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1577,3 SW GREENS WAY
CITY Or. TIGARD
ELECTRICAL PERMIT
T 1 i_ PERMIT#: ELC2003-00696
DEVELOPMENT SEPVICES DATE ISSUED: 12/1/03
13125 SbV Hall Blvd.. Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S111CC 08200
SITE ADDRESS: 1577.5 SW GREENS WA) ZONING- R-12
SUBDIVISION- SUMMERFIELD NO.2
BLOCK: LOT : 109 JURISDICTION: TIG
Project Description: JOB NO 4217 Install outlets an, iig',ts
— RESIDENTIAL UNIT TEMP SRVC/FEEL-' -_ _ IWc'-CELLANFOUS
— 1000 SF OR LESS:— 0 - 200 amp, PUMPIIRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGI41OUT LINE L.fG:
LIMITED ENERGY: 401 600 amp: SIGNAIJPANEL:
M<,NF HMI SVC/FDR: 601+amps- 1000 volts: MINOR LABEL (10):
SERVICEIFEEDE.R BRANCH CIRCUll3 ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st WIO SRVC OR FDR: 1 FER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 •• 1000 amp: _ _PLAN REVIEW SECTION
1000+amp/volt: >=,d RES UNITS- >600 VOLT NOMINAL:
Reconnect only: SVG/rOR_=225 AMPS: C'.ASS AREA/SPEC OCC:
Owner: Contractor:
MEIER,MARVIN F+IMOGENE N TRS WILLAMETTE ELECTRIC INC
15775 SW GREENS WAY PO BOX 230547
TIGARD,OR 97224 TIGARD,OR 97281
Phone: 503-684-0320 Phone: 503-624-3631
Reg t#: LIC 7509
------- --- SUL' tuficc
FEES _ _ rLf 34-281r
Description Gate Amount
_ Required Inspections
I HIRM-1 I GL('Pernul I' I ui $46,85. - �------- -�� -
(I A\j S"i Stine Surcharge I_I n — $3 75 i Flrtct'I Incl
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
wort,will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuen e,or if work Is suspended
for more than 180 days. ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utllity Notification(;enter Those rules are set
forth in OAR 952-001-0010 through OAR 952-001-0100. Yoi .aav obtain copies of these rules or direct questions to OUNt,o:(573):46.6699 or
1.1300-332-2344.
199op.+ By: �!! Permit Signature'— —
OWNER INSTALLATION ONLY _
The installation is being made on property I own which is tiot intended for sale, leant, nr rent
OWNER'S SIGNATURE �____—_ _ DATF —_
OONTRACTOR INSTALLATION ONLY
G-- — .ii
SIGNATURE OF SUPR. ELF.0 N _-__— DATE:
LICENSF NO: L
Cal; 639-4175 by 7:00prn for an inspection tire next business day
Electrical Permit ADWicatioll
Received Electrical
Dete/B : -b Permit
Planning Approval WSinn
Aty Ol Elgin-!d Date/By: Penni*.No
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Dr/By: Permit No.
Phone, � )'•-639-41': Fax: 503-598-1960 Po.t-Review Lmd Use
Date/By: Case No
Internet- www.ci.ti ard.onus
g Contact Juri;.: See Page,_for
24-hour Insp;ction Request: 503-639--1,!75 Name/Method: Supplemental Information.
TYPE OF WORK —_ PLAN REVIEW P!s:.e check all that apply)
New construction _ Def u)Iltion __ Service over 2:5 amps- Health-care facility
commercial ❑Hazardous location
Addition/alteration/replacement Other: _ ❑Service o.er 320 amps-rating of ❑Building over 10,000 square feet,
C/,TEGORY OF CO'4STRUCT_ION _ I &2 family dwellings four or more residential units to
' �• ❑System over 600 volts nominal one structurc
—1 && 2-Famil , dwellia ommercial/Industrial — g ❑Feeders,4a)am
ACCeSSO Bulldin r Multi-Family � ❑Building over three stones amps or more
!y Bu Id_�— _— ❑Occupant load over 91 persons ❑Manufactured structures or RV park
Master Builder Other: ❑Egress)ighting plan ❑Othc,:
JOB SITE INFORMATION and LOCATION Submit._sets of plans with any of the above.
The above are n�'Mplicable to temLorarvv ccmtruction servi.e.
Job site address:_ J`7 S'e, U1" _ FEE*SCHEDULE
Suite #: — Bld ./A t.#: _ Number of Ins ections er ermit allowed
Project Name:
Description Qty Fee(ea.) Toth
Cross StrPPt/Directio SstO Ob site- New rng unit.Incingle or tachemultigara' per
dwelling orad Include.ritached axraup
Service Included: 11
1000 a R.or less__ 145.15 4
Each additional 500 sq.it,or portion thereof 33.40 I
Limited energy,residential 75.00 2
Subdivision: LOt#: Lim ted energy,non residential 75.00 7T2
Tax map/parcel #: Eacl.manufactured home or rrio&iar dwelling
DESCRIPTION OF WORK servic.•and or feeder 9090
/IQ servicrs or feeders-Installation,
___ 1...n t•LX t __� T to t S / alteration or relocation:
200 ams or less _ 80.30
_,_— --.-_ _--.-- 201 amps to RX)amps luc.RS_ -- 2
401 qmps to 600 ams iW.60 2
PROPERTY OWNER TENANT 601 ems to Hxw amp! 240.60 2
r Over I(XN)amps or volts _ 454.65 2
Name: �rl�tf� tL�L- jj.(�L; Reconnect only 66.85 2
Address: Temporary services or feeders-Installation,
-- -- alteration,or relocation:
City/State/Zip: _ 2(N�i:ys nr less 66.85 1
Phone: /C F, i 4i_� `I Far: ,OI amps:,4a)ama_--_ 100.30 2
401 to 60x1 at ips 133.75 2
APPLICANT _ CONTACT PERSON Brat/ rch circuits-ncw,altcralion,or
Name— -xtension per Iionel:
--- A Fee for hranc i circuits w••k purchase of
Address: _ J —_ _ __ _ s-rvice or ree drr ree.each branch circuit 6.65 2
City/State/Zip: B.Fee for branch circuits without purchase of
service or feeder fee,First branch ow.uit 46.85 2
Phone: _ Fax: Each additional branch circuit 6,65 _ 2
E-mail: Misc.(Service or feeder not included):
-- Each rump or irrigation circle _ _ 53.40 2
_ CONTRACTOR Each sign or outline lighting 53 40 2
Job No: u 7 I } _ Signal circuit(s)or a limited energy panel
Business Name: r ���r �Xlr �� ` alteration or extension Page: 2
Address: P 6)/3 r,' - �*?d -4?
City/State/Zip: rT 1 Each additional L:spection over the ailr•wablr In any or the abode:
r .jL�_ Per inspection pe,hour Imin. I how I— — 62 50
Phone: L,? u I Fax: 4 "?Cf 3S — Investigation fee:
CCB Lic. #: 3 r LIc. #: i�t ?f 7 t- other:
�—�� Electrical Permit Fees*
Supervising electrician A Subtotal S / f
signature ret wired41w. } C Plan Review 2S of Permit Feel S
Print Name: �, iC. #: q 5'-,� State Surcharge(-8°b of Permit Fee) S
_ TOTAL PERMIT FEE I S —
Authorized %atice: This permit application expires If a permit Is not obtained vdihin
Sig/ature — _ Date: _ IRO days after it has been accepted as complete.
*Fee methodology set by Tri-Counh Building Industry Service Board.
(Please print name)
i'Dsts'Permit Form ElcPernutApp.doc ')1 03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PE"11T FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems......... .................................................. $75.00
('her!.Type of Work Involved:
Audio and Stereo Systems*
J Burglar A;ann
LI Garage Door Opener*
F1 I lcating,Ventilation and Air Conditioning S/stem*
Vacuum Systems*
LJ Other -- ----- ----
COMMERCIAL WORK ONLY:
— ---- -----
Fee for each system......................................................... $75.00
(SH.OAR 918.260-260)
Check Type of Work Involved:
Audit)and Stereo Systems
"Ander Controls
Clock Systems
❑ Data Telecommunication Installation
Fire Alarm Installation
❑ IIVAC
u Instrumentation
U Intercom and Paging System.
Landscape Irrigation Control*
Medical
Nurse Cells
outdoor Landscape Lighting"
Pnrtective Signaling
i� other
Number of Systems
* Nc-licenses are require.(. licences are required for all
other installations
C,Dst0ermit formv\ElcPermitAppPg2.duc 01103
CITY OF TIIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Llne: (503)639-4171BILIP
Received ____ Date Requested.--l-2 _ 9 AM---- PM.__ BUP
Location Suite__-__ MEC --
�`- -
Contact Person _-- Ph(-- ) ._----- PLM
Contractor Ph( _) _�I_._:,'�� _ SWR
BUILDING Tenant/Owner -_ __ .___� _ ELC
Footing ELC
Foundation Access:
Ftg Drain E►.R -
Crawl Drain
Slab Inspection Nates: SIT --
Post&Beam -------- —--- - - _
Shear Anchors - -
Ext Sheath/Shea
Int Sheath/Shear
Framing - - -- -------_ - -
Insulation
Drywall Nailing - - --- - ---- -_... - -- --- - --
Firewall
Fire Sprinkler - - --- --- --- -- - -- -- --- - - - -
Fire Alarm
Susp'd Ceiling -
Root
Other. - ---- - _-_ __-- -- --- -- --
Fina!
PASS_PART FAIL.
PLUMBING _ _
Post&Beam
Under Slab ----
Rough-In
Water Service - --- - ---
Sanitary Sewer
Rain Drains --------- ------ --
Catch Basin/Manhole
Storm Drain - - - --- --
Shower Pan
Other: - --- - --- ---
Final
PASS PART FAIL -
-- -
MECHANICAL
Post& Beam
Rough-In
Gas Line
Smoke Damper - - ---- ---- --__-__--
Final
PASS_ PART FAIL - --
ELECTRIC_ AL -
Rough-In
UG/Slab
Low Voltage
F' Alarm rr��
1SASI PART FAIL L� Reinspection fae of$—_ _-- required before next inspection. Pay at City Hal! 3125 SW Hall Blvd.
V
Please call for reinspection RE:- -_. F Unable'o inspect-no access
Fire Supply Line
ADA Data 4'--.._�.. Inspector_ - _--- s-_ Ext
Approach/Sidewalk
Other:
Final 10 NOT IREMOVr. this Inspection record front, the Job site.
PASS PART FAIL