Permit - � I1"Y F TIGARD
ELECTRICAL PERMIT
+v. `PERMIT #: ELC2004 -00505
j '" DEVELOOMENT SERVICES DATE ISSUED: 8/11/2004
ci I 13125 SW I Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 104AD -03301
SITE ADDRESS: 12950 SW 129TH PL
SUBDIVISION: ZONING: R -
BLOCK: LOT : JURISDICTION: TIG
Project Description: (1) circuit.
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:
LORENCE, WALTER P + DEBI D OWNER
12950 SW WALNUT ST
TIGARD, OR 97223
Phone: Phone: •
. Reg #:
FEES .
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/11/2004 $46.85
[TAX] 8% State Surcharge 8/11/2004 $3.75 Elect'I Final
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 -2344.
Issued By: , v ;2J .,J Permit Signature:
•WNER INSTALLATION ONLY
The installation is being made on property I .. . hic >- of intended for sale, lease, or rent. / .
OWNER'S SIGNATURE: / . ii� / / / � I DATE: �� / °7
1
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 Applicatiolt® FOR OFFICE USE ONLY
City of Tigard
Receive. ve. d
f OR DateB : G� I Permit N'6 o. / 1 9/---- J t�
13125 SW Hall Blvd., Tigard, �y ' R
Phone: 503.639.4171 Fax: 503.5 `r. r ' :1 �o - y . , ai / ev � r' i\ Plan Date/13 : Other Permit:
Inspection Line: 503.639.4175 , `(_ 1 !7' e'` Date Ready
1 Finn See Page 2 for
.. U�7
�,
Internet: www.ci.tigard.or.us Notified/Ivleth d:
Iii g Td OT.US � � o Supplemental Information
��'� ���•5�., .� -'� �r „�::a�.s�.�.t+c,r ss� is *.s.�£' � . N a.,,,.. ti,� ?c , ,. �`�'":. '�.z. : c „ > - xa:
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❑ New construction ❑ A it�(�_�'r�tton/replacement Please check all that apply:
❑ Demolition I/h�� Other:
Qj ❑ Service over 225 amps, comm'l EHazardous location
N 4.1 amps g ❑Buildn over 10,000 sq. ft.,
� - � :.. r�,��. � �> sa.:.. re� s# :.: �V,* s` �: ? * „"ai,;:..1.�','�„s v : ', E '..,�. m -r g q.
Service o ver 320 a s rating
,:, ! Ora ,
STR JCTIO N . ; ; of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commerciallindustrial Accessory building System over 600 volts nominal ,units in one structure
❑ Multi - famil ❑Building over three stories ID Feeders, 400 amps or more
y ❑ Master builder ❑ Other:
=�."t.'
,r t ,.�, <. ,. *, r r „„ y -0ei qxh ❑Occupant load over 99 persons ❑Manufactured structures or
JOB: ails E+';� 70:0 O ,. 3 + t � � ess/li htin ❑ RV ark
~ ,, 0 � r 'a E � _ � T � *' art a �s� r_*..�, �” ,m� �i ��: ad . . _� � � rl`:aw � .� / T g g Ian P p
Job no.: Job site address: /,Z �v �� 4 f lj r i ❑Health - care facility ❑Other:
/ ,�[ 6'6 / /M � S Submit 2 sets of plans with any of the above.
City /State /ZIP:
I f 4 / Z” ' / 'L' 7212' The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: �c t : ' ,,wx`:. " FEE: S LEW,,.. . :]...'•:7'. *i
Description I Qty. Fee. { Total
Cross street/directions to job site: �/ , ��/ New residential single -or multi - family dwelling unit. ,e k 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
t ,' I i 2 1 ,,c : DE s O F WORK ` g ' * s a ~': k :44 ' `s'? Each manufactured or modular
/� //� /' t �f /,e dwelling, service and /or feeder 90.90 2
` �� � /! `` �> f 7e� '`« C + /° • Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
"< .,, ...w... na.. >,t r . ; : «- ... ;p a,,. ;.��:.•� »use 201 amps to 400 amps 106.85 2
,tc x PROPERTY OWNER g
t 0 6 '. 1„, ; ” TENANT -r `t r .: 4
,� ��.�, .... �,. .,,�, 3� x- ��.,�- _ �.. ;���:�, max., _ ,. ,�.Q.,a� ,�_� ,,. - ai.. 401 amps to 600 amps 160.60 2
Name: / �' i7 ( e 601 amps to 1,000 amps 240.60 2
Address: /29 O ' Zsx,.. /f, fe,. Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: .• /,` e /1, / ,2 7221 Temporary services or feeders installation, alteration, and /or
�Sy Phone: e� ) �f/ Fax: ( ) relocation 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, _ -nt, . • •ci.: - :Kling to ORS 447, 449, 670, and 701.
/ j am► . 401 amps to 600 amps 133.75 2
Owner signature: � ' �„ _, ,_p e- Date: /-„, Branch circuits - new, alteration, or extension, per panel
�,. „, 0 ti C®NTACT; P RSO
P �' �?i "� ®- AAp�IG�AN�� � - � v �
'�i*���.mma- ,G.:.±- ��.�:.. ...i�.. - .ka.rx e.Nx �.:.k,4,.a xTs,`s� A. Fee for branch circuits with
service :
Business name: branch �rcueder fee, each
6.65 2 it
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 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 -
. rr , ”, (s' `” • § GO*:47. TOR�.,A t ? s , '� . :a , .`:' 'i ' energy panel, alteration, or
Business name: (k / / extension. Describe: Page 2 2
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50 -
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
a - �- wr: ���.�:� °:"°�a•; ".''' =��
r. v EI tC I arn, EF RIVIIT' E-ES£. ` . .
CCB Lic.: Electrical Lic.: Suprv. Lie.: Subtotal e 5.—
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) /' 75
TOTAL PERMIT FEE 5-0 ` 6 D
Authorized signature: This permit application expires if a permit is not obtai 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.
is\ Building \Permits\ELC- PermitApp.doc 12103 440- 4615T(10/02 /COM/WEB
Electrical Permit Application - City of Tigard
`V
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
'1'xzg�a+'tixn' 77Z ✓a`:` �` xtr Y 51< '
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:
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
t \ Building \Petmits'ELC- PennitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested B A \ AM PM BUP
Location a`P Suite MEC
Co ct Person t *-0, \JDz\t?-1(.:v Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing '
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain -�
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing •
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL I!
PLUMBING I
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
PASS PART FAIL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date g/ Inspector 1,"--r Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
AL „i, A SANITARY SERVICE
INVOICE NO.
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 !; - T
503 - 644 -2797 * 503 - 648 -6254 * 503 - 639 -5188
NAME: f , -- r / 64'1. r ! C.AEx
s
ADDRESS: e C -- ,,��," . r Z 7 ill
a 6
C ` .� ` Y � STATE: ZIP:
CITY. �+ d f' � � + � � +'_. b.:.
HOME: WORK: CELL: § ( r�` )
JOB SITE: ' I4Y "i?T - A ,S y -\:' 0 -. P.O. #:
PAID BY CHARGE ❑ (AO CHEC C A CASH ❑ CREDIT CARD ❑
DATE r s `-I - d r _72 0 € DRIVER 474 VG 74 a fp / AMOUNT
LB' PUMP SEPTIC TANK ' 4,' '
❑ LINE OPENING
`s
❑ INSPECTION FEE RECEIVED , 4'
❑ SERVICE CALL I
❑ LABOR, LOCATING, DIGGING, BACKFILL
AUG 10 2004
t
❑ MATERIAL y
(:ITY OF TIG/1RD
BUILDING DIVISION
r ` TOTAL $ .._C" �; r�
- - THIS IS NOT A SEPTIC SYSTEM INSPECTION REPORT - -
/Li / ', — — REMARKS - -
TYPE OF TANK: f S TEEL ❑ CONCRETE ❑ PLASTIC ❑ HOMEMADE ❑
HORIZONTAL ❑ VERTICAL ❑ RECTANGLE ❑ ❑ OTHER
SIZE OF TANK: 350 ❑ 500 ❑ 750 ❑ 1000 ❑ 1250 ❑ 1500 ❑ 2000 ❑ 3000 ❑
LID LOCATION: INLET ❑ OUTLET ❑ MIDDLE ❑ ENTIRE TOP ❑
TANK CONDITION: GOOD ❑ FAIR ❑ POOR ❑
FITTINGS: BAFFLES ❑ CONCRETE ❑ CAST IRON ❑ PLASTIC ❑
NEEDS NEW LID? YES ❑ SIZE
GROUND COVER OVER TANK
COMMENTS ON CONDITION OF DRAINFIELD ETC.
SIGNED BY DATE