Permit ELECTRICAL PERMIT
%A CITY OF TIGARD
6'' PERMIT #: ELC2004 -00279
. � 1 I , 4 DEVELOPMENT SERVICES DATE ISSUED: 5/19/2004
' --�' 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S135DB-10500
SITE ADDRESS: 1 1090 SW 95TH AVE
SUBDIVISION: ASHBROOK FARM ZONING: R
BLOCK: LOT : 022 JURISDICTION: TIG
Project Description: Service alteration and 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: 1 W /SERVICE OR FEEDER: 1 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: ,
COMSTOCK, JOSEPH R OWNER
11090 SW 95TH AVE
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/19/2004 $86.95
[TAX] 8% State Surcharge 5/19/2004 $6.96 Rough -in
[ ELPRMT] Investigation 5/19/2004 $86.95 Elect Service
Elect'I Final
Total $180.86
•
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 rule - .o.ted by the Orin .• q Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain cope- these - •1 t quests. to OUNC at (503)
246 -6699 or 1-800-33
Issued By: — " / #_., __ . 11 j Permit Signature: x \ \ �
`__ Ilff STALLATION ONLY
The installation is being made on7NOMI own h is no . tended for sale, lease, or rent.
OWNER'S SIGNATURE: '\' '` DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application . . , , . . , .
, . ' - - ' :. FOR OFFICE USE ONLY '
City of :, Tigard Date/B a / t pV j Permit No, / i lif
13125 SW Hall Blvd., Tigard, OR 97223 - -
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4 .141010 Date/B : Other Permit:
Inspection Line: 503.639.4175 E Date Ready/By: _tutu. 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
..« 4('' N .. ,. ".�,t..:,a; __,. ., , •K i , firi n , „- ^,;a :ca *n .:t�. n ,:*. I ;a,,�- ma
l t 4 : ' § o . f z.. t t ;. 6. OF xR O >- .'; d . Ii a : wit a:. -4 i 't :a - r % V"i_ i s r . 11 I P nti. L AN < I 2 E.:. , _-. s 5, _,
❑ New construction Addition/alteration/replacement Please check all that apply:
EService over 225 amps, comm'l ❑Hazardous location
❑ Demolition ❑ Other
t ;, e , r Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
' C2f O1 GO lygar's I t r,' of 1- and 2-family dwellings 4 or more new residential
ii: 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 [Weeders, 400 amps or more ❑Occupant load over 99 persons EManufactured structures or
, , >3V ^ ,2 e , u � '- En G6 v
r 0$y S14trAEOR Y, * '*TI® `OA r(5V R . ❑E gress /lighting RV park
plan
Job no.: Job site address: 11, o i--1-,,
['Health facility ❑Other:
o � - �t Submit 2 sets of plans with any of the above.
City /State /ZIP: � \ 5 m.12f., 01Z 1 4 - 1 - • The above are not applicable to temporary construction service.
Suite/bldg.lapt. no.: Project name: ' g , "> n ' E"I+''E`E *iSCT3 DL}L . r:, ''' °' .,.... #i .
Description Qty. Fee. Total
Cross street/directions to job site: c r1 - New residential single- or multi - family dwelling unit.
o1Z{ Lt� 13 �l•� r "^o Includes attached garage.
La - 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.:
Limited energy, non - residential 75.00 2
, . r , �D`ESCRIPTIONv® WOR vts " e
' ti t ,- _ " :11, ,n nib ' ,.,,6 .. .4 „ &„. „, „.' , a:t, 0, k_ 0, :. , 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
' Q= BROPERTY, OW `1EI2m r r„ I, ` } i TE} T. fi w 74 201 amps to 400 amps 106.85 2
' " , ' ...' > '''''' @• ''� '” ti , "., _ 401 amps to 600 amps 160.60 2
Name: QE W+S � 1_. 601 amps to 1,000 amps 240.60 2
Address: 1 k) 5\-- S 1. \ PA-) Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State .1' : ,.i r pry O Z ( ) ZZI -_ Temporary services or feeders installation, alteration, and /or
relocation
Phone: (riii) , I Fax: ( ) 200 amps or less 66.85 1
Owner installati in: This fl,. 1. . • eing made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, re t, •r' • = according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: .' j `; - Oy Branch circuits - new, alteration, or extension, per panel
In
E`"�" � PLIt✓ANT�>rs '�"� � ®:C0 °` " "� A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each add'I branch circuit ! 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2 •
Phone: ( ) I Fax: : ( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
t.t .:: r R . ` y , ;� , :a:giM ;ccsi=. t ` -a aS . ",wig`' < y �K: ?'' , ;' `;`°�,:'r's . ' ',' energy panel alteration, or
;, -nom �C01�11RAQTOR � x. ,.s =: s.a ;. � =;; ' .. l:t gYP
' extension. Describe: Page 2 2
Business name: V
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: ( ) I Fax: ( ) Industrial plant per hour ' 7175
u raa rl
Ware e-; "WOW, A'I; PER,iVII'1',` rafFt)t r , � j
CCB-Lic.: I Electrical Lic.: I Suprv. Lie.: Subtotal tS fit , �
Suprv. Elec signature, ;. 7/// / :Pfiarr e) SC ,9 6
Print name: -741'' + ` Date: State surcharge (8% of permit fee)
�� TOTAL PERMIT FEE f .5K1.9 -.7 Authorized signature: `� This permit application expires if a permit is not obtained within ISO
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\ Building \ Permits \ELC- PermitApp.doc 12/03 440-4615T( 1 0/02/COM/WEB
Electrical Permit Application - City of Tigard.
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�� � a.,rra � xi.'
? itir a aVO , Y
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
❑ 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- PemutApp.doc 04/03
•
1111 OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business F i e: , (503) 639 -4171 MST
BUP
Received Date Requested 82 Z AM G PM BUP
Location 11 ''C� � ' 5 Suite MEC2'4 or 294
s
Contact Person —� Ph ( 5 3) / 7C , / -- Cny PLM ,20 — 0022-3
Contractor c( Ph ( ) SWR �, J
BUILDING Tenant/Owner ELC 2 c ,, ° 002.7
Footing ! ELC /
Ft
Foundation on Access: <y� f y� it - tA eA v9
Crawl Drain S ftP AYda, ELR
Slab Inspection N es: - -> > % =�
Post & Beam ,/ 57--e70)— /
Shear Anchors
Ext Sheath /Shear iO/ C N r"
Int Sheath /Shear
Framing
Insulation
Drywall Nailing s / / , - ;��., ,/
�� !� V / �
Firewall
A63°/e f l itig L 2- 3 ° pC00'�
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
:T FAIL
44:
- .m
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / anhole
Storm Drain
Shower 4.TrE id 04.7 ........ „
Other:
0y 0 3. : FAIL -
NICAL
' a sgh- e 71 / } Ar r
as ie i 1 �/
S Dampers
FAIL
, L ' RICAL
• gh -In 1 E
II a.
Low Voltag • G !'�
F e Alar
Ii �� Reinspection fee of $ required bef next ins tion. Pay at City Hall, 13125 SW Hall Blvd.
t 7J . PART FAIL
SI 111 Please call for reinspn : q J p (, /, Unable to inspect - no access
Fire Supply Line ( !�
ADA Date 512_4(011 , Inspector �
ector R i\)06 L Ext
Approach /Sidewalk P
Other:
Final DO NOT REMOVE this Inspection r cord from the job site.
PASS PART FAIL