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Permit
CITY OF. TIGARD ELECTRICAL PERMIT PERMIT #: ELC2002 -00547 DEVELOPMENT SERVICES DATE ISSUED: 10/16/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111CB SITE ADDRESS: 14805 SW 103RD AVE SUBDIVISION: ZONING: R BLOCK: LOT : 004 JURISDICTION: TIG Project Description: Alteration of (5) branch circuits for kitchen remodel. 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: 4 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: MUNHALL, WALTER F JR AND MOM'S ELECTRIC JEAN B 13909 UPPER ALDERCREST DR 14805 SW 103RD AVE MILWAUKIE, OR 97267 TIGARD, OR 97223 Phone: Phone: 503 - 702 -0894 Reg #: ELE 3 -525C FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit 10/16/02 $73.45 [TAX] 8% State Tax 10/16/02 $5 Rough -in Elect'I Final Total $79.33 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 t80 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- 80 -2344. Iss ed By: 0 #' 1 i / Permit Signature: N Y I � 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: �1 DATE: LICENSE NO:. Call 639 -4175 by 7:0 pm for an inspection the next business day C- -TV o ��n-i � O,TON c06... Electrical Permit Applicatio OFFICE USE ONLY ,t ` -a Date received: /• //p® Permit no.:E - CY�f /7 W' — - -= . 1 0 ' Y Address:155 • •, Suite 350 -12, Hillsboro, OR ' 124 Project/appl. no.: Expire date: OREGO ' • t - . 13- 846 -3470 Fax: 503- 846 -3993 Date issued: 33 Receipt no.: Internet Address: www.co.washington.or.us Case file no.: Payment type: Land use approval: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: Ji.g . Ld) , z) -Air City: Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: I Block: N/A I Subdivision: Project name: I Description and location of work on premises: 1(/76 //6� 4¢09 .i /'170„.) Estimated date of completion/inspection: " .. A. , CONTRACTOR APPLICATION FEE SCHEDULE Job no: Fee Max Oka Business name: I L ��G ♦ , , i Description Qty. (ea.) Total no. insp Address: (3Cr pR Pm_ ' L ,�p ,R .) dwelling unit. Includes New residential - single attach family per attached garage. City: ,...(1 L w 1}wiC. i E I State: 04_I LIP: 9 72 6 7 Service included: PhoneYO3 74t. 2,0,54 Fax: I E -mail: de 1000 sq. ft. or less 150.00 4 Each additional 500 sq. ft.or portion thereof 42.00 CCB no.: �� q 9 g, I Elec. bus. lic. no: j -,9a5 Limited energy, ] & 2 Family 60.00 2 City/metro lic. no.: N/A 60' 9 q3 /oh le 5 Limited energy, Multi- Family 66.00 2 / Each manufactured home or modular dwelling /f /©'7' Signature of Supervising Electrician (Required) Date , Service and /or feeder 102.00 2 Sup. 1'1 1♦I �`' Services or feeders — installation, Su elect. name License no: alteration or relocation: PROPERTY OWNER 200 amps or less 90.00 2 I Name (print): 201 amps to 400 amps 120.00 2 Mailing address: 401 amps to 600 amps 180.00 2 601 amps to 1000 amps 270.00 2 City: I State: I LIP: Over 1000 amps or volts 504.00 2 Phone: I Fax: 1E-mail: Reconnect only 78.00 1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation: ORS 447, 455, 479, 670, 701. 200 amps or less 78.00 2 201 amps to 400 amps 108.00 2 Owner's signature: Date: 401 to 600 amps 150.00 2 ENG I NEER Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 8.50 2 City: State: ZIP: B. Fee for branch circuits without purchase i 4,$S Phone: Fax: E -mail: of service or feeder fee, firstbranch circuit: V6. gS 1 69-99- 2 Each additional branch circuit: 0(6, be /1' .5s-5.6' PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): 645 ❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 60.00 2 ❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each sign or outline lighting 60.00 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal more residential units in one structure new, alteration, or extension* 60.00 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress /lighting plan ❑ Other: Per inspection 1 1 90.00 Submit 2 sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Notice: This permit application Permit fee 7. ' � $ r_.? tam. expires ifa permit is not obtained Plan review (at 25 %),.� _ --.. within 180 days after it has been State surcharge (8 %'.... $ Z..... accepted as complete. TOTAL $_ _ 440 -4615 (7 /02 /COM) OCT -17 -02 09:30AM FROM -STOEL RIVES ACC 5032202480 T -847 P.02/02 F -073 13125 S.W. HALL BLVD. ' TIGARD, OR 97223 IMPORTANT PERMIT NOTICE OCT 1 7 2002 MOM'S ELECTRIC 13909 UPPER ALDERCREST DR MILWAUKIE, OR 97267 `_ , � y. Electrical Signature Form Permit #: ELC2002 -00547 Date Issued: 10/16/02 Parcel: 25111 CB -00500 Site Address: 14805 SW 103RD AVE Subdivision: DEL MONTE SUBDIVISION Block: Lot: 004 Jurisdiction: TIG Zoning: R -3.5 Remarks: Alteration of (5) branch circuits for kitchen remodel. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: MUNHALL, WALTER F JR AND MOM'S ELECTRIC JEAN S 13909 UPPER ALDERCREST DR 14805 SW 103RD AVE MILWAUKIE, OR 97267 TIGARD, OR 97223 Phone #: 5 03 ca 0 3Q Phone #: 503- 702 -0894 Reg #: LIC 52998 ELE 3 - 525C SUP 3160S AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Su ising Electrician If you have any questions, please call (503) 639 -4171, ext. # 310 Fft b+€_ 5c3- 55g l ct &o CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST / BUP Received Date Requested ` ° 3 AM PM Location / O 5 ( 3 Art--- Suite MEC Contact Person f.,44- --- Ph ( ) 7 00)- O eS PLM Contractor p1 Or') 4- E C r Ph ( ) 3 -5:24c, SWR BUILDING Tenant/Owner ELC ° �� s`(7 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 N/ _ Fire Alarm r ��,� Susp'd Ceiling ° , Roof Other: Final - PASS PART FAIL PLUMBING - - Post & Beam i Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: 0)4 Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Servic U 1 G/Slab Low Voltage Fire Alarm Final LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. AS PART FAIL SI LI Please call for reinspection RE: El Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date °C t • ��(�� Inspector r� .. Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION , Business Line: (503) 639 -4171 MST BUP Received Date_ Re � ' 7 AM PM BLIP �� / D3tJ10b Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR �1 r ILD Tenant/ LLD CZ —t—\ 2 ELC o� " , Footing (D 2-o -6 g ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear In • - - : Shear •n 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 P SS ART FAIL • ECTRI Rough -In UG/Slab Low Voltage Fire Alarm A r PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. � Please call for reinspection RE: Unable to inspect - no access Fire Supply Line ADA C Approach/Sidewalk Date 2 Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL