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Permit "Jr CITY OF TIGARI ELECTRICAL PERMIT r PERMIT #: ELC2004 -00342 DEVELOPMENT SERVICES DATE ISSUED: 6/11/2004 ' } 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 1 S133CC -80023 SITE ADDRESS: 14196 SW BARROWS RD 2 -3 SUBDIVISION: SCHOLLS VILLAGE CONDOMINIUMS ZONING: R-25 BLOCK: LOT : 2 - JURISDICTION: TIG Project Description: (1) branch circuit/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: HOLLINGSWORTH, KARIN EVERGREEN ELECTRICAL CONTRACTOR 14196 SW BARROWS RD. #3 23861 SE 442ND TIGARD, OR 97223 SANDY, OR 97055 Phone: 503 - 590 -2619 Phone: 503 - 668 4608 Reg #: LIC 136311 ELE 3 -472C FEES SUP 4581S Description Date Amount Required Inspections [ELPRMT] ELC Permit 6/11/2004 $46.85 [TAX] 8% State Surcharge 6/11/2004 $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- 332 -2344. Issued By: I, Permit Signature: Cri1 Q-p—eA 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 Electrical Permit Application , R eceived , - v Electrical • e #' Date/ByV to Permit No G p " 090.072 -- Cl of Ti and Planning pp va l Sign g Date pp No.: 13125 SW Hall Blvd r (1 �w ,�` Plan Review Other Tigard, Oregon 97223 tt,/ Date/By: Permit No.: Phone: 503 - 639 -4171 Fax: 5 -598 -1960 Post- Review Land Use th � yr�7t l ��l�' t _ - - -- --- DateBy.: _ _ Case No.: Internet: www.ci.tiga � . 1\' 1 U C ■ t1' .. Ail ' Contact ® See Page 2 for _ 24 hour Inspection Request: 503-639-4175 C ^ ^!' s IGA ass- - N Supplemental Information. GO 0 DIVISI °N ■ 1LD1N c , ....TYPEEOF W©RK`v'.. B VV .,i .: ,P ° ` , = °RE'VIEW (Pleas check alitthatapply) 0 New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility commercial 0 Hazardous location ❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, x. M CA`i'EGORVOCC(4NSM!CTtOW ` t,r ' t _ -; 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: 0 Egress/lighting plan 0 Other: Submit sets of plans with any of the above. ,,,� i , '' JOBI$0 I votot TIUN and LOCATION ;:1. u'. =: Y The above are not applicable to temporary construction service. Job site address: L clCp LLD rYp`.oS __.c,( 4 . ice" «" 7:2 FEE* SCHEDULE £ --...-,,, rs ', ' Suite #: Bld :. /A s t. #: Number of ins ' ections • er • ermit allowed Project Name: Description - . Total New residential - single or multi - family per Cross street/Directions to job site: dwelling unit. Includes attached garage. Service included: . 1000 sq. ft. or less 145.15 z Each additional 500 sq. ft. or portion thereof 33.40 1 Limited energy, residential 75.00 Subdivision: - - -Lot-#:- ----- — — 75:00 - — -- -- Tax map /parcel #: Each Manufactured home or modular dwelling µ DESC:RIP0,1N OF WORK .,.1404,10iMlig service and/or feeder 90.90 Services or feeders - installation, t r C...1 1 1 - nz . ) alteration or relocation: 200 -amps or less 80.30 201 amps to 400 amps 401 amps to 600 amps 160.60 , :£ ;' `; r � b 60iam.sto am . s 240.60 . t FFRa 46141 q i 1'ENANT� �; x =:. �:... , µ Over 1000 am - .or-volts. ME 454.65 IFillaITKWIMIIWMMMIMII Reconnect onl 1.1111 66.85 : - Address: Temporary services or feeders - installation, •alteration, or relocation: City /State /Zip: 200 amps or less 201 am. to 400 am . 100.30 Phone �Gb p ^ lq Fax 401 to 600 am.s 133.75 4PP.EIGAN ':a, . i . #; CpNTACT PERi;U ? ;„::, Branch circuits - new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 6.65 • Ci /State /Zip_ gy B. Fee for branch circuits without purchase of • service or feeder fee, first branch circuit Ill 46.85 Phone: Fax: Each additional branch circuit 6.65 Misc.(Service or feeder not included): Each nun. or im r lion circle II. 53.40 ® ®' Each sign or outline lighting ME 53.40 Job No: f 1p -3 209 Signal circuit(s).or a limited energy panel,- EMI ` \ alteration, or extension Business Name: � t -1 Description: Address: 9 % lo_) L A -L 1 - Each additional ins . ection over the allowable in an of the above: Ci /State /Zi s : U'1 d 012 - 1 DS Per inspection per hour (min. I hour) ■ I Phone: l £1 oSS L -1 O J e ax: ( c ( Q. ' CYC �J Investigation fee: 2 ` 1.-4 CCB Lie. #: ' ,?)(6S l ! ic. #: • . - , a (, Other: ,' :' "i Me trisal l mi ' s ) r �'v4 aid Supervising electricia , • $ Ca ` 5 si • ature re • uired: �:e $ State Surchar:e 8% of Permit Fee $ /5 Print Name: 4 1 ( � , ► TOTAL PERMIT FEE $ a .tOd Authorize. �. d a Sk Notice: This permit application expires if a permit is not obtained within a Signature: � � jet Date: o 180 days after It has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. n i t •C ( r (Please print name) i:\Dsts\Permit Forms \E1cPermitApp.doc 01/03 • CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (50).63.4,4175 INSPECTION DIVISION Business'Line: (503) 639 - 4171 MST BUP Received Date Requested 26 PM BU Location / g /�1 Si i e M O0 Contact Person Ph ( ) S7) 3 PLM Contractor Ph ( ) SWR BUILDING Tenant/Ownera,O0 -D6 �� Footing Foundation ELC Ft Drain Access: o �}� , Crawl Drain (U' p 1/ ELR Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Ina Sheath /Shear 6 1--c 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 c_r Post & Beam Rough -In Gas Line Smoke Dampers I .� RT FAIL EL C L = " Service Rough -In C:\ UG /Slab Low Voltage Fire Alarm PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW_Hall Blvd. SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach /Sidewalk Date C Inspector /kr Ext Other: Final DO NOT REMOVE this inspection record from t he ob site. PASS PART FAIL