Permit CITY. TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00640
DEVELOPMENT SERVICES DATE ISSUED: 10/5/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 109AD -01000
SITE ADDRESS: 12765 SW BULL MOUNTAIN RD
ZONING: R -
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (2) branch circuits for bathroom remodel.
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:
SCHAER, JOHN ARLEN + CHRISTI A S &A ELECTRIC, INC.
12765 SW BULL MTN RD PO BOX 218
TIGARD, OR 97224 BORING, OR 97009
Phone: 503 - 684 -6532 Phone: 503 - 658 -5358
Reg #: ELE 3 -520C
LIC 148014
FEES SUP 4833S
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 10/5/2004 $4.28
[ELPRMT] ELC Permit 10/5/2004 $53.50 Rough -in
Elect'I Final
Total $57.78
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: 49 ( � Permit Signature: e-
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 Pe. i i ' l5iiiit ion FOR OFFICE USE ONLY •
' t. d Received - lectrical
It Date/By: to o y . Permit No.:a- Co2OOy_ VC
City of Tigard OCT 2004 Planning Ap l Sign
13125 SW Hall Blvd.
Date/By: Othe No.:
Plan Review Other
Tigard, Oregon 97223 CITY OF TIGARD Date /By: Permit No.:
Phone: 503 -639 -4171 F I Post - Review
Jfr Cl An Land Use
I i H ' t�
Internet: www.ci.tigard.or.us �. %` � i j ��l Date /B t Case No.:
"'0" a ai Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method:
j �6- Supplemental Information.
J
:. .. r TYPE'.OF WORK . ,: Tsi ::.: , ::: PLAN REVIEW (Please. check: a ll'tli a t a "' l ...
PP Y)'
❑ New construction I f Demolition ❑ Service over 225 amps- ❑ Health -care facility
❑ Addition /alteration/replacement El Other: commercial ❑ Hazardous location
❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
C ATEGQRY . OP' CONSTRITCT ON: ,,''',.: 1 & 2 family dwellings four or more residential units in
I &i 2- Family dwelling ❑ Commercial /Industrial ❑ System over 600 volts nominal one structure
H El Building over three stories ❑ Feeders, 400 amps or more i
❑
Accessory Building Multi - Family p
❑ Occupant load over 99 persons 0 Manufactured structures or RV park
E Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
• JOB SI;TE.'INFORIGIAT1ONand LQ :' • • . ' . Submit ` sets of plans with any of the above.
5�51� � m � The above are tat applicable to temporary construction service.
Job site address: �2'7l
-.'.. ,: : „'t: .'•. , : :..VEE* SCHEDULE'
Suite #: • Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: , e - Description Qty Fee (ca.) Total
Cross street/Directions to job site: New residential- single or multi-family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
- Limitedenergy, residential 75 00 2
Subdivision: Lot #:
. Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
i1 .ESCRIJ'TTON;OF'WORK..': :.:: , :. ;..: 4 . : : : ' service and/or feeder 90.90 2
Services or feeders - installation,
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
)1R( 401
.`;ii,,:, . ,:: : >• ' 60 amps to 1000 amps 2
� hIt ITsi. i; �e?' .`'c�d•:.,,.,l�i� : :',; I itr. '` : 40.60 2
Name: � 1.� 6 L, -j// � Over Reconnect amps or volts 454.65 2
L Reconnect only 66.85 2
Address: I At? ( „5 -- o .` 7-j. kb Temporary services or feeders - installation,
City /State /Zip: Ti G./3- -,-t 0 2,_ .+� alteration, orrelocation:
�7o�nC 200 amps or less 66.85 I
Phone: 6,gy- 453,,2.. Fax: 201 amps to 400 amps 100.30 2
APPLICANT ". .. ..: « s;l.;;., ..;= [I::CQNTACTzt'E E ON " RS.'. ' ` 401 to 600 amps 133.75 2
-
" ''' Branch circuits - new, alteration, or
Name: extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
Phone: service or feeder fee, first branch circuit t 46.85 Li '� gr 2
Fax: Each additional branch circuit t 6.65 (p 1 1 2
E -mail: Misc.(Service or feeder not included):
;,OONT _ `'' Each pump or irrigation circle 53.40 2
� �+ Each sign or outline, lighting 53.40 2
Job No: J Signal circuit(s)Or a limited energy panel,
Business Name: A T�. alteration, or extension Page 2 2
� � t C { L +� Description:
Address: pO .1? X ,Z1
City /State /Zip: _�1 i�lC� ��� � 7�� Each additional inspection over the allowable in any of the above:
�/,� / � / � Per inspection per hour (min. 1 hour) 62.50
Phone:
5(5 e e�X / J � ,�I� Fax:5L 653 71 "7 investigation fee:
CCB Lic. #: • / I W ()1c-, Lic. #: 3 '� C 71f/0(P Other:
Supervising electrician ; : i�.:• :i.tt " . ,: ",. ;;`F ectricatT,erinat,Fees *ri "= ::
si: ature re.uired: • / �/ , � � -- Plan Review (25% of Perm Fee) S o 5O
Print Name: - #: e33 S State Surcharge (8% of Permit Fee) S �t 2_3
Authorized /� / /(7.,/ TOTAL PERMIT FEE
N otice: This permit application 6t LI
$ l t go
expires if a permit is not oatned withnt
Signature: Date: 1 1 Q 180 days after it has been accepted as complete,
*Fee methodology set by Tri- County Building Industry Service Board.
_ LS � -f\CH IQ k... _
(Please print name)
L " N , p
is \Dsts\PermiI Forms \E1cPcrmitApp.doc 01/03
z . d dui : ts0 -170 . 170 400
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503)439 -4175
INSPECTION DIVISION w;_ ` Business Line: (503) 639 -4171 MST
/ BUP
Received Date Requested l °– AM PM BUP
Location C '� `�•C , 6.. Suite MEC
Contact Person . 1.t1) Ph ( )3 /(– 244 7— PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 00 Y - 06 6
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
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P ASS 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
- T F AIL
44 21:D
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
. PART FAIL
SITE Please call for rei spection RE: Unable to inspect — no access
Fire Supply Line
ADA L
Approach /Sidewalk Date ' / Inspector OP
Other:
Final DO NOT REMOVE this inspection record from th = b site.
PASS PART FAIL