Permit CI TY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00572
11 DEVELOPMENT SERVICES DATE ISSUED: 10/10/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S103BA -00116
SITE ADDRESS: 11705 SW ANN ST ZONING: R - 4.5
SUBDIVISION: LERON HEIGHTS LOT : 016 JURISDICTION: TIG
Project Description: 2 branch circuits. Furnace and GFI
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:
ROBERT ERWERT OWNER
11705 SW ANN ST
TIGARD, OR 97223
Phone: 503 - 590 -5966 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 10/10/200( $53.50
[TAX] 8% State Surcharge 10/10/2001 $4.28
Total $57.78 REQUIRED ITEMS AND REPORTS
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 i fiett L , Permittee Signature: 0
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.
-Electrical Permit Applicatio � g ti, - 1 0K OFF ICE USL'ONLY . 1 -
' ' Received Permit N. _
1 14
Ci ty of Tigard r Day B . D f o b to _ _ .! 6 5;7 a 13125 SW Hall Blvd., Tigard, OR 97223 OCT 0 2006 Date/B Review
-:- Phone: 503.639.4171 Fax: 503.598.1960 B . Other Permit:
13 ,;
T I G A K D Inspection Line: 503.639.4175 Date Ready/By: Juns:� ® See Page 2 for
Internet: www.tigard-or.gov a + •Notified/Method: , Supplemental Information
. " TYPE O O Q '. , , . PLAN REVIEW ' ..
El New construction ❑ Addition /alte n ratron/ �• � reptl i iicem v w ent � - -U- .� - Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB ,SITE INFORMATION AND LOCATION - ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
// e i 100HP or more occupancy.
• Job no.: Job site address:
�! 70 ✓ : �u 0 vehicle parks.
❑ Six or more residential units.
City / State/ZIP: �A ve �-/ "'a (� ❑ Health-care facilities. ❑ Supply voltage for more than
4 L ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
. FEE :SCHEDULE -
`
Cross street/directions to job site: Description I Qty. I Fee. 1 Total I •
New residential single- or multi - family dwelling unit.
• Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
- DESCRIPTION OF WORK" ' . (with above sq. ft.)
A / Z ' V /' / / o /- Limited energy, multi - family
R v / 75.00 2
l l t� /9 e » it> 0 IJ 5 (0 it residential (with above sq. ft )
� Services or feeders installation, alteration, and /or relocation
Cp � / � !!! (: / "1 /))-J'( / 4 z__,0 z__,0 �s /�� (9 rl 200 amps or less 80.30 2
' - , OPERTY OWNER . ❑ TENANT • 201 amps to 400 amps 106.85 2
Name: 20 0 �, �R. (' 401 amps to 600 amps 160.60 2
' I 601 amps to 1,000 amps 240.60 2
Address: ) / 7 v 5 e LU A- .5—r Over 1,000 amps or volts 454.65 2
• City / State/ZIP: Pr, r 1 ,4 /2 D R -2--2...2 - -' 1 '7 ! Temporary services or feeders installation, alteration, and /or
relocation
Phone: (G95)v —T Fax: ( ) 200 amps or less 66.85 1
Owner installation: •' installation is being made on property, hat I own which is not 201 amps to 400 amps 100.30 2
intended for sale, 14. t, a. - xch ge ..rs - F o ORS 44.r, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: / 1L!` . Date: 1 a/1 o/ Branch circuits - new, alteration, or extension, l er panel
A. Fee for branch circuits with
❑ APPLICANT " , I ❑ CONTACT PERSON ' - " - above service or feeder fee, 6.65 2
each branch circuit
• Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 I 2
Contact name:
first branch circuit
Address: Each add'I branch circuit 6.65 1 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
• .. CONTRACTOR . ' " ' . Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: oh, energy panel, alteration, or
•
Address: extension. Describe: Page 2 2
City / State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lie.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
- ' ' , ELECTRICAL PERMIT FEES, , ,
Suprv. Electrician signature, required: Subtotal: ?),
Print name: Date: Plan review (25% of permit fee):
44 -a+ State surcharge (8% of permit fee): a. g`
Authorized signature �� TOTAL PERMIT FEE: S / •' lJ
Print name: iRl O i2 l o2W Date: 1 o I Q6 This permit ap ysc a te r ex it has been accepted if a permit d as complete. is sct obtained within 180
B� / , / days fter as be te
" Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL'WORIK 1
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.
COMMERCIAL WORK ONLY: �� }
Fee for each commercial $75.00
. system
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
• ❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
• ❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
• ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
. ❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
• for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY ������N��������
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BUILDING DIVISION ~°~°,"�~~"""~° ~~,°,~°,~~,~ PERK8|T ELC2006-00873
13125 SW Hall Blvd., Tigard, OR 97223 � ..^ DATE ISSUED: 10y10/2006
Phone: (503) 639-4171 �
Inspection Requests (24 Hrs.): (503) 639-4175 -
INSPECTION WORKSHEET FOR DATE: 10K1E/2006 TIME: 7:06AM PAGE: 3
SITE ADDRESS: 11706 SW ANN ST CLASS OF WORK:
SUBDIVISION: LERON HEIGHTS LOT #: 016 TYPE OF USE:
PROJECT NAME: BR1NERT
DESCRIPTION: 2 branch circuits, Furnace and GFI
OWNER: ERWERT, ROBERT PHONE #: 503-590-5966
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10y18/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 038431-01 603-312-5866 N •
Corrections/Comments/Instructions:
(--;"
\�JPASS PARTIAL APPROVAL 0 CANCEL n NO ACCESS
| I FAIL CALL FOR INSPECTION EI ADDITIONAL FEES ASSESSED
~ � |
Inspector: fis Date: • Phone #: (503) 718-
• _ '
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: ELC200 &.00572
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/1012006
Phone: (503) 639 -4171 u j �ll�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10117/2006 TIME: 7 :t AMMi PAGE: 2
SITE ADDRESS: 11705 SW ANN ST CLASS OF WORK:
SUBDIVISION: LERON HEIGHTS LOT #: 016 TYPE OF USE:
PROJECT NAME: ERWERT
DESCRIPTION: 2 branch circuits. Furnace and GFI
OWNER: ERWERT, ROBERT PHONE #: 503 - 530 -5966
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/1702006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 0313341-01 503 - 590 -5966 N
Corrections/Comments/Instructions:
Ala 1111 vty , td . ‘A4 j 6.r r
4
PASS I PARTIAL APPROVAL [ f CANCEL I NO ACCESS
FAIL n CAL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
'Inspector: Date: 0 4 Phone #: (503) 718 VVO
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: ELC2006 -00572 REQUIRED ON GREEN INSPECTION CARD.
✓ Code Inspection Description PASS Date By 1 • ✓ Code Inspection Description I PASS Date By
BUP - Building Permit ELC - Electrical Permit
• 405 Excavation 105 Underground/slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing X 120 Electrical rough -in
805 MFG - Structure grading/footing _ 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa/pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors X 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing MEC - Mechanical Permit
810 MFG - Structure set -up
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 • Grading fmal 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical fmal
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill • 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing _ 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final' 595 Misc. inspection:
499 Final inspection 599 Final inspection
I: \Building \Inspection Cards \Forms\AOP - InspCard- Blank.doc 12/09/2005
• P
CITY OF TIGARD e ELECTRICAL PERMIT
D EVELOPMENT SERVICES PERMIT #: ELC2006 -00572
� �f � l'LL; DAT ISSUED: 10/10/2006
- `r: -..' ' 13125 SW Hall Blvd., Tigard, OR 97223 503-639415'1
PARCEL: 2S103BA -00116
SITE ADDRESS: 11705 SW ANN ST ZONING: R -4.5
SUBDIVISION: LERON HEIGHTS LOT : 016 JURISDICTION: TIG
Project Description: 2 branch circuits. Furnace and GFI
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 FOR: 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:
ROBERT ERWERT OWNER .
11705 SW ANN ST
TIGARD, OR 97223
Phone: 503 - 590 -5966 Contact #:
FEES
Description Date Amount Reg #: 0
[ELPRMT] ELC Permit 10 /10 /200( $53.50 fi
[TAX] 8% State Surcharge 10/10/200( $4.28 •
Q
Total $57.78 REQUIRED ITEMS AND REPORTS t
7'
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: ; ., � � a ` , 1 Permittee Signature: V - ...._......
--
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.