Permit A cn CITY OF TIGARD ELECTRICAL PERMIT
CITY V PERMIT #: ELC2004 -00667
DEVELOPMENT SERVICES DATE ISSUED: 10/19/2004
13125 SW Hall Blvd.. Tiaard. OR 97223 (503) 639 -4171 PARCEL: 2S102CB 03400
SITE ADDRESS: 09820 SW FREWING ST 25
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: R-12
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Reconnect only
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
FINKE, ALEX AND LOTTE I
PO BOX 23562
PORTLAND, OR 97223
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/19/200 $66.85
[TAX] 8% State Surcharge 10/19/200' $5.35 Elect'l Final
Total $72.20
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 se forth_ n OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -06 or 1 -800 -3 - -2344. •
Issu d By: � ►I,' �, � ' � Permit 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 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application '. FOR O USE ONLY
C1ty: f1Tlgard Date /B : � 0 9 6 -II
i PermitNo.: gLGAp " 00 6ep 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 d/ i� ° III ii Date/By: Other Permit:
Inspection Line: 503.639.4175 may► e Date Ready /By: Juns n H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /7 ICI. 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
EService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
1:1 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Multi ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons El Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job Site address: CM J 2 , 0 s k 1- r jJ 5r EHealth-care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: -7-764,4_ A The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: — Project name: f FEE* SCHEDULE ..
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: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WO ,� Each manufactured or modular
7 2 t_ � /— �'�� ' yy / mac = = ��e jr ` j am _ "' J dwelling, service and/or feeder 90.90 2
/� 7�� Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
P R O PERTY OWNER ❑TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
/�
Name: � 1 , t "� - 601 amps to 1,000 amps 240.60 2
Address: - R, Of * ,2_3_6-6- Over 1,000 amps or volts 454.65 2
i
Reconnect only 66.85 64,41' 2
City/State /ZIP: '' , 0,..7c4:4•0 Temporary services or feeders installation, alteration, and /or
Phone: (S �,�A� �e p .4 t Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This . stallatio ' eing made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, leas-, /
Date: /.
r, or xc ange, ac rding to ORS 447, 449, 670, an 701 /
�j / iLt/.0 9 401 amps to 600 amps 133.75 2
Owner signature: d 7'� Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PE SON A. Fee for branch circuits with
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'I branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax::( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
ONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Address: /V Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: ttt 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 66. gs
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 5, ?j 5
TOTAL PERMIT FEE '-7'� ,
Autholized 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 \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information r 3.
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
is\ Building \Permits\ELC- PermitApp.dac 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line (5G8) 639 -4175 MST
INSPECTION DIVISION ,Business Line: (503) 639 -4171
BUP
Received Date Requested /a Zd AM PM BUP
Location zd ? 5 MEC
•
Contact Person Ph ( ) Z L/ —5-ga q PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC c- - 7
Footing
Foundation ELC
Access:
Ftg Drain )4./ � ELR
Crawl Drain
Slab Inspection Notes: A �� SIT
G�
Post & Beam . -1
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
c
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
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
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date d _ Inspector G C `' -- Ext
Other:
Final D' NOT REMOVE this inspection recor rom the Jo site.
PASS PART FAIL