Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00304
i DEVELOPMENT SERVICES DATE ISSUED: 6/1/2004
r 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S111 AC -00900
SITE ADDRESS: 14655 SW 91ST AVE
SUBDIVISION: PINEBROOK TERRACE ZONING: R-4.5
BLOCK: LOT : 050 JURISDICTION: TIG
Project Description: Installation of (2) branch circuits for a/c & future attic fan.
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: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 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:
AMOS, PAUL OWNER
14655 SW 91ST. AVE
TIGARD, OR 97223
Phone: 503 - 627 -5895 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/1/2004 $53.50
[TAX] 8% State Surcharge 6/1/2004 $4.28 Rough -in
Elect! Final
Total $57.78
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 _- • • OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 • •99 or 1 -800 -332 -' 44. /
Is ued By: , / Ozi Permit Signature: V
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not int-nded for sale, lease, or rent.
OWNER'S SIGNATURE: 41 DATE: C //
O %5Z
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE ,USE ONLY , • . . •
, v
Gity'of Tigard
A, ,,,,,\ Received 4ffilla.11111 . •,
. .
Date/B : it 0 Pernut No.: EZ . ..e .... _
.■ J.!, -0030
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 tosgvisititii Dates : Other Permit:
Inspection Line: 503.639.4175 ,...,4191, - el 1 ' Date Ready/By: 2 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: IM Supplemental Information
rigi 1,6,411 'I ' mY441 Rovfor • ' - - '
0,0004.4;-:,0'00000: 0,4- •,•qvc,',,, :•00.0a7 0„0„,00t.,„000,0,,,:;;z000v000h10000 %lit , ;(°-0;t4s00 , ,1 q.VJ , .. 7 ,„.,,,,~1,1y-,, ,, ,, , m44:,...,,,,IA„,„1....,4,A.7.,z, , e ,,,,. . :..:::. -:' : . •
El .New construction ddition/alteration/replacement Please check all that apply:
EService over 225 amps, comm'l E Hazardous location
E Demolition Iii;I-Other: iirD ' e A /c. u,-.4.
E
S ervice over 320 amps - rating [IBuildng over 10,000 sq. ft.,
1 -1; SI ' '' '=
of 1- and 2-family dwellings 4 or more new residential
i and 2 dwelling El Commercial/industrial 0 Accessory building OSystem over 600 volts nominal units in one structure
DBuilding over three stories OFeeders, 400 amps or more
0 Multi 0 Master builder El Other:
_ ['Occupant load over 99 persons ['Manufactured structures or
iltif,Vt.,::31$Al: ,,,.,. , „., ....NA ,, . 4,i ,. [I Egress/lighting plan RV. park
pHealth-care facility DOther:
Job no.: Job site address: ( tfl s i.$ (3 ( .. . , , tit .
Submit 2 sets of plans with any of the above.
City/State/ZIP: --*
1 i 6,11Z-1 - i C5R. 5 7 z--z-V The above are not applicable to temporary construction service.
IliTinlaf iiERM:$767#0:1341::5!:7
Suite/bldg./apt. no.: Project name:
Description j Qty. Fee. Total **
f .
Cross street/directions to job site: ftpr E ? ;/ E.-a:20Di( New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: - . 0 - Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
i NIF 7RMr) K Limited energy, residential 75.00 2
Tax map/parcel no.: .
Limited energy, non-residential 75.00 • 2
IMMIZAINSMEIFt*. WORPRIN,WIRMIli:A7122V Each manufactured or modular
_ dwelling, service and/or feeder 90.90 2
A - iYi - )E- ) 20 A c i c,--a" ---r)( .1- (c,. ) e Services or feeders installation, alteration, and/or relocation
iltidD D (5 aRttA.Ct Ftt FLA-twoU___ &Tit 200 amps or less 80.30 2
amps to 400 amps amps 106.85 2
amps to 600 160.60 2
Name: b 4 vybas 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
Address: (O _ 5„, $ ) ci 1 5r 4.)--e .
Reconnect only 66.85 2
City/State/ZIP: ---,,, , coia. D R q - 7 2 2.. y Temporary services or feeders installation, alteration, and/or
( relocation
Phone: (563 ) ,../3 1 - 5 - 6& 7 Fax: (SO 3 ) h o q 67
200 amps or less 66.85 1 ,
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sa - -. - ent, or exchange, accorii to ORS 447, 449, 670, and 701.
.4 401 amps to 600 amps 133.75 2
Owner signature: .....6...• ! ___ . - molow....:... Date: l 4 y Branch circuits new, alteration, or extension, per panel
A. Fee for branch circuits with
ININkb, nionve-Aniet7443a, tatidle acImuitEmONitst:va .
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder f ee, i 46.85 2
each branch circuit
Address:
Each adcP1 branch circuit / 6.65 2
*
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
mgrapaawppafzazoAatis:oatvgirgmngggmmi energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Address: Dtioo EQ___ Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Investigation per hour (1 hr ruin) 62.50
Phone: ( ) Fax ( ) Industrial plant per hour 73.75
il,7" ; VW* OATEMMErtFt
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal 53.50
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: Date:
TOTAL PERMIT FEE 61 ..0
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
i: \ Building■Permits \ELC-PemtApp doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information ` 1y
LIMITED ENERGY PERMIT FEES:
;RESID .. , L Kat OAit •NMoklia
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ N urse Calls •
❑ O utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i: \ Building \Permits\ELC- PemtitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lin-; (503) 639 -4175
INSPECTION DIVISION Business Line: 1503) 639 -4171 MST
42/2, 4 / 4-8-1 BUP
Received II �t� Date Requested AM BUP
Location I k, 1)/ 5t . lr t Suite MEC
Contact Person 0•0-)2"– Ph ( ) T �1 -S7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC -U (4 - opb
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
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
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
Service
Low Voltage 1
Fir- larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line /41 , � rP � �� ADA Approach /Sidewalk Date 7 In spector. --Kul l Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL