Permit ELECTRICAL PERMIT
o_ CITY OiF�.TIGARD
PERMIT #: ELC2005 -00376
I
DEVELOPMENT SERVICES DATE ISSUED: 6/3/2005
r� I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 114AB -03700
SITE ADDRESS: 16530 SW 93RD AVE ZONING: R - 4.5
SUBDIVISION: KNEELAND ESTATES LOT : 024 JURISDICTION: TIG
Project Description: (1) branch circuit.
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: 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:
PAINTER, JAMES & SHARON OWNER
16530 SW 93RD. AVE
TIGARD, OR 97224
Phone: 503 - 869 -1039 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 6/3/2005 $46.85
[TAX] 8% State Surcharge 6/3/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
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
Issued By: ZGC Permittee Signatur• _
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lea o' 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.
It Ap l l i c . t e R l \,, / E ® ` .FOR OFFICE USE ONLY "
Received /
Permit No.: �y� —7
Tigard, OR 97223 I DateBy:
d., Ti 2:r,......--
'1 z C�G�lr ! /
g JI I i 0 3 20U Plan
171 Fax: 503.598.1960 �G1 4,1I\ Date/B Other Permit:
: 503.639.4175 CITY OF TIGAR ^ �:._...II
Date Ready /By: 2 See Page 2 for
Ci.tigard.or.us �/ �1 a' Notified/Iviethod: Supplemental Information
-' . "e;,x �- • "4�:Cei t, i .mod° .�::.Av�::: .'._.�� = .d'!�d.,.*`Si�sr. : §>: a£s.�:'^ :�i".:`Mu' � : "S t'= .' %`n +s ^. cur. -, x•t�.�
,k er..`4 �','.�- V. x ,. t, .'q. «;(� _.x. ;a: z= '° 3.., «k�. -�- :a ^�:iti �''t '
�°�*, .: p TsI7sPE' QT�?ORK erkn F���'�.,�.,��.� :;:�`i r.. t � .� : r;'�.;�:,.. ; . ;�. , PV-R''
. s<; ?rss-" f�. �., i" 3F ..�_.r.�i����'�w,.`�..:o�r�. � :.:;.., �S:. z��an,:, �r.. m,: za; �?:,» �` �r` ���°^:? t�: e� .= ..�.��,a�.a;.:x�r�;.;s: "�'U. n:.a , > ��., rrm,.��_;_,.n._.�� :�...;- ,_..,,� u..... _
New construction Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l ID Hazardous location
❑ Demolition ❑ Other:
, , , axy> k :;,s .. =axrr -,s , yra �_ „ Y Mzgry! . , El Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
1.4.,,-; ;, �?.TEGO L 01 ONS Ri 611, It „- ,.;,, �, xt F - of 1 -and 2-family dwellings 4 or more new residential
ii 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building El System over 600 volts nominal units in one structure
❑ Multi-family ❑ Master builder El Other:
['Building over three stories ❑Feeders, 400 amps or more
,., . k ^ ❑Occupant load over 99 persons EManufactured structures or
111/41.= "i<°s s. <a� ;?�5 %""x s..�,�r�. a twva';3��ra.ai, n s
� JOB 11 L R1VI ON-e b`I OCA2ION, '; Y ❑ Egress/lighting Flan
RV. park
Job no.: Job site address: 3 a J ❑ Health - care facility ❑Other:
3„ -p fi f -,-P Submit 2 sets of plans with any of the above.
City /State /ZIP: — ? _,/ k 0 0 ' 2 9.7 2— 2-I!, The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: ` E;- ;SCF' D 0: **
Description Qty. Fee. Total
Cross street/directions to job site: (x,11 LLB,`, 0 9 3i„. . 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'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: -
1? ... , <,t e 5? _. ; ay =w _ -_.r., � : , <k:r w_rs :;. ;o- .: , v , r;, Limited energy, non - residential 75.00 2
1' , N , , � 3 A,,; S:GRY�P#01.,5511?i =g ' y ,; s , ; i Each manufactured, or modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
r � 11 :r ,,,.:W:, ., « v ;. ,s x . c �ltr,�:,.;r :� -ate . i . 1 ,< 201 amps to 400 amps 106.85 2
° a' a , ... , , OPERT. �O 1:ER AW . n ` , >U 6 TENANT A , ; 2, :; ' 5 P P
.��. > . , ate, u�3� . ra , r� s.� 401 amps to 600 amps 160.60 2
Name: cr�. s , 04,,,,..„.....i..,_ 601 amps to 1,000 amps 240.60 2
Address: ( 6 5 3 v S 9 3 der- -2 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Wit, 4 J ?_.b b. 5`7 2. Z'.f.. Temporary services or feeders installation, alteration, and /or
Phone: (�3) Es cf_ /.. 4 9 Fax: (621) 7d relocation
7 200 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, , . or exchange, accordin t S 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: ../e �r Date: 6 I Branch circuits — new, alteration, or extension, per panel
lama , `t m' ,. Wir ... ..;; !,!),&37,10V.:41; �,, s .F„K: 4 t z=a'n". �r_c :i P; X„ li :R.:s?
t ` t I � A PI ".k ON�TACT �E r a `t A. Fee for branch circuits with
:^�'�:�;sF`.�.z� �,,. f.. .... =ra '.^s.. � ,n. �'x.:�s�.`��..� ��ra-- «-r.�n�s.� " „�,` �i�,s' ...� ' ”
service or feeder fee, each 6.65 2
Business nam branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, /
each branch circuit ` 46.85 8 S 2
Address:
Each add'I branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation. circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
a :gym r-- 'am_ :� } a 3; ;: «zr`,KS ;r .,.:, a° v�n ... , ;c = .u,�. - yr " . c :^� -^ ` ;1, - ' e i "
n � s s' ,r ` ` .- : . '.4 b l . ,' .' RA�r - T O E % r a ' � � : energy Panel, alteration, or
extension. Describe: Page 2 2
Business name: •
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
g o-r r s e ", x .-, ,..�
I _EL ,CTR C7 PER111VAEFnS* b h '= + ' =� "''
CCB Lic.: Electrical Lic.: Suprv. Lie.: Subtotal ., „gr
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) J, "2 5
Print name: Date: TOTAL PERMIT FEE 5" 6 d
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: . Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
is \Buiiding\Permits\ELC- PermitApp doc 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
��� t � .�_. :max.: e,_..., xY' a.,,. _ ,
_:� - I V�O•RK- .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:
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
Li Outdoor Landscape Lighting*
❑
•
Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200 &00376
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/3/2005
Phone: (503) 639 -4171 ��n'u41mIIp�Gll�fihl
Inspection Requests (24 Hrs.): (503) 639 -4175 „.„„Aik
INSPECTION WORKSHEET FOR DATE: 6/9/2005 TIME: 7:09AM PAGE: 87
SITE. ADDRESS: 16530 SW 93RD AVE CLASS OF WORK:
SUBDIVISION: KNEELAND ESTATES LOT #: 024 TYPE OF USE:
' PROJECT NAME: PAINTER
DESCRIPTION: (1) branch circuit.
OWNER: PAINTER, JAMES & SHARON, PHONE #: 503 - 869.1039
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/9/2005 Pour Time:
Code # Inspection Description V Confirm # Contact # Message
145 A/C or heating unit circuit 008814 -01 503. 684 -1249 • Y (211/1
Corrections/Comments/Instructions:
I q I (V�Q tom-r-75°
J
•
•
P 2: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ C L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: At Date: 9 0 Phone #: (503) 718-
•