Permit 4P, I . CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00712
DEVELOPMENT SERVICES DATE ISSUED: 12/10/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 111 AA -02500
SITE ADDRESS: 14355 SW 86TH AVE
SUBDIVISION: GREENSWARD PARK ZONING: R
BLOCK: LOT : 013 JURISDICTION: TIG
Project Description: Upgrade electrical service 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: SIGNAL /PANEL:
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:
BILL CLARK SUNNYSIDE ELECTRIC
14355 SW 86TH AVE 12708 SE FLAVEL
TIGARD, OR 97224 PORTLAND, OR 97236
Phone: Phone: 503 - 760 - 8490
Reg #: LIC 131534
ELE 26 -I0IOC
FEES SUP 4500S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/10/03 $80.30
[TAX] 8% State Surcharge 12/10/03 $6.43 Elect'l Service
Elect'l Final
Total $86.73
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 ttlan 180 -days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth i AR 952 - 001 -001.Q through OAR 9 `01 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -80c332-2344.
i
Is ued By: ∎ _, g. CZ /I . ' Permit Signature: y „ill �j
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: , t� .- — , i C DATE:
LICENSE NO: 4/S '
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Received Electrical
i /D O Permit No.: ee—d,P0 , 5 D 7/.2
Date/By: / 3 O
City of Tigard Planning Approval Sig
13125 SW Hall Blvd. Date/By: Permit No.:
Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 A.. Post- Review Land Use
Internet: www.ci.tigard.or.us mfiothgittAil iy Contact Case No.:
24 -hour Inspection Request: 503-639-4175 Juris.: Su See Page 2 for
Name/Method: � Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction El Demolition ❑ Service over 225 amps- ❑ Health -care facility
Addition /alteration/replacement, ❑ Other: Commercial ❑Hazardous location
CATEGORY OF CONSTRUCTION ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
I & 2 family dwellings four or more residential units in
..g.1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
E] Accessory Building El 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.
Job site address: / y 3 jr S, 14. The above are not applicable to temporary construction service.
j FEE* SCHEDULE
I
Suite #: Bldg. /Apt. #: Number of inspectionsper permit allowed
Project Name: up s G/A rid Description Qty Fee (ea.) Total
Cross street/Direction
to job site: New residential- single or multi- family per
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 I
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 OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation: _
200 amps or less ) 80.30 _8 �,� O 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER f ❑ TENANT 601 amps to 1000 amps 240.60 2
/. //J /� /��� Over 1000 amps or volts
ll // (� 454.65 2
Name:
/ Reconnect only 66.85 2
Address: / 4/ 4-3 S r (,(, i 1 4 Temporary services or feeders - installation,
-
City/State /Zip: 7 E r 6F, alteration, 0 m relocation:
200 amps or less 66.85 I
Phone: Fa 201 amps to 400 amps 100.30 2
❑ APPLICANT C ONTACT PERSON l to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
Phone: service or feeder fee, first branch circuit 46. 85 2
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
Job No: Each sign or outline lighting 5340 2
Signal circuit(s) or a limited energy panel,
Business Name: .. Description: alteration, or extension Page 2 2
/�n� S �e �eG! i"
Address: / ld �s � ,�, F7A, v6/
City /State /Zip: � j ��� O� g�Z 3 / Each additional inspection over the allowable in any of the above:
b Per inspection per hour (min. 1 hour) 62.50
Phone: 7,4 _ 9 9 0 Fax: - 7W 2- ZO6i5 Investigation fee:
CCB Lic. #: /3 / 3 Lic. #: 26- /D to � Other:
Supervising electrician 4/. �I�`� Electrical Permit Fees*
�` I/ /C�/ Subtotal $ Ye • do
signature required: Plan Review (25% of Permit Fee) $
Print Name: air %/ .61/ L. • #: Lis) O $ State Surcharge (8% of Permit Fee) $ (p. 4/3
Authorized 1'1;b/c`7' TOTAL PERMIT FEE S g[0 . 73
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)
u: \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:
El Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
El Heating, Ventilation and Air Conditioning System
El Vacuum Systems
0 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
0 Instrumentation
0 Intercom and Paging Systems
Landscape Irrigation Control
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
El 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 OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / AM PM BUP
Location gep Suite MEC
Contact Person � Ph ( ) 577" 52-1 PLM
Contractor L3 v 1 S r c.I `� Ph ( ) SWR
BUILDING Tenant/Owner ELC 3" od
Footing
ELC
Foundation
Ftg Drain Access: .Qk.P � � 3 4 �� ELR
Crawl Drain ! SIT
Slab Inspection Notes: F a fd C l'� f 43,r� n o
Post & Beam ��
Shear Anchors
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 X55 (A) ti r c
Water�Service C. F-o'lt--
Sanitary Sewer 1 J
Rain Drains !. F F
Catch Basin / Manhole ( c 1 r - C E-
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.
' ° - PART FAIL
S E Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA JF y `g 3 Ins ector � d (9 Ext
tuy Approach /Sidewalk Date (� p �
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL