Permit CI TY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00036
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J I DEVELOPMENT SERVICES DATE ISSUED: 1/26/04
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135BD-01200
SITE ADDRESS: 09802 SW SHADY LN ZONING: C G
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install (1) 200 amp and 20 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: 20 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:
FORBES, DONALD CAROLYN JC ELECTRIC INC
BURDICK, DONALD LINDA 118 NW 184TH STREET
434 RIDGEWAY RD RIDGEFIELD, WA 98647
LAKE OSWEGO, OR 97034
Phone: Phone: 360 - 887 - 7889
Reg #: SUP 4289S
ELE 37 -724C
FEES LIC 118452
Description Date Amount
• • Required Inspections •
[ELPRMT] ELC Permit 1/26/04 $213.30
[TAX] 8% State Surcharge 1/26/04 $17.07 Rough -
Elect'I Final
Total $230.37
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 questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: i u , Permit Signature: 1 (E/911/S4..
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: 40-WC-
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY
C'r, j�r4 Ti g and RECEIVE / i Date/By: / —o?G � � Permit No.: c'L ✓ DO/ - 00 0 34 0
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �' Date/By: Other Permit:
Inspection Line: 503.639.4175 J filtl A 2 6 2O 1 e `_ � Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPCIWY OP PLAN REVIEW
❑ New construction CO FAIMInnateliBREZPNG Please check all that apply:
['Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition 0 Other:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling 12i Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi - family 0 Master builder ❑Other:
JOB SITE INFORMATION AND LOCATION ❑Occupant load over 99 persons ['Manufactured R ark structures or
❑Egress /lighting plan park
no.: o10C3�1c6g Job site address: ��p� S1,, S L(kR�. ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: '7\ Gp ' '7 The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: 1 ' \ 1 A FEE* SCHEDULE
v� ", (� & . S �/S Description I Qty. I Fee. I 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'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
DESCRIPTION OF WORK Each manufactured or modular
\..3i-Z_Z— dwelling, service and /or feeder 90.90 2
'M SVQS T/� Services or feeders installation, alteration, and /or relocation
200 amps or less I ( r 80.30 _ gyp; j(�I 2
0 PROPERTY OWNER i 201 amps to 400 amps r 106.85 2
[] TENANT
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
Phone: ( ) Fax: ( ) relocation
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
Business name: branch circuit X 6.65 13�- 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
Address:
each branch circuit 46.85 2
Each add'l branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 I 2
Sign ur outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: -er e a k ) AK
Address: ` U, Each additional inspection over allowable in any of the above
1
MN) at( `S� Per inspection 62.50
City /State /ZIP: C?NQG th.f W fl °ANA -a Investigation per hour (I hr min) 62.50
Phone: (31c0) � $ Fax: (31� s%.---A �\ Industrial plant per hour 73.75
/D _ • _ u 1 ELECTRICAL PERMIT FEES*
CCB Lic.: k� sa Electrical Lic.: I _ i Supr . • 'a S Subtotal 'a \3 36
//-4/ _0.5 / -
Suprv. Electrician signature, required: t Plan review (25% of permit fee)
Print name: State surcharge (8% of permit fee) % , 01-
�� Cott Da \ TOTAL PERMIT FEE
Authorized signature: i0— '110 . 3 - 1 -
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Cr Llr Z___ Date: \ /9,1/ • 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(10/02/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received (p 2 ! Date Requested 3 / - 0 Cli PM BUP
Location 9 d" 1 Suite MEC
Contact Person !f P (3�D) Te ? — ?8c� q PLM
Contractor .�� l.e, . ,y1.074.3(2
&�,�,��rr�� `2 72 2 7� 3 SWR
BUILDING Tenant/Owner /V y
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear SE C.v IZI`r Pe ca. vyt 0"
Insulation
Drywall Nailing
Firewall -t• S 4 G L21 otu� ( EL.C,
Fire Sprinkler 1
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final 6 L k Ci -- G Cl b ID j - ,C / 1 �° " 4 ) ,
PASS PART FAIL I + I
PLUMBING 1 ! I N CT !V
al
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
V ow Voltage
J PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line / j � )
ADA Approach/Sidewalk Dat e/ 6 - �L Inspector OE /l/ Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL