Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00198
- ..'' ,•14 }� DEVELOPMENT SERVICES DATE ISSUED: 4/13/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103CD -04400
SITE ADDRESS: 13530 SW 121ST AVE ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Bathroom remodel (2) branch circuits.
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:
MICHAEL BROWN OWNER
13530 SW 121ST AVE
TIGARD, OR 97223
Phone: 503 - 590 - 6879 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 4/13/2006 $53.50
[TAX] 8% State Surcharge 4/13/2006 $4.28
Total $57.78 REQUIRED ITEMS AND REPORTS
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. Ttose rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct question to OU Vat, i3 46 -6699 or
1- 800 - 332 -2344.
Issued By: Permittee Signature: / Ai* 4 r
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.
r
Electrical Permit Application roll o usi� oN '
City of Tigard [� � EIVED Received . /
II
Date . , [/ U - • Permit No.: (` ,� v o q II
° 13125 SW Hall Blvd., Tigard, OIL 23 Plan Review
Ill ` Phone: 503.639.4171 Fax: 503.598.1960 Date/B . Other Permit:
TIGARD Inspection Line: 503.639.4175 APR 1 3 2006 Date Ready/By: See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
' TYPE OF('ORIO TIGARD • PLAN REVIEW • .
❑ New construction 0 Addition/a7ra t>F
Please check all that apply:
ID Demolition ❑ Other: ❑Service over 225 amps, comet ['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
a' 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑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
Job no.: Job site address:/ . q/ s ❑Health -care facility ❑Other:
�� S /C C Subm 2 sets of plans w any of the above.
City / State/ZIP: 7 l4 A'.10.1) 172.-__3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE -
Description I Qty. 1 Fee. I Total 1 '*
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
dwelling, service and/or feeder 90.90 2
TJ -�! 'V9te---- Services or feeders installation, alteration, and/or relocation
`" 7 C Z Z1. /,(15-3:26,2e."Elokt 200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Fizep,p4v 601 amps to 1,000 amps 240.60 2
Address: ' ® e s A , z ) .Ps Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /Stat " - �j ,e2/6 .7Z23 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 3) e 6 , . e7 .9 Fax: ( ) 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, ,l lease, nt, o xchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner Signature: / C9- Date: * Z 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 •
B. Fee for branch circuits
Contact name: without service or feeder fee, •
first branch circuit ` - P- 46.85 2
Address: 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:
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 •
ELECTRICAL PPERMIT FEES* •
CCB Lie.: Electrical Lic.: Suprv. Lie.: Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (8% of permit fee): =.
TOTAL PERMIT FEE 1 -- 7„ 7)
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
I:\ Building \Permits\ELC- PemritApp.doc 03/23/06 440- 4615T(l1 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RERDENTIAL,W'URK 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:
Fee for each commercial $75.00
system
(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
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
•
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other
Total number of commercial systems:
'kNo licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006-00198
13125 SW Hall Blvd., Tigard, OR 97223
. 040/0 4 --4 DATE ISSUED: 4/1312006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 441. 61i.
INSPECTION WORKSHEET FOR DATE: 5/3/2006 TIME: 7:08AM PAGE: 12
SITE ADDRESS: 13530 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: i3ROWN
DESCRIPTION: Bathroom remodel (2) branch circuits.
OWNER: BROWN, MICHAEL • PHONE #: 603-590-6879
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 5/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 029203-01 503-8494645 N
Corrections/Comments/Instructions:
g5 ., /,,,e5 , ,, —•
•
• x ,
,-c
n - ,
. - .. •--,'-'-
' __--,., 4 ,--
r a PASS n PARTIAL APPROVAL I] CANCEL I I NO ACCESS
EI FAIL pi CALL FOR INSPECTION pi ADDITIONAL FEES ASSESSED
Inspector: C/qi ' S -7--- 0
Date: — — Phone #: (503) 718- Z6 Lig
CITY OF TIGARD 66,,,v,e1;- 0,4 at
Ipv.+ a
BUILDING DIVISION ii.-1. T.: ,, 14)1„4.;-1-tby PERMIT #: ELC2006-00198
I 13125 SW Hall Blvd., Tigard, OR 97223 p DATE ISSUED: 411312006
Phone: (503) 639-4171 4474104 1 I li\
Inspection Requests (24 Hrs.): (503) 639-4175 AA 'IL ,
INSPECTION WORKSHEET FOR DATE: 4/2712006 TIME: 7:04AM PAGE: 8
SITE ADDRESS: 13530 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BROWN
DESCRIPTION: Bathroom remodel (2) branch circuits.
OWNER: BROWN, MICHAEL PHONE #: 503-690-61:P9
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 412712006 Poui Time:
Code # Inspection Description Confirm # Contact # Message
120 ElecIrical rough-in 0281320-01 503.8494645 Y
e L.44 4#01. AS
Corrections/Comments/Instructions:
•
X PASS I I PARTIAL APPROVAL fl CANCEL fl NO ACCESS
I I FAIL I I CALL FOR INSPECTION H ADDITIONAL FEES ASSESSED
Inspector:
Date: l i Phone #: (503) 718-
, ,
C ITY OF ��mn w ��n n°�m��nn��
BUILDING ��U��U«�U��0� '
DIVISION PERMIT #: ELC2O05-01) 198
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2006
Phone: (503) 639-4171
Inspection Requests (24Hm.):(5O3)030'4175 ° o��� ^ �J �
INSPECTION WORKSHEET FOR DATE: 4/2&2006 TIME: 7:03AK6 PAGE: 38
SITE ADDRESS: 13530 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BROWN
DESCRIPTION: Fathronm remodel /21bnar\rh circuits.
OWNER: BROWN, MICHAEL PHONE #: 503'690'6879
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/I6/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 E|ecthcal[nugb~\n 02873601 503-849-4846 Y
Corrections/Comments/Instructions: oCorrections/Comments/Instructions: �� /] CC,uu / /
I I PASS PARTIAL APPROVAL 7 CANCEL NO ACCESS
V FAIL 7 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
'~ //�` �� �^/ ��^� � ^^
-1
Inspector: �~/�(/ Date: ~�`�~� �^�� Phone (503) 718'v�-��-�
� ` '
CITY. OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006.00 98
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/25/2006 TIME: 7:00AM PAGE: 38
SITE ADDRESS: 135313 SW '121ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BROWN
DESCRIPTION: Bathroom remodel (2) branch circuits.
OWNER: BROWN, MICHAEL PHONE' #: 503 -590- €6379
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/25/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 028643-01 50369 4645 •,
Corrections /Comments /Instructions:
rN
6 1M licativ ait Ke,YV Y 6' )
n PASS n PARTIAL APPROVAL CANCEL n NO ACCESS
)7/ ] FAIL g, CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: NC*, 1 --‘ Date: 41 S d Phone #: (503) 718 -1,44`
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200-00 1913
• 13125 SW Hall Blvd., Tigard, OR 97223 " ' DATE ISSUED: 4/13/200
Phone: (503) 639 -4171 hopt illl
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/19/2006 TIME: 7:02AM PAGE: 16
SITE ADDRESS: 13530 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BROWN
DESCRIPTION: Bathroom remodel (2) branch circuits.
OWNER: BROWN, MICHAEL PHONE #: 503 - .6.90.6879
• CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/19/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 023314 -01 503-Z49-4645 N
Corrections /Comments /Instructions:
•
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CHI l Date: 4 7 , / Phone #: (503) 718- i