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Permit A, -CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00018 ;.�j� DEVELOPMENT SERVICES DATE ISSUED: 1/12/2005 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S103BB - 13100 SITE ADDRESS: 12240 SW ANN CT SUBDIVISION: LAKE TERRACE NO. 2 ZONING: R-4.5 BLOCK: LOT : 024 JURISDICTION: TIG Project Description: Replace dimmers. 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: 4 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: KURTIS SIXEL GARNER ELECTRIC 3472 NW 115TH 2920 SW 247TH AVE #A PORTLAND, OR 97229 HILLSBORO, OR 97123 Phone: 503 - 528 -1100 Phone: 503 - 591 -1320 - Reg #: LIC 121 159 SUP 3707S FEES ELE 34 -305C Description Date Amount Required Inspections [ELPRMT] ELC Permit 1/12/2005 $73.45 [TAX] 8% State Surcharge 1/12/2005 $5.88 Rough -in Elect'I Final Total $79.33 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1-800- 332 -2344. Issued By: j' Permit Signature: £a g OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day 02425/2003 08:42 6427925 PAGE 01 Electrical Permit A»Alication - FOR OFFICE USE, ONLY City of Tigard ��� n c ed . _ _, 6 /„ / / i 13125 SW Hall Blvd., Tigard, at Plan Roviaw " 9$ x'1 %,a,,.3;,,., ' :. \ Other Permit: Phone: 503.639 4171 Fax: 3. 960 [ 3 ffi i D • • Inspeetitm Line: 503,639,4175 '� '). a � . '/ I ' Date Ready/By: • NM t$ See Fage 2 for Internet: www.ci,tigard.or.us I ■ • 0 Notifud/Metbod: Supplemental Information • rn { zn t;t ,IV R'pr A H rs b , C` �• , � �� 'in'1 +ri y„,.6.tr�,y, .- �gmu�i}yf '; ;W�i tiif r lar u1lr at ±.a�t'F>: k�, , "�` 'I ' t ,�, M J 411w•�1,.':Vri.91�l;� >: S• 1-417A714''' •1vq�.�C, •. t • I i5i t t , 1 G ' i�t+ti rVi 1rj, fi f ,ltI 1 } itla t`G ! e Sl lli nrl'tl I V Y'l r'� F . ? 6.' � Mi'la i ; , X46 d il :1 4 . r., J I 1- AA)�uuc i t I,". , r,A,@t,J1IN.,:.fa,l..x. tzo nla atro lomi,,,a i ' t& ? `.,�,; lu:A' 1 '' T Please check all that apply: ❑ New construction !i =v t ]]Service over 225 amps, comm ❑Hazardous location [] Demolition CI Other .. 1 0,000 s ft., 1g�at � � n Iti!Zs I '' +r r"I gl +tL�T7rr rL y tWt + "( P r rfi aay h ... ; ❑S ecu r es over 320 imps- rari ❑Buildng G ,: i' ' r ,r Mi i w n ; at e . . ' l l': e a F " s ? , �t � + ° tit s'[{ h11� `l'L� 1. e 'a44 , a ," of 1- and 2- family dwellings 4 or more new residential ►r 1 and 2-family dwelling ElSystern over 600 volts nominal units in one structure y g © Cammnercial/indusirial 0 Accessory building ❑Building over three stories °Feeders, 400 amps or more • Muhl family Q Master builder 0 Other: ❑Occup load over 99 persons 0Manufactured structures or ,rr,. �};, t+ eV'n ,y t'+rr� <r+ �w' ...t ? tia<���V '1,':,i, b"4'rrla^�rra7 ; u:s..+ q n rs, Il ., � 1 . ieTsYtt I s �, r, Mik v. illy , � 9.71.1.,, 3.i , ,,n ;2�.a e ? 1 :;,„ { 3� li:,itx ,f h. si ❑SBroes/hghrngp RV park 1 . , f ` S � Submit h -care fhcility Other: Job no.: Job site addross: 2.2.`--10 �� �, L`1 � Submit 1 sets of plans with any of the above. City /State/ZIP: / The above are not applicable to temporary construerion service. ����,M,yl't��Fir4ldSi ) 1 :�7 f'�1 , a Y�wtl ti n ii lien t Suite/bldg. /apt. no -: Project name:, .. thuaa'ioson Qtr. tee. Total Cross street/directions to job site: New resi single- or multi - family dwelling unit. . Includes attached garage. • - 1,000 sq, ft or less 145.15 Subdivision : ' Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 Tax map/parcel n0.: Limited energy, residential 75.00 s �.5 r ,t,ny�b, by;,t,rk rll�; }"�''P irti.� ?aysfueay r ?ran ' , a7,SyI ?n a, trig lg ji t 1 ,,,, ' Y-ZiF InFPr "7: , r ra Limited energy, non 75.00 N 9N,;1 t l tlr t ii': i , �1I I.PJ f LIT S,i`F u'i # ;'t`P('' 'r is ' Nil e'iUJil h1 ti- f 113 N r Each TrAwlfactured or modular • dwellin` service and /or feeder 90.90 immiminsiiimmiiimmo■ CQ OArarraalirIPMIMIIIMIIIIII Services or feeders installation, alteration, And/or relocation 200 amps or less 80.30 • 2 I y � r f +'"� t A}'Rl' aan� r +� b 1Gd" ` rJ rr, r �,�',� r '-'�' ra 201 amps to 400 amps 10635 2 £� tt �f 4 { i ^Ili °`�@ `•1'� �9(y^3,t,6�''1 ",. �; 1 7$"x' 11901 7 1 1 1 �' ° . "' 4 N'' 9W W` �/"d f } , k i . ` e.i41 4„ A: u:w ' , l •z6�,,-lria,. iva 51.. Ir d I i •.Alts. i, 4' " .°.g.n4Z 401. amps w 600 amps 160.60 Name: (/f. r .` • 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: 1 r 23-- ( 0 O 5 24 j( Temporary services or feeders installatio alteration, aatvo relocation • Phone: ( ) Fax: ( ) 200 aims or less • 66.x5 1 Owner Installation: This installation is being made on property that I owls which is not 201 amps to 400 amps 100.30 2 intended forsale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.. 401 amps to 600 amps 133.75 2 Owner signature: ` 4 Date: , . �p�� �v(�'�yrJ Branch circuits - new, alteration, or extension. per panel w ∎ Ij � 'Vri4 ( 1y",F14Ril 1 t � i v s �l lt� l.tr �1� iiVi fift�tr P ' 1 R i' i ie of 1 ��( i1t�C.1i l e ; i1 f }1 `1 11. `.{IP i n3Mr4 6 ��.yE3 11 A. Fee for brans r circuits with . ..a)2 t , A1W ,,rh .:a ,xu{ie:5 alha.6 ;ty tIggi l Do' ),.i'm i ,, 6;: L LL' - ?.4' S„ fifi(coSi service or feeder fee, each Busincsa name: branch circuit 6 65 2 , B. Fee for branch circuits Contact name: without service or feeder fee, l each branch circuit 46,85 1 J 2 Address: finch add'l branch circuit C- 6.65 2.(.b 2 City/State/ZIP; Miscellaneous (service t r feeder 1Aoi included) . Pump or irrigation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting • 53.40 2 E-mail: Signal circuits) or limited- k w i , d r� rr� ��7 l °r ¢ }�� 1n N .• ryes wpe :..,,gip, y � ryr , 4 iwi - wv r, 'e , ,N te 1 3?nai �g:te:l; JS IiE].v;:.titi''i,ti'.a.'ib lI u1, 1 } 2f.,.Isimt�F�tigatlq AWIEWM At atgf �t blr. �tCC6.partCl,alttr2tion,or extension. Describe: Page 2 2 gusvaess dame: `j ir Address: CI 2v c r I'Yf �t'e Each Additional it�ection over allowable in any of the above Per inspection 62.50 Investigation per hour (1 It olio) 6 II P1104e: ( }) v ( �j ]ndustrial plant erhour 73.75 4 c i' y�� .1 , j 't1::4.a i r �F: " ,�� �� > T:','�r. '7� nh' ,;'1{S� . ' t -0. t°.flY..W I "�� '.I'J�' /�1.Y{1 t U � �Cl::e. ', g7 Subtotal IMIMI Suprv. Electrician signature, required: r r} Plan review (25% of permit fee) Print name: 'r ^ . r Date: State surcharge (8% of permit fee) '- - g - 1_ 1 l __ , 1 � I (J� TOTA.L PBRNFIT ItEE JGI t �'� • Authorized signature: This per0nft application expires if a permit is not obtained within 150 days after tt has been accepted as complete Print nerds: Date: • Fee tpetbodalogy set by Tri- County Building Industry Service Board "" Number of inspections per permit allowed. hu soildine \PamitatELC- PerhlftApp.dne 12103 4404615T110/031COM/WE13 CITY OF TIGARD 24 -Hour .. • BUILDING Inspection Line: (503) 639 -4175 ,, INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date equested -/6 AM PM BUP Location / a (/ 6 Suite MEC Contact Person Ph ( ) _� • — - PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC 'pa <5! ?1 Footing Foundation ELC Access: Ftg Drain ��fi ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm Susp'd Ceiling / Roof Other: Final PASS PART FAIL PLUMBING: )42 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 mss ET FAIL Service Rough -In UG/Slab Low Voltage Fire Alarm na U Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date a- t /.� 1 d CO Inspector (),..) (`) V^'\1 Ci Ext Other: Final DO NOT REMOVE this inspection record f om the job site. PASS PART FAIL