Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 - 00261
1 A, DEVELOPMENT S d , OR ES (503) 639 -4171 DATE ISSUED: 5/9/03
13125 PARCEL: 2S110BB - 00100
SITE ADDRESS: 14059 SW 119TH PL
ZONING: R - 4.5
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 200 amp service. Service change out.
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:
JUSTICE, JANICE T OWNER
14059 SW 119TH PL
TIGARD, OR 97224
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/9/03 $80.30
[TAX] 8% State Tax 5/9/03 $6.42 Rough -in
Elect'l Service
Total $86.72 Elect'l Final
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 -2344.
Issued By: /J�til ( (.,;1� Permit Signature '
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
Electrical Permit Application FOR OFFICE USE ONLY
_
Received z Electrical 1 `
DaDate/BY: Cj -C 1 - 0 ?j 1 ) Permit No c9( ,Oa a lv (
City f Tigard Planning Approval Sign
y g Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Mn m It 101 i l k Date/By: Case No.:
Internet: www.ci.tigard.or.us _ j,. el I I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
-*,. `'1: TYPE OF WORK PLAN REVIEW (Please check all that apply)
El New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition /alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
:.,., . ; CATEGORY OF CONSTRUCTION -, . ; 1 & 2 family dwellings four or more residential units in
1 & 2- Family dwelling ❑ Commercial/Industrial ❑ m volts nominal structure
❑ Build Syste ing over over 600 three stones ❑Fee one ders, struct 400 amps or more
Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: i 'ID S:9 So-) (1 + k P (a c._ o :, .: FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total i
Cross street/Directions to job site: ' N (� r New residential-single gincd or multi-family per
���- dwelling unit. Includes attached garage.
/' t9 fl ,�, - 1 ) e_ 7 i 19 +k p( f-r -e- Service included:
h � r` ` �-' 1000 s ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax ma • / • arcel #: Each manufactured home or modular dwelling
" 2I€11 :,„+ `, 5'''''''''' service and/ 90.90 2
Services or or feeders feeder - installation,
alteration or relocation:
200 amps or less 80.30 9( , . 0 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
-, 1101.- .ER, ;; - g r`
0 601 amps to 1000 amps 240.60 2
- ? Over 1000 amps or volts 454.65 2
Name: USN( C—e. C J o ,.S l c_ Reconnect only 66.85 2
Address: ( Li0 S S 0—> ( 111-1" P / . Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: ` "' Cf ) p_T. 1 c5 200 amps or less 66.85 - 1
Phone: •• _ r Fax: 620 --,509 201 amps to 400 amps 100.30 2
T
r► 401 to 600 amps 133.75 2
f gc ` k O lrt , 1: . I' `v Branch circuits - new alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CO Each pump or irrigation circle 53.40 2
u - - Each sign or outline lighting 53.40 2
i Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 , 2
Business Name: 0 (;t} Description:
Address:
Each additional inspection over the allowable in any of the above:
City /State /Zip: Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other: ; ; Rif xv . M
Supervising electrician Subtotal $ C', - .7
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ (.. 4 19"
TOTAL PERMIT FEE $ g(0 ia -
Authorized . - r .SZ, L Notice: This permit application expires if a permit is not obtained within
Signature: /11* a° Date: 18 days after it has been accepted as complete.
d *Fee methodology set by Tri -County Building industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application /City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
n Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
0 Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
n Nurse Calls
Ei Outdoor Landscape Lighting
0 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING InspoOkiP (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested C g AM PM BUP
Location /ii S it? 4 ' - f L Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ?'8 g/ fo ELC /
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 ��� 0/ T
Drywall Nailing '41)
Firewall I9
Fire Sprinkler
Fire Alarm (1410
Susp'd Ceiling
Roof
Other:
Othe �l
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: l Y /Y `
Final /
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
ough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_il PART FAIL
Please call for reinspection RE: n Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk D ate Me9 o Inspector - _ S_ Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL