12015 SW NORTH DAKOTA STREET-1 i
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12015 SW NORTH DAKOTA ST
CITY OF TIGARD PERMIT 0:MASTER PERMIT
DEVELOPMENT SERVICES DATE ISSUED: 4 2002-oo,ea
1:125 SW:+all Blvd.,Tigard,OR 9?223 (503)039-4171
SITE ADDRESS: 12015 SW NORTH DAKOTA ST PARCEL: 1S134CA-0080;
SUBDIVISION: PANORAMA ZONING: R-4.5
BLOCK: LOT:003 JURISDICTION: TIG
REMARKS: Remodel family room
BUILDING
REISSUE: STORIE&: FLOOR AREAS REOURIED$STSACK$ REQUIRED
CLASS OF WORK: ALT HEIGHT: FIRST: of BASEMENT: of LEFT: SMOKE DETECTOR$:
TYPE OF USE: SF FLOOR LOAD: SECOND: of GARAGE: of FRONT: PARKING SPACES:
TYPE OF CONST: 5N DWELLING UNITS: FINSSMENT: of RIGHT:
VALUE: 13.16000
OCCUPANCY GRP: R3 BORM: BATH: TOTAL: 0.00 of REM:
PLUMBIAJ
SINKS. WATER CLOSETS: WASHING MACH: LAUNDRY TRAY& RARI DRAIN: TP VS:
LAVATORIES: OtSI;NASHEr.•'. FLOCIA DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH WASM:
TUBISHOWERS: GARBAGE DV P: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRATE:
OTHER PIXTI $:
MECHANICAL _
FUEL TYPES FURN t 100K: SOIL/CMP<THP: VENT FANS: CLOTHES DRYER:
FIIRN 1•1 UNIT HATERS: HOODS: OTHER UNITS: 1
MAX INP: htu FLOOR FURNANCeE: VENTS: WOODSTOVES: GAS OUTLETS: 1
ELECTRICAL
_RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELI.ANEOU$ ADD'L INBPECTK)N$
1000 SF OR LESS: 0 200 amp: 0 - 200 amp: W/BVC OR FDR: PUMPARMOATIOH: PER INSPECTION:
EA ADD'L 500SF: 201 -400 amp: 201 400 amp: lot W/O SVC/FDR: SIGN/OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 -600 amp: 401 600 amp: EA ADD!GR CSR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC/FDR: 601 - 1000 M'T'V: 601•amps-1000v: ARMOR LABEL:
10004 am0lr0lt
PLAN REVIEW SECTION
Rscom»ct only:
>•4 RES UNITS: SVCIFDR:.223 A.: 600 Y NOMINAL: CLS MEAIBPC OCC:
ELECTRICAL-RESTRICTED ENERGY
A.SF RESIDENTIAL B.COMMERCIAL _
AUDIO S STEREO: VACUUM SYSTEM: ^Y AUDIO B STEREO: FIRE ALARM: INTERCOM/PAOING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPERIIRPI: PROTErTIVE SIONL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DAYA/TFLE COMM: NURSE CALLS: TOTAL 6 SYSTEMS:
Owner; Contractor: TOTAL FEES: $ 270.25
SLAVENS,GREGORY AND OWNER This permit is subject to the regulations contained In the
KOPPER D SIGNED RESPONSIBILITY Tigard Municipal Code,State of OR. Specialty Codes and
12015 S W NORTH DAKOTA FORM IN FILE accordance
or
other applicable laws. AN wk will be done In
accordance with approved plans. This permit will expire N
TIGARD,OR 97223 work Is not started within 180 days of issuance,or if the
a work Is suspended for more than 180 days. ATTENTION:
Phan.. Phone: Oregon law requires you to folow rules adopted by the
Oregon Utlly Notification Center. Those rules are set
R.$•: forth In OAR 952-001-0010 through 952-001.0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)248-1987.
m REQUIRED INSPECTIONS
W Electrical Service Insulation Insp
J Electrical Rough In Electrical Final
Framing Insp Mechanical Final
Gas Llne:,Tsp Final Inspection
Gas Fireplace
Issued By : �����` __ Permittee Slgnatur �+�
Call (503)839-4175 by 7:00 p.m.for an Inspection needaidit Vxtbuslness day
Building Permi�Application
City of Tigard D.ter+eceivea: � o�- Permit no.: -ao/
Address: 13125 SW hall Blvd,Tile EANt ProJecUappl.no.: -- Expiredat
Ciry njTiRnrd Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payruent type:
t 1�R ') r, 7;1 7
%and use approval: _ MQ 1&2 family:Simple Complex:
IP,
1�I &2 family dwelling or accessory U Commercial/industrial U Multi-family U New consinrcdon U Demolition
IQ Addis' altcmtio placement LI Tenant improvement U Fre sprinkler/alarm U Other:
Job address: ( j( � _ Bldg.no.: Suite no.:
Lot: Block: _Subdivision: Tax map/tax lot/account no.:
Project name: _
Descript o nd location of work on premises/special conditions: y' h -�C _ �►tt
� t..L
0� Hall
Name: ("Cl 's Iti ve tis
Mailing address: I&2 fancily dwelling:
City: r , d 1_3 Valuation of work........................................ $ d r
Phone: . 7 Fax: S 61&f E-mail: No.of bedrooms/haths.................................
Owner's representative: a"" Total number of floors.................................
Phone: Fax: E-mail: New dwelling area(sq.ft.) ..........................
Garage/carport area(sq.ft.)......................_ _
Name: t,t_J J��' J'. Covered porch area(sq.ft.)......................... — —
Mailing address: Deck area(sq.ft.)........................................ __-
City: State: ZIP: Other structure area .ft.)......................... —
Phone: Fax E-mail: Co tehllVinaMlakhmiti-�ft
Valuation of work........................................ _
Existing bldg.area(sq.ft.) ..........................
Business name: ►.� New bldg.area(sq.ft.)
Address: ................................ --
City:
State: ZIP: Number of stories........................................ r
— - -- Type of construction...........................
Phone: — Fax: E•mail: Occupancy group(s): Existing: --
CCB no.: _ New: _
City/metm lic.no.: Notice:All contractors and subcontractors am required to be
RE WA 11 ILI EM I licensed with die Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: -- jurisdiction where work is being performed.If the applicant is
ZIP: exempt from I:,ensing,the following reason applies:
C City: State:
Contact person: Plan no.: — — -- ---
Phone: Fax: E-mail: --
Jw
0 Name: Contact person: _ Fees due upon application $_
7 Address: Date received: _
J City: State: 7.IP: Amount received .........
Phone: Fax: E-mail: Please refer to Pm schedule.
I hereby certify 1 have read and examined this application and the Not all Juds6krkos weep credit cv&.pleaw call Jorhekaon ror rose h("nuN1 n.
attached checklist.All provisions of laws and ordinances governing this U Visa o MasterCard
work will be complied wi ,whe 'fled herein or not. CwMt cad nurnto .
i
Authorized signaturq;1 17 _� Date.. --Name d csr�i.�er a r�ow�+on a cora
Phot name: S __— sipmeass, A.o.sr
Notice:This permit app don expires if a permit is not obtained within 180 days after it has beets accepted as complete. 41416ri(61900W
One-and Two-Family Dwelling
Building Permit Application Checklist Reference no.:
Ciryn(Tigard CI �A ' '1 Mrd Associated permits:
U Electrical U Plumbing U Mechanical
Address: 13125 SW ifall Blvd,Tigard,OR 97223 U Other:
Phone: (503) 639-4171
Fax: (503) 598-1960
low
I Land use actions completed.See jurisdiction criteria for concurrent review.;.
Zoning.Flood plain,solar balance points,seismic soils designation,_historic_district,etc. __
3 Verillcatlon of approved plat/lot. _
4 Fire dist-4pt approval required.
5 Septic s em permit or authorization for remodel. Existing system capacity,_
6 Sewer permit.
7 Water district approval. __ v
8 Soils report.Must carry original applicable stamp and signature on filk or with application.
9 Erosion control U plan U permit required. Include drainage-way prot tion,silt fence design and location of
catch-basin protection,etc.
10 ,,.3_ Complete sets of legible plans. Must be drawn to scale,showing onf<ormance to applicable local anystate
building codes. Lateral design details and connections must be incorpor ed into the plans or on a separatesheet attached to the plans with cross references between plan location a d details. Plan review cannot be cd
if copyright violations exist. _
I I Sitelplot plan drawn to scale.The plan must show lot and building setback imensions;property comer ele ions(if
there is more than a 4-Il.elevation differential,plan must show contour lines 12-ft.intervals);location of semcnts and
driveway;footprint of structure(including decks);location of welis/septic sys ms;utility locations;d' ction indicator;lot
area,building coverage area;percentage of coverage;impervious area;existin structures on site;pa surface drainage.
12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reforging pads, nnection details,vent —
size and location. _ _ _ _
13 Floor plans.Show all dimensions,room identification,window size,locati n of Spiroke detectors,water heater,
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches grade,etc.
14 Cross section(s)and details.Show all framing-member sizes and spacing o as floor beams,headers,joists,sub-floor,
wall construction,roof construction.Mone than one cross section may .qu •d to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling he' ,siding aterial,footings and foundation,stairs,
fireplace construction, diermal insulation,etc. _
15 Elevation views.Provide elevations for new constructs , immum of Iwo avations for additions and remodels.
Exteujor elevations must reflect the actual grade Jf. change in grade is great r than four foot at building envelope.
.
Full-size ddendums showin ton with cross reference are acceptable. _
16 Wall bracing(prescrlp ve path)and/or lateral analysis plans.Must indicatt details and locations;for
non-prescriptive path analysis provide specifications and calculations to engin ring standards.
17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating m6riber sizing,spacing,and hearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross seLdons and details showing placement of rebar. For engineered
systems,see item 22,"Engineer's calculations."
19 Beam calculations.Provide two sets of calculations using current code design alues for all beams and multiple joists
over 10 feet long and/or any bearn/joist carrying a non-uniform load.
a 20 Manufactured floor/roof truss design details.
21 Energy Code compliance.Identify the prescriptive path or provide calculations A gas-piping schematic is required
N for four or more appliances. _
22 Engineer's calculations.When required or provided,(i.e.,shear wall,roof truss shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project un er review.
a
m
(j 23 Five(5)site plans are required for item I 1 above. Site plans must be 8-1/2"x i 1"br 11"x 17".
J24 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 bee not accepted._
26 "Reversed"building plans must meet criteria outlined in tie Permit&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 CO'I'Street Tref List.
Checklist must be 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. ra04614(WICOM)
MedmWcalftrmit Application
rDatteeived• ,a� Permitno.:City of Tigard roject/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hal, Blvd.Tigard,OR 97223 Date issued: By:�Receipt no.:
Phone: (503)639-4171 -
Fax: (501) 598-1960 Case file qo.: Payment type:
Land use approval: _ Building permit no.:
(81 &2 family dwelling or accessory ❑Commen ialh strias C]Multi-family U Tenant improvement
U New construction Add itio terati replacement U Other.
Job address: lJot 5 .S Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: Suite no.. value of all mechanical materials,equipment,labor,overhead.
Tax map/tax lot/account no.: pront..',%!ue$ —
Lot: Block: Subdivision: _ *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP. _
Description and location of work on premises:
_ Fee(ea.) ToW
Est.date of completion/inspcction: Res. ReLoidy
Tenant improvement or change of use: 7Airhandling
Is existing space heated or conditioned?U Yes ?No unit CFM
Is existin s ace insulated?U Yes U Noon n (site an r w
B p Alteration of existing HVAC s stem
oiler/compressors
Business name: / pt 4f L4 Y4,AJ1 C 0 L State boiler permit no.:
~ HP Tons BTUM
Addmss: / �r amo
M
act smoke electors
City: I Stateeko ZIP: )i� eat mp an requ�re ) _
Phone: Fax: E-mail: nsta p ace urns ece/burner_,__FITUM
CCB no.: Includingductwork/vent liner U Yes U No
ostalUac re orate heaters-suspends,
City/metro lic.no.: wall,or floor mounted
Name(please print): ens ors appliance other than furnace -
Absofption units BTUlH
Name: Chillers V_ HP
Address: Co resaora HP
e wl Petah
City: _ State: ZIP: A lienee vent
Phone: � Fax: E-mail: ryerex aunt
ooTs Type res.kitcheidhazmat
hood fire suppression system
Name: Exhaust fan with single duct(bath fans)
Mailing address: Exhaust system nan from fiWng or
a City_ State: Z[P: VW- up to outlets)
T _ LPO NO Oil
16- Phone: Fax: E-mail: Fuel pipinpeach additional over 4 ou eta
Nrrecen (schematic requ ) _
Name: Number of outlets
1 appilhilace or eqvillpraeft
a; Address: Decorative fi lace
City: State: ZIP:
lbJ Phone: ax: E-mail: tov pe et stove
J I —
Applicant's signatur �- - .t.� Date: �
(Name(print): t.-r _
Nd all jorhdlctlom accept credit cards,pkaae call jari"cdon for more nformadon. expires I Notice: Permit fee.....................$ _
U Asa U MasterCard fa permit application f a permit is not obtained Minimum fee................
Cr•dit crd mtmhrr: �L_ _ --
—� _— Eaptrea within 190 days after it hes been Plan review(at _ %) $State surcharge(11%)....$
Name of cwt1hoMn d shmn on c -card accepted as complete.
sTOTAL .......................Z
low= Areorret 4404617 0=10W
MtCtlANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 'I &2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: 0w: Pdft Total
$1 00 to$5,000.00 Minimum fee$72.50 _ Ysb4.IA-ti4§0NMLQdda - ) Amt
$5,001.00 to$10,000.00 $72.50 for a first 55,000.00 and 1) Furnace to 100,000 BTU
$1.52 for ea additional$100.00 or Including ducts 6 vents - 14.00
fraction thereo tc and including 2) Furnace 100,000 BTU+
_
$10,000.00. Includingduds b vents 17.40
$10,001.00 to$25,000.00 e $148.50 for the i$16,000.00 and 3) Floor Fumace
$1.54 for each a itional 5100.00 or including vent 14.00
fraction thereof,to nd Including 4) Suspended heater,wall heater
_ __ _ $25,000.00._ or floor mounter heater_ 14.00
$25,001.00 to$50,000.00 _ $379.50 for the first 5,000.00 and 5) Vent not Included In appliance permit
$1.45 for each additi al 5100.00 or 6.80
fraction thereof,to an ncluding 6) Repair units
____ $50000.00. 12.15
$50,001.00 and up $742.00 for the first$50, 00.00 and Check all that apply: Dollar Ebel Air
$1.20 for each additional 100.00 or For Items 7-11,see Cour Pump Cond
fraction thereof. footnotes below. p
Minimum Permit Fee$72.50 SUBTOTAL 7) absorb unit
S -- t0 1100K00K BTU 14.00
- 8%State Surcharge $ 8)3-15 HP;absnt
unit 100k to 500k BTU 25.60
25%Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb
Requir- 'for ALL commercial Qermits onl J unit.5-1 mil BTU 35.00
TOTAL WERCIAL PERMIT FEE: $ uni 30-50 HP;absorb
unit 1-1.75 mil BTU 52.20
--- -----.----_-�_ 11)>50HP;absorb
unit>1.75 mil BTU _ 87.20
ED
ASSUMt' 'ATIONS PER APPLIANCE: 12)Air handling unit to 10. CFM -
-- 10.00
Value Total 13)Air handling unit OOG CFM+
Description: Q Ea Amount 1720
Fumar a to 100,000 BTU,Including 955 1 Non-porta evaporate cooler
ducts&vents _ _ _� _ _ 10.00
Furnace>100,000 BTU inch ding 1,170 15) nt connected to a single duct
ducts&vents _ _ _ _____� 6.80
Floor furnace Indudinwent _ 955 _ 16) Ilation system not Included In
Suspended heater,wall heater or 955 a ante permilt 10.00 _
floor mounted heater )Hond erved by mechanical exhaust
Vent not Included in appliance 445 10,00
rmlt 18)Domes incinerators
Repair units - _ _ _ 805 _ 17.40 _
<3 hp;absorb.unit, 955 19)Commer I or Industrial type incinerator
to 100k BTU 89.95
3-15 hp;absorb.un , 41 7
101k to 500k BTU 20)Other units, ducting wood stoves
- -� 10.00
15-30 hp;absorb. snit,501k to 1 2,310 21)Gas piping on On four outlets
mil.BTU _ 5.40
30-50 hp;absorb.unit 3,400 22)More than 4-per He((eaN1)
1-1.75 mll.BTU �_ 1.00
>50 hp;absorb.unit, 5.725 Minimum Permit Fee$ .x.50 SUBTOTAL: ; , y: $
>1.75 mil.BTU ,
Air handling unit to 10,000 cfm _- 656 --
_Air handling unit,10,000 cfim 1,170 8%State Surcharge S
Non-portable evaporate cooler _ 658 TOTAL RESIDENTIAL PERMIT FEE: f
J Vent fan connected to a single dud 448 _
Vent system not Included In 656
j appliance permit
Food served b my 1. Inspections
mechanical exhaust 656 1. r oections and Fees:
Domestic Incinerator 1,170 Inspections ovts!de of normal buriness boort(minimm ucharge-two hours)
_ $62.50 per hour.
Commercial or Industrial Incinerator ____4,590 - 2, Inspections for which no fee Is specifically Indicated (minimum charge-half hour)
Other unit,including wood stoves, 656 $62.50 per tour
Inserts,etc. 3 Additional plan review required by charges,additions or revisions to plant(minimum
Gas piping 1-4 outlets 380 charge-one-half hour)$82150 per tour
Ear h additional outlet - 83 "State Contractor Boller CoMflestion required for units>200k BTU.
TOTAL COMMERCIAL r; E ~Residential AIC requires she plan showing placement of uniL
VALUATION: All New Commerdel BuNdhtpa rltpulra 2 acts of plana.
1:ldstsVormsVn9ch-fees.doC 02/11/02
Electrical Permit Application
"(eived: Permit no.:H%,gC6 l-IXI
City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd,'rigard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 596-1960 Case file no. Payment type:
Land use approval:
l &2 family dwelling or accessory U Commerci al U Multi-far,ly U Tenant improvement
U New construction U Additi alteration/ lacement U Other. U Partial
Job address: 1 ;LO( � S, l� , Bldg.no.: Suite no.: Tax map/tax lotlaccount no.:
Lot: Block: Subdivision:
Project name: I Description and location ci work olr premises
Estimated date of completion/inspection:
Joh no: - LU tj eD Flee Max
Business name: ea Total ta.1-
New rrtal/taMW-sibrNeowarssWa turf!ar
Address: + t lm prop.
City: I State: ZIP: 9evvl4efsclded
Phone: Fax: E-mail: I(i(X)sq.ft.orless 4
CCB no.: Elec.bus.lie.no:
Each additional 500 sq.ft.or portion thereof _
Limited energy,residential 2
City/metro Ilc.no.: _ Limited energy,non-residential 2
Each manufactured home or modular dwelling
Si att.x of supervising electrician(required) Date Service and/or feeder 2_
Sup.elect.name(print): 1-icense no
semen
alteratles or relocathwt:
00 amps or less 2
Name(print): S ,e 0 ::01 amps to 400 amps 2
Mailing 401 amps to 600 amps -_ _ 2
address:
601 amps to 1000 amps
7-
City: I Stale:0y- ZI7 ,j Over 1000 stops or volts 2
Phone: /7 Fax: I E-mail: Rawnriectarl�_ I
Owner installation:The installation is being made on profkrty 1 own sampawymo "rFeeder'
which is not intended for sale,lease,rent,or exchange according to 0a'dlierailIOa'ar
ORS 447,455,479,67 01. � 200 amps or lees 2
201 amps to 400 amps 2
Owner's si aturec_ Date: V v �- 401 to 600 amps 2
ermcb clrealts-new,akerstMrm,
or e:teaaloa per panel:
Name: _ A. Fee for branch circuits with purchase of
Address: service or fader fee,each branch circuit 2
City: State: 'LIP: B. Fee for branch circuits widaut purchase
IL — of service or feeder fee,ftnl brwwh circnit: 2
Phone: Fax: E-mail: F�„dditionalbranch dnvlt:
� Mise.(t3ervleear sat laclatierl):
r
Service over 225 amps-eommemial U Health-care facility Each pump or irrigation circle - - 2
Servicemer320amps•rating of I&2 U Hazardous location Each si ng or outline lightin 2
amilydwellings U Building over 10,000 Square feet four o• Signal circuit(s)or a limited energy panel,
System over 600 volts nominal more residential units in one structure alteration,or extenxion* 2
U Building mer three stories U Feeders,400 amps or more •trition:
W U Occupant loaf over 99 persons U Manufactured structures a RV park F,h��1 Yrgett{ost ever the ellen le hr say of five above. -V
J U Fgress/lightingplan U tt�' -..--.--- Per inspection r—
Sobfalt__se-14 of plain wbh any of the above. Investigation fee
The above are not applicable to temporary corntnctim service. Other _
Na all)uridictiom resits credit caw please call)uridiction for more information Notice:This permit application Permit fee.....................$
U Visa U MasterCard expires if a permit is not obtained Plan review(at , %) $ _ _
Credit card number:_ _. ...L_ within 180 days after it has been State surcharge(8%)....$
Explm accepted es complete. TOTAL .......................
Name r d shown on ere cFnr--
Codbolder signature -- Amours 4"l5(fiMWM
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
TYPE OF WORK INVOLVED-RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee......... $75.00
............ ..............................
Number of Inspections et petyrilt allowed (FOR ALL SYSTEMS)
Service Included: Items Cost Total I Cheek Type of Work Involved:
Residential-per unit
1000 sq ft-or less $145.15 4 ❑ Audio and Stereo Systems'
Each additional 500 sq.ft.or
portion thereof $33.40_ 1 ❑ Burglar Alalm
Limited Energy $75.00_
Each Manurd Home or Modular
Dwelling Service or Feeder $90.90_ 2 ❑ o Door Opener'
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less 580.30 _ 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems*
401 amps to 800 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 A- 2 Temporary Servicesor FredomTYPE OF WORK INVOLVED-COMMERCIAL.ONLY
Installation,alteration,or relocation Fee for each system.......................................................... :75.00
200 amps or less $66.85 (SEE OAR 918-260-260)
201 amps to 400 nr..ps $100.30 401 amps to 600 amps $133.75 Check Type of Work Involved:
Over 600 amps to 1000 volts,
sae"b"above. ❑ Audio and Stereo Synt
Branch Circuit ❑
New,alteration or extension per panel Boller Controls
a)The tee for branch circuits
With prnchase of service or ❑ Clock Systems
feeder fee.
Each branctr circuit $6.65 2 ❑ Data Tel mmunication Installation
b)The fee for branch circuits
wfEhouf purchase ofsavvlce ❑ FI Alarm Installation
or/secler foe.
First branch circuit _ $46.85
Each additional branch circuit $6.65 HVAC
Miscellaneous Instrumentation
(Service or feeder not included)
Each pump or Itrlgelion cirr'.le $53.40
Each sign or outline 11g)lting $53.40 ❑ Intercom and Paging Systems
Signal ckailt(a)or a itm4" r> p
penel,alteration or extension � , ,p0�' ❑ Landscape Irrigation Control'
Mirror Labels(10) $125.00
lest
Each additional Inspectlon over ' — ❑
the allowable In any of the above
Per Inspection $62.50 ❑ N Cells
Per tour $62.50
In Plent $73.75--- ❑ Ou Landscape Lighting'
Fees: ❑ Prot Signaling
Enter total of above fees $—_ ❑ Other_ --
8%State Surcharge $ _ Number of Systems
j 25%Plan Review Fee
See'Plan Revk W'section on $ No licenses aro requi Lioenses are required for sit ottw Installations
front of application. —
Fees:
Total Balance Due $
Enter total of above hes $_ _
❑ Trust Account* _ 8%Stete Surcharge :
Total Balance Duo
All Now Commercial Bu!ldings require 2 sets of plans.
i:\dsts\fonns\elc-fees.doc 08/30/01
Permit#: "} 1'.�a - 1 S S<
Address: l*1O1S 16tO . 047
Issued by: C� — Date:
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not.submit this.statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 313:
1. I own, reside in, or will reside in the completed struct..re.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
❑ 3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
38. i will be my own general contractor.
CL
FIf I hire subcontractors, i will hire only subcontractors registered with the Construction Contractors
N Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
a name of the contractor.
m
aI hereby certify that the above information Is correct and that I have read and do understand the Information
Notice to Prope y Owners about Construction Responsibilities on the reverse side of this form.
_
(Signature of permit applicant) ( ate)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
Note: Hits lnjormation Notice to Property O►vncr. about Construction Responsibilities
was developed by the Construction Contractors Aloard in accordance with DRS 701.055(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the allowing responsibilitic�art;l areas of concern.
EMPLOYER ESPOi:StB1LlTIES;
If you hire persons not registered with the Construction ontractors Board to do labor in constructing or assisting in the
construction or improvement of a residential structure,you III, in most instances,be ruled to be alt employer and the people
you hire will be employees. As the employer,you must con .ly with the following:
Oregon's withholding tax law: As an employer,you must wi hold income taxes from employee wages'at the time employees
arc paid. You will'he liable for the tax payments even if you( n't actually withhold the tax from yo emplc;ces. For more
information,call the Oregon Dept.of Revenue at 945-8091.
Unemployment insurance tax: As an employer,you are reouir to pay a tax for unemployme insurance purposes on the
wages of all employees. For more information,call the Oregon l: loyment Division at the D . artment of Human Resource,
at 378-3524,
Workers'compensation insurance: As an employer,you are subjec to the'O on Workers'Compensation Law,and must
obtain workers'compensation insurance for your employees. If you fa to ain workers'compensation insurance,you may
be s ubi ct to penalties and will be liable for all claim costs if one of you iployees is injured on the job. For more informatiem.
call the Workers'Compensation Division at the Department of Co .urn r and Susiness Services at 045-7888.
U.S.Internal Revenue Service: As an employer,you mu ithhold fed A income tax from employees'wages. You will lm
liable for the taxpayment ever if you didn't actually i wild the tax. For ore information,call the Internal Revenue Service
at 1-8(X)-829-1040.
OTHER RESPONSIBILITIES AND ARE S OF CONCERN:
Code compliance: As the permit holder for this project,you ar 2 responsible for esoly iug any failure to meet axle requu-ernent
that may be brought to your attention through inspections.
(L Liability and property damage insurance: Contact your insurance agent to see.f you have adequate insurance coverage for
aaccident,,and omissions such as failing tools,paint overspray,water damage fro pipe punctures, fire,or work that must he
N re-done.
Time to supervise employees: Make sure you have sufficient time to supervise yo employees.
0 Expertise: Make sure you have the expertise to act as your own general contractor,to c dinate the work of rough-in and finish
W
—t trades,and to notify building officials A!the appropriate times so they can perform the required inspections.
If you have additional questions,write or call the Construction Contractors Board WO Box 14140,Salem,OR 97309-5052.
503/378-4621). The Board is located at 700 Summer St, NE Suite 300,in Salem.
prop-own.pm4
/94
CITY OF TIGARD
13,135 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OWNER
Electrical Signature Form
Permit#: MST2002-00184
Date Issued: 4/1102
Parcel: 1 S134CA-00604
Site Address: 12015 SW NORTH DAKOTA ST
Subdivision: PANORAMA
Block: Lot: 003
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Remodel family room
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the
electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical _aignature Form prior to the
start of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form Is received
OWNER: ELECTRICAL CONTRACTOR:
SLAVENS, GREGORY A AND OWNER
KOPPER D
112015 SSWNORTH
2 DAKOTA
AonTe # p
:' 503R-590-5177 Phon9 #:
Reg #:
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signa t upervising Electrician
If you have any questions, please call (503) 639-4171, ext. # 310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
Plumbing Signature Form
Permit#: MST2002-00184
Date Issued: 4/1102
Parcel: 1 S134CA-00604
Site Address: 12015 SW NORTH DAKOTA ST
Subdiv'sion: PANORAMA
Block: Lot: 003
Jurisdiction: TIG
Zoning: R-4.5
Remarks. Remodel family room
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Build:ng Dept.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
SLAVENS, GREGORY A AND
KOPPER D
12015 SW NORTH DAKOTA
TIGARD, OR 97223
Phone #: 503-590-5177 Phone #:
Reg #:
IL
a
AN INK SIGNATURE IS REQUIRED ON THIS FORM
t�
4hre 4of'Auethorizre==(d Plumber
If you have any questions, please call (503) 639-4171, ext. # 310
Permit#: HSt"Ve,o.P-"r' /9v
Address:
Issued by: 'YYl Date: `1 D D_
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will beffsled with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, Xid 0,her box 3A or 3B:
1. 1 owr, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
F1F13A. My general contractor is
(Name) Contractor regis. #
1 will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Constrection Contractors Board.
OR
3B. I will be my own general contractor.
n' If 1 hire subcontractors, I will hire only subcontractors registered with the Construction Contra.;tors
OC
Board. If 1 change my mind and hire a general contractor, I will contract with a contractor who is
N
registered with the CCB and will immediately notify the office issuing this building permit of,he
namc of the contractor.
OD
W I hereby certify that the above Information is correct and that I have read and do understand the Information
-t Notice toPrope ty Owners about Construction Responsibilities on the reverse side of this form.
(Signature of permit applicant) ( ate)
(White copy to issuing agency permit f le,
pink copy to applicant)
Information Notice to Property Owners
About Construction Responsibilities
Note.:. 1 his li#orination Notice to Property Owners about Comtructcon Responsibilides
was developed by the Construction Contractors Board in accordaace with ORS 701.035(5).
If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many problems by being aware of the following responsibilities and areas of coucem.
i,
FMFILOYER RESPONSIBILITIES:
If you hire persons not registered with the Construction Contractors Board to do tabor in constructing or assisting in the
construction or improvement of a residential structure,you will, in most instances,be niled to he an employer and the people
YOU hire veill he employees. As the employer, you must comply with the following:
Oregon's withholding tax law: As an employer,you must withhold income taxds from employee'W' ages at the time employees
are paid. You will he liable for the tax payments even-if you don't actunl;y withhold the tax ftbm}lour employees. For more
information,call the Oregon Dept.of Revenue at 945-8091.
Unemployment insurance tax: As an employer,you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information,call the Oregon Employment Division at&Depart,ntent of human Rewurces
at 378-3524.
Workers'compensation insurance: As an employer,you aro subject to the Oregon Workers'!C ompensation Law,and muss
obtain workers'compensation insurance for your employees. If you fail to obtaii. workers'compensation insursmce,you tsray
be subject to penalties and will be liable for all claim cosh if one of your emptoyev,is ililtired on the job. lror mole informltioti,
call the Workers'Compensation Division at the Department of Consumer and Business Services at'945-7889.
U.S.Internal Revenue Service: As an employer,you must withhold federal income rapt IVom employees'wages, You w ill he,
liable for the tax payment even if you didn't actually withhold the tax. For more information,call the Internal Revenue Service
at 1-800-829-1040. 1 . . , , t' , 0-; :I ,I .. .. .f 4 i
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
Code compliance: As the permit holder for this projec t,v(,u are responsible for resolving any failure to meet code require_ ents
that may be brought to your attention through inspections. ;
Liabilit;i:and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accident.; :md omissions such as failing toots,paint overspray,wa&.r otarhage from pipe punctures,fire,or work that must be
re-done,
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you have the expertise to act as your ow-,genetitl"h'ontritttor,to c oordinate the work of rough-In and Anish
trades, and to notify building officialck at the appropriate times so they can perform the required inspections.
I
If you have additional questions,write or call the Construction Contractors Board(PO 1 4140,Salen't;Ok 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own.pm4
1/94
4i 4`
CITY OF TIGARD 2"our
BUILDING Inspection Llne: (503)639.4175 • MST _,;2 �O
INSPECTION DIVISIO14 Business Line: (503)630-4171
' SUP
Received _Date Requested AM PM BUP _
Location ub MEC
Contact Person _ - - Mk?.n2:�� Ph( ) 7�0�'� J �y PLM
Contractor Ph( SWIR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain LIJAN 7 ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Ream
Shear Anchors
Ext Sheatt'Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing _
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING _
Post&Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manholo
Storm Drain -
Shower Pan
Other:
Finai
_PASS PART FAIL
MECHANICAL
Post&Beam
Rough-In
Gas Line
Smoke Dampers _
h-
PART GAIL
CTRICAL
Service
m Hough-In _
U' UG/Slab
J Low Voltage
Fire Alarm
Final Rein
PASS PART FAIL mon fee of S required before nod Inspection. Pay at Ciy Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: __... L I Unable to Inspect-no access
Fire Supply Line
ADA /
Approach/SidewalkDate bit_
Other:
l /
Final NOT RIMM!NM MOtlON IrOod*M do 9"PA88 HART FAIL
CITY OF TIGARD 24-Hour
BUILDING � Inspection Line: (503)631"175 0 man
INSPECTION DIVISION Business Line: (503)630.4171
BUP
Received Date R ted /0-19 AM PM BUP
Location Or+ ite MEC
Contact Person Ph( ) _ PLM
Contractor— Fh( ) SWR
BUILDING Tene^-. _ D — J��-7 -7 ELC
Footing ELC
Foundation
Ftg Drain ELR
Crawl Drain
Slab ElnepeWflonotes:
Post&Beam _m o+1--5
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Suap'd Ceiling
Roof
Other:
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:
Final
PASS PART FAIL
MECHANICAL — —
Post&Beam
Rough-In —
a. Gas Line
Smoke Dampers
F- Final
CO) PASS PART FAIL
ELECTRICAL
service
Lo Rough-In /7o�{G — ) (L S ka'y
UWSIRb
W Low Voltage AAd-
Fi arm
-13A38 PART FAIL F] Ralnepaction fee of$ required before resod kopection. Pay at City Hail, 13125 SW Hall Blvd.
AUPW ❑ Please cell for reinspection RE:___ — Unable to Inspect--no access
Fire Supply Line j(V(--'(4Aq
A#
ADA ps>a � _ Illa�ebr
Approac�/Slderwalk
Other:
Final DO NOT REMOVE Oft so III ode a re0Wd heM the job oft.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspectlon Lira: (503)UD-4175 OQ
INSPECTION DIVISIOtj Business Lira: ( 6394171
SUP
Received - Date R nested — __PM_ SUP
Location Supe MEC
Contact Person _ Ph ) PLM
Contractor_ P _) SWR
BUILDING TenanUOwner _ ELC
Footing ELC
Foundation
Fig Drain Mean: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear = O /,Z ,v _11r,�Ssa
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Coiling
Roof
WPLUMINQ
PART FAIL
Post&Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
M_FeCHANICAL
Post&Beam
Rough-In — –
IZ Gas Line
Smoke Dampers
Final
PASS PART FAIL ELECTRICAL
Servide
Rough-In _
�W UG/Slab
J Low Voltage —
Fire Alarm
Final F] Reinspection fee of$ required before next Impaction. Pay at^wily Hatt, 13125 SW Harl BMd.
PASS PART FAIL
SITE [] Please call for reinspection R�: _ []Unable to Inspect-na sooaaa
Fire Supply Line
ADA atm V
Approach/Sidewalk til !
Other:
Rnal DO NOT HIMME 11116111SMaillMl as j"dl"
FASS PART FAIL