Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00763
�k<+L ..�l�i, DEVELOPMENT SERVICES DATE ISSUED: 12/2/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110AD - 08400
SITE ADDRESS: 14805 SW 106TH AVE
SUBDIVISION: LANG HILL NO.2 ZONING: R
BLOCK: LOT : 076 JURISDICTION: TIG
Project Description: Meter base and feeder replacement.
Job No. 83307
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: 2 W /SERVICE OR FEEDER: 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:
BARBARA BENSON OREGON ELECTRIC CONST /GROUP
14805 SW 106TH AVE 1010SE11THAVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: 503 - 445 -1215 Phone: 503 - 535 -2652
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/2/2004 $160.60
[TAX] 8% State Surcharge 12/2/2004 $12.85 Elect'! Service
Elect'I Final
Total $173.45
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)
246-66 ' or 1-800- 332 -2344
Issue By: Permit Signature: J -
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: C9' DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
12 - 04 04:26PM FROM-Oregon Electric Estimating 5032313587 T -143 P.001 /002 F -159
EIectrical Permit Appltcanon c___,— f
City of T i g ard - nate/ Received / ' ' y e4 Pernit No.: E� /.CY-��- 7 70 3
v:
13125 SW Hall Blvd., Tigard, OR 9 Plan Rev
Phone: 503.639.4171 Fax: 503.59 .1
CEIVE ,m ,, ti , � , � I ; : Other Permit:
Inspection Linc: 503.639.4175 I v l J ,,, Date Rea"dy/By: inns El See Page 2 for
Internet: www.ci.tigard.or -us DEC 01 2004 Notified/Medwd: ---7-v • Supplemental information
J L
❑ New construction 0 Acitii Itlaccment Please check all that apply:
INGDIVISION ❑Service over 225 amps,comm'i ❑Ha�rdouslocation
Demolition ❑ WIP
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft„
• CA'>CE OF'.. CONSTRUCI',10N ' . . � ' . . of 1- and 2- family dwellings 4 or more new residential
El I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building DSystern over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other. ❑Occupant load over 99 persons ❑Manufactured structures or
, JOB, `SITE °JNFORMATIOIV ,AND,'L.00ATION.' ❑Egrcss/lighting plan RV park
❑Health -care facility ❑Other:
Job no.: 83307 Job site address: 14805 SW 106th Ave Submit j sets of plans with any of the above. •
City/State/ZIP: Tigard, OR 97224 The above are not applicable to temporary construction service.
,, PEE* . SCHEDULE '
Suite/bldg./apt no,: Project name: Barbara Benson e s u aa a r Qry. F.- 1 rural ( ..
Cross street/directions to job site: New residential single- or multi - family dwelling unit
Includes attached gara _
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.; Ea. addi 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy non - or residential modular 75,00 2
DESCRIPTION.' OE, WORIf� " Each man ufacd
-
Meter base and feeder replacement. dwelling, service and/or feeder 90.90 2
_Services or feeders Installation, alteration, and /or relocation
200 amps or less �jj 80,30 f(90. 66 • 201 amps to 400 amps 106.85 2
' ❑:• r'RO t.':OV1 . E*. ` ,' r .41 . ... • C1 . E1* , .:..... , . 401 amps mps to 600 amps 160.60 2
Name: � 0�/� / v • 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Pr Reconnect only 66.85 2
City /State/ZIP: C_'C(JV1 _ V1 I A / ciY j 7Q(JJ> / v J Temporary services or feeders installation, alteration, and/or
Phone: (503)445 -1215 I Fax: ( )
relocation
2000 0 amps mps or less 66.85 1
Owner installation: This installation iS being made on property that I own which is not 201 amps to 400 arrrlrs 10030 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
❑, j1►, !l'L•I ' �'� :.i,;,..:1,. ❑, A Cee for branch circuits with
>� ":, . CUIVTACI PERSON:.
service or feeder fee, each 6.65 2
Business name: branch circuit _
B. Fee for branch circuits
Contact name: without service or feeder fee, 46 -85 2
each branch circuit
Address: '
_Each add'l branch circuit 6 -65 2
City /State/ZIP:
Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) lax. ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Oregon Electric Group _.
Address: 1010 SE 11th Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Portland, OR 97214 investigation per hour (11v mm) 62.50
Phone: (503) 535 -2652 I Fax: ( 503) 231 -3587 industrial plant per hour _ 73.75 J
' ' . . ELECYJR1CA1 'PERMIT FEES" •
CCB Lie.: 203 I Electrica : -9 C -uprv. Lie.: 44605 Subtotal / 2 6 6
Suprv. Electrician signature, required / , / Plan review (25% of permit fee)
Print name: 4.9 , t '/ . i Date-ag 04 State surcharge (8% of permit fee) I ,
_ TOTAL PEktMITFEE D3, c/''
Authorized signature: y j , This permit application expires if a permit is not obtained within 180
` r aCC da ys after It has been accept.' as complete
Print na me: ,� Date: 1211/04 - Fee methodology set by Tri - County Building Industry Service Board
•• Number of insppeeuions per permit allowed.
isSw 'tdirSPennhAELC.Peni.itApp.doe 12103 444467ar0 W02/COhJWEB
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested \ ev ' \ 0 AM PM BUP
Location 11-\ Q p 0 5 v`/ 'I\ V't Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC - CP 3
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ( ' SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
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 RT FAIL
L TRIC
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
CfERSO PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Approach/Sidewalk Date / c.—. Ext
Other:,
Final DO NOT REMOVE this inspection record from the b site.
PASS PART FAIL