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Permit CITY OF TIGARD MASTER PERMIT - COMMUNITY DEVELOPMENT Permit #: MST2012 -00250 • TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2012 Parcel: 2S102DC01400 Jurisdiction: TIGARD Site address: 13762 SW 90TH AVE Subdivision: GERTZ HOMES AT EDGEWOOD NO.2 Lot: 18 Project: Gertz Homes at Edgewood No. 2, Lot 18 Project Description: New SF BUILDING Floor Areas Required Setbacks Required Stories: 2 Bedrooms: 4 First: 1154 sf Basement: 0 sf Left: 5 Parking Spaces: 0 Height: 22 Bathrooms: 3 Second: 1555 sf Garage: 439 sf Front: 20 Smoke Dwelling Units: 1 Third: 0 sf Right: 5 Detectors: Yes Total: 2709 sf Value: $303,428.20 Rear: 15 PLUMBING Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 1 Rain Drain: 1 Urinals: 0 Lavatories: 5 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100 Tubs /Showers: 3 Garbage Disp:, 1 Water Heaters: 1 Water Lines: 100 Drains: 0 Catch Basins: 0 Bckfiw Prevntr: 0 Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL Fuel Types 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: 1 0-200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add! 500 sf: 5 201 -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: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: NEW SF VB R -3 2709 Owner: Contractor: GERTZ CONSTRUCTION CO INC GERTZ CONSTRUCTION CO INC Required Items and Reports (Conditions) 19200 SW 46TH AVE 19200 SW 46TH AVE 1 Ersn Cntrl 503 - 639 -4175 TUALATIN, OR 97062 TUALATIN, OR 97062 PHONE: PHONE: 503- 692 -3390 FAX: 503- 692 -5433 Total Fees: $19,770.40 • 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 copy of the rules or direct questions to OUNC by calling 503. or 1.800.332.2344. Issued By: Permittee Signature: i P t—+C 1 / (.\ Call 503.639.4175 by 7:00 a.m. for the next available inspection 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. Bujiding,Permit Application ne . ,„ Residential t 7,1 FOR OFFICE: Us!: (1,s1,i City of Tigard 7 Received 13125 SW Hall Blvd., Tigard, OR 972 3 S E P 2 7 2012 Date/B : C i� , ? i / _ Permit No.: it,(, �i],,.. .0 .N • p �� t S Plan Review ► � ' . Phone: 503.718.2439 Fax: 503.598.1960 my 1! a°1 �- ltZr r �/'' ' ci DateB : L���� gin Other Permit: ��� _�O� l I G ,� It p Inspection Line: 503.639.4175 k Date Ready By: Juris See Page 2 for Internet: www.tigard- or.gov BUILD % { zlISION Notified/Method: lD ) i. - ' I ® Supplemental Informat►oo Pit - ..- T1u1PE,;OP ViWOI RE UIRED'.DATA: t rA4N D 2 -1i't' Viii.* jci 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 1:1 Other :'�:�- y.- ::.:- -'..,...._... .. ,.: „ , .. o.;� t:'; °::. __ overhead, and the p �F; w i -> ;i�L•'=`° y : ' :: �I,• . r° ; ._:';:::. ; _:; _; work P a equt materials, labor, overhe an e ro fit for the x.ii4 : 3 „ '- ,.:, . : ovi 11; :; :i, i i:- :- _ indicated on this application. El 1 -and 2- family dwelling ❑ Commercial/industrial Valuation: $ 30� r 22) ❑ Accessory building C:1 Multi-family Number of bedrooms: Y ❑ Master builder ❑ Other: Number of bathrooms: Z s i �•,1a i�SiCr rY - .r MP a: ^nr._. ..,�:' :���• _ _ � � . . i, `,1':Q� . j . _ . 1:.:.r - >:: �! Total number of floors: - Job site address: J 3 7 6 Z S (• ?Q New dwelling area: 270 p square feet City/State/ZIP: Tigard OR 97224 Garage/carport area: ' 7 square feet Suite/bldg./apt no.: I Project name: Covered porch area: 07-1. square feet I'Js.S`J Cross street/directions to job site: Deck area: square feet I ( Other structure area: '6148 square feet OZ.- Subdivision:. - ' e ,.►?o-c,,,:e z_. I Lot no.: 18 Permit fees* are based on the value of the work performed. Tax m no Indicate the value (rounded to the nearest dollar) of all _.a� . , ;ar.';; .,, map/parcel ce .: ;: tip 4;; �',a - !?�,,- _ ,, :, •.,.1. i:.:. - J�.`;. ;,3;, equipment, materials, labor, overhead, and the profit for the , +ii' _x °: ; ;',f%' =bra. :H ' tc '�" ?iU _,t,:z• .: :: ?;'4= work indicated on this a 11C8tlOR: N �� `(„ , Valuation: a �� Existing building area: square feet New building area:. square feet s � , ti". •i °.k. `. / 'el�; r� Z'. .iF.i r ,C i • • ,�, yam.::, J, v.• .1:. a 3' ';, .. Number �+� . _ , <., . : , �;'�e'�,,. ; ...4- y(;�`.Dils ,�.:, y: .._. '„ =� • of stories: Name: 6 >!h N4 — f 43 4 — . Type of construction: Address: /12,670 „--- c-66 • Occupancy groups: City/State/ZIP: ---1-a,,c tia, 4( V 1 D62-- 7 Existing: Phone: (J ) • ( ..I, . 3f. O _ Fax: (.,a 3) Co ?2.— •5 ti 3 3 New: l il y ..... ' ';�,'' ,i ,. Business , name: ` '` ' '' ' "Tai t'Contact name: e 4, c role T' ,v 6.04 1 -62._ plan review fee (or deposit): Address: /1 et -sue `�G FLS plan review fee (if applicable): City/ State/ZIP' T �, Q2 92 pe 2.-- Total fees due upon application: Phone: ( ?) -32f a I Fax: : (563)af2 ,- 3 Amount received: Z � -mail: ( , Commercial and residential prescriptive installation of ' ?' ° S , yh d n a , :, > -: ;: y % <= 4 rooftop mounted Photo Voltaic Solar Panel System. Business name: Guts, _ ,c�,� - „ Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: � 9 2. t 5 c,,..) �G Solar Installation Specialty Code checklist. City/ State/ZIP: - 17. 4 .,,,_ 1 C / L 0/1._. y . ©C L Permit Fee (includes plan revie $180.00 and administrative fees): `,... Phone: ( ) 4.1,2 '31 its Fax: (_ 03) G p. 2 -5 Y 3 3 State surcharge (12% of permit fee): $21.60 CCB lic.: rS 318 d D y r — Total fee due upon application: $201.60 Authorized signature: This-permit application expires if a permit is not obtained within 180 days after it has been aecepted.as complete: P nee; Date " Fee methodology set by Tri- County Building Industry Service Board. 1 .s Building \Permits\BUP- RESPerrnitApp.doc 02/24/2011 440.4613T(I 1 /02/COM/WEB) iumbin2 Permit Application • p uilding Fixtures ..L, City of Tigard ca , lved • 13125 SW Hall Blvd., Tigard, OR 97223 S EP 27 201:L1Y' 9 /1// ''''' sr Permit No.: A4. view • . Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: ,, Inspection Line: 503.639.4175 CM/ OF T*. ReadY/Br ....logY ta See Page 2 for ti A R `-' Internet ■.vvr.v.tigard-or.gov n ni Nihir ,-,,,,, 9,., , .tified/Method: I / 61. Su. .lemental Information • , m • ..4,4 ,' • .. 'T , i.t.iP ': ' ., - ,....■ M.. _..,• • • .,, ',,,. ,.' -- • ,- , -, :',4gigen , ;.?... , • -- - ,5f . :7,,J;C, , V 4 '1:4 ',, '; '*: . -‘ '. ' ' ,• . '; ', ]. WerceigiAPT ::. ,,.1.7,,i7:'. ":41f.i6=g;:a:47:',4::,..;:'7:71.:::7::j ',..:. . , : :: : '1 ::6;4..-; CI ,2: . 1 ... 1 . r ' • .i '' ' '' :. '.: t t'' k New construction X 0 Demolition • For special information use checklist. Description I Qty. I Ea. I Total Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection) , : , - ,-..i . -,;' - '. - 4giiyAtvit4 ,, . , ..: , ., ,, - ..- , .. ;,•% ,.:.• ..!..“.,i,7,...,,,,,,v,;4.:-....,..!, ..; , .;i, , ■ ;,.....::', , ,1 ,t,tr..es*,:eq;,,,,,;n-,..;:::,,,. SFR ( I ) bath 312.70 1- and 2-family dwelling )C 0 Commercial/industrial SFR (2) bath '37.78 SFR (3) bath I 500.32 Accessory building 0 Multi-family Each additional bath/kitchen 25.02 Master builder 0 Other. Fire sprinkler ( sq. ft.) Page 2 Llreittnrit*.*Iiir':-::r40:11.'i(:l' 14(*****Ol.:-:' Site utilities: , ) site address: /,3 74, 2_ 5-- LA.) I 'it- Catch basin or area drain 18.76 Drywell, leach line, or trench drain . 18.76 :y/State/ZIP: r I. b 1.-„e 0/ 1--- 1 7 2 -el-• 2 - ( 7 4 Footing drain (no. linear ft.: ____) • Page 2 ite/bldgJapt. no.: , I Project name: Manufactured home utilities 50.03 !, oss street/directions to job site: , 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 :bdivision: ,e,Z t tirxr 2.____ Lot no.: 1 r- Fixture or item: ax map/parcel no.: - Beddow preventer 31.27 12.51 j.i.FAV;a:0,,,. t :-.....!,.p.D , .. ,. - .,.., , , , . -2, -: , - .• ,--- - ' _::: r 25.02 ae s4.3 14 Aft. Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump • 25.02 '3„;':::17.7;'•..::,t'.73.2•rfTiri::fitZVAAZ4Z2,4Tfg70;74-17r, E t 12.51 Fixture/sewer cap 25.02 ••g-;.:.2.14.4.,..,,....,!■:;',..,:i,,,ois..:44l',-4,41....,tv:-,.,•<.-riivc.... ,.., -.1..-...:,„•,1. - - • • .4,: .:.i.” ,.. •,.._ -._...., , lame: 6 e44... c.i.f.& Floor drain/floor sink/hub 25.02 kddress: / ? 2.c, 6 . xia 1M Garbage disposal 25.02 :ity/State/ZIP: 174 4141.2( OA 9'24,42- Hose bib 25.02 tone: (Si 3 )642 33 9?) Fax: (6 - .2- 5 g e 3 3 Ice maker 12.51 Interceptor/grease trap 25.02 I 4.,..,t....4...tm.r.a,...4,;..t.:,,,....e.4,,',ediv...4s044APkele.4. Medical gas (value: $ _ 12.51 ) Page 2 Business name: gr4"ez- C..4•4) 4 A.4 mer ._ Pri Contact name:. /4,,,,,i 6 401.1 Roof drain (commercial) 12.51 Address: // Ler 5 $ Ct. 1 14 4 '`' 7 _ Sink/basin/lavatory / 25.02 . . City/State/ZIP: -174, d te 4;6 4.1 614 ci ) a6 2-- Solar units (potable water) 62.54 Phone: 45 7. 3 310 Fax: : ( 5 o3) 4 ?),..- 5--ie 3 3 Tub/shower/shower pan . 12.51 Urinal .. - _ 25.02 9--mail: <.,‘ e es.is.co , G4 001 I 25.02 3164"41.7.i , Y.'4".•'.."`..;.q.* '14',.,:;AW_.,i7.i.:Zi:i;t:.i.,..,: i?,.; Waxer closet ..,;40 ,... ,-, ,... ..,',, 7; 4:24r,i-i...m.F4.34.v..(,:s...-y-,...;;,::.:,?,,i.:-..,z...:y water halter 37.52 Business name: -.1/ .rer f- pt......0. ,'„ Water piping/DWV 56.29 Address: P 0 3 o)k 2 7c( Other. 25.02 City/State/ZIP: -to) es t 4 ,-,,„ p 17 OC8 Subtotal Phenix ($3 )6- 73" 0 r I Fax: (5.113 )4 316- 82/ 2_ Minimum permit fee: $72.50 Plan review (25% of permit fee) CCB Lic.: I b 3 7 i z._ Plumbing Lic. no.: 3.2r1 pa . State surcharge (12% of permit fee) Autlunized.signature: TOTAL PERMIT FEE Print name: /r ua.... .. Date: 7/1t/fi, 1 Ibis watt application seamed snerettt is net obtained within 180 days after it bar bees acamited as animists 'Foy methodology ta by Tri-C-outity Buildingledesiry Service Bond I auildinsViwarisAPLAW-PormilApp.dao I 0/01109 440.4416T(10/02/COWWEM ��..1.0 L,y - Vl I lgard Page 2 - Supplemental Information • Fee Schedule: e 't>�e <_ : <, :.:;,: ;.� Residential Fire Sur .. @ ;�'� ressi<on S stems: Footing d a , I - - 7 .' - A � rf� ',� di . M 4 n>L$ g rain - 1 100 50.03 .�;,:: _ ......e.,l,w 1 r 0 to 2,000 ,.,? z ,•. ' :a' Footing drain - each additional 100' L= $121.90 2,001 to 3,600 Sewer - 1st 100' ®_ 3,601 to 7,200 Sewer - each additional 100' 7,201 and $23 3.20 Water Service - 1st 100' �® Water Service - each additional 100' _�_ Medical Gas S stems: Storm & Rain Drain - 1st 100' Y T ( 62.54 : '- . '... ' ',; , 5�b < ti - Storm & Rain Drain - each additional 100' , ' c; ' " r ;W i , ' _ _ $1.00 to $5,000.00 37.52 - Minimum - fee first $ �, �K � �: ; � � i .,,;• •.__- J first $5,000.00 and $1.52 for $5,001.00 to $10,000.00 $72.50 for the 0 sc : each additional $100.00 or fraction thereof to Inspection of existing plumbing or for which no fee is specifically indicated and . for the ie: $10,000.00. 90.00/hr each additional $100.00 or fraction thereof, ■ $10,001.00 to $25,000.00 $148.50 for first $10,000.00 and $1.54 for minimum ch :e - 1/2 hour) to Inspections outside of normal business 90.00/hr and . f in: $25,000.00. hours minimum char: e - 2 hours $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof: to Reinspection Fees 90.00/hr Additional plan review for revisions 90.00/hr $50,001.00 and u and . f fi $50,000.00 P $742 0,000.00 and $1.20 for .00 f minimum char:e- 1/2 hour for the firsst $5 Subtotal: ___ each additional $100.00 or traction thereof. Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurate) report fixtures could result in increased sewer fees*. • Fixture-_Type for Qaaatlq r WorJtFeafDtatedr G :mod , .h: is Plan review is required for any of the ' ti.w Work Performed: Pf . � � following. `'�' i. Beth Please check all that apply. • Tub/Showe ❑ Any new commercial building with water service 2" and - .r E s • /Whirl col l3mater , except x t s ystems designed and stamped by licensed Car Wash -Each Stall ceP -Drive Thru engineer. Cue idor/Weter As irator ❑ New exterior plumbing site utilities for any complex structure Dishwasher - Commercia as defined in OAR918- 780 -0040. - Domestic ❑ Medical gas and vacuum systems for health care facilities. Dri Fountain ❑ Any multipurpose fire sprinkler system. E ee king ❑ Any complex structure as defined in OAR918- 780 -0040. Floor Drain/sink - 2" - 3" Submit 7, sets of plans with any of the above. • 4" 4 � Car Wash Drain ... • , 5i. � Garbage -Domestic -non -food • Isometric or riser diagram .::w� s Disposal -Domestic -food related i is required for new buildings • - Commercial -food related that meet the ualifications above. -Industrial -food related Ice Mach. /Refit .Drains Oil S arator Gas Station Rec. Vehicle Dam Station Comments regarding fixture work: Shower -Gang -Stall Sink/Lay - Non -food related - Bradley - Commercial -food related - Service 5 wimmin a Pool Filter � *Note: lithe fixture work under this permit Way r . 110u' acto increase of sewer EDUs, a sewer permit wip Washer be issued and Water Clos - Toilet urinal fees assessed for the sewer increase must be paid before the Other Fix ture s: plumbing permit: can be issued. http J /www, tigard -or, gov /c ity_hal l/departments/cd/docs/PLMF -Perm i tAppLdoc • Mechanical Permit Application1 .1 FOR OFFICE. (SI: ONLY ` I .Ili Received Permit No.: ST� �' 00.21.0 City of Tigard Date/By: el /} it f • 13125 SW Hall Blvd., Tigard; OR 97223 Phone: 503.718.2439 Fax: 503.598.1960 S E P 2 7 2012 Plan Review Other Permit: Inspection Line: 503.639.4175 Date Ready/By: Juris: 1,0 See Page 2 for I I G A IZ D p 0 ^ -`;'• ? r Notified/Method: 1-140 Internet: www.tigard- or.gov �� � `� � � t���v�� Supplemental Information t �w ... . . � y,..:,- .'...ter rivii ... .. :! ...�Y. ... 1111 .._..S..fl:.r.r::r, +:. ..�S ,s l _ .: _ .. -.. _.l! i .►i i /10:81 1 MN v+ q rs'w' v »- . -�., -„e �: �•. ^=� �f''' •' "� COMMERCIAL FEE SGIiE1)UIiE`' �"'"(... a. „��� �b�i�:,Y�.� `P� >ti �';w; ":;,,� �w:r %-�� � +,-�� ... -° �...:. , .. _ .'_ ":: Mechanical permit fees* are based on the value of the work New construction ❑ Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all •❑ Other: mechanical materials, equipment, labor, overhead, and profit Demolition Value: p �.•^'�,45.� .•r- ..I.z +�:�.�, AYTE 60RI '4.,�Td.C;'ONS11�T , ":. „�c ; 1tESIDENTIAI :,EQ[JIRMEIVT { %S;�STE ?_ ,,. -,l'. y'��+;' -,.,. .� ^:"'� ='r . .. - „_ . ,1011 ,. 11,1 ,_ .� . .. 011 � � t ❑ 1- and 2- family dwelling O Commercial /industrial ❑ Accessory building For spedal information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total +�, ••senrrc�? `.;ice :;,.. - �•v-o F-��«•k. . _ _ ` ':'w ,; Heatin0/coolinp,: '.c k u(..�<-rr.��, ;•_ ,JC1$irS1�I1Efliiiti: iiili LOCATION �`:;g• .1,' - ::; rr. ;u . �.,YI'to, - 4'1, .Y`_' -'1`1:+',0.:1 'u...,_....- ,.�„�...: - -- - ,"-• ---"-- . ,; ` ;�,... Air conditioning 3 7L Z S('- ?O ) (requires site plan showing placement) 46.75 Job site address: � w� Furnace 100,000 BTU (ducts/vents) 1 46.75 City/State/ZIP: D . �� !/ Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump (requires site plan showing placement) 61.06 . Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or • hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 . L ot no.: Flue/vent for any of above 23.32 Subdivision: s Z Other: 23.32 • Tax map /parcel no.: Other fuel appliances: iE'r�T ti. • - -c•� - �,:,.,;:. •:':DEBCRIPifI . :�_-..; a =. ? Y ; ,�f�:�::�'3�'� :':z�,, - q_F,:,r.: F�W1rOttIC; . � - . - ;: ,4� r' ;:` � ,� Water heater (.. 23.32 r.:t r . Gas fireplace/insert (- 33.39 Y-e W /k-e- Flue vent for water heater or gas . fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 r ;,: ;';;r Chimney /liner /flue/vent 23.32 ;�� ; i r*S r7:.a >M4}"cV6 •;"' `tip'' 71.1'.. 1 1 V T a'ii i. 'r '• 71 6 t ,„ !i E .: , 7.4.; .,= M. , 74'..,�';.,' ,#C3,, ,...4.. . ' ''. '' 5" - >- . ',''44.,:. r �� ,�_, _ -. > - .. �{ � Other: 23.32 Name: 6.0 C M s-e e..ol l•4••L Environmental exhaust and ventilation: Range hood/other kitchen Address: 1? 2� (4.3 y6, '14 / equipment 1 33.39 City/ State/ZIP: I • ' c, a O2 ) a 4 L Clothes dryer exhaust I 33.39 Y � � Single -duct exhaust (bathrooms, Phone: (1(s8 ) 4 3 f 6 Fax: (54,3 )`9 2- S" toilet compartments, utility rooms) 23.32 N1:. i 1r :;;,� \1. I M$ O N J . : ; ,' ' Attic/crawlspace fans 23.32 :4 ` .,, �2 rI ' -a: ..., '" c Other: 23.32 Business name: 0t,`•{� o s d ( Fuel piping: Contact name: x.e.,j rosit� • $14.15 for first four, $4.03 for each additional Furnace, etc. 1 Address: 67 2-4 S�tT YG Gas heat pump City/ State/ZIP: t''4 J ©/1. f 70C Wall/suspended/unit heater Phone: (50?) q L 3 3 ? 0 Fax:: (c$3) C f2 - 5 i'? 3 Wat Wate r heater . E-mail: .. A) @ Geia'fyC e , d7.•-t Range sy �K y, . ' .C q +tp}'S;•'.4'st, r. sett` -ti �. .` �:aJ �" +jr ..',le ::): ..;:, .:r'. 4 � F n4'.l'Y "}� :'t]:t:;. -s }'71 �'.;� ?; I�� O4t ?Ji!?w`i }�{��"a'< �f:. -',. •,�� .`:�.:':::�r +I: :c�.,5 Barbecue ., S ` O � " /J� -0� C 1� - Business name: Clothes dryer (gas) • [ `( Other: l C) a c»< g z lYBY Me rn *>p> ii 0 _ ;.. r. : ,.a: Address: .. City/ State/ZIP: e Z Subtotal VQ ii a 04 tat& 1 `8 Minimum permit f ee ($90.00) Phone: (503 ) (, ss . O u( -Fax: (3) tv 5t - 21f3 Plan review (25% of permit fee) CCB lic.: S/$ 57 / State surcharge (12% of permit fee) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: d ays after it has been accepted as complete. Print name: Date: 7/2 • Fee methodology set by Tri County Building industry Service Board �,,fCe . . -- . - -... mrt.aRt n r i t rovcoM/west Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information • Commercial & Multi- Family Fee Schedule: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $ 10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\ Building \Permits \MEC- PermitApp.doc 03/07/12 2 Electrical Permit Application a -- 1 a 1:01t (,hI Il F: l S U l: , �I.1 City of Tigard ; .: , , - ; R' i ved 1+ate/B : 9 a 1I Sr Permit No.: /,{sr als. VANS? III 13125 SW Hall Blvd., Tigard, OR 97223 Pla Review C Phone: 503.718.2439 Fax: 503.598.1960 SEP 7 2012 D : Other Permit: • 1 I c;,� It D Inspection Line: 503.639 Date Ready/By ® See Page 2 for Internet: www.tigard - or.gov C! ill( CV: i f.:i S Notified/Method: Supplemental Information ;59,1: �:•ie _ .�}�y �)).•:j.1 ±�wQ.a;.4C`�+v ij...,:�,�sp : : ;�'i`::C.i _ : �=ay,'!r* , • .(y: �r•..��� ; �c--� r.,: - f. ... iglfi'•G:� . �M t y {_ .`,. ) V. M? . :0••0• •7:ia:l�:; .. • ., _:.h '` 4 :... .c.. A4. y :�, Ir f. „ ...‘. ' !".1;. 1" ew construction ❑ Addition/alteration/replacement Please check all that apply (submit a sets of plans w/itema checked below): El Demolition ❑ Other. where Building o ver stories. C ❑Service or feeder 400 amps or more • ❑ three , , i Do �� ' �„ here the available fault current ❑ Marinas and boatyards: � '., � ,,. �;,, ` ;;r:; exceeds 10,000 amps at ISO volts or ❑ Floating buildia less to ground, or exceeds 14,000 ❑ Commercial -use agricultural • ❑ 1- 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 ,12:i2: ,,. _y.� u ❑Emer gency system. larger separately derived system. .. C ;' - .. Vi i. `:!l!3!_.. K.:_:;,c;'.:.`,:;.: _ Y ,•... - ._- ., :. ..:.:..:..'�:'.:: new motor load o 0 of n ❑ 1 -2 ", " -3 ", Job no.: Job site address: ` 3 74 2- 5 e• f 100HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: l t J , y ,,.p 4/L r7 2 2 4 ❑ Health - care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name:. • ❑ Service or feeder 600 amps or more. Cross street/directions to job site: Description I QM Fee. I Total I ' - . New residential single- or multi - family dwelling unit. • Includes attached garage. Subdivision: . . ....t Z Lot no.: r/fr— 1,000 sq. ft. or less ( 168.54 4 Tax map /parcel no.: Ea. add'I 500 sq. O. or portion - 33.92 1 ` " : ' ' n- t.a- e 3t _,t.... • - ' , r Limited energy, residential I 'a ., -. .-n •.t.2< e .,�'.,�.. �'._::� v :�; i ..., ,. 75.00 2 ` ' fi ;4 -.i , :_ to gt �..,.::.:, (with above sq. ft ) [ .' m ar ,a�amxav�.-at- .ie�aalnon�f+y` .:3•�%�i, .9s. ,,,. �.:;a..' [/ / - Limited energy, multi- family 75.00 2 /�-e / - . residential (with above sq. ft.) Services or feeders installation, alteration, and/or. relocation 200 amps or less 100.70 2 ....,i:)d a 1, .,, ,'.:r:;::; 20 s,.��rvs <<' ,ra �a:;,.: V , 201 amps to 400 amps :3t�; .,_..; �+`= ;;: + ..... �'e i.' ' :'':i _ ::: P P 133.56 2 /'► , e4 -eZ � AJ S ` J ( /«� 1. 401 amps to 0 amps 200.34 2 (� G.- Name: 601 amps to I ,000 amps 301.04 2 Address: / Q Z" S. cj 64.3- , ' Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City /State/ZIP: T („-5-, At 6/4_ ' 26 6 Z relocation Phone: ( std )4, 7Z -3 5.6 Fax: (543) 6 qL - 6- 1{3,,3 200 amps ar 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 - 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 • ri•. yr .�,. • , .. ".y.`•. _..,�. .:, i) above service or feeder fee, • :: 4s� r `. . _, :F��.k:r,'r':. ,' , (Q . 010 7.42 2 '.. ',::: each branch circuit Business name: G eAl s-- ea 4._e_ B. Fee for branch circuits without service a �� fee, first • �� � G r., L 56.18 2 Contact name: Each add'I branch circuit 7.42 2 . Address: /1"2.47p /1"2.47p d �G l Miscellaneous (service or feeder not induded) City / State/ZIP: L ° Each manufactured or modular 67.84 2 �-'a '� A �/ dwelling, service and/or feeder Phone: (563 ) LY'Z— 3 Fax:: (,543) G4 z-y 3 Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: AO va. • 440 Sign or outline lighting 67.84 2 ,,-a .,t;� l : a 'I ) :,' ,.. 'Th 1l., (;sip +einr 'r T' •' Signal circuit(s) or limited-energy �L� ate;, ." ra. ^ .; ;,;.L • Business name: �,� (; .�,,,•� c ( e �` Z 45.F pReJt panel, alteration,orextension. Page 2 2 Each additional inspection over allowable in any of the above Address: Z.oZell e ' L J at i'c.t Its♦ , tom Additional inspection (1 hr min) 66.25/ hr City / State/ZIP: Z4N a 6` 1 ? 0 5s • investigation (I hr min) 66.25/ hr Industrial plant (I hr min) 78.18/ hr Phone: (SG3) 84 4 2 geO Fax: (5 46g- 4 11 ! o inspections for which no fee is 90.0W hr s ifrcall listed 'A hr min CCB Lic.: m L( f , Electrical Lie.: C3 Suprv. Lic.:Y 4:.: a ., t t: ) Suprv. Electrician signaM , required: Subtotal: re Plan review (25% of permit fee): Print name: h ou g ar.j , 5 .- Ie ,, • „ so... , D State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit apparition expires If • permit not obtained within 180 Print name: Date: days after It haa+besn a spsed.as complete.. �` / Z c/tir • • Number of inspections allowed per permit. tBuildl Pmi ro1ELC- PambApp.doe 07/01/10 440.t615T 1/OS/CO/4MM a„ U1%. ila o - t.aty of "Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for a residential systems combined ... $75.00 Check Type of Work Involved: Audio and Stereo Systems* .0/Burglar Alarm Garage Door Opener* Er Heating, Ventilation and Air Conditioning System* Vacuum Systems* • ❑ Other. Fee for each, commercial $75.00 system (SEE OAR 918- 309 -0000) 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. : AauildingWmmcAet,c- aermeAVp.ax 07/01/10 o ° Building Division Development Code Provision Review T i c n iz Residential Projects Building Permit No.: � l l a - • D D 5V Site Address: 31&?.." 90 TO !/ Project Name & Lot No.: • ' Ke ' 0� < Lo I 1 ?I CWS Service Provider Letter i/ Required: Yes ❑ No lQ Received: Yes ❑ No O Routed Plans: 0. lr� '�►/ Original Plan Submittal Date: 1st Revision Submittal Date: ❑ Site Plan Only 2 Revision Submittal Date: ❑ Site Plan Only To the Applicant: Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the Building Division. Only checked (1) items are approved. Items not approved and those listed iri the notes must be - revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section. Staff: please check items along left only if approved. Planning Review (contact 0 ,dam —' .. ... at 503 -718- i'i,3Y or 9 �' @tigard- or.gov) Land Use Case No. cod -O D / V ❑" Zoning Setbacks: Front 2_O Rear 1 _ Side S Street Side / `S— Garage 2.0_ 'Maximum Building Height 3 b Actual Building Height 2 Z Z VVisual Clearance . • 12 asements Sensitive Lands Type: ,"* • Notes: _ • Ra' 72e- r 5 p rte- T z,-Teip 77 Original Plan: Approved Not Approved ❑ Date: / ^�Z- Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: • Engineering Review (contact Mike White at 503- 718 -2464 or MikeW @ tigard - or.gov) 4 Actual Slope: 5' Notes: Los Original Plan: Approved Not Approved ❑ Date: /a 3 , t. Revision 1: Approved ❑ Not Approved ❑ Date: Revision 2: Approved ❑ Not Approved ❑ Date: (Review Continues on Page 2) Page 1 of 2 City Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @tigard - or.gov) ❑ Street Trees ❑ Protected Trees Notes: • Original Plan: Approved ❑ Not Approved ❑ Date: • Revision 1: Appro - • • Not Approved ❑ Date: Revision 2: :.proved ❑ Not Approved ❑ Date: ' Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @ tigard- or.gov) ❑ Conditions of Approval Prior to Issuance of Building Permit Notes : • Original Plan: Date Sent to Applicant: Revision 1: Date Sent to Applicant Revision 2: Date Sent to / Ap li cant Okay to Issue Permit: Yes No ❑ Date Routed to Building: • Page2of2 • 004 Street trees Zelkova ! Elev. 200 " 400 Serrata 2" 5 Z J 3 O Street trees TIIio { ``' �- , Elev. 200 Ameranana 2 tikViiIP) �.� S TORM ESMT I \� 6, 28 S d / Ge F ¢ fe › . � a s c1- RE s) ''a � ti G ° ,0� �� � � 1. ee l 0 8� '1L JtN DIMS O N ii / ,'► 03 A 0 ., �`����j A v. 205 ' Elev gi. . fill 15 Ul 0 0 .ei . N V a MU MO °. C:1 .....f 7 4 et `t ` Elev. 205 0 SEE LOT 18 _ i co VCE DETAIL:, ; °� ` �= Elev. 204 ' `_� c I a O - - 6 - ` -- -- ___ o . ° . 0 -, . Elev. 205 ' 39 . 7 p Elev. 206 SW 9 0TH T. ER TZ CONSTRUCTION C INC. HOME SQUARE FOOTAGE MAIN FLOOR = 1154 SQ.FT. BUILDING UPPER FLOOR = 1555 SQ. FT. CUSTOM HOMES SINCE 1977 01 (503) 692 -3390 TOTAL = 2709 SQ. FT. /3 _— SW 90th GARAGE = 421 SQ.FT. Lot 18 EDGEWOOD EAST SCALE 1• = 20' GERTZ CONSTRUCTION COMPANY INC. PLOT PLAN 9/17/12 • 57 - oo a 5d RETURN RECORDED DOCUMENT TO: CITY HALL RECORDS DEPARTMENT, CITY OF TIGARD 13125 SW Hall Blvd. Tigard, OR 97223 JNDIVIDUAL File No.11Q4 City of Tigard O'Mara/Edgewwod..Sewer Reimbursement District No. 3 1Deferral Agreement City of Tigard Resolution No. 03 -55 provide that payment of certain portions of reimbursement fees imposed on lot owners who have connected to sewers construction through City Reimbursement Districts (Tigard Municipal Code Chapter 13.09) may be deferred until the lot is developed. The undersigned owners) of the real property described below do hereby acknowledge deferral in the amount of $21,832.00 and record their agreement to pay this amount to the City of Tigard upon partitioning or otherwise, developing the property in accordance with Resolution No. 03 -55. The obligation to pay this deferred amount transfers to purchasers upon sale of the real property. The real property that is the subject of this agreement is within the Edgewood Plat Washington County (Tax Lot 2S102DC lot 01400, addressed as 8990 SW Edgewood St, Tigard, OR 97223) and subject to• land use decision Sub 2007-13. IN WITNESS WHEREOF, I hereunto set my hand on this z9 . day of Jt., n e , 2009 /< ae4:7 6 -.14 (, .. /4A.) c,e.c Print Name Prim e Signature - ignature o Address Address Ti ar • OR ' 7223 Tigard, OR 97223 - I STATE OF OREGON ) - i County of Washington ) This instrument was acknowledged before me on f O7 2 .. 9 / o 7 (date) by: e (name of person(s)). • OFFICIAL SEAL �) 1 ` . ) . a. • KRISTIE J PEERMAN ( Notary's Signature `� NOTARY PUBLIC- OREGON My Commission Expires: Q u.t' i 8 , .20/ 9i 0 COMMISSION Na 419242 O v MY COMMISSION EXPIRES JULY 28, 2011 Accepted on behalf of the City of Tigard this , q ^ day of J c.c i/e._ , 2009 1J I - l / lI_/___ City Engine I NO CHANGE IN TAX STATEMENT rA --c ! Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 13762 SW 90TH AVE, TIGARD, OR, 97223 Residential - Master Permit 242 Interior shear walls 03/19/2013 00:00 MST2012-00250 PASS Violation Summary: Inspector Contractor STREET TREE m., . TI GARD CERTIFICATION I, ,giev4t RAA tfe-- , owner/agent for G e va z (PLEASE PRINT) (PERMIT HOLDER) do hereby certini that the following location meets City of Tigard land use and development standards for street tree installation and is consistent with the approved site plan. PERMIT NO.: M 12- - O o 5`o ST1 E ADDRESS: /3 6-w �-j o T Akre_ SUBDIVISION: 4 v d / LOT#: /' b ' SIGNATURE: / �, �_ DA1 E: /D/ (OWNER/AGENT) RECEIVED & �� VERIFIED BY: DA 1 E: O7 (C IY RD) ❑ Tree location verified per approved site plan. I:\Building\Forms\StreetTreeCertificate 05/30/2012 ms T2_012- - "2-5° Oregon Residential Specialty Code R318.2 MOISTURE CONTENT ACKNOWLEDGEMENT FORM I, .8/1440 12A,c1-C__ , am the general contractor or the owner-builder at the following address: Site Address: 13 -, 2 J t/ 7'/4 City: 4 Permit#: /2_ ^ D O D.—S-0 Subdivision/Lot#: ,/ I /" and/or Map and Tax Lot#: • To conform with the 2008 Oregon Residential Specialty Code (ORSC), Section R318.2 and OAR 918-480-0140, I am notifying the building official that I am aware of the moisture content Requirement of ORSC Section R318.2 and have taken steps to meet this code requirement. [Section R318.2 is provided for reference]. R318.2 Moisture Content: Prior to the installation of interior finishes,the building official shall be notified in writing by the general contractor that all moisture-sensitive wood framing members used in construction have a moisture content of not more than 19 percent by dry weight of dry framing members. Signature: Date: V/0....5 General Contractor or Owner-Builder I:1Building\Form\RES-MoistureSensitiveWood.doc 0925/08 Ai 5 Y 2v 12-or 2-5`' Oregon Residential Specialty Code N1107.2 HIGH-EFFICIENCY INTERIOR LIGHTING SYSTEMS Permit No.: 2 e rz , ey oa5 O Jurisdiction: Site Address: /3 7 6 2 c J T /0fC- Subdivision/Lot#: t - and/or Map and Tax Lot#: By my signature below, I certify that a minimum of fifty (50)percent of the permanently installed lighting fixtures in the above mentioned building have been installed with compact or linear fluorescent, or a lighting source that has a minimum efficacy of 40 lumens per input watt. (Oregon Residential Specialty Code N1107.2)1 Si g nature: / Date: 6//0//3 wner/General Contractor/Authorized Agent Print Name: ) 12AII4D RdC_ ORSC Section N1107.2.High-efficiency interior lighting systems. A minimum of fifty(50)percent o the permanently installed lighting fixtures shall be installed with compact or linear fluorescent,or a lighting source that has a minimum efficacy of 40 lumens per input watt. Screw-in compact fluorescent lamps comply with this requirement. The building official shall be notified in writing at the final inspection that a minimum of fifty percent of the permanently installed lighting fixtures are compact or linear fluorescent,or a minimum efficacy of 40 lumens per input watt. I:\Building\Fonns\RES-HighEBiciencyLighting.doc 07/01/08 s T-zo I 2_- az, Your home has been professionally iinsulated to provide .:. . . L.. _ .,. a guaranteed thermal resistane ce. .. 0• HomEowNkxs N.-LuE . 0°0 ' ADDRM (37 3,_ (1,4) 96'6, .:. - cm- 179444 SIAM 0/Z 7J/' • 14::: RECORD OF INSTALLIMON MOW=WOOL. SAWS AND ROLLS - . I 0 (. • j: i f m c( i*.rorxi s-ntcnox i i ..If Rt,.N.nto nr c _s oor. 7 . AEA InSuin DErnit TP:ou iqru Unm ;49 IN. si2t Fr.OF lEs 0 0 AREA INSI`LOUD / O(T4-Es-rourcu R-VALUE OF 21 Lv. ve,w_, P. PitErit m/s iMill.4170•N . 0 I • 1.. 9,1'Fr- •: TtiviliNF■s or Ixs11.xru,s_ad_ i„E.,,F l'itetairs Ixsuktrn ix Lx Arni: Bruits 30 so.Fr. 0 R-VAiri.OF Ixtal_A-rnix 0.° -P--- • tx. f c.).FE 4 CLIMATE PRO,BAG WEIGHT-MS LB.NOMINAL R-VAWE MINIMUM SETTLED BAGS PER MAXIMUM MINIMUM WEIGHT 01 INSTALLED THICKNESS IOW SG.FT. NET C.OVERAGE PER SQ.FT. THICKNESS . . . 1. . . . 0 W.obtain an lumallnl Flowed The numb's ty.Imo Conerals44 17trarigid/or oeiinsulation lust:Winn thickum ollts psi-1W°sq.ft.-of this bag should sq..p.If insialltd <00 u•sisiann- should nal long in stilling natant,sltonld nol not cover 'insulation should IR/ttl: br Irss don,: has torund: lo-less dtan: _nonr than: not In-lesv thine I I 4.9 in. 4_8 in. 6.1 16•-- 1.IL (1.155 lbs. 0 13 5.7 in. 5.6 in. 7.2 1:-1.`,1 sq.ft. 0.185 Ills. kij 0 .• 0 ,9 99 26 30 :18 8.1111. 9.3 in. 10.9 in. 12A hi. 15.3 in_ 8.0 in. 9.2 in. 10.7 in. 12.2 in. 15.1 in. 10.8 12.6 15.1 17.6 V..9 93 sq.li_ 79 sq.IL 66 sq.ft. 57 sq.ti. 0.276 Ms. 0.390 lbs. 0.385 lbs. 11.,150 lbs. 0.583-11xs. 11 kt 1 i 1 4-4 49 (10 17,1 in. 19.1 in. • 22.8 in. 17.3 in. • 19.0 in_ o9 7 in. 26.9 30,4 38.2 44 sq.rt. 37 sq.ft_ 33 sq.It . 26 sq.11. 0.686 Rm. 0.774 112S. 0.974 tbs. 00 L•SULYTION ._TOR StMYRE •Ki/41- ..04-)a;, D yr E SZ.../?//-3 .0 • •' Cow. Builders'Imitation ■ - - I - HOME BOLDER SIMATI_IRIE ..) CONIP.ANY 1 ,, Amass 2763 NE RIVERSIDE WAY.PORTLAND.OR ADDRESS PHONE • DATE 757-6283 PHONE 1 . 0 • Az. .0 . t , 5 A va • - • , gi JOhnS Manvffle • 1:0:-IM Ma ... V•MCC irms Um:lb . Z- - •- _'.:._• - '- S.... - -• - '..:.• - .:', -:.' - ''-'•,: %Vi-OtrW -.----- .:•:.:.:15 ws-.:.:a Rc.3.;.-5::3.Z.'smir.CC 5:1277-Elm..-..r.x.;:r4=zr,Fcr m70:n••=-s:7:r "5- ;-&:',I•r-,Lv-sm • . e. . Feb 12 13 03:38p BRIGHTEN ELECTRIC 5415497213 p.1 Electrical Permit Application City of Tigard t51-2.01Z— � �sed a » lit Permit No.: 1- �Srola -aPa • 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review Phone: 503.7182439 Fax: 503.598.1 O Date/By: Other Permit TI G n It D Inspection Line: 503.639,4175 Date Ready/By: ler is. 85 See Page 2 for Internet: www.tigard- or.gov F L L1S�i L' ip 1 4 Suppkmental Information TYPE OF WORK I/ PLAN REVIEW 6New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plaits iv/items checked below): I rJ CI Service or feeder 400 amps or more ❑ Building over three stories. Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION r ITY OF I exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 14 I- fa and 2- mily dwelling ❑ Commercial/industrial `' ' fsry�(jqul amps for an other installations. buildings. 1:1 Multi-family 12 Master builder ❑ Otherr • � L/ � i � 1 � lUJ ISION ❑Fire pump. ❑ Installation f75 KVA or larg ❑ Emergency system• larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E", "1 -2 ", "1 -3 ", Job no.: Job site address: �J 7 e' 1 ' ' .30 /� p I OOHP or more. «Nv y. 3 / J �1! / t uC . ❑ Six or mar residential twits. l3 Recreational vehicle parks. City/State/ZIP: t et ay-o) 0 g 9 -7 ZZ c ❑ Health-care facilities. ❑ voltage for mare than Li 1 ❑ Hazardous /op 600 volts ions 600 vo nominal. J 1 SuitelbidgJapt. no.: Project name: 13 Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Deneripetan I Qty. I Fee. I Tots/ I • New residential single- or multi - family dwelling unit. `II Includes attached garage. Subdivision: ealt'.u/00U Lot no.: I g 1,0005q. R or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 • 1 Tax map /parcel no.: Limited energ% residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 �y n .—YYl { / Q 7 &th i r Oak/ l 1,n ` J Limited energy, multi - family 75.00 2 ONLY1 e eJe CCU. l f . y A residential (with above sq. R.) J / Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 )1 r1 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 d<*c..,, N ame: 601 amps to 1,000 amps 301.04 2 Address: _ Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or % City /State/ZIP: relocation '4 Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 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 ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 • Contact name: - branch circuit Each add'l branch circuit 7.42 2 • • Address: Miscellaneous (service or feeder not included) Ci /State/Z1P: Each manufactured or modular 67 84 2 tY dwelling, service and/or feeder Phone:.( ) Fax: : ( ) Rr anne ct only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuigs) or limited - energy Business name: 6 v.- i Jh+evi e` e c hr c LI--L panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: F. 0 box 2_23 co Additional inspection (I hr min) 6625/ hr City /State /ZIP: S ( 5k�5 t f) 2 97 ! 5 J Investigation (I hr min) 66251 hr Industrial plant (1 hr min) 76.18/ hr Phone: 6 1 ) S1 L0 _`72-I C) Fax: (54 1) 5Vel - 2-13 Inspections for which no fee is 90.00/ hr specifically listed CA hr min) CCB Lic.: 132_22 24 Electrical Lic.: ... 4 g- - 3 (4 Suprv. Lic.: L/b k,'75 ELECTRICAL PERMIT FEES Subtotal: Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Lai ' un3 D surcharge (12% of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 days after It has been accepted as complete. Print name: Date: • Number of irspect(ons allowed per permit. 11Buadmg1Permibu ].C•PeemitApp.doc 07/01/10 440.4615T(1 I AS/COM/w® ■ 1 r