Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00332
e, I n, DEVELOPMENT SERVICES DATE ISSUED: 5/18/2005
'�� I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S134CA-00107
SITE ADDRESS: 11540 SW TIMOTHY PL ZONING: R -4.5
SUBDIVISION: BARTON LOT : 004 JURISDICTION: TIG
Project Description: Change out panel.
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:
HANSEN, JOANNE + DAVID G OWNER
11540 SW TIMOTHY PL
TIGARD, OR 97223
Phone: Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 5/18/2005 $80.30
[TAX] 8% State Surcharge 5/18/2005 $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. 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- 46 -6699 or
1 -800- 332 -2344.
Issued By: Z s eL5► ./� Permittee Signature: /2 aA41
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.
se
,«- -
,
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received ....... i
Date/B : 7 4 g ""lg1 I= jr,10Ming12,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 . Date/B e .
'-• :
Other Permit:
Inspection Line: 503.639.4175 . 1 110.- 6 I / Date Ready/By: lifili . See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
41. - P . P.,:f...:7?" 7 ::4: . ,;: ' ,:,HArk,iiiidilk,' . - • ,
. -:".i.,..i..N..'?: '*.t. j:1• - l'.. ' r.: - .... - -.-- , -- •-•
0 New construction Additionialteration/replacement Please check all that apply:
0Service over 225 amps, comm 0 Hazardous location
0 Demolition 0 Other:
0Service over 320 amps - rating 0 Buildng over 10,000 sq. ft.,
..q4"-15-Y*.`
of 1- and 2-family dwellings 4 or more new residential
:-.. arlz.-Ig:-'1 glr,
),SI, 1 - and 2 dwelling 0 Commercial/industrial 0 Accessory building OSysiem over 600 volts nominal units in one structure
0Building over three stories ['Feeders, 400 amps or more
0 Multi-family 0 Master builder 0 Other:
).. , • ,,,,......... e,...,-,..:- ..._.,,.. , .........,,,,...„,-,,,............ TI ,..... •,....„•_ e ,r,t,e,...)_...••••_.,.....,, ; ,-...- Li:Tee
,,,p. , , • 00ccupant load over 99 persons 0Manufactured structures or
. r..1013-:LS13EAT151101AM . L.A.LNRILOCAT - 1.011,1,,;„TV . ,. 4q ,11,-i-- 0 Egress/lighting plan RV park
0Health-care facility 00ther:
Job no.: Job site address: fl 54 Si - 1( 1 - t e pi Ac
Submit 2 sets of plans with any of the above.
City/State/ZIP: - i t 0 l ap, D fa i 1223 The above are not applicable to temporary construction service.
i
Suite/bldg./apt. no.: 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. addl 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
WO
tiO
1 of :g4P"-' . t''44':'''''' 4 4 - f ,i
. t. -• IL' 4 7"-c: -,.. - f ..--- ,:" ::`," it „ - -A.:. ....,' ::-... - . I, ti,.: .., W-1.:it '-,,,„ 4 ‘:, ... ..i. Each manufactured or modular
C dwelling, service and/or feeder 90.90 2
truck ele.c--1-r ■ (4_0 TaA,...e..1 . Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 86 _ 3c 2
- ...1: i- '`,44,7,t:A)gigpitOififfe:rdiciAie-;c0.4.,'.:;;;A.t?-3y-544iiir47, • 7;tig 201 amps to 400 amps 106.85 2
160.60 2
Name: Dp.,.,/ I C) 1.4-p R .- pi
601 amps to 1,000 amps 240.60 2
Address: 1(540 s t,i -1 i tioi il .prc 6 Over 1,000 amps or volts 454.65 2
.
Reconnect only 66.85 2
City/State/ZIP: ' c ,ppb 012._ 6 117-2 3 Temporary services or feeders installation, alteration, and/or
i
relocation
Phone: 6 )554.- i ( 5 p Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being, .. e on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease r t, or exchAge, a. eo,. ing to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: a/ A v ok-t/t-t---- Date: S . - 1 8 - c 2 OOS Branch circuits - new, alteration, or extension, per panel
07 .., t ,,,-. , .-- Tr --,. ••••-• ,, t. ,-, - ' ;.--•.• ° ',' - " '"f . ''' ',."-°'"- ' ''''' " . 1
A . Fee for branch circuits with
,114!''lite.k1W-±4s,WgVieMttlitia4V1,-.M1Y-k.;::'"ZACT•1*..C.PT*0.241V7..-`. 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 addl 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 Signal circuit(s) or limited-
Z. V...iitfe":&S:5-g energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Each additional inspection over allowable in any of the above
Address:
Per inspection 62.50
City/State/ZIP: Investigation per hour (I hr ruin) 62.50
Phone: ( ) Fax ( ) Industrial plant per hour 73.75
;;P:f61^ giOlr.regES! '• 7 - - i
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal SYCI. 30
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 6 v2_,
Print name: Date:
TOTAL PERMIT FEE >4 1.2.
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.
BBuildinePermiti1ELC-PermitApp.doc 12/03 440 I 0/02/CONVViEB
A
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
FCO : i _o 40_1WOWtKWO,N4Wit
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 \Pmnits\ELC- PamitApp.doc 04/03
CITY OF TIGARD - - .
BUILDING DIVISION . A.
PERMIT #: ELC2005-00332
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/18/2005
Phone: (503) 639-4171 .. it !,
Inspection Requests (24 Hrs.): (503) 639 -4175 -. W `__..
INSPECTION WORKSHEET FOR DATE: 512612Q05 TIME: 7 :27AM PAGE: 67
SITE ADDRESS: 11540 SW TIMOTHY PL CLASS OF WORK:
SUBDIVISION: BARTON LOT #: 004 TYPE OF USE:
PROJECT NAME: HANSEN
DESCRIPTION Change out panel.
OWNER: HA , JOANNE + DAVID G, PHONE #:
CONTRACTOR: OW NE• PHONE #:
Inspection Request Scheduled For: Date: 5/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 007713-01 503 -88B -8734 N
•
Corrections /Comments / Instructions:
( 0 02:\ C4 1V C>-
c. r,-______
.-- -
.,
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
F ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: AL-e-,,-14/ L'` Date: -- -.2._ , 6 Phone #: (503) 718 -
CITY OF TIGARD
• A
BUILDING DIVISION PERMIT #: ELC2005 -00332
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/18 /2005
Phone: (503) 639- 4171 °j
Inspection Requests (24 Hrs.): (503) 639 -4175 ` L
INSPECTION WORKSHEET FOR DATE: 5/20/2005 TIME: 7:11AM PAGE: 9
SITE ADDRESS: 11540 SW TIMOTHY PL CLASS OF WORK:
SUBDIVISION: BARTON LOT #: Q04 TYPE OF USE:
PROJECT NAME: HANSEN
DESCRIPTION: Change out panel.
OWNER: HANSEN, JOANNE + DAVID G, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 007400 -01 503-888-8734 Y
Corrections/Comments/Instructions:
praN 6-4A), �� ,8t119
y-,Ay‘r\-L t, toc\w uat. B s 11-1e. firg4 plA l
( C )" C)--U S\)4 j
;yr -
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / . L. ■ s,Esim' Date: 9 o Phone #: (503) 718 -
r