Permit Support Document (16) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II 11 ' ' COMMUNITY DEVELOPMENT Permit#: ELC2019-00445
TI(l A IF f) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/27/2019
Parcel: 2 S 102AA02100
Jurisdiction: Tigard
Site address: 9065 SW CENTER ST
Project: AV Equity Inc Subdivision: KINGSTON Lot: 15
Project Description: Replacing(1)200 amp panel. 7/16/19:REPRINT to add(12)branch circuits.
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Contractor: PARAMOUNT ELECTRIC CO Owner: AV EQUITY INC
39085 PIONEER BLVD STE#203 7505 NE 123RD CT
SANDY, OR 97055 VANCOUVER,WA 98682
PHONE: 503-703-2571 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Services or Feeders-200 amps or less 06/27/2019 $100.70
12%State Surcharge-Electrical 06/27/2019 $12.08
Type of Use: SF Branch Circuits w/Purchase Service or 07/16/2019 $89.04
Feeder
Class of Work: ALT 12%State Surcharge-Electrical 07/16/2019 $10.69
Total Number of Systems:
Audio&Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: Total $212.51
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other app'cable 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 f work is sus;ended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center., Those rule- are set forth in OAR
952-001-0010 through 952-00 0090. Y:.may obt-' a copy oft. rules or direct questions to OUNC by calling 503.232.1987 r .800.3 .23;4.
Issued By: /, Air /�/r` (� _
APermittee Signature:
lert4iir�
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Tate:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Plumbing Permit Application
Building Fixtures
NCity of Tigard n Receiveyd? i� L
! Date/B `� -Pelil )„✓7.._ 0c � J
� 13125 SW Hall Blvd.,Tigard,OR 97223 pC(,•t
I Phone: 503.718.2439 Fax: 503.598 1961) Plan Review �'r /�
Date/By: j]"J.'r f e V i,...z/1 C��/.)
1 1 G A R Inspection Line: 503.639.4175 _-,. Date Ready/By: him." H See Page 2 for��i�
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
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❑New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
'✓' ddltion/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
y\\ CATEGORY OF CONSTRUCTION ' SFR(1)bath 312.70
L,Fs and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
7 ❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
, ,,,, . JOB SITE,MFOR 1ATION AND LOCATION Site utilities:
Job site address: .p6 --. G 4/ Cy?yi-Fe r 5'71-- Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: tr e.." d
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project me: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
reM m 'I �,, „, Backwater valve 12.51
-'4 '.: ,': -', rlW ., 4W .
3. _ Clothes washer 25.02
r Dishwasher / 25.02
el/dC4l� 4-/ / i1l . -€ CtF ltc I Drinking fountain 25.02
/le col'f7C 1 j� lyitifrr
.,. : F�- r ,V G �ky (t,r ! Ejectors/sump 25.02
w a fl >` Expansion tank 12.51
Name: / / i..t i , t/� 4 e Fixture/sewer cap 25.02
/ Floor drain/floor sink/hub 25.02
Address: 666
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
. ` t r .. t NTA t Interceptor grease trap 25.02
/
Business name: fivoff- �L /4/ Medical gas(value:$ ) Page 2
dj erx W I Gi:+c"C/ Primer 12.51
Contact name: j�/ j
1
Address: .7 Xis. /2 7 c-1 Roof drain lav tory(commercial) 215.02
,/ Sink/basin/lavatory � 25.02
City/State/ZIP: //eilele.a Gx/iPs--- Solar units(potable water) 62.54
Phone:T -_�- 090rZ05,1- 67 Fax :( )r
Tub/shower/shower pan + 12.51
E-mail: �/O C/ •,e',06,--c.) Urinal 25.02
- , Water closet 25.02
.-..2 .. ' '45 a= �,. . ' 'r Water heater ( 37.52
Business name: rjq,,,,� JI 1`�`i✓ Water m DWV 56.29
PiP� g/
Address: )�f � b S�� l�j
Other: 25.02
City/State/ZIP: "�j4r4 C�t L 1�% ( Subtotal
Phone:(36 fj) �' '� e � Fax:( ) Minimum permit fee: $72.50
CCB Lic.: ��� 'y Plumbing Lic.no.: Y�/ 3 Plan review (25%of permit fee)
�� State surcharge(12%of permit fee)
Authorized signature: I
TOTAL PERMIT FEE
Print name: Date: .-77/0//ry This permit application expires if a permit is not obtained within 180 days
'1f7 after it has been accepted as complete.
/ *Fee methodology set by Tri-County Building Industry Service Board.
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�Building�Permits�PLMU-P ��'
I: App.doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
. Fee(ea).x Total :.
Srte'�tiht�es ` �• Square Footage: ° ; Permit Fee:
Footing drain-15`100' 50.03 0 to 2,000 $121.90
Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer-1st 100' 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: ' Perini Fee:
Storm&Rain Drain-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for
.f Qty• Fee tea/ ,, each additional$100.00 or fraction thereof,to
Other inspectionsox Fees and including$10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to
(minimum charge-1/2 hour) and including$25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. �� Pfan Review-tot APhinlb4.i ' y"
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for attilacel Please check all that apply.
Work Performed:. Capped'.. Abided, Relocate
0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru
0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator
0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial
❑ Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -_2 "Q s Olaztom,:" . .
D Isometric or riser diagram is requtrdd for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach./Refrig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet-Toilet
Urinal
Other Fixtures:
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