Permit MASER PMIT
CITY OF TIGARD
11 �� DEVELOPMENT SERVICES DATE ISSUED: 1/31/2006
�' i 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S104DC -04600
SITE ADDRESS: 13529 SW CLEARVIEW PL ZONING: R -4.5
SUBDIVISION: BENCHVIEW ESTATES LOT: 046 JURISDICTION: TIG
Project Description: Adding 2nd story to garage for playroom. Mech is for duct work & re- routing furnace & water
heater flue pipe.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 320 sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THRD: sf RIGHT:
VALUE: 30,000.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 320 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 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: W0ODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION'
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W /OSVC/FDR: 1 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 2 SIGNAUPANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
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 # SYSTEMS:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes
RYAN GRAY DANIEL L FORNEY CONSTRUCTION I and all other applicable laws. All work will be done in
13529 SW CLEARVIEW PL PO BOX 118 accordance with approved plans. This permit will expire
TIGARD, OR 97223 SHERWOOD, OR 97140 if work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules
Phone: 503- 332 -0790 Contact #: FAX 503- 625 -3727 adopted by the Oregon Utility Notification Center. Those
PRI 503- 625 -4975 rules are set forth in OAR 952 - 001 -0010 through
952 - 001 -0080. You may obtain copies of these rules or
Reg #: LIC 79093 direct questions to OUNC by calling 503 - 246 -6699 or
TOTAL FEES: $ 698.24 1 -800- 332 -2344.
REQUIRED ITEMS AND REPORTS
1
Issued By : , , i ,, Permittee Signature : � I' A A.... -
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
Building Permit A • • ` • FOR OFFICE USE ONLY
City of Tigard
3 1 2006 Received ,� _ P ermit No..
_
13125 SW Hall Blvd., Tigard, OR 97223 I .1N,a AR, - °''
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 .g ; /i' "xr' '14r a ` 'at+ I '
y ` Date/B . Other Permit:
Inspection Line: 503.639.4175 Ct OF 'flu I , Date Ready/By: ® See Attached Checklist for
Internet: www.ci.tigard.or.us Notified/Method: 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) of all
chi Addition /alteration replacement 0 equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 0100
❑ 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: (. 5 e W G (j l_ \(l ( L New dwelling area: square feet 3
City /State /ZIP: T.( v o il_ e\"7 z-r-5 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: (. Covered porch area: square feet
Cross street /directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED,DATA:`COMMERCIAL - USE CHECKLIST -
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
e e `TTI G J_ r Yf o — r w , ( 6" 6 -1--=' Valuation: $
1
er eu l V ' Existing building area: square feet
New building area: square feet
. ,PROPERTY. OWNER ❑ TENANT Number of stories:
Name: R .f'esi....3 A2t Type of construction:
Address: 1 -5 52_9 e7 j c _,Le {ZV l-iJ PL.. Occupancy groups:
City /State /ZIP: Tic, Ol . 97 Z_Z3 Existing:
Phone:( - ) Fax:( ) New:
APPLICANT CONTACT PERSON NOTICE
Business name: O (� J L L. R) C(\ All contractors and subcontractors are required to be
Contact name: j��N licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: pa ( ))e ti c6, jurisdiction in which work is being performed. If the
City /State /ZIP: `5iT? On.. 971 Lk ' applicant is exempt from licensing, the following reasons
y apply:
Phone: ( � —5J 'l` f 57j �y Fax: : (5c 6Z J -72.7
E-mail: C.0 r-71:: bZ.� _ (. '"t -7 5 '
CONTRACTOR
Business name: DJaN l a__ L : 1,.) CuKi %
BUILDING PERMIT 'FEES* •
Address: RD 0 I ( c:,
Please refer to fee schedule.
City /State /ZIP: b6-1-6 k),.. ofc 17( Lt.0
(�v�) ` ( (4 -52_ t �) � - - 5 , 7 17 Fees due upon application
Phone: t Fax: (
CCB lic.: 79 ('� Amount received
Date received:
Authorized signature: j j
� This permit application expires if a permit is not obtained (IT--)3,./1\ r(/ } within 180 days after it has been accepted as complete.
1fh1
Print name: ' L fcsfz/.�" �/' Date: ( -�1 --CSC * Fee methodology set by Tri- County Building Industry
Service Board.
i:\Buitding\Penn its\BUP- PermitApp.doc 17J03 440 -4613T(11 /02/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist FOR OFFICE USE ONLY
City of Tigard Received
Date/By Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 //thr ,il ❑Electrical ❑ Plumbin g ❑Mechanical
24- Hour Inspection Line: 503.639.4175
Internet: www.ci.tigard.or.us ❑ 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 a s s royal re s uired. 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.
1 1 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 applicable to the •ro'ect under review.
JURISDICTIONAL SPECIFICS •
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 tree protection measures as required by conditions 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.
I:\Bui (di ng \Perm its \BUP- RES- PermitApp.doc 2
Jan 30 06 06:50p ,•r .,Thomas 503- 537 -3021 p.1
JAN 30, 2b06 20':47 DANI' • a 3 •' (p�j�, 036253727 Page 1
Mechanical Permit Application
• , 0'11: 001 I II r a s ( c��
City of Tigard JAN 31 tta axtca
Permit No.: 2 I i s D arr✓nY '
13125 5W Hall Blvd,. Ti8ard, OR 07223 Ilan Review
Phone: 50,1 "639,4171 raw: 501.598.19 /kher l■amfe •
Inspection Line: 501.64R 4175
,� �� ,i . J_ ; }ilellly �� . ' . came ere :arynty I huh: et yte Poet for ■
Interned; .....6. •i},•"MJ.ur.ufi (fig Na pprem°
illed/Mohin.l. -- Sunt.l In rents• inn
'TYPE (SF WORK COMMERCIAL FEE* SCHEDULE - USE. CHECKLIST
1 Ncw s CulxlruGiun AAdition/allcrationJreplarxnag Mechanical jlcrmil YcCS' rro Ireaed can the vulne or the work
perturmed. Indicate the value (rounded iu the nearest dollar) of all
❑ 1)eutt'llitiun ❑ Other: tntthnniurl ntrlerials, uyuipmenl. labor. ovenccad,andprotit.
CATEGORY OF CONSTRUCTION Value:T
❑ : - and 2- farllil dw�;lin Commurcit {1 /induArial RESIDENTIAL EQUIPMENT! SYSTEMS FEES*
g 0 ❑ Acccsaory bui lding
❑ Multi ❑ Master' builder ❑ 0 hut•:
For special u((nrelarinn use rxlrj /iu,
D.`serionoa Qty Ka" Total
JOB SITE INFORMATION AND LOCATION IfeatlaritoolinE
nt ails address: (� p
I. c J — t y \r IF y, Air wndi{iunin8 or amt Pump
: - 1 cJ v�C Y 1 I'� �� (mglliltS fill[ ELI Owning th4000004I1 I 4.00 _
City /St ir:Mt I': I t"� c 7 7 .I - Pomace 100 U'l'll (d(a,1.emz) 14.00
v �r Fumaa 100.0011+ 11'111 »uveuts) 17,90
Su;leMldgiupt_no.: Project Name: Gas Ii tit Intp 14041 _
Cr(+ a¢at{'cct /dir:el ions la sit c: � _ fluct work 14.00
I lydrunichul water system 14.04
- . - Residential hailer (radiator car
• tydronle) _ I4,00
_ - - — . _ - _ , Unit hulas (Rlcl•Iype. nut electric), sp
in•wull. in -duct, suended .
etc. } 10.00 -
i Fluclvcnl fu n y r of ahnvc ! j - 10.00
Suhdivisinn; i Lot no...
-- ( Other ,._ ,. - I 10.00
Tan nup /parcut nn : f` . Other fuel appliaoccs
RESCRIPTION OF WORK t Wirer heater i 10.00
....., O G'T t A) c, e 10110 4...43 fireplace 10.00
...._ " �./� n �Q f'� �� , HuI. Veit{ lilt %HIV tit.114r t r gas
f;rvptace 10 00 I
_ .* . . r N t. 1- V t, g Et 404:c f ee— ( � Log lighter (rigs) 10.00
' —.f•_ • . LVQ p(p. . __. . "- I Wood/pelleratnvc — ....... ....._ 10.00
Wand tireplac'inscrl 10.00 -
• ❑ PROPERTY OWNER i - -- Chinhluy.linedtladvcnl 1 n.00
Q TENANL tether: In,nn
Martz k evi ran mcutat ui and vtnlflalion
/Vldre.s: { 5'7 �,� (7 V I e"- PL Range hood/other kiluhm - 1 1
v � 4 , ' 1 �. v utoirrnmt 10.00
City /Stale/ZIPC • . •TIC CY(1 ? _ Clotho dryer eahausl 10.00
Salglcduel cxhat(A lhulhrnums,
1'hatc: ( ) Fax ) ( ((Oa cumpnrtments, utility lo oms) 6.80 0
_ ? APPLICANT ❑ CONTACT PERSON Alticicrawlspacc rant 10.00
Be USin55 ttmnc: T IRO V d1 S l - A. P (t4. �`& ,. C ether. - _ L u.00 I I
• a L �1 �t _I'mI 1 in
uv 1.
( :onset name G A T� R\4 rn •_ _ .
I t IC S5,4U for first rrt four fr,en
, 51.00 udr d
aditinna
i
,Wdresls: P D Q v t . ) Fumace, etc.
f - :ity/Stale/41Y: AJ&zA) J`•,(, O 1L. q-7/3 . -^ Gan beat pump
w„„„„„,,,,,,..,, h
nil ealer
Phone: ( a i C C l 333 _. fax:: (50 Water heater
f :mail: Range
CONTRACTOR Rarhdcu r _
Tfusino s name: �.. Clulhas dryer (gu;l
• -- ale.CIIANICAL PERMIT FEES*
City;5Wlt17.IP: SA/NOM
i - Minimum permit let (172.50)
Plume.: I I I Pux: • -- ••
""' _° .,. flan review (25% of petit it fee)
/�
A
D Y
CCH tic.: 1 3ffAd C.e?Zip / ,/, _ S{ate surehar cOB.' .. R 4 °
�� O(puniit feel
'I((01 AI- PERMIT FEE _
Aulhurltul <it;lluturi (AMw 1/4(��� i /} lkb yarmir •Frikmi n ran-4ra if a INrmit it not Ob014.4.1(A1 wilhia OR?
� ,- dot tl0vr;1 h.a Iran accepu7r as (MOM.
Print (tame: ��a' .�q' _ p 1 [ _ ` 7 1_ V� � �� I Date: / / ' ,re a«•Jov4,lury set by Tn- CounOY BuiIJnf hata.o-y Scro ee Hoard
.'.14:I.■ea1rerminµtle.Ywm vApp Jr.:. ISM( 4.04017'(04 l 4020'cJhoWElll
•
•
JAN 30,2006 20:57 503 537 3021 Page 1
'D . . .. _ . .
Electrical Permit AlitatO FOR OFFICE USE ONLY ' - - - '' ' , '
City of Tigard Received
Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223
Date/By
SAN 3 1 2 006 Plan n Review
Phone: 503.639.4171 Fax: 503.598.19 49/n,ro%i�" � �� Date/By: Other Permit:
Inspection Line: 503.639.4175
'�V ',Ail; c! . Date Ready/By: Iuris: ® See Page 2 for
Internet: www.ci.tigard.or.us Cirri Or o �.' Notified/Method: Supplemental Information
, .;': , t :'" = ;*r'.� - :r,.,°.- `x`.ow, -
, T,.' t ; E O ., ,, . r . r - ,1, , a . x ANe: REVIEW' '
�ai,ax. '`i';*,:,',.',,r,'"' .:,,;''::0'&,:, 1T : � ., @a6n ».�zw :� •�:. ,� ' " .�- >. w»,� >,..s.�: „' °Fs� -�t�:� ?a,S �.:�: .� �� = ,�.- ,.•'' , w, . Y . .. - ,..
❑ New construction III►: Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: EService over 225 amps, comm'l ❑Hazardous location
;.,r. _ . „ :: ,..,r,;<,- s:.. -: �4.. . ,__, .. :.,t= .3. - , R,;, m::. .r r : . , _ :. ,.,, „., , EService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
t , . , 4 f , %„ CA O - _F O NMIl i eT ION `A w- , 5 ie of 1- and 2- family dwellings 4 or more new residential
y - and 2- family dwelling ❑ Commercial/industrial ❑ A ccessory building ['System over 600 volts nominal units in one structure
0 Multi - family 11 Master builder ❑Other: EBuilding over three stories ❑Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑Manufactured structures or
k ; + JQBSO RM TIQAD'ZOGATION ;11 . y ['Egress/lighting plan RV park
❑Health -care facility ❑Other:
Job no.: Job site address:
135z..9 5v eLv l PL Submit 2 sets of plans with any of the above.
City /State /ZIP: 'fl (, q--722... The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: , Project �,. I r °ra; ±;°' x` n < >FEE'° SCHEDUI E N, . ' '. -':, .. . * { •
Pro ect name: � �' i
Description Qty. Fee. Total
Cross street/directions to job site: New residential single - or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
� g s Limited energy, non-residential 75.00 2
T, ,,, i-.. , ec.. tiESCRIPTIQN0 Q „.4..i.:,,44,,,,,,,-,,,,4•:•;410:‘,04•44,:,:t4 ' A ,� �.
- -. Al Each manufactured or modular
dwelling, service and /or feeder 90.90 2
h et:” 1 rdl L l e_ r 3 C i t CC.t .T a Fir Services or feeders installation, alteration, and/or relocation
r'+ . (ice Gt 1 �'r '�� 200 amps or less 80.30 • 2
” i P QP RTY x,OWNERM`o t ' . E" e `-rT'E1�ANL - t o 201 amps to 400 amps 106.85 2
w . K A. _. e� 49. �.. i , . „- . , . : - a,z,..I w., e_ - 401 amps to 600 amps 160.60 2
Name: vp 61-6\--\( 601 amps to 1,000 amps 240.60 2
Address: ,'75 5 S IPI C.(_,. 12 vie,...) FL Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: TYG , op 22.33 Temporary services or feeders installation, alteration, and /or
/ relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
''.1'. r:,-, LI CANT .. e ): L .," i'° s >` = "r` :` gg < ; ". -- r:- -h. � rti ;>'- " r cMQ a A. Fee for branch circuits with
; : =�rY;° P P E Nl ,a : �::,. %TAC 1a ON,
T service or feeder fee, each 6.65 2
Business name: x4(
EL L., �IL� eo" 1 branch circuit
�� B. Fee for branch circuits
U , "
Contact name: i- �N without service or feeder fee, / '�
Address: \ v 1 x (l each branch circuit • 46.55 • y 3 2
Each add'l branch circuit 2_ 6.65 ( 3c) 2
City /State /ZIP: t ri - ezW s olt C l' -] t 1 40 Miscellaneous (service or feeder not included)
Phone: (5 65) '2,( l4. � t Fax: : (56 L - 3 47 Pump or irrigation circle 53.40 2
r /' Sign or outline lighting 53.40 2
E -mail: O F 5--( 'C ') - .5 - L4 ct ' Signal circuit(s) or limited-
Entreggy , u �..@ , CONTRACTOR R c a =" w z energy panel, alteration, or
z. >�.. -, A A :.:.__ ...�,. extension. Describe: Page 2 2
Business name: et- i C._ 2n �
Each additional inspection over allowable in any of the above
Address:
l�v i ce . 2:2., t r .5-1 Per inspection 62.50
City /State /ZIP: ' . t 91 (OA 9 7 Z_( i --1 I s-4 Investigation per hour (1 hr nun) 62.50
J Industrial plant per hour 73.75
Phone: ( %3 (a 2 -- / 9 Fax: (50 I // 9 68
r ;, _ 9 i -tio LECo:`FRICAL_ _ RER 1'IIT I ;- , `' i
CCB Lie..,ZI el o 7 4 Electrical Lic - 142eJuprv. Lie.: qo 28 Subtotal 601 i 5
Suprv. Electrician signature, required: � G �2!� J _ / Plan review (25% of permit fee)
�/� J Date: State surcharge (8% of permit fee) 4 + 53 l
Print name:
/ �'`-' e �e � /._30 / -� TA" . TOTAL PERMIT FEE & 1 9 4
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: ; Fee methodology set by Tri- County Building Industry Service Board
CS Number of inspections per permit allowed.
i:\ Building \Pernvts\ELC- PermitApp.doc 12/03 440- 4615T(10/02 /COM/WEB
Electrical Permit Application - City of Tigard .
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
-:RESIDE „NTIA�L'ORK 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:
1.1701 M =ERC:Wrird O nllagaatl:igM
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
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 \Pemtits\ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MS 2006.00030
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3'I/2006
Phone: (503) 639 -4171 0
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4124/2006 TIME: 7 :0 AM PAGE: 6.3
SITE ADDRESS: 13529 SW CLEAR VI EW Pt. CLASS OF WORK:
SUBDIVISION: 13ENCHVIEVV ESTATES LOT #: 046 TYPE OF USE:
PROJECT NAME: GRAY
DESCRIPTION: Adding 2nd story to pr:lgt: foc playroom. Mech for duct wort, & re- routing furnace & water he^tcr
Hue pipe.
OWNER: ;RAY, RYAN PHONE #: 503 - 332 -0790
CONTRACTOR: DANIEL L FORNEY CONSTRUCTION CO PHONE #: 503 -E625 -4975
Inspection Request Scheduled For: Date: 4/24/2006 Pour Time: —
Code # Inspection Description Confirm # Contact # ess e'
299 Final int3pection 028541 -02 .�if1:3-332 -0780 f
��
Corrections /Comments /Instructions:
PASS I I PARTIAL APPROVAL n CANCEL NO ACCESS
FAIL I I CALL FOR INSPECTION I I ADDITIO AL FE • ASSESSED
Inspector: //0 r 1 Date: YLY■: Phone #: (503) 718- 3
r C
CITY OF TIGARD J
BUILDING DIVISION PERMIT #: MST200G 00030
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1131/'200
Phone: (503) 639- 4171 �iiw � �� I r l
Inspection Requests (24 Hrs.): (503) 639 -4175 = , W °`__..
INSPECTION WORKSHEET FOR DATE: 4/14/2006 TIME: 7:07AM PAGE: 06
SITE ADDRESS: 13529 SW CLE.ARVIE_W PL. CLASS OF WORK:
SUBDIVISION: E3ENCHVIEW ESTATES LOT #: 046 TYPE OF USE:
PROJECT NAME: GRAY
DESCRIPTION: Adding 2nd story to garage for playroom. Mech is for duct wort. & re-routing furnace & vvatcr hestar
flue pipe.
. OWNER: GRAY, RYAN PHONE #: 503 332 - 0790
CONTRACTOR: DANIEL L FORNEY CONSTRUCTION CO PHONE #: 503 - 6254975
Inspection Request Scheduled For: Date: 4/14/2006 Pour Time:
. - Inspection Description Confirm # Contact # Message
Electrical final Q29QU:? tl1 (:03314 a ?61 Y
Cor -: •. ments /Instructions:
ALL ) ;Al VIZ
•
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑' NO ACCESS
I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GIN 0 6g Date: L if t Lil I Phone #: (503) 718- 2_2.14_
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST 200 -00030
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/31/2005
Phone: (503) 639 -4171 /gn -eim iiie "�
Inspection Requests (24 Hrs.): (503) 639 -4175 ''I �..
INSPECTION WORKSHEET FOR DATE: 4/24/2(105 TIME: 7:02AM PAGE: ira
SITE ADDRESS: 13523 SW CLEARVIEW PL CLASS OF WORK:
SUBDIVISION: BENCHVIEW ESTATES LOT #: 046 TYPE OF USE:
PROJECT NAME: GRAY '
DESCRIPTION: Adding 2nd story to garage, for playroom. Mech is for duct. work & re- routing furnace & wafor iiea�t :
flue pipe.
OWNER: GRAY, RYAN PHONE #: ;03 332 - ()790
CONTRACTOR: DANIEL L FORNEY CONSTRUCTION CO PHONE #: 503-625-4975
Inspection Request Scheduled For: Date: 4/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
099 Mechanical final 028541 -01 503- 332- 079t) Y
Corrections /Comments /Instructions:
11.111MOM
Iry
•
ASS n PARTIAL APPROVAL fl CANCEL ❑ NO ACCESS
I I FAIL .111 CA. L FOR INSPECTION ADDITION L FEE: ASSESSED
- A
Inspector: Date: v Phone #: (503) 718 -�
CITY OF TIGARD 4 iv ® m sue
BUILDING DIVISION 0 in PERMIT #: s O 30
13125 SW Hall Blvd., Tigard, OR 97223 („ V DATE ISSUED:
Phone: (503) 639 -4171 �j liLl iz �N Ay
Inspection Requests (24 Hrs.): (503) 639 -4175 , J/
INSPECTION WORKSHEET FOR DATE: TIME: X17 7 PAGE:
SITE ADDRESS: / 35 PC- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3- 6 - 0 (o Pour Time: A. , m ,
Code # Inspection Description Confirm # Contact # Message
6 l: 2 - F° 3 / L-f - s c
=lc/N
/
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:
vu,
Date: 3 1 °Q l' Phone #: (503) 718 - -1./q
CITY OF TIGAR — ,l `� IT] 5 •
r
BUILDING DIVISIO MIT PER #: a C�- 00030
13125 SW Hall Blvd., Tigard, OR 97223 r % � �-� ((,),! DATE ISSUED: '
Phone: (503) 639 -4171 �" /.41, „�� .)-'
Inspection Requests (24 Hrs.): (503) 639 -4175. � . /•° _•
INSPECTION WORKSHEET FOR DATE: TIME: l / PAGE:
r
SITE ADDRESS: / 3 50, 9 / / ' A- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: •
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time: ; 4/ i 1 )
Code # Inspection Description Confirm # Contact # Message
A-s _ 3/ — tea Cr
Corrections/Comments/Instructions:
N ' 0..
it b 2' -V :ice r e l[ /b A— 6Q .
t / A - V • ��C V
c1 A A, ,
, \
` l-t✓ CS9kA--Q LAp - L Z,... ,
6 ,
otiv, k qos(,..1/4._...,_........
t , ._.
.,,
.,,i-N5 -1--i) 1-(._c__.(4.e_cyc' tt.,‘_-(_s7-
Ok, -- t- p. 1 5 'ALA_ -- 1--2 , .n a
PASS PARTIAL APPROVAL CANCEL Li NO ACCESS
❑ FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: ;/� Date: VIVO �P Phone #: (503) 718 - / I
CITY OF TIGARD ,n ST
BUILDING DIVISION PERMIT #: 2006 — 62o v 30
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 '�I i �l _
• Inspection Requests (24 Hrs.): (503) 639 -4175 J �
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: l 3 s -- , 7 6.6 FL CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3- D ` k Pour Time: , /21
- - • - # Inspection Description Confirm # Contact # Message
C/.c.<'- b6 3 / '/ - s0-(j
b5 . e ' : omments /Instructions: • .
ea, 6a- — /J
1%\61S ° {i Clst` ALA- Ni VA C.Ae) lam' i N E (J) M i C
s 4(),,c., ,
IN N y 0 F Laos PA 1
13-- u "EZ I
•
.r
y
r,• 1 ,
• r
/
PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
AIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: GiSka.5 N L6 Date: b 6 Phone #: (503) 718-