Permit A: CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00574
wi �* DEVELOPMENT SERVICES DATE ISSUED: 9/10/2004
=Am EA 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136AD-04000
SITE ADDRESS: 11505 SW PACIFIC HWY B
SUBDIVISION: VILLA RIDGE ZONING. C -G
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Install (4) branch 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: 3 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:
SMITH, EDITA M LE ELECTRICAL SERVICE INC
833 NW 170TH DR PO BOX 33706
BEAVERTON, OR 97006 PORTLAND, OR 97292
Phone: Phone: 503 -251 -4849
Reg #: ELE 150790
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/10/2004 $66.80
[TAX] 8% State Surcharge 9/10/2004 $5.35 Rough -
Elect'l Final
Total $72.15
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 with in 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:
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:
CONTRAC OR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: r. — DATE: q (0 < O
LICENSE NO: / f qZ S
Call 639 - 4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY
+—• .
.. .
City of Tigard , • R i le _ ii , e permit No.6Lx_200 ii ...., . 5.....7
13125 SW Hall Blvd., Tigard, ORi ti
*,\Ies Plan RevIew
Phone: 503.639.4171 Fax: 9 t , 'A.4111 Date/By: Other Permit:
Inspection Line: 503.639.417 m it Date Ready/By: Juns,' • 10 See Page 2 for
Internet: www.ci.tigard.or.us
k 0 ' 1 Notified/Method: / I 1( Supplemental Information
1 4 44 , 4.. 4 :44i , :1 : 7 : . :- , i -1 : 6 1 :: 6 "4: , . '' ' ' -tiY":: 4 ; :- ':1 4 ,- ,4*), ,,tii ';: .5. 4 1e,: i 6: 3 ;: 11 1 , — ri<511711-23:41ira4%',:r4r.--41:,:PAN.r,:7,,,,1*,,„-ibi,.—„V=":".*.V.:;,':;:, .:-: :: ...' • . " i 1
u New construction . 40,1 t . .. 0 . _,,,.• , - . acement Please check all that apply:
0 Demolition civeao ['Service over 225 amps, comm'l OHazardous location
, S. 0 ervice over 320 amps - rating ElBuildng over 10,000 sq. ft.,
„, 66 ..61;-„,:itiktreditikr3-40..,F,10.-4,-40.---, of 1- and 2-family dwellings 4 or more new residential
7, ';',.". I'S • .-.S. t....?" ......1.3. . .V 4 : .?'". .i
CI 1- and 2-family dwelling El Commercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure
EiBuilding over three stories OFeeders, 400 amps or more
0 Multi 0 Master builder 0 Other: 00ccupant load over 99 persons 0Manufactured structures or
RV park
j F . , 131 tOR-MA--,.. 11 „9.,N,Y;ANI Y ,,,,, ,.,r .1rN, !.',' ' T.cY El Egressnighting plan
DOther:
Job no.: Job site address: r 1 6 ‘,14 ("Pe4c, 1-W)3/ 1: facility
Submit 2 sets of plans with any of the above.
City/State/ZIP: Ft 0 . 9 4 22: The above are not applicable to temporary construction service.
t
Suite/bldg./apt. no.: Ci Project name:
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'I 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
A „:1 '0_,,T ;: . 5- .1.,...-:,. ,,v'.....:=. ii :‘,..,:,.„. ', Each manufactured 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
to 400 amps 106.85 2
amps to 600 amps 160.60 2
Name: V \ S'%') Y.-"ot.\. .1/47/ 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
A. Fee for branch circuits with
-,..r rt , ..4„„, , ,, ,,, ,_ ,.; n i.. y ...,i,.1 ;4 , -; :,:',-4 , lus,4,7,.- ..,i,-_:, ' "- ,,;....,..., .,. •r• . ,,,, , .-.., l' ,F1'. ' ';'
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address:
Each add'I branch circuit 3 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-
rit611iyCacyil •:. :' 9 z It:, , f ■.„- — . - Iiii . ',,,".r...,i?Vzr-q , _ g: i.,.-:-' Afzi energy panel, alteration, or
.7'..1.. , -... tr.: ,,..........) , , , r7 7'.:'' 7"!' ' ,:.' ''';`,.. ' ...7%=" &C''..Fle..,::
extension. Describe: Page 2 2
Business name: L. - .E. , Ex .c 2 Q. 9 .. s c
Address: `P. 0. Zoit 3'-o Each additional inspection over allowable in any of the above
Per inspection 62.50
cs• R ( 9R29 2_ Investigation per hour (1 hr min) 62.50
t
.--,-,
Phone: ( aZ) 2S- C.,8, 4 ct Fax: (' ) 2,S) b 000 Industrial plant per hour 73.75
. 1 -. ::' , 44 " ..-:.TY.4t 4 0 - 4 1 f:-.CNA 1,TftWriTkWfs'.0.
CCB Lic.: i50? Electrical Lic. 2C- It 22c Suprv. Lic.: 4,2_( S Subtotal
C .
Suprv. Electrician signature, required: Plan review (25% of permit fee)
.. State surcharge (8% of pennit fee)
Print name: - AQiii l u 5 , I k c Date: 9 • 0 9 ,Ct
TOTAL PERMff FEE l / 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.
BBuilding\Pemits \ELC-PermitApp.doc 12/03 440-4615TO 0/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
m1 {f .'y .+-_` 11?ab =�.'.�r'. ,.c
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:
"77:A X17 v [3,NT r e AZ e
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 -Pe nitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection ~e: 1503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
U
o
Received 5�2'p Date Reques a BUP
AM PM BUP
Location Suite L3 MEC
Contact Person `I-P Ph ( 9 27) 7d 2 L/2 y3 PLM
Contractor ( -/ - ay 4 12 .ex) L .C -�� 5 Ph ( 5 W/' 760 J7 SWR
BUILDING Tenant/Owner ELC ;7004
Footing
Foundation ELC
Ftg Drain Access: A / „
u avay /'as 7y ELR
Crawl Drain
Slab Inspectio • , f SIT
Post & Beam % 7 / Y arm
Shear Anchors
Ext Sheath/Shear WL'��
Int Sheath/Shear �I
Framing
Insulation
Drywall Nailing P % F ,`�
Firewall , rr` Jl F / �
Fire Sprinkler
Fire Alarm
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
Service
Rough -In
UG/Slab
Low Voltage
Fi : larm
" Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
0 Please call for reinspection RE: 0 Unable to inspect – no access
Fire Supply Line 1661 n
ADA — 7 -0(-1 Approach/Sidewalk Date q I nspector Ext
Other:
I
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL