Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00348
z�:Ill DEVELOPMENT SERVICES DATE ISSUED: 6/11/2004
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S104CA 08400
SITE ADDRESS: 13362 SW 136TH PL
SUBDIVISION: HILLSHIRE ZONING: R -
BLOCK: LOT : 084 JURISDICTION: TIG
Project Description: (1) branch circuit to AC.
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:
FAR RIMOND, RONALD K + L KRISTI NE OWNER
13362 SW 136TH PL
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/11/2004 $46.85
[TAX] 8% State Surcharge 6/11/2004 $3.75 Rough -in
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is .
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: . J1' .` A r Permit Signature: x Q )1
OWNER INSTALLATION ONLY
The installation is being made on property I own which ich is not intended for sal�,-ase, or rent. � / •
OWNER'S SIGNATURE: X `C - DATE: v /
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application ' . FOR OFFICE, USE ONLY 4 :
Aillik R eceived �y
��
City of Tigard DateBy:r/f Permt /' _7J)Jj[} 063 j
'13125 SW Hall Blvd., Tigard, OR 97223 P1anRevie "���
Phone: 503.639.4171 Fax: 503.598.1960 /42,410011$; Date/By: Other Permit:
Inspection Line: 503.639.4175 ca ,. Date Ready/By: 7-7,5 Juris: Q See Page 2 for
w
Internet: ww.ci.tigard.or.us Notified/Method: Supplemental Information
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... �'� � � ��'s �Sf�s �. ▪ _ � <-�,: a ,�sx. � �:::� vas;,. }� �.�'a,�°`"a.�. < °..,�w,��,,� �.t� � >,�9.� ..
❑ New construction
❑Other: Please check all that apply:
❑ Demolition ['Service over 225 amps, comm'l ['Hazardous location
. '�,�e...ca_ . ] � ▪ - Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
' , �, ..k 1 �...A _ - C ATi,ur; f O G<..w =RUCT, " #�"R .a,!t ['Service r :
- ®
aa ,a_ r . �,.%a.: of 1 -and 2- family dwellings 4 or more new residential
^€�>.*fir . �s� 'w_P.. � .=a
S"" and 2 family dwelling [11 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
u_ TO STTE �iO TIlDLOI® ❑EgressJlighting plan RV. park
•
Job no.: Job site address: Q ❑Health -care facility ❑Other:
3.��y J` 52i) �l,� f Submit 2 sets of plans with any of the above.
City /State /ZIP: l Qr I O/e / 7a"/ 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: .. MIMIR S,CHED LEw , .I ;� _, .
Description Qty. Fee. Total
Cross street/directions to job site: Ag<til < xi�k f,`L,i/4 i 1 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
m i Limited energy, non - residential 75.00 • 2
: ;%eta. � u', : °` re — 'w' ; , : :m ,.r^'a r i �:t�: ; ..� .:
r � u, r . „ ...,,_P ION ®) '" O a % i 4 --
��.., �� �.._. �c�`'.�. :� �._ • � , a��� = ''; ��� � , ��`' r Each manufactured or modular
,41,/ � �e/ '/ Q� .5�� dwelling, service and /or feeder 90.90 2
7 V C�r /� y Services or feeders installation, alteration, and /or relocation
,4 �� S tS7& 200 amps or less 80.30 2
e, a ° 8 _ .R 201 amps to 400 amps 106.85 2
_ / PRQ�ERR OWLY> :12 w � k t T NE' 1
.� "� _ t. :', ,M t 401 amps to 600 amps 160.60 2
Name: /f 7 / "/ 1 Ft rri /710 601 amps to 1,000 amps 240.60 2
Address: l / 336 2-"d /36 -- // Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: 77g
ad - (( 972-2-3 Temporary services or feeders installation, alteration, and /or
Phone: (73 ) 5 3 9 . . (e ) 5( 6=- g 6 Q B 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, lea ent, .r ex . ge . ccording to 447, 449, 670, an
s 401 amps to 600 amps 133.75 2
�/ Owner signature: A_.•,.... � �i �, Date: / O Branch circuits - new, alteration, or extension, per panel
i * ° v" v ' ' '' : ` m A. Fee for branch circuits with
�. ��. „„ ��'' � „- ' € '"` s eK� ter, s �">1' ` � � y�'' - �, N..k�' "' .
. . k. <..,_.,,APPL Aerr ° y + t,td4 . ,_L..,.� CQ . � R S.O 8 8"
" '' "'��" service or feeder fee, each
Business name: branch circuit 6.65 2
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 L�/ � � 2
Address: each branch circuit I/ WW
Each add'l 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-
"' ,,i m ae ` fgrGONT14A PTO &' f`- * :=t: %' n energy panel, alteration, or
extension. Describe` Page 2 2
Business name: tr,ell'10h
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (I hr n 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
n, I`V EC.( CARL IM2ivIiITI FS 3,: a' r° .<:: A ,.
CCB Lie.: Electrical Lic.: Suprv. Lie.: Subtotal 46,$‘
•
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) '.1
TOTAL PERMIT FEE 60. (
Authorized signature: c 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- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�.0
I2ESTDENTIA WAWC NL
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*
n Other:
Fee for each commercial system $75.00
•
(SEE OAR 918 - 260 -260)
•
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n C lock Systems
❑ Data Telecommunication Installation
❑ F ire Alarm Installation
• HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting* °
• ❑ P rotective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is \ Building \Pertnits\ELC- PemvtApp.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 6 5 AM PM BUP
Location / 3 3 p /36 - f L.. Suite MEC
Contact Person Ph ( ).5d _3 ( f -• PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 66 d zi g
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Ina Sheath /Shear 7P �, wl , N
Framing � U� � Qv io UNCY
D Insulati
ywal �_ I 6 6r" a 5 ►C\PQC. 43 �
Drywall Nailing �1 _
Firewall Y l O �� cfsN t•TE - v 6� •_
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL Q _
PLUMBING W 1 1\16( •f e —' 3
Post &
Under Slabm s • cz.' 6 C � "-�--
Rough-In N G
Water Service
Sanitary Sewer --�
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: : —'
Final �/ 41?
PASS PART FAIL " �-
4v
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
1►-b El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PAS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA
Date �j Inspector V w Ext
6-Al e N
Approach /Sidewalk v
Other:
Final DO NOT REMOVE this inspection ord from the Job site.
PASS PART FAIL