Permit i
C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00752
��� DEVELOPMENT SERVICES DATE ISSUED: 10/6(2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S109AB - 04900
SITE ADDRESS: 14178 SW 134TH DR ZONING: R -
SUBDIVISION: THREE MOUNTAINS ESTATES LOT : 042 JURISDICTION: TIG
Project Description: 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:
ALEXANDER, DAVID DOUGLAS + MICHAEL RAFFAELL CONSTRUCITON
JANELL LYNNE 15170 SW KIRK RD
14178 SW 134TH DR OREGON CITY, OR 97045
TIGARD, OR 97224
Phone: Phone: 632 - 6720
'FEES Reg #: LIC 58422
tion Date Amount SUP
Description 3
p ELE 3 -299C
[ELPRMT] ELC Permit 10/6/2005 $50.50
[TAX] 8% State Surcharge 10/6/2005 $4.04 REQUIRED ITEMS AND REPORTS
•
Total $54.54
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1 -800 2
Issued By: .lam J Permittee Signature: / :/ „ /
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
T
Electrical Permit Application FOR OFFICE vsE ONLY Rece i cal
P ® Date/By: y: , b f ,_/� t:/15 Permit Electri N �G .10015 ' "'_— •
City of Tigard �r '�',� iL' Planning Approval
Date Sign
�/ By: Permit No.:
13125 SW Hall Blvd Plan Review Other
Tigard, Oregon 97223 5 '105 Date/By: Permit No.:
Phone: 503- 639 -4171 F 1503' -598 -196 Post- Review Land Use
// rm4A° DateB Case No.:
Internet: www.ci.tigard.or.us c1i A R 0 . ( �� �� Con tact J rI ® See Page 2 for
24 -hour Inspection Reques�',1T5�34V111 ON �..._.._
Name /Method: ,, Su lemental Information.
Bv11
i° - S$^ .,.E«.E. „ R .. :;: , c;.: ..._.. .A..f°.: iti'. „E 1 . is "" ._},
�� �.x�::� .�:� :,. ��F . > �TY_PE QF W�ORK�a:� ?s� ...... .���::.. h.0 ...; :.�_e �. :�, > :PLAN�REVIEWb(Please'`checkfall thatTaPP _. ,
❑ N w construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of El Building over 10,000 square feet,
ORtanftl ¢ ;_ ATEG.0RVOF C®NSTRU.CTI®N %rW : ,aIN'?*ii:> 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 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:
tt g .a - JOBTSITE INF,ORMATION"an'd LOCATION ; °` «'' ` Submit sets of plans with any of the above.
"' °' The above are not applicable to temporary construction service.
Job site address: / Ai/ 78 S tn> i 3 L/ Ti Cr 'tt t .` - ' , FEE* SCHEDULE ....:, Mi .,,,;; "" '
Suite #: Bldg. /Apt. #: . . Number of inspections per permit allowed
Project Name: A- j.; e-' A , ' eyeA Description Qty Fee (ea.) Total 1
Cross street/Directions to job site: New residential- single or multi - family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. 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 map /parcel #: Each manufactured home or modular dwelling
£ g S SiMit , ,`DESCRIPTIoNIOF WORK . .,r , .,,.,; servi and/or feeder 90.90 2
Serv ices or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
- z ;� 601 amps to 1000 amps 240.60 2
PROPERTY °OWNER_:: TEL�rAN „ . ,;. :.......
Over 1000 amps or volts 454.65 2
Name: o a V ho ,t-z.e p t7"t° -r^(' Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: . 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
AA!PPI ICAN EMMMIS : CONTACT PER$®N'
�� ri.�� Si ��� - t r 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 yin 2
Phone: Fax: • Each additional branch circuit 1 6.65 ( � 2
Email Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
�� 2W �` CUNTRA TORT . „� ” _� 0 '.71,M11
`� - - "�� Each s ign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
e ,p Description:
n r extension Page 2 2
Business Nam
tQG ' � � G a�i4 I a��`��f 4fN Description:
Address> 5, 7 0 5 k l/ev_ j2ci
Each additional inspection over the allowable in any of the above:
City /State /Zip: o R e C- cry oR 9 7 0 it S Per inspection per hour (min. 1 hour) 62.50
Phone: 63x- (,-'7 p Fax: 6 3 1-. 6 7 9 2 Investigation fee:
Other
CCB Lic. #: 5£11-/ 7 Lic. #: a 5 G a -S M ;.. ''; . I ; „ .E1 W "ricaliPermiiffn.6 ,.... ,..:. a:
Supervising electrician „ L- E -3-Big to —/ -- O �
�1 ,�1 Subtota $ 5 O
signature required, ✓Z -t.G�q e .. /c ' 0 , / / / Plan Review (25% of Permit Fee) $ �_ • Print Name/ i i t j., ,q.e i • i' -?:19 . #: 3 -�Q - State Surcharge (8% of Permit Fee) $ 1-( S_f
p4 i¢�A-e /I 77 _ ! — d19 TOTAL PERMIT FEE $ S 4/
Authorized , Notice: This permit application expires if a permit is not obtained within
Signature: / /CW),„_a_AeDate: 180 days after it has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Pagel - 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
IT Burglar Alarm
I I Garage Door Opener
ri Heating, Ventilation and Air Conditioning System
n Vacuum Systems
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
E Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation •
n Intercom and Paging Systems
Landscape Irrigation Control
n Medical
n Nurse Calls
I I Outdoor Landscape Lighting
n 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
. 44/1 .
BUILDING DIVISION PERMIT #: ELC200.5-00752
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/66/2005
Phone: (503) 639 -4171 " ')
Inspection Requests (24 Hrs.): (503) 639 -4175 .1- .. `
INSPECTION WORKSHEET FOR DATE: 9/22110QE TIME: 7 :02AM PAGE: 61
SITE ADDRESS: 141781 SW 134TH DR CLASS OF WORK:
SUBDIVISION: THREE MOUNTAINS ESTATES LOT #: 042 TYPE OF USE:
PROJECT NAME: ALEXANDER
DESCRIPTION: 2 branch circuits.
OWNER: ALEXANDER, DAVID DOUGLAS +, • PHONE #:
CONTRACTOR: RAFFAELL CONSTRUCITON, MICHAEL PHONE #: 632 -6720
Inspection Request Scheduled For: Date: 9/2212006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
150 qq��/spa/pool 036817 -01 503- 701 -9857 V
. rrections /Comments /I , , tions:
•
c
PASS I I PARTIAL APPROVAL n CANCEL I I NO ACCESS
I I FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
�
Inspector: K,'
� Le Date: 9 7i Phone #: (503) 718-
` - - - - .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005.00752
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/6/2005
Phone: (503) 639 -4171 l�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/10/2005 TIME: 7:04AM PAGE: 120
SITE ADDRESS: 14178 SW 134TH DR CLASS OF WORK:
SUBDIVISION: THREE MOUNTAINS ESTATES LOT #: 042 TYPE OF USE:
PROJECT NAME: ALEXANDER
DESCRIPTION: 2 branch circuits.
OWNER: ALEXANDER, DAVID DOUGLAS +, PHONE #:
CONTRACTOR: RAFFAELL CONSTRUCITON, MICHAEL PHONE #: 632 -6720
Inspection Request Scheduled For: Date: 10/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
150 Hot tub/spa/pool 017788 -01 503- 632 -6720 N
Corrections /Comments / Instructions:
0 krt 6 w - 7 Flo 0661c
•
The electrical installation defects noted
on this report shall be corrected and
an inspection request made within 20
calendar days per OAR 918.271.0030
❑ PASS n PARTIAL APPROVAL ❑ CANCEL ANO ACCESS
14 FAIL "CA FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _. / Date: / 16 to Phone #: (503) 718 -