Permit tti A ELECTRICAL PERMIT
CITY. OF TIGARD
PERMIT #: ELC2005 -00605
DEVELOPMENT SERVICES DATE ISSUED: 8/18/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S114BA
SITE ADDRESS: 09900 SW KENT CT ZONING: R - 4.5
SUBDIVISION: PICKS LANDING NO.2 LOT : 087 JURISDICTION: TIG
Project Description: 2 br. circuits.
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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
MASTERS, ROBERT M AND OREGON INTEGRATED CONTRACTING
MARILYN J 19239 MECHANT PL
9900 SW KENT COURT OREGON CITY, OR 97045
TIGARD, OR 97223
Phone: Phone: 503 - 880 - 8649
FEES Reg #: ELE 3 -534C
L1C 150266
Description Date Amount SUP 38535
[ELPRMT] ELC Permit 8/18/2005 $53.50
[TAX] 8% State Surcharge 8/18/2005 $4.28 REQUIRED ITEMS AND REPORTS
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 r or direct questions to 0 > at •
503 - 246 -6699 or 1 -80 ■,.. 2 -2 1
� / r
Issued By: S � /' Permittee Signature: _ 4 /0 � / / / / //�
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 503-639-417512y 7 :00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required -on the job site at the time of each inspection.
•
v" . El "ectrical Perm' • >LCa ioil FOR OFFICE USE ONLY
of Tigard
i' U ' it i
! - - ! Received � 101 Permit No.:� C � �� ..-.610 ,
Date/By.
13125 SW Flail Blvd., Tigard, OR 97223 Plan Review
Phone: 11 60 ne: 503.639.4171 Fax: 503.59u -^ // ''MN ?l `� Date/By: Other Permit:
Inspection Line: 503.639.4175 1 � 200 Sr _ Date Ready/By: to 21 See Page 2 for
Internet: www.ci.tigard.or.us G!TY OF TIGAF1D Notified/Method: f `C\ Supplemental Information
B�."�I+'R PLAN .REVIEW
❑ New construction l_ Addition/alteration/replacement Please check all that apply:
El Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
❑ Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY' OF CONSTRUCTION ' of 1- and 2 -Family dwellings 4 or more new residential
gf 1- 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 12 Master builder 1=I Other:
❑Occupant load over 99 persons ❑Manufactured structures or
- - � JOB SITE INFORMATION AND LOCATION - . ' ❑Egress/lighting plan RV park
Job no.: Job site address: ”CO , �/ C ❑Health -care facility ['Other: !( ((
-SO /� Submit 2 sets of plans with any of the above.
City /State /ZIP: � , z CV The above are n ot applicable to temporary construction service.
Suite /bldg. /apt. no.. C Project name: FEE * - SCHEDUtiE
Description 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
• Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
tg.- dwelling, service and/or feeder 90:90 2
4640'e, re (port �` , Services or feeders installation, alteration, and /or relocation
/'7/� �J 200 amps or less 80.30 2
_ ' 6 PROPERTY O NER 0 TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
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
relocation
. Phone: ( ) Fax: ( ) 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
0. APPLICANT ' ' ' ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: y^ 0 / _ = �`. `_1 _ _y 4 1, branc circuit _Id I B. Fee for branch circuits
Contact name: without service or feeder fee, ( 46.85 2
Address: K03? each branch circuit
��j e,cha� ?/• / Ea ch add'I branch circuit 6.65 2
City /State /ZIP: e n o � C / y ® ` �S 7 `°_h / Miscellaneous (service or feeder not included)
Phone: (cam) C.38 '0 _� r — Ca /�` I Fax: : ( ) Pump or irrigation circle 53.40 2
v Q Y/ Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
, . CONTRACTOR" .. ' energy panel, alteration, or
Business name:
(
,{y extension. Describe: Page 2 2
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) I Fax: ( ) Industrial plant per hour 73.75
ELE ,PERMIT FEES*
CCB Lic.: 4 5 - 75. 3 Electrical Lic.: _ /t Suprv. Lie.: .� 3 Subtotal 5
Suprv. Electrician signature, required: WerriS Plan review (25% of permit fee) il ig
�/�/�' Date: / State surcharge (8% of permit fee) T• 2S
Print name
9 , oe ` ' " ��s ' ` 6 � TOTAL PERMIT FEE 5-7, 78
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- PennitApp.doc 12/03 440.4615T(I 0 /02/COM/WEB
Electrical Permit Application - City of Tigard
•
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Im RESIDENTIAL WORT U t a .. _
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
i:\ Building \Permits\ELC - PermitApp.doc 04/03
CITY OF TIGARD ;
BUILDING DIVISION PERMIT #: ELC2006-00605
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/18/2005
Phone: (503) 639 -4171 //l 14#1411A
Inspection Requests (24 Hrs.): (503) 639 -4175 •'L.
INSPECTION WORKSHEET FOR DATE: 8/19/2005 TIME: 7:07AM PAGE: 13
SITE, ADDRESS: 09900 SW KENT CT CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.2 LOT #: 007 TYPE OF USE:
PROJECT NAME: MASTERS
DESCRIPTION: 2 br. circuits.
OWNER: MASTERS, ROBERT M AND, PHONE #:
CONTRACTOR: OREGON INTEGRATED CONTRACTING PHONE #: 503-880-8649
Inspection Request Scheduled For: Date: 8/190005 Pour Time:
Code # Inspection Description V Confirm # Contact # Message
145 A/C or heating unit circuit 013936 -01 503-880-8649 N
Corrections /Comments /Instructions:
/. 1 e'kt- I 0 V`-‘ 45-e GU 3 a\ r-eot/
r . ) , `Y°
(
IPA PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
- L it, ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1 Q
Inspector: 1\ Date: I ! OSPhone #: (503) 718-