Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00610
1 4111k
11(111 DEVELOPMENT SERVICES DATE ISSUED: 10/3/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 2S112CB
SITE ADDRESS: 15220 SW 81ST AVE
SUBDIVISION: GOOD ACRES ZONING: R-4.5
BLOCK: LOT : 006 JURISDICTION: TIG
Project Description: Electrical work for (2) sheds.
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: 6 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:
KNIPPEL, DAVID OWNER
15220 SW 81 ST.
TIGARD, OR 97224
Phone: 503 - 624 -8349 Phone:
Reg #:
• FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/3/03 $86.75
[TAX] 8% State Tax 10/3/03 $6.94 Rough -
Elect'I Final
Total $93.69
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 mor an 180 • , ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth) OAR 952 - 001 -00 c through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -8 0- 332 -2344.
11, Iss d B � � / / � :!!L • �L Permit Signature: 4 /
0 � p - -
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: x � �` �- — • DATE: 40%3
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
l x
FOR OFFICE US ONLY
Electrical Per' e ication Received / Electrical
�� V Date /By: w S4 Electrical
No.: es C'49PO0.-0o4P /Q
City Tig ard o f Tl d Planning Approval Sign 13125 SW Hall Blvd. OCT 3 20u Date /By: Permit No.: Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639- 4171C13-Fyate}F51Q 6,91960 Post- Review Land Use
•'�I Date /By: Case No.:
Internet: www.ci.ti
_ Iikpirm6G DIVISION ei Contact .. s'" ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: / / �- Supplemental Information.
: ,r . ' :i . k `' ., ITYPrOF,WORK. , ;;' ,. l'• ., , `:PLAN REVIEWOlease checkallthatapply) W:" 1, + , -r
❑ 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,
.' rf.
s.'4 ; ?CATEGORY', OF-CONSTRUCTION' ': ;' 4 : :' I & 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:
• JOB`SITE' INFORM an'd>LOCATION .'< ,', - Submit sets of plans with any of the above
- Job site to temporary construction service
a � ,.
to address: j ,5 2 0 S c.) 8'! °L T3 &L ek ;0 :: ; :i• :_ The above are not applicable . _ < `,.
,,.., .FEE SCI3EDULE .kw 4`"�n', ,� �. ,
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: 1),4c)(0 P 1�/ oyef Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per 1
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
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
.DESCRIPTION;„OE 9WORK . " r'
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?ROPERTYOWNER .1, ®'`TENANT ;, ct - '� '' 601 amps to 1000 amps 240.60 2
�� /D f Over amps or volts 454.65 2
Name: 1/ 1 '�� r Reconnect nnect nett only 66.85 2
Address: / •--,2 z ef) C/.() F7 Sr Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 7f G Q t c5-1 q 7 z z- 200 amps or less 66.85 1
Phone: 5 y 4 _ y h? Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
`,r®?A'PPLIC'INT ".: , . ":„t : El .CONTA'CiT :,PERS,ON 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 46.85 146 .i
..i 2
Phone: Fax: Each additional branch circuit 6.65 3e' _90 2
E-mail: Misc.(Service or feeder not included):
, . Each pump or irrigation circle 53.40 2
s,, - , -�,, ;fit - A
, r .;, CON.TRAGTOR ' ::,,
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: 01, 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. #:
', , . ;,0:. 7'" Electr ?PermttaF,ee's *rYW.ARs V.., � :V*:
Supervising electrician Subtotal S (p , 75 —
signature required: Plan Review (25% of Permit Fee) S
Print Name: Lic. #: State Surcharge (8% of Permit Fee) S 9
TOTAL PERMIT FEE S F , t7
Authorized , Notice: This permit application expires if a permit is not obtained within
Signature: _ _ I Wit Date: 624 3 180 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
IP'.
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
n Burglar Alarm
El Garage Door Opener
n Heating, Ventilation and Air Conditioning System
n 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
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
Medical
n Nurse Calls
I I Outdoor Landscape Lighting
0 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
is \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY GAF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 7.
INSPECTION DIVISION _ = Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested /'' AM PM BUP
Location /J Z Z0 Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenan f ELC aC 6/0
6
Footing e`// 1 —g 3 419 ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
V II4j
Roof
Other: oit
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
c Low Voltage
Fire larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA Date 3 Inspector Ca , `� Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection recor from the Job site.
PASS PART FAIL