Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003- 00689
DEVELOPMENT SERVICES DATE ISSUED: 11/24/03
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 1 S135DB 04300
SITE ADDRESS: 11285 SW 92ND AVE
SUBDIVISION: DOGWOOD RIDGE ZONING: R
BLOCK: LOT : 1 - JURISDICTION: TIG
Project Description: Reconnect
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
HOUSEHOLD FINANCE 2 FOX ELECTRIC INC
358 WARNER MILNE RD #108 1010 NE 67TH AVE
OREGON CITY, OR 97045 PORTLAND, OR 97213
Phone: 503 - 860 -3054 Phone:
Reg #: LIC 154826
ELE 26- 11113C
FEES SUP 4532S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/24/03 $66.85
[TAX] 8% State Surcharge 11/24/03 $5.35 Elect'I Final
Total $72.20
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: o �i 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:
CONT /dT,0 - S ALLATION ONLY
SIGNATURE OF SUPR. ELEC' • DATE: // Z /
LICENSE NO: gp
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application ' FOR OFFICE USE `..:
Received
Date /By: I) Ia y1d I '' ' Permit No E &)3 - 6, R9
City of Tigard Planning Approval Sign /
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 Post- Review Land Use
Internet: www.ci.tigard.or.us ' ' I -� ■� ,� r ( + y Case No.:
24 hour Inspection Request: 503-639-4175 '"" _ Date/By:
luris.: Su See Page 2 for
Name/Method: Supplemental Information.
; , . S: ,,?' . TYPE;:QF WORK;,¢ "w # _ ; 4, ?- .4;;:'' _ „* u
_ E] New construction ❑ '��� `� ��N'�'���lease'clieck all;ftiata 1 w =t.�'. ''��"
Demolition ❑ Service over 225 amps- ❑ Health -care facility
❑ Addition /alteration/replacementther: commercial 0 Hazardous location
,, ,_ r r ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
y fir `4 ^ "CATEGORY'OF " CONS' - UCTFON= < `'' : ":, ':,, ; I & 2 family dwellings Y g four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories
Accessory Building El Multi-Family ildi ❑ Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other
' .: '::; : JOB, SITE` ISTFORMATION'iti$'_I OC ' "-'- : • ' Submit _ sets of plans with any of the above.
Job site address: /1'2 ids j IA) "�'� , . The above are not applicable to temporary construction service.
Suite #: Bldg. /Apt. #: . ; I : : ::,y - �.s'41., FE_E*:SCHE t tA ,. ,t : `; :
/ Number of inspections per permit allowed
_ Project
Name: (. 71 4.1 -
t . 4k ii Ft✓ Description Qty Fee(ea.) Total
New residential - single or multi - family per
Cross street/Directions to job site:
j
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
` a te A , : : .::':e , `;> . - _,, `DESC RIP -_TIONx'OF;WORKv- ..':'i 1 - , zti x 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
® QPER. 401 amps to 600 amps
4PR O W.I�IER r:. i a::':,. , i�:= ® TENANT ?4-.i n.. tY :,T 4 ,° ,,� ,,;1.':: 601 amps amps 160.60 2
s to 1000 am s 240.60 2
Natile:/ /� ' Over 1000 amps or volts 454.65 _ 2
f <J S ' AtLica✓ e- �, " Reconnect only 66.85
Address: 3s8 MJ awt e r ,n /� °� / 6 / 1 T emporary services or feeders - installation,
Cit /State /Zl / alteration, or reloation:
y p �(i°t i��/1 G% / pP` 70 �/ 200 amps or less 66.85 I
Phone: � U3 '6 o 3o5 Fax: zo 1 amps to 400 amps 100.30 2
iii IAPPL"ICANT:j /e .;' : c;`.; . ; . AZ CONTACT! . �;,:f,? „ . < 401 to 600 amps 133.75 2
/ Branch circuits - new, alteration, or
Name: e7 f y ,., .b cu c k 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: 503 F"60 305Y Fax: service or feeder fee, first branch circuit 46.85 2
Each additional branch circuit 6.65 2
E -mail:
Misc.(Service or feeder not included):
` 17 c �k t ` 4'., ," CONTRACTOR` F' ` '/: ' + s i ?. Each u irri ci
����'`' Each p sign mp or or outline lighting gation rcle
53.40 2
Job No: 57) 3 - 3 0 7— 6 to 53.40 2
Signal circuit(s) or a limited energy panel,
Business Name: .Z F Elec `j— T A J � Description:
alteration, or extension Page 2 2
7 s/ 41-1/1/4-e--- ry Description:
Address: ii)/0 N�.
City /State /Zip: pT�� 04. 9 7 oZ /3 Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. I hour) 62.50
Phone: . 7. 7 /A i (p - Fax: 0 I( lb t'I Investigation fee:
CCB Lic. #: /,Sy�>✓tQ I ii. #: - f / /f,.T� Other:
Supervising electrician '�� "/ " ' Ele ctciea liP "..e rmiE F Subtotal $ , , ; z > F '
Subto
signature required: ta 1 $ 7, 6 , g,-
1� I • Plan Review (25% of Permit Fee) $ T
_
Print Name: /344 ' ' c. #: S "Z S State Surcharge (8% of Permit Fee) $ 5, 3S
TOTAL PERMIT FEE $ ,a C
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 \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
n Burglar Alarm
n 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
0 Boiler Controls
❑ Clock Systems
TI Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation •
n Intercom and Paging Systems •
n Landscape Irrigation Control
n Medical
n Nurse Calls
Outdoor Landscape Lighting
n 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 I ` S AM PM BUP
Location I d� gs � /4 ' c—� Suite MEC
Contact Person 1- b-- Ph ( ) 30 7 - 7661 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 -0 0 4 �7
Footing
ELC
Foundation r Access:
Ftg Drain --- t l6 Q ELR
Crawl Drain
Slab z 1,Inspection Notes^ - - SIT
Post & Beam • —
Shear Anchors
Ext Sheath/Shear t
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof �� f
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
Fin Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call fir reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Dat / / °� Inspe orA/ _ .
PP
Other:
Final DO NOT REMOVE this inspection record fro the Job - te.
PASS PART FAIL