Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00088
,,, l DEVELOPMENT SERVICES DATE ISSUED: 2/15/2005
'•' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S110BA -02200
SITE ADDRESS: 14170 SW 119TH PL
SUBDIVISION: ZONING: R
BLOCK: LOT : JURISDICTION: TIG
Project Description: Connect repaired pump.
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:
NORIN, ROBERT, SANDRA OREGON ELECTRIC CONST /GROUP
COT WELL PUMP AT SITE 1010 SE 11T1-I AVE
14107 SW 119TH PL PORTLAND, OR 97214
TIGARD, OR 97224
Phone: Phone: 503 - 535 - 2652
FEES Reg #: LIC 203
SUP 4460S
Description Date Amount ELE 26 - 95C
[ELPRMT] ELC Permit 2/15/2005 $46.85
[TAX] 8% State Surcharge 2/15/2005 $3.75 REQUIRED ITEMS AND REPORTS
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 (503)
246-6699 or 1 -800- 332 -23
yy 9 � —
Issued By: ^ / f�, � 17�Gfi Permit Signature: l' - / / 1LM // /
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
02 -11 -05 08 :57AM FR. 0 pn., i t.ilaatina 5032313587 T -551 P.001 /002 F -599
El Ideal Permit A— V C, . .: •
City of Tigard F an a 20�� ' ! `r_ o Permit No. G6. 6. o
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review payer Permit:
Phone: 503.639.4171 Fax: 503.598.1960 ,rNt, y a i `" Dam
OF T I GAR D � ».J ii Data Ready/Br, - , -: et Sec Page 2 for
Internet: In erne t : Line: 503.639.4175 wwW.Cl•tigargaid- d. or.ua UILDiNG DIVISIO Notified/M.od: ' f iv- I gupplcmentai information
TYPE OF WORK PLAN ]REVIEW
0 New construction IR Addition /atteiation/replaccmelit Please cheek all that apply;
['Service over 225 amps, consul Dliazar'dous location
❑ DelnoliliOrt ❑ Other: -_ ❑Service over 320 amp - rating ❑ Buildng over 10,000 sq. fi,
• CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
['System over 600 volts nominal units in one structure
1- and 2- family dwelling ®CommorciaUitldusttzal Q Accessory building ❑Building over three stories ['Feeders, 400 amps or more
❑ Multi - family ❑ Master builder 0 Other: ❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION • ❑Egr'ess/lighting plan RV park
- 0 I � health -care facility ['Other:
Job no.: 84047 -102 Job site address: 11900 SW Gaurde St /CET'7gb Submit 2 sets of plans with any of the above.
City /State/ZIP: Tigard, OR 97224 / V/ 7 0 51, ■ ‘ 6 1 7 L- The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg./apt no.: #2 Well Project aurae: #2 Well Deseripdoh 1 Qi - Far. J Total J
c/ — O9 ' y�/�, T at N residential single- or multi fama7y dwelling wait.
Cross ylreet/direalionS to job site: 7 r �,° ' Includes attached garage -
I . . t g _ /e 1,000 sq. ft or leas 145.15 4
Subdivision:
Lot no.: Ea. add'/ 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
conDCCt repaired 751ItP pump _ Services or feeders installation, alteration, and/or relocation
200 amps or loss 80.30 2
201 amps to 400 amps 106.85 2
® PROPERTY OWNER 0 TE NANT -
_401 neaps to 600 amps __ 160.60 2
Name: City of Tigard Water Bureau 601 amps to 1,000 amps 240.60 2
Address: 8777 SW BURN HAM ST. Over 1,000 amps or volts F 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)639-4171 l Fax: ( ) _ _ 2 00 amps or leas 66.85 1
Owner installation: This installation is being made on property that I own which is not 401 aims to 400 amps 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. _ 40 i amps to 600 amps 133.75 2
Owner signature: _ Date: Branch circuits - new, a lteration, or cxtension, per panel
'rAPPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with r
service or feeder fee, each 6.65 2
Business name: O ,,s_, � . .-7tiu brunch circuit -
B. Fee for branch circuits
Contact name. without service or feeder fee, /
46.85 I-4 . id 2
each branch circuit
Address: _ . , Each add'1 branch circuit L 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
_Pump or irrigation circle 53.40 2
Phone: ( ) k ax : (_ ) Sign or outline lighting 53.40 2
Email: Signal circuits) or limited.
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Oregon Electric Group
Address: 1010 SE 11th Ave Each additional Inspection over allowable in any of the above
Per inspection 62.50_
City /State /ZIP: Portland, OR 97214 investigation per hour (l br min) , 62.50 _
Phone: (503) 2.34-9900 I Fax (503)53S-2763 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 203 i Electrical Lie.: 26 -95C Suprv, Lie.: 4460S Subtotal (/ , (
._-.7 Suprv. Electrician signature, required: `��fa Plan review (25% of permit fee) _..---------
State surcharge (8% of permit fee) 3 , 7
Print name: G r - k_ " ' Gv_ Date: •TOTAL PERMIT FEE . 75 .-- 0 - 6 . U
7 Authorized signature ��� %��% This permit application eapitve (f a permit is not obtained within 180
r Tr%rT "' days alter It has been accepted ar complete
Pun ___ I181r1C: /1 n Date: • Fee methodoloSY att by Tri County Building Industry Service Board
J C
�L, ** Number of inssoectiona oar nem, t allowed.
CITY OF TIGARD 24 -Hour
BUILDING Inspection j.ine: 4503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location / 9' 70 /1 Suite MEC
Contact Person • Ph ( ) PLM
Contractor Ph ( ) gq — 7 L- SWR �,� )
BUILDING Tenants er ..._ _ _ ELC a4b0� d 0 08V
Footing
ELC
Foundation 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
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
FAIL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
al Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 1 1 ¶/t'
Inspector
Other:
Final DO NOT REMOVE this inspection record fr m the J site.
PASS PART FAIL
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