Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00535
0.00 00, DEVELOPMENT SERVICES DATE ISSUED: 8/24/2004
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S110DD -09500
SITE ADDRESS: 15785 SW HIGHLAND CT
SUBDIVISION: SUMMERFIELD NO.6 ZONING. R -7
BLOCK: LOT : 311 JURISDICTION: TIG
Project Description: (2) branch circuits for 2 1/2 ton heat pump & furnace.
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: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BALOGH, ALEXAN DER + BADGER ELECTRIC INC.
JOYCE I TRUSTEES PO BOX 51
15785 SW HIGHLAND CT BEAVERCREEK, OR 97004
TIGARD, OR 97224
Phone: Phone: 503 - 632 -1925
Reg #: LIC 156851
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/24/2004 $53.50
[TAX] 8% State Surcharge 8/24/2004 $4 Rough -in
Elect'l 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: 7 Permit Signature:
OWNER INSTALLATION ONLY \ i
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
V p• ECE !Y y pN \�� CI}�, of 'Tigard Da � 1' / /00Z Permit No.: U
City g Date/By: , l/ `� l (-C2 4 0 !� 545
13125 SW Hall Blvd., Tigard, OR 97223 pp ��++ 2U04 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 10 U ` / / ' i ' . t. t t' , �� : Date/By: Other Permit:
Line: 503.639.4175 CITY OF I GAR ' � I Date Ready/By: lam ' ® See Page 2 for •
Internet: www.ci.tigard.or.us Notified/Method: iG Supplemental Information
B . tt , l u DIVISION
!/� OF WORK PLAN REVIEW
ErCv construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: OService over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating DBuildng over 10,000 sq. ft.,
�� CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
�I 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
❑ Multi - family 0 Master builder ❑Other.
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
! 1 ,, ,� ❑Health - care facility ❑Other:
Job no.: Job site address:
51 Submit 2 sets of plans with any of the above.
City /State/ZIP: 64447) (Pa. qrlZIA 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: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
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 r , 2
1 1 - 2. O' i t 4 Services or feeders installation, alteration, and /or relocation
VUU*Abfka, • 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: ' � 601 amps to 1,000 am
03V_. � \'�k- � � � `t s 240.60 2 P P
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: ( ) I Fax: ( ) 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, 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 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit I 46.85 4)15 2
Address: Each add'l branch circuit ' 6.65 1
r i. 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
a0 �e.wu�aL I (l.AL. extension. Describe: Page 2 2
---I Business name: >�
Address: .-P- ' �/ S' Each additional inspection over allowable in any of the above
W^ q � �.�,�,�_ Per inspection 62.50
" City/State/ZIP: w SreAv, •� `� --� r.�'�. V'L ^ p l /VV 1 Investigation per hour (I hr min) 62.50
Phone: (5p2) 6322- 1975 , I Fax. ) 632_ 1 izo Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: 1 ea,548 1 l Electrical Lie.: 3 • -SI lc I Suprv. Lie.: s 5 Subtotal 53,
Suprv. Electrician signature, required: 1 Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: ate: ei I 7�,, -3 0
TOTAL PERMIT FEE S'1 ,°"l 8
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: a Fee methodology set by Tri- County Building industry Service Board
** Number of inspections per permit allowed.
CITY OF TIGARD 24 -Hour
BUILDING Inspection _Line :.,!503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
//!� Q' BUP
Received /lP
Date Requested ( > AM PM BUP
Location /5 �� � h - Suite MEC
Contact Person % 0 Ph (97 L) 4 3 /1 ?'7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC.
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain -
Slab Inspection Notes: /¢f Y ,/ SIT
Post & Beam o /�z G���
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing e 4- (
Fire wall /V
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
L
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
OP PART FAIL
S ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire ADA Line 1 7 / (f. i
Date Inspector
Ins
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL