Permit CITY OF , TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00806
c' DEVELOPMENT SERVICES DATE ISSUED: 12/16/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136CA-04900
SITE ADDRESS: 11085 SW 78TH AVE
SUBDIVISION: FAIRVALE ZONING: R
BLOCK: LOT : 004 JURISDICTION: TIG
Project Description: Reconnect only.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 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):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: 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: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON MUTUAL BANK
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/16/200' $66.85
[TAX] 8% State Surcharge 12/16/200' $5.35 Elect'I Service
Total $72.20
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: �r�rT o Permit Signature: Q
OWNER INSTALLATION ONLY
• The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
12/15/2004 11:43 FAX 503 629 5202 COLDWELL BANKER BSSP Zj003
Electrical Permit A o L 1...ul 1,41 ` RiEZ! '@� H O1� Abrl(:E I SE ONLI' l f [� I D /J Perrniallo,; ' & di OR 972231 DEC 5 2004 P • Phone: 503.639 -4171 Fax: 503,598.1960 a rm rlf i i �'� � Date/By: Other Permit:
•,
Inspection Line: 503-639-4175 Date Ready ho 6T H Sce Pa 2 for
Ynteraet; www,Ci,tigatd.of.tts CITY OF TIGA ,� Notified/1%40 hod: 1 1 Sapplemcntal
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sS 3.�Iiti#11E1f1l1ltu1t9lur•.iT �rd3 i� ,t ,�, i�4 hitrlr,rrll,fS, ,1i�l.k$ftihf',,,tdT(�rr ,, rorlrlc�r .ld�llij`skdPxYiSil ;IfcSf;l,
❑ New construction • Addition/alteration /replacement Please check all that apply:
❑ Dcmollhon 1a Other: ��Lb ❑Service over 225 amps, conlui I ❑Hazardous location
,t r l s H mr I A, y � + f , ❑Service over 320 amps — rating ❑Buildng over 10,000 sq. ft,,
;+o;(' >Clr ;i,i�rlil d IL •• :n it A ; rid;,,, ,�r a. ` = l thuu x is: ! �" ' t Ei F? 1 1 it''.fil t'd
? Y dwellings residential
318iA1tr . I ,, .
, • � Ir Af, At,rl[ �' E of l -and 2- faluiI dwellin s 4 or more new
1'1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building ❑System over 600 volts nominal units in one structure
1=1 Multi - family ❑Master builder ❑Other ❑13uild ng over three stories ❑Feeders. 400 amps or more
4 % I F` ti- fanu lltlritt4 li' �!N "'" ` 'y'i, 71 'iil'I,iil #�} 11Ii r :Occupant load over 99 persons ❑Manufacturedstuctures
, I¢I0 lliwliiler rp,01 Hhh r I 1 �} :1 I if91 . v+
It d I. f.,rl St ¢J 9 I :, t 1 } � h�AF+if ;ti 1 � i . 11
.1LR ,I,r.,c,l„rA AiAi
� ' ,F? �'�' �� � i t " � � �Gt#���1��! iY ��
to res Ya,J 1, A „Al tl,rA,r. IMrt,l r mr, i rl sfl`ii1T)1,1 ;iflth ; "dti�.:rt. , +9 +, [JEgress /Iighting pearl park
P
❑Health -care facility ❑Other,
Job no.: ,iob site address: I \ o q 5 5 -- 'i.. Submit 2 Beta of plans with any of the above.
City/State/ZIP: The above are applicable temporary ty -- ` T T ,e.,,_..„_(.1 r� � c am. � -i � �� Thb not �, 10 a Pp li e t ,l�,r p �v construction service.
q1 _ r` 1�1 11;i #t{ 1l S� I51¢iiiA {f?f ilti } a'irt { rs w fr } {` :lsyt I a
Suite/bldg./apt. no -: 1¢ iii lllii#�1�1,A, z„ c' 1 #aril!?#1 �ls ;3T
Project name: v '
Description I Qty_ 1 Kee } Totar { .-
Cross street/directions to job site; Ncw residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft, or less 145.15 4
5ubdivivion: is ( y - Va : t ., I Lot no.: Q Ea_ add'1500 sq. ft- or portion 33.40 _ - 1
Ina( map /parcel no.; • Limited energy, residential - 75.00 2 •
P' 1 }% rr rl % ; 1 y "+ <+f ry W pt 1, ¢ Il,r ` " l ;t,ll, Sf, ' Limited energy, non- residential 75,00 2 • ':t r'74" 1 1 ;1 ' 1 ' "' i, ' °'' 'i' ''''" "I , l A , ,, . ,., X511 :. ";, 1 +, I ; tit ?prl lei ?E ' l, r�%; d i,1 ,, 1;
1 ;fit, , Ii ;I, # ;lu,,, s , I, pth Each manufactured or modular
i C 't C r i
dwelling, service and/or feeder 90.90 2
ELI_ L e C D 1nh0 .Cr Services -or feeders installation, alteration, ad/or relocation
200 nnlps-or -1oas 80.30 2
star % ,. %� , wA,� , n, „14H rt'tr: a,i f u t•s�w it , i , ., � r
i Vii' ? ;t{! r r, ufi d 1 i1 a ) rvrs�l, hl t. OG - 2
2
} gRrn i,Y1 { + { 4 {,(fit`• l l s { 1,� �i'tSlf¢, if 1 { +l tl# 201 amps to 400 amps 1
sl ,�,i,.,,,,1i 1 !i' � "1,.,.d,,,. ,{ � nQ,l,u„F�,r, , }# iN3�t# t`' ;1'i�'�'��il�f� ;�G?rr94,4.t. �; I I, inr6 { #lfelhr'''�tr
o' 401 amps to 600 amps 160,60
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 (06345W
2
City /State/ZIP: Temporary services ur feeders inst elation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
1 200 amps or less 66.85 1
Owner installation: This instillation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date:
Branch circuits —new, alteration, or extension, per panel
f`liill# #t ;1i�lf F'oQ ". 1 , S , AI (WII A�,.,�� { t i I- Siq ".;' ¢ll ii ,,,,l.,l.l.l.,.,r�r,.,l.r.l ' r� P;4 N —
1, 1„r. 1. „ ,M
( 1 I ii, z. 1*W �f I ii #il iatbtt¢nais; #�l 1{llapii I S i ll dE I' 'a�,�` ' ;Si 41t {I!�{ ;iii}:I�I f 4 A. Fee for branch circuits "h
service or feeder fee, each
Business ,lame: C Ca ( L.1 L t� f \ ,9 o t
! branch circuit 6 - 65 2
l``�� � & � � B. Fee for branch circuits
Contact name: (?
l� Y 0 ,11 6 �- — 1T� ^ --i' \ without service or feeder fee. 46.85 2
Address: ` each branch circuit
�!, ' l \ 5 V-- _ L [mil _ ` ' 0 0 Eaeh add'l branch circuit 6 -65 2
Ciry/S tate/ZIP: 1VBseeuaacops service or feeder not included
_ pump or irrigation circle 53,40 2
(
Phone: ' Fax: I b 3 ) Co o �) �� i ^ 3 S � Sign or outline lighting 53.40 2
E -mail: ■ • , a * D
/( • �(, .v ^ {� {{ signal circuit(s) or limited -
,,¢ au; >,ne „ r,,,, ' v�r1,v•iAr,,,/, iat',� *I¢tf , r i+ „ „ y , rA1�N5 1E 1° erEyP
K# ^ #t ;feri,4a!fflxt ?t ¢t ��#Ir.r� #tilli�, i�!t',� ;ilH {{ #lid {i?� {}l,¢,H��S rn, ° °„ ' I � , Jll ( {E + � i#I pp . i, i { ¢ f1, 11 #, # 1 r C'r(' en anc1, alteration, or
1: a.A, I,� 1 � ,tiilll��if�S`i�A�yla,r _
extensio De scri b e : Page 2 2
Business name; .
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: Investigation per hour (1 hr min) 62.50
Phone' ( ) Fax ( ) Industrial plant per hour 73.75
IAa�d.l' ¢ ' ,' ' ' p¢ , 9611;1 { to n } ,;S{St' )Lr
1 #A 111 }rr!hr.it¢iE�ff,iE}f 10Wkli i l latPX _ ,I,Pg$ a#1,r,,..:ri1 #�il� r i1IFl, I ,, iPli(,
CCB Lie,: Electrical Lie.: Suprv. Lic.: Subtotal c L .5?, ...
Suprv. Electrician signtiture, required: Plan review (25% of permit fen)
_ Print name: Date: state surcharge (8% of permit fcc)
TOTAL PERMIT FEE -72,
Authorized signature: Thin permit nppllcation tezplres if a permit it oot obtalncd within 180
days after it has been aeeepced nb complete
Print name: Date: a Fee , nelhodology set by Tri -County Building industry Service Board
o• Number of im:pections per permit allowed.
i118vildinacanit L+LC- 1+ernnIcA.j,Ii o. 1110? 4441- 415T(10 /02/COM/WBB
CITY OF TIGARD
BUILDING DIVISION G = PERMIT #: t " ` ,� 73 I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: d r7
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639-4175 ' ° °1J..
INSPECTION WORKSHEET FOR DATE: 3 _ 7 TIME: PAGE:
SITE ADDRESS: / g15 98 -° 7 1-14 CLASS OF WORK:
SUBDIVISION: LOT #: • TYPE OF USE:
PROJECT NAME: —7
DESCRIPTION: _ �� / 1 3
OWNER: PHONE #: c j 2 v o – S 7Sa --
CONTRACTOR: , ` PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # f f Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
\N) \\\ I DIN/ 5' 1),\)-1\ts
)°,
iyv 4:7
❑ PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspect- . I .� J Lj i • Date: ✓ � Gj Phone #: (503) 718 - ( 4 cz6