Permit A .CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00825
DEVELOPMENT SERVICES DATE ISSUED: 12/30/2004
,274-11111' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 110AD -05400
SITE ADDRESS: 14862 SW 106TH AVE
SUBDIVISION: LANG HILL NO.2 ZONING: R-12
BLOCK: LOT : 047 JURISDICTION: TIG
Project Description: (2) branch circuits: AC and furnace.
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:
HAHN, BETTY BADGER ELECTRIC INC.
14862 SW 106TH PO BOX 55446
TIGARD, OR 97224 PORTLAND, OR 97238 -5446
Phone: 503- 684 -2724 Phone: 503 - 288 -4756
Reg #: LIC 156851
ELE 3-571C
FEES SUP 4951S
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 12/30/200 $4.28
[ELPRMT] ELC Permit 12/30/200 $53.50 Rough -in
Elect'I 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 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 - 33292344.
Issued By: Gr. G'[ ��� _ J, ,.1� Permit Signature: (')-) 2 ( cA /
OWNER INSTALLATION ONLY ' 1
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
, .• RECEIV
City of Tigard Received )
13125 SW Bail Blvd., Tigard, OR 97223 DEC 1� Date/By: 1 2� ' YLi //, t t Fait No.: t .,) ,,I _ L.(-,
Phonc: 501639.4171 Fax: 503.598.1960 �n '�• . Dat e/ Review Other Permit: 5 Inspection Line: 503.639.4175 CITY OF Date Ready /By: lyric I ® See Page 2 for
Internet: www.ci.tigard.or.us l• 1 TIG •-' +o Notified/Method: i I6i) Supplemental Information
D1 VISION PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'1 ❑limrardous location
❑ Demolition ❑ Other:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
�� CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
tom✓ I and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑ Other.
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egrrss/lighting plan RV park
1� fi j O . . ❑Healthcare facility ['Other: Oth['Other: Job no.: Job site address
r >62 �� I ( Submit 2 sets of plans with any of the above.
City/State/ZIP: The above are not applicable to temporary construction service.
Suite/bldgJapt. no.: l Project name: 1 FEE* SCHEDULE
Description ' Qty. I Fee. ' Total f ••
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: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Z 1 ` ' F � � . � dwelling service and/or feeder 90.90 2
i'�.• OAS Serv or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 106.85 ' 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454,65 2
Reconnect only 66.85 2
City / State/ZIP: • Temporary services or feeders installation, alteration, and /or
Phone: ( ) 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
❑ APPLICANT ( 0 CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name:
branch circuit 6.65 , 2
Contact name: B. Fee for branch circuits II
without service or feeder fee, 46.85 2 I
Address: each branch circuit
Each add'' branch circuit 6.65 j y 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
Business name: T,C10 j r IOC W rC extension_ Describe: Page 2 2
Address: � Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: 177 (', ' ' 3 �j L7 --1 - i Investigation per hour (t hr nun) 62.50
Phone: (5157.. (5157.. 2 - 6 ` + Fax: 1 (933) y � i �� ,U 01 plant lant per hour , _ 73.75
CCB Lic.: 1 _ I Electrical Lie.: 3 Slid_ Suprv. Lic.: Q _71......_ ELECTRICAL PERMIT FEES*
1S 6 Subtotal 53,56
Suprv. Electrician signature, required: Plan review (25% of permit fee) a . �t� �
Print name: State surcharge (8% of permit fee)
CUn4r5 s ((late: a-12- t 4- y.
TOTAL PERMIT FEE
Authorized signature:
This permit application expires Ida permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tai- County Building Industry Service Board
•• Number of insOcettons per permit allowed. S . , p
2• BDE9 882 - EOS PPol diO :E0 170 62 3013
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line* 03) 639 -4175 MST
INSPECTION DIVISION Business Line (503) 639 -4171
BUP
Received Date Requested l — AM PM ,lmuEc P
Location � `�L Suite c) ��
Contact Person 'h ( ) PLM
Contractor •h ( R
BUILDING Tenant/Owner �G ' =�. - - a ELC OQ — Sow
Footing __— I
Foundation ELC
Access:
Ftg 6 on ELR
Drain
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear / f
Int Sheath/Shear 4
Framing AIL
Insulation �'
Drywall Nailing p
Firewall S L c� �! /L� C;Z C _ 2�
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 0 0/ 1 -""
Rough -In /
Gas Line
Smoke k�
mokampers e D
( 8S 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.
PART FAIL
TE Ei Please call for reinspection RE ` Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector 41 `� Ext
Other:
Final DO NOT REMOVE this inspection record fr a job site.
PASS PART FAIL