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Permit ': OF TIGARD ; ELECTRICAL PERMIT PERMIT #: ELC2005 -00296 DEVELOPMENT SERVICES DATE ISSUED: 5/2/2005 '1' ft, 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 2S104CA -02500 SITE ADDRESS: 13599 SW LAUREN LN ZONING: R - SUBDIVISION: HILLSHIRE LOT : 025 JURISDICTION: TIG Project Description: (1) branch circuit. 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: RICO, DANIEL S + STELLA OWNER 13599 SW LAUREN LN TIGARD, OR 97223 - Phone: Phone: FEES Reg #: Description Date Amount [ELPRMT] ELC Permit 5/2/2005 $46.85 [TAX] 8% State Surcharge 5/2/2005 $3.75 REQUIRED ITEMS AND REPORTS Total $50.60 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questi "s to OUNC at 50 46 -6699 or 1- 800 - 332 -2344. Issued By: ®y Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. • This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application . , . .'' - * ' FOR OFFICE USE ONLY , .1 - ".:`:.t r.� �j City of Tigard a E D at Re c e ived ��' © eBy , � /1`' PercmtNo.:G `�� V /I�g� 13125 SW Hall Blvd., Tigard, OR 97. '' Plan Review Phone: 503.639.4171 Fax: 503.598.1960 lliW l Date/By: Other Permit: Inspection Line: 503.639.4175 10 I�•',' Date Ready/By: Juris: H See Page 2 for Internet: www.ci.tigard.or.us MAY 02 r `� Notified/Method: � / u- Supplemental Information rO IGARD PLAN REVIEW ❑ New construction ❑ A o lIJ�II i VV1V$ N Please check all that apply: 1:1 l Demolition 1 V 1 1`1 ❑ Service over 225 amps, comm'l ❑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 ❑ 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 111 Multi family 111 Master builder ❑ Other: . . ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park Job no.: Job site address: / / ❑Health -care facility ❑Other: / .._.. 9 � ! Hk S4 c /- Submit 2 sets of plans with any of the above. City/State /ZIP: Q _ / ,e, ' 7 , 3 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Q! Project name: / FEE* SCHEDULE ** . Description Qty. Fee. Total 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 Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK • Each manufactured or modular dwelling, service and /or feeder 90.90 2 7 7 / c' /-1 r/ Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 El PROPERTY OWNER ❑ 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: / 2 — 9 ' � / Over 1,000 amps or volts 454.65 2 c� 7 7 9 ! J �� Reconnect only 66.85 2 City/State /ZIP: y A,er/ tJ, Temporary services or feeders installation, alteration, and /or relocation Phone: (5-03) 5 ,2 y _ D Fg� 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 ❑ APPLICANT ❑ 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, o each branch circuit ( 46.85 2 Address: Each add'l branch circuit ` 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40' 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: m Al OIL, 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: ( ) Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lie.: Electrical Lie.: Suprv. Lie.: Subtotal ( ''S Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: /) � , Date: State surcharge (8% of permit fee) 3, 75 �N� 6 ' ' s/� TOTAL PERMIT FEE Authorized signature: u .1 i / �� 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. 0 i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM/WEB �� O ! Electrical Permit Application - City of Tigard r� Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: 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 I Clock Systems I Data Telecommunication Installation Fire Alarm Installation HVAC ❑ Instrumentation Intercom and Paging Systems n Landscape Irrigation Control* Medical I 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 c\Building\Permits\ELC- PermitApp.doc 04/03 CITY OF TIGARD .. , . 4 BUILDING DIVISION PERMIT #: ELC200 &-00296 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/2/2005 Phone: (503) 639 -4171 � Inspection Requests (24 Hrs.): (503) 639 -4175 W INSPECTION WORKSHEET FOR DATE: 6/22/2006 TIME: 7 :28AM PAGE: 90 SITE ADDRESS: 13599 SW LAUREN LN CLASS OF WORK: SUBDIVISION: HILLSHIRE LOT #: 025 TYPE OF USE: PROJECT NAME: RICO DESCRIPTION: (1) branch circuit. OWNER: RICO, DANIEL S 4- STELLA, PHONE #: 503 - 5240882 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/22/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 009809.01 603 -524 -0882 V Corre 'ons /Comments /Instructions: \\- )) 6 308 \ CV 1)---) will Z Uv\rlykW iw () `.1,vrr t \),-) k� 4`N b -- 1k\ `e'\ 1 ( D E `f% N\K `i S \o tts 6 ,\(('' • ' ()Th . ' / 7 N PASS ❑ PARTIAL APPROVAL_ _____ _ __ _❑ CANCEL. I- Na ACCESS U FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 14 Inspector: s Date: --o - K Phone #: (503) 718 - tC •