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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00158 A ■ DEVELOPMENT SERVICES DATE ISSUED: 3121/03 ---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 2S112BD SITE ADDRESS: 14640 SW 76TH AVE 070 ZONING: R-12 SUBDIVISION: TIFFANY COURT APT. BLOCK: LOT : 065 JURISDICTION: TIG Project Description: Installation of (5) branch circuits for unit #70, installation of (1) GFI, (1) heater and (1) smoke detector. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 1.00 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: 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: WASHINGTON CO. HOUSING AUTHORITY SYLVANIA ELECTRIC CO 111 NE LINCOLN ST 5328 SE 109 #200 -L, MS63 PORTLAND, OR 97266 HILLSBORO, OR 97124 -3082 Phone: 503 - 846 -4794 Phone: 503 - 762 -2714 Reg #: ELE 26 - 1086C LIC 110400 FEES SUP 4830S Description Date Amount Required Inspections [ELPRMT] ELC Permit 3/21/03 $73.45 [TAX] 8% State Tax 3/21/03 $5.88 Rough - Elect'I Final 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 t h n-180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in R 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct que� ns to OUNC at (503) 246 -6699 or 1 -800- 32 -2344. Issu By: , .0 ) • €L4'L' _4 ,� Permit Signature: ■ tr 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: ■NTRAC OR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: ' t`i�� DATE: 49 - /.7 ( ^U � LICENSE NO: 27/ Cali 639 -4175 by 7:OOpm for an inspection the next business day :' . Electrical Permit Application Received FO Electrical R,OFFICEE USE E ONLY ` °� Date /By: �� Permit No.: �c (i 23 `� /se City f Tigard Planning Approval Sign y g Date /By: Permit No.: , 13125 SW Hall Blvd. Plan Review - Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use xd� i�� p I Date /By: Case No.: Internet: www.ci.tigard.or.us , e . Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 - 4175 tiz ' Name/Method: Supplemental Information. Ii r1 TYPESCW WORK. : t ,''. s ° „ ..ttti :, .. PWEAM 711000:160`, check all1tha l- 41 11 S i,, .,. :,w t ❑ 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, ?„'V n , ,,' 1,?CAr:TEGORY OFTOONSTRUQTION ° ife- 'g 1 & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building 111 Multi-Family El Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: • Submit sets of plans with any of the above. :J®B SINE''4IFORMATION`andLO, ' TION „ , The above are not applicable to temporary construction service. Job site address: L ('I” d 5(v) 6 U . ` -T- FEE* SCHEI -01,7 " j ' Z Suite #: Bldg. /Apt. #: 1 . Number of inspections per permit allowed Project Name: $ 0 L(i 1 _f 1,4L 6 f if Description Qty Fee (ea.) Total 1 New residential - single or multi - family per Cross street/Directions to job site: dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Limited energy, residential 75.00 2 Subdivision: Lot #. Limited energy, non residential 75.00 2 Tax map /parcel # Each manufactured home or modular dwelling * , I; g fir, ^,,, OF WORKS •.'• -,4 ` �C 4b.,,.., service and/or feeder 90.90 2 Services or feeders - installation, alteration or relocation: 200 amps or less 80.30 2 • 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 1 El t -' 601 amps to 1000 amps 240.60 2 PR.®PERTY OWNER.,� = TENANTS `, ..: p p Over 1000 amps or volts 454.65 2 Name: Reconnect only 66.85 2 Address: Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: 200 amps or less 66.85 1 Fax 201 am to 400 amps 100.30 2 Phone 133.75 2 ?A 4PP18ICANtT „. '''' , „ ,„ E e CONTACT PERSON ".. k, L 401 to 600 amps Branch circuits - new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of • Address: service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of / service or feeder fee, first branch circuit / 46.85 -$s 2 � Phone: Fax: Each additional branch circuit 6.65 A( •4 2 Misc.(Service or feeder not included): E-mail: Each pump or irrigation circle 53.40 2 ' CONTRACTOR ' W ..'`re} ` h ' Each sign or outline lighting 53.40 2 Job No: e 0 1\I 1 i 'R ri 1... 1- 6 p Signal circuit(s) or a limited energy panel, 5 `/L (/ N i R Descri ti n r extension Page 2 2 Business Name: i C Description: Address: 5 2 A S -- / o 9 0 J'e Z b `C Each additional inspection over the allowable in any of the above: O City /State /Zip: 0 J �C( Per inspection per hour (min. 1 hour) 62.50 PhoneSc 3 q -- g (5 0 5 Fax: J Investigation fee CCB Lie. #: 0 q ©O Lic. #: a (p 6 C other id E `.5- . :,,,,a; :; . ". Electrical_Permlt Fees* :, .... , Supervising electrician Subtotal $ '7 ,3. «5 signature required: Plan Review (25% of Permit Fee) $ Print Name: ;1'1. VW U (f Iv{ Lic. #: CT-8 30 S State Surcharge (8% of Permit Fee) $ 5. g g TOTAL PERMIT FEE $ 7 9 • 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) is \Dsts\Permit Forms \ElePermitApp.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: n Audio and Stereo Systems 0 Burglar Alarm El Garage Door Opener n Heating, Ventilation and Air Conditioning System Vacuum Systems • n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls IT Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control n Medical n Nurse Calls n Outdoor Landscape Lighting n 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 Busines, Line: (503) 639 -4171 MST BUP Received 1 Date Requested 3 — a 1 AM PM BUP Location / `Tt L/O 74. r'e- Suit 7 MEC Contact Person Ph ( ) `?/ 3 - l'4O5 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC 3 - ' o ( S 8 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 L B ><L G c(, c,v II B 6LE0-41 L A tsL Drywall Nailing r _ ,, �I Firewall �NS I �� �� O � V ctW41 �E �'1 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 ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 41#PART FAIL . Please call for reinspection RE: • nable • inspect - no access Fire Supply Line ADA Approach/Sidewalk Date ' Inspector / Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL