Permit CITY OF TIGARD MASTER PERMIT
gi Al C . ' • COMMUNITY DEVELOPMENT Permit #: MST2012 -00255
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/16/2012
Parcel: 25111 CC06200
Jurisdiction: Tigard
Site address: 9920 SW CENTURY OAK DR
Subdivision: SUMMERFIELD Lot: 92
Project: Eischen
Project Description: Master bedroom /bathroom remodel, vault kitchen ceiling.
BUILDING
Floor Areas Required Setbacks Required
Stories: 2 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 1 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $5,800.00 Rear: 0
PLUMBING
Sinks: 1 Water Closets: 2 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 3 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Drains: 0
Tubs /Showers: 2 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins. 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 0 Backwater Value: 0
Drywell- Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Tvpes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum > =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 add9 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 7
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 8, 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:
STANLEY EISCHEN TL REMODEL AND CONSTRUCTION INC Required Items and Reports (Conditions)
9920 SW CENTURY OAK DR PO BOX 1996
TIGARD, OR 97224 LAKE OSWEGO, OR 97035
PHONE: 503 - 440 -2095 PHONE: 503 -984 -2783
FAX:
Total Fees: $606.85
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 ccordan - ith approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is su pended for more the 180
days ATTENTION: Oregon •• requires you to follow the rules adopted by the Oregon Utility Notification Center. Those r - s are set forth in OAR
95 001 -0010 trough OAR %• 2- 001 -0r - r. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 7 or 1.800.3 , 344.
Iss ed B 1 r o '
Y . - ' ` — Permittee Signature:
- Call 503.639.4175 by 7:00 a.m. for the next available inspec on date.
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.
1 Building Permit Application
T
Residential ES ,
C a roHOlrlclt;seoNl -.��
• Fik:E +-r.
N . City of Tigard Received
: _ / v im g` M Permit No.. tiSTo of a- S - 5 --
13125 SW Hall Blvd., Tigard, OR 97223 0 CT 0 2 20 Plan Review ►ft�
o Phone: 503.718.2439 Fax: 503.598.1960 p� : J� �� • er Permit:
T I G A R D Inspection Line: 503.639 ,�A"I 'r .. r Date R ... 7: kris ® See Page 2 for
Internet: www.ti ard -0r. ov �r` t ��� '` `� / / 1 ] �' Supplemental Information
g g Ci Y,Gc: t ",nee ae t�yhfied/M od: 0 i SaPP
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 El Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
v
® l- and 2- family dwelling ❑ Commercial/industrial Valuation: 3 $ $
Accessory building Number of bedrooms:
❑ ory g ❑ Multi - family
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
lob site address: 9920 SW Century Oak Drive New dwelling area: square feet
City/State/ZIP: Tigard, OR 97224 Garage/carport area: square feet
Suite/bldgiapt. no.: Project name: (:entes oali E� � L N Covered porch area: square feet
Cross st,eet/directions to job site: Sw Summerfield Drive J 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.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Master bathroom wall modifications, eliminate two windows, add sliding door unit Valuation: $
in master bedroom, vault kitchen ceiling, Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Stanley Eischen Type of construction:
Address: 9945 Brent wood place Occupancy groups:
City/State/ZIP: Tigard, OR 97224 Existing:
Phone: (503)4402095 Fax: ( ) New:
❑ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name: TL Remodel and Construction Inc (Please refer to fee schedule)
Structural plan review fee (or deposit):
Contact name: Tim Labunsky
FLS plan review fee (if applicable):
Address: PO Box 1996
City/State/ZIP: Lake Oswego, OR 97035 Total fees due upon application:
Phone: (503) 9842783 I Fax: : ( ) Amount received: ti/07,42••
E -mail: TLRemodel @yahoo.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof- : • mounted PhotoVoltaic Solar Panel System.
Business name: TL Remodel and Construction Inc Submit • : 2) sets of roof plan with co ' • ction details
and fire dep., i it access, along wi I e 2010 Oregon
Address: PO Box 1996 Solar Installation p- . ", by Code • ecklist.
City/State/ZIP: Lake Oswego, OR 97035 Permit Fee (include i. review $18000
and admi .. e .ti - ; • s):
Phone: (503) 9842783 Fax: ( ) State surcharge % of permit fee . $21.60
CCB lic.: 191214 4`' 61/// To . ee due upon application: $201.60
Authorized signature: 7 ? •l/ • [ 2 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Timothy Labunsky Date: 9/118012 ' Fee methodology set by Tri-County Building Industry
Service Board.
I:\ Building \Permits\BUP- RESPermitApp.doc 02/24/2011 4404613T(I 1 /02/COM/WEB)
Plumbing Permit Application
Building Fixtures
1c4 i,� - oI y .,
t } FOR OFFICE USE ONLY
City of Tigard Received s5-
g : ;,. ,, ,# .. � �. 3 .-' Re e ive �� I Permit No.: ��0! - UD d
III - • 13125 SW Hall Blvd., Tigard, OR 97223 7 c� 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Q C I !� /DateBy: Other Permit No.:
Inspection Line: 503.639.4175 Date Read Jur s: See Page 2 for
TIGARD Internet: www.tigard - or.gov - ° " ° -tai s-E B ®
Notified/Method: Supplemental Information
_ :
TYPE OF WORK FEE* SCHEDULE
❑ 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 (l) bath 312.70
0 I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ 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: 9920 SW Century Oak Drive Catch basin or area drain 18.76
City/State /ZIP: Tigard Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Century oak Manufactured home utilities 50.03
Cross street/directions to job site: Sw Summerfield Drive 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: f Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Zvvtt.rl0/` gekr00pM e / A44 ( 1,4,,,...p-6,- Dishwasher 25.02
f t : t tt 4 Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Stanley Eischen Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 9945 Brent wood place Garbage disposal 25.02
City/State /ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503)4402095 Fax: ( ) Ice maker ') 12.51 1 1.5 l
❑ APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02
Business name: TL Remodel & Construction Inc Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Tim Labunsky
Roof drain (commercial) 12.51 q
Address: PO Box 1996 d
Sink/basin / lavatory 4/ 25.02 /ptl ,d
City/State /ZIP: Lake Oswego, OR 97224 Solar units (potable water) 62.54
Phone: (503) 9842783 Fax: : ( ) Tub /shower /shower pan . 2 . _ 12.51 2 , OZ.
E -mail: TLRemodel @yahoo.com Urinal 25.02
CONTRACTOR Water closet 25.02 SCi1.0 )
Water heater 4. 37.52
Business name: f 1Lr M . A ,7 ,c, Water piping/DWV 56.29
Address: 1�( 54,/ El/e/iy /,,pjt £ it Other: 25.02
City /State /ZIP: A4/5 01 9 70 7 7 Subtotal ( 17. $C
Phone: ($ 3 9 51 - o s Fax: (5-..)3 S'.2 -,rs/0 Minimum permit fee: $72.50
CCB Lic.: /9 s 3 6((I'1 Plumbing Lic. no.: pg is-3 Plan review (25% of permit fee)
State surcharge (12% of permit fee) /2,51
Authorized signature: TOTAL PERMIT FEE 16:1
Print name: JJ color c ,, Date: 17/i 3 / / e2 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. 7
Electrical Permit Application '0,3i � ' t r y ✓, roil orl� Icl:: USE ONLY •
City of Tigard = : - ° R ece i v e d ` 1p9O /a >0ilSS
. Hall Tigard, 97223 ateR : l0�� � Permit No.: l
. _ ° 13125 SW Hll Bld Ti d OR OCT O C T 0 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B Other Permit:
Inspection Line: 503.639.4175 ,�- r, D aze ea See Ready/By: Juris: El S Page 2 for
TIGARD � g
Internet: www.tigard -or.gov CITY v :.•1` ! t'•:ii'i d....1 Notified/Method: Supplemental Information
P: tC /PS t °!: p.
TYPE OF WORK" ` ` '' t ' . `' ic"t. PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ® Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
® 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
less to ground, o or exceeds 1 ns, ❑ Commercial -use agricultural
ry $ 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 ", "l- 2 ", "I -3 ,
Job no.: Job site address: 9920 SW Century Oak Drive IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Century oak ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Sw Summerfield Drive 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'l 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
• - In } d i or rtv-NGot, +1 • Il �/ tkc l'\e" f A .Art t r � b*" residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
N'l 4 '1 5 + C e ' b e i k L : f: r o o r. - F., t . :17 r 0 6 � ' 200 amps or less _ 100.70 2
® PROPERTY OWNE r ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Stanley Eischen 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 945 Brent wood place Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State/ZIP: Tigard, OR 97224 relocation
Phone: (503)4402095 - 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 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ® CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: TL REMODEL AND CONSTRUCTION INC B. Fee for branch circuits without / Q
service or feeder fee, first I 56.18 r 6 . I v 2
Contact name: Tim Labunsky branch circuit
Address: PO BOX 1996 Each add'I branch circuit 6 7.42 : y , 5 2, 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Tigard, OR 97224 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 9842783 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: TLRemodel @yahoo.com Sign or outline lighting 67.84 2
CONTRACTOR
Signal circuit(s) or limited-energy
Business name: s /23,c.... e2 ^?7e--/�� panel, alteration, or extension. Page 2 2
� / Each additional inspection over allowable in any of the above
Address: �� � T�LO Additional inspection (I hr min) 66.25/ hr
...f«4. t Ole— 4, 736 Investigation (I hr min) 66.25/ hr
City/State/ZIP: —
Industrial plant (1 hr min) 78.18/ hr
Phone: an () 53 $- s tota• ( Fax: ( ,7h i , 4 Inspections for which no fee is
specifically listed (V: hr min) 90.00/ hr
CCB Lic.: /4 Electrical Lic.: S Suprv. Lic.: s2,7/1 S' ELECTRICAL PERMIT FEES
Suprv. Electrician re; required: Subtotal: i OQ jn
Plan review (25% of permit fee):
Print name:63 / /, v t), ( / (j r t I Date: l R . 12� � ,
State surcharge (12 %of permit fee): O
7 TOTAL PERMIT FEE:
Authorized signature: ,
^ This permit application expires if a permit is not obtained within 180 after has accepted as complete.
v TOTAL
it h been l
Print name: /� L 4.4 ,...),JA
Date: 9 a .! Z
4
Number of inspections allowed per permit. L 1 1
1: \Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I I /05 /COM/WEB