Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
1 DEVELOPMENT SERVICES PERMIT #: ELR2005 -00017
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/27/2005
SITE ADDRESS: 12930 SW WILMINGTON LN PARCEL: 2S109AA -03500
SUBDIVISION: WILMINGTON HEIGHTS ZONING: R -7
BLOCK: LOT: 009 JURISDICTION: TIG
Proiect Description: Limited energy.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
BOSZE, EDWARD + JENNIFER A OWNER
12930 SW WILMINGTON LN
TIGARD, OR 97224
Phone: Phone:
Reg #:
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/27/2005 $75.00 Elect'I Final
[TAX] 8% State Surcharf 1/27/2005 $6.00
Total $81.00
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 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.
Issued by L.' �"`1 Permittee Signature _ Sd>-e. 1
OWNER INSTALLATION ONLY V
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
. . ,
V
01/27/2005 10:38 FAX 5035tleS1 CITY OF TIGARD Z001/003
•
Electrical r ermit Aktatioin 1.0
ll .
FOR oFFIcE USE. ONLY
City of 'rigard
, 0 s . ‘k (, j ,,,,,,,,,
Received •
Date/Br / - c - 741 -- ti. )' - 4P6 ' PCW"1 1.1°': i--0• "
12175 SW Flall Blvd., Tigard, OR 97223 Pion Review
0 -- cx!..
Phone: 503.639. Fax: 503.598 r‘
.1960 ..0 ... ,,,,,_ON ± 1 i 1 ;1 4 Dideehn Other Permit
inspection Line: 503.639. G\ AV..7 ..,..7 - ''.!.:.„„ Daft REICIY/21: tuna: r , f el See Page 2 for
Intr./net: www.ci.tigard.OLUS OOP Notified/Method: 1 1 tr Supplemental faforostitioo
•• ' ..:.......: .." ...'..** ,.. ':; • 7: :: i .7 .4ii 0* Vit**' :: :: 4.. .:: . :' ' :: :' n: . : . . :1:. - '.: • . .. , 4 ) 0 * 404 ....:. 1 ;.' • . ' :. ': . ' ; .' .
El NCW C0115111=1013 MII Addition/alteration/replacement Please chce all that apply:
ElService over 225 amps. corrun'l OHazardous location
El Demolition 0 Other: CIService over 320 amps - raring DBuildng over 10.000 sq. ft.,
c.***Gc4.4V-P*. colIFI31ffc:I19N i • . :. .::: ::: .. .. - • .-: of I- and 2-family dwellings 4 or more new residential
0 and 2-farnily dwelling 0 COrnrnercial/industrial 0 Accessory building ['System over 600 volts nominal units in ont =lecture
°Building OVCI three stories I:Ferias. 400 amps or more
M Multi-family CI Master builder 0 Other: ClOccupant load over 99 persons DManufnelured StrkKalreS ar
. .. . .
. • _ : .. ; . iN)3 Slii; . krit.■' : • • .: .:::. • : .,. .-. 0Egresaffighting plan RV park
DienIth-core facility DOther:
Job no.: Job site address: \`11 5 \,, 4 \...„, 4
Subnit 2 sets of plans with any of the abOve.
City/SUtterZIP: --- V , 541,4,4 / DV. q 4 Thc above ere not appiicabic to twopenny constmerion service.
; • r : :: -_,.: '..' . • : ".- 'EE'..SCIAIEDllf...E': • . ; '. • : . :. --. • : . ,....•:.
Suitc/bIdg./apt no.: Project name: tornavonta I Q0J N., I run,
Cross street/directions to job site: Tee residential single- or mutti-fnmily dwelling usu.
Includes attached name.
1,000 aq. ft. or less 145.15 ' 4
Subdivision: Lot no.: Ea. addl 500 sq. ft or portion 33.40 1
. -
Limited coma, residential 75.00 2
Tax map/penal no.; Limited energy, non-residential 75.00 2
'' ' •' e : '''- ''' ' ' • - ' l :OF .... . . -. 7 !.....' Edc111111untautured or modular .
dvvening. service and/or feeder 90.90 2
SorvithoS or feeders :mutilation, alteration, and/or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 .. • 2
" • ' •• .-; • : •• FJ :PROPARtlf - OWNER::: • . •••••:,::".- ':.: .11, :•:. ' .!"' :.., T C.3 tirloif --.:.. .. '.:::: ;: • 401 amps to 600 amps 160.60 • 2
Name: EA )0S-1--- 601 amps to 1,000 amps
240.60 2
Cover 1,000 amps or volts 454.65 2
Address!
Reconnect only 66.85 • 2
City/State/ZTP: N.. 0 (Z- 1-a- 4-
Temporary services or feeders lastallation, alteration, and/or
relocation
Phone: ,•5•5 ) 5 et 0 ___ iS A .. Fax: ( ) 200 amps or less 66.85 • 2 1
Owner installation: This installation is b • : made on property that I own which is not • 201 amps to ADO amps 100.30
intended for sale, lease, re-nt, or OW • / • nge, itc . • . ". g to ORS 447, 449, 670, and 701. 401 amps to 600 amp
.
A s , 1.33.75 2
Owner signature: .......,,...,......../01 . ---_-..› Date: N r221 L'S Branch circuits - new, alteration, or extension, per panel
EI APPLICANT • ''. , -•=••... J . • • 7 '-icirCONT'ACT. PERSON .., ::::::! A ' Fe4 5Dr bumch CirCUitS with r
. - _ service or feeder fee, tack 6.65 2
Business name: bona circuit .,
B. Fee for branch circuits
Contact name: a ds -5,„)9--2e without service or feeder fee. 46.85 2
Address: '1.o. & -
1 t\hkvj 1 , , ' each branch circuit
Each add', branch circuit 6.65 _
2
-
City/StateJ ZIP: --'0 6v - j , 1 C \ I T .- 11 4 ,hriscellaneaus (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: C ) c e _4e -g,„ I Fax; ; ( ) Sign or outline lighting 53,40 2 ,
E-mail: Signet eireuit(s) or liited- .-
--.• - . . : : '• :: '' • -. .j. • . COP&RACTtipt: - '. • ':: '; i ...• .....- .1.• • . ,. • • i . • • ' . . : energy papa, au:ration, or
extension. Describe: Page 2 2
BusineaS name: \K-A m , cov‘<7c. .‘„, ,
Address: \S S\A AD.p,',A0-4- \)) 4 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: I , s a . & ail t • * Investigation per hour (I ter Nein) 62. ,
. .
Pbone: ( 5.., i a( . - 0 Ct Fax: ( ) industrial plant per hour 73.75 _
fFEksticr TEIESIr... • ;...• , ..: . •-•
CCB Lit.: \ \ . C, f..„ Electrical Licr tT v. Lie.: Subtotal - 15' ° c"
Suprv. Electrician signature, rcquirod: Plan review (25% of permit fee) E 017
Print risme t.-- Date:
STAID surcharge (8% of permit fee)
:
TOTAL PERMIT FEE
•
Authorized signature: c :1,..--2 . This p a pplication =ores do permit is not /anima within 180
days nfILT il has beep accepted at coominc
Print name: • Date: \ • • roe mthodology set by TriZoonly Building Industry Service 13.0ani
II' A i 00 . • Number of inspactions per pandt allowed.
;;d1a;talngWenaiudd..C-tnanlinponac troi 446.451srontruccaowee
a - d t•SEE EOS azsog p3 01 9S:ZI SO L, uec
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 41 75 ��,D60
INSPECTION:DIVISION Business Line: (503) 639 -4171
BUP
Received Date Req ested 2 — 3 AM PM BUP
Location D 2'4i4 _ _JA 4 _a Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) o SWR
IL IN Tenant/Owner ES ��6v, io - 77,17 ELC
g C) ELC
Foundation Access: GG 41 /
Ftg Drain R ?Vac
Crawl Drain
Slab Inspection Notes: _ SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing (� [ )
Insulation ! E0 C,Ll pl�`1 - by DISH NN) J �• W1`tD M
Drywall Nailing ! �( \1
Firewall Sprinkler 1� � � s\ � ' ` °- � " \ -
Fire \fl"
Fire Alarm
Susp'd Ceiling
Roof
Other:
ZE11 PART -_1�
earn
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
in
+T[�Z •: RT
Post& Beam j
Rough -In
Gas Line y i 7
Smoke Dampe
CFinaD
PA PART FAIL
AL
Service
Rough -In
U
ow Volt
Aar
in- '. ,
El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
1 PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date .1` Inspector Pg4'y - 4 1 Ext
Other:
y
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL