Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00360
i DEVELOPMENT SERVICES DATE ISSUED: 5/27/2005
�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S115AD -00600
SITE ADDRESS: 16740 SW 108TH AVE ZONING: R - 4.5
SUBDIVISION: WILLOWBROOK FARM LOT : 030 JURISDICTION: TIG
Project Description: 1 serv. w/ 8 branch circuits. Guest house.
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: 8 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:
MAY, MARTHA PACIFIC NORTHWEST ELECTRIC INC
16740 SW 1 18TH 16200 WIDMAN CT
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: 503 - 350 -2700 Phone: 503 - 657 -1188
FEES Reg #: LIC 162893
ELE C6
Description Date Amount SUP 5089S
[ELPRMT] ELC Permit 5/27/2005 $133.50
[TAX] 8% State Surcharge 5/27/2005 $10.68 REQUIRED ITEMS AND REPORTS
Total $144.18
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 throu• h OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 -246 -6699 or 1 y - 332 - 2344.
Issued By: ` ��� Permittee Signature: D (
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: 5 d-? 7)5
LICENSE NO: S
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 } p i l r C R I 0 ' E D. , , - FOR'OFFICE'USE ONLY ` .
Received /% /
City of Tigard W J DateBy: J/� 7 /p5� j', perm ii N °. � ��DS —O �Q
13125 SW Hall Blvd., Tigard, OR 97228Y 2 ry 2005 P lan Review /
Phone: 503.639.4171 Fax: 503.598.160 -- „ , y — t ` Date/By: Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGARD ELL Date ReadyBy: ns: H See Page 2 for
Internet: www.ci.tigazd.or.us BUILDING DIVISION Notified/Method: r Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply:
El Demolition / ❑ ❑Service over 225 amps, comm'l ['Hazardous location
❑ Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
g..1 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building El System over 600 volts nominal units in one structure
❑ Multi - family 111 Master builder E] Other: ❑ ❑
Building over three stories Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
❑Health -care facility CI Other:
Job no.: c� '� Job site address: C �1 ) o }� Submit 2 sets of plans with any of the above.
City /States /ZIP: .. ^ r I - / The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. 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'l 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
dwelling, service and/or feeder 90.90 2
[2 P.0 — t J — �-g'i - e_ — Services or feeders installation, alteration, and /or relocation
200 amps or less / 80.30 2
❑ PROPERTY OWNER (11 TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: yyl /4 Cl 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
relocation
( F ax: ( )
Phone: �� 3 — "� 7z 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 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit n 6.65 S 3.x. 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) 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: 1`
rr,, c„, - - -C, ” 0(c(' -k v v-e0 -- Clc- d-,; --, .l C.
Address: Each additional inspection over allowable in any of the above
�� t - X J D 1 4. a r■ � � fi Per inspection 62.50
City/State /ZIP: 0 p r Ct , 0 IL 9q, _sr--- Investigation per hour (1 hr min) 62.50
Phone: r /kk Fax:() 7p /, Industrial plant per hour 73.75
� �� ` �" 7C� ELECTRICAL PERMIT FEES*
CCB Lic.: 1b�-kc13 Electrical Lic.: e G Suprv. Lic.: cDk S Subtotal /5 570
Suprv. Electrician signature, required: p . 'lb - 1 - 0 7 Plan review (25% of permit fee)
Print name: E ___,,, l7 t�,, `' Date: 6 : i � 7 State surcharge (8% of permit fee) /0,
I t Q TOTAL PERMIT FEE /4(../. / g
Authorized signature. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete .
Print name: L y - �� Date: ` �0"7 ,_�A * Fee methodology set by Tri -County Building Industry Service Board
* * Number of inspections per permit allowed.
i:\Building\Permits\ELC- PermitApp.doc 12/03 440- 4615T(10/02 /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:
I Audio and Stereo Systems*
Burglar Alarm
Garage Door Opener*
I Heating, Ventilation and Air Conditioning
System*
I I Vacuum Systems*
I Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
I I Clock Systems
I I Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
• n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
Nurse Calls
I Outdoor Landscape Lighting*
Protective Signaling
n 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
BUILDING DIVISION PERMIT #: 66 —o 63 D
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 irn u vp�tl@aj 1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ‘,796 U O Y'4 CLASS OF WORK:
SUBDIVISION: - LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
• OWNER: fl? PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 - 7 - o Pour Time:
Code # Inspection Description Confirm # Contact # Message
ti r at,.6k/d 3 '(- / (o
Corrections /Comments /Instructions:
•
•
X. PASS I 1 PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
0 17
Inspector: Date: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: W.72005-00360
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5127/2005
Phone: (503) 639-4171
Jri
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 12/29/2006 TIME: 7:00AM PAGE: 42
SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 030 TYPE OF USE:
PROJECT NAME: MAY
DESCRIPTION: I setv. Irv/ 8 branch circuits. Guest house.
OWNER: MAY, MARTHA PHONE #: 503-350-2700
CONTRACTOR: PACIFIC NORTHWEST !ELECTRIC INC PHONE #: S03-5!-1
Inspection Request Scheduled For: Date: 12/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 024136-01 503-380-1693
Corrections /Comments/ Instructions:
•
CAA c_g-q PgR, ONAR..`"DA.N ykict
•
PASS 0 PARTIAL APPROVAL AANCEL ,..JO ACCESS
I I FAIL ACALL FOR INSPECTION DI ADDITIONAL FEES ASSESSED
Inspector: C 21251( Or Phone #: (503) 718-V14
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005-00360
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/27/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/27/2005 TIME: 7:09AM PAGE: 53
SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 030 TYPE OF USE:
PROJECT NAME: MAY
DESCRIPTION: 1 sere. w/ 8 branch circuits. Guest house.
OWNER: MAY, MARTHA, PHONE #: 503 -350 -2700
CONTRACTOR: PACIFIC NORTHWEST ELECTRIC INC PHONE #: 503. 657 -1188
Inspection Request Scheduled For: Date: 6/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service 010192-02 503. 969.8839 N
Corrections /Comments /Instructions:
11104'1 r a vwe,"-et, IAA et. ele-r
(k nag, - 0 I •31--hg
( i Ii en e k / j
Ff>
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 6 ---2) ? as' Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00350
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 5/27/2005
Phone: (503) 639 -4171 ll / /mjii j
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/27/2006 TIME: 7 :09AM PAGE: 54
SITE ADDRESS: 16740 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 030 TYPE OF USE:
PROJECT NAME: MAY'
DESCRIPTION: 1 sere. w/ 8 branch circuits. Guest house.
OWNER: MAY, MARTHA, PHONE #: 503 -350 -2700
CONTRACTOR: PACIFIC NORTHWEST ELECTRIC INC PHONE #: 503 -657 -1188
Inspection Request Scheduled For: Date: 6/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # - Message
120 Electrical rough -in 010192 -01 503. 969-8839 N
Corrections /Comments /Instructions:
il 0 k : 4 le1
' 0 it 1 c a'' A 3 eetivei 0 , c-e_-- 0
c i
z6-k- •u .,r 3 6 '- 0 v 4- v p4-0 7 42 1 4 it,
4-A Pe-Ci if ` rext. iLI APfroi tal- %or de-e4y ace
E 444
ii 4 c ' . Om P/' Q' � ., �
1 S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 1 0
Inspector: Date: Phone #: (503) 718-