _ 2
Name(print): a Ili' ( r l 1 G c ►< ��_ 201 amps to 400 amps_- 2
-- 401 amps to 600 amps 2
MailiSiTSPP 601 amps to 1000 amps 2
city: 1 1 stale:off r I ZIP: (J�ZZ j Y Over 1(Xx)amps or volts 2
Phone: , Q .fid&j I Fax: I E-mail: Reconoctimily I
Owner installation:The installation is being made on property I own Temporary service or feeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,orrelocaNnn:
ORS 447,455,479,670,701. 200 amps or less _ 2
201 amps to 400 amps 2
Owner's Signature: _ Dale: 401 to Min ams 2
Branch circuits-nen,alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City_ State: 7.11'. �- H. Fee for branch circuits without purchase
— of service or feeder fee,first branch circuit 2
Phone: Fax: Email
Each additional branch circuit
al
alIpLIAIW17,=. Misc.(Service or feeder not Included):
U Service over 225 naps-commercial U Iteallh-carefaciln, Each pump or irrigation circle 2
U Service over 120 amps-rc.,ng of 1&2 U Hazardous locaiwii Each signor outline lighting 2
family dwellings U Building over 10,(xx1 square feet four or Signal circuit(s)or a limited energy panel,
USysteniovrr600volts nominal more residential unit%in one structure alteration,or extension*_ 2
U Building over three stories U Feeders,400 amps or more "Description:
O Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over the alto-sable in any of the above:
U Egress/lighungplat U Other- _ Per inspection
submit sets_ sets of plats with any of the above. Investigation fee
The above are not applicable V)temporary conslrucllon service. other
Na ail juriidictions accept credit comit
ds,please call jurisdiction foi e inkrnuidow Notice:This permit application Permit fee.....................$ _
U Visa U Mastercard expires if a permit is not obtained Plan review(at _ %) $ _
credit card number:__ _ /—_1_-_ within 180 days after it has been State surcharge(8%)....$ �
uiownon credo cam —
Cxphes accepted as complete.
h- —
_ S
Cardholder danature Amount 440.4615(6M COM)
Electrical Permit Fees: Limited Enet-gy Fees:
Complete Fee Schedule Below: _TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
PRestricted Energy Fee...................................................... $75.00_
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total I Check Type of Work Involved:
Residential-per unit
1000 sq ft.or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq.It or
portion thereof $33.40 t ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ Garage Door Opener'
Dwelling Service or Feeder _ $9090
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 ❑
2U1 amps to 400 amps v $106.85 2 Vacuum Systems'
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 _ 2 r� Other
Over 1000 amps or volts $454.65 2 f —
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation
200 amps or less $66.85 _ 2 Fee for cacti system.......................................................... $75.00
201 amps to 400 amps — $100.30 _ 2 (SEE OAR 918-260-260)
401 amps to 600 amps $133.75 _ 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see"b"above.
F-] Audio and Stereo Systems
Branch Circuits
New,altaralion or extension per panel F-1a)The fee for branch circuits Boiler Controls
with purchase of service or
feeder fee. ❑ Clock Systems
Each branch circuit $6 65 2
b)The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service
or feeder fee. ❑ Fire Alarm Installation
First branch circuit _ $46 85 _
Each additional branch circuit $6.65 ❑
HVAC
MiEnellaneous
( ervic3 or feeder not Included) ❑ Instrumentation
Each p,imp or Irrigation circle — $5340 _
Each si 3n or outline lighting _ _ $5340 _ ❑ Intercom and Paging Systems
Signal r ircuit(s)or a limited energy
panr 1,alteration or extension $7500
_
Minor Labels(10) $12500 ❑ Landscape Irrigation Control'
Each additional Inspection over ❑ Medical
the r Ilowable in any of the above
Pr, inspection $62.50
Per hour _ $62.50 ❑ Nurse Calls
In Plant $73,75 ❑
Outdoor Landscape Lighting'
Fees:
❑ Protective Signaling
Enter total of above fees $
8%State Surcharge $ — ❑ Other
25%Plan Review Fee !Number of Systems
See"Plan Review'section on $ ' No licenses are required Licenses are required for all other installations
front of application.
Total Balance Due t Fees:
Enter total of above fees $
❑ Trust Account# —_
8%State Surcharge $
Total Balance Due $
i:\dsts\fonms\elc-fces.doc 10/09/00
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
�� � � BUP
Received __ —_.. Date Requested-___.__1L�L_-_ AM
/� ---- BUP -- - - _ - -
Location _— D l 1L�.0,l�P ;-Ly-- --Suite G -- MEC --- - -
Contact Person _. ��/ d-rr Ph(_ _) � �. PLM
�_ ---
Contractor - - Ph( - ) -----r~ d- I SWR - -- _
BUILDING Tenant/Owner -__ ELC
Footing ELC -
Foundation Access:
Ftg Drain ELR
Crawl Drain _
Slab Inspection Notes. SIT -
Post R Beam
Shear Anchors ----
Ext Sheath/Shear
Int Sheath/Shear
Framing _
Insulation
Drywall Nailing
F i rewa"
Fire Sprinkler - ---- - —
Fire Alarm
Susp'd Ceiling —
Roof
Other._ -
Final
PASS PART FAIL
PLUMBING ___—
Post&Beam
Under Slab
Rough-In
Water Service ----
Sanitary Sewer
Rain Drains _----
Catch Basin/Manhole
Storm Drain -
Shower Pan
Other:
Final
PASS PART FAIL_
MECHANICAL
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL -
ELECTRICAL
Service ---
hough-In
UG/Slab -- ___ - - -- -- - ---- - -
Lo..Voltage
Fire Alarm
Reinspection fee of$_ _�__ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
_ _ PART_ FAIL
SITE I j Please call for reinspection RE:. _ L] Unable to inspect--no access
Fire Supply Line
ADA
Approach/Sidewalk late ,� ._-' Inspector f=L �� '_ yc? Ext ----
Other:
Final DO NOT REPO LOVE this Inspection record from the Job site.
PASS PARI' FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION * Business Line: (503) 639-4171
BLIP
Received .___
.. Date Requested...- --- AM -_ -- PM-- _ BLIP
Location _-_ y `-ESuite / MEC
Contact Person __ _ �'__— Ph (_ ) -L Z – 31c PLM
Contractor — Ph( ) _ SWR -
BUILDING _ TenanUOwner _ ELC
Footing
Foundation ELC -
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing
Firewall
Fire Sprinkler I
Fire Alarm
Susp'd Ceiling --- '�' / / -- --- ---
Roof
Other: —
Other.
Final
PASS_ PART— FAIL
PLUMBING_
Post& Beam
Under Slab \� `I (�_—kk
Rough-In (✓ \�11. 1 \ 1 ��
Water Service --
Sanitary Sewer V
/ - — -
Rain Drains V�`
Catch Basin/Manhole
Storm Drain - — -
Shower Pan
Other: -- -
Final
PASS PART_ FAIL
MECHANICAL
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL_
E CTRI�_' NL
rvic -
Rough-In
UG/Slab
or-M
ire arm
Reinspection fee of$_ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS ,PART
SI rE _ \Please call for reinspection RE: _ Unable to inspect-no access
Fire Supply Line
ADA 7 ��.tf
Approach/Sidewalk Date �� % Inspector" [�� Ext
Other:_
Final DO NOT REMOVE this inspection record from the job site.
L. PASS PART FAIL
ELEVATION CERTIFICATION
PER SECTION 710.1 of the OSPSC rC17TY
GARD
3510.1 ofthe OTFDSC
REGON
THE UPSTREAM MANHOLE RIM APPEARS TO BE ABOVE SOME OR ALL
OF THE FIXTURE SPILL RIMS IN THIS STRUCTURE.. INFORMATION IS
NEEDED ON THE ELEVATION DIFFERENCE FROM THE MANHOLE TO
THE LOWEST FLOOR CONTAINING PLUMBING FIXTURES TO
ESTABLISH THE NEED FOR A BACKWATER VALVE(S) AND TO
DETERMINE. WHICH FIXTURES NEED TO BE PROTECTED FROM
BACKFLOW. OBTAIN AND SUBMIT WRITTEN DOCUMENTATION TO THE
CI'T'Y OF TIGARD BUILDING DEPARTMENT WITH THE FOLLOWING
INFORMATION:
LOT NUMBER
SUBDIVISION
ADDRESS ID 5-O l N 4 F1/L
PERMIT# P'5 r ,SOU ( -� �r/_C)
A TRANSIT SHOT ON (DATE) Z HAS VERIFIED THAT THE FIRST
UPSTREAM MANHOLE SPILLRUNI IS 'y5r L6;
R LOWER(CIRCLE
ONE)THAN THE fPIT FINISH FLOOR ELEVATION.
DATE O9 ?U OZ_
PLUMBER
_ DATE
JCiB SUPERINTENDANT
.ABOVE INFORMA'T'ION ACCEPTED AND APPROVED BY:
INSPECTOR yc�S DATE C7
13125 SW Hall Blvd., Tigard, OR 97223(503)639-4171 TDD(503)6U-2772
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175 >
INSPECTION DIVISION Business Line: (503) 639-4171 MST
/
BLIP -
Received Date Requested �1.1� AM PM -- - BLIP
Location D SCi�> % _ Suite -_ MEC _v
Contact Person Ph PLM
Contractor------ -- -- _ Ph( ) SWR
BUILDING Tenant/Owner -_- _ ELC
Footing — ELC
Foundation Access:
Ftg Drain ELF! --
Crawl rain _
Slab Inspecticr,, Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Vire Sprinkler
Fire Alarm
Susp'd Ceiling —
Roof
Other. -
Final
PASS PART FAIL -- - - -- - - -
PLUMBING _
Post& Beam -
Under Slab
Rough-In
Water Service
Sanitai y Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other: _
-Ti
ASS,) PART FAIL
Wirt _
Post& Beam
Rough-In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
----- ------
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm ----
Final [r j, Reins tion fee of$ required before next ins
PASS PART_FAIL L__J P� � inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE — [� Please call for reinspection RE: Ej Unable to inspect-no access
Fire Supply Line �
ADA Date InspAetor
Approach/Sidewalk _ ---
Ext
Other:_ _
Final DA OT REMOVE this Inspection record from the job site.
PASS PART FAIL
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CITY OF TIGARD 24-Hour cl
BUILDING Inspection Line: ;503) 639-4175 MST
INSPECTION DIVISION Business Line: (503) 639-4171
7BLIP —_-_
Received -_—_ Date Requested __ r` Z Z AM - PM BLIP --- --
Location -- - - - U SD Suite_ MEC -----
Contact Person A Ph(—) "3I 07 PLM
Contr r - Ph(--) SWR -
UILDIN¢ TenantJOwner _ — ELC
00 -----_—_ ELC
Foundation Access:
Fig Drain ELR -
Crawl Drain — SIT
Slab Inspection Notes: -
Post&Beam - -----
Shear Anchors
Ext Sheath/Shear -
Int Sheath/Shear
Framing - —-
Insulation
Drywall Nailing -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: _ - )
tin _ - -----------��-/ -- _ .
ASS PART FAIL
PrMMG
Post&Beam
Under Slab --- — -
Rough-In
Water Service --�`--- --
Sanitary Sewer
Rain Drains - - - - -
Catch Basin/Manhole
Storm Drain -
Shower Pan
Other:
Final -
-
FAIL
ECHANICA
Rough-In
Gas Line
SmQke Dampers
rn
A PART FAIL -
E RICAL
Service
Rough-In -
UG/Slab
Low Voltage _ -- --- -- --
Fire Alarm
Final Reinspection foe of$ required before next inspectlun. Pay at City Hall, 13125 SW Hall Blvd.
PASS ASS PART FAIL
PA Please nail for reinspection RE: Unable to inspect-no access
_ -
Fire Supply Line '7 /Z Z/O •�-��
ADA Date / Inspector {/—`J'-" ' Ext -
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from th„i job site.
PASS PART FAIL
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a'
/ CITY OF T'IGARD _-__ MASTER PERMIT
PERMIT#: MS12001-00560
DEVELOPMENT SERVICES DATE ISSUED: 1!4/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 10509 SW NAEVE ST PARCEL: 2S110DA-06200
SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5
BLnCK: LOT: 023 JURISDICTION: TIG
REMARKS: New S1= detached residence.Path 1
13UILDING
REISSUE. STORIES. FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT. 24 FIRST: 1,720 of BASEMENT: 81000 of LEFT. 15 SMOKE DETECTORS-
TYPE OF USE: SF FLUOR LOAD. 40 SECOND: 1,765 of GARAUE: 786 of FRONT: 46 PARKING SPACES: 2
TYPE OF CONST: 5N DWELLING UNITS. I FINSSMENT: sl RIGHT: 5
OCCUPANCY ORP: R7 BDRM a BATH 4 TOTAL: 3485 00 0l VALUE: 5 410,278.80 REAR: 49
PLUMBING
SINKS: 2 WATER CLOSETS: 4 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN, 100 TRAPS:
LAVATORIES: 6 DISHWASHERS: I FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATSH BASINS:
TUB/SHOWERS: 4 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLV4 PREVNTR: I GREASE TRAPS:
MECHANICAL OTHER FIXTURES:
_- FUEL TYPES FURN c 10OK: BOILICMP-3HP: VENT FANS: 6 CLOTHES DRYER: 1
GAS FURN>000K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 2
MAX INP: btu FLOOR FURNANCES: VENTS: I WOODSTOVES: GAS OUTLETS: I
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDER5 BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 200 amp: 0 200 amp WiSVC OR FOR: t PUMPIIRRIGATION: PER INSPECTION:
EA ADO'L 8008F: 9 201 •400 amp: 201 400 amp: 1%1 W/O SVC/FDR: 00 SIGNIOUT LIN LT: PFR HOUP.:
LIMITED ENERGY: 401 600 amp: 401 600 amp. EA ADDL BR CIR: SIGNAL/PANEL! IN PLANT:
MANU HNVSVCIFDR: 601 • 1000 amp: 601+ampo-1000v. MINOR LABEL:
1000•amplvolt:
PLAN REVIEW SECTION
Reconnect only:
>-4 RES UNITS: SVC/FDR>•225 A.: >600 V NOMINAL: CLS AREAISPC OCC:
ELECTRICAL-RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREC: VACUUM SYSTEM AUDIO&STEREO: FIRE ALARM: INTERCOM/PAGING OUTDOOR LNDSC LT:
BURGLAR ALARM. OTH BOILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR
HVAC: DATA/TELE.COMM: NURSE CALLS: TOTAL a SYSTEMS.
Owner: Contractor: TOTAL i SES: $ 9,027.44
RENAISSANCE CUSTOM HOMES RENAISSANCE CUSTOM HOMES This permit is subject to the regulations contained in the
1672 SW WILLAMETTE FALLS DR 1672 WILLAMETTE FALLS DR Tigard Municipal Code,State o OR. Specialty Codes and
WEST LINN,OR 97068 WEST LINN,OR 97068 all othercewith
applicable laws. All work will be Bono it
accordance with approved plans. This permit will expire N
work is not started within 180 days of issuance,or it the
work Is suspended for more than 180 days. ATTENTION.
Phone: Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Reg e: LIC 049955 forth In OAR 952-001-0010 through 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987.
REQUIRED INSPECI IONS
Erosion Control Insp& Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Eleclric2l Final
Crading Inspection Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Mechanical'final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Insl Rain drain Insp Plumb Fln,,l
Footing Insp Crawl Drain/Backwatw Electrical Service Low Voltage Water Line Insp Final Inspi.clion
Foundatlon Insp Footing/Foundation Dr; Electrical Rough In Gas Line Insp Appr/Sdwlk Insp
IS8U@d By : I - � ( ►!.�� / Permltt�e Signature —
Call (503) 639.4175 by 7:00 p.m. for an inspection needed the next business day
CITY OF TIGARD _ SEWER CONNECTION PERMIT__
DEVELOPMENT SERVICES PERMIT#: SWR2001 00310
13125 SW Hall 31vd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/4/02
PARCEL: 2S1 10DA-06200
SITE ADDRESS; 10509 SW NAEVE ST
SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5
BLOCK: LOT: 013 JURISDICTION: TIG
TENANT NAME.
USA NO: FIXTURE UNITS.
CLASS: OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection permit for new SF residence
Owner: _— _ FEES_
RENAISSANCE CUSTOM HOMES Type By Date Amount Receipt
1672 SW WILLAMETTE FALLS DR _ --.-- — — --
WEST LINN, OR 97068 PRMT CTR 1/4102 52,300.00 27200200000
INSP CTR 114102 $35.00 27200200000
Phone: 557-8000 Total $2,335.00
Contractor:
Phone:
Rog #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires
180 days from the date issued The total amount paid will be forfeited if the permit expires The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is riot located at the mea sure rnent given,the installer
shall prospect 3 feet in all directions from the distance given It not so located, the installer shall purchase n"Tap and
Side Sewer' Permit and the Agency will install a lateral ATTENTION Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 i0 through OAR 952-001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987
Issued by: Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
One-and Two-Family Dwelling
Building Permit Application Checklist Referenceno.:
Associated permits
City of Tigard City of Tigard J Electrical U Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 9722 1 J Other:
Phone: (503) 639-4171
7ax: (503) 598-1960
1 land use aetloos completed.See jurisdiction criteria for concurrent reviews.
2 Zoning.Flood blain,solar balance points,seismic soils designation,historic district,etc.
3 Verification of approved plat/lot.
4 Hire district _ approval required.
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 U plan U 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 he completed
if copyright violations exist. _ —
I i Site/plot plan drawn to scale.The p an must show lot and building setback dimensions;property comer elevations(if
there is mon;than a O4 elevation di Xerentlal,plan must show contour lines at 24 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;percentbge 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 Croav sections)and details.Show all framing-member sizes and spacing such as floor beams,headers,foists,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 Wail bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysis and calculations to engineering standards.
17 Floor/roof frisming.Provide plans for all floors/roof assemblies,indicating memoer 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 heam/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 Oregon and shall he shown to he applicable to the project under review.
23 Five(5)site plans are required for Item I I above. Site plans must be 8.1/2" x 11"or l l" x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 above.
25 Building plans shall not contain red lines or tape-ons.
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. _
27 No"mirroted"building plans will he accepted.
28 "Drawn to scale"indicates standard architect or engineer scale. —
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614(b' WOM)
Plumbing Permit Application
—� Date received Permit no.gj ;j 61 . '
City of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd,Tigard,OR 972?1
('uvq(Tigurd Pro
Phone: (503) 639-4171 Project' ppl.no,: Expire date:
Fax: (503) 598-1960 Date isajed: _Y— By: Receipt no.
Land use approval: Case file no Payment type:
My Mz=
I &2 family dwelling or acCt•1;511v J C:onunercial/industria;
0 Multi-family J Turiant indprovcmcnl
New construction ❑Add itiorr/allerat on/replacement J Food service J r ill cr:
11 SITE INFORMATIOlit
Job address: L"`� Si✓ oPt-G 5
Description (jt). I M(ca.) Total
Bldg.no.: —wile no_: Ne" 1-and 2-family hHrltcoonly:
(includes 100 ft.for each utility c•unneclion)
Tax map/tax lot/account no .: SFR(1)bath
Lot: 7.3 Block: Subdivision: E /� ,, /r SFR(2)bath
Project name: / s•,,.., /err !, SFR(3)bath -- --- -- ---
City/county: ZIP: Each additional hath/kitchen
Description and location of work on premises: IJ.1.4 - A" /r Site utilities:
Catch basin/area drain
Est.date of romplctirnd/inspection Drywells/leach Iine/trench drain
l 1 Footing drain(no. lin. ft.) _
NTRAUFOR Manufactured home utilities _
Business name: G,,r f�,,.�/, �IUr,C ,,., f Manholes _
Address: j7A 14—, A/ key T Rain drain connector
t%P I State: q4 I ZIP: 9 7 OOX Sanitary sewer(no. lin. ft.) _
Phone:
Fax: E-mail Storm sewer(no. lin. ft.)
S�';-6 -g' 7 Water service(no. lin. ft.)
CCB no.: 79(;L(, Plum 1.bus_reg_no: 'ZT_/ (,
Fixture or item:
City/metro lic.no.: 25,O/ _
Abson,tion valve
Contractor's representative signature: tr '" �'
_ 1- Back flow preventer _
Print name: fele //,,,. I',t1r Backwater valve
CONTACT 1 Basins/lavatory --
Name: Clothes washer
Dishwasher
Address: -. Drinking fountain(s)
-
City: State: ?IP:_ - ---_ Ejectors/sump
Phone: Fax: E-mail; Expansion tank _
Fixture/sewer cap
7inj�ddress:
�. Floor drains/floor sinks/hub(Frauftso;Yc '.�, a.K Hr+M Garbage disposal(6 TZ Sw ,//a +: N Nc Hose bibb
State: ryC ZIP: 7�;�' Ice maker
Phone: S'n� is 7�+" Fax: Email: Interceptor/grease trap _
Owner instal lation/residential maintenance only: The actual installation Primer(s) _
will he made by me or the maintenance and repair made by my regular Roof drain(commercial) _
employee on the pmperty I own as per URS Chapter 447. Sink(s),basin(s),lays(s)
Owner's si nature: Date: Sump
Tubs/s_hower/shower an
Urinal _
Name: Water closet _
Address: Water heater
City: _ State: ZIP: Other:
Phone: -----JFax: E-mail: Toth �-
Nay all jurisdictions accept credit cards,please call jurisdiction for more mP
for,nation. Notice:This permit application Minimum fee................$
O isa O MasterCard expires if a permit is not obtained Plan review(al _ %) $ _
Credo card number _ within 180 days aR-r it hag been
EeState surcharge(89F) ....$
pires
accepted as complete. TOTAL .......................$ _.
Name of cardholder u shown on credit card
E _
Crrrdhclder eignemrc Amount 440.4616(6,CNCOMr
PLUMBING PERMIT FEES:
TOTAL New 1 and 2-family dwellings only:
FIXTURES individuals — QTY ea AMOUNT (includes all plumbing fixtures in PRICE TL
ITAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMO:INT
----- for each utilityconnectlo
----- 16.60 — — -- -n __
_.
Lavatory One(l)bath $249.20
---
Tub or Tub/Shower Comb 16.60 Two(2)bath 350.00
_ -- -— 1660 _ Three 3 bath $399.00
Shower Only _--- ---�_�—.�— -------- -- —
Water Closet — t6 GO —__ SUBTOTAL —
Urinal 1660 — 8%STATE SURCHARGE _
fiishwasher 1660 PLAN REVIEW 25%OF SUBTOTAL _—
16 60 — TOTAL ----- --- —
Garbage Disposal __—
LaundryTray ----! — 16,60 —
Washing Machine 16.60
Floor Drain/Floor Sink z" - _ 1660_ PLEASE COMPLETE:
3" 16.60
4^ 16 60 — -
-- _— Quantity b Work Performed
Water Heater O conversion () like kind 16.60 Fixture Type: New Moved Replaced Removed)
Gas piping requires a separate mechanical Capped
permit. - -- —
MFG Home New Water Service 46,40 Sink
46 40 — Lavatory— _ -
MI=G Home New San/Stone Sewer Tub or Tub/Shower
Hose Bibs 1660 Combination
Rcoi Drains — 1660 Shower Only _
16 60 Water Closet _
Drinking Fountain Urinal _
Other Fixtures(Specify) 1660 Dishwasher
Garba a Disposal _
--- — Laundry Room Tr2y -- _
Washina Machine _
Floor Drain/Sink: 2' _ v _--
Sewer-1 st 100' — — 5500 -- — 3" -�
Sewer-each additional 100' — 46.40 4"
ate. —
Water Service-1st 100' 5500 WHeater
Other Fixtures
Yater Service-each additional 2C0'
4640 SLerif —
Storm&Rain Drain-1st 100' 5500 -- —
Stcrm 8 Rain Drain-each additional 100 46 40 -
Commerc!al Back Flow Prevention Device 4640 —
Residential Backflow Prevention Device- 27 55
Catr..h Basin 1660 — —--
Inspection of Existing Plumbing or Specially 7250
Requested Inspections er/hr — COMMENTS REGARDING ABOVE:
Rain Drain.single family dwelling 65.25 —
Grease Traps —— ---- --_ 1660 —_ ----- ---------- --
QUANTITY TOTAL — —
Isometric of riser diagram is required if
Quantity Total is,.>9 ------
*SUBTOTAL --- — _
8%STATE SURCHARGE ------- --- ----
"PLAN REVIEW 250,e OF SUBTOTAL
Required only if nxture qty total is>9
TOTAL
minimum permit fee is$(2 50.MI.state surcharge,except Residential BaOflow
Prevention Cevice,which is$36,^5•896 state surcharge
"All New Commercial Buildings require plans with isometdc or riser diagram and
plan review
is\dsts\forms\plm-fees.doc 10/10/00
Mechanical Permit Application
Date received: Permit no.: �r)tel
City of Tigard Project/appl.no.: Expire date:
City n(Tigard Address: 11125 SW Hall Blvd,Tigard,OR 97223 Date issued: By Receiptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type
Land use approval: ,_ Building permit no
OF PERMIT
1 &2 family dwelling or accessory U COMITIcrcutl/indutitr)al ❑Multi-(amply U Tenant improvement
New cons(niction U Addition/alteration, lacement U Other
JOB SITE INFORMATION COMMERCIAL VALUATION-SCIIEDULE
Job address: e✓ d S Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax Iol/account no.: profit. Value$
Lot: Z-3 Block: Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county:T;;. • !„* �, ZIP: I & 2 FAMILY DWELLIV PERMIT FEE SCIIEDULF
Description anis location of work on premises: /
r"J,cvn+//ti/ Fee(ea.) -folal
Est.date of completion/inspection: Description Qt . Rei-onlyRes.only
Tenant improvement or change of use: Air handling unit CFM
Is existing space heated or conditioned?U Yes U No Air conditioning(site plan require )
Is existing space insulated?U Yes U No
Alteration of existing system_
of er/compressors
late boiler permit no.:
Business name: �� S
C� frti_J?1.._S•. 11�0•1 - _ HI Tons BTU/fl
mdampers/duct
Address: 2 7 g F y y'� _ •ire sn o e ampers/ uct smo a electors
City: /.///j4; - Slate: Cyt' "LIF': 7 7/Z 3 Heat pump is plan require )
Phone:f�3 . 27n2yZ Fnx: _ E-mail: nsta i+rep ace furnace burnerD — '
--- Including ductwork/vent liner U Yes❑No _ l
CCB no.: Q1 Z 17 Pf e 2') >n� nsle rep ac re locate heaters-suspen e ,
City/metro lic.no.: .>I �� _ wall,or floor mounted
Name(please print): (�,-�/,, +� crit forappliance other than furnace
-00-1V1'A-CT PERSON Refrigeration:
Absorption units BTU/11 _
Name: Chillers_ ___. _ HP
--- Com ressors lip
Address:
- Environmental exhaust anventilation:
City: State: 'Z.IP: Applia•acevent
Phone: I .i E-mail: ryer"x aust ---- _ _
0o s,Type 11 II/rcs.kite en/hazmat
^ hood fire suppression system --
Name: /f r�nt,,sA.+�e {s f.-+ NA�.e-s Exhiust fan with single duct(bath fans)
M-ailing address: //� Fxhausl s stem apart from heating or AC
Cit f- � State: nQ ZIP: •tie piping andistribution(up to outlets)
Y: i✓r s +.n Type: LPG NG Oil
Phone:jJ?.SS jFLiCC, Fax: ;n.;fsGlie, s -mail: uel i in each additional over 4 outlets
Process p p ng(schematic require ) _
Name: Number of outlets
_— fTl erNed appliance or equipment:
Address: _ Decorative fireplace
City: State: ZIP: - nsert-type
Phone: Fax: E-mail (-)(her:stov pe et stove _
Applicant's signrture: '' - Date. —_ _ ter:
Name (print): reit•✓, �: _.��i - -- _ __-.�
Not all jurisdictions accept credit cards,pleme call jurisdiction f(x more mtommunn Permit fee............. .......$
O Visa ❑MasterCard Notice:TI is permit application Minimum fee................
expires if a permit is not obtained plan review(at _ °�1
Creditcud number -_— - - within 1 gU da s after it has been
Expires _ Y State surcharge(8%) ....$ __
Name of cardholder u:ht,wn on credit card accepted a i complete. TOTAL
Cardholdet siprature Amount 440.4617(6MCOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code _ Oty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to ducts
& 0 BTU
including ducts&vents 14.00
$1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+
fraction thereof,to and including 17,40
$10,000.00. includin ducts&vents _
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or including vent 14.00
fraction thereof,to and including 4) Suspended heater,wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit 6.80
$1.45 for each additional$100.00 or -
fraction thereof,to and including 6) Repair units
$50000.00.
$50,001.00nd aup _ $742.00 for the first$50,000.00 and Check all that apply: Boller Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. footnotes below. Comp
7)<3HP;absorb unit
Minimum Permit Fee$72.50 SUBTOTAL: to 100K BTU 14 00
$
S'/.State Surcharge v 8)3-15 HP;absorb
$ unit 100k to 500k BTU 25.80
25%Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb 35.00
eq
_ Ruired for ALL commercial permits onlyunit.5-1 mil BTU ___
10)30.50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20
11)>50HP;absorb
_---- unit>1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: _ 12)Air handling unit to 10,000 CFM 10.00
Value Total 13)Air handling unit 10,000 CFM+
Descri_ ytion: _ Qty_. Ea Amount 1720
Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler
ducts&vents _ 10.00
Furnace>100,000 BTU including 1,170 15)Vent fan connected to a single duct
ducts&vents 5.80
Floor furnace including vent _955 16)Ventilation system not included in
Suspended heater,wall heater or 955 appliance ermit 10.00
floor mounted heater -- - ""445 17)Hood served by mechanical exhaust 10 00
Vent not included In applicance _-`
ermlt - 805 18)Domestic Incinerators 1740
Re air units ---
<3 hp;absorb.unit, '955 19)Commercial or industrial type incinerator
to 100k BTU _ ___ 69.95
3-15 hp;absorb.unit, 1,700 20)Other units,including wood stoves
101 k to 500k BTU _ 10.00
15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets
mil.BTU 5.40
30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each)
1-1.75 mil.BTU 1.00
>50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $
>1.75 mil.BTU
Air handling unit to 10,000 cfm 656 -� 8%State Surcharge $
Air handlin unit>10,000 cfm 1,170
Non-portable eve orate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not Included In 656 _appliance ermit Other Inspections and Fees:
Hood served by mechanical exhaust 656 1 Inspections oulside of normal business hours(minimum charge-two hours)
Domestic incinerator 1,170 $72 50 per hour
Commercial or Industrial incinerator 4,590 2 Inspections for which no fees specifically indicated (minimum charge-hall hour)
Other unit,including wood stoves, 856 $72 50 per hour
Inserts,etc. 3 Additional plan review required by changes.additions or revisions to plans(minimum
charg"ne-hall hour)$72 50 per hour
Gas piping 1-4 outlets 360
Eac__h additional outlet 83 'State Contractor Boiler Certification required for units>200k BTU.
_
: "Residential AIC requires site plan showing placement of unit.
TOTAL COMMERCIAL
"ALUATION; All Now Commercial Buildings require 2 sets of plans.
I:\dsts\forms\mech-fees.doc 08/29/01
Electrical Permit Application
— —` Date received: Pcrntitnol
City of Tigard Project/appl.no.: Expire date:
rrev(of Drnrd Address: 13125 SVS' Ihill 131vd,1igard,OR 97223 Dale issued: By: RCCelpin0.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval.
I & 2 fainly dwelling or accessory U Commercial/industrial U Multi-family U'I'enant improvement
New construction U Addilion/nUi r:tunnhrlil,u i nu nl U Other: U Partial
JOB SITE INFORMATION
Joh addre,�: 10507 SV Ala, }T Bldg. no.: Suite no.: ITax snap/tan IoUaccount no.:
Lot: -23 Block: Subdivision: etlyl,"o4v _- -
Project name: /ry,„, f,•, Description and location of work on premises:
Estimated date of con ploit,n/ins ection:
APPLICATIONCONTRACTOR 1
Job no: td� nl:rr
T--- - Description Qts. (ea.) total no.lns
Business name: ,� 1�� yi.C__
- Ness residential k
sin{ ormulti-fandlsr:r
Address: fit.) �, - Z`� dnellingunit.Itic ludesattached garage.
City: Lel s lcw 5lale: G)k IIP: �7 f S Seniccincluded:
Phone: y:,^ . sr61;L/z Fax. E-mail: I1100sy It.or lest 4
CCR no.: r f Elec.bus.lic, no: '' Each additional 500 sq.ft.or portion thereof
3 y �'^�r Limited energy,residential 2
City/metro lic.no.: zil I Limited energy,non-residential 2
—�f ? Each manufactured home or modular dwelling,
Signature of supervising cicctr craptu (rcyuired) DaService and/or feeder 2e
Sup elect nnnne(pnnu: C�.,� l icrnseno r:i g f Services or feeders-Installation,
alteration or relocation:
1 200 amps or less 2
Name(print): �- -„ 201 amps to 400 amps 2
C~•�cv'' ^`~ c"`" �L9j -- 4U 11 amps to 600 amps 2
Mailing address: 16.l Z 5.,/ 1./,//Q,,,,fla `ups �r'�_ 601 amps to 1000 amps 2
Oily: ,;l State:-1Q ZIP: `j•7r;6`f Over 1000 amps or volts ---- 2
Phone: f. 3s!9f4t�Z' Fax: Sr'2 S i h7 I •Itlall: Reconnectonl I
Owner installation:The installation is heing made on property I own 7emparoryurerativices o,arrflrs-
which is not intended for sale,lease,rent.or exchange according to Installationraheratlon,nrrrlocmion:
ORS 447,455,479,670,701. 201 amps ser less _ _ 2
201 amps to 4011 amps 2
Owner's signature: D;Itc and to 600 amps 2
Branch circuits-new,allerallon,
or exlensipn per panel:
Nanie: _ A Fee tar branch circuits with purchase of
Address _ service or feeder fee,each branch circuit 2
City: Slate: ZIP: B Fee for branch circuits without purchase
-- —
fax: oil service or feeder fee,first branch circuit
Phone: F'-nail
I aeh additional brunch circuit:
Misc.(Service or feeder not included):
I]Service over 225 unnps-conunercial J liealih care facility Each pump or irrigation circle 2
U Service aver 320 amps-rating of 1&2 U Hazardous locution Each sign or outline lighting _ 2
familydwellings U Building over 10,000 square feet four or Signal circuiusl or a limned energy panel.
System Durr 600 volts nominal more residential units in one structure alteration,or extension' 2
U Building over three stories U Feeders,400 amps or more *Des"Ittlion
J occupant load over 99 persons U Manufactured structures or RV park Fs,.h additional inspection over the allowable In any of the above:
J Egress/lightingplat U Other: P.rnnspection
Submit sets of plans Neth ani of the above. I ivestigation fee
The above are not applicable to temporary cortoruc•tion service. O bei
Not all jurisdictions accept credit cads,please call jurisdiction for uunr mtorrra!ion. Nonce: fbi5 permit application Permit fee.....................$ _
J Viso U MasterCard expires if a permit is not obtained Plan review(at -_ %) $ _—
Credit cad number _—__ _L_L_ within IRO days after it has been State surcharge(8%) ....$
Expires accepted as complete. TOTAL $ _
......................
Name of cardlicilder as shown on credit card
Cardholder sisnalure Amount 4413-4615(W)/('()M)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
- TYPE OF WORK INVOLVED -RESIDENTIAL Y
Complete Fee Schedule Below: ---
Restricted Energy Fee..................................................... $75.00
Number of Inspertions per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved.
Residential-per unit E]1000 sq If or less $145 15 Audio and Stereo Systems'
Cach additional 500 sq it or
portion thereof $33.40 1 Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular Garage Doo.'Opener*
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,-,'teration,or relocation
200 amps or less $80.30 2 Vacuum Systems'
201 amps to 400 amps $106,85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60_ 2 Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Fee for each system........................................................ $15 D0
Installation,alteration,or relocation
200 amps or less $6685 2 (SEE OAR 918-260-260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps _ $133.75_— 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see"b"above. Audio and Stereo Systems
Branch Circuit's Boiler Controls
New,alteration or gxtenslon per panel
a)The foe for branch dreuits
with purchase of service or Clock Systems
feeder fee.
Each brandi circuit _ __._ $6.65 ❑ Data Telecommunication Installation
b)l lie fee for branch dicuits
without purchase of service. Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 - HVAC
Each additional branch circuit $6.65
Miscellaneous Instrumentation
(service or feeder not Included)
I ach purnp or Irrigation circle $53.40 Intercom and Paging Systems
F ach sign or outline lighting $53.40
'signal circuit(s)or a limited energy
panel,alteration or extension $75.00 _ Landscape Irrigation Control'
Mincr Labels(10) $125.00
Medical
Each additional Inspection over ❑
the allowable in any of the above Nurse Calls
I'ei inspection $62.50
Per hour $62.50 ^ __
In Phill — $73 75 — Outdoor Landscape Lighting'
Fees: ❑ Protective Signaling
Enter total of above fees $ — _ Other -----
13%State Surcharge $ Number of Systems
25%Plan'Review Fee No licenses are required Licenses are required for all other installations
See"Plan Review"section on $
front of 3pp4cation
Fees:
Total Balance Due $
—��— Enter total of above fees $
❑ Trust Account# 8'.4 State Surcharge $
Total Balance Due —
I ,(ISIS'forms.eic-tees doc 060701
SEE 3 ,5MM-
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