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9300 SW Edgewocd Street
CITYOF T I G A R D _ MASTER PERMIT
DEVELOPMENT SERVICES PERMIT#: M 00441
DATE ISSUED: 10//30/0230/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
S1TE ADDRESS: 09300 SW EDGEWOOD ST PARCEL: 2S102DC-01900
SUBDIVISION: EDGEWCOD ZONING: R-4.5
BLOCK: LOT: 01 JURISDICTION: TIG
REMARKS: Addition of 483 square feet, 2 bedrooms and 1 bathroom. Path 1
BUILDING
REISSUE: STORIES: 1 FLOOD AREAS REQL R'D SETBACKS REQUIRED
CLASS OF WORK. ADD HEIGHT: 10 FIRST 'I tIA sf BASEMENT: of EFT: SMOKE DETECTORS: Y
".'Pt OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: at FRONT: PARKING SPACES:
TYPE OF CONCT: 5N DWELLING UNITS: FINBSMENT. sf RIGHT: 5
OCCUPANCY GRP R3 BDRM: 2 BATH: t TOTAL. 40' VALUE: 4q 529 2b at REAR:
PLUMBING _
SINKS: WATER CLOSETS: I WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: 1 RAPS.
LAVATORIES 2 DISHWASHERS FLOOR DRAINS. SEWER LINES: SF RAGI :RAINS: CATCH BASINS:
TLIBISHOWER& I GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFL W PP EVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUE..TYPES FURN<100K: BOILICMP<3HP: VENT FANS: I CLOTHES DRYER:
GAS FURN—100KUNIT HEATERS: HOODS, OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 3 WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 200 alnn: 0 200 amp: WISVC OR FDR: PUMPARRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 400 amp: 201 400 amp: 1st WIO SVC/FDR: SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 600 amp: 401 •600 amp: EA ADDL BR CIR: SIGNAUPANEL: IN PLANT:
MANU HMfSVCIFDR: 601 • 1000 amp: 601+ampa•1000v: MINOR LABEL:
1000+amplvolt:
PLAN REVIEW SLCTION
Reconnect only: -
-4 RES UNITS: SVCIFDR>-225 A.: >600 V NOMINAL CLS AREA/SPC OCC:
ELECTRIC 1L•RESTRICTED ENERGY
A.SF RESIDENTIAL 8.I'IMMERCIAL
AUDIO S STEREO: VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT.
BURGLAR ALARM: 0TH: SCILER: HVAC: LANDSCAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS TJTAL N SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 1,011.17
JOHN 8 DEB SCHMIDT JSC!NC This perni t Is subject to the regulations contained in the
9000 SW OMARA MI 9000 NC OMARA ST Tigard Municipal Code,State of OR. Specialty Codes and
9000 S ,OR 97223 9000TIGSD,OR 97223 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 the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503-684-0471 Phone: 503-684-0471 Oregon Utility Notification Center. Those rule.i are set
forth in OAR 952-001-0010 through 952-001-0080. You
Rep N: LIC 82?'l may obtain copies of these rules or direct questions to
CLINIC by calling(503)246.1987.
REQUIRED INSPECTIONS
Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Plumb Final
Foundation Insp Footing/Foundation On Electrical Rough In Insulation Insp Final Inspection
PostlBeam Structural PLM/Underfloor Framing Insp Rain drain Insp
Post/Beam Mechanical Mechanic'ml Insp Shear Wall Insp Electrical Final
Underfloor Insulation Plumb Top Out Exterior Sheathing h,sl Mechanical Final C
Issued By : f % tiC. (, Z�.j�__ Perm' `ee Signature
Coll (503) 639.4175 by 7:00 p.m. for an inspection needed the next business day
Building Permit Application
Date received:/D /� r' Permit no.• �i'�x'��
City of Tigard
Aodress: 13125 SW Ball Blvd,Tigard,OR 97221 Project/appl,no.: ate:
City of Tigard Phone: (503) 639-4171 Date issued: BY:k kReccipt no.: 11
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: I&2 family:Simple Complex:
OF PERMUJ
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition
I$Addition/alteration/replacement U Tenant impn,veniont J Fir,sprinkler/alarm U Other:
.10111 SITE�N�011(kIATION
Joh address: C).3� J V k;a, _-)L,(a`W k x-) -11 C1 N Zc Bldg.no.: Suite no.:
Lot: Block: Subdivision: rev', f u,)!'O T' Tax;iiap/taxlot/accountno.::
Project name-
Description and location of work on premises/special conditions: _ PK_y.-r_�+,j
011 NJ 11 FOR SPECIAL INFORMATION.
' '
dpigin.septic capacity.solaraletc.)
r Mailing address: �>vj I &2 family dwelling:
State:&ijZIP:"-j'-Z1_3 Valuation of work........................................ $
Phone:(, q`1l Fax: o E-mail: No.of bedrooms/baths.................................
Owner's representative: _ �►t�tkTf" Total number of floors................................. _
Phone: q t.r,-11 Fax: b-j U4-11 E-mail: New dwelling arra(sq.ft.)
Garage/carport area(sq.ft.).........................
Name: Sv O-li t- Covered porch area(sq. ft.) .........................
—'-" -� 7Deck area(sq.ft.)
Mailing address: ........................................
City: State: '!_lP:
Other structure area(sq. ft.).........................
Phone: Fax: E-mail: CommerciallinduOrlal/multi-family:
Valuation of work.......... ....... .................... $
Business name: ' , Existing bldg.area(sq.ft.)�............ .....
New bldg.area(sq.ft.)..................
Address: Number of stories
City: �stale: , Z1P: - `` ................. —.
Phone: r; �.�; Fax: E-mail: Type of construction........ ..........................E-mail: - — Occupancy group(s): Existing:
CCB no.:
— -- -" -. New:
City/metro lit. no e:All contractors and subcontractors are required to be
sed with the Oregon Construction Contractors Board under
Name: sions of ORS 701 and may be required to be licensed in the i
Address: 7t7 iction where work is being performed. If the applicant is
Cit State: LII': exempt from licensing,the following reason applies:
Contact person: _ Plan no.: _
Phone: Fa X --
Name: e ontavt Immm: Fees due upon application ........................... $
Address: Date received: _
----- ----------
City: State: ZIP: Amount received ..................................... ... $
Phone: Fax: I F-mail: Please refer to fee schedule. —
hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards,please call jurisdiction for nuxr mfortnation.
attached checklist. All provisions of laws and ordinances governing this U Visa U MasterCard
work will be complie wi w e specified herein or not. credit card numtcr ____ _��_ _-L-1__
Expires
Authorized signature: + � Date: STV�- Name of carMolder as shown on credit card
$
Print name:=�_Se 0 tr pelt- Car"det silinuure Amount
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Maul(&VWbM)
One- and Two-l' milt' Dwelling
Building; Permit Application Checklist Referenceno.:
Associated permit:.:
Cltyof,"Tigard Cit of Tigard City g ❑Electrical U Plumbing U Mechanical
Address: 13125 SW Hall Blvd,Tigard,OR 97221 UOther:
Phone: (503) 639-4171 T —
Fax: (503) 598-1960
THE FOLLOWING r t t '
1 Land use actions completed.See jurisdiction criteria for concurrent reviews,
2 'Zoning.flood plain,solar balance points,seismic soils designation,historic district,etc. _
3 Verilicatlon of approved platilot.
4 Fire district p _approval required.
5 Septic system permit or authorization for remodel. Existing system opacity
6 Sewer permit. _
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application. _
9 Erosion control U plan U pemtit required.Include drainage-way protection,silt fence design and location of
catch-basin protection,etc.
10 3 Complete sets of legible pians.Must he drawn to scale,showing conformance to applicable local and state
building codes. Lateral design details and connections must he incorporated into the plans or on it separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot he completed
il'co ryrighl violations exist.
I I Site/plot plan drawn to scale.The plan must show lot and building setback dinwnsions;property comer elevations(it'
there is more than a 4-ft,elevation differential.plan must show contour lines at 2-ft.intervals);location of eascnivnts surd
driveway;rbotptim of structure(including decks);location of wells/septic systems;utility locations;direction indicator;It)i
area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage.
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details, vent
sire and location.
13 Floor plans.Show all dimensions,room identification,window sire,location of smoke detectors,water heater.
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 (Toss sections)and details.Show all framing-memlxr sizes and spacing such as floor beams,headers,joists,sub floor,
wall construction,rool'construction.More than tine cross section may be required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and lbundation,stairs,
Fireplace construction, thermal insulation,etc.
15 Elevation views.Provide elevations for new construction;minimum ri two elevatioto for addit'.ons and remodels.
Exterior elevations must reflect the actual grade if the.hinge in grpJc is greater than four foot at building envelope.
ruii-size sheet addendums showing foundation elevations with cross references are acceptable.
10 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for
non-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing.Provide plans for all Floors/roof assemblies,indicating member sizing,spacing,and hearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections and details showing placement of rebar.For engineered
systems,see item 22,"Engineer's calculations."
Iii Beam calculations.Provide two sets of calculations using currant code design values for all beams and multiple joists
over 10 feet long and/or any heam/joist carrying a non-uniform load. -
20 Manufactured floor/roof truss design details. Y _
21 Energy Code compliance.Identify the prescriptive path or provide calculations.A gas-piping schematic is required
for four or more appliances.
22 Engineer's calculations.When required or provided,(1.c..shear wall,roof tntss)shall be stamped by an engineer or
architect licensed in Oregon and shall b^shown to be applicable to the project under review.
to 111 Ln 11 NIMEM
./U1 Five(5)site plans are required for item 11 above. Site plans must lee H-1/2" x I I"or I I" x 17".
24 'two(2)sets each are required for Items 16, 19,20&22 above. _
25 Building plans shall not contain red lines or tape ons. "Mirrored"building plans will he not accepted.
26 "Reversed"building plans must meet criteria outlined in the Pertnit&System Development Fees document.
27 "Drawn to scale"indicates standard architect or engineer scale.
28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and COT Street Tree List.
Checklist must he completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. "14614(r, M'ONr(
Electrical Permit Application
- — Date received: Permit no.:M'�j�, �;��•-�-
City Of Tigard Pro?ect/appi.no.: Expire date:
City(!/'ligand Address: 13125 SW II'ill Blvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone.: (503) 639-4171
Fax: (503)598-1960 Case file no. Payment type:
Land use approval:
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
C.I New constriction Addilion/alteration/replacement U Other: _ U Partial
Job address: S W (`C'-%E ' Bldg.no.: I Suite no.: ITax map/tax lot/account no.:
Lot: I Block__ Subdivision
Project name: Description and location of work on premises
Estimated date of completion/inspection:
i_� U� F�•r• Mm
8miness name: r 1 7 F. - L Dewription Qly. (ea.) total no.ins)
G New nWdentW-single or multi-family per
Address: 1 c7 '5U.:1 0;W V4 -F` dne111n ".Includesattachedganrge.
City. -llac�c\
Slate:6V-1 ZIP: Servicelncluded:
Phone: _ Fax: Email 1000 sq.n.or less _ 1
Each additional 500 sq.ft.or portion thereof
CCB no.: t' EIeC.bus.lic.no: Limited energy,residential _
City/metro lic.no,: Limited energy,non-residential _' _
Each manufactured home or modular dwelling
Service and/or feeder 2
5i nsturc of su rvisin electrician(required) Date —
Sup.elect,name(print): License no:
7 Servlcesorfeeden-Installation,
alteration or relocation:
PROPERTY—O—PROPERTY-O—ViM. 200 amps or less 2
Name(print): 201 amps to 4W amps 2
401 amps to 6W amps 2
Mailing address: (a�ZA 601 amps to IOOO amps 2
City: (� Com.r7 StateCXk. ZIP: 9-12Z –over too0turps orvolts _ 2
Phone: "1 1 1 Fax: E-mail: Reconnectonl
Owner installation:The installation is being made on property 1 own Tempornry services orfeeders-
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation:
200 amps or less 2
ORS 447,455,479,670,701.
201 amps l0 4(N)amps _ _ 2
Owner's si mature: _ Date: _ 401 to 600 ams 2
Branch circuits-new,alteration,
or extension per panel:
Name: _ A. Fee for branch circuits with purchase of
Address:
service or feeder fee,each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
- -------------- - — of service or feeder fee,first branch circuit: I
Phone: Fax: G-mail:
Each additional branch circuit:
Mbe.(Service or feeder not Included):
Each pun: or irrigation circle
2
U Service over 225 amps-commercial U Health-care facility Eac�--
O service over 320 amps-rating of 1&2 U Hazardous location Each sign or outline lighting 2
family dwellings U Building over 10,0(1(1 square feel four or Signal circuit(s)or a limited energypanel. 2
U system over 600 volts nominal more residential units in one structure alteration,or extension*
U Building over three stories U Feeders.400 amps or more •lcscrition,_
O Occupant load over 91 persons U Manufactured structures or RV park Fitch additional Inspection over the allowable In any of the above:
•Fluss/lightingplan U Other per Inspection _ F_r
Submit__sets of plans with any of the above. lnvt aigalion fee
The above are not applicable to temporary construction service_ other
- --_._ – -- .. �.—
Not all jurisdictions accept credit cards,please call jurisdiction lot motr information. Notice:This permit a,,.• ^alion Perniit fee.....................$
U visa U MasterCard expires if a permit is t tbtained Plan review(at _ %) $
Credit card number: _ -_ —_ _L�.— within 180 days after it has been Slate surcharge(R%,) ....$
Expires accepted w complete. TOTAL .......................$
Name c of r w shown on cte•h card
Cardholder sitinsture — --Am•wnt 440-4615(6MCQM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED RESIDENTIAL U
NLY
Restricted Energy Fee...................................................... $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work involved:
Residential-per unit
1000 sq ft or less �4 $145.15 4 ❑ Audio and Stereo.systems'
Each additional 500 sq.ft or
poilion thereof $33.40 1 ❑ Burglar 41arm
Limited Energy $75.00 _
Each Manufd Home or Mudular ❑ Garage door Opener'
Dwelling Service or Feeder $90.90 2
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 2 El Vacuum systems'
201 amps to 400 amps _ $106.85 2
401 amps to 600 amps _ $160.60 2
601 amps to 1000 amps — $240.60 2 ❑ Other_
Over 1000 amps or volts _ $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Fee for each system.......................................................... e r 5 00
Installation,alteration,or relocation
200 amps or less $66.85 2 (SEE OAR 918-260-260)
201 amps to 400 amps _ $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑
see"b"above. Audio and Stereo Systems
Branch Circuits ❑ Boller Controls
New,alteration or extension per panel
a)The fee for branch circuits ❑
with purchase of service or Clock Systems
feeder fee.
Each branch circuit $6.65 ❑ Data Telecommunication Installation
b)The fee for branch circuits
without purchase of service t—J Fire Alarm Installation
or feeder fee. .44 5
First branch circuit _ $46.85
Each additional branch circuit _�� $6.65 ❑ HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not Included)
Each pump or Irrigation circle $53.40 Intercom and Paging stems
Each sign or outline lighting $53.40 LJ g g S y
Signal circult(s)or a limited energy
panel,alteration or extension $75.00 L Landscape Irrigation Control
Minor Labels(10) _ $125.00
Each additional Inspection over F—] Medical
the allowable In any of the above rr,, Nurse Calls
Per Inspection $62.50 _— u
Per hour _ $62.50 _
In Plant $73.75 Outdoor Landscape Lighting'
Fees: p ❑ Protective Signaling
Enter total of above fees $ Other--
8%
ther_8%State Surcharge $ '_i Number of Systems
25%Plan Review Fee
See 'Plan Review"section nr i $ No licenses Are required Cleanses are required for all other installations
front of application
Fees:
Total Balance Due $
— Enter total of abcve fees $_ _--
Trust Account# -- 8%State Surcharge $ ---
_------ Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
r\dsts\formsklc-t'ees.doc 08/30/01
Mechanical Permit Application
Date received;),-,/)g 6r; Permit no
City of ,F hgard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd.Tigard,Ok +1722; Date issued: By: Rcceiptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
U I roc 2 family dwelling or accessory U Com mercial/industrial U Multi-family U Tenant improvement
U New construction W Addition/alteration/replacement U Other:
tSWEDULF
Job address: �' ) St,,� 4r-,'M ZWCkNA Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead.
'fax map/tax lot/account no.: profit.Value$
_Lot: Block: Subdivision: 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: � 1ZZ-3 _
Description and location of work on premises:
Est.date of completion/inspection: Dewri tion (My. Res.only Res.only
Tenant improvement or change of use:
Is existing space heated or conditioned'?U Yes U Na Air handling unit _--__CFM---
Air conditioning(site plan reywr�ec�_-
Is existing space insulated?U Yes U No Alteration of existing HVACsystcin
MECHANICAL CQNTRA(TOR of er compressors
Business name: State boiler permit no.:
_---._-_ --_ -----�. - —
lip —Tons- BTU/H
Address: ire smo a dampers/duct srno a electors
City: ---� Statef i• ZIP: cat pump(site plan required)
Phone: Fa•: E-mail: nsta replacefurnac urner
CCB no.: --- Including duetwork/vent liner U Yes U No
nsta rep lam
rc ovate eaters-suspende
City/metro lic.no.: - wall,or floor mounted
Name(please:print): Vent for appliance of er than furnace,
Refrigeration:
CONi"lit-t PERSON It Absorption units_` BTU/H
Name- _ ue��e iJj _ Chillers HP
Address: ` �j mp,t-t Com ressors___, HP
,n ronmenta ex aunt and vent t,:on:
StateCj(2- ZIP: e`1"1 ZZ3 Appliancevcnl
Phone: q o`t l\ Fax'(o8d}o9 71 E-mail: Dryerex gust _
io r, ypc res. itc en azmat
hood fire suppression system
Name: A-S Q(js1sJ\ Exhaust fan with single duct(bath fans)
Mailing address: Exhaust system Peart from heating or AC
City: State: ZIP: ne piping on(up to outlets)
Ty LPG NG Oil
Phone: Fax: E-mail: Fuel piping each additional ovc-rl out ets
r(we."piping(sc emat c require )
N)nnber of outlets
Name: -- Other er st appliance or equipment: -�
Address: Decorative fireplace _
City: State: ZIP: nsert-type =_
Phone: Fax: E-mail: Woodstove/pel let stove _
er:
Applicant's signature: Date:
Name (print):
Na dl jurisdictions accept credit cards,please call,jurisdiction for ore minrmttation. Permit fee.....................$
U Visa U MasterCard Notice:'This permit application Minimum fee................$
-LL expires if o permit is not obtained Plan review(at __ %) $ _
Credo card number_ --��— _ Expires within 180 days offer it has been —
p State surcharge(89h) ....$ _
Name of cardholder ar shown on credit card accepted p as complete.
$ TOTAL .......................$ --
Cardholder signalure Amount W-4617(~'0M)
MECHANICAL. PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: _.._ Price Total
$1.00 to$5,000.00 Minimum fee$72.50 Table 1P.Mechanical Code _ _ _ Uly (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional$100.00 or including ducts&vents 14.00
fraction thereof,to and Including 2) Furnace 100,000 BTU+
_
$10,000.00. including ducts&vents _ 17.40
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Fumace
$1.54 for each additional$100.00 or includingvent 14.00
fraction thereof,to and Including 4) Suspended heater,wall heater
$25,000.00. or floor mounted heater 14 00
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not Included In appliance permit
$1.45 for each additional$100.00 or 6.80 _
fraction thereof,to and Including 6) Repair units
$50,000.00. 12 15
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boller Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. footnotes below. Comp •'
Minimum Permit Fee$72.80 SUBTOTAL: $ to 1 100K 7) 00K absorb unit
BTU 14.00 _
ate Surchar a 8)it 15 k t absorb
8%St
g $ unit 100k to 500k BTU 25.60
25°/.Plan Review Fee(of subotal) 9)15-30 HP;absorb
unit.5-1 mil BTU 35.00
Required for ALL commercial permits qnly -
TOTAL COMMERCIAL PERMIT FEE: $ 30absorb
unit 1-11.7.75 mil BTU 52.20
unit
11)>50HP;absorb
------ unit>1.75 mit BTU 1 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM
_ 10.00 _
Value Total 13)Air handling unit 10,000 CFM+
Description: Qt Ea Amount _ 17.20
Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler
ducts&vents _ 10.00
Furnace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct
ducts&vents 6.80 _
Floor furnace Including vent 955 16)Ventilation system not included in
Suspended heater,wall heater or 955 appliance permit 10.00
floor mounted heater 17)Hood served by mechanical exhaust -
Vent not Included in appliance 445 10.00
efmil - ---
e air units 805 18)Domestic Incinerators
17.40
<3 hp;absorb.unit, 955
Commercial to 100k BTU 19) or Industrial type incinerator
89.95
3-15 hp;absorb.unit, 1,700 _
101k to 500k BTU 20)Other units,including wood stoves
- 10.00
15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets
rnll.BTU 5.40 _
30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each)
1-1.75 mil.BTU 1.00
>50 hp:abc.orb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $
>1.75 mil.BTU _
Air handling unit to 10,000 dm 656 ---
Air handling unit>10,000 cfm 17p 8%State Surcharge $
Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 448
Vaiit system no,Included in 656 1appliance permit
Hood served by mecha_n_ical exhaust 656 other n pection o and Fees:
Domestic incinerator _ 1 170 1 Inspections outside of normal business hours(minimum charge-two hours)
per hour
Commercial or Industrial incinerator 4,590 Inspections
2 Inspedians far which no fee is specifically indicated (minimum charge-hall hour)
Other unit,including wood stoves, 656 $62.50 per hour
Inserts etc. 5 Additional plan review required by changes,additions or revisions to plans(minimum
Gab piping 1-4 Outlets_ 360 charge-one-half hour)$62 50 per hour
Each additional outlet -b3
-- -- "Stale Contractor Boller Certificaflon required for units>200k BTU.
"- ."Residential A/C rgqulres site plan showing placement of unci.
TOTAL COMMERCIAL a
VALUATION: �- All New Commercial Buildings require 2 sets of plans.
IAdstslformsVnech-fees.doc 02/11/02
Plumbing Permit Application
�Datercccivcd.. -P Permitno.:�S%n 9- �
City of Z'ioard Eewcromit no.: Building g permit no.:
Address: 13125 SW Hall Blv,I,Tigard.OR 97223
City njl ii urd Phone: (503) 639-4171 PrgjecUappl.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receiptno.:
Land use approval Case file no.: Payment type:
1
U I K 2 Gamily dwelling or accessory U Commercial/industrial U Multi-family 0 Tenant improvement
U New construction V Add ition/al te rat iotihepi acenx•tit U tool sClvicc U Other: _-
1 t t
Job address: 9_2V y. Stye L:;�T�t'1�`^'�<� I)cscription Qty. Icc(ea.) Total
Bldg.no.: Suite no.: New 1-and 2-family dwellings only:
Tax map/tax lot/account no.: SFR(includes l 100 for each utilityconnect ion)
O
I.ot. Block: Subdivision:
SFR(2)bath _
Project name: _ SFR(3)bath
City/county: -1J&tcrz _w/, ZIP: ") '1 z-z 3 Each additional bath/kitchen
Description and location of work on premises: Siteutilities:
�__ C�t�CTIa _L'`►,ST%�h Catch basin/area drain
Est.date of completion/inspectitu,: _ Drywells/leach line/trench drainIVIX N1 RING
1N*KAVI Olt Footing drain(no,lin. ft.) _
Manufactured home utilities
Business name: W.kvj , . .5-Vr- '-.t Manholes
Address:2`t510 ) O9 a 1 a T Rain drain connector
City: L )f Q State:i 71' ZIP:r/'1 I 3 Sanitary sewer(no.lin.ft.)
Phone: O 6,7 1 Fax: I E-mail: Storm sewer(no.lin.ft.) _
CCB no.: Plumb.bus.reg.no:
Water service(no.lin.ft.)
City/metro lie.no.: Fixture or Item:
Contractor's representative signature: Absorption valve
--- — --- Back flow preventer
Print name: Date: backwater valve _
Basins/lavatory
Name: c Clothes washer _ -
Address: c,10w c-wzcA S t, — Dishwasher
•w—' v;n Drinking fountain(s)
City: -pE� -7 State ZIP: �Z 3 DEjectors/sump
inkinun
Phone: g q M 11 Fax: )Oa?I E-mail: Expansion tlnk —
Fixture/sewer cap _
Name(print): SC kA r.Is r� Floor drains/floor sinks/hub —
Mailing address: SVU 0 mpaP, Garbage disposal
Hose Bibb _
City: �lEt4RC� State ZIP: y-1 zZ� Ice maker
Phone: '( I I Fax: '9 OA-1 E-mail: Interco for/grease trap —
Owner instal lation/residential maintenance only: The actual installation Primer(s) _
will be made by me or the maintenance and repair made by my regular Roof drain(commercial) —
employee on the pmRvrly 1 own as r ORS Chapter 447. Sink(s),basin(s),lays(s)
Owner's si nature: Date: 1� oCT 0z- Sump _
Tubs/shower/shower pan _
Name: Urinal _
Water closet
Address: Water heater
City: _ State: ZIP: Other: -- —� —
Phone- — Fax- _ E-tuail: _ _ Total
Not all jurisdlcUma accept credit curds.please call juds.,'lction for nae infonrutdott. Notice:This permit application Minimum fee................. •__
❑Visa U MasterCard expires if a permit is not obtained Plan review(at — %) $
Credit card number ___ _�—��_. _ -�— within 180 days atter it has been State surcharge(13%) ....$
lispircs
Name of cardholdet as shown on ctedit card �- accepted as complete. TOTAL .......................$
S
—- _---Cardholder signature _- — Amount 44o-4616(6rM OM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (individual) OTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink Z 1660 -3'312-u I the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory -^ 16.60 for each utility connection)
One 1 bath _ $249.20 _
Tub or Tub/Shower Comb 1fi 60 �-
�(.p,(Q� Two 2)bath
Shower Only 16.60 Three 3 bath — $399.00
Water Closet �I 1660 1 11'a (11,p -- SUBTOTAL
Urinal 16.60 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray i 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" 1e 60 PLEASE COMPLETE:
4" 16.60
Water Heater O conversion O like kind 16.60 V�Qeduantit-b Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved ReplacHemove'df
permit- _ i _ Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 4640 Lavatory _-
-- Tub or Tub/Shower j
Hose Bibs 1660 Combination
Root Drains 16.60 Shower Only— _
Drinking Fountain 16.60 Water Closet
Other Fixtures(Specify) 16.60 Urinal
_ Dishwasher
Garbage Disposal _
Laundry Room Tray
--- -- WashinggMac imn
Floor Drain/Sink: 2"
Sewer•t st 100' 55.OU 3., —
Sewer-each additional 100' 46.40 4"
Water Service-1 st 100' 5.5.00 Water Heater
Water Service-each additionat 200' — 4640 Other Fixtures i
(Specify)
Sturm b Rain Drain-1st 100' 55,00
Storm&Rain Drain-each additional 100' 46.40 -- _
Commercial Back Flow Prevention Device 4640
Residential Backflow Prevention Device' 27.55 ---
Catch Basin 16.60 —
Inspection of Existing Plumbing or Specially 62.50
Requested Inspections _ erlhr COMMENTS REGARDING ABOVE:
Rain Drain,single family dwelling 6.5.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric,or riser diagram is required if
Quantity Total Is >9
'SUBTOTAL --- ---- --
8%STATE SURCHARGE - --
"PLAN REVIEW 25%OF SUBTOTAL
Required only if fixture qty total is>9
TOTAL a
i
*Minimum permit fee Is$72.50+8%state surcharge,except Residential Backflow
Prevention Device,which Is$38 25-8%stale surcharge
"All New Con merclal Buildings require 2 sets of plant with Isomobic or riser
diagram for plan review.
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CITYOF T I G A R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2004-00081
13125 SW Hall Blvd., Tigard, OR 97 223 (503) 639-4171 DATE ISSUED: 2/24/04
SITE ADDRESS: 09300 SW EDGEWOOD ST
PARCEL: 2S 102DC-01900
SUBDIVISION: EDGEWOOD ZONING: R-4.5
BLOCK: LOT: 015 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE. HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB/SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: (4) Fixtures for bath and laundry remodel. _
-------- -- FEES ----
Owner: -
Description Date Amount
SIMMONS, CRAIG --
9300 SW EDGEWOOD "T I I'LUNIH] Prrmit Fee 2/24/04 $72.50
TIGARD, OR 97224 1 I'AX]M/0 StatC Surrharl 2/24/04 $5.80
Total $78.30
Phone : 503-820-1(113
Contractor:
R D PLUMBING IN
13900 NW SPRINGVILLE RD
PORTLAND, OR 9722.9
REQUIRED INSPECTIONS
Phone : 503-297-7422
Rough-in Insp ---- -------------_-------------
Top-out Insp
Reg #: LIC 73913 Final Inspection
PLM 26-313pb
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 fol;ow rules adopted by the Oregon
Issued By: ylt L� Permittee Signature: rr� I /� ✓,' =(�<.� L L-
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next businks4 day
FEB-23-04 MON 10:52 AM R, D• F I umb i ng, Inc, FAX NO, 503 297 7344 P.
r
Plumbing Pe><�
16ceeived
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nbinl
mitNo"
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Ci tyof Tigard �� � DrN "
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PermitNo.:
13125 SW 11n11 Blvd. C.g Plan Review Ocher
Tigard,Oregon 97223 IGAFj DIV : Petmittve.:
"�st•Rev ew Land Uso
Rhona: 503.639-4171 Fax: SGb13y�1�96�IV1 Uaic/B • CueNo.%
Internet: www.ci.dsard.or.uiBL)ILDIN Contact Ju Cee age z ror—
24-hour inspection Request: 503.639-4173 Nm ethod: (} $ypptem nbl{nrenh,,�+-s�p�
'11 �!OI O_R;4 " ' FEE".SCI�EUULE(for•: eela�l"b[orm'titfioa�se�cbcc it
Z
ew construction Demolltion acro��-dditiott/alte_rahon/tCOlacement yO- ther: 7r'' �a`� 1 &3 rz+hrlC;;dwelhaSa
�—
CAONSTR aQ�t, !ncl4da apo�t dor:'e11eb4rtilG conrieel(oti •.. ;k
]-Er,0RY'OFC SFR 1 bath 34920
i'&_2-Fanlil-dwelling Cor erciraldustci0l SFR 2 bath 3So.o0 �MM
k�]Accesso Buildio�g ❑Multi-)ram�ly 5FR ath _ _ 199-60 ,�•
(Mester l)Uilder I�Other; _ � goeh a dition11)bath/kitchen _^ 4300
J09ST7'IG LTIEOR\4A'rI0 O ATX " Fire s tin"-.: ft
rJob site address: - -d•6:+.;:n
Suite#: IBM JA X: Catchbasin/uea r stn - _ eta�6.0,
D ellneach Iindticr.A drain _16,60
P>�eot Name: yV1 A►JS — Footing drain(no.linear ft.) PegO Z
_b0
Cross street/DirecHons to job site: ,nuueme
facnd hoti Ines �110 _
Manboles _ 1650 w -
Rain drai connector 115,60
Sanita sew t n0.lI tear ft• Page Z _
Subdivision:
Stotm acw .linear ft•
arael#: Wattr s'Mce o,linear flPaP�e
Tax ma 4' ',i'te 1 ,M:' ^F, f""r4,61t
Y ".'t'•D U C4.1PrT LQ .'. 0 K 'fir .' "'N t Abso,tion valve ^_ 16.60 _
Back-flow reverter put 1
eIQ Backwater valve
Clothes washer
---- ---- -
Dishwashcr 16,50
- AVN ! yNA�1!1T s D[inkin fountain _ 16.60
�.
7s to
ectors<su -16.60
Name: CLi �olLank
Bx ansion t1
Flztutc/sc�•er cam 1 b_J
Address: - __ -'--
• Floor drain/doer emkrttu
City/Sti;te/Z / Garba c disposal - 16 rs.� _w"
Pliwie' Pte: ose b'b - - _ '660
�~
. .«. ..W.,
J a
r LTC' ;: t l'' CON ACP)LRSON _ ice maker
Name' Interco tor/ tMc M16.600
Address:
Primer 16.60 _
Ciit /y Sk1t�Zip: p — _ Rood in comrnercia _ _ 16,60 _
Phone: ._,--�-�ax: -� irl"asiNlavato
-milli ub/showct/shower pan 1660 ..l�s.;1R.SJ.
-�. c:,• ,i.!J. ;rr .TORS.:. . t., Urina —_ __— 166 _ _
BusinessNante: �� n
Water Closet -f6
Water healer �_ __t6. .�•_
address: �N(,Ill .S, ( 1 9 Other:
�'-
Phone:
Faxq Y
Submral S
CCB Lir.., A': )?limb, T,ic.#:a�31 j P "�C2-
--Minimum r�r um petmil Fee S72.S0 5 '
Authorized Resldential Sacktlow Minintum Fee 36.25
DatA .7
Signature' 1� �- 1,�4 _ � Plan 1teVlt w(25%of Permit Pee) t _
State Surchatee(8'/.of Permit Fce ����...
(Alceee print name) TOTAL]PEP-NUT ER S
Radeet Ihll permit eppllam
uen expiros its permit is not obtained within All new cotnt a uildinls repair*7 Vets erptant pith l..nnttoleot
tso days miter it has been aceepted.,cempletc. riser dl.c�.m for plan rt%low,
*Fa methvdellRY sN by Tri•C.oun,;8uildln(t-d,.rtu Sc,,kt leerd.
i.\Nts\Permit Ponrs\PktnPerrnitApp,doe 01103
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT#: ELC2004-00092
DEVELOPMENT SERVICES DATE ISSUED: 2/26/04
13125 SW Hall Blvd.,Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S102DC-01900
SITE ADDRESS: 09300 SW EDGEWOOD ST
ZONING: R-4.5
SUBDIVISION: EDGEWOOD
BLOCK: LOT : 015 JURISDICTION: TIG
Project Description: Bath remodel, (7)branch circuits.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION:
EACH ADD'L 500bF: 201 - 400 amp: SIGN/OUT LINE LTG:
I LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/FUR: 601+amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA AOD'L BRNCH CIRC: (3 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amp/volt: -4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVC/FDR—225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
SIMMONS,CRAIG MAPLE LEAF ELECTRIC
9300 SW EDGEWOOD ST. 157;4 S REDLAND RD
TIGARD,OR 97224 OREGON CITY, OR 97045
Phone: 503-820-8113 Phone: 503-505-1708
Reg #: FLE 3-4290
_ — 1,K' 127256
_
-FEES_ Sill) 43735
Description Date Amount
Required Inspections
11:I.I'RNI I I 11,C 1'crmit 2/26/04 $86.75 ---- _�_
[TAX] R'4o State Surcharge 2/26/04 $6.94 r Ele(TlROUgFinal Eler,t'I Final
Total $93.69
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 160 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 Utility Notification Center Those rules are set
forth in O6R_%2_Q01-0010 through OAR 952-001-0100. You may obtain copies of these:rules or direct ques ns t OUNC at(503)246-6699 or
1.80 2-2344.
Is ed By: Permit Signature: ,
OWNER INSTALLATION ONLY
1 hr� installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:_—
CONTRACTOR INN rA_LLATION ONLY _
SIGNA',URE OF SUPR. ELEC'R'- __ �. ���C DATE:
1 ICENSE NO: ___ s -- — -- --
Call 639-4175 by 7:00pm for an inspection the next business day
Flectrical Permit Application ONLY'
Received a
City of'Tigard Date/B D� Pin, 1 r...
13125 SW I[all Bivd.,Tigard,OR 97223 Phut Review 41
Phone: 503.639.4171 Fax: 503.598.1960 UatcfB : Other Perrot
Inspection Line: 503.639.4175 Ali date Ready/fly: lura ® See Page 2 for
hucmet www.ci.tigard.ur,us Notified/Method SupplementalInformation
TYPE OF WORK - PLAN REVHW
Nvw construction Addition/alteration/replacement — Please check all that apf'y:
_1 Ucnn 111ion ❑Other: ❑Service over 225 amp,,comm'l ❑Hazardous location
❑Service over 320 amps-rating ❑Buddng over 10,000 sq.R.,
CATEGORY OF CONSTRUCTION of I•and 2-family dwellings 4 or more new residential
I-and 2-family dwclingf ❑Commercial/industrial ❑Accessory building ❑System over 600 volts nominal units in one structure
(] Mnln-faintly ❑ Master builder ❑Other: ❑Building over three stories ❑Feeders,400 amps or more
-- ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITF. 111ATION,,W LOCATION ❑Egress/lighting plan RV park
--- q
Job no.: Job site address: I � W ❑Ilealth-care facility ❑Other:
' Submit 2 sets of plans with any of the above.
City/State/ZIP: . 4 r —�� 3 the above are not applicable to temporary construction service
Suite/bldg./apt.no.: Project name: _ FEE* SCHEDULE
Cross street/directions to job site: Oft,- aee New residential sinkle-or mulli-family dwellinv,unit. ;
- Includes attached garage.
1,000 sq.fl.or Icss 145 15 4
Subdivision_ _ - Lot no.:- — Fa.add'I 500 sq.R.or portion 33.40 1
Limited energy,residential 75.00 2
'lax trap/parcel no.:
- ,. _ ��-_-__.-_r._— __.._._�.� � Limited energy,non-residential 75.00 2
�
DESCRIPTION 01 WORK Each manufactured or modular
Rdwelling,service and/or feeder 90.90 2
! 2 YI� _MI! Services or feeders Installation,alteration,and/or relocation
200 amps or less 80.30 2
❑ TENANT 201 amps to 400 ams 106.85 2
0 PitOl'ERTY OWNF,R P p
n - ----- 401 amps to 600 amps 160.60 2
Name: V .1. f t S_,^Ms t S 601 amps to 1,000 amps 240.641 2
Address: &%.3Over 1,000 amps or volts 454.65 2
IU t Reconnect only 66.85 2
City/State/ZIP: Tjjj0r& O? Temporary services or feeders Installation,alteration,andlor
Phone: relocation
_(�� t{_ CV 1 Fax..( 3�yd. X94 -- 200 amps or less 6685 1
Owner Installation: I his insh anon is being made on properly that I own which is not 201 amps to 400 amps 10030 2
intended fir sale,Icasnt, xchange,according to ORS 447,449,670,and 7(l l. '- - -
+x� 4(11 amps l0 60(l amps 133 75 2
t)wner signature ,d ( ��� _��.- fate:Ala y Branch circuits-new,alteration,or extension,per panel
t .rPLICANT CONTACT PERSON
- A.Fee for branch circuits mlfh
rl []
' -------- ----- - - - service or feeder fee,euch
Business name: branch circuit 6.65 2
Contact name: ,�s B.Fee our branch circuits
s without service or feeder fee, ' gG.RS 2
Address each branch circuit
fie. "�-t1+y C �
Fitch add'Ibranch circuit 6.65 2
City/State/ZIP_ T-�, ,, 1 1�_ `T Miscellaneous(service or feeder not Included)
- -� �--`��
Phone: Fax:
Pump or irrigation circle 53.40 2
( ) :( )
Sign or outline lighting 53.40 2
E-mail: Signal circuil(s)or limited-
energy" ,r., ar!f; -------- ----- ---
panel,alteration,orCONTRA(TOt
- - _ --_--�- --- -�- extension.Describe: Page 2 ,
Business name: -Pie L.64r r-V,C f
Address �z Each additional Inspection over allowable In any of the above
- -5 - k--S- -- Per inspection 62.50
City/State/ZIP: Or _ 9V4 s' _ Investigation per hour 1I hr mint 62.50
Phone: Fax: AIndustrial plant per hour -717S -_
- � -- --.- ELECTRICAL PERMIT FEES*
UCB Lic.:1'LElectrical Lic.:3- Suprv. Lic.: j ?j S Subtotal . 7
- 3�
OLP
- —
Suprv. Electri 1 to Xgnaturc,required: &44 P4Plan review(25%of permit fee)
Print name: Nits,K - `er y nDa State surcharge(8%of permit fee)
- - - - TOTAL.PERMIT FEE
AUthOfIZCd signature: This permit application espires if a permit Is not obtained within I90
-- days after It has been accepted as complete
Print name: �1,M&P-j< �- _ Date: — I Fee methodology set by Tri-Counly Building Industry Service Board
Number of inspections per permit allowed
i�Buitdina\Penniu\Ft_C-PermitAppd,x IJn) 140-461!r(Ioro2/COM.M'Fn
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTC MORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Aud o and Stereo Systems*
❑ Hurglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air CondiIion Ing,
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercials stem.........
.............. $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Boiler Controls
Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarrn Installation
❑ HVAU
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls /•
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Intal number of con,,,wrrial systems: _v t
No licenses are required. Licenses are required •4
for all other installations
i.It H p Vertmn dilV Pw,,A App rk! 04103