Permit CITY QF. TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00267
DEVELOPMENT SERVICES DATE ISSUED: 4/20/2005
`''� c4l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S114BD -01100
SITE ADDRESS: 09890 SW RIVERWOOD LN ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.2 LOT : 072 JURISDICTION: TIG
Project Description: 200amp service.
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: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
FENSTERMAKER, ROBERT K/LINDA A OWNER
9890 SW RIVER WOOD LANE
TIGARD, OR 97223
Phone: Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 4/20/2005 $80.30
[TAX] 8% State Surcharge 4/20/2005 $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 1 332 -2344.
Issued By: , , a__, � � & TL /v Permittee Signature: I(
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.
lNED fl . r " ONLY
Electrical Permit Ap, :� '�(�►% �� I�i�. �`� FOR OF FICE�USE � ' i '
/:
City of Tigard *: DateB _ ` Permit 1 , , _� ,,,j,,,,7
13125 SW Hall Blvd., Tigard, OR 97223 APR 2005 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 0 �oo i�W� / del i I Date/By: Permit:
Inspection Line: 503.639.4175 �►' I D ate ReadyBy: Ju s: B See Page 2 for
Internet: www.ci.tigard onus CITY OF TIGA Notified/Method: \� Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
11 Demolition ❑Other: ❑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
El 1- and 2- family dwelling III Commercial /industrial ['Accessory building ESystem over 600 volts nominal units in one structure
El Multi family El Master builder El Other: ❑Building over three stories [Weeders, 400 amps or more
Occupant load over 99 persons EManufactured structures or
JOB SITE INFORMATION AND LOCATION ElEgress/lighting plan RV park
Job no.: Job site address: C g r � S' fJ lt) 3 ❑Health -care facility ❑ Other:
` (� Submit 2 sets of plans with any of the above.
City /State /ZIP: n 6 CO_ '' 7 Z Z / The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: •
I 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
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK • 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 5,0. 3,0 2
PROPERTY OWNER 1=1 TENANT 201 amps to 400 amps 106.85 2
) 401 amps to 600 amps 160.60 2
Name: (2. 0 l _
-L j 5 1 j2 ,.. ff} kiYL 601 amps to 1,000 amps 240.60 2
Address: e1 ' ?lc) s to (t L� y - iO3l7 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
7
City /State /ZIP: �, 6 0 Gy 7 . ' 2- 4 Temporary services or feeders installation, alteration, and /or
1 F / relocation
Phone: ( 5' x 9 7 gif 03 5 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, r t, or exchan actor ing to ORS 447, 449, 670, and 701 401 amps to 600 amps 133.75 2
Owner signature: Date: 4 //Z0105 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, 46.85 2
Address: each branch circuit
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: 6 ^' J�, do
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 Lic.: Electrical Lic.: Suprv. Lic.: Subtotal 'Q a
Suprv. Electrician signature, required: Plan review (25% of permit fee)
•
Print name: Date: State surcharge (8% of permit fee) CO , i f y
TOTAL PERMIT FEE
Authorized signature: - 2:::1;1 This permit application expires if a permit is not obtained within 180
d ays after it has been accepted as complete
Print name: R 0 -a zyt_N Faiii5 myt. n Date: v/ ,, 5 ' * Fee methodology set by Tri -County Building Industry Service Board
** Number of inspections per permit allowed.
i:\BuildinglPermits\ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information ~'
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
I I Burglar Alarm
Garage Door Opener*
Ti 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
I I Boiler Controls
Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
1 HVAC
• Instrumentation
Intercom and Paging Systems
n Landscape Irrigation Control*
1 I Medical
❑ Nurse Calls
Outdoor Landscape Lighting* •
n Protective Signaling
Ti 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 #: ELC2005.00267
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2006
Phone: (503) 639 -4171 : n
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/27/2005 TIME: 7:11AM PAGE: 14
SITE ADDRESS: 09090 SW RIVERWOOD LN CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.2 LOT #: 072 TYPE OF USE:
PROJECT NAME: FENSTERMAKER
DESCRIPTION: 200amp service.
OWNER: FENSTERMAKER, ROBERT K/LINDA A, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 005471 -02 503-003 -9513 N
C . /Comments /Instructions:
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector (�.,�� U _. Date: �� Phone #: (503) 718 -