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Permit A CITY `` O I TIGARD CARD ELECTRICAL PERMIT *Y PERMIT #: ELC2004 -00663 tiI� DEVELOPMENT SERVICES DATE ISSUED: 10/15/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S115AA -05800 SITE ADDRESS: 10932 SW CHATEAU LN SUBDIVISION: REBECCA PARK ZONING: R-4.5 BLOCK: LOT : 015 JURISDICTION: TIG Project Description: Installation of (2) branch circuits for hot tub & outdoor outlet. 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: JIM JOHNSTON OWNER 10932 SW CHATEAU LN TIGARD, OR 97224 Phone: 503 - 464 -8514 Phone: Reg #: FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit I 0/15/200e $53.50 [TAX] 8% State Surcharge 10/15/200, $4.28 Rough - Elect'l Final Total $57.78 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 am setifsrth_io 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. Issue By: k ),;Jyf�._ J` / /i /f :� Permit Signature: y I �,t, (9.1 OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or nt. / / OWNER'S SIGNATURE: X V"� DATE: / /sad` C TRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day Fa • Electrical Permit Application FOR OFFICE USE. ONLY City (;f Tigard Received / Permit No.: • 13125 SW Hall Blvd., Tigard, OR 97223 DateB : 0A a a L i��/ �' U /l(/ g Plan Review Phone: 503.639.4171 Fax: 503.598.1960 U "�¢'Hil� + °� Date/B Other Permit ni till 1 Inspection Line: 503.639.4175 Date Ready/By: H See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: n Supplemental Information t .., . .' <-Q.' '''/'1, ' ;�.��+. ;) v.�3rs. ' : -, - z v :. , , OI:P - .. ate- � T, =r: F ;ck xx ; ,.:,� V , 3 =- . = , Ic ,: >._ � ;� - - - ' 24 ,,, 1r,�3O SI :-` � � r k �Y. £. i. 'i '�4 : ( , + + j .�� .i•' - .. °P �N . „ - „ „ .' • „_S'.. ... .«n�' s ,�, � 1 a.: ,'. � o.m� =��d . ,� .aL ts.• aYt�. paa.? s:. �� �: S��: �w, x :.;�.r�..,��:�'�:3`.,.as �.-� o, .. - �. <� w.5. ., x : e ... » _.. 4 ,. ., • _ ID New construction [ Addition /alteration/replacement Please check all that apply: ❑ Demolition El Other: ❑Service over 225 amps, comm'l ['Hazardous location t 4` � ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., '' (? ' ' raft O CONSfRUGTIO�IY r� ' A t s _ ; =( = of 1- and 2- family dwellings 4 or more new residential 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑ Master builder ❑ Other: ['Building over three stories ['Feeders, 400 amps or more ❑Occupant load over 99 persons Manufactured structures or O k a refa rS ^” I O LION 0 Ol k t3 , _ .. A ;„ i i....4'.ih. ' ;,. r ., A,•,- ._ .s :a `.:. .. ,.. , 4,, ; ❑Egress /lighting plan RV park Job no.: Job site address: 109A, C r - G „¢1 ❑Health -care facility ❑Other: C / Submit 2 sets of plans with any of the above. City/State /ZIP:�e1 ,i r) a- 97 0-c.-/ ). 3 ' The above are not applicable to temporary construction service. Suite/bldg./apt. no.: Project name: f .: ' " 7''' ?' "IKOHF DLI E '_'. . ., Description Qty. Fee. Total Cross street/directions to job site: New residential single- or multi - family dwelling unit. , Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Rjletto. C t Lt- Lot no.: % Ea. add'l 500 sq. ft or portion 33.40 1 Tax map /parcel no.: • Limited energy, residential 75.00 2 y _ • . .. `' _ „ _ 1;'''',” Limited energy, non- residential 75.00 • 2 , .; rj kl iSESi _ ` LAWSW 4r . : „_ - v . . ' Each manufactured or modular _ 2 _0 c v& 'biktAm .k C..4�, Z-.N.- TQt itai,kozia. 1 _ b . , }- `,A.b ,tin dwelling, service and /or feeder 90.90 2 1, �_^ �� 'l / Services or feeders installation, alteration, and /or relocation — 253004A9 b ecoA t c -u.l'f- CC 0 t.t-►e� 3DQ. e.u. f tCk 0 Lt11 ' 200 amps or less 80.30 2 r,.dg,7 '^.;fir*° %t ax :zx» �°'ra *; - ;r- t �,� •.°r..: ,w» ---, ^'„ i ;':::w , :-S r..a , :"_ 201 am s to 400 a s 106.85 2 ,,: sw. �P ©P TY.O,W,... ,it W; ❑"`-', N' T` . -t ' �..��� "� ',�::�' "..,��.k.�`"�. "'- �`�''= ,�`.�`"'�'- :�:'��^; 401 amps to 600 amps 160.60 2 Name: 1 3 601 amps to 1,000 amps 240.60 2 Address: KY :\ 3 2 S W C t.Clecu.i L.n3 Over 1,000 amps or volts 454.65 2 Reconnect only • 66.85 2 City/State /ZIP: " a a 1 0 (Z q'1 "e l- Temporary services or feeders installation, alteration, and /or Phone: (la)3 ) 4i, 5 %1/44 1� - Fax: (Gb3) L4lpk 3 relocation 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, l e, rent or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: tAnA " 7r Date:10( ( s(oy Branch circuits - new, alteration, or extension, per panel ` r ` ,v, "i A. Fee for branch circuits with 4 _ _.„, r ::fit f •;M ' .'s; .iW r1` ®°''E �1 CT i' � „ :,..4 ' = service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'1 branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Phone: Pump or irrigation circle 53.40 2 ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - '�. lnii� i a Al�?€P'I.2"t M T12° • r' : mil _; energy panel, alteration, or extension. Describe: Page 2 2 Business name: Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 talk: ,i-ANSWEIN:CataMat-0. r t:a t° a'. CCB Lie.: Electrical Lic.: Suprv. Lic.: Subtotal ,,- + 573 Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) 7 .$ TOTAL PERMIT FEE 57 , 7' Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. i:\ Bui lding\Pemuts\ELC- PermitApp.doc 17/03 440- 4615T(10 /02/COM/WEB Electrical Permit Application - City of Tigard r . Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 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: Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls n Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC ❑ Instrumentation . n Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC- PecmitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line. (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested I ( AM PM BUP i Location 0 �[ _� �! _ . -11 Suite MEC Contact Person Ph ( ) PLM Contractor " Phh ( ) SWR BUILDING Tenant/Owner C../A/n. ' ( 4 7 1 (0 -o o , 7L ELC d DO 6C 3 Footing 0 Foundation ELC Ftg Drain Ss. I t 8 ELR Crawl Drain Slab Inspection Notes: l — 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 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 PASS PART FAIL ELECTRICAL - Service Rough -In UG/Slab Low Voltage Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall,- SW Hall Blvd. AS PART FAIL ,SITE ❑ Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Date ! Inspector _ ` _ � Ext Other: Final DO NOT REMOVE this inspection record f e job site. PASS PART FAIL