Loading...
Permit �, CITY OF TIGARD MASTER PERMIT ell ! I - COMMUNITY DEVELOPMENT Permit#: MST2014-00126 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/12/2014 Parcel: 2S114BB01100 Jurisdiction: Tigard Site address: 10185 SW SERENA WAY Subdivision: PICKS LANDING NO.1 Lot: 10 Project: Chinn Project Description: Remodel kitchen,dining room and living room BUILDING Floor Areas Required Setbacks Required Stories: 0 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: 0 Third: 0 sf Right: 0 Detectors: Total: 0 sf Value: $80,000.00 Rear 0 PLUMBING Sinks: 2 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Tubs/Showers: 0 Garbage Disp: 1 Water Heaters: 1 Water Lines: 0 Drains: 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 Tvoes Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 1 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: 5 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 - 0 Owner: Contractor: CHINN,FRANK L TR& KROPF CONSTRUCTION WEST Required Items and Reports(Conditions) REBECCA A TR 6025 N WILBUR AVE 10185 SW SERENA WAY PORTLAND,OR 97217 TIGARD,OR 97224 PHONE: 503-705-9343 PHONE: 503-867-2822 FAX: Total Fees: $2,060.05 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. ATT • regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- -0010 through 0 952-0r :090. u may obtain a copy o the rules or direct questions to OUNC by calling 503.23 .19:7 or 1.800.332 2344. Is ued By:(\ • Permittee Signature: /• __.J\ 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. Building Permit Application Residential .(ECEIVED FOR !�OFFICE: I SE ON I 1 Received Cam"'/ Ill/0ey x 711 City of Tigard Received alit / Permit No.: -DOl - •• 13125 SW Hall Blvd.,Tigard,OR 972r 4 2014 flan Review Phone: 503.718.2439 Fax: 503.598. UU `t Date �' /�— G f�cher Permit: Y T I G A R D Inspection Line: 503.639.4175 Date Ready/By: of `r T % 4,2 tuns See Page 2 for Internet: www.tigard-or.gov CITY OFTIGARD Notif ethod: 0 /I Supplemental Information BUILDI'VG DIVISION L._--- VII_ '`� `-`- TYPE OF WOR)� REQUIRED DATA:1-AND 2-FAMILY DWELLING ®New construction ❑Demolition Permit fees' are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ®Addition/alteration/replacement ❑Other: equipment,materials, labor,overhead, and the profit for the m CATEGORY OF CONSTRUCTION work indicated on this application. 'Ns ® I-and 2-family dwelling ❑Commercial/industrial Valuation: $80,000 'R❑Accessory building ❑Multi-family Number of bedrooms: 0 ❑Master builder ❑Other: Number of bathrooms: 0 JOB SITE INFORMATION AND LOCATION Total number of floors: 0 w Job site address: 10185 SW Serena Way New dwelling area: 0 square feet ?- City/State/ZIP: Tigard,OR 97224 Garage/carport area: 0 square feet Suite/bldg./apt. no.: Project name: Kitchen Remodel Covered porch area: 0 square feet r. Cross street/directions to job site: SW Picks Ct and SW Serana Way on NW corn Deck area: 0 square feet Other structure area: 0 square feet ~ REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no Permit fees* are based on the value of the work performed. r• Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all equipment,materials, labor,overhead,and the profit for the ,12 DESCRIPTION OF WORK work indicated on this application. I.A Renovate Kitchen,dining room and living room Valuation: $ Existing building area: square feet (, New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: ts- Name: Frank and Becky Chinn Type of construction: Address: 10185 SW Serena Way Occupancy groups: City/State/ZIP: Tigard OR 97224 A' Existing: Phone:(503)705-9343 fax:( 1 New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: Kropf Construction West 1�`a"Kf°r°f"s`hed�`1e� Structural plan review fee(or deposit): Contact name: Levi Kropf FLS plan review fee(if applicable): Address:6025 N.Wilbur Ave Total fees due upon application: City/State/ZIP: Portland OR 97217 tt Phone:(503)867-2822 Fax::( ) Amount received: I.�Coao .Q q E-mail:kropfconstructionwest(agmaiLcom PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* - Co • ercial and residential prescriptive installatio t CONTRACTOR roof-t., mounted Photo Voltaic Solar Panel S •m. Business name: Kropf Construction West Submit t : 2)sets of roof plan with co.• tion details and fire dep. •nt access,along . • the 2010 Oregon Address:6025 N.Wilbur Ave Solar Installation •• tally '•.e checklist. City/State/ZIP: Portland OR 97217 Permit Fee(Intl • .lan review $180.00 an, •'minis • . e fees): Phone:(503)867-2822 Fax ( ) State su • arge(12%of permit -. $21.60 CCB 1ie.. 188694 la/IS//5 Total fee due upon application: I .0 Authorized signature: t / This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Levi A.Kropf I Date:8/4/2014 I *Fee methodology set by Tri-County Building Industry Mechanical Permit Applicatio F,n FOR OFFICE USE ONLY City of Tigard "" TV ED i/ Received Permit No.: g DateBy: Er 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit: Inspection Line: 503.639.4175 l 2 Q�4 Date Read 3��s' la See Page 2 for TIGAR[) Internet: www.tigard-or.gov Notified/Method: Supplemental Information CITY OFTIGARD TYPE OF MUM DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction Ef Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 2 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION ileating/cooling: SAM QE- A Air conditioning 46.75 Job site address: jp/ 'S-S11 v .K►=/0 A A y Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: /1-S A, a (Z q a 9 `( n Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: i;(�� Kett( Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: ,SbJ S L>�� 'J Al S P rc..KS 6_ - 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 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 / Flue vent for water heater or gas ��S �(( ActiJ A.:6S V,,."-1- fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 121 PROPERTY OWNER ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: J j-..{L 7 k_ 614.,,,,, Range hood/other kitchen f • T equipment I 33.39 Address: (0(es— S LA.) S.eitneA. (A- 1 Clothes dryer exhaust 33.39 City/State/ZIP: � "'' D(L a';- �,A Single-duct exhaust(bathrooms, T" toilet compartments,utility rooms) 23.32 Phone:(0 v ,p.s II'1 Fax:( ) Attic/crawlspace fans 23.32 kg APPLICANT ❑ CONTACT PERSON Other: 23.32 ;/u E) t Fuel piping: Business name: lc 1 ��C i,„ (A)Q�(- $14.15 for first four;$4.03 for each additional Contact name: lam) , A,c •Sol (P Furnace,etc. Address:649�s ti , ,�J ,. lb ter- N A-- Gas heat pump(� p Wall/suspended/unit heater City/State/ZIP: 4 0r LA v! ._ 401 i} Water heater Phone:(SO)g(o } - c?..)6,),� Fax: :( ) Fireplace Range E-mail: ( t"V Cb---5 k 1./c.(-,y,"l,e->k- P^a,r 1.c an n.. Barbecue K CON TRA R e) Clothes dryer(gas) Other:Business name: 20 cr 0,.,s\ >T `o L si MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) ( ) Fax:( ) Phone: State surcharge(12%of permit fee) CCB lic.: /b b 1Y7LI I"/r s(47 TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: `h` . Fee methodology set by Tri-County Building Industry Service Board Print name: / Date: 1:\Building\Prnnits\MEC_PermitApp_040113..oc 440-46177(1 1/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $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. L\Building\Perm its\MEC_PermitApp_040i I 3.doc 2 Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE USE ONLY City of Tigard Received Permit No.: Date/By: 14 . " 13125 SW Hall Blvd.,Tigard,OR 972p„,, 4 2014 Plan Review Phone: 503.718.2439 Fax: 503.598 tl Other Permit No.: Date/By: Inspection Line: 503.639.4175 Date Read B Jur s• 63 See Page 2 for T I V A R D Internet: www.tigard-or.gov CITY Notified/Method: OFTIGARU - Supplemental Information TYPE OF l*t�•DIVISION FEE* SCHEDULE ❑New construction ❑Demolition For special information use checklist Description I Qty. 1 Ea. I Total Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 r-"-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: /Q - 4 J N t IN� Catch basin or area drain 18.76 Job site address: / / °� � Drywell,leach line,or trench drain 18.76 City/State/ZIP: 11-5A14.05 6 2 Q:aa Li Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: 1441,,f.„,‘ A.,..dCA,I Manufactured home utilities 50.03 Cross street/directions to job site: S NP k r 5 hi trfLS-C>` 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: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 .- - ( ` ,/ t ' Clothes washer 25.02 ()(ati Sr• _1 0-A& 5I C.rA/�- i t 14.114 0.-r-sl Dishwasher I 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 DI PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 d Fixture/sewer cap 25.02 Name: F2.;‘11L ; het Y C grALit . Floor drain/floor sink/hub 25.02 Address: /0 as s_.s c.,..) S 2F_N4. kkiNti Garbage disposal 25.02 City/State/ZIP: 4A4.0 c9 P. q-/- a y Hose bib 25.02 Phone:(SQL) 76s- - q 3,1 S Fax:( ) ice maker 1 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51 E-mail: Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater I 37.52 Business name: t 7& y 4-8--- / A�Lu,.,-l4,,x Water piping/DWV 56.29 Address: /0 /5c,y (1v� Other: 25.02 City/State/ZIP: C( -C/j\/1T N/-.5 / G 12 F70/5-"" Subtotal Phone:( U -3 y 7- Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: ,. 1:5-6.i t t1 ,!'t Plumbing Lic.no.:3•- Oro/95 State surcharge(12%of permit fee) / Authorized signature: ?c ,���r 7/1//7 TOTAL PERMIT FEE Print name: ` / Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Pennits\PLMU•PennitApp.dac 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 Valuation: Permit Fee: Storm&Rain Drain-1st 100' 62.54 $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 Inspections 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 OAR9I8-780-0040. 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 non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice Mach./Refrig.Drains Comments regarding fixture work: Oil Separator(Gas Station) Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -Bradley -Com/Scrv/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 Water Closet-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 RECEIVED 08/12/2014 10:41 09/11/2014 21:38 5035g8196RECEIVEI) CITY OF TIGARD PAGE 01/01 Jlee1ricdl Permit Application A U G C y � n S l /l/ pia 1 _640/.267 City of Tigard 11111,� + 131:5 SW Nall)tivd.,TI : d t: t Plan Review Pane 503.7IS 439 sflr 501595. ' .r1 b� 1o $k RsImad Petmlm ti: er Rc n dM age 2 for — – Inspection Lino: 503.63'.• i ` Interne www_tigrd-or.gov BI ormO1 }jAk r{. Na M 9upphReptal{efoerat nn Please cheek a 1 of apply(agbmlr$nda o p one wliecma rROCke ❑New construction Addition/altcrStionlrapl oeemcnt CI sc yi.4 or hod&400 amps or mono ❑RuMing ova-throe mall Demolition ❑Other: whomnic ay.iIable Noncurrent O Marinti+sad boeq'ards. seeacds 10.000 empa at ISO volts or D Floating buildings ler,to ground,or exceeds 14.000 ©Commorcial•ua nar:eultural mot'' 1-and 2-family dwelling ©Commercial/industrial []Acces try building amps for another intecdtione buildings. D Multi-fmnily ❑Master builder D Other ❑Fire pump. 0InsmllatIMr of 150 KVA or . '#3Sl$S1'1C" 111o111Vtitroteri lfdr J'1 nYm DEmcrgcnay ay atom. Iaigvr sw.,r�tely derived ---." ❑Additionof>r.,-motor loudof Mira, lob/t: lob site addre;e: lord's-S -SE1 -ok 11 loons orators. CI"A.'E','l•x t 3 Qa�u S!x or err :c;dental cntn. Recreation. City/State/ZIP: t ��p� 1 1 c Health-care facililiaa- 0 Recreational wMete Catuv. `f!T`,'s= ❑Harsrdous locations, ❑9apply Volta`o for moti Than suite/bldg./apt/apt d' Project name: },1, L 6m1 vnhs nomitt-,l. Q Snrviclou fouler or mero, Cross strcct/dirceticrostojob site: 2C..J SX.P.PAJ, ek.)h1P -4-CAA‘ E 9CJi 1 Dori..a, ti'!JiniMMINl3i�l0 Nil".re+idrntial eingk-or multi-family dwelling unit. Subdivision! Lot$: Includes tlttAChed gpr9Rc. 1.OD0 nq.R or 1!ss 169.54 IMO Tax map/parecl#: Ea.odd'I no sq.R.or portion IIIIII 33.92 p . . • • ,ptscinrrtly.':04"�PVtPV T{ - Limited energy,rca dcnnal M 75 OD II with Aare-•.'t y Up �L It �t t-� C 11 f Z I r Limited energy.muhi-family 111 75.60 rciodcrttlal with above^ .R. 0 Renewable Entrty • P -e 2 — PRQP�'11LTY (WNER - F_1 1 1tIRNT wises or feeders iustsll don Alteration srtd/nr rcIodtion �, Namc: F.,....._lL t y y 200 amps of Ins, 100.70 OMH J c 201 amps to 400 amps 133.S6 M Address: JO t�s`,S c,) Lre- 401 amttc to 600 amps 200 24 � City/Statc/ZIP: 'r. �T I■ 0 k.Q_7 u 901 amps to 1,000 amps 301 04 I Phone:( oA) , - ' 1'0x:( J„ ) Over l,000ampoorvolt. 553.26 2 - Tentporsity services cat!coders Installation_*Iteration,and/or V 1?marl! rclornOon q' _ owner installation:This installation is being made on property that l own which is not 200&flops or Inss 59,36 I `.4i intended for sale,lease,rcrtt,or exchange.according to ORS 447,449,670,and 701.. 201 amps to 400 amps 125.08 —13 I Owner u naturc: 'Date: 401 amps In 599 amps 188.54 El t� Branch circuits-new,,alien t,ut .r • teal&n . r . nel tYPt:iCAl9 C r Q CONTACT P 40N A.Fee for branch clreulot web V 13u9ine99 name: i O fe,•slp o,„ o,„ j aboveacrvicc or feeder fee, .7 41 welt branch circuit Contact name: ' Ai A . ( ` r B.Fee for branch circuits wit awl -. scrvtcc or feeder fee.(list Sy,t e /�ddresa: G,,.�s .co ,I y�wM branch circuit 61ch add'I branch olrcult 7.42 Ng City131ttte17.IP�� . 1,10— -- MiceeIlantoua(service or!eerier not included) Phone:( S-°, a C,4_ a$8.,1, ,__ Fax'.( ) Each mantdhctured or modular 97.94 2 i dwcllm- Berries and/or feeder Email: w,, LP-4 mt)1 4,ayF-- - 1.4]*\ Rcconnactonly 67.84 2 ., '' -- Al i'• Pump or irrigation circle 67.84 El Business name:. I. ' IC, Aa Slgnorauttinclighting ( 67.84 El i Signal circuit(3)or limrtatnelgy ❑ Rte}.ate 2 Address: 1.6 ( t - ' Y( . lei,alteration or of taroton.■ CI iStatrl7lp. ,. _ Est h additional inspection over snlowabl• -t • ,fthc.lrtrvt ty / -a 6.1 Additional lnspeetion(I hr min) 1- 6625/hr Phone:(S(. ) )- 2— 6,0., Fax:( 3 ) ZS 3 —Sg3 / Investigation(1 hr min) 0.25/hr Email..&I-4,f Induattinl plant 1 hr min NUR/hr , il t re , L • Incpactions for h no fee u . 90.00/hr ■ CC13 Lic.:i 3 ,t.-r Etc mica]Lie.: 6,,/l pi c., Suprv.Lie._Lig V__mac` 4'• Iv 110ei %hr min Suprv.Electrician signature.required: /)} _ Subtotal. Print name. l� Date, I .,/ ❑Plan Review Required(253/4 of permit fee): P �5- I�// 1 Stro surcharge(l2%of permit fee: Authorized at nature: TOTAL FLRMIT FEE: "e i - Thb perr.tt.pptkatloe cepixe it a permuit to rat obtelned within 180 Print name: I Date: dor!.tir.it hid berg acs meal..enmplct4s Number of imspeclioms allowod per pormit I'Svildinq➢ertmts\ELC Perrni•tApp-,LR.,ERRdocr Rev oat/linIa 44646151'(It/OS/COMP' -R Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10185 SW SERENA WAY, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical final PASS MST2014-00126 Jeff Grove Violation Summary: Inspector Contractor