Permit CITY OF TIGARD
4 ELECTRICAL PERMIT
PERMIT #: ELC2004 -00192
DEVELOPMENT SERVICES DATE ISSUED: 4/15/04
A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 109AD -00300
SITE ADDRESS: 14580 SW 126TH AVE
SUBDIVISION: BLUE RIDGE ZONING: R
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: 1 branch circuit to AC.
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:
CRINO, ARTHUR D + SALLY J TRUSTE OWNER
14580 SW 126TH
TIGARD, OR 97224
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/15/04 $46.85
[TAX] 8% State Surcharge 4/15/04 $3.75 Rough -in
Elect'l Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or
1- 800 - 332 -2344.
Issued By: 4 ,1 - __ // Permit Signature: k -- _,✓ `ti --� r- ,-'r - D
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: 4, - -::); DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY �_/
City of Tigard Received,f / �,1 ; ; Permit NoE ev /7 /
/ / n /1 °h'P�
13125 SW Hall Blvd., Tigard, OR 97223 Da �i��f —
H f/
Phone: 503.639.4171 Fax: 503.598.1960 1l��1�'�� Plan n Re vie
Date/By: Other Permit.
Inspection Line: 503.639.4175 1L Date Ready/By: 1 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: J ! C.4 Supplemental information
`' 1 1tii$ : ?T'EkE WOR PLAN REVIEW
❑ New construction kr 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.,
4 ' lVit,pti A I ? `T of 1- and 2- family dwellings 4 or more new residential
/k 1 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 0 Master builder 0 Other
❑Occupant load over 99 persons ❑Manufactured structures or
M V" ySIT,E t i a l i l i ,8:1 a a , RV
,.� ��. s. ��, _ � � .- u.�:� a ..z,.� .. � - . _ �.�. , .. �, Q � � � ��� � ❑Egress /lighting plan park
P
❑Health -care facility ❑Other:
Job no.: I Job site address: l 4 5 ga f w / ZG 7n-t
V = Submit 2 sets of plans with any of the above.
City /State /ZIP: -r / ( orz, D d (7— 1-7-2---4-- The above are not applicable to temporary construction service.
E
Suite/bldg. /apt. no.: I Project name: ' ' `° S CHEDULE ,
Description Qty. Fee. Total
Cross street/directions to job site: a V j_ i n/L 7-A/ pip A i New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'1500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
7 ,. Limited energy, non - residential 75.00 2
6. i 3 ®.�__ ® .. ; =1 Each manufactured or modular
dwelling, service and /or feeder _ 90.90 2
C 0 Al M f-. CT f. 1 R Co Alb d 1 in/ I NG- Co M Pa - Services or feeders installation, alteration, and/or relocation
S S tJ ' TO A—/ /r . Are 200 amps or less 80.30 2
,' s , . I , , , : 1p 0 201 amps to 400 amps 106.85 2
:0, v H � � i , . , 8 , k -- - ` .. , . , - : ' 401 amps [0 600 amps 160.60 2
Name: /4 rk.v� ca J Nc 601 amps to 1,000 amps 240.60 2
Address: ` 4s g O S or 1 G 71-I /i - 1/7Z Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP:
I^ i 6-- Aft, 7 0 (2, 4 / 224- Temporary services or feeders installation, alteration, and/or
Phone: ( 5 77) ( 3 9, 6 54_5 I Fax ( ) S 4„„,.s,
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 rent, pr exchang ccording to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: 5/94- Branch circuits — new, alteration, or extension, per panel
t „ ' p'' '" 0 4 0 „ A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name:
without service or feeder fee,
each branch circuit 46.85 � 2
Address: Each add'I branch circuit 6.65 2
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-
14 t o ro g,f . t c " , o r energy panel, alteration, or
Business name: C 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
yi t C'L t AL 1'E VIIT E .
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal # 6,_v,5-
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date:
State surcharge (8% of permit fee) 3. 7±
TOTAL PERMIT FEE X 50* ci
Authorized signature:
T his permit application expires if a permit is not obtained within 180
4 ..4.—. days after it has been accepted as complete
Print name: 4 0, - - n C Ft i N O ¢/
Date: t 5 / g /4� * Fee methodology set by Tri- County Building Industry Service Board
a ` ` Y ** Number of inspections per permit allowed.
i:\ Building \Pernits\ELC- PermiiApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
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
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i: \ Building \Pentits\ELC- PentitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received y, 3 e Date Requested 22 r1 AM PM BUP
Location /`' S 80 /Z� i°t ~ , Suite MEC
Contact Person ( ) PLM
Contractor Ph ( ) SWR C /
BUILDING Tena 1 Ow . M �' i v0 / 9 a
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
Drywall Nailing
Firewall
Fire Sprinkler
C (.:*:-
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
P FAIL
LECTRICA
■
ice
Rough -In
UG/Slab
Low Voltage
F larm
PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
'Ili Approach/Sidewalk Date Inspector2- Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL