Permit ELECTRICAL PERMIT
CITY OF TIGARD
PERMIT #: ELC2005 -00732
1 DEVELOPMENT SERVICES DATE ISSUED: 9/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 103 D D - 00431
SITE ADDRESS: 10770 SW FAIRHAVEN WAY ZONING: R - 3.5
SUBDIVISION: FAIRHAVEN COURT LOT : 007 JURISDICTION: TIG
Project Description: (1) branch circuit.
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 WIO SRVC OR FDR: 1 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:
RYAN GARRETT OWNER
10770 SW FAIRHAVEN WAY
TIGARD, OR 97223
Phone: 503 - 358 -3554 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 9/28/2005 $46.85
[TAX] 8% State Surcharge 9/28/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
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 dire A ga, -stions to OUNC at
503 - 246 -6699 or 1- 800- 2344. A •
^
Issued By: ` �� — f - �� =G� Permittee Signature
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 Application _ ___ ho R.ol l ICE..U 0NLY. _
._ �
w ,., _ �.�,
City of Tigard Dear r`► �S �' Permit No.: ak I3_ .,_
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4p p��gY Other Permit:
Inspection Line: 503.639.4175 1 ^'I i ` Date Ready/By: Ella El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
• TYPE OF WORK PLAN REVIEW .
❑ New construction 4 Addition/alteration /replacement Please check all that apply:
El Demolition ❑Other: ❑Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION " of 1 -and 2- family dwellings 4 or more new residential
FE 1- and 2 -famil y dwellin g ❑ Commercial /industrial 0 Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE°. INFORMATION AND LOCATION ' . . ❑Egress/lighting plan RV park
Job no.: Job site address: II 1r9Ay' ❑Health -care facility DOther:
70 CAA FPr � 1.44-veil, t Submit 2 sets of plans with any of the above.
City / State/Z1P: f A v \ r) r 9 2 �, 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: ,- f vl,AV �..ti s L New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: . Lot no.: bt°) 3 Ea. add'! 500 sq. ft. or portion 33.40 l
Tax map /parcel no.: Limited energy, residential 75.00 2
• Limited energy, non - residential 75.00 2
' , DESCRIPTION OF WORK Each manufactured or modular
+ dwelling, service and/or feeder 90.90 2
ti t t d',S n x :5 -t�-� 5 fir t t T J s. Services or feeders installation, alteration, and /or relocation
t 200 amps or less 80.30 2
❑ PROPERTY OWNER I . ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: k_ 7 J f� 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: 4 13-4,... r q 7 , ). 3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
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, lea - ent, or exc ,:e, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: 0..d.".--, • • le ,. �, .( '( Date: 3- 49 Branch circuits — new, alteration, or extension, per panel
' , ❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
a B. Fee for branch circuits
Contact name: s- r U r (Z fY ., J, t L 1 without service or feeder fee, ) 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( F ax :: ( ) Pump or irrigation circle 53.40 2
.3 34 to. S Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: O f'a , A . ' )..-
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
ELECTRICAL 'PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE D d d
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:\ Building \Pernits\ELC- PerrnitApp.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:
I .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- PermitApp.doc 04/03
CITY OF TIGARD
�Gw_5 ary � rr � y
BUILDINb DIVISION PERMIT #: ELC2005.00732
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/28/2005
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 ,
INSPECTION WORKSHEET FOR DATE: 11/29/2005 TIME: 7:05AM PAGE: 52
SITE ADDRESS: 10770 SW FAIRHAVEN WAY CLASS OF WORK:
SUBDIVISION: FAIRHAVEN COURT LOT #: 007 TYPE OF USE:
PROJECT NAME: GARRETT
DESCRIPTION: (1) branch circuit.
OWNER: GARRLI I, RYAN PHONE #: 503.358- 3554
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final , 022561-01 503-332-4035 Y
x,
Corrections /Comments /Instructions. lU '
itfma1,0 F5 i p,yu v zas-66)-0
13t,i4' Az4- OGY3z,
g PASS ❑ PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � Date: W "gq '" Phone #: (503) 718-
CITY OF TIGARD .
BUILDING DIVISION PERMIT #aaGLOd S�Db 7 32-
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: / O/( ti / coc TIME: PAGE:
SITE ADDRESS: 1 o 10 4tWLJWA jpi CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: . / PHONE #:
CONTRACTOR: uuu��� PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Ia0 Inspection Description 44 1,k Confirm # Contact # Message
Corrections /Comments /Instructions:
1 15Y4A^ ifi". 7 l At
■
rri PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: P A . Date: r / Phone #: (503) 718-
CITY Of TIGARD
BUILDING DIVISION PERMIT #: ELC200S -00732
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/28/2005
Phone: (503) 639 -4171 Anp "
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/1412005 TIME: 7 :02AM PAGE: 77
SITE ADDRESS: 10770 SW FAIRHAVEN WAY CLASS OF WORK:
SUBDIVISION: FAIRHAVEN COURT LOT #: 007 TYPE OF USE:
PROJECT NAME: GARRETT
DESCRIPTION: (1) branch circuit.
OWNER: GARRETT, RYAN PHONE #: 503- 358 -3554
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/14/20066 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 018373 -01 503 -332 -4035 N
Corrections /Comments / Instructions:
t o c 4- t
n PASS ❑ PARTIAL APPROVAL ❑ CANCEL O ACCESS
IL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / O - Ai' O
Phone #: (503) 718-