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Permit
A., `` CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00609 � , i DEVELOPMENT SERVICES DATE ISSUED: 9/24/2004 s i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 25111 AB -06700 SITE ADDRESS: 09255 SW INEZ ST SUBDIVISION: PENROSE TERRACE ZONING: R BLOCK: LOT : 012 JURISDICTION: TIG Project Description: Furnace reconnect. 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: 2 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: SCOTT, ARLA SOHLER ELECTRICAL CONSTRUCTION 9255 SW INEZ 41131 SW BURGARSKY RD TIGARD, OR 97224 GASTON, OR 97119 Phone: • Phone: 971 832 - 0807 Reg #: LIC 158285 ELE 34 -667C FEES SUP 594S Description Date Amount Required Inspections [ELPRMT] ELC Permit 9/24/2004 $60.16 [TAX] 8% State Surcharge 9/24/2004 $4.81 Rough -in Elect'I Final Total $64.97 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: • Permit Signature: S' p,..e-- p) 1 OWNER INSTALLATION ONLY �j 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 E1ectrieaI Permit Applica ' `� 1v�® FOR OFFICE USE ONLY City of Tigard � � V Received _ _ Pe // Received D� f Pen nit No_: .L 13125 SW Hatt Blvd., Tigard, OR 97223 2 00 _ ` v. .. ,.... t ar .J. 0 9 Phone: 503.639.4171 Fax: 503.598.1960 i . � _ t e J By r rl;. e: -. -:: Other P ermit : Inspection Line: 503.639.4175 �� l `1 I c � y Note � �� o f e i See P a g e 2 for Supplemental Information Internet: vnvw_ci.tigard_or.us ^ 1Y of S IG ` A` s_ a� Notified/Method: 1 1C ,..:,I, • e` . •. r' . - _ ., . ,. - ... _.: ,BL1eYN;•I2EVIEW .. ❑ New construction " Additi r a teration/replacement Please check all that apply: ❑Service over 225 amps, comm'1 ❑Hazardous location ❑ Demolition ❑Other_ ,CA TEGQRX' .OF'GON .: _ ` ' °Service over 320 amps — rating © Buildng over 10,000 sq. ft ST)LUCI ION ; of 1 -and 2- family dwellings 4 or more new residential ''i' 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building ❑System over 600 volts nominal units in one structure !]Building over three stories ❑Feeders, 400 amps or more ❑ Multi- family ❑ Master builder ❑ Other ❑Occupant load over 99 persons °Manufactured structures or . JOB SITE' INF'ORM I;OK " `.. _. :•: ❑Egress/lightingplan RV park Job no.: Job site address CT) ]]Health -care facility °Othel: 1 1 �s Sl,✓ ...-171,/ 6-2- Submit 2 sets of plans with any of the above. City/State/ZIP: / f2 Q C) r •7�,2 t-/ Th ab ove arc not applicable to 7 � pp - temporary construction service. Suite/bldg. /apL no.: Project name: A / :..:`'.:`. `, "'. -' *:-'?' -FEE SCHEDULE:. • F u R N A C C : Description 1 Qr. I Fee. 1 Tclal 1 •• Cross street/directions to job site: New residential single- or multi- family dwelling unit. 1 . Includes attached garage. 1,000 sq. ft. or less j 145.15 J 4 Subdivision: Lot no.: Ea add'l 500 sq. R or portion 33.40 I Tax map/parcel no.. Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 . 70F WORK i - ;-,-,:%-."-- ,. " -: - : c• -:. Each manufactured or modular (J (� N c E rL 2. C O N NQ dwelling, service and/or feeder 90.90 2 t Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 PROPERTY - OWI+iER '• :1 ' ... L1 .rENAuV T: • . ' . 201 amps t0 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: LEO PA A Afro J , 5 c , O \-\\- , `0 'r \p 601 a Address: 1 amps to 1,000 amps 240.60 2 s S 5 '6./ Z J z 1 1 _ Over 1,000 amps or volts 454.65 2 City / State/ZIP: � econnect only 66.85 2 0 r , 0 o` C l -7,2-.. V �/ Temporary services or feeders installation, alteration, and/or I relocation Phone: (S3 ) (_ + / g I o1 Fax: ( ) 200 amps or less Owner installation: This installation is being made on property that I own which is not - 66.85 2 intended for sale, lease, rent, r exchange, 201 amps to 400 amps 100.30 2 t ge, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 O wner" signature: Date: : or extension, Bsanch decants -- new, alteration, o n, Per panel APPLICANT ......... .' "` O1NTA:CT' ?PERSON•-' ": A- Fee for branch circuits with J ;�: -a 11 service or feeder fee, each Business name: O F. P .r.4 t e� I , r 7 branch circuit 6.65 2 Contact name: S A I �K / I B. Fee for branch circuits Tp R- S without service-or feeder fee, � Address: L 1 S , J each branch circuit 46.85 "I . 1 8 2 C� ,, cc, al,Tt )c �-/ l - ii Each add'] branch circuit .2 6.65 j 4. 2 City/ State/ZIP: 5 , � In) V ^2 / (J(} Miscellaneous (service or feeder not included) Phone: 9 7 1 / Pump or irrigation circle ( �) CS) — o F 0 7 I Fax: (5 i2) �'f 8 S / 0 7 6 Sign or outline 53.40 2 E -mail: • ne lighting 53.40 2 .. Signal circuit(s) or limited- . ,CONITRACTOR• f`' .':: " , _ _ ' energy panel, alteration, or Business name: /> N g extension- Describe: Page 2 2 So 1-, e/ E re cd-r, c 3, L-o Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City / State/ZIP: Investigation per hour (t hr thin) 62.50 Phone: ( ) I Fax: ( ) Industrial plant per hour 73.75 - .:•;:-: _.:, - -- • (FRICAL E BE a: 9 • Ele ctrical L t- ' r .. RMIT;r., .ES *... CCB Li c.: 8�$ 3 .. s ic.: % Li— Subtotal —7fo Suprv. Electrician signature, requir zfirr , � Plan review (25% of permit fee) IL Print name: J 0 Al r ,f /I r/e s c Date: 1 s /0 State surcharge (8% of permit foe) (i L.- /r ii / TOTAL PERMIT FEE /U! i 1 � .2 Authorized signature: / �44 <4.../ T h i s permit application expires if a permit is not obta ed within lg " �t days alter it has been accepted as complete Print name: �p -` f‘ O Date: J e / � l t • Fee methodolom, set by Tri -County Building Industry Service Board t� I 1 •• Number of inspections per permit allowed_ attoikungWemniu ■Et.c- NrmitAavdnc 171 ' ee11.41e,crr, ran, rrvu•,..roo Z 'd BLOT SB6 -EOS .laTyog aor dOI :EO 170 Ta daS CITY OF TIGARD 24 -Hour BUILDING Inspection ttne:. 03) 6394175 INSPECTION DIVISION Business Line: 503) 639 -4171 MST BUP Received Date Requested /6 - /-S AM ✓ PM BUP Location Suite —O' Z- I Contact Person Ph ( ) PLM Contractor Ph ( ) SWR ' BUILDING Tenant/Owner CP �0' / 6 6 6 a 7 Footing ELC Foundation Ftg Drain Access:: Mc °. �•� ELR Crawl Drain '(I . !=� " �; 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 ' ; Post &Beam Ett) Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL <IVIECHAN _ Post & Beam Rough -In Gas Line Smoke Dampers 1- ASS' -T FAIL CTRIC �_° Service Rough -In UG /Slab Low Voltage Fire Alarm ... PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. 4 lia 5 Ei Please call for reinspection RE: 4 r ri Unable to inspect — no access Fire Supply Line ADA Jam} Approach/Sidewalk Date /() ' L/ Inspector A Ext Other: Final DO NOT REMOVE this inspection r - ._ rd from the job site. PASS PART FAIL