Permit CITY I TIGARD GARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00758
DEVELOPMENT SERVICES DATE ISSUED: 12/1/2004
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S103DA - 02600
SITE ADDRESS: 10760 SW DERRY DELL CT
SUBDIVISION: DERRY DELL PLAT 2 ZONING: R
BLOCK: LOT : 028 JURISDICTION: TIG
Project Description: Service change and (3) branch circuits.
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: 1 W /SERVICE OR FEEDER: 3 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
STOUDER, CHARLES H TR + TYLER ELECTRIC LLC
SUSAN K PO BOX 807
10760 SW DERRY DELL CT MULINO, OR 97042
TIGARD, OR 97223
Phone: 503- 620 -8076 Phone: 503 - 829 -2498
Reg #: LIC 144089
ELE 3 -497C
FEES SUP 4709S
• Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/1/2004 $100.25
[TAX] 8% State Surcharge 12/1/2004 $8.02 Rough -in
Elect'l Service
Total $108.27 Elect'I Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speoalty 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 ort in -OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these rules or direct questions to OUNC at (503)
246-6 9 or 1-800 -332- • 4 .
Issu d By: K , I / • //r :I 1 Permit Signature: y
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: 410
Call 639 - 4175 by 7:00pm for an inspection the next business day
Electrical Permit Application . FOR OFFICE USE ONLY
of Received
it of Tigard Date/B f / e M. % Permit N AL/ o.' —Q 4 is
13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 :',11111",1 � uy� �� � p /B ,
Other Permit
Inspection Line: 503.639.4175 ^''_ Date Ready/By: Rids. ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
•
' . TYPE OF WORK • PLAN REVIEW .
❑ New construction Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
' CATEGORY OF CONSTRUCTION . of I- and 2- family dwellings 4 or more new residential
E71--1 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
El Multi - family 0 Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
- JOB SITE INFORMATION AND LOCATION ❑Egressflighting RV park
O 0 S _\'ZRrZ.� ` ❑Health -care facility ❑Other:
Job no.: Job site address: 10 7 (c) Submit 2 sets of plans with any of the above.
City /State/ZIP: \ ���� 8� The above are not applicable to temporary construction service.
■ Suite/bldg./apt no.: Project name: Q\„. ,, FEE* SCHEDULE
� Lk- rc ` »-. Description .
I Qty. I Fee. I Total 1 `"
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: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK ' Each manufactured or modular
\ � dwelling, service and/or feeder 90.90 2
2 v�'t.- (: --"^°'"- j'Z- \ C — \CC ' v c: -.s -",' , c -IDR'ar` Services or feeders installation, alteration, and /or relocation
CA u�N^ - 200 amps or less ` 80.30 $0, 2
litE PROPERTY 'OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: ' "1--0 --r7 2- 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: Temporary services or feeders installation, alteration, and /or
Phone: (, (6 ---7p Fax: ( ) relocation
77 200 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, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
(►APPLICANT , 'I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each z 6.65 VA °�? 2
Business name: --1C ��c- �f � k.L G branch circuit J
�Q1t
Contact B. Fee for branch circuits
ontact name:
-fie tz \a —\ \P1s without service or feeder fee,
each branch circuit 46.85 2
Address:
Each add'I branch circuit 6.65 2
City /State/ZIP: ��.\ �o�� C\---1 o4Z Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) � 0 - 9J-29 1 - o f c Fax:: (Su b 2-c\ - cO.A
�t Sign or outline lighting 53.40 2
E -mail: tai Signal circuit(s) or limited-
. j CONTRACTOR energy panel, alteration, or
extension Describe: Page 2 2
Business name: "\----�\ \,�� . L, L c.-
Address: i�� d Each additional inspection over allowable in any of the above
Per inspection 62 50
City/ State/ZIP: \A \ ,..,„\ „N„„ ° I 0 CA DMZ Investigation per hour (I hr min) 62.50
Industrial plant per hour 73.75
Phone: (533)621 `�
Za Fax: ( S �3) e 2-k _ ,a3dr0s ELECTRICAL PERMIT FEES* .
CCB Lic.: \4.40 ,n Electrical Lic.:3 4 o C Cr' . Suprv. Lic.: -7- 5
O qS Subtotal /pp .
Suprv. Electrician signature, require • ` Plan review (25 %ofpermit fee)
te: State surcharge (8% of permit fee) g ° 7 '
Print name: �
�1�-�"5'\ (( ~- �c r TOTAL PERMIT FEE /O R . 7
Authorized signature: 1.711 l This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: G , ''' \ ` Date: ` e Fee methodology set by Tn- County Building Industry Service Board
e• Number of inspections per permit allowed
i : \BuildiagWermits\ELC- PennitApp doc 12/03 440.4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
(RESIDENTIAL WORK ONLY: .
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 system $75.00
(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
i \Building\Permits\ELC- PermdApp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection 639 -4175
INSPECTION DIVISION Business Line: (50 639 -4171 MST
BUP
Received Date Requested a f AM PM BUP
Location / d 7 D iCze h Suite MEC
Contact Person � Ph ) PLM
Contractor Pr' ( ) g`U / 77Y SWR /!
BUILDING Tenant/Owner ELC c' O `7 — CO 7
Footing
ELC
Foundation Access:
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
PASS PART FAIL
PLUMBING' I _ F �
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
.��Firre�e Alarm
v+'s, El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
(;, x r PART FAIL
S z Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA /.Z?'
Inspector
Date r Ext
Approach/Sidewalk •
Other:
Final DO NOT REMOVE this Inspection record from the- job site.
PASS PART FAIL