Permit '. I. GITY OF TIGARD
ELECTRICAL PERMIT
PERMIT #: ELC2003 -00344
DEVELOPMENT SERVICES DATE ISSUED: 6/12/03
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639 -4171
PARCEL: 1S136CA-00600
SITE ADDRESS: 11070 SW 78TH AVE
ZONING: R -4.5
SUBDIVISION: FAIRVALE
BLOCK: LOT : 006 JURISDICTION: TIG
Project Description: Alteration of (1) branch circuit for new a /c. •
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: 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:
LARRY PRESTON OWNER
11070 SW 78TH
TIGARD, OR 97223
Phone: 503 - 670 -8472 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/12/03 $46.85
[TAX] 8% State Tax 6/12/03 $3.75 Rough -
Elect'I 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 ance 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- i • • otificaf.I Center. Those rules are set
fiiith in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questi. s to i9.1 NC a c 246 - 6699 or
- 800 - 332 -2344. •
I ed By: , I l i , // V / Pe rmit Signature � ��
� ' NSTALLATION ONLY
The installation is being ade on pre serty I own Which is no ended for sale, lease, or rent. a/dS--
OWNER'S SIGNATU -- DATE:
•
CONTRAC • R INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY' t
rr Received / Electrical ' /
DaDate/By: 611 /2 O_3 Permit No.: gu 7 r� - G`3Yc/
City f Tl and 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
'ar ffi4u � 1 i Date /By: Case No.:
Internet: www.ci.tigard.or.us ` ^, � 67 Contact �.. r See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ''' Name /Method: / / Supplemental Information.
F .1 4 ntit' TYP OVV,VORK..,. „ . ,.,: l t„ P ,MIEW (Pleasefctieck all -411f aPP1SVM*I A
❑ 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,
rtR�"� �r,CAT;EGORY®F,XONSTRUCTIONMV W 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 ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
;; VJOB1SITEa'INFORMATIQN NVOCA "-TION. , "~' ` Submit sets of plans with any of the above.
�' The above are not applicable to temporary construction service.
Job site address: J/ U'] 0 1 fZ r+ Si' 1) T1 1114 , _ . ,, „, , f Z F EE* SCH�EDUEE , ,, . : „
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
New residential - single or multi - family per 1
Cross street/Directions to job site: _ dwelling unit. Includes attached garage.
q y Ta 1 ( S C� pFA-� Service included:
D� � 4 NT 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
igeg - , ' D,ESCttI TIONAOF WORK i; ,, , 11 ( service and/or feeder 90.90 2
/ / � / Services or feeders - installation,
/K, l / /G(' —L./ J f 2 )4 4 /r_ 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
r i + " "„ � TENANT. , a -,§ ;" 601 amps to 1000 amps 240.60 2
EROERTI' OWN x .
� � ��� ' Over 1000 amps or volts 454.65 2
Name: .2 S7 r0/t-J . Reconnect only 66.85 2
Address: /10 E "7 f(r+f Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 1 44 , -2 ) , 200 amps or less 66.85 1
Phone: 470- ey72._ Fax: 201 amps to 400 amps 100.30 2
;. T:
401 to 600 amps 133.75 2
, ® APPLICANT A. r r,..R , 4 cCON CT; r x 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 O 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
401W ".4V. MC t, fl, CONTRACTOR:" ,.,''' '' �° Each pump or irrigation circle 53.40 2
.. -� Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
C C Ig - alteration, or extension Page 2 2
Business Name: r Description:
Address:
Each additional inspection over the allowable in any of the above:
City /State /Zip: Per inspection per hour (min. I hour) 62.50
Phone: Fax: Investigation fee:
Other:
CCB Lic. #: Lic. #: t` r f g . erf , Electricalf *., .... , : tl ` , .. y
' Supervising electrician Subtotal $ (' • g•
signature required: Plan Review (25% of Permit Fee) $
Print Nam% Lic. #: State Surcharge (8% of Permit Fee) _ $ _5'• 77
TOTAL PERMIT FEE $ n . (p U ,
Authorized ` f _ a ��� Notice: This permit application expires if a permit is not 7i6tained within
Signature: Date: 0V / � 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 \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:
n Audio and Stereo Systems
F - 7 Burglar Alarm
Garage Door Opener
I I Heating, Ventilation and Air Conditioning System
I I 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
I T Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
I - 1 Intercom and Paging Systems
I — I Landscape Irrigation Control
n Medical
n Nurse Calls
I I Outdoor Landscape Lighting
F 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 ° 4' AM PM BUP
Location 61 a 7 Suite MEC th
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR 2 1-/c(
BUILDING Tenant/Owner ELC � 3 -- z50 3
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing 1 _(� 0
Insulation 1,, 0 6 ��C'6 \(0 LA, V► \ �r 1 FO
Drywall Nailing ( \,�`
. Firewall A�'� Y�1`"� \f lDplo�ay;
$ S N�iK6
Fire Sprinkler �!
Fire Alarm
Susp'd Ceiling �` � I (
Roof � �L YA•� S 5 � TAT CCU\ IN�
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 C 0 — d 3 a T f SS Pt'
FAIL
` MECHANICAL
Pos -
Rough -ln - C
Gas Line ,
Smoke Dampers
_ FAIL
ECE ICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
\ 'ASS PART FAIL
SIT ❑ Please call for reinspect to RE: / ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Dat 6 Inspe - or / /. 4 -- '""" Ext
Other:
Final DO OT REMOVE this inspection record rom the : b site.
PASS PART FAIL