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8885 5W Hamlet
CITY OF TIGARD ELECTRICAL PERMIT
L• PERMIT#: ELC2003-00169
DEVELOPMENT SERVICES DATE ISSUED: 3/26/03
13125 SW Hall Blvd., Ticiara, OR 97223 (50 316?9-4171 PARCEL: 2S111DD-03300
SITE ADDRESS: 08885 SW HAMLET S7
ZONING: R-4.5
SUBDIVISION: STRATFORD
BLOCK. LOT : 0<15 JURISDICTION: TIG
Project Description: Alteration of(1)branch circuit.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: V 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):
SERVICEIFEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 200 amp: WISERVICE 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 amt:. _ PLAN REVIEW SECTION
1000+ ampivolt: -4 RES UNITS: ---;'660 VOLT NOMINAL:
Recomiect only: _ SVC/FI? '> 225 AMPS: 4 CLASS AREA/SPEC OCC: _ —
Owner: Contractor:
PEARSON,RICHARD E+MARY A' V TR OWNER
888G SW HAMLETS
TIGARD,OR 97224
Phone: Phone:
Reg #:
F------ _ FEES-------.�—�_
Description Date Amount
Required Inspections
I PRN!11 I.L(' I'l'i'nlit ' 'r til $46.85 — ---�--
1
IA X 18'.,State lax 3 20 ti t $3.75 Rough-in
i - Elect'I Final
Total $50.60
This Permit is isso9d 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
1.800-33'2.2344.
,,
Issued Ely: , i~ CPermit Signature: ,�,�•,�2'fs� I �"L-r2as-.
OWNER INSTALLATION ONLY
The installation is being made on nronprty l own which is not intE tided for sa'e, lease, of rent �7
OWNER'S SIGNATURE: -4c'r- ftw- 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
41
Electrical Permit Application
— Received a Electrical
Date/By: O� /�' Permit No.: �
City of Tigard Planning Approval Sign
y g Datc/B : Permit No.: _
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 DateB Permit No.:
Phone: 503-6394171 Fax: 503-598-1960 Post-Review Land Use
DatcBy: Case No.:
Internet: www.ci.tigard.or.us Contact Juris: See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental information.
^_ TYPE OF WC_R_ K PLAN REVIEW Please check all that apply)
1�leW COt]Shruction Demolition Service over 225 amps- 0 Health-care facility
commercial El hazardous location
Addition►/alteration/replacement Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I&2 family dwellings four or more residential units in
1 &2-Family dwelling _ F1_ Commercittl/Industrial ❑System over 600 volts nominal one structure
❑Building over three stories ❑Feeders,400 amps or more
Accessory Bu___- Multi-Family �.__ ❑Occupant load over 99 persons ❑Manufactured structures or RV park
_ Master Builder__ 011ier: ❑Egress/lighting plan ❑Other: _
JOB SITL INFORMATION and LOCATION Submit`acts of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: t s k. "" '`'r' FEE*SEHEDULE
Suite#: Bld ./A t.#: Number of Ins ections per permit allowed
Project Name: Description Qty Fee(ca.) F Total
IT
New residential-single or nrolll-famlly per
Cross street/Directions t0ob site:
J dwelling unit.Includes attached garage.
HV-i r r/ Gr r/ >w Service Included:
"c /
r ^ �� o �., /f �. 1000 sq.fl,or leas 145.15 4
Each additional 500 sq.fl.or portion thereof 33.40 1
Limited energy,residential 75.00 2
Subdivision:
Lot#: Limited energy,non residential 75.00 1 2
Tax map/parcel M Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders-Installation,
/I i, r r , t'ralteration or relocation:
200 amps or less 80.30 2
201 amps to 400 ams 106.85 2
r< r� i„/,r h r f s,•' 401 ampsto 600 ams 160.60 2
PROPERTY OWNER _707i ENANT _ 601 amps to 1000 amps 240.60 2
Ov_r 1000 amps or volts 454.65 2
Name: /ti t r/I o / r;' r O P, _ Reconnect only 66.85 2
Address: 8 F s H /f femporary services or feeders-Installation,
_ alteration.or relocation:
Cit /State/Zi 210 amps or less 66.85 I
Phone: ? Fax: ?o,ampto 400 amps 100.30 1
t01 to 600 amps 133.75 2
APPLICANT CONTACT PERSON
-- Branch circuits-new,alteration,or
Name: extensicn per pane!:
A.Fee for branch circuits with purchase of
Address_: servi:e or feeder fee,each branch circuit 6.65 2
City/State/Zip: d.Fer for branch circuits without purchase of
---- — service or feeder fee,first branch circuit 46.85 2
Phone: Fax: _ Each additional branch circuit 6.65 1 2
E-mail: Misc.(Service or ft:eder not included):
CONTRACTOR Each um r itrigatian circle_ 53.40 2
Each sign or outline lighting 53.40 2
Job No: _ x Signal circuit(s)or a limited energy panel,
Business Name: !Iteration,or extension P 2
_ Description
Address: -
Each additional ins�r_e_ctlen over the allowable in any ofthe drove:
City/State/Zip: Per it apection per hour(min. i hour _ 62.50
Phone: _ Fax: lovestigation fee:
CCB L1c. #: �LiC.#: Othnr_
_ -
Electrical Pprintt Fel, * _ __
Supervising electrician subtotal S
si name required: Plan Review(25%of Pennit Fee) $
Print Name: Lie. #: State Surcharge 8%of Permit Fee S
TOTAL PERMIT FEE $ 9 L C
Authorized f, Notice: This permit application expires if a permit is not obtained within
Signature: ,`[c� ` �"'a` '_ bate: 180 days after It has been accepted as complete.
I *Fee methodoloRv set by Tri-Count)Building Industry Service Board.
(Please print name)
i•\bits\Permit Forms\F!,PermitApp.doc 01103
t�tstt�st�ttatr
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Feefor all systems............................................................ S75.00
Check Type of Work Involved:
L_.J Audio and Stereo Systems*
F] Burglar Alarm
Garage Door Opener*
I leating,Ventilation and Air Conditioning System*
vacuum Systems*
Other
COMMERCIAL WORK ONLY:
Fee for each system.......................................................... $75.00
(SEE OAR 918-260-2(,0)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
CJ Intercom and Par.ing Systems
ElLandscape Irrigation Control*
Medical
Nurse Calls
0 Outdoor Landscape hghtitig*
Protective Signaling
Other -- — -- — -- —
_____Number of Systems
* No licenses are required. Licenses are required for all
other Installations
1\Dsts\Pe"mt t orms\LlcPermnAppPg2 doc 01 03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BLIP -- ---- ----
Received - o _Date Requested_. :3 AM___ PM BLIP
Location 4�� —Suite - _ MEC
Contact Person -__ Ph(. ) 1(+,;L D-(a 7)?4 PLM _
Contractor _ _ -. _ Ph( —) _. -- SWR --
BUILDING - Tenant/Owner —__._- ___ ELC �✓ ��U_l _
rooting ELC
Foundation Access:
Fig Drain ELR
Crawl Drain - -- --_---
-- —
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors c� -
Ext Sheath/Shear
Int Sheath/Shear
Framing -- -—
Insulation
Drywall Nailing
Firewall
Fire Sprinkler - - - —
Fire Alarm
Susp'd Ceiling
i
Roof
Other: --
Final
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 Dampers —--- -- —- -
Final
PASS PART FAIL — -------- -- -- —
ELECTRICAL
Servic
UG/Slab
Low Voltage
Fire Ajprm
PART FAIL ElReinspectieon fee of 3 required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
aPA -
.
Please call for reinspection RE:_ _— Unable to inspect-no access
Fire Supply Line
ADA / -,
Approach/Sidewalk Dats / Inspector _ _ Ext
Other: __
Final DO NOT REMOVE this Inspection record from the)oto site.
PASS PART FAIL.