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Permit
CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2006 -10026 DEVELOPMENT SERVICES DATE ISSUED: 3/7/2006 I'� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 0�2@6 PARCEL: 1S125DB-02300 SITE ADDRESS: SW TAYLORS FERRY RD ZONING: R -4.5 SUBDIVISION: BOULEVARD HEIGHTS LOT : 003 JURISDICTION: TIG Project Description: Temp service. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 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: 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: JOAN FARCAS OWNER 7200 SW TAYLORS FERRY RD TIGARD, OR 97223 Phone: 503 - 887 -3761 Contact #: FEES Description Date Amount Reg #: [ELPRMT] ELC Permit 4/1/2006 $66.85 [TAX] 8% State Surcharge 4/1/2006 $5.35 Total $72.20 REQUIRED ITEMS AND REPORTS 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: M � Permittee Signature: _1_P Qf\ 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. CITY OF TIGARD ELECTRICAL PERMIT BUILDING SERVICES DIVISION v � 1( 13125 SW Hall Blvd., Tigard, OR 97223 ' '� 503- 639 -4171 www.tigard - or.gov PERMIT #: og: DATE ISSUED: g 7 - O 6 SITE ADDRESS: -1 () S �T� 0, � � I - PARCEL #: _ V BLDG /STE #: ZONING: _ SUBDIVISION: Swc,t,C LOT: JURISDICTION: - This is an interim permit issued during computer system maintenance. Construction work and inspections may proceed under this permit number. The actual permit will be issued and mailed to the applicant within one week of the date issued above. PROJECT DESCRIPTION: 3 c _, - j ; c - & , � e S \�' ' n , RESIDENTIAL TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: � PUMP /IRRIGATION: —_ EACH ADD'L 500 SF: _ 201 - 400 amp: SIGN/OUTLINE 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: PER HOUR: � 401 - 600 amp: — -- EA ADD'L BRANCH 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 FEES Name: __ Q Permit Fee $ Address: Plan Review Fee $ City /State /Zip: —_ —_ - -_ State Surcharge (8 %) $ _ . 35 .- Phone: Other Fee: $ CONTRACTOR Other Fee: Name: f Y� Total Fees: $ Address: __I..571,�1- L-.5_s._. CL� _i.o City /State /Zip: -3> � � _ 6 1_1_231_ — Phone: _x_63 - Z -- ( j _ Fax 7_711_1_2-7 ''7 CCB Lic #: Elect. Lic. #: ...— ._------ ----- -- - -- Supr. Lic. #: 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 -0080. You may obtain copies of these rules or direct questions to OUNC by c. I'- 246 -1987 or 1-800-332-2344. - - 800 - 332 -2344 , � - Issued By: ".i9 ,C�O c L X Z 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. ELECTRICIAN: DATE: LICENSE NO.: Call 503 - 639 -4175 by 7:00 AM for an inspection that business day. Note: If you cannot schedule an inspection while the system is down, please call 503 - 718 -2433 for assistance. 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. I:\[3uilding\ Forms\ ManualPermitForms \ManualELCpermit.doc 03/06/06 Electrical Permit A ®® a, : . ° FOR OFFICE ()SE :ONLY . . - �! ® Received 7 �/ A,, q City of Tigard Daze /By 3 _ / L,O Permit No.: (_S.! -e6 p - Q/�y 13125 SW Hall Blvd., Tigard, OR 9722 2006 Plan Review Phone: 503.639.4171 Fax: 503.598.19 2UU6 GHiM2` i 'l ' Date/B : Other Permit: Inspection Line: 503.639.4175 II„ Date Ready/By: Fiffil ® See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information _ B $J G ii3ZON PLAN REVIEW ❑ New construction ❑ Addition/alteration /replacement Please check all that apply: El Demolition ❑ Other: El 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 4 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Multi- family ❑ Master builder ❑ Other; ❑Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: 71 O 'J rb 1 ©(s� r „ ❑ Health -care facility ❑Other: i Submit 2 sets of plans with any of the above. City /State /ZIP: C\ ) 6\b c d ( The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE Description I Qty. I Fee. I Total I 1° Cross street/directions to job site��--( - r cr-', " 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 1 \cD G p ��,, �, � V � dwelling, service and/or feeder 90.90 2 `� (� J Services or feeders installation, alteration, and /or relocation l l\ N 200 amps or less 80.30 2 , ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: .© 0_ 1/4.r\ (. C' 601 amps to 1,000 amps 240.60 2 Address: 4, r�r�� C L G / s ( & 5 9 k Over 1,000 amps or volts 454.65 2 r �� 1SC Reconnect 66.85 2 O City/State/ZIP: Temporary services or feeders installation, alteration, and /or Phone: (p15) 1 � --\ 6 1 Fax: f) ) 7 C., G i 5 12, relocation 200 amps or less i 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, leas rent, or exc e, according to ORS 447, 449, 670, and 701. [ 401 amps to 600 amps 133.75 2 Owner signatur ,� Date: o5 - 0 I -d b Branch circuits - new, alteration, or extension, per panel . Ea APPLICANT la CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: - \SCG>S 4 9 ( r A_,, �.,, Al ©� branch circuit B. Fee for branch circuits Contact name: C .Q ( �-.0� without service or feeder fee, 46.85 2 Address: k ----- ) e 4 6 t- ,_Z- �� first branch circuit �- E ach add'! branch circuit 6.65 2 y 0 C k o?-_ c -1 ( ) Cit /Stat /Z IP: Miscellaneous service or feeder not included n Pump or irrigation circle 53.40 2 Phone: ( j '$ b'1 ._ 1 a 4 Fax: : ( ) rTG 2 G-1 5 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: 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 Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) TOTAL PERMIT FEE 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 -Perm itApp.doc 12103 440-46I5T(I0 /021COM/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: El Audio and Stereo Systems* El Burglar Alarm El Garage Door Opener* El Heating, Ventilation and Air Conditioning System* El Vacuum Systems* • El Other: COMMERCIAL WORK ONLY: Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: El Audio and Stereo Systems El Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation El Fire Alarm Installation El HVAC El Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* • El Medical El Nurse Calls El Outdoor Landscape Lighting* n Protective Signaling El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is \Building \Permits \ELC -Perm itApp,doc 04/03 - CITY OF TIGARD 4/1/2006 III r " 13125 SW Hall Blvd. 10:32:03AM Tigard, Oregon 97223 TIGARD (503) 639 -4171 Receipt #: 27200600000000001078 Date: 04/01/2006 Line Items: Case No Tran Code Description Revenue Account No Amount Paid ELC2006 -10026 [ELPRMT] ELC Permit 220- 0000 - 431510 66.85 ELC2006 -10026 [TAX] 8% State Surcharge 100- 0000 - 207020 5.35 Line Item Total: $72.20 Payments: Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid CreditCard FARCUS CONSTRUCTION DER/DLH 010499 In Person 72.20 Payment Total: $72.20 cReceipt.rpt Page 1 of 1 CITY OF TIGARD ,6 BUILDING DIVISION PERMIT #: a / 0 024 13125 SW Hall Blvd., Tigard, OR 97223 ; DATE ISSUED: Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: 2 0 f• ■,.�� CLASS OF WORK: SUBDIVISION: �] A LOT #: TYPE OF USE: PROJECT NAME: l DESCRIPTION: OWNER: PHONE #: 7 _ 3 74 CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: •• - ; Inspection Description Confirm # Contact # Message � CA 4' . Corrections /Comments /Instructions: .0 • & n PARTIAL APPROVAL n CANCEL I I NO ACCESS FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: ND✓ I v tiv Date: . 5 2 64 Phone #: (503) 718 -2114) CITY OF TIGARD �Z G BUILDING DIVISION PERMIT #: 2 006 -1 i ;) ( 13125 SW Hall Blvd., Tigard, OR 97223 s DATE ISSUED: Phone: (503) 639 -4171 4,10 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: a d C/ Tzelet w CLASS OF WORK: SUBDIVISION: � ,\ LOT #: TYPE OF USE: 6 PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message g 87 - 3 7(4 Corrections /Comments/ Instructions: tte (9 L. 1'` 4 0 ,ti/1 1 0 (� � v I) 4-6(rm W i � � - l to a (A) 1-) AA/ lofed v of 00, /s ( « 1240 rs A ha4q rJA,<.,y 62- 5 .2e-4-i-a /4/0 t-Yee-tA 01- Pa f/Le_449p_&&€.,1 p ue ) 4_ vi -ID "Lev -/ .6?; • .n PASS n PARTIAL APPROVAL n CANCEL 7 NO ACCESS ,FAIL [CALL FOR INSPECTION ADDITIONAL FEES ASSESSED WO � O Inspector: � � �• Date: Phone #: (503) 718 -�