Permit IN
r 9
.. . . CITY OF TIGARD MASTER PERMIT
. COMMUNITY DEVELOPMENT Permit #: MST2010 -00196
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2010
TIGARD. Parcel: 1S125DA05600
Jurisdiction: TIG
Site address: 6640 SW ALFRED ST
Subdivision: Lot:
Project: SAARINEN
Project Description: New SF. Demo credits from BUP2009 -00016 applied.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 4 First: 1884 sf Basement: 0 sf Left: 5 Parking Spaces: 0
Height: 0 Bathrooms: 4 Second: 440 sf Garage: 600 sf Front: 20 Smoke
Dwelling Units: 1 Third: 0 sf Right: 5
Detectors: Yes
Total: 2324 sf Value: $257,613.80 Rear: 15
PLUMBING
Sinks: 1 Water Closets: 4 Washing Mach: 1 Laundry Trays: Rain Drain: 1 Urinals:
Lavatories: 5 Dishwashers: 1 Floor Drains: Sewer Lines: 100 SF Rain Storm Sewer: 100
Tubs /Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Drains: Catch Basins:
Bckflw Prevntr:
Footing Drain: Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures:
Drywell- Trench Drain:
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 6 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units:
Furn <100K: 1 Vents: Woodstoves: Gas Outlets: 4
Furn > =100K:
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 1 0 -200 amp: 0 -200 amp: W/ Svc or Fdr:
Ea add'I 500 sf: 4 201 -400 amp: 201 -400 amp: W/O Svc /Fdr:
Mfd Home /Feeder /Svc: 401 -600 amp: 401 -600 amp:
601 -1000 amp: 601 +amp- 1000v:
1000 +amp /volt:
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: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R -3 2324
Owner: Contractor:
LUIS, RICHARD & CANDACE HAGGART RENOVATIONS LLC Required Items and Reports (Conditions)
6640 SW ALFRED ST 15555 SW BANGY RD SUITE 120 1 Ersn Cntrl 503 - 681 - 4444
TIGARD, OR 97223 LAKE OSWEGO, OR 97035
PHONE: PHONE: 503- 654 -2030
FAX: 503- 654 -2028
Total Fees: $7,115.53
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. A • •N: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-011-0010 thro ; OAR 9 -00 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 2.1987 or 1.800.3 .2344.
Issued Permittee Signature: f 1. , _ _ 4
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.
w --V
Building Permit A , 4.ao X0-00 ) 6/
ReS dent><al FOR OFFICE USE ONLY
R eceived
CI of Tigard ) Permit No.: !- -
`J g ® Date /B lL I. / iUinf oct<
- ° 131 SW Hall Blvd., Tigard, OR 9° ��� Plan Review
Phone: 503.639.4171 Fax: 503.59: 1 • � ® Other Permit: tp_� //_
Date By: 11��
TIGARD Inspection Line: 503.639.4175 C � � Date Ready/By: turfs: See Page 2 for
Internet: www.tigard- or.gov O o C � ", Notified/Method: Supplemental Information
{�
a ` ` TYPE OF WOR t\N � ' O ` �� 1 rf " # f EQUIRED DAT A ND 2 FAMILY DWELLING
� :...�>< a....� ... t r ,..� �ti h .a. a.¢nF ,. , at-... , _.: -q+M, a,.. �.. _ R 4)!..,1,;,,,,„, .a �s� .,z x._,.,. , may .„i , �= ,_ _ .,.Ti k,.��
ew construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
?' ` w ` CATEGOR -OF CO zE , w , " ; A C y work indicated on this application.
1 -and 2-family dwelling Valuation: Z .57 �1 3,3e� '� , r, 4 n
y g ❑ Commercial /indus r 6 ' —
❑ Accessory building ❑ Multi - family Number of bedrooms: LF
❑ Master builder ❑ Other: Number of bathrooms: 3, S
' ' `' i; JOB SITE I FORM TION AN D A
LOCTION ;, ' K Total number of floors: 1 Z-
Job site address: ( /.1-0 S W ALrR S r New dwelling area: 2 3 2 Li - square feet
City /State /ZIP: 7" 1 4 e () he •=j 7 '2-2 3 Garage /carport area: Co ' o square feet
r
Suite/bldg. /apt. no.: Project name: Lu t5 Covered porch area: Opp square feet
Cross street/directions to job site: Deck area: 49- square feet
Other structure area: $- square feet
REQUIRED DATA COMMER USE CHECKLIla
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: -, 0I5 (�' O) W 5 2S Qi s-I / Ro 2 30468 Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
r, .(" DESCRIPTION OF WORK , , .: ei, k work indicated on this application.
Valuation: $
Existing building area: square feet
New building area: square feet
"g ' t PROPERTY O f i a ;
E
T ® TN ANT r � i „ Fw ., t Number of stories:
Name: C'1 -,4 Q
1) p.�jy) 66 j94CE LI, t3 Type of construction:
Addtess: l` Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) Fax: ( ) New:
. �' 1 ® APPLICANT ❑ 'CONTACT PERSON ' ' e , � .. A y , ;
s . . A ,w.. ,� , ,. : 44 :5R *.. i ,.� NOTICE + ,
Business name: .H Q6 6 1 1- Lo X1A11 0646 All contractors and subcontractors are required to be
Contact name: ,412.4. S� -E ?.H e...105 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1 c.c.s 5 SVA/ z,A PD T' apt jurisdiction in which work is being performed. If the
City/State /ZIP: LAS c J E&' 0 e. q - 2 D 3 S apply:
a
applicant is exempt from licensing, the following reasons
Phone: (50-) ) 6oS4 -, j Fax: : (S2 ) to Sq - a O a. g E -mail: MA-k- c_ 0 466 1 NoFItl✓ - J ■ COM
p CONT , '
_m _ . �'- �, �`.,. a�i �.�U :, � �a� . s bays . � r k , m . � .�, . - sl d� +'���
_. . _ _ _.
Business name: 5 `' ° BUILDING PERMIT, FEES*
n .
Address: r* a � _ - - ,: LTI (Please refer ",fo fee schedule) 4 , i_ . a ,
Structural plan review fee (or deposit):
City /State /ZIP:
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: e Total fees due upon application:
q Amount received:
Authorized signature /� This permit application expires if a permit is not obtained
/ `� / �^ �, within 180 days after it has been accepted as complete.
Print name:4 c � �GtuS Date: 10 (zz�/Z21(0 * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits\BUP -RES PermitApp.doc 10/01/09 440- 4613T(11/02/COM /WEB)
r ,-:
Electrical Permit Application � oROI rlcE ils:
. City of 1 l `� Received
T ��
• Date/By: Permit No..
13125 SW Hall Blvd., Tigard, OR 972 t 6 Q�o
Plan Rev
? -. Phone: 503.639.4171 Fax: 503.598.P 60 ((«�' � Date/By: Other Permit:
TI GARD Inspeehon Line: 503 639.4175 4k+ k hate Ready/By Tuns El See Page 2 for
Internet: www.tigard-or.gov C 1\ r 1 edlMethod Supplemental Information
. L � .. � 9
-: TY$ Q
PF;WORK t� � P 1 ` .. '_= .. . :: .1 1 ELAN REVIEW
,:New construction ❑ Addition/alteration /t '�eMenit Please check all that apply (submit 2 sets of plans w /items checked below): .>
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGOR% QF -CONSTRUCTION :. exceeds 10,000 amp at 150 volts or ❑ Floating buildings.
' ' ' " ' less to ground, or exceeds 14,000 O Commercial -use agiculturai
1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
O Emergency system. larger separately derived system.
JOB' SITE INFORA•IATIQN AND' L_ OCATION
- — O Addition of new motor load of ❑ "A ^, °'E ", "1-2", "1-3 ",
Job no.: 1 Job site address: 6 �d 4✓ @� r j or more. occupancy.
psi. x er or more residential units. 0 Recreational vehicle parks,
City/State /ZIP: (� � r e.. 7 Z Z 3 ❑Health -care facilities. O Supply voltage for more than
1 0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: L (Service or feeder 600 amps or more. .
�, _ FEE,SCIEEOULE
Cross street/directions to job site; Description 1 Fee. 1 ?mat 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
�" p 1 5 �I CI w 5, 25 64, Z51 � Ea. ic ed ne s d 33.92 1
Tax map /parcel no.
/�� 2 30 Limited energy, residential
• , DESCRIPTION OF WORK i ': (with above s ft) 75.00 2
Limited energy, multi - family I
residential (with above sq. ft) 75.00 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
-
❑ 1 O1'ERTY OWNER ❑::TENANT 201 amps to 400 amps 133.56 2
�^ 401 amps to 600 amps 200.34 2
Name: « lc 1-M. 4 � t_-o4 t )- (A. I S' 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 i =
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 1 =
•
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICAN:I above service or feeder fee, • CONVICT AER` 742 2 • each branch circuit
Business name: ti ilr (614- u�r 9 63 B. Fee for branch circuits without
` ( service or feeder fee, first 56.18 2
Contact name: 141 k), $T g S branch circuit
Each add'l branch circuit 7.42 2
Address: 15s S (3/34_6a./ 20 S r r 01 Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State/ZIP: Lae MW Go toe. q - 3 dwelling, service and/or feeder 67.84 2
Phone: F ax:: 3 Reconnect only 6 7 .84 2
( rye , )��y -2o ( S �)�s�( -Boa �
Pump or irrigation circle 67.84 2
E mai! lMAY-- . e 14./,66; /s pork ° / Co 44
Sign or outline lighting 67.84 2
t . CONTRACTOR 1 , , Signal circuit(s) or limited- energy
Business name: p v.-, e g �+ ir - -
t panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: ea Dap ,JE 8 5+ Additional inspection (I hr min) 66.25/ hr
r �I
Investigation (1 hr min) 66.25/ hr
City / State/ZIP: lki,,,, u ve -- 1,04 7866.S
Industrial plant (I hr min) 78.18/ hr
Phone: (3 60 ) S73 — Z75-0 Fax: (3100 ) 6 7 — 7' 12 Inspections for which no fee is 90.00 / hr
7,e_)/ 7
specifically listed (%r hr min)
CCB Lic.: J f �9
8 Electrical Lic • 3 4G 2 � uprv, Lie.: 3 � 7 — �. _ � EI;ECTRICAE��)ii14fIT;_FEES
Subtotal
•
Supr Electrician signature, required r 'f Plan review (25% of permit fee): •
Print name: t 1 / ,0l6,,,,r.1 11 Date: 042//0 /0 Statc surcharge (12% of permit fee):
� v/ / �, / __ ! TOTAL PERMIT I FEE:
Authorized signature: �/ /'J/ This permit application expires if a permit is not obtained within 180
•
Print name: � � j( Date: • days after it bas been accepted as complete.
� �' Number of inspections allowed per permit,
1:4 Building \PernitsXFS.C- PetmitApp.dec 07 /01/10 440- 4615T(It /05/COMiWE3
Mechanical Permit Application ® FOR OFFICE USE ONLY
CI Of Tigard Received
lig City g , � Date/By: Permit No.:
° 13125 SW Hall Blvd., Tigard, OR 97223' {
o
Phone: 503.639.4171 Fax: 503.598.19.o
2Q 1 Plan Review Other Permit:
L
TIGARD Inspection Line: 503 O( ' � DatDate/By: Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard - or.gov ��++ 1G A Q D Notified/Method: Supplemental Information
OV 1N 1
d, I TYPE -OF WORK � ti �NG! ' ,1I1S, .r COMIVIERCIALtFEE* Sthitii LE uSEiCHEChLIST x
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.
g"" t ''' ti' CATEGORY OF r CON S TRUCTION °s a aiaF �`t r Value $
- .. . v �.... e» � , s t - n, - � � z � x .!re ^� rcx, ,� r ...
�. . � . ke d. REsm ENTIAL EQUIPMEIV"I / SYSTEMS FEES* �`'
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty.
Ea. Total
' rk - JOBgSITE INFORMATION " A N D _LO_ CATION. I „44 ,i t 5 1 Heating/cooling
Air conditioning
Job site address:
G(0140 W AL NCB SI` t (requires site plan showing placement) 46.75
City /State /ZIP: T-(.6.-44,0 (04( q -7 Z2 Furnace 100,000 BTU (ducts /vents) 46.75 3
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: L ` Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
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.:-1-7 O S Q W 5:25 ( ZsV Z 3O -"o j Other fuel appliances
r DE SCRIPTION OF WORK ''%'-''',-,.:-7 1 i ' ' Water heater ✓ 23.32
Gas fireplace 1 33.39
Flue vent for water heater or gas
fireplace V 23.32
Lou lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
l ' ''',0"'''"T,'', (k ROPERTY' OWN i z ` ' ®TENANT ° �"` Chimney /liner /flue /vent 23.32
y
.�t ..e, x F:. . i. � . <. ` ; i a_ � Other: 23.32
Name: IZ 1 c44.4 es) d !� A ,010, � L Environmental exhaust and ventilation
l Range hood /other kitchen
Address: equipment 33.39
City /State /ZIP: Clothes dryer exhaust V 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
"= r APPLICANTS Y i ® CONTACT PERSONF Attic /crawlspace fans 23.32
B usiness name: Other: 23.32
N �E� /� L u x LLtR � ( t7 /t { E Fuel piping
Contact name: V 4 /),..0._V__ /),..0._V__ S'(- cI- S $14.15 for first four; 54.03 for each additional
1 Furnace, etc.
S�S � � ��k��Y �� ST
Address: ' Gas heat pump _
City /State /ZIP: dxv_.' 05W Gao 1 tk_ Ci w 3 Wall /suspended/unit heater
Phone: (`7 c c“ .- p 3 d Fax:: (5'p; ) /5 , Z p z 8 Water heater
Fireplace
E -mail: .,/L(t 4,.... 'l --1, t✓a`1'C-( bd.t-C j i C42)1. Range
7 t - P
' .w 1 I. . CONTRACTOR ,` € li , i Barbecue
Business name: ?� tJ Q t u b D ` , U� Clothes dryer (gas)
l Other
Address: 5(41 S. 'tI 0 0 AA- Uil ' r k - 1VIECHAN�ICAG PERMIT FEES e� " t i :1
City /State /ZIP: ,/�. 5 - J 2 2 2 Subtotal
u- 1/V AUl�l �' 1 Minimum permit fee ($90.00)
Phone: (r 9) -- ' q -z., Fax: ( col") -- 7 g4, - 3 4 3 Z Plan review (25% of permit fee)
CCB lic.: q Cf 3 • 2._ State surcharge (12% of permit fee)
/ i TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: .fie' days after it has been accepted as complete.
Print name: IkApdg, fril' j - t2 Date: 0 / Z 21/0 * Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc 10/01/09 440 -46I7T (11/02 /COM/WEB)
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard - :' • Received Permit No.:
UP Date/By:
13125 SW Hall Blvd., Tigard, O'44 . Plan Review
P hone: 50 3.639.4171 Fax: 50 1 -�.: L9, i {.01 Other Permit No.:
Date/By:
TI`GARD Inspection Line 503 639 417 t Date Ready/By: Juris: El See Page 2 for
Internet: www tigard or gov G ® Notified/Method: Supplemental Information
b ix ... s ' x t 'a t E O 7, �,?.�ii
1 , A Notified/Method:
" F 'S : : : - 4 . . rer4 .- ,.,�1 . .
„ ; *;u* -' at- r`
!; u a :tgt P "z a�� ii, E . T YPE O „ WORK Q ` ' , �` � ` 5` .,-... . ty , 'Ant I ,.x FEE SCHEDLJLEa .#+0, . m..��, ka ;
F:New construction El D I i iv) �� For special information use checklist
Description Qty. Ea. Total
❑ Addition /alteration/replacement ❑ (gti er: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
1. " CATEGORYxOF'�CONSTR UCTION x ) 4 I ` "may SFR (I) bath 312.70
ja1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath ( 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen / 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATIONe'AND LOCATION' t'9 iii `, Site utilities:
Job site address: f/ s iii c:o Catch basin or area drain 18.76
Drywell, leach line, or trench drain I 18.76
r
City /State /ZIP: ( 614.12_0 )�_ G i -- 7 2Z 3 -
t Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: LA)) 5 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector I 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 I 31.27
_ 7" (�I S IZ' O 1 W 5 ZS (� t �S 1 � D 230
e :' µ # ,~ DE SC R I PT, ION OF W {
ORK 1 P ota� i A "rf Backwater valve 12.51
r - '� Clothes washer 1 25.02
Dishwasher I 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
Fit PROPERTY OWNER ' n «It TENANT _ Expansion tank 12.51
�" ' ` Fixture /sewer cap 25.02
Name: RICU6,4w 4- X17DA,c,E Li,lts
Floor drain floor sink/hub 25.02
Address: Garbage disposal I 25.02
City /State /Z1P: Hose bib '/ 25.02
Phone: ( ) Fax: ( ) Ice maker ( 12.51
T . 4 4 APPLICANT ? tiel m CONTACT PERSON Interceptor /grease trap 25.02
�L .. .P - -_� §�-�c . u,[i+S. . a s!��`..X . . tY �§,k. M:.M. . ,. t, l ,.
Business name: a 4 /v - � 14.,04.4m.5 Medical gas (value: $ ) Page 2
, �{ ^ , ,, t '�✓' Primer 12.51
Contact name:
1 v �'"'�� - 5 Roof drain (commercial) 12.51
Address: ' S`s'S' S' l ' 3A- & " J 9,0 S i c,c;1ti 20I Sink/basin/lavatory 25.02
City /State /ZIP: "r IEt A-v ) r! 1)L - 7 3 . 7 0 S' Solar units (potable water) 62.54
Phone: ( ab) (, 9-( - 30 Fax:: ( c�2 z ),(5 -( 2-62 i Tub /shower /shower pan 12.51
E V IC uA C x.66. }}n X6-5 , CO /1...\____, Urinal 25.02
ie e - , ° it .71', &1'.ex ..i 4 ., rt: d ry, Water closet 25.02
: CO IV T RA CTOR4 � 1- x ,,r n � ' + .
„_ , ,,._ ; �,w s s;;�i , ��m .� u w ..a�.� ..a � , • � .E :e VA �'� �,'�(�,rS«�.# . Water heater ( 37.52
Business name: e- W t I - pl_t t , yyt (2 1 06. Water piping/DWV 56.29
Address: i c, i 0 SG ) 14 6-►-g 4-0 Other: 25.02
City /State /ZIP: ‘, '/ J V Ail_ 61 0 ((L C j ' 70 $,6 Subtotal
Phone: (7)3) "111 I - . (� . 1 Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: 1 0 ? Z /41!/ J Plumbing Lic. no.: 765' 32 f7 Plan review (25% of permit fee)
�� State surcharge (12% of permit fee)
Authorized signature: / P' 4' 7 /t /it TOTAL PERMIT FEE
Print name: U,,V1 ,� ^ �►1 Date: 10 2. � L r 0 This permit application expires if a permit is not obtained within 180 days
� / I after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building\ Permits\PLMU-PermitApp.doc 10/01/09 440- 4616T(10 /02 /COM/WEB)
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
a RESIDENTIAL „WORKryQNLY T $'„
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
Garage Door Opener*
19- Heating, Ventilation and Air Conditioning System*
'Vacuum Systems*
B Other: * 4 ) 6 + -uV
COMMERCIAL WORK ONLY' .:' P
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
RECEIVE t
Pi_ T2 62010
CITY OF TIGARD
•
3 5 r& Ta 01P � BUILDING DIVISION
. 4 ue
t _, y
LS a -e s
., - a , o `.4 `.
t ice: �"". - ..�� r. t
4 if
. . 0 i "
en *
3 s
w t
1 6 .
` !6`.0 r "'': e a
PXtS'ftf f
M' 4
t
• r -r
i.�l : . 14t w 4 - • . . .. • f.. • I A ......- 0
. . •
. .- • - • ... - , .....„,,,, - , . ,......„. .
. ,
• . _ _ •
. . ' . ... .... ..
r___,
,....,...r.„ t.,1 s.se.
Gee rti C,A/ 1 l ST+i C *Ale--
mote t .ate N M+f'veit_ I TV, 4d pir 'gee,
0
CITY OF TIGARD - SITE PLAN REVIEW /4,, BUILDING PER NO.: .�_
PLANNING DIVISION: roved ❑ Not Approved
Required Setbacks: Approved
Side: �C Street Side: .._1_
Front.
.—.7z---z. Garage: -�- 2. Rear: 1,..t—
Visual Clearance: ,s Approved ❑ Not Approved
Maximum Building Height 2.L. feet
(WS Service Provider etter Required: 0. Yes n o
/ ❑ Received
1 ti, , Date: i!. ,
ENGINEope: _DEPARTMENT: Approved ❑ Not Approved
Site Pl lope: �.-. Approved ❑ of A proved
Site P • n:
B : v Date: b z /
Notes:
tTfY Of TIGARD - SITE rtAm gram V G W
BUI piNG PERMITNOL_ enSTh
Street Trees: � pp 'ed 0 Not Approved
Protected Trees L+3 Appr'oved ❑ Not Approved
By: ( d R„ Date: /y00/6
10,0�e h ee.1 Tri reroH„1 j q///r, f ,,,,,,,l /
6
Z.., -,n s,,, i7 h"^�fi
II J l 5ahh F-i- 4
K. r,