Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: . DEVELOPMENT SERVICES DATE ISSUED: 6/7/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135CA -02200
SITE ADDRESS: 11405 SW 95TH AVE
SUBDIVISION: BOETCHERS ADDITION ZONING: R-4.5
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: Circuit for NC, installing a light on the furnace circuit
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: 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:
VICTORIA VILLARREAL OWNER
11405 SW95TH
TIGARD, OR 97223
Phone: 503 - 620 -6016 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/7/2004 $46.85
[TAX] 8% State Surcharge 6/7/2004 $3.75 Rough -in
Elect'I Final
Total $50.60
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 ( 3)
246 - 6699 or 1.800 332 - 2344. le/44 Issued By: _ Permit Signature: � � ,�(
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
EleCetrical Permit A 1' • E ® Received FOR OFFICE USE ONLY
City of Tigard Date/By: ' Permit No.: / , Io X0
13125 SW Hall Blvd., Tigard, OR 97223 y ���
g Plan Review
Phone: 503.639.4171 Fax: 503.598.1 p6Q� 7 200k �� "�'�- iiii'.'N 1 ''� B Date : Other Permit:
Inspection Line: 503.639.4175 U• '1 Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us I F TIGARD Notified/Method: Supplemental Information
El New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ID Other: ❑Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
A , , y k 0 s '' , „:, ,', < . y of 1- and 2- family dwellings 4 or more new residential
M 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
[=I Multi- family ['Master builder ❑Other: ❑Building over three stones OFeeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
> , A D I: g 1 , ,. : 1 9 * e Ir ,: 3 ° °" RV ark
- _ � ! ::Z .�. R L. ❑Egress /lighting plan P
Job no.: Job site address: � t/ nc �I/ / I' � 9 / q /��,`Q - ❑ Health -care facility ['Other:
_ { Submit 2 sets of plans with any of the above.
City /State /ZIP: ' (0, j.„ or 0?-2a3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: I Project name:
1.1, Via
Description J Qty. Fee. Total
Cross street/directions to job site: (7re-P 41... U% New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 1 Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
,* _ Limited energy, non - residential 75.00 2
A 4 ` .. l. Each manufactured or modular
C C 1Yt,vs4 ge.60 Q�pp��+i ^� / h I / dwelling, service and /or feeder 90.90 2
PI oo�4 . Lei yl f 5 'hi lIt. O. Services or feeders installation, alteration, and/or relocation
I , a ^ i f ti ol y( ' — C ( A 4- 200 amps or less 80.30 2
6 z a 4 201 amps to 400 as 106.85 2
' 401 amps to 600 amps 160.60 2
Name: vi � iv 1A IL ire4 601 amps to 1,000 amps 240.60 2
Address: (10c tf
- Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: -I � or T7Z2 3 Temporary services or feeders installation, alteration, and /or
Phone: (.5)3 ) J 62,0 - 01(), I Fax: ( ) relocation
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 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
� y s � -- , , - A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business n• i e: V I IC -- //�---' branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit ' 46.85 L� g�2
Address: Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax:: ( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
" -, ,,v f'", , .j : a% ,la energy anel, alteration, or
extension. Describe: Page 2 2
Business name:
01A 111Q7
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
Industrial p lant per hour 73.75
Phone: ( ) Fax: ( ) ,,:
CCB Lic.: I Electrical Lic.: 1 Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee) I f„ . VS
Print name: 1 Date: State surcharge (8% of permit fee) / 3 7 t
i
t TOTAL PERMIT FEE , e), 6 0
Authorized signature: - f,(4441 This permit application expires if a permit is not obtained within 180
LL � days after it has been accepted as complete
Print name: U I c � s (. , 1 . U,1 a & I Date: 6 al( * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Pemdts\ELC- PemtitApp. 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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
❑ Nurse Calls
❑ Outdoor 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- PermitApp.doc 04/03
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 J/ 1 7 1- 0 u �s — Suite MEC
Contact Person Ph ( ) CO SV — � � PLM
Contractor f Ph ( ) SWR
BUILDING Tenant/0 a v V ELC o?Oc 6 3 / ,
Footing COaC' coot co ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: n • SIT
Post & Beam / �'� l- O
Shear Anchors
Ext Sheath/Shear 0--( A) . 11 , 7.
Int Sheath/Shear
Framing
Insulation LQQ r ct, 6 r ® PA €L,
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm `J � RC, -60 vt. ,. J 65 1 N b7--b c. r..
Susp'd Ceiling `J y, 11
Roof O � > L W �( '.k e, > V Iv c-
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In 619
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan ��
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough—In
Line
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.
.4E110 PART FAIL
SITE ❑ Please call for reinspection RE: Unab - to inspect — no access
Fire Supply Line
ADA .77 Approach/Sidewalk Date , Inspector Ext
Other:
Final DO NOT REMOVE this inspection r rd from the job site.
PASS PART FAIL