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Permit 4P, I . CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00712 DEVELOPMENT SERVICES DATE ISSUED: 12/10/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S 111 AA -02500 SITE ADDRESS: 14355 SW 86TH AVE SUBDIVISION: GREENSWARD PARK ZONING: R BLOCK: LOT : 013 JURISDICTION: TIG Project Description: Upgrade electrical service panel. 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: 1 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: BILL CLARK SUNNYSIDE ELECTRIC 14355 SW 86TH AVE 12708 SE FLAVEL TIGARD, OR 97224 PORTLAND, OR 97236 Phone: Phone: 503 - 760 - 8490 Reg #: LIC 131534 ELE 26 -I0IOC FEES SUP 4500S Description Date Amount Required Inspections [ELPRMT] ELC Permit 12/10/03 $80.30 [TAX] 8% State Surcharge 12/10/03 $6.43 Elect'l Service Elect'l Final Total $86.73 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 ttlan 180 -days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth i AR 952 - 001 -001.Q through OAR 9 `01 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -80c332-2344. i Is ued By: ∎ _, g. CZ /I . ' Permit Signature: y „ill �j 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: , t� .- — , i C DATE: LICENSE NO: 4/S ' Call 639 -4175 by 7:00pm for an inspection the next business day Electrical Permit Application Received Electrical i /D O Permit No.: ee—d,P0 , 5 D 7/.2 Date/By: / 3 O City of Tigard Planning Approval Sig 13125 SW Hall Blvd. Date/By: Permit No.: Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 A.. Post- Review Land Use Internet: www.ci.tigard.or.us mfiothgittAil iy Contact Case No.: 24 -hour Inspection Request: 503-639-4175 Juris.: Su See Page 2 for Name/Method: � Supplemental Information. TYPE OF WORK PLAN REVIEW (Please check all that apply) ❑ New construction El Demolition ❑ Service over 225 amps- ❑ Health -care facility Addition /alteration/replacement, ❑ Other: Commercial ❑Hazardous location CATEGORY OF CONSTRUCTION ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet, I & 2 family dwellings four or more residential units in ..g.1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more E] Accessory Building El Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above. Job site address: / y 3 jr S, 14. The above are not applicable to temporary construction service. j FEE* SCHEDULE I Suite #: Bldg. /Apt. #: Number of inspectionsper permit allowed Project Name: up s G/A rid Description Qty Fee (ea.) Total Cross street/Direction to job site: New residential- single or multi- family per dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 I Subdivision: Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75 00 2 Tax map /parcel #: Each manufactured home or modular dwelling DESCRIPTION OF WORK service and/or feeder 90.90 2 Services or feeders - installation, alteration or relocation: _ 200 amps or less ) 80.30 _8 �,� O 2 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 ❑ PROPERTY OWNER f ❑ TENANT 601 amps to 1000 amps 240.60 2 /. //J /� /��� Over 1000 amps or volts ll // (� 454.65 2 Name: / Reconnect only 66.85 2 Address: / 4/ 4-3 S r (,(, i 1 4 Temporary services or feeders - installation, - City/State /Zip: 7 E r 6F, alteration, 0 m relocation: 200 amps or less 66.85 I Phone: Fa 201 amps to 400 amps 100.30 2 ❑ APPLICANT C ONTACT PERSON l to 600 amps 133.75 2 Branch circuits - new, alteration, or Name: extension per panel: Address: A. Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of Phone: service or feeder fee, first branch circuit 46. 85 2 Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): CONTRACTOR Each pump or irrigation circle 53.40 2 Job No: Each sign or outline lighting 5340 2 Signal circuit(s) or a limited energy panel, Business Name: .. Description: alteration, or extension Page 2 2 /�n� S �e �eG! i" Address: / ld �s � ,�, F7A, v6/ City /State /Zip: � j ��� O� g�Z 3 / Each additional inspection over the allowable in any of the above: b Per inspection per hour (min. 1 hour) 62.50 Phone: 7,4 _ 9 9 0 Fax: - 7W 2- ZO6i5 Investigation fee: CCB Lic. #: /3 / 3 Lic. #: 26- /D to � Other: Supervising electrician 4/. �I�`� Electrical Permit Fees* �` I/ /C�/ Subtotal $ Ye • do signature required: Plan Review (25% of Permit Fee) $ Print Name: air %/ .61/ L. • #: Lis) O $ State Surcharge (8% of Permit Fee) $ (p. 4/3 Authorized 1'1;b/c`7' TOTAL PERMIT FEE S g[0 . 73 Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) u: \Dsts\Permit Forms \ElcPermitApp.doc 01/03 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: El Audio and Stereo Systems n Burglar Alarm n Garage Door Opener El Heating, Ventilation and Air Conditioning System El Vacuum Systems 0 Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC 0 Instrumentation 0 Intercom and Paging Systems Landscape Irrigation Control ❑ Medical n Nurse Calls n Outdoor Landscape Lighting* El Protective Signaling n Other Number of Systems * No licenses are required. Licenses are required for all other installations is \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 - CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested / AM PM BUP Location gep Suite MEC Contact Person � Ph ( ) 577" 52-1 PLM Contractor L3 v 1 S r c.I `� Ph ( ) SWR BUILDING Tenant/Owner ELC 3" od Footing ELC Foundation Ftg Drain Access: .Qk.P � � 3 4 �� ELR Crawl Drain ! SIT Slab Inspection Notes: F a fd C l'� f 43,r� n o Post & Beam �� Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab X55 (A) ti r c Water�Service C. F-o'lt-- Sanitary Sewer 1 J Rain Drains !. F F Catch Basin / Manhole ( c 1 r - C E- Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ' ° - PART FAIL S E Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA JF y `g 3 Ins ector � d (9 Ext tuy Approach /Sidewalk Date (� p � Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL