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Permit
1 0/27lio c-4 ( c ,5 5 7 CITY OF TIGARD MASTER PERMIT IS • COMMUNITY DEVELOPMENT Permit #: MST2010 -00159 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2010 Parcel: 1S125DD09100 Jurisdiction: Tigard Site address: 9674 SW VENTURA CT Subdivision: WASHINGTON SQUARE ESTATES NO. 3 Lot: 99 Project: Glanz Project Description: Residential elevator. 10/19/10 added (1) service and (3) branch circuits B.T. 10/22/10 added (4) branch circuits B.T. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First 0 sf Basement 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $15,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Tema 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 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add, Br Cir: 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: Owner: Contractor: Required Items and Reports (Conditions) GLANZ FAMILY TRUST SAMUEL PHILIP DIGREGORIO BY KENNETH RICHARD GLANZ &, 1839 SE PARKVIEW CIRCLE BESSIE JEAN GLANZ, TRUSTEE, Milwaukie, OR 97267 9674 SW VENTURA CT PHONE: PHONE: 503 - 310 -5692 FAX: Total Fees: $705.23 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 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 throu 952- 001 -0100. You may obtain a s or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. • Issued ' Permittee Signature: /,q/o aA -e` CO E-cvv 62_ c (.) d3 e CITY OF TIGARD MASTER PERMIT [i COMMUNITY DEVELOPMENT Permit #: MST2010 -00159 T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2010 Parcel: 1 S 125DD09100 Jurisdiction: Tigard Site address: 9674 SW VENTURA CT Subdivision: WASHINGTON SQUARE ESTATES NO. 3 Lot: 99 Project: Glanz Project Description: Residential elevator. 10/19/10 added (1) service and (3) branch circuits B.T. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $15,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =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 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add, Br Cir: 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: Owner: Contractor: Required Items and Reports (Conditions) GLANZ FAMILY TRUST SAMUEL PHILIP DIGREGORIO BY KENNETH RICHARD GLANZ 8, 1839 SE PARKVIEW CIRCLE BESSIE JEAN GLANZ, TRUSTEE, Milwaukie, OR 97267 9674 SW VENTURA CT PHONE: PHONE: 503- 310 -5692 FAX: Total Fees: $671.99 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 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through O:R 952 - 001 -0100. You m y obtain a rn. .f the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued B . �_� . — i' Permittee Signature: - n CITY OF TIGARD MASTER PERMIT 14 C COMMUNITY DEVELOPMENT Permit #: MST2010 -00159 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2010 TIGARD Parcel: 1S125DD09100 Jurisdiction: Tigard Site address: 9674 SW VENTURA CT Subdivision: WASHINGTON SQUARE ESTATES NO. 3 Lot: 99 Project: Glanz Project Description: Residential elevator. 10/19/10 added (1) service and (3) branch circuits B.T. 10/22/10 added (4) branch circuits B.T. 10/27/2010: Reprinted to remove (1) branch circuit and transferred to MST2010- 00169. DLH BUILDING Floor Areas Required Setbacks Requ Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $15,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Tema Srvc/Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 6 Ea add 500 sf: 0 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add Br Cir: 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: Owner: Contractor: Required Items and Reports (Conditions) GLANZ FAMILY TRUST SAMUEL PHILIP DIGREGORIO BY KENNETH RICHARD GLANZ &, 1839 SE PARKVIEW CIRCLE BESSIE JEAN GLANZ, TRUSTEE, Milwaukie, OR 97267 9674 SW VENTURA CT PHONE: PHONE: 503 - 310 -5692 FAX: Total Fees: $696.92 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 days. ATTENTION: Oregon taw requires you to follow the 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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. e/v i°i° / C6' / 7c ^/ / Issued By: Permittee Signature: 10/2-7 /rte kpr -,lti / ,Y,,1; tci- w0Kk. CITY OF TIGARD MASTER PERMIT .11 I: COMMUNITY DEVELOPMENT Permit #: MST2010 00159 • T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2010 Parcel: 1S125DD09100 Jurisdiction: Tigard Site address: 9674 SW VENTURA CT Subdivision: WASHINGTON SQUARE ESTATES NO. 3 Lot: 99 Project: Glanz Project Description: Residential elevator. 10/19/10 added (1) service and (3) branch circuits B.T. 10/22/10 added (4) branch circuits B.T. 10/27/2010: Reprinted to remove (1) branch circuit and transferred to MST2010- 00169. DLH. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $15,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 6 Ea add'I 500 sf: 0 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add' Br Cir: 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: Owner: Contractor: Required Items and Reports (Conditions) GLANZ FAMILY TRUST SAMUEL PHILIP DIGREGORIO BY KENNETH RICHARD GLANZ &, 1839 SE PARKVIEW CIRCLE BESSIE JEAN GLANZ, TRUSTEE, Milwaukie, OR 97267 9674 SW VENTURA CT PHONE: PHONE: 503- 310 -5692 FAX: Total Fees: $797.72 , 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 •• • = the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. ^ ose rule - - set forth in OAR 952 - 001 -0010 through OA; .2-001-0100. You may obtain . + e ru es • •' -ct questions to OUNC by calling 503.246.669 ' Issued B �i ✓ _ - ' i._i Permittee Signature O' � - a CITY OF TIGARD MASTER PERMIT IN 0 COMMUNITY DEVELOPMENT Permit #: MST2010 -00159 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2010 Parcel: 1 S125DD09100 Jurisdiction: Tigard Site address: 9674 SW VENTURA CT Subdivision: WASHINGTON SQUARE ESTATES NO. 3 Lot: 99 Project: Glanz Project Description: Residential elevator. BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 0 First 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: sf Value: $15,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Catch Basins: 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Other Fixtures: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Bckflw Prevntr: 0 MECHANICAL Fuel Times Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temo 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 20 1-400 amp: 0 201 -400 amp: 0 1st W/O Svc/Fdr: Limited Energy: 401 -600 amp: 0 401 -600 amp: 0 Ea add Br Cir: 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 Owner: Contractor: Required Items and Reports (Conditions) GLANZ FAMILY TRUST SAMUEL PHILIP DIGREGORIO BY KENNETH RICHARD GLANZ &, 1839 SE PARKVIEW CIRCLE BESSIE JEAN GLANZ, TRUSTEE, Milwaukie, OR 97267 9674 SW VENTURA CT PHONE: PHONE: 503- 310 -5692 FAX: Total Fees: $534.27 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 days. ATTENTION: Oregon law requires you to follow the 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 a copy of questions to OUNC by calling 503.2 .669 or 1.800.332.2344 LO 1. 7 Issued By % �� Permittee Signature: 0',.1/ 4Zr''ant) J. /:.J 010:ib4770104 rvirmau • ...�.- lea! Pclydiit licatiioia , i . 1 11 111 - 18 9W E120 Blvd, OR , Roma No,; - 4 (0 — c , ' 5 1 •__,_. k - . Phone: 503.639.4171 Pat: 503.998.19 Ohm t r i , , , , , htspeittion Lind 09.439.4175 Internet to w.ttgaldgr • : +� elkedy - 1 8t- fbr ,gAta �J` • 41' � �• •.: :. - ...,,■ , 1Tat'eteol�Hn TYPE OP won 4 91- — FLAP/ REVIEW 0 New construction IdAddition/altcfati• • r + ., -. i 17eafeacheek ' : that applyn'^ a aces ofpbenwlbams • helm ©DentotUdon 0 other D deck* OT reader 400 cps a. onto D 19al dri 8 owe then sto vdere do av*Abte fame patent 0 M ohm sad bonne . CATEGORY OF evNSTRtrtyrloiv � for ; i � Q o W n ° e � t � . m n+�a�+ ®.1- and 2- Comity dwelling D CotamerciaUbdustriul 11 Accessory building m�e alt ether tetentatbns. bnndnr(o +ne ❑ i�4litti• indl� tJ Master builder 0 Ocher: alien pwnp, 0 inadation or 75 RYA or JOB SITE INFORMATION AND IACATIION • D Eateraeory aynon. Torpor reparably derived ay 0 Addition anew motor load of D "A ". Ir. *1.2 ". °WM lob no.: . Job elit addt�e: q ^ mow or mom ear• ` �' 4 '�'• i�9!t seas. r, Ra maentetebole% City/State/ZIP: -11 7..2 DKestwtme tmegtke. 0 Supply veltnea for more th O Howdah Ineatiosa. 600 vette naminni. $u[odbldgfapt, no.: Project name: D Swim or Rader 600 amps or more. Cross atrcet/dlteoNonslo Job site _ FRB SCHE - New redden . stride. or m . • 1 .. • y dwell on11. Iad des attached barag Subdivision: /Vat N ► . - _ —. l no.: i,ono a co less t6s 54 Ho Tax map/pared map/pared . ) 1 ' al 47 t�'I 500 atilt er pardon 39.42 f t telltales! 75.00 DRECEVITON ON WORE (with above aa. Al Limited mtmgy, muMdhrolly U75,00 Ns, ,, • i i ti A , otlal aesida (WM above m. Rtl 75,00 *miss or 1beder2 Marano • , a - 11: a • , • re E 4.4.: • _: -,, a. • cA / -A! ( 20o mr2s ar tees ] 100.70 MO _ • 7 d . PROPERTY O W N E R ❑ T E N 2 0 1 so" t o 4 0 0 ono / . 133.S6 Nam: 6 �a 401 amps to 600 imps _ 200.34 601 mnps 1,000 amps 301.04 � Address: 5141 a •tv _ • Ovtr ono anroa of V0119 552,26 CityantatErp: G ►. o Qr 7 2 - Temporary aerobes or - -, ere , , .. Mattoon, al - , p, and /ot Fiume: ( ) Fax: ( ) 200 ' 1 •< or tees _ 54.36 201 mop to 400mry 125.08 Owner inabillation: This insbatlation is being strode on properly • = 1 own ch is not 401 on to mops 168.54 intended fbr salo, lease, rant, or according to ORS 447, 449, 670, and 701. d -new _IL tit t>r - , . Owner signature: Date: AVPUCM T 0 oo1 TACT PERSON . ;--)...9.4 Business name: vrF 40. c 5 u rr .4,�S • n. bc a arenas n . � saeYVim whetter fee. Mat 56.16 Contact natntx G b' r _ ,1 �1 Womb tdteoit Address: go too �, 1911111 wroth bond bond alrwtt 7.a2 r ,,I.„. . •' smite r lQeedc � " (eel • City/ :1: 7"' arm 11, .• • .• or .., ler 67.84 ._.., QOR-- - let 4mM:woo/viceani/arfeeder Phone: (503) 6.2.1_,. . W 9 awe,:( ) Radium only 67 e4 hoop or mimeos Otto 67.84 E•mfdl: ' ! CL► es A %Ili 14 biC r 4 1'4'1 Sign eumalariati�l+dtg 6r►t14 R )/ Signal c4eNt(9) tlntited•mtmgy Bash :: • i • ' . • i: • • ' o ' • allowable is an of , a . va Addre83; i //1 y 'MAO , , &•••• 411/, Additleaat Inspection (1 hr min) 111 66.25/ m .1 // q q (l tmre4gffntion (t Iv n� 68.25/ lac City/State/ZIP: /,� /fig G_� ` fidtnafal Paget l min 78. t 8/ hr Mtn: (6 5 6+ ' . SO -�58'" Fax: ( ) __ ,.:1:17' 1, •[ ' . !, s • 90,00/ hr CCB Lio.: OW - Eieetrical Lie.: 6 Suprv. Lie.: 3 g j'j L • • Post i , , (p Subtotal: _ 9uprv. Electrician signature, tegtllnod: f - < �r ► 4lan Ieviea►�9'Y6 of ?comb fed): Print name: 5 Imo' ll it 0 at 1 / 40 Std en harge (12% of permit tee): 01 -1 . Co Authorized signature: ;. _ a piv i PP.1iMiT PE6: /.. , AP • / : 'file permit:myr idon mtwt4 iaa secant to not el w( t Who Print neme; r r. Date: • ' - Z ' r ir e rammer ort,ayedtemr et etkwad pet permit. 11 8 aempkla 1•:MalUyfamitalC rsmiNfq.dee 4M01/W 440-4619() 1/e,/t:>7Wwaa Mechanical Permit Application ,` v VA rc)IZ r,rrlcl•: Lisl•: ONLY City of Ti and OCV 1I Received City Tigard 0 1 • 1 Permit No.: 1 1 1 5 1 , 3 ._,,,,, i y 13125 SW Hall Blvd., Tigard, OR 972 Phone: 503.639.4171 Fax: 503.598.1960 Plan Review C� i ( Date/By: Other Permit: L 1 C; n It 1) Inspection Line: 503.639.4175 c 1 G � Date Ready/By: twis 10 See Page 2 for Internet: www.tigard- or.gov ` � G � 1 v1S lp N ot i fied/Method: '` Supplemental Information C TYPE OF WOW COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: ! I Ow ..� • `[[ Air conditioning �(Q �( V ��V l CT r (requires site plan showing placement) 46.75 City /State /ZIP: 7--, 100,000 BTU ( ducts/vents) 46.75 �' Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: V /0, Z__ Heat pump 61.06 Cross street/directions to job site: Duct work 4 23.32 2,7) .52 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Flue /vent for any of above 23.32 Subdivision: Lot no.: Other: _ 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 Gas fireplace 33.39 Gana t\I\Jq d , }f.. / L ( -t tht t t rO it l Flue vent for water heater or gas J fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 ❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 23.32 Other: 23.32 Name: Environmental exhaust and ventilation Range hood/other kitchen Address: equipment 33.39 City /State /ZIP: Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: Fuel piping Contact name: � , 5 12,187,--- S14.15 for first four; S4.03 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall/suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range } CO CTOR Barbecue Business name: 1 l,�r Clothes dryer (gas) / //' � Other: Address: S ✓t`e+ &r ,-C"-- MECHANICAL PERMIT FEES* Y �/✓t- �.L,U `2 (> YI G� ' Subtotal 3-3. - City/State/ZIP: bi- 0 \ Minimum permit fee ($90.00) OW .420 Phone: ( 91) 310 cleig Fax: ( ) Plan review (25% of permit fee) CCB lic.: I 1.1 46s- / State surcharge (12 %ofpermit fee) 10. TOTAL PERMIT FEE ( U( ) - k7.) This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: So_ O /1 0 t 6 f e i r c) f I Date: I () 17; / 0 * Fee methodology set by Tri -County Building Industry Service Board I:\ BuildingWermitAMEC- PennitApp.doc \ 10/01/09 440 -4617T 1 /02/COM/WBB) 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. 1:\Building\Permits\MEC- PermitApp.doc 10/01/09 2 Building Permit Application , : .... EX. .. 'tc O'a Residential I OR ()mu.: uS[ :.ONI.Y City of Tigard �, 1 0< 2�\ Received DateB : ' if 0 1 permit No.: V) ��• ICS • 3i 13125 SW Hall Blvd., Tigard, OR 97223 5 �� C ' Phone: 503.639.4171 Fax: 503.598.1960 �•�l('j DaPla dy : at Revi : e ii�j�il 1 p Other Permit: T o . it Inspection Line: 503.639.4175 t• r 1v Date Rea : ® See Page 2 for Internet: www.tigard C '''.' Notified/Method: , y `pi R� Supplemental Information TYPE OF WORK REQUIRED DATA: I- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Et Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. jE 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ (� p6D ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 16,111 sw L/ -t r Ci-, New dwelling area: square feet City /State /ZIP: -772 9 72-23 Garage /carport area: square feet Suite/bldg. /apt. no.: // I Project name: (p(a Z Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet �,� l ,j REQUIRED DATA: COMMERCIAL -USE CHECKLIST ��( Subdivision: r 5QQ •.S Tam J 3 Lot no.: Cr cf Permit fees* are based on the value of the work performed. 2 Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: "` Si 5DD o glad equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. N a. wr 1 CI l 4.(1 0ATO Valuation: $ � k � Existing building area: square feet New building area: square feet ,PROPERTY OWNER I ❑ TENANT Number of stories: Name: Grey[ e. G L AnJ 2, Type of construction: Address: Ito ?L+ s(ti) Vf_+n -. Occupancy groups: City /State /ZIP: 'PG -2.) 6 e- '31 2-2.,3- Existing: Phone: ( ) Fax: ( ) __ New: ® APPLICANT .❑ CONTACT PERSON NOTICE Business name: (JT F Cokg V LTt ,t(■•_ All contractors and subcontractors are required to be Contact name: FF CO (L((� (- licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: / 40 (.k) F to pe4.1e.e. € 36 jurisdiction in which work is being performed. If the City /State /ZIP: Be, 04,46¢.r)Ai 0 t.._ q -20p7 applicant is exempt from licensing, the following reasons apply: Phone: (5C ))02 -2.- 2.811 Fax: : ( ) E -mail: g 0 04-r cb *Jso (+y C4544-''-- V CONTRA *OR .�� , ,, Business name: 5(�1rv( Dj.g C"" r'c c&.f ii. (deg BUILDING PERMIT FEES* Address: /gN Rnt" /C--W G r ti / , . (Please refer to fee schedule) City /State /ZIP: kitty* V /44‘ a IZ - q 7241 Structural plan review fee (or deposit): Phone: (03) 3 t 0 5 (s.__1.::, Z FLS plan review fee (if applicable): Total fees due upon application: ) C (4 ) CCB lic.: L (1 859 f Amount received: Authorizes SI . / JN 10 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Csroo PF w O•dG riT Date: 9• 19 ` I D * Fee methodology set by Tri -County Building Industry Service Board. I:\Building\Permits\BHP -RES PerrnitApp.doc 1.1/6/07 /� 440- 4613T(I l /02/COM/W ei L- S41`'1 E �*/ E7i /< ) Building Permit Application Checklist One- and Two - Family Dwelling FOR Omer: USE ONi.Y City of Tigard R eceived Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Dated t C Phone: 503.639.4171 Fax: 503.598.1960 Associated permits: : 1 . AR1) 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical Internet: www.tigard- or.gov ❑ Other: THF; FOLLOWING ITEMS ARE REQUIRED FOR I'LAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: ❑ ❑ ❑ 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 ❑ plan ❑ 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 be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. 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; percentage 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 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, 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 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member 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 beam/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 Ore : on and shall be shown to be a, r licable to the r ro'ect under review. JURISDICTIONAL.',) I CII ICS 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre- Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1:\Building\Permits\BUP- ICES- PermitApp.dot 03/21/06 440- 4613T(11 /02/COM/WEB) tr.lf « /'[:tllt� 1 (: 7.J. 717Jby rrvlrrctu �— IL eCt>I'- Permit lit , 1:()H r >i i l( r, I ` i r )NI \ r *, Ci O f' Tigard p It 11 1 11 11 N' 13129 9W HaI! elVd Tigard, Olt ' .1 Pray! No,: /1J 57J (p —C is r Phone: 503.639A171 lo 583.598.19: � ' 1 � 1.1 1 ; ,\ 1; i , lnapection 1.irt0: 503.639.4115 \. c R lurk /g ; PM* see Prole o 2 ituKajtCC tvurw,tlgmd�r.gov 3 ,. 1k/da Sapp ontat immolation TYPE OF WOW Ili ' . � — rim RViEW C I New construction ig Addition/alterationlrep ++e cat fr qu that app ( 8 sc 6 Mph= wfitenit enticed below); olitioti $ Q aerviee or folder 400 amps Or more ❑ B ow three gorier. ❑ Other; where the imitable fault emtent 0 Mining', std bentyarda• CATEGORY OF CONSTRUCTION exexcde IU,Qno mom to 150 wt1 0 Yhtnting building/4 0..1- and 2-family dwelling teas to r e r er,cccds 14,800 ❑ Carnmaobuno ngriotdtumI Y 1< >g Q CommrrciaUindnstriel [] Accessory building eemr for an etrrer e f0atnlUtttorre. balidinle0. ie ❑ Mu1t1413ntlilx_ 0 Master builder 0 Otter: CI z'ire pump. O rastallation or 75 KYA or •108 SITE INFORMATION AND LOCATION d> y ' , tam terser ceperately derived ardent ❑Addition anew mem total of CI °A ","13", "1d ", "I.B ", Job no.: Job rate add1'ese @44, ,` C' �,. loom or mare. eueulkky. © Sbt a more reeidentief units. CI (teereatioeml'chicle peek% City/State/ZIP:. f. Q� +�1 Q ' D 1ciIth -care (magic& ❑ Supply voltage PM more they J t --.ti O Hientrtfees leantiona. 600 vette nominol• Suitc/bldgiapt, no.: I Project name: ❑ Service at feeder 60o nm• • or more. — Cross street/directions to job site: r > SCHEDULE a J • I.0 1.11 New residential single- or mold- family dwelling unit, Includes nilaNtcd >tara Subdivis 14 .a4 6 3 1 Lot no.: �_ t,tMO R or less 16!{54 4 Ea. midi J Tax map/ p2rcc1 no )S,f D / 500e identlia1 73.00 t _ DESCRJPxUDN OP woRK abv rR 75. 2 ,•y Limited emerge, muhi411mfly 78 2 e $1 i s 4P..rA nesiaecmet (with Owe sq. R,! - Ism or hod : inetaM a . 6I; . a , . v. reloead.,, 200 amps or tees _ 100.70 2 11'ROk'Fdt'i'X OWNER 0 TENANT 201 maps to 400 ammo 133.56 2 I Name: fJr4e., G+q•Ai 401 maps M 800 amps 200,:;4 2 � � c 601 amps to 1,00o cum 1.1 301.04 2 Address: i w Over IMO Mu of volts 552,26 2 City/Stata/7.i.P: 6 ,,0, 7 DZ. Temporary >tPrvieot °i1Eriltstt lntttaltnuon ,alttarxtt8tt,and/or Phone: ( ) Feat: ( ) 200 ramps or teen 11111111111=11111111111111111 Owner installation: This installation is being malt: on property that t, own which is not 201 mops to 400 , 125.08 © intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 4 01 m 599 amps A 168.54 • c, • - -.1.. —new n.taratith or - • L•,. . r .,, I Owner signature; Date: A. Fee for branch oircuiha witlr II — I! APPLICANT 0 CONTACT 1 ON abeam service or Feeder fee, 7.42 1� eh circuit Business name; t � u4-105. B. i ervic • or M eh dn:aitf � 5 . setvitx or Metter fe4 first 56.18 Contact nam Gd�>F� w ��•- 1r;atlldt twit Address: W O w Flo . u MY/Stare/ZIP: — h munulbeturcd m' RMdater 0 t•;.� — Viso? Aell nAd/a .a 67.8A Phone: (5 0 3) Cj 22r '24 ` Pax : ( ) Reconnect only IM M1111� E "meth: . @ a •��"t! 1 r ¢141Mi Sign or f circle 6714 1 CON oiroda ign oin t00 0hting aroma . Sigler dtdtlt(eQ -orgy Busine9s,ttamc: ,,,l;s, ah� i on OT .: . / n? • / ' . • Each Additional In. , eetioi over allowable is an . of , above 4 Address; Additlon I �j DO �, ; �� O (/t/ - nspedimr(l hr min) / f/ ,� r/ Invsattgatloh (1 hr min) MS 251 hr - City /9tata/7.1P: �� G O! 5 hO I iinl plant 1 hr rein) 711.18/ fir 11111111111111 Ph onCe(V, ) 5 7 . ,3 CS j' Fax: ( ) ' Inspections For idr no the la :, r : -men listed A hr min III men hr �r GCB Lio.: /Jf / 'l/ 1 Electrical Lie.: 576 Suprv. Lie,: 3 gs' S ELECTRICAL iraasol' FEES ' Subtotal: Suprv, Electrician signature, required: �2 •,/ . r Plan review .3'Air of , . it — Print name; - �f E tZC� ( D ID: o' lQ � . TOTAL PERMIT PEE; Authorized signature: , • •t•6ia permit yppilentiott Wire! Ara permit to not obtomod witiOn Ilan Print name: / Date: ' ^ dm AO It Ceti hrs.!' eteeclp+ees ap eempMta • �ln� Z I monitor er ipeatioM allowed per permit 1:1 8uIMAIa0WarmitaLcAlkmitMpp,doc mine 440- 16 ISM uin /COM/Wr{n e.=� Elevator Installation Application Mail app> don with payment to: + ;A-7, - 11 DCBS Fiscal Services r � ` ) . . Department of Consumer and Business Services P.O. Box 14610 Building Codes Division • Elevator Safety Program Salem, OR 97309 - 0445 1535 Edgewater St. NW, Salem, Oregon 503 -373 -1298 • Fax: 503 -378 -4101 Web: bcd.oregon.gov Instructions; This application must be completed by an elevator contractor 1 APPLICA N $ licensed in Oregon. Print or type, filling in all areas that apply to this installation. contract valuation $ 24,000 Submit three complete sets of shop drawings for each permit request. Equipment sold in Oregon must be listed by an approved testing lab or plans shall bear a Plat fee: (7021 1/1212) $ 78 registered professional engineer's stamp. Supporting documentation may be + Permit fee: (70211/1195) $ 360 requested by BCD before approval of plans. x 12%surcharge (70211 /1291) $ 53 No installation may begin until plans are approved. All rs bject to final Total tee: $ 481 inspection by this division. Post each inatallatiph per n c r view in machine room. P U ONLY ID no Plan review by: / � ` Date approved: Assigned area: received: (� rte o.: R/P no.: Seismic zone: 0 2B ❑ 3 ❑ 4 s checked to: ASME A 1 .1 and applicable codes. SITE INFORMATION FORMATION Site name: Glans 'Now: Ken Glans -� Address: 9674 sw Ventura Ct. Address: sw Ventura Ct. City/ State/ZIP: Tigard, Or 97223 City /State/ZIP: rd, Or 97223 ❑ New structure ® Existing structure ELEVATOR CONTRACTOR INFORMATION Elevator contractor: Sam DiGregorio Phone: 503 -310 -5692 Address (street or P.O. Box): 1839 SE Parkview Circle Fax: 888-837 -8270 E - mail: dlgregorlosam@yahoo.com City: Milwaukie State: Or ZIP: 97267 Contractor's license no.: 26- 1223ECM CCB no.: 117859 Contact name: Sam DlGregorlo Licensed supervisor /installer: lem006 Supervisor's license no.: N/A Continued on next page Secure fax for credit card payments: 503- 947 -2333 Make check or money order payable to Department or Consumer & Business Services. if paying by credit card, applicant must Do not send cash. sign credit card information box. ® Visa ❑ MasterCard Q Discover Phone: 503.31D -5892 CBS Fiscal use only: 4802099814733088 3/12 Credit card number Expiration dale sum digrsgorto Name of cardholder as stem on credit card 1W,� /C - � `�` � .c-, 1 491 Cardholder si m e -_ Amount a• l d XPd « 6402659£05 011109311910 MIN £D'S0 0Z-60-0t0Z Electrical Permit Application Received FO It t I F F I C I: l i S I.: (1,N I. City of Tigard DateB : /0 1( P3 +y Illi q 13125 SW Hall Blvd., Tigard, OR 97 Q,0 Plan Review p 1. Phone: 503.639.4171 Fax: 503.598.1 6 •c 0:1:1 j ►+ Date/B Other Permit: r11 : ,nRI) P I ns ection Line: 503.639.4175 ( ‘ V cd \ t .. ' ® See Page 2 for Internet: www.tigard- or.gov \e 0 c 7 4 S`1iN' Supplemental Information TYPE OF WORK G `\ V" ` PLAN REVIEW ❑ New construction ❑ Addition/alteration/i ement Please check all that apply (submit 7 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ['Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ", Job no.: Job site address: r// , ,� _ 100HP or more. occupancy. q�, 7 ✓t/ v� �✓ll &f `. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: G, ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi - family CL•� ! e GN - � L. `� n -,✓� residential (with above sq. ft.) 75.00 2 r t�'T Services or feeders installation, alteration, and/or relocation e \37 CAD L.S-wl 200 amps or Tess 100.70 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7.42 ?....q, 6c{ 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'l branch circuit 7.42 _ 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: /State /ZIP: Each manufactured or modular 67.84 2 ty dwelling, service and/or feeder Phone: ( ) Fax:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Investigation (1 hr min) 66.25/ hr _ Industrial plant (1 hr min) 78.18/ hr Phone: (' ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (V2 hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: o Subtotal: a1, Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): t 3 ,5 TOTAL PERMIT FEE: q 3 Authorized Signature: x This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: i...- s � �` ` Date: �� 2 • Number of inspections allowed per permit. I: 1BuildingTermits\ELC- PermitApp.doc 07/01/10 440.4615T(11/05/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\ Building \Permits\ELC- PermitApp.doc 07/01/10