Permit CITY OF TIGARD MASTER PERMIT
2.. COMMUNITY DEVELOPMENT Permit#: MST2018-00334
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/20/2018
T[ t'�I.C� Parcel: 2S109AC05900
Jurisdiction: Tigard
Site address: 13168 SW NICOLE LN
Subdivision: WILSON RIDGE NO.2 Lot: 27
Project: WRIDGE
Project Description: Remodeling bonus room to make an office and a fourth bedroom with closet.
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: 1 First: sf Basement: sf Left Parking Spaces:
Height: Bathrooms: Second: sf Garage: sf Front: Smoke
Dwelling Units: Third: sf Right:
Detectors: Yes
Total: sf Value: $35,000.00 Rear:
PLUMBING
Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Urinals:
Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Storm Sewer:
Tubs/Showers: Garbage Disp: Water Heaters: Water Lines: Drains: Catch Basins:
Bckflw Prevntr:
Footing Drain: Ice Maker: Hose Bib: Backwater Value:
Other Fixtures:
Drywell-Trench Drain:
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers:
Heat Pump: N Hoods: Other Units:
Furn<100K: Vents: Woodstoves: Gas Outlets:
Furn>=100K:
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: 5
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
Owner: Contractor:
WRIDGE,AMBER M OWNER Required Items and Reports(Conditions)
13168 SW NICOLE LN JEFF CEDERBERG
TIGARD,OR 97224 13168 SW NICHOLE LAND
TIGARD,OR 97224
PHONE: PHONE: 541-306-1671
FAX:
Total Fees: $1,099.71
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable =w. 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 suspend-• for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notif at n ter. Those rules • e set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a •py of the rules or• =ct questions to OUNC by callin 503,2 . 87 r . 0/ 2.234..
Issued By: i�.'_r_ _ Permittee Signature:
Cal ;03.••.4175 by 7:00 a.m.for the next available inspection da
This permit card shall be kept in a conspicuous place on the job site until completion f the project.
Approved plans are required on the job site at the time of each inspection.
Buildirie Permit Application
Residential FOR OFFICE USE ONLY
City of Tigard 1 CEIV I) Received. Date/By: /l-/ 0/15/ Permit No.: 17 S)-7f j 341/
13125 SW Hall Blvd.,Tigard,OR 973,vii
Plan Review / / 1 '�SGdr �
3 Phone: 503.718.2439 Fax: 503.598.1960 {� Date/By: Z �7ti
Other Permit:
1.I G A RD
Inspection Line: 503.639A 175 OEC st 0 2111 B Date Ready/By: ' Juris: RI See Page 2 for
Internet: www.ttgard-or.gov trfied/Method: /l7 X. /4 ' I Supplemental Information
CID Of ' CARD ir��
TYPE OF WO g v (QUIRED DATA:1-AND 2-FAMILY DWELLING
tr fionNG SIJ Permit fees*are based on the value of the work performed.
0 New construction emolition
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® 1-and 2-family dwelling ElCommercial/industrial Valuation: $ �j� (�0
❑Accessory building 0 Multi-family Number of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:13168 SW Nicole Lane New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Bonus Room Remodel c�6�� Covered porch area: square feet
/G'�
Cross street/directions to job site:SW 133rd Ave. Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Remodeling the bonus room to now include and office,fourth bedroom and closet Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name:Jeff and Amber Cederberg E tr`, 4.4),/),*
im ,__ Type of construction:
Address:13168 SW Nicole Lane Occupancy groups:
City/State/ZIP:Tigard,OR 97224
Existing:
Phone:(541)306-1671 Fax:(N/A) New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:
Structural plan review fee(or deposit):
Contact name:Jeff Cederberg
FLS plan review fee(if applicable): r
Address: 13168 SW Nicole Lane
City/State/ZIP:Tigard,OR 97224 Total fees due upon application 316•_70
Phone:(541)306-1671 Fax: :( Amount received:
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:cederbergj@yahoo.com
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name: efi,vArer- 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 lic.:
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.
�,j� Date: *Fee methodology set by Tri-County Building Industry
Print name: ��, tG"� 1 z� Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 l/02/COM/WEB)
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
/1111 - �;eBY:
g 13125 SW Hall Blvd.,Tigard,OR 97223 ,l Il' Related Permit#:
Phone: 503.718.2439 Fax: 503.598.1960 •
Inspection Line: 503.639.4175 Ready Date/By: Juris: 0 See Page 2 for
T I G A RP Internet: www.tigard-or.gov Notified/Method: Supplemental Information
DEC 1 0 2018
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/ICF '116AR Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition El Other: G DIAVADIIO where the available fault current 0 Mannas and boatyards.
CATEGORY OF CONS l� exceeds 10,000 amps at 150 volts or ❑Floating buildings.
1-and 2-familydwelling ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
® ❑Commercial/industrial amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE'INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job 4: Job site address: 13168 SW Nicole Lane 100HP or more. ❑"A","E "1-2",°`1-3",
City/State/ZIP:Tigard,OR 97224 0 Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.4: Project name:/B,pryrr 0 Hazardous locations.om emodel0 Supply voltage for more than
t0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW 133rd Ave FEE SCHEDULE
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#: Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Remodeling the bonus room to now include and office,fourth bedroom and closet
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:Jeff and Amber CederbergL _ .4; 200 amps or less 100.70 2
Address: 13168 SW Nicole Lane (f 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97224 601 amps to 1,000 amps 301.04 2
Phone:(541)306-1671 Fax:(N/A) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is b • made on property that I own which is not 200 amps or less 59.36 1
intended for sale,leaartrjt, ixch e,according t ORS 447,449,670 d 70J. 201 amps to 400 amps 125.08 2
Owner signature:.(M � Date: 1� d O�201 % 401 amps to 599 amps 168.54 2
APPLICANT ❑ CONTACT PERSON((( Branch circuits—new,alteration,or extension, ler panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name:Jeff and Amber Cederberg B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: 13168 SW Nicole Lane branch circuit
City/State/ZIP:Tigard,OR 97224 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder n t included)
Phone:(541)306-1671 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:cederbergj@yahoo.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(%Y hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date: 0 Plan Review Required(25%of permit fee):
ill ,
/ State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
' ", i� This permit application expires if a permit is not obtained within 180
Print name: Jeff Cederb g "> e,i Date: I-t�/ft ci) days after it has been accepted as complete.
Z * Number of inspections allowed per permit.
I:\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 06/17/2015 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: $75.00Qty.DescrEach electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n 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
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
111 Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n 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
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015