Permit CITY TI GAR® ELECTRICAL PERMIT
PERMIT #: ELC2003 -00370
DEVELOPMENT SERVICES DATE ISSUED: 6/19/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S109AB - 09300
SITE ADDRESS: 14226 SW 132ND TERR
ZONING: R -
SUBDIVISION: RAVEN RIDGE
BLOCK: LOT : 022 JURISDICTION: TIG
Project Description: Alter (1) branch circuit to finish basement. 7/3/03, add additional branch circuit for bathroom.
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: 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:
MARC MOORE METZGER ELECTRIC INC
14226 SW 132ND TERR 8780 SW LEHMAN ST
TIGARD, OR 97224 TIGARD, OR 97223
Phone: Phone: 244 - 9025
Reg #: L1C 96805
SUP 3130S
FEES ELE 34 -167C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/19/03 $46.85
[TAX] 8% State Tax 6/19/03 $3.75 Rough -in
'[TAX] 8% State Tax 7/3/03 $0.54 Elect'I Final
(additional fees not listed here)
Total $57.79
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 9 - 11 P. • I 0 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (51 246 -6699 or
1 -800 -3 44.
ARO
P ermit Si nature: -� Iss ed By: )♦ / / a �� �. i i g � %di
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
• FOR OFFICE USE ONLY -
Eleet.' I Permit Application Received Electrical
Date/By: ( i q 103 Perm No.: 6 e
w. - 005 70
Cit o f TI and Planning Approval Sign
Y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 5O3-598-19O Post- Review Land Use
Internet: www.ci.tigard.or.us .01404 0 ( IJ 1� Da Case No.:
i Contact J is.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: 7 Supplemental Information.
2 "az':,4:y�.,�� F "� ; � s . ;.. =��, - ow^""'� X 51,. �,. .*:�w''c 3',.::; "�'� .�. .�� -- � �..^..^�;�sr,��».r e �'��,
-*Za : niR : ,;a: r;NrYPE OP WORK, -,Zga ... , . �f t ;' ::!': <$ = = .W° iVil:.. P REVIEW (Pleise ehecktall ,thaiTapPlY). #=: '�,,. �.
O ›iew construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
a t fi ' •` ,CATEGORY,.OF.CONSTRUCTION . tiY.;w . ;.r 1 & 2 family dwellings four or more residential units in
1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
.. ei AOB£SITE INFORIVIATI®N CandIEOCAT3IOTNM ' „ „ Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 42.26 (3:3 -f a( 7PN/". �
�` m`.._ 1-PE °E *, S014EDULE. CO. V � tig a
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: p re.. RPS,1c/o c. Description Qty Fee(ea.) Total
Cross street/Directions to job site: New residential-single or multi-family per 1
� dwelling ngunit. Inn cludes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: /'P k; Lot #: ''•.2- Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
r - �'":-' °°- t:, service and/or feeder 90.90 2
,{ t, „ „� DESGRhPT10NOF. WORK. Services or feeders - installation,
• I ' 'n k 141 b alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
st ,�� "" 4 ; . 601 amps to 1000 amps 240.60 2
PROPER�T1' OWNER -fTENANT ; . -:. p p
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Ph. e: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
APPLICANT ,t ;` .94M 1 CONT #ACT;PE SON
} Branch circuits -new, alteration, or
Name: 6426/26 14016-5 , At./ C.lris Lie. extension per panel: of
Address: / QB c5t) 0E4421494 tA) A. Fee for branch feed rfee,te each branch circuit service or feeder fee, each branch circuit 6.65 2
B . Fee for branch circuits without purchase of
City /State /Zip: '�'(�� -(Z D Old �7ZZ3 0 (• .SS
/ service or feeder fee, first branch circuit 46.85 2
Phone: ,403)30"7— 7 // 7 Fax: ,, 3), 79-O77S Each additional branch circuit • 6.65 2
E -mail Misc.(Service or feeder not included):
r _ - - - Each pump or irrigation circle 53.40 2
� ` I ::`S �. :,CONTRACTOR. F, a.. ..: _ . . , is
Each sign or outline lighting 53.40 2
Job No: - Signal circuit(s) or a limited energy panel,
j / alteration, or extension Pa . e 2 2
Business Name
H e 3 E- ie,- 7" ,,e.... Description:
Address: 878® Le,i.1man Sf.
Each additional inspection over the allowable in any of the above:
7 '
City /State /Zip: • �� DA 7i �3 Per inspection per hour (min. 1 hour) 62.50
Phone:,03) ,4j 16— 'Y Fax: j- o3 Investigation fee:
CCB Lic. #: Q /e1oS Lic. #: CL- 3 /61 e Ot ther• aa M „: e _ Electrical Perm►t Fees *, 3 § µ ,. te
.,✓ Supervising electrician Subtotal $ / ( p • S'
/ signature required: Plan Review (25% of Permit Fee) $
Print Name: Lie. #: State Surcharge (8% of Permit Fee) $ & - ? 5
TOTAL PERMIT FEE $ .Jd , 6)0
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: _ 180 days after it has been accepted as complete.
*Fee methodology set, by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Jr'
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
Ell Garage Door Opener
ri Heating, Ventilation and Air Conditioning System
In Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
n Boiler Controls
n Clock Systems
ri Data Telecommunication Installation
Ti Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
Medical
n Nurse Calls
El Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested � _ AM PM BUP
Location / 2 Z�O / 3;- i 7TAI Suite ME — 6c) 337
Contact Person Ph ( ) 3 C - 7 — 71(7 AV 3 -
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC3 ` 00 3 7 0
Footing ELC
Foundation 1
Access: 1
Ftg Drain d 3 (� I
Crawl Drain / ' t U "
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 _PRAT FAIL
UMB
Post Beam /77-2
Rough-In
Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O ther::
fl PART FAIL
NI L
- - .m
Rough -In
Gas Line
Smoke Dampers
ma
f '1 PART FAIL
RI
Service
Rough -In
UG /Slab
Volta
►re arm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S El Please call for reinspection RE: Ei Unable to inspect — no access
Fire Supply Line. .
�/� 7/ ADA
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
— --