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13260 SW HOWARD DRIVE b W CD Q cS S S O 0 0 X m I I V I 13260 SW HOWARD DRIVE CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST — -. INSPECTION DIVISION Business Line: (503)639-4171 BLIP � ----- ------- - — Received 2 2'4 Date Requested._ AM_—_ __ PM BUP Location 2— �26 _ ._ CL- «Suite MEC Contact Person _ Ph (_�v3) �79 7 PLM - — Contractor _. — Ph (_—_—) ---_----- -- SWR - -- 3UILDING Tena wne�-.. � Footing ELC Foundation Access: Ftg Drain ELR ___-- Crawl Drain SIT Slab Inspection Notes: Post& Beam --- --------_ - - Shear Anchors Ext Sheath/Shear - - - Int Sheath/Shear Framing — Insulation Drywall fJa+Iiny - -- --- -- - -— .-_ --- Firewall Fire Sprinkler -- - — -- ---- - --- - Fire Alarm sp'd Ceiling Roof n — � ft- &k h---- Other:Other: PARS PART FAIL Post&Beam Under Slab — ----- Rough-In _ Water Service V — ----- — Sanitary Sewer Rain Drains Catch Basin/Manhole --__ Storm Drain Shower Pen Other: — FinalPAS&_-PAF1T-_ -FAIL - — Post Namm Rough-in -- Gas Line oke Dampers -- ------ - -- ----- --- -- �$ —PART FAIL — --------_---- ------------- ---- - -- ELECTRICAL Sarvic --- UG/Slab � Low Voltage _ ------ -- -- -- - Fir. arm �n Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ART FAIL_ S ---- Please call for reinspection RF: _- Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Date , Inspector, �` ! =Job ExtOther:Fi„al DO NOT REMOVE this inspection record frame t . PASS PART FAIL r CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST ASNECTION DIVISION Business Line: (503) 639-4171 BUP Received _ Date Requested__—_ _- AM------- PM BUP __ - LocationSuite __ MEC '7111 � I Contact Person __—___�------___-- -- Ph(— ) 111.-11 PLM �---j1- ------ Contractor _ ___-_— v— __ Ph( ) —___ _ SWR BUILDING Tenant/Owner _ _-.___ ELC — Footing - — ELC _ - Foundation Access: Ftg Drain ELR Crawl Drain ---- �" SIT Slah Inspection Notes: Pus!&Beam Shear Anchors - — Ext Sheath/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/Manhole Storm Drain __.. - ----- ----------- — — Shower Pan O r: F AS PART FAIL —- -- - ---- — --T H—ANICAL _ Post& Beam Rough-In -- Gas Line Smoke Dampers -- - -- -- Final PASS PART FAIL ----- -- — - ELECTRICAL Service _— _----------- - — — Rough-In — - -- ------ — ------ -- UG/Slab Low Voltage _,_- — ---- —----- — - _ ----- Fire alarm Fina ❑ Reinspection fee of$__—___ --required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE _ - C Please call for reinspection RE:_ Unable to inspect-no access Fire Supply Line -- ,-� ADA Approach/Sidewalk Data Other: r DO N01 REMOVE this Inspection record f ara the jib site. PASS PART FAIL CITE( OF TIGA►RD PLUMBING PERMIT n DEVELOPMENT SERVICES PERMIT#: PLM2003-00220 13125 SW Hall Blvd , Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/27/03 SITE ADDRESS: 13260 SW HOWARD DR PARCEL: 2S103CA-01100 SUBDIVISION: WOODCREST ZONING: R-4.5 BLOCK: LOT: 010 JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYNE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES_ _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of backflow preventer device. FEES O�.vner - ----� -- Description Date Amount JORDAN, MICHAEL P + JENNIFER A 13260 SW HOWARD DR I I'I.I'\ll+i I'crnu� I cr 5127/03 $36.25 TIGARD• OR 97223 5/27/03 $2.90 Total $39.15 Phone Contractor: DALE SCHREDER LANDSCAPE 29060 SE HF_IPLE RD. EAGLE CREEK, OR 97022 REQUIRED INSPECTIONS RP/Backflow Prevenler Phone : 503-630-6355 Final Inspection Reg#: LIC 5165 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OIZ. 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 day:, of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rule:: adopted by the Oregon Issued By: .J) 9 , er/1_/ l �,'!; ( '� Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for an inspection needed tNie nAxt bus�es!j d y 1111 ming r IXtureS Plumbing Permit Application ' Received Plumbin@, Date/By.1 �� /-�'3 � Permit NoJLl%1, CityCit Of Tigard Planning Approval Sewer Datc/B : Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard,Oregon 97223 Datc(B : I Permit No.: Phone: 503-639-4171 Fax: 503-598-1960 Post-Rcview land Use Internet: www.ci.tigard.or.,ts Date/By: Case No.: Contact Juris.: Sec Page 2 for 24-hour Inspection Request: 503-639-41'5 Name/Method: Su i drrirntal Information. TYPE OF WORK _ FEF,*SCHEDULE(for special Information use checklist ❑ New construction Demolition _ Description Fee(ra•)-I Total Addition/alteration/replacement Other:' New 1-&2-family dwellings CATEGORY OF CONSTRUCTION Includes 100 ft.for each uIllify connection _ - _ � _ 1 &2-Family dwelling Commercial/Industrial SFR I)bath 249.2USFR 2 bath 350.00 Accesso BuildingMulti-Family SFR 3 bath 399.00 _ Master Builder _ Other: Each additional bath/kitchen 45.00 _ ____JOB SITE INFORMATION and LOCATION Fire sprinkler-sq. ft.: Page 2 Job site address: 13Z O(D E J)l'�� Site Utilities Suite#: -TBldg./Apt.#: Catch basin/area drain 16.60 Project Name: Dr ell/leach line/trench drain 16.60 Footing drain no. linear ft. Pae 2 Cross street/Directions to job site: Manufactured home utilities 110.00 { 2-� Manholes 16.60 Rain drain connector 16.60 Sanitary sewer(no.linear ft.) _ Pae 2 Storm sewer no. linear ft. Page 2 Subdivision: Lot#: _ _-_ Tax ma / arcel #: Water service no. linear ft. Pae 2 DESCRIPTION OF WORK Fixture or Item _ - - Absorption valve _ 10.60 Backflow prevcnter Pae 2 Backwater valve _ 16.60 Clothes washer16.60 - - _ ---- Dishwasher e 16.60 _ Drinking fountain 16.60 _ PROPERTY OWNER TENANT Ejectors/sump 16.60 Name: - ►J - Expansion tank 16.60 Address: •D ��tot_y R Q� 012 Fixture/sewer cap 16.60 Cit /State/Zi : Floor drain/floor sink/hub 16.60 - ----- Garbage disposal 16.60 Phone: _ Fax. [lose bib 16.60 APPLICAN_T__ I Ll CONTACT PERSON _ Ice makar 16.60 Na=77 A L - "� Interceptor/grease trap 16.60 Address: Z ��'�� E_ (Z17•_ Medical as value: S Pae 2 Cit /State/Zi _ � �' -�-}� Pr mer 16.60 Phone: 7 O � tp> ) �. f Roof drain(commercial) 16.60 _ � . Fax: �(. r y 7 Sink/basin/lavatory 16.60 E-mail: Tub/shower/shower pan 16.60 CONTRACTOR Urinal _ 16.60 _- Business Name: r n Water closet 16.60 ' (' Water heater 16.60 Address: �_ _ Other: City/State/Zip: t, Other: _ hone: ( 1 -f�'., I Fax: Plumbing Permit Fees* Plumb. Lic.#: Subtotal S ---- --- - Minimum Permit Fee$72.50 $ Authorized _0117Residential Backflow Minimum Fee$36.25 re: Dat . �_- Signature: <1[tC� Plan Review 25%of Permit Fee S 4AL State Surcharge(80,1a of Permit Fee) S I .e grin name)^ TOTAL PERMIT FEE S �• / Notice: This per�pplication expires If a permit Is not obtained%�iiwn All new commercial buildings require 2 sets of plans with Isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri-County Building Industry Service Hoard. 011stsTetmit FormsTImPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2-Supplemental Information Fee Schedule: _ Residential Fire Suppression Systems:_ Site Utilities — Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain- I" 100' 55.00 0 to 7,000 Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00 3 601 to 7,200 $220.00 Sewer-Ist 100' 55.00 7,201 and greater $309.00 — Sewer-each additional 100' 46.40 - WaterService- Ist 100' 55.00 Medical Cas S stems' Water Service-each additional 100' 46.40 _Valuation: Permit Fee: Storni&Rain Drain-Ist 100' 5500 $1.00 to$5,000.00 Minimum Ice$72.50 Storm&Rain Drain-each additional 100' 4640 $5,001.00 to$10.000.00 $72.50 for the first$5,000.00 and$1.52 for each additional$100.00 or fraction thereof,to and Future or Item Qty. Fee(ea) Total includino$10,000.00. 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 $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$50,000.00. s cially requested inspections-per hour 72.50 $5QC01.00 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 performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Quantity b Fixture Work Performed Comments regarding fixture work: Fixture Type: Replace New Moved Existing Capped Ba>tist /Font Bath -Tub/Shower -Jacuzzi/Whirlpool — -- Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher -Commercial _ -Domestic Drinking Fountain �--- E c Wash Floor Thain/sink -2" .4" Car Wash Drain *Note: If the fixture work under this permit results In an Garbage -Domestic Disposal -Commercial increase of sewer EDUs,a sewer permit will be Issued and -Industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refri .Drains plumbing permit can be issued. Oil Separator Gas Station Rec.Vehicle Dump Station Shower -Onng -Stall Sink -Bar/L.avatory -Bradley _ -Commercial -Service Swimming fool Filter Washer-Clothes Water F.xiractot _ Water Closet-'toilet Urinal Other Fixtures: i:\Dsts\Permit Forms\PlmPenmtAppPg2.doc 01103 /r\ MECHANICAL PERMIT CITY OF TIGAR;� DEVELOPMENT SERVICES PERMIT #: M24/04 -00076 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2 PARCEL: 2 S 5103 103CA-01100 SITE ADDRESS: 13260 SW HOWARD DR SUBDIVISION: WOODCREST ZONING: R-4.5 BLOCK: LOT: 010 JURISDICTION: TIG CLASS OF WORK: OTR FLOOR FURN: EVAP COOLF TYPE OF USE: SF UNIT HEATERS: VENT FA OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEh STORIES: BOILERS/COMPRESSORS HOODS: FUEL TYPES _ 0 3 HP: I DOMES. INCIN: LSF 3 15 HP: COMMI_. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 i• HP: CLO DRYERS: FURN < 100K BTU. AIR HANDLING UNITS____ OTHER UNITS: FURN —100K BTU: <= 10000 cfm: G > 10000 cfm: AS OUTLETS: Remarks: Install exterior A ( unit. Owner: ._.__. - -- FEES -_-' JORDAN, MICHAEL P + JENNIFER A Description Date i Amount 13260 SW HOWARD DR IMIJ1II Permit Fee 2/24/04 $7250 TIGARD, OR 97223 1 I,\ x State Surclmn. 2/24/04 $5.80 Phone: 503-590-7817 - —Total $78.30---- Contractor: _ AAA HEATING & CC "'.ING 2915 NE MARTIN LU I HER KING BLV PORTLAND, OR 97212 REQUIRED INSPECTIONS _ Cooling Unt Insp Phone: 503-284-2173 Final Inspection Reg #: LIC 222 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. 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 in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-6699.- Issued By: "_r A c _ Permittee Signature Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day Medianical Permit A ' • tion Received Mechanical G Date/I3 'j 1` Y -Permit No./1/ CVf1 Uwe City of Tigard Planning Approal Building +_ Date/By- Permit No. 13125 SW Hall Blvd. g cZ ZOOII Plan Review Other Tigard,Oregon 97223 F Datd Permit No.Post- . Phone: 503-639-4171 Fax: 503,- is 96D GP, Date/ y: Land use Date/By: Case No.: Internet: www.ci.tigard.or.us `' Olv g NC] Contact luris.: See Page 2 for 24-hour Inspection Request: 50311175 Namc/Mcthod: ( Supplemental Information. TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST New construction Demolition Mechanical permit fees*are based on the total value of the work Addition/alteratioll/re .lacement Other: performed. Indicate the value(rounded to the nearest dollar)of all CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit. id 1 &2-Farnfly dwelling Commercial/Industrial Value: $_ See Page 2 for Fee Schedule Accessory Building_____ Multi-Family RESIDENTIAL E UIPMENT/SYSTEMS FEE*SCHEDULE. -- Description oollFee eat Total Master Builder Other: Hestin cn JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning•• 14.00 t Job site address: Gas heat inp 14.00 Suite#: Bld ./A to Duct work 14.00 -- Hydronic hot water system 14.00 Project Name: M I1JgALJ +�- Residential boiler Cross street/Directions to job site: for radiator or hydronic system) 14.00 Unit heaters(fliel,not electric) in wall in-duct,suspended,etc. 14.00 Flue/vent for any of above 10.00 Subdivision: Lot#: Repair units12.15 Other Fuel A Ilanecs Tax map/parcel#: Water heater 10.00 DESCRIPTION OF WORK Gas fireplace 10.00 *&M1,014 -_ Flue vent water heater/gas fireplace) 10.00 #a Lo li fiii as 10.00 — Wood/Pellet stove _ 10.00 _ Woad fireplace/inseri 10.00 _ Chimney/liner/flue/vent 10.00 PROPERTY OWNER TENANT Other: 1 10.00 Name: M 1 ,t/l/¢ ! Environmental Exhaust&Ventilation -'- Range hood/other kitchen equipment �10.00 � Address: I be. Clothes dryer exhaust 10.00 1 CA Stat /Zt C� '% Single duct exhaust Ph0 Fax: (bathrooms,toilet compartments, APPLICANT CONTACT PERSON utility rooms)____ 6.80 Name: �~ Attic/crawls ace fans _ IO.W - -.--------- Other. 10_00 AddreS Fuel Piping City/State/Zip: _ _ _ ••$5.40 for first 4,$1.00 each additioral � Furnace,etc. " Phone: I rttX Gas heat pump E-mail: Wall/suspended/unit heater •• CONTRACTOR Water heater Business Name: AAA Y4L&,h f &T h-H a h- Fireplace Range Address: _y � _t')') BB -- •• City/State/Zip: lothes dryer as " Phone:5W—Z —�12 1 ax:7j2•Z Sf —/ Other: CCB Lic. ��, _ Total _ Mechanlal Permit Fm*5 Signature: &A- Date: tL��� Subtotal: S 1 Minimum Permit Fee$72.50 $ ( A„_ Plan Review Fee 25%of Permit Fee S (Please print name) IV State Sumhar a 8%of Permit Fee 5 _ TOTAL PERMIT FEE 5Q Notice: This permit application expires If a permit Is not obtained within 'Fee methodology set by Trl-Coi,.nty Building Industry Service Iloard. Igo days after It has been accepted as complete. "Site plan required for exterior A/C units. i:\Nts\Permit forms\MecPern App.doc 01/03 AAA HEATING & COOLING 2915 NE MLK JR BLVD PORTLAND, OR 97212 503-284-2173 FAX 503-284--1552 CCB#22i i -------__-_--A C ST-TE PLAN r M �i 41. r CITY O F T I G wH R D ELECTRICAL PERMIT PERMIT#: ELC2004-00108 DEVELOPMENT SERVICES DATE ISSUED: 3/8/04 13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S103CA-01 100 SITE ADDRESS: 13260 SW HOWARD DR SUBDIVISION: WOODCREST ZONING: R 4.5 BLOCK: LOT: 010 JURISDICTION: TIG Project Description: Install sub panel and(8)branch circu?ts for kitchen remodel and AC. 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: 31GNAL/PANEL: MANF HMI SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 200 amp: 1 W/SERVICE OR FEEDER: 8 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR. 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ _ PLAN REVIEW SECTION 1000+ amp/volt: _ > 4 RES UNITS: > 600 VOLT NOMINAL SVCIFD _) Reconnect only: R —225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: JORDAN,MICHAEL P+JENNIFER A HOT WIRE ELECTRIC INC. 13260 SW HOWARD DR PO BOX 2142 TIGARD,OR 97223 HILLSBORO,OR 97123 Phone: 503-590-7817 Phone: 503-848-6823 Reg # LIC 146276 -- – EEE 14-549(* _ FEES stir 44875 Description �sDate Amount Required Inspections [ELPRMT] ELC'Permit 1 $133.50 --- -- [T'AXj 8"1,State Surcharge .ti ii l $10.68 Rough-in Electect'I Service Total $144.18 Elect'I Final This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialty Codes and W 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 160 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 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)246-6699 or 1-800-332-2344. I34ued By: Permit Signature: A ��6 1/ OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNFR'S SIGNATURE: DATE:.--- CONTRACTOR ATE:--_CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO' Call 639-4175 by 7:00pm for an inspection the next business day NLY Electrica. Permit Application FOR ' " Received 3 Ji Permit a.: City of Tigard Date/By: ? (/ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Rev'e Other Permit: Phone: 503.639.4171 Fax: 503,598 1960 Date/B : Date Ready/By: Jura ® See Page 2 for Inspection Line: 503.639.4175 Notified/Method I Supplemental Information Internet: www.ci.tigard.or-us -- -- TYPE OF W81t1C PLAN REVIEW — -- Please check all that apply. ❑New construction �]Addition/alterationireplacement ❑ ery Sice over 225 amps,comm'i ❑Hazardous location [DDemolition —_❑Other: ❑Service over 320 amps-rating ❑Buildng over 10,000,q.ft., _ CATEGQjtY�OF CONSTRUCTION of 1-and 2-family dwellings 4 or more new residential []System over 600 volts nominal units in one structure 1-and 2 family dwcllmg ❑CommerciaUindustrial ❑ Accessory building ❑Building over three stories ❑F«eders,400 amps or more �]Multi-family _❑Master builder [�Other: ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE iN____TlO?V ANIS LOCATION ❑Egress/lighting plan RV park -- —' — _ ❑Health-care facility ❑Other: Job no.: _ Job site address: k'y to rt f .j Submit I-sets of plans with any of the above. J The above arc not applic,.ble to temporary construction service City/State/ZIP: , rr EEE' SCHEDULE Suite/bldg./apt.no.: Project name: Eadd'l _ Qty.— Pee. Total Cross street/directions to job Site tial single-or multi-family dwelling unit. ached garage._ r less 145 15 4 Lot no.: sq.ft.or portion 33,40 1 Subdivision: _ ---- Limited energy,residential 75.00 2 Tax map/parcel no.: Limited energy,non-residential 7500 2 _ -DESCRIPTIO OF WORK _ �Iw J, Each trtanufactured or modular dwelling,service and/or feeder 90.90 2 Services or feeders installation,alteration,and/or relocation —— 200 amps or less 80.30 B 3fI 2 201 amp �s to 400 amps 106.85 2 WN [j PROPERTY OER TENANT_ 0 — 401 amps to 600 amps 160.60 2 Name: _ v ir ,( , — 601 amps to 1,000 amps 240.60 2 Over 1,000 amps or volts 454.65 2 Address: r Reconnect only 66.85 2 City/State/ZiP: Temporary services or feeders Installation,alteration,and/or relocation Phone: -7 y' 17 - F ( ) 200 amps or less 66.85 1 Owner Installation:This installation is being made on property that I own which is not 201 attips to 400 amps 100.30 T 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps 133.75 2 Owner _ signature Date Branch circuits-new,alteration,or extension,per panel K _ — - APPLICANT t ❑ CONTACT PERSON _ A.Fee for branch circuits with _ service or feeder fee,each 6.65 r' 2 Business name: , i branch circuit f-�� t W ,r>c- � / v r� --------- B Fee for branch circuits Contact name: r•- iS r�k without service or feeder fee, 46.85 2 each branch circuit Address: �/✓ l 4/1 — Each add'I branch circuit -6.65 2 City/State/ZIP; 1 //S•6 _ Miscellaneous(service or feeder not included) Pump or irrigation circle 53.40 - 2 Phone:( Jo 3) V,) y' Fay :(6-oS r!�e k 3-- Sign or outline lighting 5340 '- E-mail J Signal circuit(s)or limited- i_ energy panel,alteration,or - ---- extension.Describe: Page 2 2 Business name: ,� W rW l r c•1 Each additional inspection ov,a allowable In any of the above Address: r O d X l l.Z -- -- Per inspection 62 50 City/State/ZIP: �.�, /C a,0 Investigation per hour(1 hr min) 6250 industrial plant per hour 73.75 Phone:( s J) d c/ — Fax:( � ) qi/y- y.1 y' �« tEC't't1CA1.'PE CCB Lic.: Electrical Lic.:s q- 6'a J y i Suprv.Lic.: t 1 t1j"7-j Subtotal J J!— Suprv. Electrician signature,required: Plan review(25"/0 of permit fee) State surcharge(9%of permit fee) r� Print name: Dace: f , i ! � TOTAL PERMIT FEE Authorized signature: This permit application expires If a permit is not obtained.wlthln Igo days after It has been accepted as complete Print name: Date: Fee methodology set by Tri-County Building Industry Service Board Number of inspections per permit allowed. I%Sulldin0mvniUTLC_PerrtdtApp doc 12103 "0.46I5TI101n2/C0M/W88 C Electrical Permit Application - City of'Tigard I'age 2 - Suj)plemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL_WORK ONLY: Fee for :all residential systems comhined........ $75.00 Check Type of Work Involved: ❑ .11.1io and Stere,^ Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating,Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial system....................... $75.00 (SEE OAR 918-260-260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Sysiems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i�Buddinglrrmitv\FLC Pm Mvpdoc 04/03 e