Permit ELECTRICAL PERMIT
CITY OF TIGARD PERMIT #: ELC2005-00729
����► . DEVELOPMENT SERVICES DATE ISSUED: 9/27/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S136AD-00700
• SITE ADDRESS: 10470 SW 67TH AVE ZONING: R -4.5
SUBDIVISION: VILLA RIDGE NO. 2 LOT : 006 JURISDICTION: TIG
Project Description: (5) branch circuits.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVCI 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: 4 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:
PATRICK SIMMONS WILLAMETTE ELECTRIC INC
10470 SW 67TH AVE PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: 503 - 246 -1764 Phone: 503 - 624 -3631
•
FEES Reg #: LIC 75059
SUP 1965S
Description Date Amount ELE 34 -283C
CITY OF TIGARD MENU 9/27/2005 $73.45
[TAX] 8% State Surcharge 9/27/2005 $5.88 REQUIRED ITEMS AND REPORTS
Total $79.33
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 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.
Issued By: ��i Permittee Signature: r 0
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
SEP 27 2005 9: 0419M HP LASERJET 3200 p.2
a
.-< lectrical Permit A ( '
tjtk
1 jE fl ratio . s_, ,, „
City of Tigard Received w " '7
Da n R 'Q ' 'Z, Permit No.:� , .
13125 SW Hall Blvd., Tigard,. OR 97223 Pa Review - o � a �
Phone: 503.639.4171 Fax: 503.598. 1960 SEP 7° f 20 ! ' : q P ` f� ` ' ' : Odor permit
Inspection Line: 503.639.4175 ° '1 " Date Ready/By: Effli ® See Page 2 for
Internet: www.ci.tigard.or.us Notifted'4ethod: Supplemental Information
,,,i n ^r Fq >�ryaAd''``;i'+ Fr` . I' r + i y� a t o u t i t p�t :T 7 , rrr -te r � a. ;n. • o i : +
t:i'' ;it F k }i' ?l,''L .:4. ` IKIY II 1 y i .l 1 A Y n a ; � y M , IV log i ! T � I .,.$7 � cl .r � :d a . ...
.�f.W. ..ar.- "'.L�iXi��W _:�..iG..v�jiF� � ..rf<.Ec.Kt".`.... �Jr 1:- _ 3'tS•.. . "a^ •.^'r ���a���� y 4?;t a: w. �`�,�i!'��.�, ., ... �
❑ New construction i:,II . 1 IR�•j,w 1 • ' ; :4 - •l :c- 7 # Please check all that apply:
❑ Demolition ❑ Other ❑Service over 225 amps, comm'l ❑ Hazardous location
L , r s 1, i �h T nn , t l„ , u , oLI S a Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft,
r rLLr / , ; - s,.a y 1 , t ry�, t �G .. ,,L ,, ,; cam , t t,: `} r i y '� $ of 1 - and 2 - family dwellings 4 or more new residential
r ar...: s.._c.3. ,. -til;j _dw1G ! : ,�::E+,,.'S'...ntr? TIT ,....3u .'!.f 'l V- fi '�:,.,s + '
tq 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑Master builder ❑Other:
b A + '� `. Y r li , r r I i '5+ i Y9 is ti ,14 � ^ ' I �, :`.. 2 ! load over persons Manufactured structures or
Y 7 ev r � I 1 1 I s 1. 91, , `e �, "i l I r i EI + s t ['Occupant
: i'i'i_lt j1 41: ��.; Mi , .'c:fie.1ls.. :::....:.i.iV. :' '- 5.x. P U -p 41 1kti i,ti+ . l, iNtil :ic ii-4 _ . _ .....it ❑F .greS$ /l lghtrng plan park
Job no.: (� Job site address: /U�(� SW i ".�A ❑Health -care facility ❑D:
Submit 2 sets of plans with any of the above.
City /State /ZIP: r t . j � • L'Z.. The above are not applicable to temporary construction service.
r . �
Suite/bldg.apt.no.: Project name: it ` '>; .f; ' 'a � ',; t' +rl�
11,I ' " ) :.' ..
it ,. , Desadpdan Qty. Fee. Total
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
Y 4 4 1,000 sq. ft. or less 145.15 4
Subdivision: Lot na.: Ea. add'l 500 sq. ft or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no
s !••• i sYll £ • - t t - nt A>_^ Met, ; .. r - a� 7 I i' 'l" 1 �l �'qi . ! ri t : Limited energy, non-residential 75.00 2
t ,r. 7 91 i 7(d1 i - c: s k 5, tot- 1 ; a4� r : -:
` , , : 't v { n..fi't ` r r 7a i, 1 ..ii , J 3 S , � 41 + l { l_ p' la 1 N 1142: ,
Ltl '��.v +.:Cw�S +.:_... fy�4.i l�..i.aa..r �..r+, ..�:4?l, ,c ,wA:._ .1�.� -J... . +1.. -.. ,. .`�MI't,�,rt�l[�1 . Each manufactured or modular
dwelling, service and/or feeder 90.90 2
" " ` Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
F t Y 1" 1, `fi ,11, iti.:
T I r iTP,,7,L�I g 6 . 1 ' '� -! it` - Y��I ztiPi { R i 3, � Y f i r 1 tTlu j .F f11, 7+�..
( ;: 201 amps to 400 amps 106.85 2
ri i/- k•t :. . � °.e;uL 4) : :1 'e_._
4 .1 .l v 1i ,. tIV ._.1 ,
..4.Si - c'r:.l2L_!A'> �'�1:J:n r F i k. i �lRP.`
401 amp to 600 amps 160.60 2
■■ y 601 amps to 1,000 amps 240.60 2
Address: 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
Phone: ( ) -- 200 / 76 ' Fax: ( ) relocation
200 arms or less 66.85 1 1
Owner Installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 1 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
il " ,T ii r ! • , , i '.. - 7 . +R a - ; A. Fee for branch circuits with
i' 4 L 3 ? �, 17 F,J. Li I I It I - 91: ° I '4 I ,,,- f ri ' , '� P i '1 ` c Wi
; : v ? , ,� .. 2 L - ,; 7 .. c .:� ! , , ... s, l,.e.v,.. _�. _ - service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee, I 46.85 LItS. s 2
Address: each branch circuit
Each add'] branch circuit ii 6.65 (L 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( ) Sign cr outline lighting 53.40 2
E Signal circuit(s) or limited -
jlM ,%
,a l�ilXi i4 llP;? fi . > F' . i. ;�' I' Iy, AA, ', ii o-:a1 4 S t +l !lr � lgil t; Y �+`K ? 1 I ,I ,fil'Lrr41- energy panel,alteratl or
:. ?tn,.!,..tL_ � Ju lr,1..,�1..... � .a . _t.7..,,i. .r ok:1.. ..ii.. x,.,.z . 1 . .. 1_ •!
extension. Describe: Page 2 2
Business name: . - , • ree ,
Address. r Each additional inspection over allowable in any of the above
Z- • } Per inspection 62.50
City/ State/ZIP: T , ► ri, V • ? ( Investigation per hour (t hr min) 62.50
Industrial plant per hour 7� 75 '
Phone: ( So3) 62-t ' 3!e Fax: ( OA(- Di 3 a I Y i s ,:
( i; � ���G!; �£ i�' r��. ii��. �sGl� i�r.. ��r_.���Lus,���I!�- �!.;J 4'4t";' ". ,r -,
CCB Lic.: 7-j t) rd'j Electrical Lic.: c(. ' 3 C Suprv. Lic.: (16 S c Subtotal 73, (
Suprv. Electrician signature, required: ` Plan review (25% of pen-nit fee)
Print name: Date: �^ State surcharge (8% of permit fee) ss, If
. r- 9, Z - TOTAL PERM TT FEE
•
Authorized signature: A . - - ; r .Ii This permit application expires if a permit Is not obtained within 180
days Mier it has been accepted as complete
Print name: • 1 Date: • Fee methodology set by Tri-County Building Industry Service Board
•• Number of inspections perpetmit allowed
:BuildiagVe.miteaLGPemctApp.doc 12103 440.4e131(IWOVACO NWEB
• _CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00729
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175 __! "`' -� •
INSPECTION WORKSHEET FOR DATE: 11/4 /2005 TIME: 7:O8AM PAGE: 34
•
SITE ADDRESS: 10470 SW .67TH AVE CLASS OF WORK:
SUBDIVISION: VILLA RIDGE NO. 2 LOT #: 006 TYPE OF USE:
PROJECT NAME: SIMMONS
DESCRIPTION: (5)1branch circuits.
OWNER: SIMMONS, PATRICK PHONE #: 503 '764
CONTRACTOR: W LLAML. F I E ELECTRIC INC PHONE #: 503- 624 -3631
Inspection Request Scheduled For:. Date: 11/4/2005 Pour Time:
Code- # Inspection Description Confirm # Contact # Message
199 • Electrical final 020385-01 503-624-3631 Y
Corrections /Comments /Instructions:
•
•
•
•
r
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL - ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 ' - Phone #: (503) 718-
.
CITY - F TIGARD
BUILDING DIVISION - - \ PERMIT #: ELC200500729
13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 3/2712005
•
Phone: (503) 639 -4171 emu
Inspection Requests (24 Hrs.): (503) 639 -4175 I ' ° .LL
INSPECTION WORKSHEET FOR DATE: 9/3W2006 TIME: 7:05AM PAGE: 81
SITE ADDRESS: 10470 St�167TH AVE CLASS OF WORK:
SUBDIVISION: VILLA RIDGE NO. 2 LOT #: 006 TYPE OF USE:
PROJECT NAME: SIMMONS
DESCRIPTION:
(5) branch circuits.
OWNER: SIMMONS, PATRICK PHONE #: 503 -246 -1764
CONTRACTOR: WILLAMETTE ELECTRIC INC PHONE #: 503 -624 -3631
Inspection Request Scheduled For: Date: 9/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 017102 -02 503 - 624 -3631 Y
Corrections /Comments /Instructions:
[Y\
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
E FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: " N 6v L` Date: 3 O Phone #: (503) 718- 2 '