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Permit C ITY OF TIGARD ELECTRICAL PERMIT • PERMIT #: ELC2004 -00402 Vii, �i� DEVELOPMENT SERVICES DATE ISSUED: 7/2/2004 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2 S 102 B B -0040 9 SITE ADDRESS: 12070 SW KAROL CT SUBDIVISION: KAROL COURT ZONING: R-4.5 BLOCK: LOT : 008 JURISDICTION: TIG Project Description: 9 branch circuits for kitchen remodel. 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 FOR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 8 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: BRICKEY, JUDY F AC ELECTRIC INC 12070 SW KAROL CT 18820 SHENANDOAH DR TIGARD, OR 97223 OREGON CITY, OR 97045 Phone: 503 - 620 -4676 Phone: 232 -8656 Reg #: LIC 055615 SUP 4527S FEES ELE 3 -261C Description Date Amount Required Inspections [ELPRMT] ELC Permit 7/2/2004 $100.05 [TAX] 8% State Surcharge 7/2/2004 $8.00 Rough - Elect'l Final Total $108.05 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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- 2 -2344. / Issued By: i ` jf` Permit Signature: /0 OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or r 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 Elect ctrl Permit Application FOR OFFICE USE ONLY City o Tigard Received ? Permit No / s / 13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev - - ' Phone: 503.639.4171 Fax: 503.598.1960 �A te '» ! 4 ' n� Date/B : Other Permit: Inspection Line: 503.639.4175 ■� I ' Date ReadyBy: RE El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information ❑ New construction E Addition/alteration /replacement Please check all that apply: ❑Service over 225 amps, comm'l ❑Hazardous location ❑ Demolition ❑Other _ ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., : o 4_ C- t . t '' r � � Q t �_ 'k'` of 1- and 2-family dwellings 4 or more new residential '4 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure builder Building over three stories ❑Feeders, 400 amps or more ❑ Multi - family 0 Master builder ❑Other: x �� � ❑Occupant load over 99 persons ❑Manufactured structures or .7„ t k l : i^ ,- r RV ark ; , '. 1- " ,, . ' ,,„ ❑ Egress /li g h t i n l an P Job no.: Job site address: EHealth-care facility ['Other: l ., , - . ..4.! , Submit 2 sets of plans with any of the above. The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: `� ° .: .. x. 7 ` , " ' 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: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 r P Limited energy, non - residential 75.00 2 r 7 e a.- 3 c �. tl $`-, � i �: . a .c - . b _ 6 -_ <_ ; , s, „. l _ k ,, Each manu or modular dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 3: 1 1Y` � ,, -ter _4-� , i 201 amps to 400 amps 106.85 2 s �' - -- . 'g:�. _ . . - -- ' ,..'' _ u ''- --1- 401 amps to 600 amps 160.60 2 • Name: w>tj ' 8 i A 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 ir "' ∎ Reconnect only 66.85 2 City /State /ZIP: Temporary services or feeders installation, alteration, and/or s Phone: ( ) , -7 (� Fax: ( ) relocation i 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 a it ` A. Fee for branch circuits with -- . _._. -m t -' -'_ a -' . "' ,- , _.. x' ' - , ...., . - '-'' ,. e _ service or feeder fee, each Business name: branch circuit 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, (, each branch circuit 46.85 . iy# b 6 2 Address: Each add'l branch circuit 8 6.65 �3, 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax :: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- ` tt i energy panel, alteration, or i J I.IMIIII_ extension. Describe: Page 2 2 D Address: g i / / Each additional inspection over allowable in any of the above N 1 u � � Per inspection 62.50 City /State /ZIP: 0 0 A - ✓� - ' 1 ' 4. 0 J Investigation per hour (1 hr nun) 62.50 Industrial plant per hour 1 73.75 Phone: ( ) 4# . ' � LLl r CCB Lie.: Suprv. Lie.: 3 2 S Subtotal C Suprv. Electrician signature, required: 1 Plan review (25% of permit fee) Print name: e e ee Date: State surcharge (8% of permit fee) S 0 Ai ....2-i.) ', v _ °1 D TOTAL PERMIT FEE /00. 0 5 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 \Permits\ELC- PermitApp.doe 12/03 440- 4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ZSIDENFIA`� WORK ON ,� Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* f] Other: W4r7 `. z Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is\ Building \Permits\ELC- PermitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (,503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested 7-- 7 AM PM BUP Location / 0 70 / S O-ALD --P Suite MEC Contact Person Ph ( ) 3/ 3 - 3 id-c1 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC &')0 Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain K Slab Inspection Notes: SIT _IEM Post & Beam / /- (00-62 Mar Shear Anchors — Ext Sheath /Shear 0A .inn J fi7„� 6 Int Sheath /Shear J Framing _ _ Insulation Drywall Nailin Q O 1 / y Firewall Fire Sprinkler Fire Alarm t 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 ELECTRICAL Service Rough -In UG /Slab Low Voltage Fire Alarm iriso PART FAIL I I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SI I I Please call for reinspection RE: U Unable to inspect — no access Fire ADA Supply Line 1,6,m ta� Date - I ector Ext Approach /Sidewalk P Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (4;03) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received 7� Date Requested 41 AM PM BUP Location / 7v (5 Suite MEC Contact Person Ph ( ) lv- 4Z/r/ PLM Contractor Ph ( ) SWR V-4941 BUILDING Tenant/Owner �LC c� Q Footing Foundation ELC Access: 2_/6 / Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing Insulation 11P � - (� - L / - �`� / e e J Drywall Nailing � V , y 1� l �G Y Firewall S L ND Fire Sprinkler &P) fQ � /`- I-� IL!? Alarm ri>f)'/VI Dap l,l. U ,e�C .5 p t LIJ S Susp'd Ceiling f N �7 /w `� - Roof j FR-ow . T1 /5 / Other: , � / p , �, / �'Y Final PART FAIL Li v ,V 1 N � eG 7 ' 7 PLUMBING O rg • I / Post & Beam ,¢�.� t ,, / Under Slab / V" Lam �,/ C44 �l� arerA A' `�" / Water ("IA ]C/ /P /`T L1 $ 1 l/V � � N &r, ► 7� Water Service Sanitary iDrains Sewer = L -; hr 27 � � Rain Drains "�-- � 7[[ 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 • bug -In —1L1- 1740,1 U a. ��-�l Low Voltage - r larm �. Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. j PART FAIL I I Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA --- �f D /c1_, )/ (, Y Ext Approach /Sidewalk Date c !/ Inspector [Nl Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection L`inet1503)139 -4175 MST INSPECTION DIVISION Business Line: (103) 639 -4171 7 BUP Received Date Requested / -1 AM PM BUP Location 1 D 7 v 1K0A4t_C ' Suite MEC Contact Person Ph ( ) PLM ntrac Ph ( ) 63 —0- ( f (( SWR BUILDING _ Tenant/Owner ELC 4 4-46 4 7 10 ?"— Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Ins c es: / SIT AF.PAI / A Post & Beam �-d�(� = /' Shear Anchors O O '0 Ext Sheath/Shear Int Sheath/Shear Framing a Insulation Drywall Nailing a Firewall a �'� ® k j {� Fire Sprinkler ;7 4 ' ^ 1 Fire Alarm ,� 1 ,.1 pn 6 �,\ R SJ )L Q L Susp'd Ceiling ,,,,�^� Q 7�`� V Roof L .� 1 ,� 6�: t1A�+ V Other: V Final PASS PART FAIL PLUMBING Post & Beam e . 0-1 4V Y 1 .' Under Slab 1 �J 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 ELE RICAL Servic= (` ($ •1 Rough -I • UG /Slab -tv Low Voltage Fire Alarm Final Reinspection fee of $ L Y.; required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART 4 SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Date {� 1 � Uc� Ext Approach/Sidewalk `J Inspector Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection ,Line!-NO3):639-4175 INSPECTION DIVISION Business Line: *503) 639 -4171 MST d BUP Received Date Requested 7 — O AM PM BUP Location / 0 0 f( ii 4 .Q &E Suite MEC Contact Pers �-- Ph ( ) PLM Contractor (2z �t�c - lLicyrl a R . Ph ( ) 635- 9 11 SWR BUILDING Tenant/Owner ELC y Za 2 5/CZ Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain � � `�� � Slab Inspection Notes: . C� SIT Post & Beam Shear Anchors Ext Sheath /Shear 0 --- .. D = Int Sheath/Shear Framing .h AZ_ Insulation Drywall Nailing - iti - 4.01/ ✓ /L • .• ... Firewall Fire Sprinkler Cc- / // 1 Fire Alarm P ff c 3 1 q . Z3 0 1J: !3 ( 5 /WAY N'ar Susp'd Ceiling ,.r te Roof 3 /'4D (.rllr7 60 w r/� Sclz -Ey5 � f eZ)6 -( 77( Other: S-5 _ Final l' D , uMLE5 7}tE - if 4726 V e -F 771& PASS PART FAIL PLUMBING $/t - lllc Mt g 50-X i 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 -,• -ou.h- . 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 Date 7 r 8 - ©Y Inspector " JCitt Arf'r' Ext Approach/Sidewalk Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection ,CLne: 03r639 -4175 INSPECTION DIVISION Business Lisle: (503) 639 -4171 MST L• BUP Received Date R-•. ested _ AM PM BUP Location C1 D =1 _ Suite MEC Contact Person Ph _ • ) 3? - c Imo PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC �' - b0 • - Footing ELC Foundation Ftg Drain Access: 6,6,k4 P. / 1i1 0 1-& uvi -o' 33 I ELR /VAN Crawl Drain SIT gr. Slab Inspection � • es: -- Q - / Post & Beam Ext Sr ea h /h ' i rtW Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation 6 Drywall Nailing `1`i E e Firewall 1W Fire Sprinkler Fire Alarm (•s) L \J M,E E's Susp'd Ceiling Roof Other: OQ b� ' Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In N 0 *HIV A�� 6 W ® b( , 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 ervice 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 CFAI. SITE Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ,r ADA /� Q Approach/Sidewalk Date fl 0 Inspector 1 1 " � L Est Other: Final D NOT REMOVE this inspection record from the job site. PASS PART FAIL