Permit •
•
•
CITY OF ,TIGARD ELECTRICAL 1 PERMIT #: ELC2005 00 PERMIT 0
8
PERMIT
DEVELOPMENT SERVICES DATE ISSUED: 6/14/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109AA -00500
SITE ADDRESS: 14215 SW 125TH AVE ZONING: R - 4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Panel upgrade.
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: 2 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:
JONES, SHIRLEY J TR ALAN FITCH ELECTRIC
14215 SW 125TH AVE 25973 S MOEHNKE
TIGARD, OR 97224 BEAVERCREEK, OR 97004
Phone: Phone: 503 - 313 - 0761
FEES Reg #: ELE 3 - 387C
tion Date Amount SUP 35
Description LIC 151952
[ELPRMT] ELC Permit 6/14/2005 $93.60
[TAX] 8% State Surcharge 6/14/2005 $7.49 REQUIRED ITEMS AND REPORTS
Total $101.09
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 Notificati•n Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules] r •irect uestio • /.UNC at
503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: - 7:244-7 / Permittee Signature: AV /,
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.
Electrical Permit •' r tc fi'o>i V - - J )
;~d—
FOFOR OI i'IC � USE ONI v
, „
Received
S City of Tigard ' ! UN 142005 DateB • Permit No.: C;tr.C.,z cu /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
41,
"� bx'�0 u;� v Date /B . Other Permit:
Inspection Line: 503.639.4175 • , Date ReadyBy: WI ® See Page 2for
Internet: www.ci.tigard.or.us CITY OF TIGA q T Notified/Method: Supplemental Information
-- �� OF `dX ISiONN " " PLAN REVIEW
❑ New construction NI Addition/alteration /replacement Please check all that apply:
El Demolition ❑Other: ❑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
^tj 1- and 2- family dwelling ❑ Commercial industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
1:1 Multi- family ID Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
•
JOB SITE INFORMATION AND LOCATION, ❑Egress/lighting plan RV park
❑Health -care facility ['Other:
no.: Job site address: Z1 s' yy,��� ��'
SW � Submit 2 sets of plans with any of the above.
City /State /ZIP: ///� ,9 /J O ( The above are not applicable to temporary construction service.
r� FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name:
Description I Qty. I Fee. I Total l
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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
Ake,/ dwelling, service and/or feeder 90.90 2
U/. �1 rl7j Services or feeders installation, alteration, and/or relocation
V 200 amps or less / 80.30 0', ct, 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
c 401 amps to 600 amps 160.60 2
'�
Name: c/ / / .J 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
3' / ` / relocation
Phone: (��) [ / �� 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, 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 Z• 6.65 0:3 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 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
� _ r� extension. Describe: Page 2 2
Business name: /' l Z fire ��T-,
Address: 2S-9 7 r ��� Each additional inspection over allowable in any of the above
3 S ,/I �ud 4: Per inspection 62.50
City /State/ZIP: , v tf9/ 9 kV V Investigation per hour (1 hr min) 62.50
• Phone: (?5)3'j5 0 / lb / F ax: ( 95) �5� -1 Industrial plant per hour 73.75 9"7 L r , ELECT PERMIT FEES* % ,
CCB Lic.: /57 Electrical Lic.:5 J C Suprv. Lic.: " 7 - z%S Subtotal Sv % / j
Suprv. Electrician signature, required: 1i d , --- ■ , , Plan review (25% of permit fee) / :TT
�� ^ C 7 1
State surcharge (8% of permit fee) t
Print name: A '"" ,) ' ` �^'e,11- Date: & ..1 C. , -
TOTAL PERMIT FEE i
. Authorized signature: This permit application expires if a permit is not obthrned within 80
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\E1.0 -PermitApp.doc 12/03 440- 4615T(l 0 /02/COM /WEB /04 a
c
Electrical Permit Application - City of Tigard r �,
Page 2 - Supplemental Information
PP
LIMITED ENERGY PERMIT FEES:
RESIDENTIALWORK 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 system $75.00
(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
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ 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 W A+ PERMIT #: ELC2005 -00408
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/14/2005
Phone: (503) 639 -4171 ill �ii�(� j � l+ �
Inspection Requests (24 Hrs.): (503) 639 -4175 "__-
INSPECTION WORKSHEET FOR DATE: 9/3/2005 TIME: 7 PAGE: 19
SITE ADDRESS: 14215 SW 125TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: JONES
DESCRIPTION: Panel upgrade;
OWNER: JONES, SHIRLEY J TR, PHONE #:
CONTRACTOR: ALAN FITCH ELECTRIC PHONE #: 603- 313 -0761
Inspection Request Scheduled For: Date: 8/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 012723-01 971- 221 -4559 V
a ty A -cfn
Corrections /Comments /Instructions:
♦
(.../
U
1
PASS ❑ PARTIAL APPR• fAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL IP/ ALL Fs iv` P • ION ❑ ADD o L FE` ASSESSED
//
Z
Inspector: /'L /_ Date: Phone #: (503) 71'x"