Permit A _, t- CITY OF TIGARD • ELECTRICAL PERMIT
PERMIT #: ELC2004 -00796
c DEVELOPMENT SERVICES DATE ISSUED: 12/13/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134AD
SITE ADDRESS: 10765 SW BLACK DIAMOND WAY
SUBDIVISION: BLACK BULL PARK ZONING: R
BLOCK: LOT : 031 JURISDICTION: TIG
Project Description: (1) branch circuit for reconnect of furnace.
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:
•
CHRIS MONTY OWNER
10765 SW BLACK DIAMOND
TIGARD, OR 97223
•
Phone: 503 - 312 - 0103 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/13/200 $46.85
[TAX] 8% State Surcharge 12/13/200 $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 • • in : e 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -06:• or1 -800- 332 -23
Issue By: ,L % ;/ _: Permit Signature:(
OWN R INSTALLATION ONLY
. The installation is being made on opert ow whit is not i tended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE: 1W5/
CONTRACTOR INS ALLATION 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 -F012 OFFICE USIA O,N ..v
. A . ..,
City of Tigard Received , "a) �_ 7 Permit No.: „ ��
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review /
Phone: 503.639.4171 Fax: 503.598.1960 ”' ,,,, ,, 5 � ,: Date/B Other Permit:
Inspection Line: 503.639.4175 __._.t_i - '•'_'_1 D ate ReadyBy: ral El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction j tddition/alteration/replacement Please check all that apply:
m
❑ Demolition /❑ Other: ❑Service over 225 amps, com'I ['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
v `- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure
El Multi-family ❑Master builder ID Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons 0 Manufactured structures or
JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
D
(�v ` > - W r 0 Health-care facility ❑Ofaar
Job no.: Job site address: Poo lySubmit 2 sets of plans with any of the above.
City /State/ZIP: e-n *; /` ,,.') D G The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: r � Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I '*
Cross street/directions to job site: / 0 6 Not-ilf 04Xo Fit 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'I 500 sq. ft. or portion 33.40 l
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 _ 2
• DESCRIPTION OF WORK Each manufactured or modular
(5 � n JA ,e -5 flit IC e
dwelling, Services service and/or feeder 90.90 2
J I ( / i -� L (�/� �// ervces or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
,I4P ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: � \ s Mron 601 amps to 1,000 amps 240.60 2
Address: I I 475- 5- (A) - N`l) NC—LE Over 1,000 amps or volts 454.65 2
Reconnect only 66:85 2
City/ State/ZIP: 71 g.. & �7 2z3 Temporary services or feeders installation, alteration, and /or
Fax: relocation
Phone:
(0 3 Z - D72 ( ) 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 r e lease, rent, or e c ge a rding to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
'I - Owner si Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT KCONTACT PERSON A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
JA `� n/ r-,/ B. Fee for branch circuits /
Contact name: M 1 6V1 cc / l/I CM without service or feeder fee, ( 46.85 14.9J 2
Address: V1 �� // / a each branch circuit
�/� (,� s �L�}C / rt/}7 Each add'I branch circuit 6.65 2
City/ State/ZIP: '1I 4 - ""t! (0 L Miscellaneous (service or feeder not included)
�n Pump or irrigation circle 53.40 2
Phone: ( ) 50 Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: J Signal circuit(s) or limited -
CONTRACTOR, energy panel, alteration, or
extension. Describe: Page 2 2
Business name: "'t ii4.e % e,
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 1/4. $�
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) , • 7 5
Print name: Date:
TOTAL PERMIT FEE 50 46.
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:\ BuildingWennits \ELC- PermitApp.doc 17103 440-4615T(10/07/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
;RESIDENTIALLWORK ONLYc
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*
❑ 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 \Pennits\ELC- PennitApp.doc 04/03
CITY OF TIGARD - 24 -Hour
BUILDING Inspection Line: (503 639 -4175
INSPECTION DIVISION Business Line: (51 639 -4171 MST
J BUP
Received Date Requested t / 7 PM BUP
D , . ; X60 � -Oo & R 7
Location
4_4/Suite GCA ( r
Contact Per Ph ( .' )3 /a — 131 3 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC Z c --
Footing
Foundation ELC
Ftg Drain Access: G /E J i fir 1 GA � �, ELR
Crawl Drain LI J Slab Inspection Notes: ►� �� o ` oo SIT
Post & Beam l/
Shear Anchors
Ext Sheath/Shear . T Y
Int Sheath /Shear
Framing �^�
Insulation -� E3 /7` / oz-/
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:
f -
Final
PA (C A FAIL
H ' CAL
Post & Beam
Rough -In 'U'� �' , V
Gas Line
Smoke Dampers
RT FAIL
Service
Rough -In
UG /Slab
Low Voltage
Fire larm
400 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
'A PART FAIL
SITE El Please call for reinspection RE: /� — –_ El Unable to inspect – no access
Fire Supply Line
ADA
Approach /Sidewalk Date / � Inspec Eat
Other:
Final DO NOT REMOVE this inspection record m the job site. -
PASS PART FAIL
•