Permit C IT 1 OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00339
As DEVELOPMENT SERVICES DATE ISSUED: 5/20/2005
= F � I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 AD -15100
SITE ADDRESS: 14814 SW 91ST AVE ZONING: R - 4.5
SUBDIVISION: MALLARD LAKES LOT : 017 JURISDICTION: TIG
Project Description: Wiring for swim pool and equipment.
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: 4 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:
GARCIA, CATHRYN MICHAEL RAFFAELL CONSTR
14814SW 91ST. 15170 SW KIRK RD
TIGARD, OR 97224 OREGON CITY, OR 97045
Phone: 503 - 684 -2819 Phone: 632 -6720
FEES Reg #: LIC 00058422
SUP
Description Date Amount 3
ELE 3 -299C
[ELPRMT] ELC Permit 5/20/2005 $106.90
[TAX] 8% State Surcharge 5/20/2005 $8.55 REQUIRED ITEMS AND REPORTS
Total $115.45
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- 0- 332 -2344.
Issued By: ,7.K jam Permittee Signature: jam LI
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: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1 0 USE ONLY
Ele al Permit A it Li IL
; Received Electrical D q
�` "� DateB :
der O`5 /56 PermitNcj L O2 ' I
Planning Approval Sign
City of Tigard MAY 2 U * 05 Date/ :
Permit No.: •
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 � }� DateB : Permit No.:
Phone: 503- 639 -4171 Fax: 503 - $6 OF 4; Post- Review Land Use
J � U /l .t! , r 4 z 1� Plann DaDate/13 Case No.:
Internet: www.ci.tigard.or.us ILDIN! 6 i J i N Contact ® See Page 2 for
24 -h our Inspection Request: 503 -639 -4175 =" Name/Method: Su demental Information.
�.. .. � IE I
-x -,.._ .�. ,: .;_ .-,, .. : - . ,.;, .•:�:'::` % , ,_ - ., �PLAN'REV W =(P ease ctieckal . �aPpl Y) .
._.. . ; = k, - • , :., v -, _ : ..: . r - . - _ <.;� -sa• lahat:
III 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,
'`42 Vin. ';Zc- ATEGORY;OFX,C1NSTRUCTION : i & 2 family dwellings four or more residential units in .
1111 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 INFOM
RATION aiid °LOCATION : >' ; <
Submit sets of plans with any of the above.
- -- .. -- . The above are not applicable to temporary construction service.
Job site address. _ / • ..:_:.... - k.W ,FEaSeC*HEME:»".a
Suite #: Bldg. /Apt.#: Number of inspections per permit allowed
Project Name: .., .• Descri i tion Qty Fee (ea.) Total
New residential - single or multi - family per
Cross street/Directions job site: 5 L...)
'T dwelling unit. Includes attached garage.
S
IQ SA- /��2- 9 C� .. 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: 1 Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling - 90.90 2
';` „ja:,gff., DESCRIPTiON:OF WORK` . ..,
'" =` `` service and/or feeder Services or feeders - installation,
i�r -t.� t . - ,4..-4N ^ n Y - g - alteration or relocation: o
i,44
_ 200 am or less 80.30 , 0 ' 2
_ ___..w - .--. / 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
w t _,. ;; 601 amps 1000 am
iPROPERT OWNER ®`TENANT =- 454.65 2
_ ' � Over amps or volts
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
Phone: Fax: RS 133.75 2
201 amps to 400 amps 100.30 2
• 401 to 600 amps
® j'APPLICANT. -1 :.' �' ii -_ :. ;:' = rl ® 'cONTAcr..
PERSON = •, ; ,,, T .7.. Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of 6.65 6 6 2
Address: service or feeder fee, each branch circuit a-�
:
City /State /Zl l� B. Fee for branch circuits without purchase of
City/State/Zip: service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
•
E -mail: Misc.(Service or feeder not included):
�_ Each p rm up or irrigati on circle 53 40
�, _ _ - 'r . , 42, GUNTRACTOR= Eac si gn or ou lighting 53.40 2
60 Job No: S ignal circuit(s) or a limited energy panel,
Q alteration, or extension Pare 2 2
1 Business Name / ( pr, IA tr., 1,14 -el •Q ( Description:
(\f Address: 15 ) •? D S k I tt tc la t.
C1 /State /Zi : C) �,,, - 7 0 `f Per inspection per hour (min. 1 hour) ■ 62.50 _
— Phone : c - • � - , M g t Invest' .-2 lion fee:
II other x
L. CCB ic. #: S -i 2 Lic. #: " g 9 " G ' `� ` t . ., * ,,..., ,:,:',1.5-i.'*:
� - 3 Electrical,-P- rmia eei.. X5,V . :' =5 -
Supervising electrician < -7 — ' —0 ' Subtotal $ d v(0 1—
signature required: )31.-■-c.,Q, "X-, Plan Review (25% of Permit Fee) $ • s c�
Print Name C- k ,, Li 5 , - State Surcharge (8% of Permit Fee) $
PA-Fr-AR-1i /-O - /- 0 7 TOTAL PERMIT FEE $ ) ! S
Authorized c t1 n /� Notice: This permit application expires if a permit is not obtained within
Signature: m . K�- 1'i._� t'� Date: 5/17)03 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
144ir.Lti4e / real trz Q0.-//
(Please print name)
CITY OF TIGARD .,‘, -9l5r
r
BUILDING DIVISION , "." ` - PERMIT #: ELC200&.00339
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/20/2005
Phone: (503) 639 -4171 m ��r a UM11ill'i l `
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/3/2005 TIME: 7:09AM PAGE: 56
SITE ADDRESS: 14814 SW 91ST AVE CLASS OF WORK:
SUBDIVISION: MALLARD LAKES LOT #: 017 TYPE OF USE:
PROJECT NAME: GARCIA
DESCRIPTION: ) ermt� for swim pooland equipment.'
OWNER: GARCIA, CATHRYN, PHONE #: 503 - 604 -2819
CONTRACTOR: MICHAEL RAFFAELL CONSTR PHONE #: 6316720
Inspection Request Scheduled For: Date: 6/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
160 Hot tub /spa/pool 008332 -01 503. 632 -6720 N
Corrections/Comments/Instructions:
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. .
/..
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PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
n FAIL ❑ CAL FOR INSPECTION
El ADDITIONAL FEES ASSESSED
,
Inspector: Date: �' Phone #: 503
p � ) 718 -