Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 - 00746
DEVELOPMENT SERVICES DATE ISSUED: 10/4/2005
��" Ail DEVELOPMENT
SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109AD - 09600
SITE ADDRESS: 14631 SW 126TH AVE ZONING: R -7
SUBDIVISION: PARSONS MLP97 -0017 LOT : 001 JURISDICTION: TIG
Project Description: (1) 200 amp servicef, (10) 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: 10 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:
DEREK & EN RICHARDS DICKENSON'S ELECTRIC
14631 SW 126TH AVE 8449 SW BARBUR BLVD.
TIGARD, OR 97224 PORTLAND, OR 97219
Phone: 503 - 646 -8411 Phone: 503 - 246 - 3550
FEES Reg #: LIC 65534
Description Date Amount ELE 26-140C
SUP 3100S
[ELPRMT] ELC Permit 10/3/2005 $146.80
[TAX] 8% State Surcharge 10/3/2005 $11.74 REQUIRED ITEMS AND REPORTS
Total $158.54
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 N9tification 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,queAt: ns- to 246 -6699 or
1- 800 - 332 - 2344.
Issued By:
Permittee Signature , �� r
wir
%ham
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: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
• This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
• B Fixtures
• • Plumbing Permit Application • FOR OF U.SE ONLY
City of Tigard ■ Received
ECEI �^^+' Date/B M y�� l,✓ Permit No.
13125 SW Hall Blvd., Tigard, OR 972 3 ��i t , ! Plan Review �i �/
Phone: 503.639.4171 Fax: 503.598.1960 /ixrq:H'ld }� ? \, Date/By: Other Permit No: 1 �'�► 5
3/
24- Hour Inspection Line: 503.639.4175 _a.1,l -`� I Date Ready/By: r ° "S El See Page 2 for �/
Internet: www.ci.tigard.or.us OCT ® � ZOO v Notified/Method: -7 ( 1 . , . . , Supplemental Information
• TYPCP '0'OI ° • FEE * - SCHEDULE
•
BUILDIN ^ For special information use checklist.
❑ New construction ®�� QIQn Description I Qty. I Ea. I Total
A ddition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION - . _ SFR (l) bath 249.20
- 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
' JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I W 3 ( S 1 -aO Catch basin or area drain 16.60
City /State /ZIP: � .4 Q. v' l �1a Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2 -
��` \ Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
10 )4 I . ( T % 1 lat,ll I r " "h Y\ a, Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION ,OF WORK Backflow preventer Page 2
A 12-44
AXJ .- 6-M 6U7:(111tAr,c) t, hl£N,-- ¶ Backwater valve 16.60
J a IPPA5 Clothes washer 16.60
Dishwasher f 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
. Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 .
Hose bib 16.60
V ] APPLICANT ❑ CONTACT PERSO
x Ice maker I 16.60
• Business name: p, yyh,�,�
"` vl Interceptor /grease trap 16.60
Contact name: • Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: Sink/basin/lavatory 16.60
( ) Fax: )
Tub /shower /shower pan 16.60
• E -mail:
Urinal 16.60
' CONTRACTOR Water closet rq . . 16.60
Business name: ' (o Water heater 16.60
Address: Qom/ Other:
Subtotal
City /State /ZIP: 19/ , l7C0
.
Minimum permit fee: $72.50 , i f
Phone: (50'3) 6E4 ( _ s-g a.Lj Fax: ( ) ` ?f _, Residential backflow minimum permit fee: $36.25 // 1- t
CCB Lic.:4,2 / 7‘f y-n"' U7 Plumbing Lic. no.: Plan review (25% of permit fee)
/ State surcharge (8% of permit fee) 9 , ,3 d
Authorized signature:
S Q C� Qj�2 ��./ TOTAL PERMIT FEE 4ri i:efb
Print name: Date: This permit application expires if a permit is not obtained within
• 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\ Building \Permits\PLMF- PermitApp.doc 06/05 440-46t6T(10 /02/COM/WEB)
•
Plumbing Permit Application - City of Tigard ..
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utillties� ' "` . F : ` Qty . F ee (ea). 'Total
S "quare • Footage: • , Permit f ee:; : ' .. ,:
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems: •
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
• FIxtU're Or Item Qty. Fee (ea) ' Total additional $100.00 or fraction thereof, to and
including $10,000.00..
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
• Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Compl Structures
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed" ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
• Bath - Tub /Shower - ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool providing services to human beings.
Car Wash -Each Stall - ❑ Plumbing installations, alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2' sets of plans with any of the above.
3"
4 „
Car Wash Drain ` . . Isometric or Riser Diagram '. ,
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial •
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this .permit results in an
Water Extractor p
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Permits\PLM- PennitApp.doc 07/06/05
CITY OF TIGARD L
BUILDING DIVISION v �- (,
PERMIT #: 0 O 7 y�o
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
�u1P
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: q,Ll4' — / tfS PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
1.N) tc,i': te N\j, — 01 cs-5 I cl -D f 1.1
Corrections /Comments/ Instructions:
N PASS ❑ PARTIAL APPROVAL ❑ CANCEL Li NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t., <A-----7 Date: /6 Phone #: (503) 718-
/ f
CITY OF TIGARD j' •
BUILDING DIVISION PERMIT #: ELC2005 -00746
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/4/2005
Phone: (503) 639 -4171 k i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/17/2005 TIME: 7:04AN1 PAGE: 9
SITE ADDRESS: 14631 SW 126TH AVE CLASS OF WORK:
SUBDIVISION: PARSONS NMLP97 -0017 LOT #: 001 TYPE OF USE:
PROJECT NAME: RICHARDS
DESCRIPTION: (1) 200 amp servicef, (10) branch circuits.
OWNER: RICHARDS, DEREK & ENDRE PHONE #: 503- 646.8411
CONTRACTOR: DICKENSON'S ELECTRIC PHONE #: 503 - 246-3550
•
Inspection Request Scheduled For: Date: 10/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 V Wall cover . 018519 -02 503.944 -9745 N
Corrections /Comments/ Instructions:
—_,„ J. m D V. st R Lam bro. wia o.-
2,. 2 aNt Gxs 1-11 \ CA
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Ci'.\1/N ) 1^(1vA ,1 `r*
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(A/0 `9\cog1?(---cipii-,
VQ(}V1 )() i
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO. ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ki4v0 e Date: Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00746
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1(114/2005
Phone: (503) 639 -4171 „ Atilioq�i" l � j
Inspection Requests (24 Hrs.): (503) 639 -4175 '''
INSPECTION WORKSHEET FOR DATE: 12(2/2005 TIME: 7 :19AM PAGE: 27
SITE ADDRESS: 14631 SW 126TH AVE - CLASS OF WORK:
SUBDIVISION: PARSONS MLP97 - 0017 LOT #: 001 TYPE OF USE:
PROJECT NAME: RICHARDS
DESCRIPTION: (1) 200 amp servicef, (10) branch circuits.
OWNER: RICHARDS, DEREK & ENDRE PHONE #: 603-646-8411
CONTRACTOR: DICKENSON'S ELECTRIC PHONE #: 603- 246-3550
Lebo: mks . Tali - 't5 • 22
Inspection Request Scheduled For: Date: 12/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 022835-01 971 - 404 -8798 N
• Corrections /Comments /Instructions: ‘4.‘ `1
— PLUN i bli 10 <se wm lea6 ®o tAr.rat, tE
s‘.-c- CA L.. P■l.- •
RKSV 1 $ UN� %61A-D• - Tb 6-1i c
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,` ., • —v\ cg n0.A c citNbu ®t
st•yR SIC—U. +e ►Q 11/4A2i1/49.1) .
) .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
N FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: C e-- Nt6 LE" Date: tt 0 6 Phone #: (503) 718 - ZA •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200S-00746
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1014/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 - 4175'' I..
INSPECTION WORKSHEET FOR DATE: 1215/2005 TIME: 7:00AM PAGE: 26
SITE ADDRESS: 14631 SW 126TH AVE CLASS OF WORK:
SUBDIVISION: PARSO S MLP97 - 0017 LOT #: 001 TYPE OF USE:
PROJECT NAME: RICHARD'
DESCRIPTION: (1) 200 amp rvicef, (10) branch circuits.
OWNER: RICHARDS, DE K & ENDRE PHONE #: 503 - 646.8411
CONTRACTOR: DICKENSON'S EL •.TRIG PHONE #: 503 -246 -3550
Inspection Request Scheduled For: Date: 12/5/2005 Pour Time:
Code # Inspection De . ription Confirm # Contact # Message
199 Electrical final ► 2931 -01 503 -515 -2922 N
Corrections /Comm- • s/I ctions:
)(LPASS n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V `* 1 v Date: `'•.. I O5 Phone #: (503) 718 - 2.N14b