Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00277
0 DEVELOPMENT SERVICES DATE ISSUED: 5/19/2004
a--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103CB -03600
SITE ADDRESS: 13185 SW 124TH AVE
SUBDIVISION: WILLAMETTE NO.2 ZONING: R-4.5
BLOCK: LOT : 015 JURISDICTION: TIG
Project Description: New service for bathroom remodel
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: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 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:
ERICKSON, NEIL A/PAMELA S A + E ELECTRIC INC
13185 SW 124TH PO BOX 684
TIGARD, OR 97223 BEAVERCREEK, OR 97004
Phone: Phone: 503 - 632 - 8575
Reg #: LIC 00066263
SUP 3752S
FEES ELE 26 -706C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/19/2004 $86.95
[TAX] 8% State Surcharge 5/19/2004 $6.96 Elect'I Service
Elect'I Final
Total $93.91
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- 332 -2344.
Issued By: �r Z'2-1 4- 7 _ Permit Signature:
� 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 INS ELATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE: 5 I
LICENSE NO: 376a S •
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Per>4it� -i1 Ev FOR OFFICE USE ONLY
City of Tigard Received DateBv: ( �' 10 Permit ` • Gam Gb " I A
13125 SW Hall Blvd., Tigard, OR 4 200 7223 i 9 Plan Review
Phone: 503.639.4171 Fax: 503:598.196 I Date/B : Other Permit:
Inspection Line: 503.639.4175 F TIGARD r All Date Ready/By: lures Ea See Page 2 for
Internet: www.ci.tigard.or.us CITY � G p ,�� St O N NotifiediNlethod: Supplemental Information
51311D OF WORK PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ❑ Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
l• t- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Multi- family 0 Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
,y ❑ Health -care facility ❑Other: _
Job no.: Job site addres / , ....S /2 yi �� 1 Submit 2 sets of plans with any of the above.
City /State /ZIP: ! t - 1 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 7 Project name: FEE* SCHEDULE
Description I Qty. I Fee. Total I '"
Cross street/directions to job site: ( -( ,+ "le (a 54- /hut, New residential single or multi- family dwelling unit.
r I nc l u d es attac gar
I24 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Q / / V dwelling, service and /or feeder 90.90 2
,,3 ' Pos•eD GuJ Services or feeders installation, alteration, and /or relocation
200 amps or less / 80.30 WI°
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( )
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, 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
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each S
Business name: 'E �:�7re-rxic e / � �L ( / NG branch circuit 6.65 / ` 2
Contact name: y B. Fee for branch circuits
C I!
/�N 6_2_4 c9u without service or feeder fee, 46.85 2
Address: Po r % 6,13.4. each branch circui
Each add branch circuit 6.65 2
City /State /ZIP: 0 Qte_. Miscellaneous (service or feeder not included)
Phone: ( 5 -- D3 ) Z — 8 57 Fax: ( ) Pump or irrigation circle 53.40 2
3 Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
/ / d j � e �_ ,4/c.__ extension. Describe: Page 2 2
Busi name: L
Address:/ 0.,11c-- 4 r'¢ Each additional inspection over allowable in any of the above
Per inspection 62.50 t
City /State /ZIP: 8 , Investigation per hour (I hr min) 62.50
Phone: (5'0 )6 72_, - F 5 Fax: ( ) Industrial plant per hour 73.75
-l5� ELECTRICAL PERMIT FEES*
CCB Lic.: 6 2_63 Electrical Lic.: 6_ 706c Suprv. Lic.: _ s Subtotal 76
Suprv. Electrician signature, required: '2,e_ ,- Plan review (25% of permit fee)
•
Print name: � �r�` Date: 5--_0-__a State surcharge (8% of permit fee) G , 74,
TOTAL PERMIT FEE > 7
i
Authorized signature: This permit application expires if a permit is not obtained ssithin 1 811
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Scr%ice Board
" Number of inspections per permit allowed.
i'. Building \Permits \ELC- PermitApp doc 1 2'03 440- 4515TI 10i02. COx7,WEB ,
Electrical Permit Application - City of Tigard
•
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
Heating, Ventilation and Air Conditioning
System*
Vacuum Systems*
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
Fire Alarm Installation
n HVAC
❑ Instrumentation
Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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
` Buildings 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 Date Requested 4, k AM PM BUP
Location / "3/ 5.0 /c4 T Suite MEC
Contact Person , riLL-/ Ph ( ) ( e) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner SID,ROO Ol9 ). 7 7
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ` SIT
Q
Post & Beam � .�� 44y T�'
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 T FAIL
Roug -In
UG /Slab
Low Voltag
�l�rm
I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SIT I Please call for reinspection RE: I I Unable to inspect — no access
Fire Supply Line
ADA n r I
Approach /Sidewalk Date v Inspector I V� �"' Ext
Other:
Final O NOT REMOVE this inspection rec d from the job site.
PASS PART FAIL