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7416 SW CEDAR CREST STREET-1 A O� N C1 Q. 0 m N r. N 1 m 7416 SW Cedarcre ,t Street CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST - INSPECTION DIVISION Business Line: (503)639-4171 BUP _ --- Received ,' Date Requested. - S' AM. PM BUP Location -7 4-11 co ����f� - Suite—___ �,.LEC -3 ' U� �TL7 Contractor Contact Person _ - Ph( ) --- -- Ph( ) - _ SWR --- -- �— BUILDING Tenant/Owner _. ___ _ ELC _ Footing EL.0 —.— Foundation ACCBSS;� � � Ftg Drain ? ELR trawl DrainSIT Slab Inspec on Notes: Post&Beam ---- — — _ Shear Anchors Ext Sheath/Shear — — Int Sheath/Shear Framing Insulation Drywa!!Nailing — -- Firewall _ Fire Sprinkler — --" — Fire Alarm _ Susp'd Ceiling -- --- Root � __ —_ Other: _ --�`' ��" -- OL Final — PASS PART FAIL PLUMBING_ -- Post&Beam Under Slab — — Rough-In _ Water Service Sanitary Sewer — — Rain Drains --- ----- Catch Basin/Manhole Storm Drain - — Shower Pan Other:---- - - -- -- - PAS _PART FAIL ---- HANICAL —-- -— — Post&Beam Rough-In -- —- — ---_.— —_ - Gas Line S PART FAIL ------ _ CTRICAL - --- Service --^ - — ------ — Rough-In _ ... - ------ --------- - — UG/Slab Low Voltage -- Fire Alarm Final F] Reinspection fee of$ —required before next inspection. Pay at City Hal', 13125 SW Hall Blvd. PASS_ _PERT FAIL SITE_ LlPleaae call for reinspection RE:---------_ Unable b inspect-no access Fire Supply LineADA I / ��J Approach/Sidewalk Date i/ Y -- Inspector Other: _ Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24.-Hour BUILDING Inspection Line: (503)639-1175 MST INSPECTION DIVISION Busimiss Line: (503)639-4171 _ G / __ SUP _ Received . 4 I ,Date equeAed_ �� M,- PM '____ __ BUP c Location --- � Y ����Suite Contact Person _ Ph( ) = Contractor __ _ _ _ Ph(—) �� SWR BUILDING TenF.nVOwner - __ _ ELC Footing ��_---- _ ELC Foundation access: Fig Drain �"/C (� ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors Ext Shoath/Shear int Shbath/Shear Framing - Insulation Drywall Nailing — Firewall Fire Sprinkler f— -- - Fire Alarm �� - Susp'd Ceiling ---- Roof i Othor Poal PASS PART FAIL os & Beam UnderSte_ u atee Say Sewer Rainin Drains - — Catch Basin t Manhole Storm Drain Shower Pan -FAIL -- HA Post&�t3e�a+m - ---- - — ou F� — Gas Line Vnq� a DaS PAR FAIL - --- -- -- - -- -- - ELECT IC Service Roup -In _ UG/Slab Low Voltage Fire Alarm Final Reinspection fee of s___ required before next ins PASS_ PART FAIL P -- Inspection. Pay at City Nall, 13125 SW Hall Blvd. $ITE s^ Please call for reinspection RE:- __ Unable to Inspect-no accass Fire Supply Line _ ADA = Approach/Sidewalk Late ` Inspector... ...�.t_.(��—__ Other Final ` r0 NOT REMOVE this Inspection record from the job tante. PASS PART FAIL 1 CITYOF T I GA R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2003-00137 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/15103 SITE ADDRESS7 07416 SW CEDARCREST ST PARCEL: 1 S 125CA-04001 SUBDIVISION: BOULEVARD HEIGHTS ZONING: R-4.5 BLOCK: LOT: 016 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHI14 G MACH: BACKFLOW PREVN FRS OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS- CATCH BASINS: _FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: —� SINKF: URINALS: GREASE TRAPS: LAVATORIF F` 1 OTHER FIXTURES: TUB/SHOWEF 1 SEWER LINE: ft WATER CLOSE 'S: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft I Remarks: Instal plumbing fixture. 1 lay., 1 tub/shower, 1 toitlet and piping FEES Owner. -- --`------ Description Date Amount RICHARD GEDROSE 7416 SW CEDARCREST ST I I'I.UM131 I'Crnlll Fee 4/15/03 $72.50 TIGARD, OR 97223 I1 AX1 8"i,Statr'Tax 4/15/03 $5.80 Total $78.30 Phone : 5(3452-21~27 Contractor: OWNER REQUIRED INSPECTIONS Phone : Water Line Insp Rough-in Insp Reg#: Top-out Insp Final Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon issued [3y: �� , �;`� --_ - Permittee Signature: :✓� .J��,�c�c,t Call (503) A39-4175 by 7:00 P.M. for an Inspection needed the next business day Building Fixtures USE Plumbiri� Permit Application Received , � � Plumbing--, Date/Hy: _ - Permit No. CV3 City U� ]( 1 ill'( Planning Approval Sewer y Data/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/8 : Permit No.: Phone: 503-6394171 Fax: 503-598-1960 Post-Review Land Use ard.or.us Daus Case No.: Internet: www.ci.ti _ g Contact Juris.• See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method.- _ Supplemental Information. TYPE OF WORK FEE-SCHEDULE forspecial information use checklist New construction _ HDemolition Descrl Nan Qh. F'ec(ca.) Total Addition/alteratior./re lacement Other: New 1-&2-family dwellings CATEGORY OF CONSTRUCTION includes 100 ft.for each u 111ty connection 1 &2-Family dwelling L SFR(1)bath 249.2()Commercial/Industrial SFR 2 bath 350.00 Accessory Building Multi-Family - SFR 3 bath 399.00 Master Builder Other: Each additional bath kitchen _ 45.00 JOB SITE INFORMATION and LOCATION Firesprinkler-sq.fl.: Pae 2 Job site:address: � (p S ;Cpe/u,/�c�5�_ ._Si• Site utilities Suite h� � 131dg./Apt.i;t: `W Catch basin/area drain _ 16.60 Protect Name: Dr ell/leach line/trench drain 16.60 -- --- Footing drain no.linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 _ / C fw 3� -5q ' Manholes _ 16.60 _ Rain drain connector 16.60 _ Sanitary sewer no. linear 9. Page 2 Subdivision: Lot#: Storm sewer(no.linear fl.) Page 2 --- Water service no.linear R. Pa=c 2 Tax map/parcel M Fixture or Item DESCRIPTION OF WORK Absorption valve 16.60 Backflow prevcnter Pa c 2 _ -, __..-- - --- ----- Backwater valve I6.60 - - -- Clothes washer 16.60 -- - -- ---- -------�- ---- Dishwasher _ 16.60 Drinking fountain - _ 16.60 Rt)PERTY OWNER __LarENANT Ejectors/sump 16.60 erne: Expansion tank 16.60 - Address: -��(o St.J Cv�`?�CG $t Fixture/sewer ca i6.60 Clt /Slate/ZI -n6-A Floor drain/floor sink/hub If.60 -�' - - Garbage disposal 16.60 phone:LICAN p 52 7_,e-Z-)) Fax: Hose bib 16.60 APl' f UNTACT PERSON Ice maker 16.60 Name:_�pLL- ALS AL Q dCC- ___ Interce tor/ rease trap 16.60 Address: Medical gas-value. S Pae 2 J Cit /State/Zi : Primer 16.60 y p _ Roofdrain commercial 16.60 Phone: Sink Fax: /basi avato 16.60 E-mail: �- show lower pan 16.60 CONTRACT_OR - Fr 16.60 Business Name: _ Water closet _ 16.60 _ -- -- ---- __--- Water heater 16.rk0 _ Address: _ _ Other -- _ City/State/Zip: _ Other: Phone: }'aX_: PlumbinQ Permit Fees* Subtotal S CC8 Lic. #_ Plumb. LlcA - _ Minimum Permit Fee$72.50 Sr Authorized Residential Backflow Minimum Fee$36.25 . Z) Signature: _ Gate:_ 5"d Plan Revicw 23%of Permit Fee $ State Surcharge 8%of Permit Fee S 5.cL I11kaw print ncmc) TOTAL PERMIT FEE S Notice: This permit application expires if a permit is not obtained%NM1,111 All new commercial buildings require 2 sets of plans with Isometric sr Igo days after It hos been ocrepted as complete. r:r:r diagram for plan review. *Fee methodology set by Tri-County.Building Industry Servtce Boar d. is\Dsts\Permit rormusTImPe-nnitApp.doc 01/03 Plumbing permit Application - City of Tigard Page 2 - Supplemental Information - Fee Schedule: Residential Fire Suppression Systems: Site Utilities 4", Fee(ea) Total S ur re Footage: Permit Fee: Footing drain• 1"100' SS.tNI 0 to 2,000 _ $115.00 Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00 __ 3,601 to 7,200 $220.00 Sewer-I st 100' 55.00 7,201 and grcater $309.00 Sewer-each additional 100' 46.40 Water Service- Ist 100' 55.00 1lcdical (;as SySteMS: Water Service-each additional 100' 46.40 Valuation: Permit Fee: Storm&{fain Drain-Ist 100' 55.00 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Fain Drain-each additional 100' 46.40 $5,001.00 to$10,000.00 $72.50 fin the first$5,000.00 and$1.52 for each t Fee Total additional$100.00 or fraction thereof,to and Fixture or Item Q y (ea)) V including$10010.00. Commercial Back Flow Prevention Device 46,40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for Residential Backflow Prevention Device each additional$100.00 or fraction thereof,to minimum permit fee$36.25) 27.55 and including$25,000.00. Rain Drain,single family dwelling 65.25 $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 Inspection of existing plumbing or _ and including$50,000A). specially requested ins ections•per hour 72.50 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for Subtotal: each additional$100,00 or fraction thereof. Fixture Work: Are you capping,moving or replacing existing fixtures? if "yes",please indicate work perforated by fixture. Failure to accurately report fixtures could result to Increased sewer fees*. uantlt h Flxturc)werk t'erf.rmed )Comments regarding fixture work: Fixture Type, Replace New Mored ExI tlna Capped -" Iia fist /I ant Bath -tub/Shower — -jacuzzi/whirlpool ——�— —""— Car Wash -Eacl.Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher -Commercial — - -Domestic Drinking Fountain _ — Dje — Floor Drain/sink 2" _ -4" _ Car Wash Drain _— *Note: If the fixture work under this permit results in an Garbage -Domestic _ Commercial increase of sewer IDUs,a sewer permit will be issued and Disposal -Commercial r fees assessed for the sewer increase must be paid before the -IndustIce Mach./Refri .Drains plumbing permit can he issued. Oil Separator-Station_ Rec.Vehicle Dump Slalion Shower -Gang -Stall Sink -Her/Lavatory -Bradley -['omme,cial _ -Service Swimming Pool Filter Washer-Clothes Water Extractor _— Water Close,-T"oilci Urinal Other Fixtures: iArnwPermit Fomu\PlmPemnL&ppPg2.doc 01/03 i CITYOF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2003-00192 13125 SW Hall Blvd., Tigard, OR 9-223 (503) 639-4171 DATE ISSUED: 4/15/03 PARCEL: 1 S 125CA-04001 SITE ADDRESS: 07416 SW CEDARCREST ST SUBDIVISION: BOULEVARD HEIGHTS ZONING: R-4.5 BLOCK: LOT: 016 JURISDICTION: TIG CLASS OF WORK: Al_T FLOOR FURN: EVAP COOLERS: i YPE OF USE: SF UNIT HEATERS: VENT FANS: 1 OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1 STORIE=S: _ BOILERS/COMPRESSORS S _ HOODS: FUEL TYPES _ _ 0 - 3 HP: DOMES. INCIN: LPG 3 - 15 HP- COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP OD GAS PRESSUPE: 50 + HP: CLO DRYERS: FURN < 100K BTU: 1 AIR HANDLING UNITS C FURN >=100K BTU: _ <= 10000 cfm: OTHER UNITS: > GAS OUTLETS: 10000 ctm: Remarks: Instill �,i, �urnarc,�IuctinE. �entin� anal 1 I)hathnu,m ezhau�t. Owner: _ FEES _ RICHARD GEDROSE Description Date Amount 7416 SW CEDARCREST ST Nil (111 Pcrink Fcc Y 4/15/03 $72.50 TIGARD, OR 97223 � I:\X1 .10"5iatr"!'ax 4/i 5/03 $5.E30 Phone: 501-452-2527 L____ _ Total $7930 Cootractor: REQUIRED INSPECTIONS Phone: Mechanical Insp Heating Unt Insp Reg #: Duct Inspection This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Cortes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 4�Issued By: L �� Permittee Signature* .c s J Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day USE ONLV 1Vl �chanical Permit A plication ' � _ —� ReFFICE ceived Mechanical Date/By: Permit No.:Acc 3 1" City Ot Tigard Planning Approval Building Date/by: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Date/By: Permit No.: se Phone: 503-639-4171 Fax: 503-598-1960 Post-Review land o.: Internet: www.ci.ti ard.or.us Dau/B : Case No.: 8 Contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information. TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST New construction I LJ Demolition Mechanical permit fees'are based on the total value of the work Addition/alteration/replacement Other: performed. Indicate the value(rounded to the nearest dollar)of all CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit. 1 &2-Family dwelling Commercial/Industrial Value: S See Page 1 for Fee Schedule Accessory Building— Multi-Family RESIDENTIAL E UIPMENTAYSTEMS FEE*SCHEDULE Description I QtyFee ea. Total Master Builder Other: Heath Conlin _ JOB SiTE INFORMATION and LOCATION lllrumac -add-on air conditioning" 14.00 Job site address: C = ,Ct a 3T_ S I as eat pump 14.0(., _ Suite#: Bld ./A t.#: Duct work 14.00 — Project Name: _ H dronic hot waters stem 14.00 Residential boiler Cross st get/Directions to job site: for radiator or h dronic system) 14.00 C6agec:�C'G`s7— ST. Unit heaters(fuel,not electric) in wall,in-duct suspended,etc.)_ 14.00 Flue/vent for any of above 10.00 Subdivision: — Lot#: Repair units 12.15 Other Fuel A t Ilanca Tax map/parcel #: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 _ ^ � i-�/,Gn� ©�� — � G-i) Flue vent water heater/ s fireplace) 10.00 — �D1Oxl�S G/Z ,Ot. W lighter as 10.00 Wood/Peellll et stout _ 10.00 `r oy V_ /Able-iw�Nl tr)0 .J tic 1--A J Wood fireplace/insert t0.00 Chimne /liner/flue/vent 10.00 PROPERTY OWNER TENANT Other: 10.00 Name: Environmental Exhaust&Ventilation — Range hood/other kitchen equipment Address; �7 y�(o $t..� C t,;l,Q/�cC"� S 1 Clothes dryer exhaust 10.00 City/State/Zip:—7164a /_•0 _ Single duct exhaust Phone: . -) 5Z Z5Z 7 Fax: (bdthrootM,toilet compartments, 'APPLICANT CONTACT PERSON -Uwi"looms 6.80 v Attic/crawl_s ap ce fans 10.00 Name: s9yh�s_ Other: 10.00 Address: _--- Fuel Pining_ Cit /state/Zi •"(55.40 for first 4,$1.00 each tddltlonal- -�- ---- Furnaaezetc. `• Phone _ -ax��-.-_-- tlas heat pump •• E-mail: Wall/suspended/unit heater '• CONTRACTORWater neater •` Business Name: _ J Fireplace " ------------- -------- Range •• Address: _ _ BB .. city/state/Zip. Clothesdryer as •' Phone: — Fax: Other: _ ___ '• CCB Lic.W. Total: -- Mechanical Permit Fees* Authorized / Subtotal: S Signature: Ae_LT 21 is-- Dele:_'�t13 Minimum Permit Fee$72.50 S L11du y 4_ _ Plan Review Fee 25%of Permit Fee S (Please print name) State Surcharge(8%of Permit Fee) S p _TOTAL.PERMIT FEE S Notice: This pern;il Application expires if a permit Ic not of tained Nithin "Fee methodology set by Tri-County Building,industry Service Board. T; 180 days after it has been accepted as complete. "Site plan required for exterior A/C units. is\Dsls\Permit FornrsWccPcinMApp.doe 01/03 Mechanical Permit:i_plicatiou - Cite of Tigard Page 2 - Supplemenia! '►f-rmation - Commercial Fee Sche, Total Valuation: $1.00 to$5,000.00 Minimum fcc$72.50 $5,001.00 to 510,000.00 572.56 for th,,first$5,000.00 and$1 52 for each additional$100.00 or fraction thereof,to and including$10,000-00, $10,001,00 to$25,000.00 5148.50 for the first 510,000.00 and 51.54 for each additional S100.00 or fraction thereof,to and including $25100000, $25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and $1.45 for each additional$100.09 or fraction thereof,to and including $50,000.00. $50,001.00 and up $742.00 for the first$50,000.00 and $1.20 for each additional$100.00 or fraction thereof. Assumed Valuations– Ap Ilance: _—T--� Value 'fowl Description; t Ea Amount Furnace to 100,000 13113,including 955 ducts&vents Furnere>100,000 BTU including ducts 1.170 &vents Floor furnace including vent 955 Suspended heater,wall heater or floor 955 mounted heater Vent not included in appliance permit _ 445 Repair units 805 <3 hp;absorb.unit, 955 to 100k OTU — 3-15 lip;absorb.unit. 1,700 101k to 500k BTU 15.30 hp;absorb.unit,SUM to I mil 2,310 BTU _ 30-50 hp;absorb.unit, 3,400 1-1.75 mil.BTU _ >50 hp;absorb.unit, 5,725 >1.75 mil.BTU Air handling unit to 10,000 cfm_._ _ 656 Air handling unit>I0,000cfin 1170 Non-portable evaporate cooler _ 656 _ Vent fan connected to a single duct _ 446 Vent system not included fn appliance 656 permit Hood served by mechanical exhaust 656 Domestic incinerator_ 1170 Commercial or industrial incinerator 4,590 Other unit,incl iding wood stoves, 656 inserts,etc. _ Gas piping 14 outlets 300 Each additional outlet 63 TOTAL COMMERCIAL S VALUATION: 1:1D&\Pormit Fo nns\Meet ermitAppNg2.doc 01/03 l I , CITY OF TiGARD ELECTPICAL PERMIT PERMIT#: ELC2003-00213 DEVELOPMENT SERVICES DATE ISSUED: 4/15/03 13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 1S125CA-04001 SITE ADDRESS: 07416 SW CEDARCREST ST ZONING- R-4.5 SUBDIVISION: BOULEVARD HEIGHTS ULOr.K: LOT : 016 JURISDICTION: TIG Project Descril-•ion: Install(4)branch circuits. — RESIDENTIAL UNIT -TEMP SRVC/FEEDERS __MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/SVC/FDR' 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION- 201 - 400 ainp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADDT. BRNCH CIRC: i IN PLANT: 601 - 1000 amp: _ - __ PLAN REVIEW SECTION 1000+ ainplvolt: —.4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: ,—_ S'JC/FDR>=225 AMPS: -__-__ CLASS AREAISPEC OCC: Owner: Contractor: RICHARD GEDROSE OWNER 7416 SW CEDARCREST ST TIUARD,OR 97223 Phone: 533-452-2527 Phone: Reg #: -_ FeEs Description Date Amourt Required Inspections —-- II I.11RM1'1 GLC Permit 41lSi113 I AX] 8%State Tax 4/15/03 $;i ,t, Rough-in Elect'!Final Total $72.15 This Permit is issued subject to the regulations contained it the Tigard Munldpal Code,State of OR.Specially Codes and all other applicable laws. 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 then 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth In OAR 952-001-0010 through OAR 9E2-001-010rJ. You may obtain copies of these rules or direct questions to OUNC at(503)246.66%or 1-800-332-2344. Issued By: t I ,�c i, c:� 4�-'- --- Pprmit Signature: l OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _ DATE:. -- CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. E+-EC'N: _�- E% ----.------ — DATE: LICENSE NO: - ----- — - --- --- ------ Call 639-4175 by 7 00prn for an inspection the next business day FOR OFF1'CE USE ONLY Electrical Permit_ Application Received L•lectrical Date/B Permit No. • g' 3—00PI Planning Approval Sign City of Tigard Date/By: Per.,' 'o_ 13125 SW Hall Blvd. Plan Review C'' Date/By i't ..,L No.: Tigard,Oregon 97223 post-Review Land Use Phone: 503-639-4171 Fax: 503-598-1960 Date/By: Case No.: Internet: www.ci.tigard.or.us Contact Juris.: 10 See Page 2 for 24-hour inspection Request: 503-639-4175 Namc/Method ___ Su Icmental Information. _ TYPE OF WORKPLAN REVIEW Please check all that apply) DE m011tlon Service over 225 amps- —_ Health-care facility New construction — commercial ❑Hazardous location Addition/alteration/replacement Otlter: ❑Service over 320 amps-rating of ❑13uilding over 10,000 square feet. CATK'CORY OF CONSTRUCTION i&2 family dwellings tuur or more residential units in ❑System over 600 volts nominal one structure 1 &.2-Famil y dwellin Commercial/Industrial _ ❑Feeders,400 amps or more S_ -- — (]Buildir¢over three stories P Accessory Buildin Multi-Famil _ []Occupant load over 99 persons ❑Manufactured structures cr Rl nark Master Builder Other: ❑I:gressAighting plan ❑Other._ _ Submit —sets of plans with any of the above. JOB SITE INFORMATION and LOCATION The above are net a llcable to temporary construction service. Job site address: /t C fS,G S r' FEE*SCHEDULE _ Suite#: _ Bld l•�A tp — Number of Inspections per erndt allowed Descrl tion Qty Fee(ca.) Total Project Name: - - New ential-single or multl-family per Cross street/Direutions to job site: dwelling unit.Includes attached garage. Service Included: 145.15 4 (t I000 s . .or Icsa Each additional 500 a .n,or nnrtion thereof 33.40 1 --� ; - Limited energy,residential 75.00 2 Subdivision: #. --- Limited energy non residential 75.00 1 Tax ma / areal#: Each manufactured home nr modular dwelling 90.90 2 service and/or feeder DESCRIPTION OF WORK � 1 Services or feeders-installation, &Les� 1T-,, IHI_ �'3�! W�-- alteration or relocation;--- 80.30 2 / 200 am sur less 201 amps to 400 amps 106.85 1 �J 401 amps to 600 am 160.60 2 2V d 601 am s Io 1000 am 249.60 2 ROPE TY OWNER ENANT over 10�o am or vola 454.65 1 �s--- 66 84 2 Name: �( � Reconnect onl — 5 Temporary services or folders-Installation. Address: L I� SI/J c�� ST` $ alteration,or relocation: 66.85 City 200 am s or less i /Siate/Zl�—�� F -- 201 am to 400 amps - 13 75 2 Phone: t13 �51 ZJ77 FaX: 401 to 600 amps 133.75 2 PPLICANT ONTACT PERSON _ Branch circuits-new,alteration,or N'airne.: �� ���J �— �— extension per panel: Se�1t. A.Fec for brunch circuits with purchase of service or feeder fee,each branch circuitAli 6.65 2 h circuits without purchase of 46.85 �/� 2 B.Fee I t 9;W-cCit /State/Zip: — __ ---"— service or feeder fee,first branch circuit 1 Fax: Each additional branch circuit 6.65 Phone: - — ---- -- Misc.(Service or feeder not included): 53.40 2 E-mail: Each um or irri ation circle _ CONTRACTOR Each sign or outline Ijtina 53.40 2 Job NO:_ — _ _ Signal circuh(s)or a limited energy panel. PA e2 2 alUeration,ar extension _ Business Name: _ _ _ Description: Address: —- --- Each additional Inspection over the allowable In an of the weave: Crt /Y State/Zip: _ --�__ Per insicction r hour min. i hour) 62.55 Fax; Invest;gation fee: i}lone: other: _ CCB Lic.#: Lic.#: Electrical Permit Fees* _ Subtotal Supervising electrician — ` si nature reviyired: _ — _ Plan Review(25%of Permit Fee $ $ _- Print Name: _ Lic.#: —. State Surcharge 8%of Permit Fee S '__ _ TO'TAL PERMIT Authorized Noticc: rids permit appllcallon expires If■permit Is not obtained%01011 ,�_� _ � y Date: 180 da %i after it has been accepted as complete. Signature: *Fee methodology set by Trl-County BuHding Industry Service itnerd. (Please print name) is\ihts\Permit Forms\L•IcpermitApp.doc 01103 Electrical Permit ,Application - City of Tigard Page 2 - Supplemental Inf-ormation LIMITED ENERGY Pt:RMIT FEES: RESIDENTIAL WORK ONLY: Fee for L11 systems............................................................ $75.00 Check Type of Work Involved: Audio and Stereo Systems* ❑ Burglar Alarm Oarage Door Opcncr* I1 Heating,Ventilxion and Air conditioning System* F1Vacuum Systems* F1 Othcr -- COMMERCIAL WORK ONLY: Fee for each system.......................................................... $75.00 (SEE OAR 918-260-260) Check Type of Work Involved: Audio and Stereo Systems Boiler Controls EJ Clock Systems Data Telecommunication Installation vire Alarm Installation M IIVAC Instrumentation Intercom and Paging Systems ElLandscape Irrigation Control* Medical Nurse Calls l__J Outdoor L.nndscape Lighting* Protective Signaling Other _ -----— -- — Number of Svstems * No licenses are required. Vicenses are rcluired for all other installations i astaU'ermit rorms\ElcPcrmitAppPg2.doc 01/03