Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00204
DEVELOPMENT SERVICES DATE ISSUED: 4/21/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136DC - 04300
SITE ADDRESS: 11930 SW 72ND AVE
SUBDIVISION: FRUITLAND ACRES ZONING: C -G
BLCCK: LOT : 030 JURISDICTION: TIG
Project Description: (1) branch circuit.
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: 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: 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:
KROO, STEVEN HOOD TO COAST ELECTRIC
17643 CHASE ST. PO BOX 793
NORTH RIDGE, CA 97223 LAFAYETTE, OR 97127
Phone: 616- 345 -5265 Phone: 503 - 835 -7209
Reg #: ELE 36 -78C
LIC 1272941
FEES SUP 4877S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/21/04 $46.85
[TAX] 8% State Surcharge 4/21/04 $3.75 Rough -
Elect Final
Total $50.60
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:
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 639 -4175 by 7:OOpm for an inspection the next business day
El `ical Permit A lication FOR OFFICE USE ONLY
Clt of Tigard
Received
t. 1'Q 16 Permit 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi s
Phone: 503.639.4171 Fax: 503.598.1960 I A Date Bv: Other Permit:
Inspection Line: 503.639.4175 Date Ready By. Jura el See Page 7. I'or
Internet: www.ci.tigard.or.us \otitied Method• � CX Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ on
c
New onstruction 0Adition /alteration /replacement Please check all that apply:
12 N e w 0n Other: ❑Service over 225 amps, comm'I 01- lazardous location
['Service over 320 amps - rating ❑ Buildng o■er 10.000 sq. It..
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories OFeeders, 400 amps or more
❑ Multi family 0 Master builder 0 Other:
DOccupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑ Egress /lighting plan RV park
El Health-care facility ❑Other
Job no.: Job site address: // 5(,,,,) 72 A v �
// O rJ Submit 2 sets of plans with any of the above
City /State /ZIP: r/, wrca / 6e y' 7Z2 3 The above are not applicable to temporary construction sen:cc
Suite /bldg. /apt. no.: Project name: > FEE* SCHEDULE
Description Qiv. Fee. l Totut
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 '
Tax map /parcel no.: ,
Limited energy, non - residential 75.00 _
DESCRIPTION OF WORK Each manufactured or modular
C L dwelling, service and /or feeder 90.90 2
e ✓ Pau' .iif C- ( / T Services or feeders installation. alteration. and /or relocation
200 amps or Icss 80.30 2
la PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 3
401 amps to 600 amps 160.60 2
Name: 51-e llp & e) 601 amps to 1,000 amps 240.60 2
Address: / 7 (' [ / / 3 SF Over 1,000 amps or volts 454.65
( ` Reconnect only 66.85
City /State /ZIP: �(,J R f c , Temporary services or feeders installation. alteration. and /or
/ 0 e ' (�N � relocation
A Phone: (sp • ) 3 y5 - - 5 -- a c s - 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 '
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 j 2
Owner signature: Date: Branch circuits - new. alteration. or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with 1
service or feeder fee, each
6.65
Business name: branch circuit
B. Fee for branch circuits
Contact name: widwut service or feeder fee,
46.85 0 2
each branch circuit
Address: Each add'I branch circuit 6.65 '
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( )
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: 6d) rD Co S £k /( I
Address: �7 Each additional inspection over allowable in any of the abuse
/ �O x 7y-s.. Per inspection 62.50 ' 1 I
City /State /ZIP: Ld # / ot f 7/ Z 7 Investigation per hour (1 hr min) 62.50
Phone: (5b3 ) 83� 7z y Fax: ( /OY J. /O Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 1272 9/ Electrical Lic.: J - 7 g ( .. _ Suprv. Lic.: i/g775 Subtotal 6 SS
,' •• D� Plan review 5'
Suprv. Elect requ )42.1% t / l '6 of permit tee) ,
I
State surcharge (8% of permit fee) .3 if
Print name: 3 f ( /', i 1 Date: 9 2/-6 �- �D 1
TOTAL PERMIT FEE I
Authorized signature: This permit application expires if a permit is not obtained nit hin ISO
days after it has been accepted as complete
Print name: Date: • Fee 'methodology ;et byTri- County Building. Industry sell ice Braid
•• Number of inspections per permit allowed.
I Building .Permns ELC- PermuAppdoe C. 03 440—:0151 02 CO >I w'I:B
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 'Buildin ELC.PcrmitApp doc 04/03
CITY OF TIGARD 24Hour -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested - AM PM BUP
Location /1 � 3v 7 a /1-(9-2-- Suite MEC
Contact Person C1 Ph ( ) 3 3 ? SZ 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC a 6(—(36) a o4
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors /
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 1 , A
Drywall Nailing
Firewall
Fire Sprinkler /
• /
Fire Alarm C1-1)6143
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
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
in `IPAPP ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
Si, PART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line n 1
ADA (, It (�Q L�
Approach/Sidewalk Date v 2 � Inspector K vV Ext
Other:
Final DO N T REMOVE this Inspection record from the Job site.
PASS PART FAIL