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Permit a CITY OF TIGARD MASTER PERMIT 2 COMMUNITY DEVELOPMENT Permit #: MST2012 -00102 T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2012 Parcel: 25111 BA02400 Jurisdiction: Tigard Site address: 14350 SW 100TH AVE Subdivision: INGEBRAND HEIGHTS Lot: 29 Project: C & L Properties LLC Project Description: Interior remodel BUILDING Floor Areas Required Setbackk R Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 2 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $10,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 2 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 3 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 0 Tubs /Showers: 3 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 Bckflw Prevntr. 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 2 Clothes Dryers: 0 Heat Pump: N Hoods: 1 Other Units: 0 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 1 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits 1000 sf or less: 0 0-200 amp: 1 0 -200 amp: 0 W/ Svc or Fdr: 6 Ea add! 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0 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 0 Owner: Contractor: C & L PROPERTIES LLC C & L PROPERTIES LLC Required Items and Reports (Conditions) 14350 SW 100TH ST 9279 SW 75TH TIGARD, OR 97224 PORTLAND, OR 97223 PHONE: 503 - 939 -2310 PHONE: 503 - 245-4944 FAX: 503- 245 -5038 Total Fees: $898.59 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 4 be done ' cco •a with ap•••ved plans. This permit will expire if work is not started within 180 days of issuan if work is suspended for more the 180 days. TENTION: Ore• •n :w re•uires you to follow the rules adopted by the Oregon Utility Not •.lion C-. Th•:e rule =re set forth in OAR 952 1 -0010 through OAR _ 2 -00 -0 -, • •. You may obtain a copy of the rules or direct questions to OUNC by calling 50 .' - or 1. • , 2.234 t I; / / " Issu By: .A..i 1a• i Permittee Signature: W Call 503.639.4175 by 7:00 a.m. for the next available Inspe on date. This permit card shall be kept in a conspicuous place on the Job site until completion of the proj •,t. Approved plans are required on the job site at the time of each Inspection. Buildine Permit Application Residential RECEIVED EIVED I OR ()1 I lCl: usl.: oN ,1 City of Tigard Received / per No. MAY 17 2012 Date/By: 5 /7 / 5ri0%?- 404,02 111 • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie :JCS • Phone: 503.718.2439 Fax: 503.598.1960 Date/By: JL 2 ( Other Permit: Inspection Line: 503. 639.4175 CI Ty ������ Date Ready/By: a June: See Page 2 for fIGARD Internet: www.tigard or.gov BUILDING DIVISIO Notified/Method: 5 /?i3 //L I — , Supplemental Information 6 30/E Ale 77F/® CRI—A 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: 5ZE 1,1 A g equipment, materials, labor, overhead, and the ofit for the CATEGORY OF CONSTRUCTION work indicated on this applicatio . l0" Q X1- and 2- family dwelling ❑ Commercial/industrial $ ❑ 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: ) A 3 50 S. W • 1 0 OTC New dwelling area: square feet City/State /ZIP: IT GtflftZt d e_ 9 1 221 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area square feet Cross street/directions to job site: M 9.- 0 jut., se' . Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I 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 n work indicated on this application. j J , 1\AIN 80TFA p c►� Q K 1 `s M$re - 6tral Valuation: $ 61.GG rts■L . Existing building area square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City /State /ZIP: Existing: Phone: ( ) Fax: ( ) New: ❑ APPLICANT VI CONTACT PERSON BUILDING PERMIT FEES" Business name: LE,( p , �c (Please refer lo deposit): osit): te) L62)2,9 ` , ' e/4 � Structural plan review fee (or deposit): Contact name: , 1 � FLS plan review fee (if applicable): Address: 92,-7q 5 -�N , 151= City/State /ZIP: - Po e( o e , 9 7 Z23 Total fees due upon application: Fax: ; �3) _ Amount received: 61; SI Phone: (5 3) 9 39 -2_31 O Z 5 503S E -mail: Ca■L4e. 1. ■en CibtA. • PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof -to. • Photo Voltaic Solar Panel Syste Business name: ( E L Pao LrI=S (....Lt Submit two ' ets of roof plan with co - • n details � and fire departme - cess, alon _ , .. I e 2010 Oregon c w Address: 1 e.a. AS e)OV E., Solar Installation Specr ', • e checklist. City/State /ZIP: Perini : ncludes p eview - $180.00 and administrative e • - • Phone: ( ) Fax: ( ) • State surcharge (12% of permit fee): $21.60 CCB lic.: Oe I 4 k 10 , 7 Total fee due upon application: $201.60 Authorized signature: This perm application expires if a permit i s not obtained with 180 days after it has been acc epted as complete. Print name: ( r 1 ft �) R 11 1 D ate: 5 I ) ? I ' Z, * Service Bo dd d Ogy set by Tri County Building Industry I:\ Building \Permits\BUP- RES'ermitApp.doc 02/ 24/2011 440- 4613T(l 1 /02 /COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling FOR OFFICE uSl: O l.\ Cit of Tigard "' Received `'� Permit No.: 1 114 Date/By: 13125 SW Hall Blvd., Tigard, OR 97223 Associated permits: 0 Phone: 503.718.2439 Fax: 503.598.1960 f I G n R D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing ❑ Mechanical Internet: www.tigard- or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 e No N/A I Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ • • 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. CI CI 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 . ❑ ❑ ❑ 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. Planreview 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 El ❑ ❑ 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 , t , : , • . ' 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. , , • t 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 a rlicable to the rro'ect under review. , JURISDICTIONAL SPECIFICS 23 Three (3) 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. ' ' , . El ❑ ❑ 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 must include 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. 1:\Building\Permits\BUP- RESPermitApp.doc 02/24/2011 440- 613T(11/02 /COM/WEB) y_ ° .-PI bin Permit Apulication RECEIVED Building Fixtures MAY 17 2012 Received - n p � ^ City of Tigard I1 *y Date/By: / 7 /,Z Permit No.: M . pD /O 2 14 v 13125 SW Hall Blvd., Tigard, OR 9 OF IGARD Plan Review 2 Phone: 503.718.2439 Fax: 503.5'':. . 'DING DIVISION Date/By: Other Permit No.: T I G,\ R D Inspection Line: 503.639 Date Ready/By: Juris: ti7 See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist J'' Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement NI Other: `lA B New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ❑ 1- and 2- family dwelling ❑ Commercial/industrial . SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler (__ sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: I ^ 3C 0 .5,v4 , 1 l O O Catch basin or area drain 18.76 �-{ J Drywell, leach line, or trench drain 18.76 City/State /ZIP: II 0e. c)7224 Footing drain (no. linear ft.: Page 2 Suite/bldg./apt. no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: H si Oni t ki) Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: _ ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer ! 25.02 . 25.C"Z. 1\k Hill r.1 P ATN I MOLE. Uri LI ry TO Dishwasher ( 25.02 -Z6; 07__ 6 iSsEMe347 n Srr Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT V CONTACT PERSON Interceptor /grease trap 25.02 Business name: clisL P(2. 2 its LLC. Medical gas (value: $ ) Page 2 Contact name: et N l Primer 12.51 Roof drain (commercial) 12.51 Address: 9 Z Lei S, Z W 5t-- Sink/basin/lavatory /1 I + 25.02 (QO, (� City/State /ZIP: � (De' OC 9 7 2.25 Solar units (potable water) 62.54 Phone: /5 93q_ 2,510 Fax: : (5oa )C,L5 - 5038 Tub /shower /shower pan Ill ,_. 2 , 7,' 1 Urinal 25.02 E -mail: c . de. � =VQNG. mcv...i CONTRACTOR Water closet 1 / 25.02 ,( � �ta0 f' CBI Water heater 1 37.52 Business name: De� 1 U �Li S )C • Water piping/DWV 56.29 Address: ( 2zo 5 S� . L (�" w Other: 25.02 q ty �d PP �! pl.L�.. be Sub total 2. 7.0 City/State/ZIP: 3 1 P i one: so qol g - oi (i 3 Fax: ( ) Minimum permit fee: $72.50 I Al CCB Lic.: I •52 $'� 412 Plumbing Lic. no.: p 8 5 b 2 /14 Plan r (25% of permit fee) "Xj / State surcharge (12% of permit fee) "X",•5 Authorized signature: I TOTAL PERMIT FEE 2,( Print name: GA6Ci .. (3 Date: 5/1'11 1 2 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 \Pennits\PLMU- PermitApp.doc 10 /01/09 440- 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' , ; 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' _ 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Storm & Rain Drain - 1st 100' 62.54 Valuation: Permit Fee: $1.00 to $5,000.00 Minimum fee $72.50 Storm &,Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Ins ections or Fees Qty. Fee (ea) Total each additional $100.00 or fraction thereof, to p and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. ' Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions - 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following: Fixture Type for Replace/ Please check all that apply. Work Performed: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2" and greater, except systems designed and stamped by licensed Bath: -Tub/Shower engineer. - Jacuzzi/Whirlpool Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive tall as defined in OAR918- 780 -0040. Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR918 -780 -0040. Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: - 2" 3" Isometric or Riser Diagram ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage Domestic hon food that meet the qualifications above. Disposal: - Domestic food related - Commercial food related • - Industrial flood related Ice Mach./Refrig. Drains Comments regarding fixture work: Oil Separator (Gas Station) . • Rec. Vehicle Dump Station Shower: -Gang -Stall Sink: -LavBar non -food related - Bradley - Com/Serv/Util food related • - Service *Note: If the fixture work under this permit results in an Swimming Pool Filter increase of sewer EDUs, a sewer permit will be issued and Washer - Clothes fees assessed for the sewer increase must be paid before the Water Extractor WaterCloset - Toilet plumbing permit can be.issued. , Urinal Other Fixtures: I:\ Building \Permits\PLMF- PermitApp.doc 08/04/2011 2 05/16/2012 16:31 5035503898 CENTRAL AIR INC FADE 01/01 . x5/17/2012 03:02 E26 655 PAGE 01 • _ ` - _ RECEIVV'i`" 1'cntion feat ft, l )- � `I` N 11iecUani Permit MAY 1 1 2012 E i �' r p+nnt+,.. .--- a '- City o�'Tigard •v t3inSwH511Blvd..'rigtud'"R :� pten 14,Am. (Aber remit: h nr~ : h3. ?, e2a3v . tax: 51)3. 1 1 4 rit I� DING DIVISI �a,erHy. , , / r 9 (Abe g page for l'am I i • ` . i., ?rime: Line: 503.639 4175 QN 1 iIi 5ui, ettel lntorm.tia• tnterxl: www tl4ard •gr,gvv _ • r TYPE OF WORK COMMERCIAL Pt31G• SCHEDULE - 19E G11RC]ctJ6T Mechanieal permit fees* are bated oo tho velue of One work D New eeriStrdeliCd ❑ AdditiO:tlahgeationrreplacemont perfumed. Indicate the - vat ae (rounded to the nearest doll ar)ofail 1, • anical material 6 i, labor. rn • , -,• a1d , rofil ❑ Demolition Q ()ibex: Value: S CATEGORY OF CONSTRUCTION I L E S I V E N T I A L gees. ❑ I - and 2- faintly r)welling. ❑ Comm rcinUirxlustrial ❑ Acctesor • building Foray etl irtfbnro i u31 eAt.�ffad. ❑ Multi-family Q Muter builder v3 Other. ...C. thscriptian 1 Qty. 1 I:a, i 'Total' NeatinghoolliN: 4 SITE INFORMATION Ale LOCATION Air u•nJition hob rd lc arSthtra. 1 4 5 5 0 s.\14. t b❑ r$ (tteniret tile elan thowiny,Wacent!to 41..75 Fufnata t00.VUOCITL 4h.7s City7St4wMP: "r1 Cti pRO oe. q Tw nece i 3tl.o aTl l rtlac,elvorra 1 4.1 Suite/bldg. /apt. no.: ' 1 Project norm: Iteat pump _ ` - re• sift, riff oleo .hs..in natio (;t.0f1 - 1�Al.L� - ,_.�,. Ductw 2332 Cross atreel,'direai�ms,n job eitc: .- — l (vdrwlic hot water setem _______L_23 3 Rusidoatial bt (rarlialvr en' h atonic 23 32 _ - ' -- Unit...cr (fuel -type, nol electric). • • — w V in .wall in -duct. steoand utc, 46,71 . .... «J. 1 lueiscnt Tot any of atwve Othn_ —. 23.32 bdhi ston: T ( i rririo.: , _. -- - _ 23.32 i ax map /parcel no.: Otbir fuel apDlianeer: — DESCRI;PTION OF WORK j Walctheat � . 23.32 C, 1 �+,� ()ey flreplaettnsctt 33.34 l'644 Kil J 1J♦�� }�[A Vc�rJi VdO e. 0.„ vent fur nkt healer or ere 13 OQ. P _ - 4 111 !`J5v f `l F_ fireplace 23 32 • — 1 D _�: l' Lop be. (Ras) 73.3 1 cp R■ G4is lb 1 t- • wood,. 'Oct Mile 33.39 Wood Ii , let ;insert _ za.'s: 1 Chi /liner/Hue/vent 23.32 ; ❑ PROPERTY OWNER , 0 TENANT ' {{ • C , 23.32 Name: I Eoviroamemtal erbautt and.eattladon: • I Range boodotttukitchen Address: ec 3 ' Wrik (_ity /5tttter %IP: _ ' — "'� Clothcy dryer achaust I — Sinetr- duct ex l 33.39 l+WYt(bathtOOIrq, �y I P1.onu: ( ,) �a : ( i I toitcl, eomrnn•ttnents. utifity tt) I i 23.32 r 6� C ONTACT PERSON Attit:lc w s we fan= .:_- 23.32 — ❑ APPLICANT . 1 C.' L P r2 •t� 27..&S t�C Mar: _ 1 23.32 . 13uSinessrttunc 1 Fact In . I Contact mine: ieR �CI( � $14.lS for first Nor; . D3 for car s. , Would r--- Vanua. etc •__ _ — I Address: 9429 S Ti t� t;ari brat e tc. City; hater /JP: . 3 walla tove ndudhintt beataT _ Phone: 3i939' Z� 1 _ f ax: . (5D3 i 2 4 _ e Water Mater MI I 2, lace _ 6-tnait: a. .. o' Q7 6 t a _ • km ! NI I! 0:1 CONTRACTOR i 7atbccuc — I 1 Business name: .....- il+_ 4 , L 61 P _ . Clothes dryer (gas) MIN —I Othur Address: Q Q, G 'd 3 MECHANICAL PFRM7I FEES* City/Staid/Jr: Q bf,°1 X15 sa btotat ('' A Mhrimutn ptnrtit Era (l;W2.dQ) Phone: (sb _ (Ctb'b ' Fax: (503 (t3 St) -"'" 3'598 Man review (25�oa1'permitl'ee) y CC I3 iie.: j "') ist 2_� I State aurdtar$e (123/4 of pt emit Ice) ��— TOTAL PERMIT pet , � TMs permit applitalios empires If a permit is put ablalaed within 1 AUthDt i' /.e+l 5lgnatar•; dins after it boa been accepted as cerapteta. [tint .rne c' „no 2 V Date: 5] i (J l 7 J • F., me hadelogy se b .1 ii- County Buildin Iadunry sand., Band cdhipmmPerra∎eMC•ra.nnnmaoc rr.,rlri2 au- we77*(1e 21,1 - 0606ra) May 17 12 09:38e White Lightning Electri • (503)772 -4008 p.1 Electrical Permit Application, CErvE 1 vlt 01, 1e k I tiI CAA ,l • Gam wf T AY o B / /A wv Permit r�.: r , ;/ • ;/ /O A 1 2012 law • ' - ' ` Phone: 503.718.2439 Fax: 503,56 Due/By. OlherPamit r: c A I: . ll. Inspection Line: 503.639.4175 81 j1 OF T1� Due/By. Ready rey: la See Page 2 for • rntear www.t;gatd -m.gov L AD D Notified/ Method: ___j s ell Information TYPE OF WORK PLAN REVIEW New construction risAdditionialtastiontreplacentent Mass dank a l ter apply (submit a acts of ptaas Ratans checked w): Dental ition [] Q ❑ Service or 4t» amps or more p Building ova mime e,. wham the salable matt current Marinas ars and boatyards. ! CATEGORY OF CONSTRUCTION aaeeds 10,900 a at 150 wits 9.r Q Fleabag buildings �,]- and 2- family dwelling ❑ Comrnercialfindustrial 0 Accessory building amps tr or to s 14,000 p Cmamenial�ne agricultural Multi - family ❑ Master builder 6x a �,auaa�. buildings. Other: ❑ �� Pip. 0 htstalladonof 75 Y.VA _r - '-'-"i ❑ Fotergengr system:. larger separately derived awes • JOR SITE INFORMATION AND LOCATION ❑ Addition of aces motor load of ❑ - A', `E',"1.2 - , - 1 -3 ", Job no.: 0 - /55- I lob site address: /A/35 S / 00 41 100BE a more. ea ouuo�y. C ;C IStaiMZJY' ( 1 � L7Si:oraeuetesidtial 0aeamdonalvehicleparts. y : , n 1 d once.. facilities. 0 Supply voltage for more than. r ❑ lt$rardora tomtiana. 600 volts nominal. Suite/bldg./apt no.: Project name: ()Service or Reda 600 amps or more. Cross street/directions to job site: r FEE SCHEDULE Deceiprrao re . Taut - r I New resideottal tie - or multi -fr ally dwelling unit ���1 I Iadodes attached garage. Subdivision: I Lpt no.: 1 1.000 sq. R or Ins 168.54 . f Tax map/pm'cel no.: L ` - i Ea. add' l 500 all. ft or 33.92 i t 1 Limited mere, residential 7500 DESCRIPTION OF WORK (with at vesq.ti) + 9 Limited war, 75.00 i �\ r � residential faith above sq. fl.) I _ (� Ser Ices or feeders installation, alteration, d/or relocation r fJ 4 ampsorless ; 7 I° /00.7n 2 i ❑ PROPER ©TEP 1 PROPERTY OWNER _ 201 amps to 400 amps :33.56 I 1 Name: 401 a tq 600 amts ; 200.34 12 601 amps to l,)00anpa ! 30114 : 1 2 Address: 552.26 , , 2 Over 1,000 am or vans t City/State/ZIP: Temporary services or feeders installation. alteration. and'or relocation Phone: ( ) I F an: ( ) _ 20o magearitse 5936 ' i t Owner Instaflation:171is instal anon is b made on 201 amps to 400 amps 125.08 2 property that i own tvh;ct? is not 401 amp to ` 599 alts I 168.5a ! 2 intended for sale, (ease, rent, to exchange, according to ORS 447, 449, 670, and 70 L _ Branch circuits -new, attenti on, or esteasiml, per panel; Owner signature: Data A. Fee for tsar= circuits with i ❑ APPLICANT I 0 CONTACT' i' PERSON above service or feeder fce, each branch r l 7.42 #4.5 1 2 • Bltls iness name .� B. Fen far o widnoa4 v_ ..a is a _ 14w . r - ' service or feeds fee, fast Contact name I / f t.. • branch circuit 56.18 1 2 i Each add'I branch circuit , 7.42 I Ad j 12 dress -7 'SZt `5 S� P'v4- _ Each (service or feeder put included) City/State/ZIP: n J - Eact atannfaenued o: modu ' 49 . ' • ., - drvdevtg, careen and/or fader 67.84 1` Pole: C r 4 . 1 j -71'1- - - F a ( ) - 7 - 7 2 — 11/,01, Palm or t city circle 67.x4 12 Eimail: L , L j 4 TL � G t �• - ,c -,, _ I 2 ` Sign or outline lighting 67&4 2 CONTRACTOR Signal circuits) or liniited-enasj &dsinessname: Lvk4.Q �k( iA �►cu#rnc� ,— , , rte,altaa;on.orottotsion. ; Page 2 - Lath additlonai Invader) over allowable in any of the a - 721 S \,`'' .Rve. Additional iaapeaion t 1 hr mm) 66.2 J to City/Stare/722: /State/ZT1s: �? - Investigation (I brrain) 66.25/ hr lactum Ml Nam (1 In min) I 78.18,/hr 1 P ; ' d w C . C ' A ) 7 , , - Fax: ( 3) -r - L j Inspearmt for which flo fee is ll �•; CCB Lic.: � 'S" Electrical Lic.:1/ -ir p____:. Suety. Lie.: 47 speciOCay Gsai (14 hr ilia) 90.00/ hr Eur.c -n cAL IrEnwor FREE 5 t i prv. Electrician signature, required: SOMME t 4 " ' , Z2- - nine talus, (25% of icnnit fee): Print name / / u & Date: - / 7- / State surcharge (12% of permit fee): / '7 ' Authorized sagoatrue �� .� TOTAL PERMIT FEE: / /P A (=`? wag es oo iess d s bbd a permit not obtained withr'b ISO Print name: *' 7 ) �: txr days alter it his bees emoted as complete I e • Number ofias: onsWooedper permit. tiBuita. .,mtialie- P..,,;asp.d a o+rolno 4404615T(ruoncnwnaEl