Permit CITY :TIGARD ELECTRICAL PERMIT
., PERMIT #: ELC2004 -00633
mo DEVELOPMENT SERVICES DATE ISSUED: 10/1/2004
� �I li 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S104CD-00500
SITE ADDRESS: 13679 SW BLUE GUM CT
SUBDIVISION: HILLSHIRE ESTATES ZONING: R -
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: (1) branch 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:
MCFALL, TIMOTHY G + ROBIN L OWNER
13679 SW BLUE GUM CT
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/1/2004 $46.85
[TAX] 8% State Surcharge 10/1/2004 $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. Spedalty 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 a re 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.
i
Issued By y „ 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: �1 DATE: / �/�
l 61-
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 lic_a •ion L FOROFFICE USE ONLY
v Received _
City of Tigard • tl E DateBy: /� f ��-/ PermitNo.:6C C 9/ 0) Cry
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �"
Phone: 503.639.4171 Fax: 503.598.1660 I I 1 200 1 , 4 i t wd i Date /By: Other Permit:
Inspection Line: 503.639.4175 V 2004 �► d � n Notified/Method: '7(r Supplemental Date Ready /By: Juris: Ei See Page 2 for
Internet: www.ci.tigard.or.us
CITY OF TIGAR Information
BUIt h:IsICIOMMON PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑ m'1 Service over 225 amps, com ❑Hazardous location
EService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 and 2 family dwellings 4 or more new residential
.0'1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
Master builder Other: ❑Building over three stories ❑Feeders, 400 amps or more
Multi -family ❑ y ❑ ❑
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address: i ( rf S w a( �- or ❑Health -care facility ❑Other:
� Submit 2 sets of plans with any of the above.
City/State /ZIP: l 1 (/ Gt -y 01' '9 9- Z 2 3 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: (*I aSkty e_ �j Li New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: ! L.l j (e_ Gs tz'GCS 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
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
- 200 amps or less 80.30 2
1v1 ) ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 11 61 4. gc,Co Pi A 601 amps to 1,000 amps 240.60 2
Address: `� ( ' (
�, — , G.. i Is / , 4 ,� n l. � r Over 1,000 amps or volts 454.65 2
oVv Wi.�
Reconnect only 66.85 2
City/State /ZIP: i f..
v' ( O_ i : -.-q--2 7 —j Temporary services or feeders installation, alteration, and /or
Phone: ( D 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, rent, or exc angee, din to ORS 447, 449, 670, and 701. , / 401 amps to 600 amps 133.75 2
Owner signature: /6(/ Date: / /i l�"f Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ 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,
each branch circuit 46.85 2
Address: • Each add'1 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 -
CONTRACTOR energy panel, alteration, or
• extension. Describe: Page 2 2
Business name:
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
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: 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:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ A udio and Stereo Systems*
❑ B urglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
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
i:\ Building \Permits\ELC- PermitApp.doc 04/03
J
CITY OF TIGARD , _.... , ,.
BUILDING; DIVISION PERMIT #: ELC2004-00633
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/'/2004
Phone: (503) 639- 4171u- IW��ii p) I + I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/25/2005 TIME: 7:10AM PAGE: 82
SITE ADDRESS: 13679 SW BLUE GUM CT CLASS OF WORK:
SUBDIVISION: HILLSHIRE ESTATES LOT #: 005 TYPE OF USE:
PROJECT NAME: MCFALL
DESCRIPTION: (1) branch circuit.
OWNER: MCFALL, TIMOTHY G + ROBIN L, PHONE #:
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 006021-01 603-690-3718 Y
Corrections/Comments/Instructions:
N
C 1
)./M
' PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: p 26�� Phone #: (503) 718-