Permit CITY OF TIGARD ELECTRICAL PERMIT
4 411 1)
PERMIT #: ELC2005 -00578
tif DEVELOPMENT'•SERVICES DATE ISSUED: 8/12/2005
' =-- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 111 AC -01400
SITE ADDRESS: 14560 SW 92ND AVE ZONING: R -4.5
SUBDIVISION: PINEBROOK TERRACE LOT : 055 JURISDICTION: TIG
Project Description: Furnace & A/C unit.
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: 1 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:
GRAHAM, KRISTIE PHIL'S ELECTRIC
14560 SW 92ND 6600 SE CHARLES ST
TIGARD, OR 97223 MILWAUKIE, OR 97222
•
Phone: 503 - 620 -9944 Phone: 659 -0303
FEES Reg #: LIC 46126
Description Date Amount
ELE 3 -217C
SUP 3201S
[ELPRMT] ELC Permit 8/12/2005 $53.50
[TAX] 8% State Surcharge 8/12/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
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:1 :7 Permittee 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:
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.
.. ` Electrical Permit Application t t FOR OFFICE USE ONLY
City of Tigard el Received i - / y v p ermit No.: �� ?v
13125 SW Hall Blvd., Tigard, OR 972231�jc Plan Review
Phone: 03.639.4171 Fax: 503.598. 60 V
1� ^ LO ! _ a 1�.1 =•f �r,� �tq;; I' " /4 i \ Other Permit:
1 Date /B
) •
y
Inspection ection Line: 503.639.4175 L Da te Read By: El See Page 2 for
Internet: www.ci.tigard.or.us � Notified/Method: Supplemental Information
• TYPE OF ;tom \O� PLAN REVIEW
❑ New construction . Additio / re Please check all that apply:
V
\\-V ` OService over 225 amps, comm'l ❑ Hazardous location
❑ Demolition ❑ Other: 8
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
1- and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
DOccupant load over 99 persons 0 Manufactured structures or
JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
Job no.: Job site address: J� ❑Health -care facility ❑Other:
• jo a j Gv f A/0) Submit 2 sets of plans with any of the above.
City /State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I `*
Cross street/directions to job site: i ti r`O New residential single - or multi - family dwelling unit.
® Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
• Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
9 n . -f t. sg` r- el' R_ C4 Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY , OWNER ❑ TENANT . ' •
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT -❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 2
• B. Fee for branch circuits
Contact name: • without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'I branch circuit i, 6.65. 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
. • CONTRACTOR • energy panel, alteration, or
extension. Describe: Page 2 2
Business name: PP /, 157,p ,-.4 r .
Address: / Each additional inspection over allowable in any of the above
1°(9 fl ® 4 4 CAI A-dz Per inspection ■ 62.50
City / State/ZIP: fr / C / 4 ''.4, art ( -7 t! Investigation per hour (t hr min) 62.50
�
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
� 030 3 ELECTRICAL PERMIT FEES*
z, CCB Lie.: Electrical Lie.: Suprv. Lie.:
'y191 �o2 /~1 p 32O /. Subtotal
Suprv. Electrician signature, required: `J f� l ��` Plan review (25% of permit fee)
Print name: Date: /653--. State surcharge (8% of permit fee)
Q.- �y/ Li A' " ,,/ C � �� act / ll TOTAL PERMIT FEE -.5 - 7 , i'
Authorized signature: `,( C / A This permit application expires if a permit is not obtained within 180
(.� it.„,_` ....., .."%- ■` ° days after it has been accepted as complete
Print name: P/3 1 L 4 ,- A., 01 e 12. n A Ai Date: 4 / / ii / * Fee methodology set by Tri- County Building Industry Service Board
* * Number of inspections per permit allowed.
I:\ Building \Permits\ELC- PermitApp.doc 12/03 440-4615T(10/02/COM/WEB
F-
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
SIDENTIAI. W OItK ONLY: , - • •
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System *
❑ Vacuum Systems*
❑ Other:
r COMN1 RCIAL WORK ONLY: _
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD , _
BUILDING DIVISION PERMIT #: ' ELC2005-00578
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/12/2005
Phone: (503) 639 -4171 b « jlll
Inspection Requests (24 Hrs.): (503) 639 -4175 -I_
INSPECTION WORKSHEET FOR DATE: 8/16/200 TIME: 7:05Aivl PAGE: 69
SITE ADDRESS: 14560 SW 92ND AVE CLASS OF WORK:
SUBDIVISION: PINEBROOK TERRACE LOT #: 055 TYPE OF USE:
PROJECT NAME: GRAHAM
DESCRIPTION: Furnace & A/C unit.
OWNER: GRAHAM, KRISTIE, PHONE #: 503. 620 -9944
CONTRACTOR: PHIL'S ELECTRIC PHONE #: 659 -0303
Inspection Request Scheduled For: Date: 8/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 013563 -01 503-803-7074 N
Corrections /Comments / Instructions:
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:+ PASS MA/ RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL j'' LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ra Date: 8 ! v S Phone #: (503) 718 -