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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00032 DEVELOPMENT SERVICES DATE ISSUED: 1/24/03 = 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 1 S125DA -07700 SITE ADDRESS: 09245 SW 69TH AVE SUBDIVISION: KINGS VIEW ZONING: R -4.5 BLOCK: LOT : 076 JURISDICTION: TIG Project Description: Replace damaged 200 amp panel. 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: SIGNAUPANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W /SERVICE OR FEEDER: 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: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: TOMASOVIC, ROBERT S AND STAR ELECTRICALSERVICE DENISE B PO BOX 68712 9245 SW 69TH AVE PORTLAND, OR 97268 TIGARD, OR 97223 Phone: Phone: 503 - 579 - 9201 Reg #: ELE 26 -963C LIC 153627 FEES SUP 4313S Description Date Amount Required Inspections [ELPRMT] ELC Permit 1/24/03 $80.30 [TAX] 8% State Tax 1/24/03 $6.43 Rough - Elect'I Service Total $86.73 Elect'I Final 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: Permit Signature: / „ /J j jr_ 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: 7 3 Call 639 -4175 by 7:OOpm for an inspection the next business day Electrical Permit Application FOR OFFICE USE ONLY Received ∎-> r Electrical Date/B : t — — _ I - Permit No.: C n'' 4 /, - City of Tigard Planning Approval Sign DateB Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/13 : Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 / / Post - Review Land Use p t; i Date/B : Case No.: Internet: www.ci.tigard.or.us ■ annirtM1n'. I i� Contact Juris.: ® See Page 2 for 24 hour Inspection Request: 503-639-4175 "- �! Name /Method: Su. lemental Information. TYPE OF WORK PLAN REVIEW (Please check all that apply) New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial ❑ Hazardous location Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet, CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in N g 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: FEE* SCHEDULE Suite # :q� i 69 t Bldg. /Apt. #: Number of inspections per permit allowed Project ame: Description Qty Fee (ea.) Total i New residential- single or multi - family per Cross street/Directions to job site: / dwelling unit. Includes attached garage. O g ii47DA' . r 7 /. m 776y14. r ice° ' R � . Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Lot #: Limited energy, residential 75.00 2 Subdivision: Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or feeder 90.90 2 n �/ Services or feeders - installation, R !? CZ } 1T ei4 �C • alteration or relocation: // ` LL 200 amps or less 1 80.30 ��. �l 2 TDA'rn R U L 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 ❑ PROPERTY OWNER � ❑ TENANT 601 amps to 1000 amps 240.60 2 �. Over 1000 amps or volts 454.65 2 Name: a 1 --/ Sc p 1, T ,y T2 v0 c Reconnect only 66.85 2 Address: / i ,,,, 6 9 � Temporar services or feeders - installation, y p: �7 ct 617 e alteration, 00 mso le ss relocation: Cit /State /Zi 200 amps or less 66.85 1 Phone: Fax: 201 amps to 400 amps 100.30 2 401 to 600 amps 133.75 2 © APPLICANT -❑ CONTACT PERSON Branch circuits - new, alteration, or Name: 9 W& r a.e/ c .4 5 , e � ( /> Co . . ^�C o extension per panel: A. Fee for branch circuits with purchase of Address: ` , . () a 136 y B / / 7 Q service or feeder fee, each branch circuit 6.65 2 City/State /Zip: 4 ,, A2 / Aq va 0 1t } j an R 7 ®7 � B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: J 32 9 — ?„20 I Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): CONTRACTOR Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: 6 — / f 4 Signal circuit(s) or a limited energy panel, f alteration, or extension Page 2 2 Business Name: y l r�el�/j'e/C 41 c Description: • • Address: p, p O. 5 0 x / 7 Each additional inspection over the allowable in any of the above: City /State /Zip: 13 ep V z fTir q R, w 7 0 7 Per inspection per hour (min. 1 hour) 62.50 Phone: 7q — 9 (P f Fax: Investigation fee: CCB Lic. #: / 6 3 ‘ 7 Lic. #: 4-- 03 e_..--1 firer: Electrical Permit Fees* Supervising electrician Subtotal $ signature required: ‘4„, : Plan Review (25% of Permit Fee) $ .5 . Print Name: i c. 3 / State Surcharge (8% of Permit Fee) $ 6 �� CG L �"/I TOTAL PERMIT FEE _ $ `S(p , Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. (Please print name) i ADsts\Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard _ _,, Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: • Audio and Stereo Systems ❑ Burglar Alarm Garage Door Opener • Heating, Ventilation and Air Conditioning System Ei Vacuum Systems O Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: 0 Audio and Stereo Systems Boiler Controls Clock Systems ❑ Data Telecommunication Installation D Fire Alarm Installation HVAC Instrumentation 0 Intercom and Paging Systems n Landscape Irrigation Control 0 Medical 0 Nurse Calls O Outdoor Landscape Lighting ❑ Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested � C ( — 1 �►M PM BUP Location / �� 6 1 MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR rn BUILDING Tenant/ ' ELC 2 CAD 3 —47a4)3 Footing c� 3 � ` 1 ELC Foundation Access :., Ftg Drain 1Co /ACC- -2- A A., ELR Crawl Drain Slab Inspection Notes: � j �� SIT Post & Beam J Shear Anchors — //' O —, yl 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 Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL CTRIGA UG/Slab Low Voltage Fir- larm .4.11'11112,40 PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE 111 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line 1-,� ADA / , / Q U' l.J " Ext Approach/Sidewalk Date Inspector Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL