Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00122
,T I� DEVELOPMENT SERVICES DATE ISSUED: 3/1/2005
n � f + 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112CD-02100
SITE ADDRESS: 07895 SW BOND ST
SUBDIVISION: BOND PARK ZONING: R
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: (1) branch circuit for new a /c. Job No. 1115
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: 6014-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:
BORJESSON, SHARON DI PAULAS FIELD ENGINEERING TECH IN
7895 SW BOND 8532 N IVANHOE STE 202
TIGARD, OR 97224 PORTLAND, OR 97203
Phone: 503 - 670 -0395 Phone: 971- 570 -5197
FEES Reg #: LIC 154961
ELE 26 -1163C
Description Date Amount SUP 4819S
[ELPRMT] ELC Permit 3/1/2005 $60.15
[TAX] 8% State Surcharge 3/1/2005 $4.80 REQUIRED ITEMS AND REPORTS
Total $64.95
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 day of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the go • Utility Notification Center. Those
rules are o BAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rul s r /: ct estions to ? NC at (503)
246 -669s or 1 -800 -332 3 '4.
/
Issue. By: 7 as ( • - Permittee Signature: /
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease .r rent.
OWNER'S SIGNATURE: DATE:
' O T CfOR INST), LATION ONLY
SIGNATURE OF SUPR. ELEC'N• DATE:
LICENSE NO: 1151 5
Call 639 -4175 by 7:00pm for an inspection the next 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 Application -., i. FOR OFFICE USE ONLY . -
City of Tigard Date/By: if Permit No.: /}S - la'^�,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie (J � �
Phone: 503.639.4171 Fax: 503.598.1960 111 ° � 1 Date/By: Other Permit:
�
Inspection Line: 503.639.4175 c-1-111' c-1-111' � r
6 I Date Ready /By: Juris: H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction *I Addition/alteration/replacement Please check all that apply:
El Demolition 1=1 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
A 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑ Feeders, 400 amps or more
El Multi - family ID Master builder CI Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.: / (/S Job site address: 7895 S , 6 OA) U ❑Health -care facility ❑ Other:
x Submit 2 sets of plans with any of the above.
City/State /ZIP: 7 , S1 A D . 10(` The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE **
Description Qty. Fee. Total
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'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
DESCRIPTION OF WORK Each manufactured or modular
/�/( f
I G `c j dwelling, service and/or feeder 90.90 2
I 74 �1 / R / ! 1/ / Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
J � J 401 amps to 600 amps 160.60 2
Name: 54 4-4.0.-J 4-4.0.-J l'� 0 !� e_.53 o 601 amps to 1,000 amps 240.60 2
Address: f ..S ..S f 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
Phone: (57)3) 2
J 6 ) l� ' ✓7 � � 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 I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, f
Address: each branch circuit t 46.85 �� 2
Each add'l branch circuit ` 6.65 13 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I 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
I r - 1 / / ext nsion. Describe: Page 2 2
Business name: I ( -Or (4 / f /-
`,e ( t ( (.' (,./- �if-tA
Address: 8 a tr V s / V4 f\//7 Q_ Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: P D (f �
/ C� )a 3 Investigation per hour (1 hr min) 62.50
Phone: (q 7/ ) c9 60 7 9 /) � Fax: (5D ) c E . 9_9,s. Q Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: ) S 7 q 6 1 Electrical Lic.:, , /_l a ♦l a Suprv. Lic.: 9 ¶ S Subtotal (, a J S
Suprv. Electrician signature, required: P V/" / _ Plan review (25% of permit fee)
Print name: 0,11) r k r ' /� Date: _ % - �n State surcharge (8% of permit fee) y ' 0 j2",‘) �� 1 v TOTAL PERMIT FEE /_ 5 (9 c '
Authorized signature: 1 /// _ This permit application expires if a permit is not obtained within 180 i iiK e l �' days after it has been accepted as complete
Print name: k v - , OC' 4-\ /, Date: 3 -- / D S * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i/ iBuilding \Permits\ELC- PermitApp.doc 12/03 440- 4615T( l0 /02 /COM/WEB
Electrical Permit Application - City of Tigard • • ,•
Page 2 - Supplemental Information t
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
. n Audio and Stereo Systems*
Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
n Vacuum Systems* •
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
I I Outdoor Landscape Lighting*
Protective Signaling
n 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 24 -Hour - .
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 3 AM PM BUP
Location 739,S' 86414 Sk. Suite MEC
Contact Person 646.-e Ph ( ) 670 —039S PLM
Contractor COv Ph ( 9 3 — S197 SWR
BUILDING Tenant/Owner ELC .I - O j —6d 1 3-a.
Footing ELC
Foundation Access:
Ftg Drain .l v \-) A \i4 y m — ELR
Crawl Drain
Slab Inspection Notes: / / SIT
Post & Beam ��l +� e �A-� 42/171 Gv✓ v �a.t
Shear Anchors Cvot ��
Ext Sheath/Shear / F
Int Sheath/Shear
Framing �,r^� `!
Insulation I. ) S 0 e0 SM ) \ v) . v 1 �, id" o
Drywall Nailing
Firewall 4 C-- L O �, , t‘ n` 1 \r-.
Fire Sprinkler
Fire Alarm LI) 1■ ■
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL \ (1.1
PLUMBING -
Post & Beam
Under Slab
Rough -In
\'1
Water Service
Sanitary Sewer
Rain Drains /
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
—PASS PART FAIL
[IT CHANICA� /
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
'ART FAIL
ELECTRICA
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 3 3
Approach/Sidewalk Date Inspector i ' - Ext
Other:
Final DO NOT REMOVE this inspection record rom the Job site.
PASS PART FAIL