Permit 4k. ` "� '"1 OF O TIGARD ELECTRICAL PERMIT
V`� PERMIT #: ELC2003 -00159
DEVELOPMENT SERVICES DATE ISSUED: : 3/21/03
.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 1126 D -00100
SITE ADDRESS: 07560 SW BONITA RD 026
SUBDIVISION: TIFFANY COURT APT. ZONING: R
BLOCK: LOT : 065 JURISDICTION: TIG
Project Description: Installation of (20) branch circuits. Installation of (1) GFI, (1) heater and (1) smoke detector in each
unit.
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: 19 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:
WASHINGTON CO. HOUSING AUTHORITY SYLVANIA ELECTRIC CO
111 NE LINCOLN ST 5328 SE 109
#200 -L, MS63 PORTLAND, OR 97266
HILLSBORO, OR 97124 -3082
Phone: 503- 846 -4794 Phone: 503 - 762 -2714
Reg #: ELE 26-1086C
LIC 110400
FEES SUP 4830S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit . 3/21/03 $173.20
[TAX] 8% State Tax 3/21/03 $13.85 Rough -in
Elect'I Final
Total $187.05
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 que tions to OUNC at (503) 246 -6699 or
1- 800 -332- . . /
R ,
Issued •• -y: L \ j / " Permit Signature: At
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:
NTRACT'AR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 1 DATE: 6 7— 2-1 —o(.3
LICENSE NO: •
Call 639 -4175 by 7:00pm for an inspection the next business day
•
Electrical Permit Application e • FOR OFFICE USE ONLY
Received y{ Al �. Electrical ee n /.
Date/By: d Permit No.: Coe a�J t /�
City f Tigard Planning Approval Sign
y g 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 Igy Post - Review Land Use
l � , I I \ Date /By: Case No.:
Internet: www.ci.tigard.or.us e• ' Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 W Name/Method: Supplemental Information.
rw ;r�. �F �:.,• x ....,:;. yS .?..t ^:v ,_ ... ..�,.. .�� �` "zt "`'' " ;'�, ,`�, r._ , a,c.0 e.. b � to : - . �.. :a :- '�`.�;' x�jM j�:
.ice ITt,i ;,t r itER ATO OF WORK .�:.. _ :.. , , Ar EI . O AN #RE_ W,0ase clhecktall that applSOM
_.P,L' °._V� ..
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial 0 Hazardous
Addition/alteration/replacement E1 Other: on
0 over 320 amps-rating o f ❑ Building over over 10 10,000 square feet,
AtiEf ' Ct1T
e EGORY OF';C RU
ONSTCTION ,. e � *'` I & 2 family dwellings four or 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 `i ulti- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder • Other: ❑ Egress/lighting plan ❑ Other:
I' JOB SITE INFORMATIONapdLOCATION
2C Submit sets of plans with any of the above.
The above are not applicable to temporary construction service
Job site address: 7, 0 5 i� ,go i [ f Qct, " r.'.. m;-, a , -�..k ., ,7 "`, ';FEE* SCHEA JLE" m ; t _ ar -,: i
Suite #: Bldg. /Apt. #: Z '6 1 .Z, $ , 3 d 1 3 6 Number of inspections per permit allowed
Project Name: 30 isa T A. v (L L R Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential-single or multi-family per 1
� 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 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
,je �; ial S Mil.) ON „OF WORIC� , .� T .. > ;: ;:..� : t .
service and/or feeder 90.90 2
”' Services or feeders - installation,
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
Tl'ONER ,l ;� TENA ; a. 601 amps to 1000 amps 240.60 2
. ®PROPER ° =� ..'_. �.. , � a �..
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
In APPLICANT , 3 'k ` : , . ': rC_ON t G'I's PERSON
° °T- Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
B. Fee for branch circuits without purchase of
City/State/Zip: /State /Zi 46.85 (a, SS
y p service or feeder fee, first branch circuit l 6.85 2
Phone: Fax: Each additional branch circuit / 7 6.65 f 2
E-mail: Misc.(Service or feeder not included):
a ;' t .� GONTRAMTOR� " y r Each p um p o r irrigatio 53 40 2
Ea n circl 53 40 2
-•_ m > Each sign or outline l •
Job No: (0 N l .R v- (- d--07/.1- Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: S �/ L I A 1 A j i/`� (C Description:
Address: , 23 S 6 ( 0
City /State /Zip: (p r I ` dl ( a ) 99 I. i) 2 6 C Each a additional r inspection over he allowable in any of the above:
r Per ins pes ction r how min. 1 hour) 62.50
/
p�
Phone( / 0 q ) c((3_ sCc) Fax: V ( ! Investigation fee:
Other
CCB Lic. #: f O 0 0 Lic. #: Z6 08 G - . . -.��.� •, A
t{ � . �,� •-",; � ,���:..,,E►ectrtcal�Permit�Fees ;,,.���,,. �.�.v�'� ...•__�
Supervising electrician Subtotal $ / 23 • 8Z)
signature required: Plan Review (25% of Permit Fee) $
Print Name: $ i t J fu (' U tvr Q Lic. #: 3 30 S State Surcharge (8% of Permit Fee) $ /3 8.5
TOTAL PERMIT FEE $ / R 1. car
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 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
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:
n Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
ri Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
T7 Audio and Stereo Systems
n Boiler Controls
n Clock Systems
F - 7 Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
F - 7 Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
ri Nurse Calls
n Outdoor Landscape Lightirig
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 Date Requested 3 a- -7 AM PM BUP
Location '7 (� O / Suite 30 MEC
Contact Person Ph ( ) 9/3- FO G:5.5 PLM
Contractor Ph ( ) SWR _
BUILDING Tenant/Owner ELC 3 - D D 75 7
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 1--- `-, 6CL W �� N ‘t --
Drywall Nailing '' II - VV �-t r
Firewall `V C� U z5 �� 1 � sac
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
Fire Alarm
AS PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line /,-
ADA
Approach /Sidewalk Date 3 ^ -1 Q)3 Inspector � / Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL