Permit r
CITY OF TIGARD MASTER PERMIT
°• : -- COMMUNITY DEVELOPMENT Permit #: MST2012 -00003
13 125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/11/2012
T . ... g Parcel: 25111 CC21500
Jurisdiction: Tigard
Site address: 10270 SW GREENLEAF TER
Subdivision: SUMMERFIELD NO.5 Lot: 274
Project: Miller
Project Description: Convert portion of garage to living space.
BUILDING
Floor Areas Required Setbacks Required
Stories 1 Bedrooms: 0 First: 94 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0
Detectors. Yes
Total: 94 sf Value $3,500.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain 0 Urinals 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers. 0 Garbage Disp 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib 0 Backwater Value: 0
Other Fixtures: 0
Drywell- Trench Drain: 0
Other Fixture Units
MECHANICAL
Fuel Types Air Conditioning. N Vent Fans 0 Clothes Dryers 0
Heat Pump: N Hoods: 0 Other Units 0
Furn <100K: 0 Vents: 0 Woodstoves 0 Gas Outlets 0
Furn > =100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits
1000 sf or less: 0 0 -200 amp: 0 0 -200 amp' 0 W/ Svc or Fdr 0
Ea add' 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc /Fdr: 1
Mfd Home /Feeder /Svc: 0 401 -600 amp' 0 401 -600 amp: 0
601 -1000 amp: 0 601 +amp- 1000v: 0
1000 +amp /volt. 0
ELECTRICAL - RESTRICTED ENERGY
SF Residential
Audio & Stereo: N HVAC: N Security Alarm. N Vaccuum System: N Garage Opener: N All
Other. N Other Description:
Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R -3 94
Owner: Contractor:
MILLER, KENNETH C & VICKI S JD HOME SERVICES LLC Required Items and Reports (Conditions)
10270 SW GREENLEAF TER 12768 SW BEXLEY LN
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503 - 780 -0870 PHONE: 503- 922 -3324
FAX.
Total Fees: $403.63
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a co. of the rules or direct questions to OUNC by calling 5 .232.1987 or 1.800.332 2344.
Issued By: ----
_....►�� i r mittee Signatore - -• -
Call 503.6 '. 7:00 a.m. for the next available inspection da e.
This permit card shall be • • : . 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 Application
Residential FOR OFFICE USE ONLY
City of Tigard RECEIVED Received ` � , Permit No.: /7S7 ilk axe 3
:: a Date /B `'�
° 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review 1.
P hone: 503.718.2439 Fax: 503.598.1960 ® 4 Z Z Date/B : � ���� Other Permit:
T.1 RD Inspection Line: 503.639.4175 Date Ready /By: .rut ® See Page 2 for
and -or. ov Notified/Method: i/ d er Supplemental Information
Internet: www.ti
g g CITY OF TIGARD ��
TYPE Of —91 1 ! ' 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
T Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling ❑ Commercial/industrial
�i�a
❑ 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: ` 0 0 2 , 7 0 5 t o y am „ L /LT- New dwelling area: 9s1 square feet
City /State /ZIP: - r ii cord dQ 172.214 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: I - v1GK1 S Rp01h 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.
t..OW% 1164 1” of f rile. 40 boll . 5 Valuation: $
ll Existing building area: square feet
New building area: square feet
PROPERTY OWNER y " ❑ TENANT Number of stories:
Name: Ken cove( Vtc. 1) (Ler• Type of construction:
Address: 102 7o 510 U 1rt.Gtn lea TG-er. Occupancy groups:
City /State /ZIP: .--ri 7c .rd , 6g, two 4 Existing:
Phone: (663) • 730- 0170 Fax: ( ) New:
RrAPPLICANT • ❑ CONTACT PERSON BUILDING PERMIT FEES*
1 ��� � . (Please. refer to fee schedule)
Business name: Tom' t f ice5 Structural plan review fee (or deposit):
Contact name: 7 6s,roble S4.9.,1.K FLS plan review fee (if applicable):
Address: 4274.Q St.J l'3..id tr 4.-, Cit /State /ZIP: � - G , Total fees due upon application: /
City/State/ZIP: � l v O / � (le'. 9 '1 / / 7 .7 f/
j
Phone: (03, ) 9 .2a„ 3304 Fax:: ( ) Amount received: ��// (�
E -mail: .1 1,., i A • s k e d� § .�, not PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR . roof -top mounted PhotoVoltaic Solar Panel System.
Business name: "I') SK VIe.C.5 Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: 62•76Q sta, 11444 Lr■ Solar Installation Specialty Code checklist.
City /State /ZIP: 719 and ye. 97x 2 (, Permit Fee (includes plan review $180.00
and administrative fees):
Phone: ($V3) 922 - 3 4 Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lie.: (9 /757 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
i 5 within 180 days after it has been accepted as complete.
Print "nan�e: -Tames * Fee methodology set by Tri- County Building Industry
, Date: I/ y / Service Board.
Electrical Permit Application ` FOR OFFICE USE ONLY
c" � Received
City of Tigard Date/By: Permit No.S7-7.nn R.- trovo,3
° 13125 SW Hall Blvd., Tigard, R'� 44, 11,\I � �� Plan Review ( (�)CC[(//
Phone: 503.718.2439 Fax: 50 . Bur 60 � r 1 Date /By: Other Perm t:
1,,\ 'TIGARD Inspection Line: 503.639.4175 ' � A l i ` .\\ Date Ready/By: Suns I3 See Page 2 for
Internet: www.tigard- or.gov c c 'Cv.s°' ,) Notified /ivlethod. Supplemental Information
4
T E OF WORI{\ ri��iC?v . ' - . . - ; 't ', PLAN _REVIEW. _ =:'' - ` _' Z•, `i ="
❑ New construction Addition /alteratioaleement
�� 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 ❑ Mannas 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
❑ I - 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 denved system.
❑ Addition of new motor load of ❑ "A', "E ", "1 -2 ", "I -3',
j . 100HP or more. occupancy.
Job no.: Job site address: /�.;t70 � L`- ( , l . '�
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: r' "/ 7 ❑ Health-care facilities. ❑ Supply voltage for more than
I l '( r [i 600 volts nominal.
❑Ha za rd ous locations.
Suite /bldg. /apt. no.: Project name: C ILL - VIck i j Re,i=i'A ❑ Service or feeder 600 amps or more
• FEE' SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168 54 4
Ea. add'I 500 sq. ft. or portion 33 92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
CC)ti er— g'r O-F 17 ) T 2 r16,C- TO LIV/tt.`%- 5Pilc-C. residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
,-,
� 200 amps or less 100 70 2
0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: KC l 4 i C 1 141 1LZ ey, 601 amps to 1,000 amps 301 04 2
Address: /t 2��, cu.') C7 1 t- � e cr Over 1,000 amps or volts 552 26 2
/ Temporary services or feeders installation, alteration, and /or
I 1
City/State /ZIP:
t c c7 t..- , y � relocation
Phone: °j ) Fax: ( ) 200 amps or less 59 36 1
�� ��' 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
EI APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: � , ril B Fee for branch circuits without
h c 5"t' V 'C Es service or feeder fee, first
branch circuit X6.18 2
Contact name:
' �ta r,�..;� ,SQL � �
Each add'l branch circuit 7.42 2
Address: 1:,17(,,V 54,,.) LE i [_1■1 Miscellaneous (service or feeder not included) _
City /State /ZIP: 6,1162 / Each manufactured or modular 67.84 2
TI t7 o e 9 7 7 dwelling, service and/or feeder
Phone: (Sc. ) ,_ 3 4 Fax: : ( )
Reconnect only 67.84 2
a Pump or irrigation circle 67.84 2
E -mail:
�0avv,.;� _(;.i. S'1 Q cam: \ C-taS - r\-0r Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Fti 7y�`�d , n S � panel, alteration, or extension. Page 2 2
pod pa Y Each additional inspection over allowable in any of the above
Address: 2"17 °2 IQ xtt f s., Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: eiliQhGa OA 9 Teo& Investigation (1 hr min) 66.25/ hr
• / Industrial plant (1 hr min) 78.18/ hr
,..:.=Phone: (5,:)3 ) 5 - _ 6;033 Fax: (93 ) on -2,4e9 Inspections for which no fee is 90.00/ hr
specifically listed (/2 hr min)
CCB Lie.: 1 -- ii' /:? Electrical Lic.: C 5q i Suprv. Lie.: S 5. - °S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: Z p'e..t' f " T Ail Date: i — 1 l — I 2 State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
0 in This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name { 6 y& cTo 4yL . Date: 1— I (.- I * Number of inspections allowed per permit.
I\Bui 'ding \Permi ts\ELC- PermitApp.doe 07/01/10 4404615T(1 I /05 /COM/WEB