Permit 4, , CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00061
DEVELOPMENT SERVICES DATE ISSUED: 2/4/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S104DB -03400
SITE ADDRESS: 13110 SW WELLINGTON PL
SUBDIVISION: AMESBURY HEIGHTS ZONING: R -4.5
BLOCK: LOT : 034 JURISDICTION: TIG
Project Description: Reconnect only.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 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 BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BARBAY, JOHN OWNER
13110 SW WELLINGTON PL
TIGARD, OR 97223
Phone: 503 - 590 -5280 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/4/2005 $66.85
[TAX] 8% State Surcharge 2/4/2005 $5.35 Electrical final
Total $72.20
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 Utili o i ation Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of th s or direct • e o o OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: Permit Signatu e: / /
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 'Permit Appli V teN FOR OFFICE USE ONLY
a•
City of Tigard Received ^�� �� Permit No.. � O 0 I
Tigard, OR
13125 SW Hall Blvd., Ti Date/By
g �oo� Plan n Review
!/
eview
Phone 503 639 4171 Fax. 503. 8.1960 �� ""sl rh\ D ate/By. Other Permit
Inspection Line: 503.639.4175 ( �L n!. Date Ready/By Juns Fl See Page 2 for
Internet. www.ci.tigard.or.us ` r(1 Notified/Method - Supplemental Information
; t' �d,. , .. '.F - . ; "„' _ , `:��j'Y. ■ JO , .'i.•:, 'r; . edvr: • „".p'a�• K :4i: r '�' " , ri;.;.na €� ` 61V _ A. _ r, ..
❑ New construction ❑ Al • t., Ai : on/replacement Please check all that apply:
❑ Demolition g ,)t (r ['Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps – rating ❑ Buildng over 10,000 sq ft ,
• :. CATEGORY f.OF , R UCTION; �x tL" "'= Il an of 1- and 2- family dwellings 4 or more new residential
K1- 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
.'"/;= r•' . ,' , ' , - '1 . 1i .- , - ,,,_ : , - ,!;, OB_ '
r 3istiO: MJ TZO '' ANA' L O C 2 i _TroNY ; ;. . :, _ , ` �'.:, .. ❑Egress/lighting plan RV park
Job no.: Job site address: 131 JO St,3 wet /01 Pi. ❑Health -care facility ❑Other
Submit 2 sets of plans with any of the above.
City /State /ZIP: 1 16A- (3 / 0 E, G(` 72.23 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name:
' r•.. tz , r ,?,e�;F�s,`E: * °.� 0,1 ,'D:CI;I�E ;a,_'
Description Qty. Fee. Total
Cross street/directions to job site: 1 J 0_ hG C ? Oc. lr16110‘..,‘ 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 l
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75 00 2
1 ' , - `.;' , '' - -`!1"."':= , ::' ' ,,if' :. - "zy ?DESCRIPTION OF WORK ' S 1 . _ =:.-} '' 1 Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
kt'i4E-Rty :, ci VER - . +.: -',..1:„":'
rw , , ,p" Tr} + ” t ! , w ' 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 77 13 4, 134 601 amps to 1,000 amps 240.60 2
Address: 131 ` ® ,9Lt) (,t) e [f? n �ti P / Over 1,000 amps or volts 454.65 2
t9 Reconnect only g 66.85 2
City/State /ZIP: `"- 16 f)e b / 0 e_ ' 7223 Temporary services or feeders installation, alteration, and/or
Phone: (5 3 S�D - S2 g O Fax: ( ) 2 2000 0 a amps mps
or less 66 85 1
Owner installation: This installation •: se'. 1. made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, l , ren , ex s . 1. , • c. ordin: to • 'w 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature / Date: Branch circuits – new, alteration, or extension, per panel
K ' , . 1 ,.: • APP CAN ; h : : - � ".I. � , . ,0-: 4 � f ] CON`P E RS • O &',,''.>.- A. Fee for branch circuits with
....- -' "" service or feeder fee, each
Business name: aw,(if branch circuit 6 65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each add'I branch circuit 6 65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53 40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
• ": • 'ar" r°ta -
; r •
3;{' °-- + energy panel, alteration, or
. _ 4 _" �• .i:., .. . t � �,C OI�TRACT:01t . ; . - "'s <,., .... `r� -� �w -�`•,. � `*s;. _� ;t
extension. Descnbe• Page 2 2
Business name: at,),1)---,_
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (I hr min) 62 50
Phone: ( ) Fax: ( ) Industrial plant per hour 73 75
'..", '."..:0;E7,71-004.;:k ER1*t,tEE5ti "'r''`•:° '... 1 ` .
CCB Lic.: Electrical Lic.: Suprv. Lie.: Subtotal pb, g t
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 3S
TOTAL PERMIT FEE 7 .2 d
Autholized signature: This permit application expires if a permit is not obtain ` 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- PemutApp doc 12/03 440-46 15T( 1 0/02/COM/WEB
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:
U rg it . ,r W �ll'�.Vl� \1i
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 .\BwldingTerttuts\ELC- PetmttApp doc 04/03
CITY OF TIGARD , • 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION -- Business Line: 503) 639 -4171 ' -T
�-y UP
Received Date Requested _a AM - M ./ / BUP
Location / 3 //d (,)LP,�'i / ; Suite MEC
Contact Person (/ P , " ) PLM
Contractor - P ( ) / / SWR
BUILDING Tenant/Owner 4 ��a - 3�"t 4- / LC 003' o ( I
Footing S g Sa o ELC
Foundation Access: 15 Z f
Ftg Drain ELR
Crawl Drain
• Slab Inspection Notes: 42, . _ �� -- SIT
Post & Beam 1
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 I_ _
Post & Beam
Under Slab _ _-
Rough-In
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 T FAIL
C L
erica
Rough -In
UG/Slab
Low Voltage
Fir - m
' �� El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
(I1 PART FAIL
S ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA � j
Approach/Sidewalk Date - - L/ Inspector ` Ext
Other:
Final DO NOT REMOVE this Inspection record fr he job site.
PASS PART FAIL