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Community Develupinent ELECTRICAL PERMIT APPLICATION
13 0 Flail P' rd. _
Tigard,
G'i 972;,,3 Planck/Rec. # QS=� 7)y
Permit # F1L,'9.(- O y,�'/ _
Phone (503) 639-4171 Date Issued in - " s - 4d"
FAX (503) 684-7297 Issued by
CITY OF TIGARD TDD No (503) 684-2772
Inspection (503) 639-4175
1 Jab Address: 7 4. Complete Fee Schedule Below:
,r.
Name of Development (( � �� / �Y14IIl3 V Number of Inspections per permit allowed —
Address `� �1JV l�r? /�-1---u=-/ Service included 11'3ms Cost(pa) Sum
City/State/Zip_—r7(1,Tf'%' � CC!---`_ 4a• Residential • per unit
1000 aq if or lees $11000
or name of business i /
Each additional doral f as It or
Name
( )_ portion thereof $2600 _s
Limited Energy ,:2600
Commercial❑ nesidential(� C-t' EachFach Manu1'd Homs or Modular Z
Dwelling Service or Feeder $88 00
2a Contractor installation only: 4b.Services or FF,'adwe
Installation.alteration,or relocation 2
Electrical Contractor UI k'-E A ` 200 amps or Iess _ _ $W00 2
Address G 9c:�i S +19 )01 amps Jr.400 amps __ $80 00 2
401 amps to 600 amps _ _ $120 00 2
city ,a St,3te ZIP 801 amps Io 1000 amps $10000 _ 2
Phone No. Over 1000 amps or volts $34000 _
Contractor's License No. -7'7(o"1 Rer.onn only _— $56 00 —
Contractor's Board Reg. No. ;%�_; 76'Z r= I 4c.Temporb-y Services or Feeders I
Installation alteration.or relocation
r L 1 200 amps or Ices $50 00 '
Signature of Supr. Elec'n �� .� _ -
License No_� `I� C} Phone No. 7 -'2'2b` 201 amps to 400 amps $0500 `
401 amps l0 800 amps $10000
Over 800 amps to 1000 volts
b. For owner installations: see•b*above
- 4d. Branch Circuits
Print Owner's Name i law alteration or extension per panel
Address r—y n)T'ia lee for branch circuits with
purchase of Nrvko or baiter Ms
city --- '— each branch circuit $500
Phone No. ' h)The Ise for branch circuits wuhour
The installation is Tieing niade on property own which is port neat of aarrrce a beer Me
Fust brarx h arcim $3500
not intended for sale, lease or rent. Each additional branch circuit $5 00
l Owner's Signature4e. Miscellaneous
(Service or feeder not included)
3. Plar. P.evices section (if required): Each pump or irrigation circle $4000
Each sign cr outline lighting $4000
Signal ctn:urls)or a limited energy
Pies se cheek appropriate item and atter tee in section 58. panel alteration or extension `� $4000
4 or more residential units in une structure Mm, , e 001 $1 cc n^
Service and feeder 225 amps or more
Sy„am over 600 volts nominal 4t. Each additional inspection over
_ the allowable in any of the above
Classified area or structure containing special occupancy
as described in N E C Chapter 5 Per mages"°” $35 o0
Per hour $55 00
In Plant $55
Submit 2 sets of plans with application where any of the above
apply. Not required lot temporary construction services. I Fees:
5a. Enter total of above tees $ _ A
NOTICE 5%Surcharge(05 X total fees) $ -�--?
PERMITS BECOME VOID IF WORK OR CONSTRUCTIONSubtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED ❑ Trust Account 0 $
Balance Due $ -= -�^-
etla•MrAINWtAT RO
`LECTRICAL PERMIT ✓
CITY OF TIGARD DATPrEE=IISSUEDl:C95a1/1ET8/9C
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd,Tlperd,Oregon 97223.6190 (503)539-4171 F-'A RCEL.:
I_. it:Jh;i3L,,a:1. . . . i�_t_•i.. ' 'W 6Rt ii'vi 1�11vc_
UBDIVIGION. . . . : N0. TIGARDVILLE ADDITION AMEND. ZONING:R--4. 0
LOCK. . . . . . . , . . . I_OT. . . . . . . . . . . . . :5
Project Description : RESIDENTIAL ADDITION W/SRONCH CIRCUIT?
- --REGIDEN-r1AL UhIIT-_._._.._ -. -TF-MP RVC/FEE✓DE:RS----- ------_-MIGCIE'_L ANEC)UG_-_-_....__.
211710 -Jr-- 0R LES . . . . : 111 0 200 .amp. . . . . . , s 0 PIJMP/IRR1,.;ATTCnh.. . . .
�1
ACH ACID' L 500SF. . . 0 201 - 400 amp„ , . . . , . : 0 SIGN/OUT LINE. LTG. . : 0
IMITED ENE"RGY. . . . . 0 401 - 600 amp. . . . . . . . k� SIUNAL/PPNEl.. . . . . . . . 0
;4NF. HM/ SVC/FDR..., 0 601+amps--101 0 volts. : 0 MINOR LABEL ( 10) . . . : 0
INaF'E CTiON(; --
'W710 atop. . . . . . : 171 W/SE'RVICE OR FEEDER: 0 PER INSPECTION. . . . . . 0
11, /400 ,aml.). . . . . . , 0 1 st W/O SRV(; OR FDR. .' 1 Pr'Q 1-101JR. . . . . . . . . .. . 171
11 600 amp. . . . . . : 0 EA ADD' L ARNC'H CIRC- i. IN PL.ANT. . . . . . . . . . . : 0
h; 100Q! amp. . . . . : 0 ___......._______.__-----PLAN REVIEW
000+ amG1/volt. . . . , : 0 ) =4 RES UNITS. . . . . . . . s ) 600 VOLT NOMINAL.. . c
econTiert only. , . . . 0 SVC/F'DR > = E25 AMPS. . : CLASS ARTA/SPF:,C OCC.
nwnwr: -..__.__. _�._.___..____._... _._.._______.__..__________ FEES
X M CONSTURCTION tyre amol.tnt by (Dote rc+i^r7t
,'021 N 157TH PRMT i 40. 00 CJS 10/28/95. 95-271985
5Pr T 171
�i0 C.JS 11T/�-'A/95 9 -;�'71')nc
)RTLAND OR `37730
Torte #-
ontractor ..
& M ELECTRIC INC 3 42. 00 TOTAL
.53 N(H BAL-DW I N ST
REQUIRED INSPCCTIONF;
T l._SI�ORO FiR 97124 ('c--i l inn C:ovar, 'r'1 act' 1 Servir-1s
lone #: Wa Cover pct' 1 Final
1s permit is issued subject to the requIRtions contained in the
pard Municioal Code, State of Etre. 5oecialty Codes and all other Per m i r: i ❑na'?
,licable law;, All work will be done in accordance with
i^oved clans. This nermit will ewoire if work is not started
,hin 188 days of issuance. or if work is susoended for more
in 186 days. I s s�lecl -Ay
-..__._. ..... ._._...._...._._ -.-.-..--_OWNER INSTALLATION ONLY._...__.__ ._...._.._..
e installation is being made on nrCOptr^tv I own whi.c,h is not intended for
lease. or 7,ent.
CIWNF•.R' ,3 RS I GNATURC=: DAI E:
INSTALLATION
"SIGNATURE OF L"iUPH. rA.E'C' N: DATE:
L_I CEN'.",E NO:
Call for inspection 639--4175
---- __ _-- -- MASTER PERMIT
CITY OF T I GARD FDA11-7 ISSLIF"Z): . 1 1 .'OM/15 rn r,�.
COMMUNITY DEVELOPMENT DEPARTMENT
13125 8W Hall Blvd,Tigard,Oregon 07223.8190 (503)639-4171 P='i f2CCl._: S51 v�ti:'L�C- 04rTr!
SUBDIVISION. . . : NC). 'T'IGAP'.,VIL.LE ADDITION AMEND. ZONING: R--4. 5
BI-OC VI. . . . . . . . . . . I-CIT. . . . . . . . . . . . . :5
Remarks: 524 SQ FT ADDITION PATH I
- ------------------------------------------------------------ BUILDING -------------------------------------------------------------
REISSUE: STORIES.......: 1 FLOOR AREAS---------- BASEMENT...; 0 sf REQUIRED SETBACKS---- REQUIRED-------------
CLASS OF WORK.:ADD HEIGHT........- 14 FIRST....: 524 sf GARAGE.....: 0 sf LEFT........... 48 SMOKE DETECTIS: Y
TYPE OF USE...:SF FLOOR IOAD....: 40 SECOND...: 0 sf FRONT.........: 0 PARKING SPACE''
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT; 0 sf RIGHT.........: 28
OCCUPANCY GRP.:R3 BDRM: 3 BATH: 1 TOTAL------: 524 sf VALUE-$: 33&2 REAR..........: 99
--------------------------------•------------------------------- PLUMBING -----------------------------------------------------------------
P ws.......... n. WATER CLOSETS,: 1 4ASHINS MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 1 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 St RAIN DRAINS: 0 CATCH BASINS..: 0
TUB/SHOWERS...: 1 GARBAGE DISP..: 0 WATER HF.ATERS.1 0 WATER LINE ft: 0 BCKFLW PREVNTA: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
-------------------------------------------------------------- NEC14ANICAL --------------------------------------------------------------
FIIEL TYPES----------- FURN ( 100K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....- 1 CLOTHES DRYERS: 0
/GAS/ ! / FURN )=100K ..: 0 UNIT HEATERS..: 0 HOODS.........- 0 OTHER UNITS...: 0
MAX INP.: P BTL' FLOOR FURNACES: 0 VENTS.........: 4 WOODSTOVES.... : 0 GAS JLITLETS...: 0
---- - --- ----------------- -..---------------------------- ELECTRICAL -------------—-------------------------------------------------
--RESIDENTIAL UNIT--- ---SERVICEI FEEDER—-- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS--
1000 SF OR LESS: 0 0 - <'00 ago..: 0 0 - '00 apo..: 0 W/SVC OR FDA..: 0 PUMP!IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 201 400 ago..: 0 201 -- 400 ago..: 0 1st W/0 SVC%FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR...... : 0
LIMITED ENERGY.: 0 401 600 amp..1 0 401 - 600 amp..: 0 EA ADDL BR CIA: 0 SIGNAL/PANEL... : 0 IN PLANT......: 0
MANE HM/SVC/FDR: 0 601 1000 amp.: 0 601+amps-1000 v: 0 MINOR LABEL -101 0
1000+ amp/Volt.: 0 ------------------------------------ PLAN REVIEW SECTION ----------------------------------
Reconnect only.; 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS ARER/SPC OCC:
---------------------------------------------•------ ELECTRICAL -- RESTRICTED ENERGY -----------------•--------------------------------- -
A. SF RESIDENTIA,L---------------------------- B. COMMERCIAL------------------------------------------------------------------------------
AUDIO 4 STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM...., : INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..- DTH: s- BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: :'
HVAC...........: DATA/TELE COMM. : NURSE CALLS....: TOTAL # SYSTEMS: 0
Owner: ---------- --------------Contractor: - ----- ------- - --- TOTAL FEES:4 421.51
KA1Al.IN RATKAI CHRISTIAN CONSTRUCTION CO
6222 SW EDGEWOOD 5T 2580 SW GARDEN VIEW AVE
LAKE OSWE60 OR 97033 PORTLAND OR 97,,'25
P1,a^o N: 639-7441 Phone tt: 203.1088
Reg A..: 95606
This permit is issued Subject tc the regulations contained in the Tigard Municipal Code, State of Ore. Soecialtv Codes and all ott-!
aloclicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started withil 1R0
days of issuance, or if cork is suspended for more than 180 days.
--------------------------------------------------------•- REQUIRED INSPECTIONS --------------------------------___.--------------------..
Footinq Insp PLM/'Jnderfionr Framing Insp Electrical Final
Foundation Insp Mecha,.ical Insp Low Voltage Mechanical Final
Post/Beam Struct Plumb Too Out Insulation InsD Plumb Final
Rest%Beam Mechan Llectr,cal Servi Gyp Board Insp Building Final
Crawl Dre'n Electrical Rough Rain drain Insp Erosion Control _
mi.ttee Sinn atr-ti"e. : �' I,s,_red 'tom
ion 639- 4175
Residential Building Permit_. Application
City of Tigard
13125 SINHall Blvd. `�-
Tigard, OR 97223
(503) 639-4171
Jobsito Address: I(`� ✓J '� SLI �T t�'� i ' v Y � �
Subdivision: _ Lot #
Office Use Ong
40: G
Valuation: ' O 7 C,:ntact Date / / Initials _
Result
New Construction Only: (Square Footage)
Planck/Rec #
";) Permit # ry�3
House - --- Garage Reissue of
Corner Lot? Y %:l Flag Lot? Y C Z apeys
& TL #��C>'�Jg;t - ^o< <�o
Plat
Owner: . �' nJi A- t, # l��a��.'�/r (`� -���
Address ro,?t?W, � Approvals Required
Planning Setbacks(' SolarCt` r _- l (�
Engineering
Phone: ( ���) (� � G������ Other
Contractor:
���- ,tit C�`�_212 �4,. Items Required
t-� c-44 Subcontractors
Addressto Qf�1 V ( �►`" �� Truss Details
Other
Phone: Notes
Contractor's License # U �Q �)) r- V ��� jot-IT
ot�T�' �
attach copy of current Oregoq license)
Contact Name: r7 2tA. /3 �l'77
Contact Phone fQ
Subcontractors: r: f'��,,-r�P d Architect/Enginee ��� E'I�-� (�� >��/�/ �111C
Plumbing: �7(f7�.-t"�sJ ( LU M ' ,g=1G-- (ILt Address: _����T�U, F_�L'�� L —
sC c/ - �'7 r7
Mechanical: , Ad'�Z �� � � � ( ?
(attach copy of current OR Contractors License)
Phone: ��
JOB DESCRIPTION: 4A 661 -C/y TV
r.
Applicant Si na Applicant Phone number
Received by Date Recei,
Permit ;$ Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (nUILC) ,,L c _
Plumb. Permit (PLUMB)
Mech. Permit (!AECN) D
State Tax (TAX)
Bldg: /0-55 5
Plumb:
Meth:
Pian Chick (PLANCK)
Bldg:
Plumb:
�o 4, 3
Mech:
Sewer Connection (SWUSA) .�
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutional TIF (TIF-IS)
Office TIF (T,�-(.;)
Water Quality (.WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntri Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck!COT (EROSN)
TOTALS:
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wfe7-iV P- / 9947,41 L) +4 l
gr'o-kP o-P 7?Ar tiFLA,./
A-D �Y71 CA) b4i 1/3(57-7-
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