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Permit ,, CITY OF TIGARD MASTER PERMIT N11 I COMMUNITY DEVELOPMENT Permit#: MST2016-00026 T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/23/2016 Parcel: 2S109DA12400 Jurisdiction: Tigard Site address: 12987 SW KOSTEL LN Subdivision: SUMMIT RIDGE NO.2 Lot: 113 Project: HERNANDEZ Project Description: Converting existing crawl space to a bedroom. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 1 First: 0 sf Basement: 432 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 1 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 432 sf Value: $32,000.00 Rear: 0 PLUMBING Sinks: 0 Water Closets: 1 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs/Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell-Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 0 Furn<100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 F u rn>=100 K: 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'I 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: Y BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R-3 432 Owner: Contractor: HERNANDEZ,SAMUEL C HELP GROUP INC Required Items and Reports(Conditions) 12987 SW KOSTEL LN 10006 SW CANYON RD TIGARD,OR 97224 PORTLAND,OR 97225 PHONE: PHONE: 503-244-8232 FAX: 503-246-2167 Total Fees: $1,721.99 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 ' accordance 'th 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: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 95 001-0010 through OAR 95'-r t -00.0. •u may obtain a copy of the rules or direct questions to OUNC by calling :13.232.198 .3.232.198 r 1.800.332.2 . I ued By: k..... / �� Permittee Signature: �,a,,, itiA1 bleO%.tr1r 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. r I / ,t.St1.Yc4 �/ i i ) ) V r Building Permit Application 3 - ,....:` Washington County` Phone: 503-846-3470,Fax: 503-846-3993, Inspection Request: 503-846-3699 oerco1.4 155 N. 1st AV, Suite 350,MS 12,Hillsboro, OR 97124 1Af www.co.washington;or.us *a r r.,_ A ,, t1. ,_ q ,l ±- diol/„/ � Permit# els-Tax,� v 1�iorTYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING 0 New construction 0 Demolition Permit fees*are based on the value of the work performed Indicate the value(rounded to the nearest dollar)of all Iii Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION FEB 11 2016 work,indicated on this application. Or Valuation f .Qai D -- 14 1-and 2-family dwelling ❑Commercial/indts"1�l 1�/ F�1 lrH 0. Number.of bedrooms: ❑Accessory building 0 Multi-family BUILDING DIVISION Number of bathrooms: JOB SITE INFORMATION AND LOCATION V� fw �J 7'�C r r )(„ eE•(,yiTotal number of floors: Job site address: City/State/ZIP: 1 l idc/VcI, V . tiC4 ' New dwelling area: square feet i __ l „.....,..2„.,„.....,..2„. Garage/carport area: square feet Suite/bldg./apt.no.: Project name: v#61h`!Vn) ly Covered porch area. square feet Cross street/directions to job site:pi(7SW mer Y ec d i - 5+0 � Deck area: square feet rQe N �r,/` �� Other structure area: square feet Plan No Reissue: Yes CI No E 1 REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot no.: Permit fees*are based on the value of the work performed. Tax map/parcel no. Indicate the value(rounded to the nearest dollar)of all DESCRIPTION OF WORK equipment,materials,labor,overhead,and the profit for the /'�,,�Nw�-) �y_1 j� �ny1 /� �/ work indicated on this application � OleVk .'ei 1 'e.- GL I t' L)fe pe .P 2kV / RJa"r V't Valuation 124,5e p(\f- Existing building area: square feet AL PROPERTY OWNER ❑ TENANT New building area: square feet , Name: j ct VI,,LI A H eN /tat fie'- Number of stories: Address: l Vete1 SW544. 1,..e. Type of construction: City/State/ZIP: 'r(}�(�,r'C Let 1,‘,..e.2 Z Occupancy groups: Phone:mil ) 7 „ 4'f 7,(.1 I Fax:( ) Existing: 11 APPLICANT ti CONTACT PERSON New: Business name: /-j ,6,, (. 9. Co rbio t in C----t NOTICE Contact name: ✓✓je r e,vk. ( -P Lo e Z,„ All contractors and subcontractors are required to be `' licensed with the Oregon Construction Contractors Board Address: )000 c 2 _ )- .C1.14- (/� IZ°Cd l20 under ORS 701 and may be required to be licensed in the City/State/ZIP: p 0 y'+-ta,1,d, r i 7 Z-. jurisdiction in which work is being performed.If the applicant is exempt from licensing,the following reasons Phone:( ) 2,4 4. e23 `Z.. Fax::( ) apply: E-mail: tk O Sika-(? (26.:5,..,-.. c vt-- CONTRACTOR Business name: H ,e, L , e , & t VI-C-- BUILDING PERMIT FEES* Address: ( apt) 6 45J ..,! C a e i U L4 L'k Please refer to fee schedule City/State/ZIP: ov.f1/� t Q Q t , ' Fees due upon application `"�) Phone: Fax: ) Amount received $ r x"03) 2,` 14 3-L3 Z.• ( 3 Scf G. -zr 6-'] CCB tic.: 1 e 5 r 1.f 111.51)7 _Date received: Engineer: Architect: This permit application expires if a permit is Address: Address not obtained within 180 days after it has Phone:( ) Phone:( ) been accepted as complete. Email Email: * Fee methodology set by Tri-County Building Authorized o, Industry Service Board — signature. -. 440-4613T(8/06/COM/WEB) Print name: .�... a � 14 l U`nk...,C7 G d,Date: / A.P/1/ f YOM�O Mechanical Permit Application P A Washington County www.co.washint"ton.or.us Inspections: 503-846-3699/www.co,washington.or.us/piro "'�,,,,.. 155 N. l st AV,Suite 350-12 Phone:503-846-34 Email: lutbldg@co.washington.or.us Hillsboro,OR 97124 Fax:. 50 '.;fir ° Goo Land Use Approval: 00.4. Project#: Permit#: TYPE OF WORKCOMMERCIAL FEE SCHEDULE — USE CHECKLIST 0 New construction Cil Addition/alteration/replacetn ,,� ��16 Mechanical permit fees are based on the value of the work performed Indicate ❑Demolition ❑Other: � he value(rounded to the nearest dollar)of all mechanical materials, " ��t1 meet,labor,overhead,and profit. CATEGORY OF CONSTRUCTION I." �� ' l,� �`� Value:$ 14 1-and 2-family dwelling ❑Commercial/industrial ■*• •.,, Y';, t big ""- • RESIDENTIAL EQUIPMENT/SYSTEMS FEES ❑Multi-family 0 Master builder ■t.o ter: For special information use checklist. JOB SITE INFORMATION AND LOCATION Description Qry. En. Total Job site address: i tG 6' 7 451„J I .„l Lap-e Heating/cooling FurCity/State/ZIP: �/(9 Q(, /, bit t i-7�Li Air con,ilioncl ductwork,rspn vent,eand d)lin925 Air conditioner(site plan required) 9 25 Suite/bldg./apt.no.: Project name:T'U41YVat.,'1-‘ Heat pump(site plan required) 9 25 Cross street/directions to job site: S 0,e 1 7;T, \€1 /2� Duct work,alterations and additions 9 2S p ::// Hydropic piping system 9 25 -f-t 5 w Gree 1,-4-e c 9 Dow 7 • ,c'� Boiler.incl.vent** State Permit Required JC(A,4 (/k�l rj�c3 �l Gas suspended,hedetci nn-wall,in-duct, J(� 7-' etc.not incl vent. 9 25 Other: Subdivision: Lot no. Other fuel appliances Water heater 9 25 Tax map/parcel no. Gas fireplace/insert/stove 9 25 _ DESCRIPTION OF WORK Gas log/log lighter 9,25 Pool or spa heater.kiln* 9 25 "i_ be s.t •��OI`-I ---c--0-1/\t t/kWood/pellet stove/insert 9.25 Wood fireplace 925 Chimney/liner/flue/vent w/o appliance 9 25 Oil tanks/gas/diesel generators 9 25 Other: PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation rL Range hood/other kitchen equipment 9.25 Name: Sai Clothes dryer exhaust 925 Address: 1 Z',a ! SO F''`��,i-e, I tot � Single-duct exhaust(bathrooms,toilet compartments.utility rooms) I 9.25 City/State/ZIP: -,--,-9,,, / 07, 6, .C- Attic/crawlspace fans 9 25 ! Whole house ventilation or Radon Phone:071 ) -? e7 Z q 1 Fax:( ) mitigation 9.25 APPLICANT Other: t Business name: i C, , , t , aro-) 1 rri c - Fuel piping $9.25 for first four;$1.25 for each additional Contact name: f 3.eve, �� By r✓ Furnace outlet C Address: d 000 6 Sof 6,4,kL 1.i I Wall/suspended/unit heater By outlet# City/State/ZIP: P0_e_r,c cQ �Jr � cl WaterFireplace/log #e/tor By outlet � ' t lighter/gas log By outlet# Phone:(5.-t0)) Fax:( ) Range By outlet ii C.� tie I ) Barbecue By outlet E-mail: /w) Clothes dryer By outlet II CONTR C OR Other: _ Business name: G , L , p. 6 _ /�C'. MECHANICAL PERMIT FEES Address: l ,.. .700 6 A,,...2A,,...2 �, l 7'1 Subtotal $ '"� ._ Minimum permit fee $107.00 City/State/ZIP: 'PQ 7-j-. / Cif 4 14 Plan review(65%of permit fee) $ / f�) , ` 23State surcharge(12%of permit fee) $ Phone:Y `(/�j�r,� j� Fax:( ) , TOTAL PERMIT FEE $ E-mail: t '-` i'`e C'f 1k44, L_. t� This permit application expires if a permit is not obtained within 180 CCB lic.: 1 6 r &,/ /7 City or metro lic.: days after it has been accepted as complete. * Site plan requited fol an outdoor unit 1-1 6 . L.41111111.....jillill In' I- -- **State Building Codes Division's approval required signature.; --- Print name Sims"j{I I-4 u iii..e.Z. Date: i J2';7�6 S:IPORMS\.July 2013 forms\Mechanical Permit Form rev 06-13.doc Plumbing Permit Application Building Fixtures '1[' FOR OFFICE USE ONLY City of Tigard 1,6�j Received Date/By: A, 1I /V ;; Permit No.: 1-",$)--2)16` . 41 13125 SW Ha Blvd.,Tigard,OR 97223 {�(/lX/9TJ 477 Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 1 7 \I Other Permit No.: p Date/By: Inspection Line: 503.639.4175 D D to Read /B Jur s: ® See Page 2 for TIGARD �� Y Y S Internet: www.tigard-or.gov ff�y .A•, ted/Method. 'C'> Supplemental Information TYPE OF WORK �,N 44.1V ( FEE* SCHEDULE ❑ New construction ❑ Demolition ^� � } For special information use checklist. Description Qty. Ea. Total [ „Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 l-and 2-family dwelIing ❑Commercial/industrial SFR(2)bath 437.78 building> SFR(3)bath 500.32 ❑Accessory 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: l 1,C) p)-7 J4 Let Catch basin or area drain 18.76 Drywei 0 C_ , l "1 Footing 1,leach line,or trench drain 18.76 City/State/ZIP: ;�/(9'l-- �, Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.. I Project name: Z Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Da-ON vU 0 LA/-‘ Dishwasher 25 1 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER ❑ TENANT Expansion tank 12.5 r ` ' -i ,^, e Fixture/sewer cap 1 Name: " � i C/t �' 1 iG_37 LTJ ( � Floor drain/floor sink/hub 1 Address: �� p Garbage disposal 1 City/State/ZIP: `�7,0 0.4. ' 0 [ C_-.— Hose bib 1 Phone:( ) `� Fax:( ) Ice maker 12 51 ❑ APPLICANT ��qq � �A CONTACT PERSON Interceptor/grease trap 1 Business name: H i )/ ui o f°�',, & ' 1 fns Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: e v ( / p ��C/Y `�t ��/ ) � Roof drain(commercial) 12.5 Address: 0-30 5� C - Lare-- 1 City/State/ZIP: Y-T qq.4P _S Solar units(potable water) 62.54 1 Phone:q))) 2 x vl Q 7 Z Fax: :( ) Tub/shower/shower pan U ` /� t� / Urinal 1 E-mail: i i,w - G 1:� `� ,,/ l C, V Water closet 1 CONTRA OR Water heater 37.52 Business name: !4 ,,-_,,t ‘11,1„) p/ ,W V 'i v L7 / Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Phone:603) 5'-/ , Fax:( ) Minimum permit fee: $72.50 CCB Lic.: ipy') � 1/�� Plumbing Lic. ..: P8 t 9 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: i'l /7 TOTAL PERMIT FEE Print name: Q ' , 1Date:ay / , / tL/ This permit application expires if a permit is not obtained within 180 days C. C Jaip ,` ' after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\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 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 l� and including$10,000.00. Inspection of existing plumbing or for S10,001.00 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 nonnal 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 ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower -Jacuzzi/Whirlpool engineer. Car Wash: Each Stall ❑ New exterior plumbing site utilities for any complex structure Drive Thru as defined in OAR918-780-0040. Cuspidor/Water Aspirator 0 Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial 0 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 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/Sery/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: 1:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Electrical Permit ApplicationVAC-VINO) FOR OFFICE USE ONLY City of TigardReceived Permit#: a 13125 SW Hall Blvd.,Tigard,OR 97223 TA Plan Review Phone: 503.718.2439 Fax: 503.598.1960 1 Date/B : Related Permit#: 'ft GA R I) Inspection Line: 503.639.4175 FES 1 Ready Date/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov ++pp ��,'1Notified/Method: Supplemental Information TYPE OF WORK' VI', A- PLAN REVIEW ❑New construction i�� Addition/alteration/ 1 � -' ' Please check all that apply(submit 2 sets of plans w/items checked): ..°" ❑Service or feeder 400 amps or more 0 Building over three stories. El Demolition El Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. , -and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived l J/� ❑Addition of new motor load of system. Job#: Job site address: 12,937 5z,1/4) l L t 100HP or more. ❑`A> E» 1.2» `l_3» ` ❑Six or more residential units. occupancy. City/State/ZIP: 1 �/ �/j Recreational vehicle parks. ��—/V t t 0 Health-care facilities. 0 Suite/bldg./apt.#: Project name: ❑Hazardous locations. 0 Supply voltage for more than 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I Each I Total I * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPT N OF WORK Limited energy,residential j," v 21 (with above sq.ft.) 75.00 2 1i7 .( t 1zy of ci Limited energy,multi-family 75.00 2 residential(with above sq.ft.) iiRenewable Energy 0 See Page 2 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 6/] L./1 t,' Pa/� ��JJ /� 200 amps or less 100.70 2 Address: 1 t QC'-�'V y,`7l 1 i �--�) ' Y" J[�, 1 - 201 amps to 400 amps 133.56 2 —I V_ (� Ijl 401 amps to 600 amps 200.34 2 City/State/ZIP: 1—' (Dire a ci 601 amps to 1,000 amps 301.04 2 Phone:(�7 ) V l / Fax:( ) Over 1,000 amps or volts 552.26 2 ��—�✓ "L Temporary services or feeders installation,alteration,and/or Email: l se s /'g) .n relocation 1\:"e'° 4 Owner installation:Thstallation is bein ma e on property that I own which is not 200 amps or less 59.36 I intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 0 APPLICANT CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: ti) Lv l 1.1�'i, / 9; ,, 1, in C above service or feeder fee, 7.42 2 each branch circuit Contact name: 0 elf i(�/J e —n B.Fee for branch circuits without Address: l "]� �,v �(J� service it feeder fee,first 56.18 2 V cct�� branch circuit City/State/ZIP: "✓ice�../ 6"- ab Each add'l branch circuit 7.42 2 Phone: 03 j.`14 s�s7 Fax: : Echman Miscellaneous ed(serviceror feeder not included) ( ) "`�� ( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR p Pump or irrigation circle 67.84 2 Business name: Et 'c' Ek c.,44,6-11._j,„6 5F(I /� loc„,T Sign or outline lighting 67.84 2 "/ `}I� (,�lx Signal circuit(s)or limited-energy Address: panel,alteration,or extension. ❑ See Page 2 2 City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:( 0)e r 9 0 -7-z.,. Fax: ( ) Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is 90.00/hr CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(/z hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: A,6—C— ,9�--e - 3 Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qt . Each I Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 5.01 to 15 kva 133.56 2 2 Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: Burglar Alarm 25.01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: n Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('L hr mm) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): y * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC n Instrumentation n Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 • RECEIVED 02/18/2016 15:55 5036243681 CITY OF TIGARD • Feb 18 1604:05p HELP Fax 5032462167 p.1 Electrical Permit Application 1' yti - 1.4:1R of i ICf: 1.5F r��.Ll Clth'4�Tia8r[Y �`' • t Pennil41: • r 125 S W 11x11 Blvd.,Tig:ertL OR 97223 y.,;(-- ti itaximd PJaa113,: rPRelated 1 crmilPhone: 503.7182439 t:ax: 503598.1960 \ Q t7¢Icily: Inspection Line: 503.639.4175 Ready DaeAs-: fess B See Paget for i t C n R D Internet: www.tig uttor.00v Neti&odOrldbod: Supplanting!lofortnation TYPE OF WORK PIAN REVIEW 0 New construction El Additioaralterationlrcptacemenl Place check all that apply(submit 2 sets of plans a+:'itcues checked)_ ❑Seniee or feeder 400 amps or more 0 Building oxer three stories_ 0 to its- []Demolition ❑Other wee=etc available iamb corm. 0 Marinate and boas rds. CATEGORY OF CONSTRUCTION minces 10.000 amps al 150 sults or 0 Floating holding_ lees to ground,or c ee&14.000 I]Caonnocial-iso agticattarat [-and?-flinch dwelling ❑ComrucrciafTndustrial ❑Acccssor building 1 amps for all other installation_ hveldings. 0 Multi-family 0 Master builder 0 Other [Eft pump, ❑lacafarion of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emerismey*'seem harm separatel-deriaed 0 lt4 inion of oerr mora lucid of --swan Job 4: Job site address: i 2-z 1'7 S w i<o s i E.t L.Ar.7E tootiP or more. 17"A•"t�•`7- •"1-3 ['Sit or wee residential unite c ' City/State:21P: ( t c.!:L P D!2 q72.14- 0 p t Ieah6 r et t clIieies. Re mew!aehicle pales.. Suite/bldg./apt.b: Project name: i ❑liarrrelouslocations. Qrmore than SuppIwtw1Ots a ft a. D Sica aaofe der-6 O amps m more. Cross Slreer/direclions to job site: FEE SCHEDULE urge-4.s. I pr.. I Eters I z,..1 l. New residential single-or multi-family dwelling unit: Subdivision: 1 Lot 4: Includes attached garage 1,000 sq.[i.or 1-ss I 16854 4 , fax map/pareel ff: Ea.addi 500sq. or portion ion „92 I DESCRIPTION OF WORK Limited energy,res( niai (with abovesq.R.) TS UD 2 NIEio 6,45EN4NT ;; (-1 8IC,ndRoa, {Q�HaUr_L Iimiwdetxrn:mufti-family PR.6,16-C-7 residential(with about:sq.III 75.00 i ` Renewable-Eater*: CI See Page 2 1 PROP£RTS'OWNER ❑ TENANT 1 Services or feeders installation,alteration,attdlor rrlontian Name: '4_,4/‘ e't/- aN ` 200 amps or l 100.70 I 2 `� 207amps tod00amps 133.56 2 Addles: �� -7 5‘,1/4) ),0_, �3 �1( C,G 401 amps to 600 amts 200-3i 2 City/StateiZIP: '71-T 9 � Cr 1 9 '"1 .)-. 4.---t c7 601 mops to 1.000 amps _ 301.04 2 Phone:( ) Fax.:( ) Cher 1.400 ampssor Notts 5526 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 antes orless 5936 { 1 intended for sale kale_rent,or exchange.according to ORS 447,449 670.and 701. 201 amps to 400 amps I , 125.08 2 Owner signature: Date: 401 attgia to 599 amps 1 163.54 2 APPLICANT I ❑ CONTACT PERSON Branch circuits—nen,alteralion,oreztensiou, rpanet _ A.Foe for branch circuits with Business name: `�� ,A� aboycscmiceorfeeder fee. 742 D' G each branch circuit . Contact name: v. s a li .� B.Foe for brunch cunt([-wirhotd W��" service or mala fem.first Address: f ,�h-/� / ;/1 _ branch circuit I I 56.1s 1 2 CitvlStaterZIP' ''C / 1r Each add.]branch circuit 1 7.42 2 / L - tireseel ancoas(service or fender not included) Phone:may)} ,,(,,/t.,{ /3 Fax::( ) Each mainifaetmd or modular 67.84 2 rJ" _ V / �/� dwellings ire mulfor fell.. 2 Entail: i V\`'fey 1- . &Qf d)&6 CR) Reconnect only 67.84 I " l•� 1'liter O Pump or litigation circle 6784 2 Business name:6tec rye r-t' Li G Ai T 1iJG .1 64-4--e--TIL i c (,t!e . Sign or outline lighting I 67.84 2 Sigctl cleatinst of Iimi4ed-crtatv 0 see Pie 2 2 Address: 6 s ,+/C /g/ s F A v: /i /S7 panel.alteratiaL or mumesion. L City/State/ZI P: Each additional inspection over allowable in any of the above Po rL rr n n/ D `( -7 3 O Additional inspection(1 hr mit) 66.257hr Insctu Phone:{s�> ) S 7 O - if 0 7 2. Fax:( S L:';) Z S'?I-- 6 6 93 �'tat(1 hrmin) 90.00/hr Email: 't_/eC. tG.cL1ii9it-I'irtj ecora hast"'. lvet Industrial plant(1 hr rain) 78.18 hr Inspections for tallith no roc is90.00/hr CCB fit.: /6?Z 6.0 tecuiail Lie.: 3 7 7 Suprrt_Lie.: 53 5 7 5 .-vaiftcalis Iistal i%_hr mut) _a�/r'� �/ - ELECiRICAL PERMIT FEES Suprv.Electrician st A required. i Lki1.5 tNa //6////0Subtotal: 1 Print name: .1.-'1,.1.-'1, S aS e i+ids 6 N Date: -al/ / g j 2L•/b I ©flan Review Required(25%of permit fat): State surcharge(12%of permit fix): Authorized signature: F-/1AA' t- � SZ . TOTAL PERMITFEE: t / This permit-application espirm .h ifa per is nor olxaioed within 180 Print name: S w;-k 1fi S 3 a rt r.I Se,Jami Date: 2/1 S/2-0(6 days alter it has been accepted ascomplcee. . (:umber of inspections allowed per petrnie. 1.11miacry:PcmirsEl.f Pertr:Arc_ELP._EREdoe Rev 1G'17!`015 440-14151(1 1.0 COQ/RFS 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 12987 SW KOSTEL LN, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection FAIL MST2016-00026 David Young Provide approved electrical ﬁnal inspection. Provide ﬁre separation at door exiting to garage. Violation Summary: Inspector Contractor 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 12987 SW KOSTEL LN, TIGARD, OR, 97224 Residential - Master Permit 699 Mechanical ﬁnal PASS MST2016-00026 David Young Violation Summary: Inspector Contractor 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 12987 SW KOSTEL LN, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical ﬁnal FAIL MST2016-00026 David Young New addition not on arc fault breakers per code. Oesc 210.12 Violation Summary: Inspector Contractor 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 12987 SW KOSTEL LN, TIGARD, OR, 97224 Residential - Master Permit 399 Plumbing ﬁnal PASS MST2016-00026 David Young Violation Summary: Inspector Contractor 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 12987 SW KOSTEL LN, TIGARD, OR, 97224 Residential - Master Permit 199 Electrical ﬁnal PASS MST2016-00026 Jeff Grove Violation Summary: Inspector Contractor 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 12987 SW KOSTEL LN, TIGARD, OR, 97224 Residential - Master Permit 299 Final inspection PASS - No C of O MST2016-00026 Jeff Grove Violation Summary: Inspector Contractor