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Permit CITY OF 1 I RD ELECTRICAL PERMIT PERMIT #: ELC2004 -00688 DEVELOPMENT SERVICES DATE ISSUED: 10/27/2004 '--" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 1S135DD-01800 SITE ADDRESS: 11565 SW HALL BLVD SUBDIVISION: METZGER ACRE TRACTS ZONING: C -P BLOCK: LOT : 026 JURISDICTION: TIG Project Description: Alteration of (2) branch circuits for addition of shed. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 1 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: PANG, KEIKO TR GENIE ELECTRIC CONSTRUCTION 46 -442 HOLOLIO ST 8701 SE 156TH AVENUE KANEOHE, HI 96744 PORTLAND, OR 97236 Phone: Phone: 503 - 762 -9296 Reg #: LIC 56639 SUP 4536S FEES ELE 34 -488C Description Date Amount Required Inspections [ELPRMT] ELC Permit 10/27/200' $53.50 [TAX] 8% State Surcharge 10/27/200' $4.28 Rough - Elect'I Final Total $57.78 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility N otification Center. Those rules are se - - e - 952 - 001 - 0010 throu. h OAR 952 - 001 - 0100. You may obtain copies of these rules or dire t questions to OUNC at (503) 246 or 1 -000- 332 -23 ■• Is . ued By: �� % ' Permit Signature: OWNER INSTALLATION ONLY The installation is being made on property { own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: ���'�� y DATE: LICENSE NO: 5 � Call 639 -4175 by 7:OOpm for an inspection the next business day f �t s _ 4 w ' , a ' " .'9:z 3rF -* . � d r .r VG ntr '',i n' 2 i, ' 1 r t .,1 TM s, , r , < ' ° ` 'iFOROFFICE U SE ONiJYr� i,` r ` fi h J � --, g r r;11,': 1,, Electrical Permit Application twl .1 ;,t M- ex. ;,. I.-ii - A ,riaf? S , "J„ n .. ' l r .. 'ii 'V 6ititiiti 0, :,ii +;ii City of Tigard RDeacteived: fO Permit No.: dttlin g 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 t r�tll4 Date /By: Other Permit: Inspection Line: 503.639.4175 ,, J� ► ".Y', Date Ready/By: J i 21 See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: //0 Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ❑Service over 225 amps, comrn'l DHazardous location ❑ Demolition ❑ Other: ['Service over 320 amps - rating ❑ Buildn over 10,000 sq. ft., CATEG ! RY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling L':1 / ommercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder ❑ Other: ❑Buildin over three stories ['Feeders, 400 amps or more ['Occupant Toad over 99 persons [I Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park Job no.: Job site address: > P J � DHealth-care facility ❑Other: r � s 5° r7/�L�. l ^`r! Submit 2 sets of plans with any of the above. City/State /ZIP: 'T1 ( b OR- The above are not applicable to temporary construction service. Suite/bldg./apt. no.: Project name: t FEE* SCHEDULE ■�G` V ✓V Description Qty. Fee. 1 Total ** Cross street/directions to job site: L(�l Ct ,� 0 New residential single- or multi - family dwelling unit. 2 Includes attached garage. D in 6'1 IA c „ , (1 4 1,000 sq. ft. or less 145.15 4 Subdivision: Lo n o. : Ea. add'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map/parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular y- dwelling, service and/or feeder 90.90 2 I k I Services or feeders installation, alteration, and /or relocation ' c r 730 V 61 - 4 - y - CO p , 200 amps or less 80.30 2 ©PROPERTY OWNER ❑ T NANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: rn K I�t-O d1, di --C� N_ 601 amps to 1,000 amps 240.60 2 Address: r f Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 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 ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with 1 re service or feeder fee, each 6.65 Ip - 2 Business name: branch circuit B. Fee for branch circuits �. t - C without service or feeder fee, I 46.85 i ` Contact name: lI a a L. = J2 1 `� " each branch circuit Address: Each add'l branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Phone: () g(0 .. -- Liq 3 zi Fax: : ) 76 7 _3 i 0 3 Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: ....6.--/y..1 EL 6 , ro�.S' t/t^.r zoete Address: ' 7o S / 5-4- 441 Each additional inspection over allowable in any of the above Per inspection 62.50 City/State /ZIP: p p. TL t D 7 z3 C • Investigation per hour (1 hr min) 62.50 Phone: (503 ) 762 - q 2 9 6 Fax: ( 3 ) n Z - l i Sea Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* _ CCB Lic.:' 5 C 6 39 Electrical Lic.:3 i 'Legg C Suprv. Lic.:45 36 5 Subtotal 53. 5 V Suprv. Electrician signature, required: O _,. e. CSI /J� 'L Plan review (25 %ofpermit fee) Print name: �w """ Da te: State surcharge (8% of permit fee) 'i. a g GE ph d . 2? - TOTAL PERMIT FEE 5 7. 5 Authorized signature: g thi This permit application expires a permit is not obtained within 180 days after it has been accepted as complete Print name: L(, 2.0 (4 - L trtr Date: t _2 0 I * Fee methodology set by Tri-County Building Industry Service Board [ ** Number of inspections per permit allowed. i:\ Building \Permits\ELC- PermitApp.doc 12/0 440- 46!5T(10 /02 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo 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 Systems ❑ 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:\ Building \Permits\ELC- PermitApp.doc 04/03 CITY OF TIGARD 24 :HbUr BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business i fhe: (503) 639 -4171 MST BUP Received Date Requested // 7 AM PM BUP Location Suite MEC Contact Person O? 4.k=f; Ph ( ) F60 - PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC aGG{- j 6 ( S') Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & 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 s Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL . Post & Beam Rough -In Gas Line Smoke Dampers Final RT FAIL Service Rough -In UG/Slab Low Voltage Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ZPA PART FAIL SITE _ 0 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date,// / Inspector, 70 Ext Other: Final DO NOT REMOVE this inspection record from the ‘b site. PASS PART FAIL