Permit A : CITY OF TIGARD ELECTRICAL PERMIT
''I DEVELOPMENT SERVICES
PERMIT ISSUED E 9/2004 -00498
DATE ISSUED: 8/9/2004
,,�I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25111 CB -02601
SITE ADDRESS: 14925 SW 100TH AVE
SUBDIVISION: MURDOCK HILL ZONING: R-3.5
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: (1) 60 amp sub panel. (4) branch circuits.
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:
WINSTON, MARK OWNER
14925 SW 100TH AVE.
TIGARD, OR 97224
Phone: 503 - 624 -1633 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/9/2004 $106.90
[TAX] 8% State Surcharge 8/9/2004 $8.56 Rough -in
Elect'l Service
Total $115.46 Elect'l Final
This Permit is issued subject to the regulations contained i n 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 -ire questions to OUNC at (503)
246 -6699 or 1 -800 -33. 2344.
Issued By: /f_, j 41_ / , Permit Signature: V
OWNER INSTALLATION ONLY
The installation is being made on proper I o n which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: / op Ai 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 API EQeIVED FOR OFFICE USE ONLY
Cityof Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 AUG 0 2004 planRevie a 40 —�
Phone: 503.639.4171 Fax: 503.598.1960 bHiehitv4l411, Date/By: Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGARD W Date Ready/By: ® 1.vis� See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: I Supplemental Information
❑ New construction , Addition/alteration/replacement Please check all that apply:
El Demolition ❑Service over 225 amps, comm'l ❑Hazardous location
❑ Other: Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
' R Q'e+lS''ItiIC'ON o f I and 2 f il d lli 4 or more new residential
o - anamy wengs
�: 3�x..;rx )ar . � Gfi > #: a ` .. _ , �
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building El System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
;,. Occupant load over 99 persons ['Manufactured structures or
�t _ : l4fi
1 � � 9 ' k' � � . a �_ � 6 � A®_ ._. ..,�. * _ ❑ Egress/lighting RV park
� � �, p z� AVE---- P lan
Job no.: Job site address: / Lf / Z S S' /06:11-1 , ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: TI G A le—in D (/2-- 9 '1 2 Lc/ The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 1 Project name: foot: AQ,p inipp.i WW1-WAN F :h * SCCHEDULE '
Description Qty. Fee. I Total I "*
Cross street/directions to job site: .A17 ..._ 0 7 ^ / 91 7 ( New residential single - or multi - family dwelling unit.
Includes attached garage.
0 c2'"14 1,000 sq. ft. or less 145.15 4
Subdivision: I 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
e e,',, ll � 70,, ,;;; 7. .,.„ 4„ � ,: Each manufactured or modular
60 ,(Af) I ) (� � dwelling, service and /or feeder 90.90 2
//1 —` t �{ Services or feeders installation, alteration, and/or relocation
200 amps or less / 80.30 te.30 2
: q . � , , ; , .` M 201 amps to 400 amps 106.85 2
;^n 401 amps to 600 amps 160.60 2
Name: ► v l A 1 2. 4 4_ (o Nc--p,,D 601 amps to 1,000 amps 240.60 2
Address: `tf9 LT 56,19 / —t 24 t,li-- Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
J
City/State /ZIP: t co n � DOa__ q ! '''7 ZZ(t Temporary services or feeders installation, alteration, and /or
Phone: (1-D3 ) 86 +� j3c,„ relocation Fax: ( ) 200 amps or less 66.85 1
Owner installation: This i tallati . is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, leas - ore hange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner si a b ate:
gn L� V Branch circuits — new, alteration, or extension, per panel
7- 4* 1 a ° a i q s , fi ( A. Fee for branch circu with
" = service or feeder fee, its each ..,/
Business name: branch circuit 6.65 4 4, . 470 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 ,
Address: - ' -
Each add'I branch circuit 6.65
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
,> ::: r = . . Z:; �. = . # y . . energy panel, alteration, or
Business name: O 2^ extension. Describe: Page 2 2
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
' ` ..' - ` 7 E " `'RI PERJ U 'FEES * * _
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal /06. 9
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) S 05-(0
TOTAL PERMIT FEE / (F,.z• /(P
Authorized signature: This permit application expires if a permit is not obtameu ,,,,,,,,,,,,,,
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.
i:\ Building \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:
RESIDENTIAL W ORK, 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:
WIT
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
is\ Building \Permits\ELC- PennitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
G� BUP
Received Date Requested / � AM 1- PM BUP
Location / c/ a I D O YA 1 r -Q Suite MEC
Contact Person rn Ph ( ) J 3f PLM
Contractor Ph ( ) SWR ry
BUILDING Tenant/Owner ELC A DD 7 _ o
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation f0 OAA41/1-6) yvt ra-v p A - -
Drywall Nailing
Firewall l! ` k4/
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
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
Fina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS PART FAIL
Please call for reinspection RE: fl Unable to inspect - no access
Fire Supply Line
FDA aq _ El
(
14( 1'
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL