Permit s. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00461
ZIP DEVELOPMENT SERVICES DATE ISSUED: 7/26/2004
I
r ' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 25111 BC -03800
SITE ADDRESS: 10390 SW VIEW TERR
SUBDIVISION: DOUGLAS HEIGHTS ZONING: R
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: (3) branch circuits for kitchen remodel.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0.00 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: 2 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:
BERTULEIT, MIRIAM R /DANIEL TRS OWNER
10390 SW VIEW TERRACE ST •
TIGARD, OR 97224
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/26/2004 $60.15
[TAX] 8% State Surcharge 7/26/2004 $4.81 Rough -in
Elect'I Final
Total $64.96
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 se = - • R 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules •r direct questions to OUNC at (503)
246 -669! or 1 -800 -332- ' • • /
Issue s By: A , '' Permit Signature: 4. / �_ ,
OWNER INSTALLATION ONLY
The installation is being made on p•••erty I own which is not int- ded for sale, lease, or rent.
/
OWNER'S SIGNATURE: /(, 1 A / L � DATE: 7 1,V
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Appli FOR OFFICE USE ONLY
"/ ,
City Received
of Tigard Date/By 2 07 O Permit No &Wee —Ce 4/
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone 503 639 4171 Fax: 503.598.1960 Allk 1 l Date/By. Other Permit:
Inspection Line: 503 639.4175 e'II Date Ready/By Ju ® See Page 2 for
Internet: www ci.tigard.or.us Nonfied/Method: /! 02 Supplemental Information
TYPE, OF WORK .._ _ . , _ . PLAN REVIEW
❑ New construction 121 Addition/alteration /replacement Please check all that apply•
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
OService over 320 amps — rating EBuildng over 10,000 sq ft ,
- ' - , CATEGORY OF CONSTRUCTION • - - - • _ of 1- and 2- family dwellings 4 or more new residential
f 1- and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
12 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 n ,, L ❑Egress/lighting plan RV park
Job no.: Job site address: /x370 S w \/ E I M T i4 n
� / 2rr�° C ❑Health -care facility ['Other: addre
Submit 2 sets of plans with any of the above
f _ Q
City/State /ZIP: 7- k iroject . 7 2.2. L The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: 1 G.LLt � Yroject name: L i 't• G7 e g� Q Em U 0 E (__ , FEE* SCHED I LE I **
' ` Description Q. 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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75 00 2
DESCRIPTION OF WORK Each manufactured or modular
G I r � ` t AWL 1A-IV dF J[ ! � i ^s( dwelling, service and /or feeder 90.90 2
/I 7 Services or feeders installation, alteration, and/or relocation
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: DANIEL, 13 i 7 V / t /7 601 amps to 1,000 amps 240 60 2
Address: /U 3 fD S, 1/r 11 1 (E� � /Tf- ARAOQE Over 1,000 amps or volts 454.65 2
J Reconnect only 66.85 2
City /State/ZIP: 7 ( ( .4 fa 0 / O� t �J 72- z Temporary services or feeders installation, alteration, and/or
Phone: ( ) / 6 Fax: ( ` ) relocation
V� b'J 9' - C� `7 200 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, leas - , en , or exchan' e, . , 1 t�,y ORS 447, 449, 670, d 701 401 amps to 600 amps 133.75 2
Owner signature: //, , , ` // / �� Date: 7�Zr1 t V Branch circuits — new, alteration, or extension, per panel
0 APPLICANT i I, '. .. • , ❑ 'CONTACT PERSON j A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits {[{
without service or feeder fee, 1 46 85'" 2
each branch circuit
Address: Each add'l branch circuit p` 6 65 /..g,0 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:
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 W 6 .,/ S
Suprv. Electrician signature, required: Plan review (25% of permit fee) �
Print name. Date: State surcharge (8% of permit fee) y. 8
TOTAL PERMIT FEE 6y, /^
/// 7
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 Tn- County Building Industry Service Board
"" Number of inspections per permit allowed
r\ Building \Pemuts\ELC- PermitAppdoe 12/03 440- 4615T(i0 /02/COM/WES
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
`RESIDE °t r WORK *ONLY -h
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:
•
NCO_ t R_ .CIAI:4wWO ON:L ; 481 a, x :- v ',
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
\Buddmg\Pernuts\ELC•PemutApp doc 04/03
CITY OF TIGARD 24 -Hour '
BUILDING Inspection Line: (503) 63:-4175
INSPECTION DIVISION Business Lie: 3) 6 '° -4171 MST
BUP
ei e• �J� I Date ue / 5_I!.?
� AM = PM BUP
Location i 0 " ( e' "A Suite MEC
Contact Person Ph ( _ ) PLM
Contractor Ph ( ) SWR /�Q���//��
BUILDING Tenant/Owner ELC c94 � V 0 l
Footing
Foundation ELC
Access: Me- p '^' � /0
Ftg Drain
ELR
Crawl Drain
Slab Inspection Notes: �/ _T____�� SIT
Post '& Beam �tt✓l J- - - — a1/l= c' -e/"�
Shear Anchors
Ext Sheath/Shear /�� �/ �/
Int Sheath/Shear T7 � � , =SS" o6 C S Framing
Drywall Nailing 7
Dryll Nailing
Firewall
•
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 rIIMMEIV
Storm Drain
Shower Pan
moor
" Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
SA PART FAIL
ELECTRICAL
ServR;e
Rough -In .
UG/Slab
Low Voltage
Fir= Ala
' ❑ Reinspection fee'of $ required before ne. inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: / ErUnable to inspect - no access
Fire Supply Line
ADA Z.,2-
Approach/Sidewalk Date Inspector
Other:
Final DO NOT REMOVE this inspection record fr = job site.
PASS_ PART FAIL