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Permit .1 ELECTRICAL PERMIT CITY OF TIGARD PERMIT #: ELC2005 00696 DEVELOPMENT SERVICES DATE ISSUED: 9/19/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 • PARCEL: 2S103AA -03800 SITE ADDRESS: 12295 SW 106TH DR ZONING: R -4.5 SUBDIVISION: CLYDESDALE LOT : 020 JURISDICTION: TIG Project Description: Service replacement. 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: MATT GENT OWNER 12295 SW 106TH DR. TIGARD, OR 97223 Phone: 503 - 598 -0543 Phone: FEES Reg #: Description Date Amount [ELPRMT] ELC Permit 9/19/2005 $80.30 [TAX] 8% State Surcharge 9/19/2005 $6.42 REQUIRED ITEMS AND REPORTS Total $86.72 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 • - 'ons to OUNC at 503 - 246 -6699 or 1 -80 2 -2344. r Issued By: �� Permittee Signatur >. 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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. . Electrical Permit A • ,.. j,i',,,.. IV ED 8ED F 0li OFFICE USE ONLY City of Tigard pe i c t M11 Permit No.:, D = .«, 13125 SW Hall Blvd., Tigard, OR 97223 n q ii'' Pl an R ev i ew /, Phone: 503.639.4171 Fax: 503.598.196S[r [p 9 L UJ "','B ,r� i � Date/By Other Permit: dv r27%' I' Inspection Line: 503.639.4175 � ! D ate ReadyBy: J 0 See Page 2 for Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: Supplemental Information atimaNGArMiks IO PLAN R IEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: El Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous location ['Service over 320 amps — rating ['Bulldog over 10,000 sq. ft., `,j` , - CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential 3'1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure • El Multi - family El Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons 0 Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: / Z 2 9S s t..) /06, 6 r ve- ❑Health -care facility ❑Other: � Submit 2 sets of plans with any of the above. City /State/ZIP: 7)6.42 ` J v Q 9 -- 2 3 The above are not applicable to temporary construction service. FEE* SCHEDULE Suite /bldg. /apt. no.: Project name: Description I Qty. I Fee. Total I ' , Cross street/directions to job site: New residential single - or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular 4, / e44- --- Fox C 1_,� j - kI /�� �� dwelling, service and/or feeder 90.90 2 �7 l Services or feeders installation, alteration, and /or relocation 200 amps or less I 80.30 2 ❑. PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 �, C' 401 amps to 600 amps 160.60 2 Name: . C 601 amps to 1,000 amps 240.60 2 Address: Z 2 Cs S k--.. ����`` t ime , c� e_ Over 1,000 amps or volts 454.65 2 n Reconnect only 66.85 2 City /State/ZIP: .�� /f e. e— 97� S Temporary services or feeders installation, alteration, and /or Phone: (5b3 ) 15/ Oct/ '. F ax: ( ) relocation 200 amps or less 66.85 1 . Owner installation: This installation is being made on property that I own which i not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or - fir ge, . t. .r• ng to ORS 447, 449, 670, a'd 7 9 ii G 401 amps to 600 amps 133.75 2 Owner signature: L,_ ., J „_ _ Date: Branch circuits — new, alteration, or extension, per panel ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit Contact name: B. Fee for branch circuits without service or feeder fee, Address: each branch circuit 46.85 2 Each add'I branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax :: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- . • CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: &LA rte.. V e 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 • Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT' FEES* CCB Lic.: • - Electrical Lic.: Suprv. Lic.: Subtotal WC) Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) (Q . TOTAL PERMIT FEE S to .7g.. Authorized signature: L � , / 4 tt4?? This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: -1A-j" ( )' ', I Date: // 9) * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. i:\ Building \Perrnits\ELC- PerrnitApp.doc 12/03 440- 4615T(10 /07/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information • LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: 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: COMMERCIAL WORK ONLY•: : , 1 • 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 irk Building \Permits\ELC- PermitApp.doc 04/03 CIT=Y OF TIGARD _ BUILDING DIVISION PERMIT #: ELC2005 -00696 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9119d200� Phone: (503) 639- 4171 +�y�u �ii�j �hl Inspection Requests (24 Hrs.): (503) 639 -4175 . �' :_.. INSPECTION WORKSHEET FOR DATE: 912212005 TIME: 7:12AM PAGE: 75 SITE ADDRESS: CLASS OF WORK: SUBDIVISION: 12295 SW 106TH DR LOT #: TYPE OF USE: PROJECT NAME: CLYDESDALE 020 DESCRIPTION: GENT Service replacement. OWNER: GENT, MATT PHONE #: 503 - 598 -0543 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9122 2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 016338 -01 503 -971 -2462 Corrections /Comments /Instructions: . r .. i r PASS ❑ PA 'TIAL APPROVAL n CANCEL I 1 NO ACCESS FAIL /CALL FOR ,. ''CTION — ADDITIONAL FEES ASSESSED Inspector: / /' � 1�� Date: ! v J Phone #: (503) 718- ."`"? , s,' CITY OF TIGARD BUILDING DIVISION PERMIT #:5\,(.2017 .5' O4L % 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639-4171 w y , Inspection Requests (24 Hrs.): (503) 639 -4175 ` INSPECTION WORKSHEET FOR DATE: -1.17 st* TIME: PAGE: SITE ADDRESS: ` Z,Zgs 5 fL b CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: R. PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message Corrections /Comments /Instructions: Dp) PASS PARTIAL APPROVAL CANCEL I I NO ACCESS FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: PO N` J CCr4J� Date: '" "5 Phone #: (503) 718- Inspections Required for: ELC2005 -00695 ✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By BUP - Building Permit ELC - Electrical Permit 405 Excavation 105 Underground/slab cover 410 Fill 110 Temporary electrical service 415 Grading X 115 Electrical service _ 205 Footing X 120 Electrical rough -in 805 MFG - Structure grading /footing 125 Wall cover • 210 Foundation walls 130 Ceiling cover 215 Footing drain 135 Low voltage 220 Slab 140 Sign installation 310 Crawl drain 145 A/C or heating unit circuit 225 Post/beam structural 150 Hot tub /spa /pool 230 Underfloor insulation 195 Misc. inspection: 235 Shear walls /anchors X 199 Electrical final 240 Exterior sheathing 245 Firewall 250 Roof nailing ELR - Restricted Energy Permit 255 Wtr proofing basement walls 135 Low voltage 260 Tilt -up panel 195 Misc. inspection: 265 Masonry 199 Electrical final 270 Reinforcing steel (rebar) 275 Framing 810 MFG -Structure set-up MEC - Mechanical Permit 280 Insulation 605 Post/beam mechanical 285 Drywall nailing 610 Gas line 287 Suspended ceiling 615 Mechanical rough -in 295 Misc. inspection: 620 Hydronic piping 899 MFG - Structure final 625 Duct work 498 Grading final 630 Fire damper 299 Final inspection 635 Smoke detector shutdown 640 Exhaust hood 695 Misc. inspection: 699 Mechanical final BUP - Fire Protection System Permit 905 Sprinkler underfloor /slab PLM - Plumbing Permit 910 Sprinkler rough -in 305 Plumbing underslab 915 Fire alarm rough -in 310 Crawl drain 920 Suppression trip test 315 Post/beam plumbing 995 Misc. inspection: 320 Plumbing rough -in 998 Alarm final 325 RP/backflow preventer 999 Sprinkler final 330 Water service 335 Rain drain 340 Storm drain SIT - Site Work Permit 505 Sanitary sewer _ 405 Excavation 345 Culvert/catch basin 410 Fill 350 Septic tank 415 Grading 395 Misc. inspection: 205 Footing 399 Plumbing final 210 Foundation walls 215 Footing drain 420 Sprinkler supply lines SWR - Sewer Permit 495 Misc. inspection: 505 Sanitary sewer 498 Grading final 595 Misc. inspection: 499 Final inspection _ 599 Final inspection I: \Building \IVR \InspCard- AOP.doc 06/17 /2005 C ITY O F TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00696 �f� DEVELOPMENT SERVICES DATE ISSUED: 9/19/2005 "�'`" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2 S 103AA -03800 SITE ADDRESS: 12295 SW 106TH DR ZONING: R - 4.5 SUBDIVISION: CLYDESDALE LOT : 020 JURISDICTION: TIG Project Description: Service replacement. 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: MATT GENT OWNER 12295 SW 106TH DR. TIGARD, OR 97223 Phone: 503- 598 -0543 Phone: FEES Reg #: Description Date Amount [ELPRMT] ELC Permit 9/19/2005 $80.30 [TAX] 8% State Surcharge 9/19/2005 $6.42 REQUIRED ITEMS AND REPORTS Total $86.72 1 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 CSN 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 • - 'ons to OUNC at 503-246-6699 or 1-80 2 -2344. , Issued By: ,)� Permittee Signatur � ' 1' , 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 503- 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection.