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Permit
CITY TIGARD ELECTRICAL PERMIT f " Q PERMIT #: ELC2004 -00508 DEVELOPMENT SERVICES DATE ISSUED: 8/12/2004 cl Ij 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S 102CA -00943 SITE ADDRESS: 13580 SW VILLAGE GLENN DR SUBDIVISION: VILLAGE GLENN ZONING: R-4.5 BLOCK: LOT : 043 JURISDICTION: TIG Project Description: 1 branch circuit to hot tub. 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: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 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: ROBBING, KEITH DICKINSONS ELECTRIC 13580 SW VILLAGE GLENN DR 8449 SW BARBUR BLVD TIGARD, OR 97223 PORTLAND, OR 97217 Phone: 503 - 670 -7589 Phone: 246 -3550 Reg #: LIC 65534 SUP 3100S FEES ELE 26 -140C Description Date Amount Required Inspections [ELPRMT] ELC Permit 8/12/2004 $46.85 [TAX] 8% State Surcharge 8/12/2004 $3.75 Rough - Elect'I Final Total $50.60 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 -33 344 Issued By: Permit Signature , i w 44, , 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 639 -4175 by 7:00pm for an inspection the next business day Electrical Perthit Application FOR OFFICE USE ONLY -- R eceive d A C it y of Tigard Date ' , t( a � 4 j Permit No.: / t xvii-t'�D jl 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie Phone: 503.639.4171 Fax 503 598.1960 //. di i ill Date/By Other Permit: Inspection Line: 503.639.4175 ■ r =' I Date ReadyBy 0 See Page 2 for Internet. www.ci.tigard or us Notified/Method "' 1 Supplemental Information , TYPE OF -WORK -. PLAN REVIEW s New construction ❑ Addition/alteration/replacement Please check all that apply ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑Hazardous location OService over 320 amps — rating ❑ Buildng over 10,000 sq. ft , CATEGORY OF CONSTRUCTION' ' . ` ' ' of 1 - and 2- family dwellings 4 or more new residential s 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building El System over 600 volts nominal units in one structure ❑Building over three stories ❑Feeders, 400 amps or more ❑ Multi - family 0 Master builder 0 Other: ❑Occupant load over 99 persons EManufactured structures or JOB SITE INFORMATION AND LOCATION - ❑Egress /lighting plan RV park ❑Health -care facility ❑Other: Job no.: Job site address: I 3s .15-40 S� � �' GI�, Submit 2 sets of plans with any of the above. City/State /ZIP: ii b) Of 4� 3 � C The above are not applicable to temporary construction service Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE' , f ) Description Qty. I Fee. I Total •• Cross street/directions to job site: S' °19 O On ' 01 '{'O U, j(c1 , New residential single - or multi - family dwelling unit. Includes attached garage. (,J4,„ y - 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 l 4, dwelling, service and /or feeder 90 90 2 /�[� Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 PROPERTY OWNER I ❑ TENANT ` 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160 60 2 Name: OV,), D IpGi,,v7 601 amps to 1,000 amps 240.60 2 f Over 1,000 amps or volts 454.65 2 Address: vv �3,sy -0 0..)146)t, '� 6 14,14 Reconnect only 66 85 2 City/State /ZIP: a f ( I'M Temporary services or feeders installation, alteration, and/or Phone: (503 ) 6) o 1 ) relocation g9 Fax: ( ) 2000 0 a 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 6.65 2 Business name: branch circuit Contact name: B. Fee for branch circuits without service or feeder fee, / 46.85 14,, O S 2 Address: each branch circuit Each add'l branch circuit 6 65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) I Fax :: ( ) Pump or imgation circle 53.40 2 Sign or outline lighting 53 40 2 E -mail: Signal circuit(s) or limited- CONTRACTOR energy panel, alteration, or i 2 extension. Descnbe Page 2 2 Business name: 1 1 t i C � / Address: €' 4 4' 7 , L / Each additional inspection over allowable in any of the above c Per inspection 62 50 City/State /ZIP: par 1s l _ , 1 G, J/9 Investigation per hour (I hr min) 62 50 Phone: 3 21/6 35-5- Fax: (SO) 2 1360gq. Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* , CCB is Elect Suprv. _ I 3 G ! o S Li 4.e...... Subtotal 41, gr�— Suprv. Electrician signature, mph • " ■ Plan review (25% of permit fee) " /' Dater ` ©� State surcharge (8% of permit fee) 3 , 15 Print name: 40 -`, TOTAL PERMIT FEE 50. ( ,� 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. I \Buddmg\Permits\ELC- PernutApp doc 12/03 440-461 5T( 1 0/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ._RESIDENTIAI;WO O1VI:Y:z: "�" U, 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: r O_ ort RCIAAL toU OPTI Y.a - `P °.., :,, ,. ` n 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 \Bwlding\Pcrmns\ELC- PemutApp doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION, .< Business Line: (503) 639 -4171 MST BUP Received Date Requested AM PM BUP Location /'5 80 V� -Li , . p,y uite MEC Contact Person - Ph ( ) 670-7S PLM Contractor Ph ( ) SWR k BUILDING Tenant/Owner ELC " ?c (_ �o -6 Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof _ Other: Final PASS PART FAIL PLUMBING G ✓ Post & Beam Under Slab Water he 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 Low Voltage Fire Alarm ' Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SITE ❑ Please call for reinspection RE: Unable to inspect — no access Fire Supply Line - ADA / Approach /Sidewalk Date V Inspector /�, Ext Other: Final DO NOT REMOVE this inspection record from t job site.. PASS PART FAIL V CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC-a 0 4 - 00 gel 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 00 $DST Phone: (503) 639 -4171 41I A rt■ Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 3 - i+- O,S' TIME: PAGE: SITE ADDRESS: I 356, Vi El &5e GfeArt t72. CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: Ke,i RA) irt.A3 PHONE #: 0/A V 11° — i1 S 56 ( CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description • Confirm # Contact # Message F• tea.@ c:o( ORS c 0.Ae t � , h3 0 1 Corrections /Comments /Instructions: Ti411 'R i rJ (7 Si • 1 1 PASS I ❑ PARTIAL APPROVAL ❑ CANCEL el ❑ NO ACCESS ❑ FAIL 5 ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED / — _ / Inspector: Date s4 �`� Phone #: (503) 718- � / 116