Permit 'CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00657
DEVELOPMENT SERVICES DATE ISSUED: 10/29/03
44'` 6411 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 102 BC -02600
SITE ADDRESS: 12875 SW WATKINS AVE
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R-4.5
BLOCK: LOT : 026 JURISDICTION: TIG
Project Description: Installation of (1) branch circuit to wire garage. Job No. 4083
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:
JAMES, ALAN K + JULIE A WILLAMETTE ELECTRIC INC
12875 SW WATKINS AVE PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 10/29/03 $3.75
[ELPRMT] ELC Permit 10/29/03 $46.85 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 OA - ° 901 -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 B • " i0 / 1t - � Permit 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. ELEC'N: . -e DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
•
• FOR OF I1CI? USE ONLY
Elet t� ,al Permit Application Received Electrical
Date/By: /0 /0 /a 5 Permit No.: CI- s oD5 -494ps 7
city f 'Tigard Planning Approval Sign
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
���"+ �M�yl; Date/By: Case No
—
Internet: www.ci.tigard.or.us _ "0
Contact ❑ See Page 2 for
24 -hour Inspection Request: 503 - 639 -4175 Name/Method: /0 Supplemental Information.
'',.'; TYPE OF WORK • , •�3t)` ,' ; "*.P'; 41Q1 '_.',: ; REVIEW (Plea se check all that apply) " "" `•t :' :l
New construction ❑ Demolition ❑ Service over 225 amps- ❑ I Icalth -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement , ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
. t.',.. i :: :' :• CATEGORY ,OF f,'',41'. :,tp`,. I & 2 family dwellings four or more residential units in
p._
1 & 2- Family dwelling El Commercial/Industrial El system over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder ❑Other: ❑ Egress/lighting plan ❑ Other:
■' JOB SITE INFORMATION'and'J.:OCATION iY:;,. Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 1 0- C CLJ L rt ,v . ,,, '•r;. 'll
.z r S ;�:,,�'e�tt:e),if�s,. �'C;. FEE"; SCIIEDULE;,, ,, . . .:�r.d:r�, , .•,� r; ,, i, t''.•i
r. I .1 1:.
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: ik I A .✓ 1; .1„,,,,,A.N Description . Qty Fee (ea.) Total 1
Cross street/Directions to job site: New residential - single or multi - family per
dwelling unit. Includes attached garage.
Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq ft. or portion thereof 33.40 1
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map/ parcel #: Each manufactured home or modular dwelling
34. 1) ''.Y it -.; ': ; DESCRIPTION ;OF WORT IN' ti0;$41:, :'hl w service and/or feeder 90.90 2
Services or feeders - Installation,
w .A— e ( PrA..t�ea.� e alteration or relocation:
) 200 amps or less 80.30 2
' 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
' Ri :AO '_ . .OWNER- fit} •;'•'t .` RI ' ' {a -^ 601 amps to 1000 amps 240.60 2
q � ' Ove 1 000 amps or volt 454.65 2
Name: 7 / Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City /State/Zip: relocation:
200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
fib+ 1 , 401 to 600 amps 1 33.75 2
Ui .P.141 T'''•��:''V' :. 111 .CO r. 41, ' ItSQ f Branch circuits - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State/Zip: B. Fee for branch circuits without purchase of S
service or feeder re^, first branch circuit ( 46.85 t/C 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
• q v ,�. ; cs ?, ' CO • tit l 1, �y ;,r rimiim ; t J1 .1;`;�: Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: 1 ( V - 3 Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: ( A ) , l i r5 M e l ~ e F(e c T4 t c /".- c Description:
Address: PO d Z30 cy 9T ? e / 2-
City /State/Zip: � ,S AY) 01 Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. 1 hour) 62.50
Phone: 6 2,(- 3 4 ' / Fax: 424 - 25 - Investigation fee:
C Lic. 2 s '' Lic. #: y - 2 &3 L
Other:
CB #: ,u �: m
CCB
electrician r' MAIM, r t Z R " { '' -
Supervising Subtotal $ Y 6 , E
signature required: �j�( .., 9 Plan Review (25% of Permit Fee) $
Print -Name: P 4 ,,, e, ( 1 . #: // 6 S' S State Surcharge (8% of Permit Fee) $ 9' f 11 3 l'-
TOTAL PERMIT FEE $ ice, 4 [)
Authorized Notice: This permit application expires if a permit Is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Trl- County Building Industry Service Board.
(Please print name)
i :\Dsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard r.
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Burglar Mann
El Garage Door Opener
Heating, Ventilation and Air Conditioning System
El Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
Boiler Controls
El Clock Systems
Ei Data Telecommunication Installation
Fire Alarm Installation
D IiVAC
❑ Instrumentation
fJ Intercom and Paging Systems
El Landscape Irrigation Control
C] Medical
C] Nurse Calls
El Outdoor Landscape Lighting
El Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\DstsTemtit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour - -
BUILDING Inspection Line: 003) 639 -4175
INSPECTION DIVISION Business Line: (503) 639-4171 MST
BUP
Received Date Requested /2-- AM PM BUP
Location 1 -75- lNat-K; n-S At • Suite MEC
Contact Person. Ph (( ) ai-I - 36.3/ PLM
r,
Contractor _ L . .1" /r •p'r- ) SWR
BUILDING Tenant/Owner ELC
Footing (. 3 -006S
Foundation Access:
Ftg Drain ELR
Crawl Drain -
Slab Inspection Notes: SIT
Post & Beam ( - - r 1
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear JJF Framing
Insulation
Drywall Nailing . : `,
Firewall ���` L_ / i L _ - ✓ irr - �& .
Fire Sprinkler • -_ , / '
Fire Alarm
Susp'd Ceiling
Roof
Other: - - -
Final
PASS PART FAIL .
PLUMBING
Post & Beam /
.Under Slab /rte 77 Rough -In f/1/7 Water Service P--7-...—.1„
I 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
T FAIL
LECTRICA `
Service •
Rough -In
Low olt r/d El, / Low Voltage
i larm •
Fin ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS ART FAIL
❑- Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA n `
Approach/Sidewalk Date 0 Inspector - . - I .. Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL