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11905 SW Fonner Street
CITY OF TIGARD 24-Hour
BUILDING Inspection Linb: (503)639-4175
MST
INSPECTION DIVISION Business Line: X503)639-4171 _—
BUP
Received _--_-_ ____ ")ate Requester AM— PM_.._ _. EIUP
Location
�._ _ 1� -- �.}_ '�� Suite--- ----- .- --- MEC -----------
Contact Persor. __-- - -- - -_�_ ---.-._ ( ) --
- -- - -- ------ PLM ------------
Ccntractor - - ------ Ph-- _ Ph( �) _`. SWR — --
BUILUING ----- TenanUC�aGI > - --- C � ...1�__.?0 .�S�(o U (�LC�
Fo0ng
Foundation ELC _—
Access:
Ftg Drain ELF!
Crawl Drain
Slab Inspection Notes: /1�' SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing - - - -
Insulation
Drywall Nailing -,—
Firewall -- - - — �i
Fire Sprinkler --- { —
Fire Alarm I ��
Susp'd Ceiling - - — - -
Roof
Other: -- -- - _
Final
FASS PART FAIL
PLUMBING
Post&Beam
Under Slab --------- — -
Rough-In
Water Service I -
Sanitary fewer
Rain Drains --
Catch Basin/Manhole
Storm Drain - -
Shower Pan
Other: -
Final
PASS PART FAIL I
MECHANICAL
Past&Beam -
Rough-Ir - -- - - _ --- _--
Gas Line
Smoke Damper, - -----
Final
- iT FAIL -- - - - --
ELECTRI T --
Roug - n - -- - -
UG/Slab -- - - -
Low Voltage I
Firer Alarm - - - -
Final Reinspection fee of�_ required before next inspection Pay it City Hall, 13125 SW Hall Blvd
` PART FRAIL
SITE Please call for reinspection RE:._ __ .-_- L 1 Unable to inspect -no access
Fire Supply Line
ADA // (�
/ _
Approach/ idowalk I Dat V J__ _'� d - Ins �_ J.' `,` ,'� • -:-- Ext ---
Other
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF T I GA R D ELECTRICAL PERMIT
PERiMIT#: ELC2003-00195
DEVELOPMENT SERVICES DATE ISSUED: 4/4/03
13125 SW Hall Blvd.,Tigard OR 9723 (503) 639-4171 PARCEL: 2S103BD-03700
SHE ADDRESS: 1 1905 SW FCNNER 5T
ZONING: R-4.G
SUBDIVISION:
BLOCK: LOT: JURISD:t;TION: TIG
r Project Description. Install 200amp service replacement and (13)branch circuits.
Vi RESIDENTIAL Ulllf _ _ TEMP SRVC FEEDERS MISCELLANEOUS
_
1000 SF OR LESS: ____ 0 Y 200 amp: ^� PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG--
LIMITED
TG:LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANE HM/:,VC!FDR: 601+amps -1000 volts: MINOR LABEL (10):
SERVICEIFEEDER BRANCH CIRCUITS ADD'L WSPECTIONS
0 - 200 amp: 1 W/SF RVICE OR FEEDER: 13 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: — ^_ i_ � PLAN REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: JC/FDR>=2.25 AMPS: i CLASS AREAISPEC OCC:
Owner: Contractor:
JUSTIN BRUMMETT OWNER
11905 SW FONNER ST
TIGARD,OR 97223
Phone: 503-624-0301 Phone:
Reg #:
FEES_
Description Date Amount
_ Required Inspections
If.I.PRMTIEiLC'Perr,iit 4/403 $126.85 V
TE_—ug 8%State Tax 4/4/03 $10.15 � n
leot'I Service
I:I.PRMTI ELC Pennit I0/14/03 $39.09 Elect'I Final
(additional fees not lislcd here)
Total $180.09
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 accrrdance with approved plans. This permit will expire if work is not started wHhin 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: �?✓?�YYV — Permit Signature:
OWNER INSTALLATION ONL`f _,_�_
The installation is being made on property I own which is not intendlad for sale, lease, or rent.
OWNER'S SIGNATURE: ___ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNAMPE OF SUPR. ELEC'N: —_�_ DATE:
LICEbISL NO:
Call 639-4175 by 7:00pm for an Inspection the next business day
Electrical Permit Aixcation 'FFICEArSE ONLY
_---�_ Recrived J Electrical
Date/Ry: 0 ( a Permit No.: _
It Oi i and Planning Approval Sign
S Date:B : Permit No.
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/Bv: Permit No:
Phone: 503-639-4171 Fax: 503-598 1960 ,.. Post-Review Land Use
Dste/By: _ Case No.:
Internet: www,ei.tigard,or.us Contact i Juris.: EFSee rag,•2 for
24-hour Inspection Request: 503-639-4175 Name/Method 1Supplemental Information.
TYPE OFWORK PLAN REVIEW Please,.heck all that apply)
New construction �� Demolition Service over 225 amps I lealth-care facility
commercial ❑Hazardous location
AddltlOn/alteration/replacemen. ❑ Other: ❑Service over 320 amps-rating of" ❑Building over 10.000 square fee(,
CATEGORY OF CONSTRUCTION I &2 family dwellings four or more residential units is
1 & 2-Family dwelfirill 0 Commercial/Industrial ❑System over 6f N)volts nominal one stmcture
AccessoryBuil Multi-Family ❑Building over three stories ❑Feeders,400 amps or more
_ ❑Occupant load over 99 persons ❑Manufactured structures or RV park
Master Builder El Other: ❑Egress/lighting plan ❑Other
JOB SITE INFORMATION and LOCATION Submit`sets of plans with any of the above.
The above are not applicable to temporary,mustruction service.
Job site address: �lqo� <<,� �,- I'- V FEE*SCHEDULE
Suite#: B1�./Apt,#: ` Number of insseec_tions der permit allowed
Project Name: Description QIN Fee(ea.) Total
Cross street/Dir Cti0115 t0 job site: New•esidentfat-single or multi-family per
1 dwelling unK Includes atlarhed garage.
yT l� Service Included:
7/ 1000 sq n.or less 145 15 4
Each additional 500 sq.ft.or portion thereof 33.40 1
Subdi��isfon: Y r[,ot#: Limited energy,residential _ 75.00 2
—__ Limited energy,non residential 75.00 2
Tax map/parcel #: Each mare.factured home or modular(I(selling
DESCRIPTION OF WORK service and or feeder 90.)0 2
Set vice%or feeders-ftnlaliation,
alteration or relocation:
2W amps or less 8030 2
_— 201 amps to 4W amps 106.85 _ 2
401 amps to 600 ams —` 160.60 _ _ 2
PROPERTY OWNER TENANT
601 amps to I0t10 amps V 240.60 2
Over 1000 ams or volts __ 454.65 1 2
Name: nl _ 66.85 2
Address: 1 1- 10,5 5a ��,u, � remporary services or feeder%-installation.
altCity/State/Zip: 2W amps
oon, le relocation:
7 Z 3 2lN)amps or less 66.85 I
Phone:S- -s-try-5:3 nl Fax: 2(11 amps to 4110 amps _ — 100.30 '-
APPLICANTCONTACT'PERSON 401 to 600 amps _ 133.75
rName — Branch circuits-new,alteration,or-
Name:
: extension per panel:
—-- "� — A.Fee for branch circuits with purchase of
Address: _ service or feeder fee,each branch circuit 6.65 _ •—
City/State/Zip: B.Fee for branch circuits without purchase of
service or feeder fix,first branch circuit 46.85 _ _'-
Phone: Fal' Each additional branch circuit 6.65 __
E-mail: !fisc(Service or feeder not included)
CONTRACTOR Each pump or irrigation circle 53.40 2
-- -- -- Each sign or outline lighting 53.40 2
Job No: -4j-, 6_12 Signal circuli(%)nr a limited energy panel,
_ alteration.or extension Page? 2
Address:
Business Name: NSef;p,;on, -- --
_
Cit /Stan'/Zi _— Each additional Ins ep ction over the allowai.lr in anv of the above:
Per inspection per hour(min. I hour) h2.50
Phone: _ Fax: Investigation Fee
CCB Lic. #: Lic. #:--- — Other _
-- Eledrica!Perm:t Fm*
Supervising elcetrician _ -_` Subtotal S ,J p
si naturo required: _ Plan Review(250'o of Permit Fee) S
print Name:_ Lic. #: -� _—. _ State Surcharge t8%of Permit Fee S
— -- 'TOTAL PERMIT FEE I S 14
Authorized Notice: This permit application e•(pires It a permit Is not obtained within
Signature: _ bate: J / :1 180 dad�,after It has been accepted es complete.
*Fee methodology set by Tri-(bunk Building Indusir% Seri ice Itoard.
-— - jLAC
(Please print nae) ,c-a t ""-
i'Dsts\Pcrmit Fwms\ElcPermi App.doc A 03
i
Electrical Permit ,Xpplicat,*un - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for till systems........................................................... $75.00 �ff
Check type of Work Involved: t
W
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ (jarage Door Opener*
❑ '
Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
Other
COMMERCIAL WORK ONLY:
Fee rot each system.......................................................... $75.00
(SEE OAR 91 8-2(10-260)
Check Type of Work Involved:
Audio and Stereo Systems j
❑ boiler Controls t�
Clock Systems
Data Telecommunic ttion Installation
Fire Alarm Installation
r
HVAC
instrumentation
i
Intercom and Paging Systems
I
❑ Landscape Irrigation Control*
Medical
❑ Nurse Calls
Outdoor Landscape:.ighting*
Protective Signaling
othct
Number of Systems
* No licenses are required. Licenses are required for all
other Installations
r Dsts,Permit F)ms\ElcPermitrlppPg2.doc 01'0?