Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00659
,11� DEVE M T I S OR I SERVICES (50 639 -4171 DATE ISSUED: 10/30/03
13125 PARCEL: 2S111 BD - 00401
SITE ADDRESS: 14860 SW 96TH AVE
SUBDIVISION: DARMEL NO. 3 ZONING: R
BLOCK: LOT : 019 JURISDICTION: TIG
Project Description: Job #4069 Replace FPE 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:
COX, THOMAS W WILLAMETTE ELECTRIC INC
COX, BEVERLY J PO BOX 230547
14860 SW 96TH TIGARD, OR 97281
TIGARD, OR 97223
Phone: 503 - 639 -1954 Phone: 503 - 624 -3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/30/03 $80.30
[TAX] 8% State Surcharge 10/30/03 $6.42 Rough -in
Elect'I Service
Total $86.72 Elect'I Final
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 B - - r -cam Permit Signature: a.42-10.Y.
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 7:00pm for an inspection the next business day
FOR OFFICE; tiSF: ONI,Y
Electrical Per Apylication FOR
j ._ ' ���
Date/By: /� A �� 3 Permit No.: L.+ 2 :3 . -- e26..59
Planning A Sign
City of Tigard C� '2 I V"- Date/By: Permit No.:
13125 SW Hall Blvd. ® Plan Review Other
Tigard, Oregon 97223 NRO Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503- 598 -1960 ` ��0� Post- Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us �I
La- r _� Contact Juris.: See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/Method: 1 Supplemental Information.
'' TYPE ::OF WORK - :�` . ' ul' ,;, x, ar -1
B : ! . e,, r r ,.;„ r � r PLAN REVIEW (Please all that apply) ` ", ,?'
New constru ❑ Demolition 0 Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition /alteration/replacement , ❑Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
:':', ' ' ` CATEGORY OF CONSTRUQTIOlst 'i r t,; ," I & 2 family dwellings four or more residential units in
I & 2- Family dwelling ❑ Commercial/Industrial 0 System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder El Other: ❑ Egress/lighting plan ❑ Other:
'i' ,` JOB SITE INFORMATION`and.LOCATION t ,11 Submit sets of plans with any of the above.
The above are not applicable to temporary construction service
Job site address: l'•i IS C (<) ,.."/,.., /4, = s " , t FEE" SCHEDULE .r , :; '' , ' s ,r i f . ;) =' -
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: * c , t o , - Description Qty Fee (ea.) Total
New residential - single or multi - family per j
Cross street/Directions to job site: 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 1
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
I1t,�k' ', yy�,f . ` ' r DESCRIPTION OT.WOIO��.'f tiff i
C '' service and/or feeder 90.90 2
_ Services or feeders - installation,
e , o k ., r- 1 ' 5.‘ F p;, (; I alteration or relocation: ;_
( 200 amps or less j 80.30 � �. 2
' 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
. glni I' • ,a ER `.z,', i:s4® � } - o;wcr
� v i 601 amps to 1000 amps 240.60 2
�' ` Over 1000 amps or volts _ 454.65 2
Name: 7�3 -i (�J)C Reconnect only 66.85 2
Address: c Temporary services or feeders - installation,
alteration, or relocation:
City /State/Zip: 200 amps or less 66.85 1
Phone: S - / % 5 Fax: 201 amps to 400 amps 100.30 2
�; 5 5 ;w ` 401 to 600 amps 133.75 2
fA$1�,�411VT 0 GQNTt! rCTRSOI:r�er.,; 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
service or feeder fee, first branch circuit 46.85 2
_
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
` ,' et1]�Y Y .' ik !`b' ,, : 7,1 ' ,,, 2 Each pump or irrigation circle 53.40 2
• tp.m.�r Each sign or outline ligiaing 53.40 2
Job No: y C L 5 Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: W , II ,5 Ai.e fl c I'(. c T4 r c I a Description:
Address: po 6 Z-30 s'i ?-
City/ State/Zip: Q Each additional inspection over the allowable in an of the above:
Y p: T t 5 k A r) �� ! 2 Z' / Per inspection per hour (min. 1 hour) 62.50
Phone: 6 2.y - 3 r, 3 / Fax: G 2 4 - 2..9 t e. Investigation fee:
Other
CCB Lic. #: 'SO c - 7 Lic. #: 34 - 2 &3 L ; aa " Y "' ^y 1'
Supervising electrician Subtotal $ ''—
signature required: /IV ti ( ' / Plan Review (25% of Permit Fee) $
Print_Name: O A - .v h= i! , <_ I Lic. : )5 6 S — C State Surcharge (8% of Permit Fee) $ f • t - Z
TOTAL PERMIT FEE $ 4. , /2
Authorized 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)
i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
J ,I MITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
0 Audio and Stereo Systems
0 Burglar Alarm
[1 Garage Door Opener
f ] Heating, Ventilation and Air Conditioning System
0 Vacuum Systems
U Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
0 Audio and Stereo Systems
LA Boiler Controls
Clock Systems
Data Telecommunication Installation
n Fire Alarm Installation
HVAC
0 Instrumentation
n Intercom and Paging Systems
Landscape Irrigation Control
Medical
❑ Nurse Calls
Outdoor Landscape Lighting
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
BUILDINGS Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
pP BUP
Received / 2(2 / D // Date Requested_ I 0.3 AM PM BUP
Location /4/f & 0P'
) Suite MEC
Contact Person Ph ( _6I�3) J 2( 3 3 / PLM
Contractor �� C X�,P� Ph ( ) SWR ^�
BUILDING Tenant/Owner OP 3 -- (.( ) &9'
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Drywall ywal
Dywall Nailing f
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof )244?
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
.�ervlc'e
Rough -In
UG/Slab
Low Voltage ii d lsl.r2 , F
F' awl rm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
A PART FAIL
SITE El Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA r�
Approach/Sidewalk Date — d Inspector '� /! � Ext
Other:
Final DO OT REMOVE this inspection record from the b site.
PASS PART FAIL