Permit CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC1999 -00264
.111V DEVELOPMENT SERVICES DATE ISSUED: 5/3/99
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134AC
SITE ADDRESS: 11405 SW IRONWOOD LP
SUBDIVISION: ENGLEWOOD ZONING: R - 4.5
BLOCK: LOT : 042 JURISDICTION: TIG
Project Description: Add a first branch circuit to an existing single family dwelling.
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: 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:
ANNA TANADA MT HOOD ELECTRIC INC
SW IRONWOOD LOOP, 8900 SW BURNHAM RD
TIGARD, OR 97223 • UNIT.F -27
TIGARD, ,OR 97223
Phone: Phone: 639 - 5833
Reg #: LIC 000011
SUP 3801S
ELE 34 -425C
FEES Required Inspections
Type By Date Amount Receipt Elect'l Service
PRMT GEO 5/3/99 $35.00 99- 315013
Elect'l Final
5PCT GEO 5/3/99 $1.75 99- 315013 O RIGINAL Total $36.75 ,,
This Permit is issued subject t� 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 throug •AR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246-1987. C /
Permit
Signature — / Issued By:
mot" /
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: 04 '''` --G DATE:
LICENSE NO: 5v/
Call 639 -4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST ,/
Inspection (503) 6394175 Print or Type Permit f / 60 aZ y`'
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) A- IA 1 ■ l' a X24 Service included: Items Cost Sum
I
Address 1 1 Lip 5 310 :7uk, We-oc � 4a. Residential - per unit
1 000 sq. ft. or less $110.00 4
City /State /Zip 7 t S o .. 0 2_ Li q>223 Each additional 500 sq. ft. or
Commercial ❑ � Residential 1=.1 portion thereof $25.00 1
Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only: 4b. Services or Feeders
(Attach copy of all cu r: t lic: -es) / ,° Installation, alteration, or relocation
Electrical Contractor Ad - [. _ , c- 4,--c- 200 amps or less $60.00 2
Address C� (#4, -� � �u f 7 201 amps to 400 amps $80.00 2
City I c4 ...6.- State (� lZ State Zip %'7 223 401 amps to 600 amps $120.00 2
Phone N. � d (#4, 1 / - L 3 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Elec. Cont. Lice. No. 3 K- K2- SL Exp.Date 1 0 - (- Vi Reconnect only $50.00 2
OR State CCB Reg. No. itU Y( Exp.Date 4 - 3 00 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date 12 -9 7 Installation, alteration, or relocation
I 200 amps or less $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec n !� 401 amps to 600 amps $100.00 2
C' Over 600 amps to 1000 volts,
License Nr 380/ Exp.Date see "b" above.
Phone Ne C,31 - 5 3
4d. Branch Circuits
New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with
. purchase of service or
Print Owner's Name feeder fee.
Address Each branch circuit $5.00 2
b) The fee for branch circuits
City State Zip without purchase of
Phone No. service or feeder fee.
First branch circuit ) $35.00 3 ' 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
(Service or feeder not included)
Owner's Signature Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in.N.E.C. Chapter 5 In Plant $55.00
* Submit 2 sets of plans with application where any of the above apply. 5. Fees: a
Not required for temporary construction services. 5a. Enter total of above fees $ s -
5% Surcharge (.05 X total fees) $
NOTICE Subtotal $ 3 G. is
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $ 3 (o - 7S
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY / 2C
TIME AFTER WORK IS COMMENCED. ❑ Trust Account # $ 3 b > _
Total balance Due
I: \DSTS\ELC96.APP Rev 9/96
Sc40 //5 F — S Arir
CITY OF TIGARD BUILDI INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line 639 -4171
Q BUP
Date Requested S - S_ l AM PM BLD
Location I I 1 1L) . ' (J) 2 Suite MEC
Contact Person ,, (()litn JJ Ph (i29 �S ' PLM
'"
Contractor. WI of ('iov, Ph SWR
BUILDING _ «t : Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm /
Susp'd Ceiling /--"/
Roof
Misc:
Final
PASS PART FAIL
PLUMBING`q° y _, _
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL ',_„
Post & Beam
Rough In
Gas D
Smoke Dampers
Final
( P ASS PART FAIL
(LECTRIZ` C ;,
Service
Rough In C4.
UG /Slab
Low Voltage
F rm_
inal
PASS ART,. FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: /a ] Unable to inspect - no access
ADA
Approach /Sidewalk t
I
Date 3 9 J& Inspector ,
Other D Q Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .
' I