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11505 SW MANZANITA ST
ELECTRICAL PERMIT
�'�� O e ® PERMIT ELC2000-00002
DEVELOPMENT SERVICES DATE ISSUED: 1/3/00
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.1171 PARCEL: 1S134CA-00525
SITE ADDRESS: 11505 SW MANZANITA ST
SUBDIVISION: PANORAMA NO.2 ZONING: R4.5
BLOCK: LOT: 346 JURISDICTION: TIG
Project Description: Install 2 branch circuits in single family dwelling.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ MISCELLANEOUS
1000 5F OR LESS: amp: /
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
MANF HMI SVC;FDR: 601+amps -1000 volts: MINOR LABEL (10):
SERVICEIFEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W/SERVICE OR FEEDER_
201 - 400 amp: let W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp/volt: -->>=d3rTJNR'S >600 VOLT NOMINAL:
Reconnect only: SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
Hr:L, CHARLES M CANBY ELECTRIC INC
PA I"RICIA A 790 S IVY
11505 SW MANZANITA CANBY, OR 97013
TIGARD, OR 97223
Phone: Phone: 266-7878
Reg#: LIC 000260 V 1�1!R I G I'N/LA,1,L
SUP 2123S
ELE 3-112C
- FEES Required Inspections
Type By Date Amount Receipt
Elect'I Service
PRMT KJP 113100 $43.85 HAIVD REC Elect'I Final
5PCT KJP 1/3/00 $3.43 HAND REC
Total $46.28
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specialty Codes and AN other applicable laws. All
-Mork will be done in accordance with approved plans. This permit will a)pire if work is not started within 180 days of issuance,or if work is suspended
a 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 952-001-0080. You may obtain copies of these rubs or direct questions to OUNC at(503)246-1987.
PERMITTEES SIGNATURT .� ISSUED BY
OWNER INSTALLATION ONLY
LU The installation is being made on property I own which is not intended for sale, lease, or rent.
.�I
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: Cy ��„�,eCc_ �-t>`-J DATE:—.1123 0
LICENSE NO: '37 / '2 �S
Call 6394175 by 7:00pm for an Inspection the next business day
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd, RECEIVEpp,
Tigard, OR 97223 t"lanck/Rec. #_
Phone (503) 639-4171 JAN - 3 26jrmit #
te Issued
CITY OF TIDARD FAX (503) 684-7297 "pd by
TDD No. (503) 684-2712MMUNITY DEVELOPME11
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development I Number of Inspacttone per permit allowed
Address I +j O S S ,1) . ,,,3 Qr.i�T f' Service included: Items Cost(es) Sum
City/State/Zipq 4s. Residential-par unit 4
1000 sq It or lass $1 to 00
Name (or name of business) Fach additional 500 aq 11 or
portion therod $2500
Commercial❑ Residential Limited Energy $2500
Each Manor("d t4ome or Modular 2
Dwelling Servide or Feerfar IN 00
2a. Contractor Installation only:
Ib.Servicers or Feeders
Installation,sltaration.or relocation 2
Electrical Contractor �)ioA4 V ke kwy- -E e 200 amps or Woe sm 00 2
Address 11 . 'rg — 201 amps to 400 amps 580 00 2
City State_ Zip_.CM o 1 3 �) sol amps to IWOa 600 pre $180000 '– 2
Phone No. 2 6 ib :a I � �_/_ Over 1000 amps or volts $34000 _ 2
Contractor's License No._ 3 \ \Z L I��° Reconnect only $5000 ----
eX
Contractor's Board Reg. NO.�a (,Ls Z 1 t�0 4c. Temporary Services or Feeders
Installation.alteration,m relocation 2
Signature of Supr. EIec'n c -,—'-j .�..-; 200 amps or less $5000 2
License No. "Z k 1'3 'S Phone No.?L h..1 b 7_g � 201 amps to 400 arr 117s oo � 2
401 amps to 800 a SIM 00
OverWo amps to r volts
2b. For owner installations: sae.b.above
4d. Branch Circuits
Print Owner's Name New,alteration or•dension per panel
Address a)The lee for braich circuits with
City State Zip purchase of soaks or Ardor be. 2
Each Manch circuit $500
Phone No. b)The tee for Manch circuits without S 1
The installation is being made on property I own which is purchase of''rinks or alder Am. 1 2
circuit orrf
acklccir 5 00 2
I
not intended for sale, lease or rent. Each First branch Manu,dra $
ri, _� {500
Owner's Signature+ _ 4e. Miscellaneous ` S
(Service or feeder not included) 2
3. Plan Review section (i/required): Each pump or wrigation arde $4000 2
Each sign or outline lighting $4000
Signal circuit(s)or a limited energy 2
Please check appropriate Item end enter fee in section SR. panel,alteration or extension $4000
_ 4 or more residential units in one structure Minor Labels(10) V0000
a Service and feeder 225 amps or more
System over 600 volts nominal 4f.Each additional Inspection over
U)j Classified area or structure containing special occupancy the allowable In any of the above
as described in N.E.0 Chapter 5 Porinspection :7500
Per hour $5500
J Submit 2 sets of plans with application where any of the above In Plant $5500
m apply. Not required tot,temporary corstructlon services. S. Fees:
So. Enter total of above fees $ '1
W
NOTIt J e6%Surcharge(.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Sb.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 Subtohl $ _
COMMENCED. ❑ Trust Account N
$
Balance Due $
MOId�11�MOCQT
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 —
BUP -
Date Requested_ l L —c7� AM PM _ BLD
Location j "�� ;� _ 1.�• I��n .�: + _ Suite MEC
Contact Person Ph PLM _
Contractor_ C;4134. Ph (s� );z6 "2K swR
BUILDING Tenant/Owner Char t c s «i'll KL--C =eoaQ
Retaining Wall ELR
Footing Access:
Foundation FPS
Fig Drain SGN
Crawl Drain Inspection Notes:
Slab _ SIT
Post&Beam —�
Ext Sheath/Shear
Int Sheath/Shear
Framing _. C
Insulation
F L 3f ,o �
Drywall Nailing S � d : - � �
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling „Zn 5 fa It _ — ?ra.7cA C-k-f7A. -161sz'
_
Roof
Misc:
Final
PASS PART FAIL -- - - -- --
PLUMBING
Post& Beam -
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains _
Final
PASS PART FAIL. _ --
MECHANICAL
Post& Beam --
Rough In
Gas Line ---
Smoke Dampers
Final
PASS PART PART FAIL
ELECTRICAL
ough In
N UG/Slab
Low Voltage -- —
Fire Alarm
J
m PART FAIL
w
SITE
-� Backfill/Grading —
Sanitary Sewer
Storm Drain ( J Reinspection fee of$ required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( J Please call for reinspection RF_:_ —_ i ]Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk —
Other Date _ =� --D/ Inspector �--
L_ off_ � ., —Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.