Permit 10
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00209
111 DEVELOPMENT SERVICES DATE ISSUED: 6/27/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102CA 00400
SITE ADDRESS: 09750 SW FREWING ST ZONING:
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT: 018 JURISDICTION: TIG
Project Description: Remodel, frame for header & install french door.
BUILDING
REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT:
VALUE: 1,800.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR:
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: 1 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: 0 - 200 amp: W /SVC OR FOR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/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 HWSVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIE W S ECTION
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: DATAITELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
This permit is subject to the regulations contained in the
Owner: Contractor: Tigard Munidpal Code, State of OR. Specialty Codes
EGGERT, VIRGINIA A REVOCABLE SAGNOTTI INTERIORS and all other applicable laws. All work will be done in
LIVING TRUST 4800 SE HULL accordance with approved plans. This permit will expire
9750 SW FREWING MI LWAUKIE, OR 97267 if work is not started within 180 days of issuance, or if the
TIGARD, OR 97223 work is suspended for more than 180 days.
ATTENTION: Oregon law requires you to follow rules
Phone: Phone: 503 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
Reg #: LIC 8840 direct questions to OUNC by calling 503 -246 -6699 or
TOTAL FEES: $ 251.40 1 - 800 - 332 - 2344.
REQUIRED ITEMS AND REPORTS
I
-
Issued By : j ,_ / 7 Permittee Signature
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.
Pt
Building Permit Ana atio - ONLY
FOR OFFICE USE ONL
City of Tigard � ® R eceived �, Permit No.. " - G in
13125 SW Hall Blvd., Tigard, OR 97223 p A{�'' Plan Review
�'� "�✓/.� l V 1 2474 ,2
Phone: 503.639.4171 Fax: 503.598.196��ty '� 2005 fit" *, ; ;a' l ` Date/B . Other Permit:
Inspection Line: 503.639.4175 a�.l •_ Date Ready/By: ® See Attached Checklist for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information
BUU nING nlInsinN
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
❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $
•
❑ 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 Fv. isl.J ) I n f New dwelling area: square feet
City /State /ZIP: �) C t 0 v r (r 2 2.3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: l /) , q 1 4 I T 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
I DESCRIPTION OF WORK work indicated on this application.
Re A 1 O o b O C r 3 t G1 `/ 2.0. ®�1 oCA (Pmt a Valuation: $ t ) 70 Q
..J C f ( 1 1 t L. �/1 � (h g-o V t"4 C &ci ! y cA \A Gt Existing building area: / square feet
1 z=v e,v C D vow S (2 " t -ec( 4V my U A ov.,Q. New building area: square feet
❑ PROPERTY OWNER ❑ TENANT • Number of stories:
Name: (A k .e_ 1 cQ 4_ Type of construction:
)
Address: G ' [0 sLi � \/4w ikul■r� Occupancy groups:
City/State/ZIP: `7 , 0 v , 0 11 271, / 6z,/ / 7 Existing:
Phone: ( .3) 4 / —, 0 AO (S3) g' Ri — 14 3 p? / New:
. 0 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: SA CI i Att I F 1 f) V < All contractors and subcontractors are required to be
Contact name: �n N , licensed with the Oregon Construction Contractors Board
' (e1\! a e S ! bit[ under ORS 701 and may be required to be licensed in the
Address: 1 -t O 5 € irk Uk 1 jurisdiction in which work is being performed. If the
City /State /ZIP: ‘1,, t ` Q t - 2. applicant is exempt from licensing, the following reasons
t ® S 3 cA-ni apply:
Phone: (Jd 3) (� S 3 - 0 7 6 � F ax:: ( Q )
E -mail:
, CONTRACTOR '
Business name: BUILDING PERMIT FEES*
Address: Please refer to fee schedule.
City /State /ZIP:
Fees due upon application
Phone: ( ) Fax: ( )
CCB lic.: e e. 4/0 AA A �� 3 SS Amount received
� � VD ✓ Date received:
Authorized signature: This permit application expires if a permit is not obtained
�f/f within 180 days after it has been accepted as complete.
Print name: �� !/ / Date: /2_7/4 s * Fee methodology set by Tri- County Building Industry ......C. Service Board.
i:\ Building \Pennits\BUP- PermitApp.doc 12/03 4404613T(11 /02/COM/WEB)
One- and Two - Family Dwelling
Building Permit Application Checklist , FOR OFFICE USE ONLY
• City g of Tigard
' �� Received
Date/By. Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 �� " ' iv Associated permits:
Phone: 503.639.4171 Fax: 503.598.1960 ' 1'���Vµlli ❑ Electrical ❑Plumbing ❑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
l 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' ' royal re I 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.
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 applicable to the .ro'ect under review.
.IURISDIC"I'IONAL 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. ❑ ❑ ❑
3.0 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:\ Building \Permits\BUP- RES- PermitApp.doc 2
• "Building.Fiitures
Plumbing Permit Application FOR OFFICE USE ONLY
•
City of Tigard R eceived Permit No.: % / Q?J e r0 0
13125 SW Hall Blvd., Tigard, OR 97223 Cj * Date/By:
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �0 //V fii, c Other Permit No.:
24- Hour Inspection Line: 503.639.4175 .• 1 Date/
By.
Ready/By: Y md5
®
JUN See Page 2 for
Internet: www.ci.tigard.or.us U� 9 __ 2 / Notified/Method: Supplemental Information
' y
TYPE OF, WORK FEE* SCHEDULE •
t _
` -.i l r iN rlr Ar For special in ormat use checklist'.
❑ New construction ❑ emt
BUM, -'l`' ^j,;iSinhi Description Qty. Ea. 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
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: GI -7 S v S W PV CL.) 1%.1k G Catch basin or area drain 16.60
City /State /ZIP: (L 6V r (A' `) 1. 1 J Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt, no.: I Project name: , 1 ; ,e 'el 1 a � ""' Footing drain (no. linear ft.: ) Page 2
, � t
Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft. "r Page 2' 5
Storm sewer (no. linear ft.: ) Page 2
Subdivision: l Lot no.: Water service (no. linear ft.: -- Page 2 ...S
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF' WORK Back flow preventer Page 2
T .A \\. °2, - 44p,S e' t �\j i Backwater valve 16.60
p ' L I M 40v 2.44 ` 06 \, `.� A 4 L , t p� Clothes washer 16.60
8 Q ( \ V 1 4 4 \ C , C _ i 1� Dishwasher 16.60
' ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
�,_., p Ejectors/sump 16.60
Name: LA. 1 145 p G V
•
, Q. Expansion tank 16.60
Address: `�1 10 SW t F V e4J \ ■G Fixture /sewer cap 16.60
City /State /ZIP: - 7, t t C\ `1 1 2. 3 .5 9 3 Floor drain /floor sink /hub 16.60
Phone: (S 681 '7 p 2 G r ( C.h/ t '1 6 3 9 7 Garbage disposal 16.60
❑ APPLICANT t ❑ CONTACT PERSON Hose bib 16.60
. + Ice maker 16.60
Business name: C Ci.�v dik + I 1kk eV 1 0\re S
Interceptor /grease trap 16.60
Contact name: t Medical gas value: $ ) Page 2
Address: a c< O d S U I` Primer 16.60
City /State /ZIP: Y V ` I O v °I-v-2.67 �'' ° Roof drain (commercial) 16.60
• Phone: ( 503) 6 S 3 1 C> °' 0 i : ( c-41I) So q- , 7 s 3 0 Sink/basin/lavatory % 16.60
� � � Tub /shower /shower pan // 16.60
E -mail: I y 1 ¢, 4S' 8 f zit Urinal 16.60
' CONTRACTOR • • Water closet / 16.60
Business name: ' i1 I, (< ‹, ttP `1 3 0 (Al/In t y Water heater 16.60
Address: (' S a % S A k � . 1 1 Vv .e. Other:
• CC') Subtotal 9 iv
City /State /ZIP: «\ C A. OV d LI S
Minimum permit fee: $72.50
Phone: (S 67) , 1 2 ' ? 3 7s_/ Fax: ( ) Residential backflow minimum permit fee: $36.25 7.25r)
CCB Lic.: 2I 7 Alt, Plumbing Lic. no.:?- 3 5 ci pd Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5; <d')
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.
*Fee methodology set by Tri -County Building Industry Service Board.
is \Building\ Permits\ PLMF- PermitApp.doc 06/05 440-4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site: Utilities = • .Qtr7 Fee To • 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: PermitFee:
$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
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 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. Complex Structures
Are you capping, moving or replacing existing fixtures? If A "complex structure" is defined as an installation of a plumbing
"yes ", please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fiztui a Type: Replace ❑ Any new exterior plumbing site utilities.
New Moved Existing Capped ❑ A commercial building with installation, alteration or addition
• Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 - multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
-4 "
Car Wash Drain Isometric or RiiserDiagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Pertnits\PLMF- PennitApp.doc 06/05
Electric,al.Permit Application . FOR OFFICE USE ONLY
City of Tigard 1 ' Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 ° Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /*' 4!; i!t !I ' Date/B . Other Permit:
• Inspection Line: 503.639.4175 JUN 2 7 IX en- Date Ready/By: ions: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE o VolitCTIGA D • PLAN REVIEW
❑ New construction ❑ Additi ii'tin/r'ap7ae's(r�i,8 t Please check all that apply:
❑ Demolition Other: ['Service over 225 amps, comin'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
. CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ['Building over three stories ❑ Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
1
Job no.: Job site address: Ct 1 So S W FV l■AGt ❑He 2 -care facility ❑
• /', Submia t t abo ve.
2 sets of plans with any of the abovv
e.
City /State/ZIP: ` CI t j a `°t °' . 2 .• J The above are not applicable to temporary construction service.
CI G \e- FEE* SCHEDULE
Suite/bldg./apt. no.: • Project name: , ]� t ..t Q Description I Qty. I Fee. I Total
Cross street/directions.to job site: V j 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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
.DESCRIPTION OF WORK Each manufactured or modular
V. ` t_
dwelling, ervice and/or feeder 90.90 2
C v �'�A 1 s 2 i\- 1 l ei4°` Service or feeders installation, alteration, and /or relocation
LA e-V d - ' coy P (u ei 4- a (.., t Cod - \ i r e 200 amps or less 80.30 2
❑ PROPERTY OWNER - ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: J& `t e .1 Ci. \ 601 amps to 1,000 amps 240.60 2
Address: C Co S LI 'Env eta t ,. 64 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: \ o y , , C t 7 Z 3 co 3 Temporary services or feeders installation, alteration, and /or
Phone: ( $63) 4 ist/ - `7 ® 1 6 c4rwtt (C.4 V Ti g -4 39 ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that town 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
❑, A PPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: „,..clIA to E 4 . =\r• c5\14e branch circuit
B. Fee for branch circuits
Contact name: h 6 *" S 4- lA t1 I without service or feeder fee, 46.85 2
Address: i i gb 0 c I 144 ti
each branch branch i t y • Each add'I branch circuit 6.65 2
City/ State/ZIP: ,1 (D4 , G "� 22.6 '7 S6 B Miscellaneous (service or feeder not included)
• Phone: (( 63) d S.? - 69 o' \ etw: e .5641 - 7. 3 It Pump or irrigation circle 53.40 2
(� Sign or outline lighting 53.40 2
E ��)e ..0 hi e # a/ e 4* Signal circuit(s) or limited -
CONTRACTOR. . energy panel, alteration, or
- p
Business name: ∎ 14 A 11 01 �,� tl / `eC� Ci` J V 1 !° extension. Describe: Page 2 2
• Address: 2'-683 3 y 1 b fo k Each additional inspection over allowable in any of the above
N Per inspection 62.50
City /State/ZIP: (Q tv 00' V/ A, e 6 0� t 9 7 ‘ v Investigation per hour (1 hr min) 62.50
(5®3) ien - 16, Gi S o Li g z ' 9 d / Industrial plant per hour 73.75
Phone: !. Fax: ( ) - 7 Q ELECTRICAL PERMIT FEES*
CCB Lie.: $ 7 ply r Electrical Lie.: Suprv. Lie.: 3 3 7 ra C Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
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
•' Number of inspections per permit allowed.
i:\ Building \Permits\ELC -Penn itApp.doc 12/03 440- 4615T(10/02/COM/WEB
r _
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:
I COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 91 8- 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 \Permits \ELC- PermitApp.doc 04/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MIKE PATTERSON PLUMBING
15028 S MITCHELL LANE
OREGON CITY, OR 97045
Plumbing Signature Form
Permit #: MST2005 -00209
Date Issued: 6/27/2005
Parcel: 2S102CA -00400
Site Address: 09750 SW FREWING ST
Subdivision: FREWINGS ORCHARD TRACTS
Block: Lot: 018
Jurisdiction: TIG
Zoning:
Remarks: Remodel, frame for header & install french door.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for
the plumbing permit to be valid, please have the appropriate individual from your company sign below and
return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building
Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
EGGERT, VIRGINIA A REVOCABLE MIKE PATTERSON PLUMBING
LIVING TRUST 15028 S MITCHELL LANE
9750 SW FREWING OREGON CITY, OR 97045
TIGARD, OR 97223
Phone #: Phone #: 503 - 632 -7374
Reg #: LIC 81746
PLM 3 -359PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authorized Plumber
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
SAM HARDING INC
23833 NE GLISAN
WOOD VILLAGE, OR 97060 -2942
Electrical Signature Form
Permit #: MST2005 -00209
Date Issued: 6/27/2005
Parcel: 2S102CA -00400
Site Address: 09750 SW FREWING ST
Subdivision: FREWINGS ORCHARD TRACTS
Block: Lot: 018
Jurisdiction: TIG
Zoning:
Remarks: Remodel, frame for header & install french door.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
EGGERT, VIRGINIA A REVOCABLE SAM HARDING INC
LIVING TRUST 23833 NE GLISAN
9750 SW FREWING WOOD VILLAGE, OR 97060 -2942
TIGARD, OR 97223
Phone #: Phone #: 780 -3159
Reg #: LIC 00087048
SUP 3376S
ELE 26 -549C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X L'a44.
Signature of Supervising Elean
If you have any questions, please call 503.718.2433.