Permit 1 CITY OF TIGARD
DEVELOPMENT SERVICES s ELECTRICAL PERMIT
PERMIT #: ELC2006 -00513
DATE ISSUED: 9/12/2006
1 3125 S H all Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S134DD-01500
SITE ADDRESS: 11775 SW TIEDEMAN AVE ZONING: R -4.5
SUBDIVISION: LOT : JURISDE56 - M_
Project Description: (1) branch circuit for water heater. Job # 1547. //YY!! RED
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:
VAN DOORNINCK, WOLTER H CONDUIT ELECTRIC EXPIRED
6555 SW DALE AVE 19461 SW 89TH AVE !!
BEAVERTON, OR 97005 TUALATIN, OR 97062 1 . 20 •0
rn
Phone: Contact #: PRI 503 - 692 -1428 V"/I / r
FAX 503- 692 -3652 V ()
N
FEES O
Description Date Amount Reg #: ELE 26 - 905C 0
[ELPRMT] ELC Permit 9/12/2006 $46.85 LIC 109669
SUP 4501S t
[TAX] 8% State Surcharge 9/12/2006 $3.75 0
Total $50.60 REQUIRED ITEMS AND REPORTS Q
CA
i
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. Al
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 - 332 -2344.
e-- r ,). ,t;,,,
Issued By: '7), Permittee Signature: 3 Q. c),\q)
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 - 6394175 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.
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: ELC2006 -00513 REQUIRED ON GREEN INSPECTION CARD.
✓ Code I Inspection Description I PASS Date I By ✓ Code Inspection Description I PASS Date I By I
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground/slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing X 120 Electrical rough -in
805 MFG- Structure grading/footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa/pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors X 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG - Structure set -up MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
I: \Building \Inspection Cards\Forms\AOP- InspCard- Blank.doc 12/09/2005
CITY OF TIGARD ELECTRICAL PERMIT
• / 0 PERMIT #: ELC2006-00513
.i DEVELOPMENT SERVICES DATE ISSUED: 9/12/2006
°�' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S134DD -01500
SITE ADDRESS: 11775 SW TIEDEMAN AVE ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: (1) branch circuit for water heater. Job # 1547.
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:
VAN DOORNINCK, WOLTER H CONDUIT ELECTRIC
6555 SW DALE AVE 19461 SW 89TH AVE
BEAVERTON, OR 97005 TUALATIN, OR 97062
Phone: Contact #: PRI 503- 692 -1428
FAX 503 - 692 -3652
FEES
Description Date Amount Reg #: ELE 26 -905C
[ELPRMT] ELC Permit 9/12/2006 $46.85 LIC 109669
[TAX] 8% State Surcharge 9/12/2006 $3.75 SUP 4501 5
Total $50.60 REQUIRED ITEMS AND REPORTS
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 - 332 -2344.
Issued By: "22, Permittee Signature: 1D e
\cc)
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.
. 2006/•SEP/12/TUE 10:54 AM Conduit Electric FAX No. 5036923652 P. 001
, .
.
. .. . • • • •
Electrical Permit Application • • • rill OFFICE USE ONI A'
City of Tigard Rea:dyed p --•• , ' -.-6 ). Ex 4. 019
D../By: , , - v
13125 SW Hall Blvd., Tigard, OR. 9"/223 rtilz , man Rel4ow
Phone: 503.639.4171 Fax 5033913.1960 I,u "" ' Dee/B - . Other Permit:
• I 1
Inspection Line: 503.639.4175 -... % - • • ...-:!.,iso- '__- Date Ready/By: • . lin El See Page 2 for
A-- : .
Internet: -www.ci.t . igard.or.us Noliged/M . ethod: Supplemental Information • _...i
:gyi :0 4'ggialiigaittO.WW..14*
El New construclion IXMAI:iotitiiieration/replacement . • • Please check all that apply
DScrvice over 225 amps, conun'l 0Hazardous location
0 Demolition 0 Other: ...,. ,..., ......., , 0 .. .... °Service over 320 amps OBuildng over 10.000 sq. ft.,
ilf4-‘:,;4 s - , ,e4 - faejiVizi4ib/OBitftlgoli.::::::-' , ..'"aV : r "-' ". of I-And 2-family .dwellings 4 or more new residential
53L,I. and 2 dwelling 0 Commercial/industrial . Accessory building 0 System over 600 volts nominal units in one structure
0Building over three stories DFccders, 400 amps or more
0 Multi-family 0 Master builder El Other: 00ccupant load over 99 persons 0Manufactured structures or
,W4*.Aft.***0.4:4070g0.0.0-07...1:"..,,I4?..W..:Wi`A,N DEgress/lighting plan RV park
011ealth-care facility 00ther: •
Job no.: i V-I - 1 I Job site address: I I - 11 S StD 7 i r A eima.n Submit3_ sets apians with any of the above. .
. City/State/ZIP: - r;iela ok._ ei -1 ?a . The above are not applicable to temporary construction service.
. iakrettr.faNtIgige-041:0004
Suite/bldg./apt no.: Project name: nemitoden I QM I Fee. I Tout I "
Cross street/directions to job site: • • New residential single- or multi-fatally dwelling unit.
Includes attached garage. _ .
1,000 sq. fL or less ' 145.15
Subdivision: ' • Lot no.
Ea. add'! 500 sq, ft or portion • 33.40 - 1
. :
Limited energy, residential ' 75.00 ' 2
Tax /parcel no
Limited encrinchon-residexidal 75.00 2 .
:&41.00.W.17%Mar•f-C-§004/44.140.#10..t4101WMMRV4..ti_q4.4jeg• Each tnanuthctured or modular
dwelling, service aod/or feeder.; • • . 90.90 . • ' 2
r CIA.; 1- I-104- _ LOCL.4 Pita_ i tr . . .: Services or feeders installation, atteradon, and/or relocation
. • 200 amps or less 80.30 • 2
' Fiq..W47:-200:4iit-tjAiya4ilithAls41e..i,:.t,i-,..:-.estIstz:isti■sticg.-41,1*,:ins i. 201 amps to 400 amps 106.85 2
_ 1 2 6 40. 6 6 ° 0 . . : -2 2
Name: Q (1\ \ vNC, . 1. n\\-t7 . 601 amps to 1,000 amps
Address: • . Q 1,000 amps or volts , . • 454.65 . 2
. • Reeonnect only 66.85 2
City/State/VP: .
• Temporary services or feeders installation, alteration, and/or
. • relocation
Phone:( ) ' -I Fax: ( • ) 200 strips or less 66.85. • 1
Owner insEallation: This instaUstion 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
.4.4■AWLO;O:ilitaettOttl4WilgqVi.Vgi:at0,40:a4g45$1.45.1.3te k Fee for branch drat:1ft with . •
.,....::.M.,.. ....-.,., ! r'”'st '', • ,•• •• : • — ••"" ••--- • •"••' •' '-'''' ' .'" '' '' ' "' ' '• service or feeder fee, each • • • • -
. 6.65 " 2
Business name!' branch circnit '
.
B. Fee for branch circuits •
Contact name: • • • without service or feeder fee, ItS
each branch circuit . I 46.85 L ---.. 2
Address: . • • • Each add'I branch circuit • : 6.65 2
City/State/ZIP: P: • Miscellaneous (service or feeder not included)
• Pump or irrigation circle 53.40- • 2
Phone: ( ) ' 1 Fax: : ( ) Sign or outline lighting , -
53.40 2
—
• E-mail: " . Signal circuit(s) or limited- •
•
„:::,,p.k,g...::., 0. ..
,...:; •••i::.4p .....:.etkuieittrsjk::. *.:.:.c:•:. .i.,:=;:t-A.•••:.7: energy panel, alteration, or
' extension. Describe: Page 2' . • 2
Business name: c i i 1
t Fir ,iq-eiC-, •
Each additional inspection over allowable in any of the above •
Address:
q /.‘2151:1)31.9____ALIC...... Per inspection • I • 62.50 .
...
Cit - YU_ n On 4-i n 1 .e_ g-101-PQ lnvestigation_per hour (1 hr trio) 62-50 •
)
iodustrialskort per boor 1 73.75
Phone: ( 4 el , — zi ;— - 78..44 : dive — ,,...,..„.;. --.-.-7-- „ .
40 A. e 1' • . ... - ..." t ;A !; ,,,,,,,,,,,,,,,,,,,,,,,,, Pagr ..$0.0 ';,... c.;.i ., !; •• • - : :: .M;':: :
CCB Lic.: icytql Elecirical Lic.: c a o pli Lic.: Z/5( )1 Subtotal I.4 i . 25
Suprv. Electrician signature, required: .., 4 Plan review (25% of permit fee)
• State surcharge (8% of permit fee)
3 !
Print mane: , e ip I , Date: • '. 7.06
• TOTAL pERMIT FEE ±;.....
• _
Authorized signature: Ibi permit application expires We permit is not aligned within 00
- 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.
inuilding■PaaniteNELC.PennitApp.doc 12/03 • . 440.461sroolo2/cow■vrta . • •
•
• . . .
r
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200 6-00513
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/12/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 . =' I �..
INSPECTION WORKSHEET FOR DATE: 10/10/2006 TIME: 7:06AM PAGE: J9
SITE ADDRESS: 11775 SWTIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE: 1
PROJECT NAME: VAN DOORNINCK
DESCRIPTION: (1) branch circuit for 7.). heater. Job # 1547.
OWNER: VAN DOORNINCK, WOLTER H, PHONE #:
CONTRACTOR: CONDUIT ELECTRIC PHONE #: 503 - 692 -1428
Inspection Request Scheduled For: Date: 10/10/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 037918 -02 503 - 430 -7856 N
Corrections/Comments/Instructions:
•
r
NO (INC iP(716(YI.k -
1
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
1 ):S FAIL XCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v • 43 Date: I opol oi Phone #: (503) 718 - VA.