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Permit . CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00711 DEVELOPMENT SERVICES DATE ISSUED: 12/10/03 % 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S 102CA -00228 SITE ADDRESS: 13118 SW ASH DR SUBDIVISION: VIEWCREST TERRACE ZONING: R BLOCK: 02 LOT : 017 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: WALTER, BURT OWNER 13118 SW ASH DR TIGARD, OR 97223 Phone: 503 - 639 - 8935 Phone: Reg #: FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit 12/10/03 $46.85 [TAX] 8% State Surcharge 12/10/03 $3.75 Rough -in Elect'l 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: / r f Permit 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 639 -4175 by 7:00pm for an inspection the next business day , u Elect ieal Permit Application . FOR oFric USEONLY 7..a. .'.., t Received Electrical Date/By: (�pl 0 ( D 1 [ , Permit No.: C, 3-OO — 00) / City of Tigard Planning A rov 1 Si Date /By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 rid Post- Review Land Use Internet: www.ci.tigard.or.us D a t e /B t Case No.: _Al. I Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information. -'` .. - at., yp, ; R';. - TYPETOE WOR_ I{�:tx' r!Z; :a _ - �'��; -�r:` �..� w : :. d s -,, _ . ,., . -�,+ °.PLAN: , (>'tease cbeck;al 1' � p���� -. o : •� ° :F ❑ New construction ❑ Demolition }' ❑ Service over 225 amps- PP Y), p 0 facility E] Addition/alteration/replacement ❑Other: commercial ❑ Hazardous location ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet, i' -" ''5 ' '.' t, ' # CATEGORY'OF;;GONSTR 1 . " " I & 2 family dwellings four or q ,. - � - � 'f CTION p _ _'� °`..° - y g 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 P p 0 Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: :Nr, ;` / °SITE''INFORMATION *arid° L'`OCATION'`.`w' i; _ '' °° ' Submit sets of plans with any of the above. Job site address: 1 31 l 8 5W 5 h Dc. Ve The above are not applicable to temporary construction service. , Suite #: �. ". -•� ' D_�' ~ . tv *, SCHEDULE; fi' '_" '. FEE �,.� ���;� _" .�� „: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: 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 Subdivision: Limited energy, residential 75.00 2 Lot #' Limited energy, non residential 75.00 2 Tax map/parcel #: Each manufactured home or modular dwelling .. t..a;« ., : :"`„ :' ` :' C TION ::OFiWORK ;4te2 ' `: ' service and/or feeder °�DES� RIP � `�- ,��,..,.��, : > 90.90 2 • A 1 t L Services or feeders - installation, l �- ' 1 ,d rAnc ' C rC (.0 t `I 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 [it PROPERTY:'OWNERn-; , : -'Jc - •mt* VT- Vase :,1 ;' fia '; = 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: @ CcV 1. L (JAI -). Pl n Reconnect only 66.85 2 Address: 7 3 i ( g' SW �S� Dr: Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: 77 p rd DR. c7 7 .2,73 200 amps or less 66.85 I Phone: 5'03 - 6- p 35 Fax: 201 amps to 400 amps 100.30 2 l ® APPI:IC/ NT _ . ;" - '.: , CONTA'CT',PERSON� t', _ "" 40I to 600 amps 133.75 2 " Branch circuits - new, alteration, or Name: S.pcirY.6 4- OW tO �//e._ extension per panel: Address: A. Fee for branch circuits with purchase of service or feeder fee, each branch circuit 6.65 2 City /State /Zip: B. Fee for branch circuits without purchase of l service or feeder fee, first branch circuit / 46.85 /446 2 Phone: Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): • N = ;u :,:'' b .`.. tGON;TR'ACT w .'t ` ;v,.. ,; ;. ra,, Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: €J J l� 6.f Signal circuit(s) or a limited energy panel, Business Name: A- L 1191 Description: or extension Page 2 2 Address: 1 3) 1 g .5(' /9Sin Dr. Description: City /State /Zip: .-/- ��� GI �� 3 Each additional inspection over the allowable in any of the above: Per inspection per hour (min. I hour) 62.50 Phone: 5 6 'C(35 Fax: Investigation fee: CCB Lic. #: Lic. #: Other: 5i � , . . _ ,,` ,. , : i _ `�Electncal'Permi`t'fF.,ees *k.� /�"k`'::, ��; = h - �� Supervising electrician Subtotal 1 S 4-67 -C signature required: Plan Review (25% of Permit Fee) S Print Name: Lic. #: State Surcharge (8% of Permit Fee) S 75 TOTAL PERMIT FEE S 570 , ( {2 Authorized �� 11 Notice: This permit application expires if a permit is not obtained within Signature: w D ate: �� %tl —�� 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 a Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: ri Audio and Stereo Systems n Burglar Alarm 0 Garage Door Opener Heating, Ventilation and Air Conditioning System 0 Vacuum Systems n Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation n Fire Alarm Installation n HVAC El Instrumentation n Intercom and Paging Systems Landscape Irrigation Control n Medical n Nurse Calls ri 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 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST ,/ BUP Received Li Z Date Requested r jed / – 7� AM PM BUP Location /3 / I c) ys.f SA j� • Suite 4 ( l MEC Contact Person 4 dieLA Ph ( ) 9-,935 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner LZ �� uce�:f,�JG{ , ELC70 ?, — 00 71/ Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING 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 ELECTRICAL Service Rough -In UG /Slab Low Voltage / K Fina El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. AS PART FAIL SITE El Please call for reinspection RE: Unable to inspect — no access Fire Supply Line Approach /Sidewalk Date 7 Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL