Permit x CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00526
,11, DEVELOPMENT SERVICES DATE ISSUED: 8/23/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103DB -01100
SITE ADDRESS: 13415 SW 110TH AVE
SUBDIVISION: MIRA PARK ZONING: R-4.5
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: 1 branch circuit for AC 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: 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:
PHILLIPS, CLINTON J + OWNER
RHONDA L
13415 SW 110TH AVE
PORTLAND, OR 97223
Phone: Phone:
• Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/23/2004 $46.85
[TAX] 8% State Surcharge 8/23/2004 $3.75 Rough -in
Elect'I Final
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 -33 - 2344.
Issued By: Permit Signature / ,40
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE:
��tr-` 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
Electricql Permit ApplarIGEIV ED FOR OFFICE USE ONLY
2004 Received Date/By: i D
3 /��� �Y
City of Tigard V • '
Permit No.: / G �r
Tigard, OR 97223
13125 SW Hall Blvd., Ti
g AUG 2 Plan Revte
Phone: 503.639.4171 Fax: 503.598.1960 '''' ' ^ h` . , , -; iI , Date/By: Other Permit:
Inspection Line: 503.639.4175 OF 1V1S1 , Noti T1GA �► Date Ready/By: Jur s: See Page 2 for
Internet: www.ci.tigard.or.us CITY • 1NGD fied/Method: rQ k ®
Supplemental Information
1 T ,. O;4 141 #s; ; a
"
1:1 New construction ID Addition/alteration/replacement Please check all that apply:
❑ Demolition E ether r ❑Service over 225 amps, comm'l ❑Hazardous location lici, J
DService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
KaMT:;'; ~' , " of 1- and 2- family dwellings 4 or more new residential
P. 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
Occupant load over 99 persons ❑Manufactured structures or
- tit:_ ?I t' ,� N
,.. .a.- ‘�. �. - a : :. 7; �, � . . � ', k ❑Eg ress/]ightingplan RV park
Job no.: Job site address: �(�` '' y� V ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: , it, • , Z1- The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: , Project name: -- ° S UEDPL
Description Qty. Fee. Total
Cross street/directions to job site: I k \ AVi V't New residential single- or multi - family dwelling unit.
`
l T D t i t s li-- `'r V \ l` Q � Includes attached garage.
, ! 1,000 sq. ft. or less 145.15 4
Subdivision: M, k 04._ b • k_..., . No - Lot no7.1 - •(12 Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no Z �� Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
'i'. # i 1: , . ``';2 �� 1 '`' ,
: ..1).?"....: t o l � � � � i_ _., �. r; . Each manufactured or modular
5 6 1' (i l dwelling, service and /or feeder 90.90 2
�. .>L 1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
£� . . . ]� ".. =z , a : ; ; .F i ll . - " A " � ,,� , .. 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: \ S \ t \c -\ IW• Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: • =d, � l Temporary services or feeders installation, alteration, and/or
z. Phone: • 1 • 73) a Fax: ( ) relocation
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, leas r/ , pr; change, . cording to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: !� Ai Date: Ia. - � Branch circuits - new, alteration, or extension, per panel
1: .. , u'
�, �, � � � . Fee for branch circuits with
- , . ..4. a ��, �. x. -- . , .. . . .vt ' .i 's-. . } , _ .�.. 4 .�.,.,. . "---1' 'C - . --3 A
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: ( La Y)T� B. Fee o ur service or feeder � � � without service or feeder fee, / 46.85 2
f � ti� O Each a branch a ch c i t
Address: �_ Each add'1 branch circuit 6.65 2
City /State /ZIP: C t ri0 Cr • L 22-7") Miscellaneous (service or feeder not included)
Phone: ) r Pump or irrigation circle 53.40 2
Fax. ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
energy panel, alteration, or
Business name:
O 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 nun) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal /r, .g'5
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 3. Print name: Date:
7s
TOTAL PERMIT FEE , loo
uthorized signature• This permit application expires if a permit is not obtained within Iso
INIMMINFAIlli. `/ days after it has been accepted as complete
Date: d Z3 0 • 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(10 /02/COM/WEB
e
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information '
LIMITED ENERGY PE ' 1 IT FEES:
Fee for all residential syste • combined ... $75.00.
Check Type of Work Inv lved:
❑ Audio and Ster- o Systems*
1 Burglar Al.
❑ G. .: e G oor Opener*
Heat. g, - ' . tion and Air Conditioning
S stem*
❑ acuum Systems*
U Other:
.5 ii g.a.,:.., ii , x:11 sY P g h p ; a," ,
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 \Pounds\ELC- PermitApp. doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received f 0� Date Requested /b /c/ AM PM BUP
/ 3� /r Sc) / /CT' ,, . 0 - �1
Location Suit � � 00 7
Contact Person Ph (�3) -793 35� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner - y-- [906
Footing
Foundation ELC
Access: 6
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam �'.�i� 1•�
Shear Anchors CAZ-1 Ext Sheath/Shear ,71 12: ic)
Int Sheath/Shear
Framing
Insulation
Drywall Nailing /
Firewall A /C/ MA- X
Fire Sprinkler ll!
Fire Alarm <E) /4v" l (� F.L t 5 cenki #iC�iy
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
PAS PART FAIL
ECH L
Post & Beam
Rough -In
Gas Line
Sm • : Dampers
- AS PART FAIL
Service
Rough -In p C
UG/Slab
Low Voltage 4-
Fire Alarm ti �(,Lt�
- PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line /
ADA //
Approach/Sidewalk Date / (/ Inspector ■r�� Ext
Other:
Final DO NOT REMOVE this inspection reco ' fr i m the Job site.
PASS PART FAIL