Permit q CITY OF TIGARD- MASTER PERMIT
PERMIT #: MST2008 -00057
COMMUNITY DEVELOPMENT DATE ISSUED: 5/13/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135CD-04700
SITE ADDRESS: 11865 SW 95TH AVE ZONING: R -4.5
SUBDIVISION: BOETCHERS ADDITION LOT: 008 JURISDICTION: TIG
PROJECT: GOOD
Project Description: Construction of 522 sq ft storage shed.
BUILDING
REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: 15 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: 522 sf FRONT: 20 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD: sf RIGHT: 5
VALUE:
OCCUPANCY GRP: U1 BDRM: BATH: TOTAL: 0 sf 19,491.48 REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 174 TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUBISHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 1 0 - 200 amp: WISVC OR FDR: 3 PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amplvolt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable
JAMES & JULIA GOOD OWNER laws. All work will be done in accordance with approved plans. This
11865 SW 95TH AVE permit will expire if work is not started within 180 days of issuance, or
TIGARD, OR 97223 if the work is suspended for more than 180 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 952 - 001 -0080. You may obtain copies of these rules or direct
Phone: 503 - 560 - 3868 Contact #: questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Reg #:
TOTAL FEES: $ 764.40
REQUIRED ITEMS AND REPORTS
/
Issu d By : , �1►��/ , Permittee Signature : - r ��
Call 503.639.4175 by 7:00 a.m. for an inspection that b mess day.
This permit card shall be kept in a conspicuous place on the job si - until completion of the project.
Approved plans are required on the job site at the tim - of each inspection.
Building PelilitK tion 30 6 ; 95.17:?"---- .
,,
Residential :
FOR OFFICE USE ONLY
III City of Tigard Received
: ..--A2r0 a Permit No.: Ar / / 4S
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
I Phone: 503.639.4171 Fax: 503.598.1960 Date/By: . S , J,2 .2 t ag Other Permit:
T I c; A R r) Inspection Line: 503.639 D ate Ready/By: „�/ _ � t 0 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: fO v0 Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- 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) 11
❑ Addition/alteration/replacement Other: 5rl k 1 ✓ equipment, materials, labor, overhead, and the pro the n
CATEGORY OF /Other:
work indicated on this application. (`7 c/9 / U
❑ 1- and 2- family dwelling 0 Commercial/industrial 4 Valuation: $
W
'Accessory building ❑ Multi - family Number of bedrooms: .�`
❑ Master builder ❑ Other: Number of bathrooms:
...
JOB SITE INFORMATION LOCATION Total number of floors:
Job site address: t 1)4 f ' J New dwelling area: square feet n�
City /State /ZIP: 1 I A W I 0 r& 9r '2 �j Garage /carport area: square feet `+
Suite/bldg. /apt. no.: ` Project name: �( Covered porch area: square feet
Cross street/directions to job site: Deck area: 5 Z square feet
-A Other structure area: " . square feet 'I
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.
5dd 66 5Ta2 Cp t , 1 Valuation:
OO Existing buildin; area: squar eet
New building area. •uare feet
X PROPERTY OWNER ❑ TENANT Number of stories:
Name: J � C� Type of construction:
Address: 11 ii „, j 1 G ✓ Occupancy grout
City /State /ZIP: C & 2 2 3 Exis • • _• :
3 C ' �
Phone: Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: jurisdiction in which work is being performed. If the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:: ( )
E -mail:
CONTRACTOR
Business name: /41, ,�/ BUILDING PERMIT FEES*
Address:
l ^"' (Please refer to fee schedule)
City/State /ZIP: Structural plan review fee (or deposit): /6 7. 3V'
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: Total fees due upon application:
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: ) / 7 j Date: * Fee methodology set by Tri -County Building Industry
Service Board.
I:\Building\Permits\BUP -RES PermitApp.doc 11/ 440- 4613T(I1 /02 /COM/WEB)
Building Permit Application Checklist ,
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
74 • 1 3125 SW Hall Blvd., Tigard, OR 97223 Assoc
O Phone: 503.639.4171 Fax: 503.598.1960 Assoc permits:
24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical
T IGARD
Internet: www.tigard- or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN 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 ❑ CI
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 °Icatch- ❑ ❑ ❑
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 Oregon and shall be shown to be applicable to the . ro'ect under review.
JURISDICTIONAL SPECIFIC'S
23 Five (5) 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 accompanied by 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.
C\ Building \Permits\BUP- RES- PermitApp.doc 03/21/06 440 3T(II /02/COM/WEB)
Plumbing Permit Application
Building Fixtures �D E FOR OFFICE USE ONLY
City of Tigard
Bli GICI
D ate By: / Permit No A - 5 7
III 13125 SW Hall Blvd., Tigard, OR 97223 0
Date/By: )*T
II Phone: 503.639.4171 Fax: 503.598.1960 '1 6 2 Plan Review Other Permit No.:
Date/By:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: m ,� 0 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: /!(ter " Supplemental Information
TYPE OF WQRK FEE* SCHEDULE
0 New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
Accessor building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder 0 Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCA ON Site utilities
Job site address: i I e6,5 51,j c. 5 = Catch basin or area drain 16.60
City /State /ZIP: t� 0 2 Z Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2 17y
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
5P-1) f .rp/_ r'o iG ,(.f f Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: < f
V __,[ Expansion tank 16.60
Address: I 1 �p 5 ("3 1 ! :- -Q� Fixture /sewer cap 16.60
City /State /ZIP: J tr 2 Floor drain/floor sink/hub 16.60 %
Phone: (5 js3) 56b. 3 g g Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
A , � J Ice maker 16.60
Business name: !,.5 6 cop Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax:: ( ) Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: J .�5 Ua� a Water heater 16.60
Address: 1,9 � k) 4 ✓ "\ r Other:
City /State /ZIP: J1 4 . 4 I '1 2 . f �j Subtotal
�� Minimum permit fee: $72.50
Phone:50� ! fr el 8 Fax: x ) Residential backflow minimum permit fee: $36.25
CCB Lic.: r Li . o.: Plan review (25% of permit fee)
Authorized sign State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Print name: Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits\PLMF- PermitApp.doc 12 /27/06 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard ,
Page 2 - Supplemental Information •
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' / 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
- 4"
Car Wash Drain
Garbage -Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PernutApp.doc 12/27/06
' r
Electrical Permit Application . . IV FOR OFFICE USE ONLY
City of Tigard Received /,.. p /��
0
` g p H I DateBy: 5 / 6 6 Permit No.: ii O`l/� - DGS
b 7
13125 SW Hall B Ti gar d , OR 97223 0 Plan Review
' g Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
T I GA R D Inspection Line: 503.639.4175 Date Ready/By: Suns 0 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / ' Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/altergggtio replacement Please check all that apply (submit 2 sets of plans w /items checked below):
/ ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: fit 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 ", "1 -2 ", "1 -3 ",
Job no.: Job site a ress: ' ) N5 W i "--- 100HP or more. occupancy.
//�� 7 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: / � �& / 22 ❑ Health a dour facilities.
❑ Supply voltage for more than
_< VVV ` ( ✓ ✓✓ ❑Hazrdous locati 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
Qty. � Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
5 a-$ �( � /? a e, t t residential (with above sq. ft.)
'7� Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: J ��1 401 amps to 600 amps 160.60 2
1\ W 9 �y.Q Over amps to amps amps 240.60 2
Address: 1 •: - Over 1,000 amps or volts 454.65 2
City/State/ZIP: �f , I� Temporary services or feeders installation, alteration, and/or
ty �1 f�'�/ relocation
Phone: 90 3) h r 1 O �`}' sf s �all 6 0 Fax: ( 200 amps or less 66.85 1
Owner installation: This ins ' eing mat .. . operty that I own which is not
201 amps to 400 amps 100.30 2
intended for sale, lease, rent, 6 -- ge, acco •'f. . ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
i % Branch circuits — new, alteration, or extension, per panel
r
Owner signature: ` Date: A. Fee for branch circuits with
P • 'PLICANT I ❑ CONTACT PERSON above service or feeder fee, 3
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: I hywe F (� r energy panel, alteration, or
Address: ' 1 (p `) 5 W - extension. Describe: Page 2 2
City /State /ZIP' r 9 7 9,2 9- � Each additional inspection over allowable in any of the above
Phone:)) 5dr) `�/ g Fax: ( ) P Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date:
Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
1. \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 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*
El 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 03/23/06
5
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BUILDING DIVISION PERMIT | ~�~~"~~~°""°~� ~�"°"~°^~""~ � &XsT2008
| 13125 SW Hall Blvd., Tigar . OR 97223 DATE ISSUED: 6/131200B
Phone: (503) 639-4171
Inspection Requests �4Hm.):�@3)830-4175 _to n� ��
INSPECTION WORKSHEET FOR DATE: T|K4E� PAGE:
� 1C�51/2UU0 � ��OUAm � 7
SITE ADDRESS: 11865 CLASS � �����5TH�VE �
SUBDIVISION: LOT TYPEOFUSE�
� BOETCHERSADD|T|{�N #: 008 �
PROJECT NAME: � GOQQ
DESCRIPTION: � Coiistruction of 522 sq ft storage shed.
OWNER: PHONE � GOOD, JAMES &JUUA #: 503_560.3868 CONTRACTOR� PHONE #:
CONTRACTOR: OWNER �
Inspection Request Scheduled For: Date: 10131/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
239 Final inspection 077488-01 603-660-6838 N
Corrections/Comments/Instructions:
.
4� PASS APPROVAL ���ANCEL ��NC�ACCESS
r - �� ��
' | | FAIL CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Date: / Phone #: (503) 718- Zq__X
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CITY OF TIGARD
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PERMIT #: MST2008-00067
13125 SW Hall Blvd., Tigard, OR 97223
BUILDING DIVISION DATE ISSUED: 5/13/2008
Phone: (503) 639-4171 hi PlitAlei
Inspection Requests (24 Hrs.): (503) 639-4175 AJAI'' 11.
.,.
INSPECTION WORKSHEET FOR DATE 10/29/2008 TIME • 7:00AM PAGE: 14
SITE ADDRESS 11865 sw 96TH AVE CLASS OF WORK:
SUBDIVISION: BOE1CHERS ADDITION LOT #: we TYPE OF USE:
PROJECT NAME: GOOD
DESCRIPTION: -
Construction of 622 sq ft storage shed.
OWNER: GOOD, JAMES & JULIA PHONE #: 603-560-3868
CONTRACTOR: PHONE #:
OININIER
Inspection Request Scheduled For: Date 10/2912008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 077323-01 503-660-3868 N
Corrections/Comments/Instructions:
OM 1111 PARTIAL APPROVAL n CANCEL 0 NO ACCESS
I I FAIL i CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
■111111111 ' L
Inspector: Date: /t9 " ° Phone #: (503) 718- •
CITY OF TIGARD .
BUILDING OF TIGAR • #: MST2008-00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/13/2008
Phone: (503) 639 -4171 ' � „,ii ! ” ;I
Inspection Requests (24 Hrs.): (503) 639- 4175'I_�..
INSPECTION WORKSHEET FOR DATE: 10/2012008 TIME: 7:00AM PAGE 11
SITE ADDRESS: 11865 SW 95TH AVE CLASS OF WORK:
SUBDIVISION: BOETCHERS ADDITION 000
#: 008 TYPE OF USE:
PROJECT NAME:
GOOD
DESCRIPTION: Construction of 522 sq ft storage shed.
OWNER: PHONE #:
CONTRACTOR: GOOD JAMES & JULIA PHONE #: X03 - 560 3068
OWNER
Inspection Request Scheduled For: Date:
10/201 2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 076911 -01 503 - 560 -3868 N
Corrections /Comments /Instructions:
•
(PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
V .� , ``� 3
Inspector: - n or Date: /� Phone #: (503) 718-
4 ,,
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MST2008.00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5113/2001
Phone: (503) 639 -4171 - a 0 � , '�' t �hl "'BP i
Inspection Requests (24 Hrs.): (503) 639 -4175 �!�!+-
INSPECTION WORKSHEET FOR DATE: .10130/2008 TIME: 7 :00AM PAGE: 12
SITE ADDRESS: 118V SW 95TH AVE CLASS OF WORK:
SUBDIVISION: BOETCHERS ADDITION LOT #: 008 TYPE OF USE:
PROJECT NAME: GOOD
DESCRIPTION: Construction of 522 sq ft storage shed.
OWNER: GOOD, JAMES & JULIA PHONE #: 5035GP -3668
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/30/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 077402 -01 503- 560.386B N
Corrections/Comments/Instructions:
PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL rA CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
I'
Inspector: , - - ' _ ./ Date: 1V /SO bR Phone #: (503) 718- (v
■
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CITY OF TIGARD
BUILDING DIVISION :. PERMIT #: M T 0Q8 000`i7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/13/2008
Phone: (503) 639 -4171 444#41# •'-.a
Inspection Requests (24 Hrs.): (503) 639 -4175 VIII
INSPECTION WORKSHEET FOR DATE: `,. , TIME: PAGE:
10120/2008 1 7:00AM 10
SITE ADDRESS:
SUBDIVISION: CLASS OF WORK:
11865 SW 95TH AVE
BOETCHERS ADDITION LOT #: 00 0 TYPE OF USE:
PROJECT NAME: GOOD 'Ili
DESCRIPTION: Construction of 522 sq ft storage shed. t , , , .
OWNER: GOOD, .JAMES & JULIA -F PHONE #: 503 6
CONTRACTOR: OWNER Vi PHONE #:
Inspection Request Scheduled For: Date: 10/2012008 , Pour T
Code # Inspection Description Confirm # Contact # Message
335 Rain drain 076912• -01 603- 560.3868 • ''.= N
Corrections /Comments /Instructions:
r (,� -
�u � .r�,ltnJf .S �ti, � 1. ��''J �....1ac� �T A.� �,�.+v��- G "r -",
gr PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 01 k 6 Vr2. Date: I D I2o I aV Phone #: (503) 718-
•
CITY OF TIGARD .
BUILDING DIVISION A 1 PERMIT #:
MS1°2000-00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
5/13/2008
Phone: (503) 639-4171 Azahoot lit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/20/2008 TIME: 7:00AM PAGE:
12
SITE ADDRESS: 11965 SW 95TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
BOE1 CHERS ADDITION 008
PROJECT NAME: (.300D
DESCRIPTION: Construction of 522 sq ft storage shed.
OWNER: PHONE # 503,560
GOOD, JAMES & JULIA
CONTRACTOR: PHONE #:
OWNER
Inspection Request Scheduled For: Date: 10/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
215 Footing drain 076910-01 503-560-3868 N
Corrections/Comments/Instructions:
.1. • .441 4.1 te0 C t 4 1`...- 3,,,9,11...i,
l i_o.,1..k4.A....n.... ,- liosk■-e- e--e-ev Co kiLic..c4-1■. o (2 ,,,,,,. a ,c,,--.4c.....„
laLet-
e „.„.., 6 v - A - i v I; 1-- FO .44\ DVAS\-• • NAT CO 0.-.4./e (-14 To Elf_A r-Or1 t.-
n PASS XI PARTIAL APPROVAL fl CANCEL ' 0 NO ACCESS
n FAIL n CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: 11N1--4.--A \)‘,...; 1,—.. Date: to 2-- 1 (s Phone #: (503) 718-
___ _
CITY OF TIGARD • .
BUILDING DIVISION
PERMIT #: MST2008-00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/13/2008
Phone: (503) 639-4171 ..,goilivoi t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/22/2008 TIME: 7:00AM PAGE: 5
SITE ADDRESS: .11866 ..-pv 95TH AVE CLASS OF WORK:
SUBDIVISION BOE ADDITION LOT #: 008 TYPE OF USE:
PROJECT NAME: GooD
DESCRIPTION: , ..
L,onsuustion of 522 sq ft storage shed.
OWNER: GOOD, JAMES & JULIA PHONE #: 5,03-560-3868
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/22/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 077050-01 503-5603868 N
Corrections/Comments/Instructions:
No + : 0 k "To Cov-eA
i rp - Ass 0 PARTIAL APPROVAL 0 CANCEL NO ACCESS
I I FAIL El CALL FOR INSPECTION H ADDITIONAL FEES ASSESSED
Inspector: 73---S Date: 0 Phone #: (503) 718- .22
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2008 -00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/13/2(00
Phone: (503) 639 -4171 u.agN�i�,61'
Inspection Requests (24 Hrs.): (503) 639 -4175 :�' .....
INSPECTION WORKSHEET FOR DATE: 9/16/2008 TIME: 7:01AM PAGE: 6
SITE ADDRESS: 11865 SW 95TH AVE CLASS OF WORK:
SUBDIVISION: BOETCHERS ADDITION LOT #: 008 TYPE OF USE:
PROJECT NAME: GOOD
DESCRIPTION: Construction of 522 sq ft storage shed.
OWNER: GOOD, JAMES & JULIA PHONE #: 503- 560 -3868
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # ' Message
235 Shear walls/anchors 075518 -01 503 -560 -3869 N
24-o gj-7-' 4.1
Corrections /Comments /Instructions:
PASS _ PARTIAL APPROVAL ❑ CANCEL _ NO ACCESS
n FAIL n ALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 7r Date: 9 — /(o --a g Phone #: (503) 718- ..
__ _ . _ _ , . •
CITY OF TIGARD .
BUILDING DIVISION - PERMIT #: MST2008-00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/13/2008
Phone: (503) 639-4171 "aPitti lit
Inspection Requests (24 Hrs.): (503) 639-4175 ,_..._41r _.....
INSPECTION WORKSHEET FOR DATE: 9/15/2008 TIME: 7: ODAIV1 PAGE: 6 '
SITE ADDRESS: 11865 SW 95TH AVE CLASS OF WORK:
SUBDIVISION: 60ETCHERS ADDITION LOT #: 008 TYPE OF USE:
PROJECT NAME: GOOD
DESCRIPTION: Construction of 522 sq ft storage shed. .
OWNER: GOOD, JAMES & JULIA PHONE #: 603-560-38613
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/15/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
235 Shear walls/anchors 075468-01 503-660-3868 N
Corrections/Comments/Instructions:
•
PARTIAL APPROVAL fl CANCEL n NO ACCESS
FAIL 0 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: A Date: F— /1= 4"'S Phone #: (503) 718-
CITY OF TIGARD . -
BUILDING DIVISION PERMIT #: MST200B -00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/13/2008
Phone: (503) 639 -4171 ' ��U t Inspection Requests (24 Hrs.): (503) 639 -4175 .J °`'IL
INSPECTION WORKSHEET FOR DATE: 9/15/2008 TIME: 7:00AM PAGE: 4
SITE ADDRESS: 11865 SW 95TH AVE CLASS OF WORK:
SUBDIVISION: BOETCHERS ADDITION LOT #: 008 TYPE OF USE:
PROJECT NAME: GOOD
DESCRIPTION: Construction of 522 sq ft storage shed.
OWNER: GOOD, JAMES & JULIA PHONE #: 503-560-3868
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/15/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
250 Roof nailing 075470 -01 503- 550.3858 N
Corrections/Comments/Instructions:
•
P ❑ PARTIAL APPROVAL ❑ CANCEL • I NO ACCESS
FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: !S -Gg Phone #: (503) 718 -4-g5--
.
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: It4ST 0 -0( 057
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 5/13/2008
Phone: (503) 639 -4171 r A 4p��o�l
Inspection Requests (24 Hrs.): (503) 639 -4175 ..:' �f I..
INSPECTION WORKSHEET FOR DATE: 9/16/2008 TIME: 7:00AM PAGE: 5
SITE ADDRESS: 11865 SW 95TH AVE CLASS OF WORK:
SUBDIVISION: SOETCHERS ADDITION LOT #: 008 TYPE OF USE:
PROJECT NAME: GOOD
DESCRIPTION: Construction of 522 sq ft storage shed.
OWNER: GOOD, JAMES & JULIA PHONE #: 503 - 560 -3868
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
240 Exterior sheathing 075469.01 603 -660 -3868 N
Corrections/Comments/Instructions: .�L / /� /
l C ; )e.4.-i/oL" .4 -4L-t- * ,..4k-C/‹.., -J ,A41 C £ t 24
❑ PASS n PARTIAL APPROVAL n CANCEL I I NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: F-13 a Phone #: (503) 718 -K4-
CITY OF TIGARD • ,.
BUILDING DIVISION PERMIT #: MST200E- 00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5,
Phone: (503) 639 -4171 i�
Inspection Requests (24 Hrs.): (503) 639 -4175 L . L�
INSPECTION WORKSHEET FOR DATE: 0//212008 TIME: 7:00AM PAGE: 31
SITE ADDRESS: 11865 SW 95TH AVE CLASS OF WORK:
SUBDIVISION: BOETCHERS ADDITION LOT #: 008 TYPE OF USE: ,
PROJECT NAME: GOOD
DESCRIPTION: Construction of 522 sq ft storage shed.
OWNER: GOOD, JAMES & JULIA PHONE #: 503 -560 -3868
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 0112/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
235 Shear walls/anchors 075308 -01 503- 660 -3866 N
Corrections /Comments/ Instructions:
eh , ,--,-2 .4A6 ,-- 45 • z447 ‘24-4//1- ..9"' .1 it-, , d - , ,i6-2-k
5s,
❑ PASS PARTIAL APPROVAL 7 CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /L - 4 '"g Phone #: (503) 718 - "?..
CITY OF TIGARD
BUILDING DIVISION PERMIT #: M ST2008 -00057
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/13/2008
Phone: (503) 639 -4171 ibu i � ,i,,,
I Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/25/2008 TIME: 7:00AM PAGE: 23
SITE ADDRESS: 11865 SW 85TH AVE CLASS OF WORK:
SUBDIVISION: ROETCHER S ADDITION LOT #: 008 TYPE OF USE:
PROJECT NAME: GOOD
DESCRIPTION: Construction of 522.sq ft storage shed.
OWNER: GOOD, JAMES & JULIA PHONE #: 503 -560. 38613
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/25/2008 Pour Time: 2:00
Code # Inspection Description Confirm # Contact # Message
220 Slake 071818"01 503 - 560.3868 N
Corrections/Comments/Instructions:
46 CJFE - - moo ( -i1 &
,, L__ I Svc .� Lt.— 4 Ari // '/ ..— r i - ' -- ci/,cl_. i r L...f
PASS fl PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
❑ FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: lam-- 25 Phone #: (503) 718 - 9-9-N---/
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^~`� = ,~ PERMIT �°~°,~~~~, ,°,~°,~°,° NISl 200;:7':-Ot1057
13125 SW Hall Blvd., Tigar , OR 97223 DATE ISSUED: 6w1Snui
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 8304175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: � 1w3i/2000 � ��(X)��| � 7
SITE ADDRESS: 11865 SyV9617HAVE CLASS OF WORK:
SUBDIVISION: BOCrCHE]lS ADD|l<ON LOT #: OOR TYPE OF USE:
PROJECT NAME: � 800o
DESCRIPTION: Cnom|o/c1ioUmf storage shed.
OWNER: GOOD, JAMES &JULIA PHONE #: WI. 660i38C8
CONTRACTOR: WyVqFp PHONE #:
Inspection Request Scheduled For: Date: 1mj/2O8@ Pour Time:
Code # Inspection Description Confirm # Contact # Message
�99 Final i noper1 ion 077408'01 9U3- 660-6D311 N
Corrections/Comments/Instructions:
�
-
�� PAS; H NO ACCESS
|C�NCEL | )
- ^� ' '
| |FA|L CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
' ���/ /`��
Inspector: Oa�e� /��y ��, / c/�� Phone #: K503\ 718- ________YXZZ.,