Permit C ITY OF TI GARD ELECTRICAL PERMIT
! a V PERMIT #: ELC2005 -00929
1 11 DEVELOPMENT SERVICES DATE ISSUED: 12/2/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102BC - 00113
SITE ADDRESS: 12570 SW BROOKSIDE AVE ZONING: R - 4.5
SUBDIVISION: WALNUT ACRES LOT : 012 JURISDICTION: TIG
Project Description: 200 amp service.
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: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
ZANA DOHERTY OWNER
12570 SW BROOKSIDE AVE
TIGARD, OR 97223
Phone: 503 - 443 -4879 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 12/2/2005 $80.30
[TAX] 8% State Surcharge 12/2/2005 $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72
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'
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Orego. Notific. on Center. ose
rules are set forth in OA' 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules o :wed ques' : • OUNC at
503 - 246 -6699 or 1-:,.:8-332-2 , A4. / '�► . fl , 4
Issued By: II _ , , , . Permittee Signature ,j ,,j !
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 503 - 639 -4175 by 7:00 a.m. for an inspection that 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_ FOR OFFICE USE ONLY .
City of Tigard E u t. I V E.l Date /B ■ Permit No.: _Q
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � / /a'1.4 ;, r + ' I' 't Date/By Other Permit:
Inspection Line: 503.639.4175 DEC Cl, fl : 200 '' i ., ' Date ReadyBy:s: ®See Paget for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method: t Supplemental Information
0r'I\W *VISION PLANNVIEW .
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑Service over 225 amps, comm'I ❑Hazardous location
❑ Demolition ,,U OTher: ti \ cT v i a \( vei ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION _ of I - and 2- family dwellings 4 or more new residential
J21- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: ` - lrttn `n n ❑Health - care of any ['Other: c 7- , � Lji C e i_ti xt� 40 Submit 2 sets of l with an of the above.
City / State/ZIP: ; .1 > o kz . The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name:
Description I Qty. I Fee. I Total J ,
Cross street/directions to job site: U \AN) New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
�
p �y . ct7 /� ` pp C. dwelling, service and/or feeder 90.90 2
1 C �_ 1.) C t 1 ` Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 / 2
tOI'ERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 • 401 amps to 600 amps 160.60 2
Name: 7 ec..4 A 601 amps to 1,000 amps 240.60 2
Address: • `✓` 'N rA1c c ) c j Over 1,000 amps or volts 454.65 2
�l v � r Reconnect only 66.85 2
City /State /ZIP:` - 14 0 Temporary services or feeders installation, alteration, and /or
Phone: (5:12)) iii �- Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installatio is being :le on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, t, / or ex ding * el . 447, 449, 670 ' and 701.
` '7 � 401 amps to 600 amps 133.75 2
Owner signature: 4.4/ , /LA 6�1/ ---- ate: / O�/ ER �c/ 3 Branch circuits - new, alteration, or extension, per panel
jr Or
❑ APP iCANT I MP CONTACT PERSON
l• 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, 46.85 2
Address: first branch circuit
Each add'I branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I 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: ne 1'� A g , & .
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Investigation per hour (I hr min) 62.50 .
Phone: ( ) I F ax: ( ) Industrial plant per hour 73.75 •
1 ELECTRICAL PERMIT FEES*
CCB Lie.: I Electrical Lic.: I Suprv. Lic.: Subtotal Co 30
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: _ Date:
State surcharge (8% of permit fee) 6. rya -
��� :,� TOTAL PERMIT FEE -
Authorized signature: (' If This permit application expires if a permit is not obtained within 180
f +� days after it has been accepted as complete
Print name: Z71,,v). Date: ) /,,, / * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspecti per permit allowed. S - �f
i:\ Building \Permits\ELC- Penni1App.doc 12/03 440- 4615T(1 0/0?JCOM/WFB (P /
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
PRESIDENTIAL WORK ONLY,: j
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
7COMMERCIAL; 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
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations •
i:\ BuildingWermits \ELC- PennitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION = ' ' PERMIT #: ELC2005-00.929
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/21200
Phone: (503) 639-4171 Ai
Inspection Requests (24 Hrs.): (503) 639-4175 .... jilt
INSPECTION WORKSHEET FOR DATE: 5/10/2006 TIME: 7:02AM PAGE: 18
SITE ADDRESS: 12570 SW BROOKSIDE AVE CLASS OF WORK:
SUBDIVISION: WALNUT ACRES LOT #: 012 TYPE OF USE:
PROJECT NAME: DOHERTY
DESCRIPTION: 200 amp service_
OWNER: DOHERTY, ZANA PHONE #: 50:4143-41879
CONTRACTOR: OWNER PHONE #:
UJ ALN 1/431 1 111.X. PO CHIA IN .
Inspection Request Scheduled For: Date: 5/10/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
029635-01 971-732 1460 V
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Con 0 ) ns/Comments/ r nstructions:
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Inspector: '- 1\9 - --- (1\ X Date: (5 Phone #: (503) 718-1-14-
CITY OF TIGARD A
BUILDING DIVISION •
PERMIT #: ELC2005-00929
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1212/2005
Phone: (503) 639-4171 /.1111100
Inspection Requests (24 Hrs.): (503) 639-4175 ALIAP■
INSPECTION WORKSHEET FOR DATE: 1/11/2006 TIME: 7:01AM PAGE: 16
SITE ADDRESS: 12570 SW BROOKSIDE AVE CLASS OF WORK:
SUBDIVISION: WALNUT ACRES LOT #: 012 TYPE OF USE:
PROJECT NAME: DOHERTY
DESCRIPTION: 200 amp service.
OWNER: DOHERTY, ZANA PHONE #: 503-443-4079
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 1/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
110 — "Furrypirtify electrical seryir,-0 024770-01 503-768-1460
Corrections/Comments/Instructions:
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Inspector: .e"ZOP Date: / I
41 . Phone #: (503) 718- 2411‘
7
CITY OF TIGARD
BUILDING, DIVISION PERMIT #: ELC2005-00929
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/2J2005
Phone: (503) 639-4171 -hol .
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/312088 TIME: 7:01AM PAGE: 28
SITE ADDRESS: 12570 SW BROOKSIDE AVE CLASS OF WORK:
SUBDIVISION: WALNUT ACRES LOT #: 012 TYPE OF USE:
PROJECT NAME: DOHERTY
DESCRIPTION: 2(X) amp service.
OWNER: DOHERTY, ZANA PHONE #: 503.443.4879
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 1/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
110 Temporary electrical service 02428&01 603
Corrections/Comments/Instructions: CA LI"
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Inspector: Date: l'°3 • Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION , " r PERMIT #: ELC200 &006
13125 SW Hall Blvd., Tigard, OR 97223 • , DATE ISSUED: 12/2/2005 Phone: (503) 639 -4171 i ti dial
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: /2116/2005 TIME: 7:06AM PAGE: 92
SITE ADDRESS: 1 2570 SW BROOKSIDE AVE CLASS OF WORK:
SUBDIVISION: WALNUT ACRES LOT #: 012 TYPE OF USE:
PROJECT NAME: DOHERTY
DESCRIPTION: 200 amp service.
OWNER: DOHERTY, ZANA ,. PHONE #: 503-443-4879
CONTRACTOR: OWNER a,-) PHONE #:
Inspection Request Scheduled For: Date: 121/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1113N1 1 electrical service 023553 -01 50: -768 -1460 N
Corrections /Comments/ Instructions:
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FAIL • CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
-
Inspector: L/ c - -- -,-._. Date: /0 h Phone #: (503) 718 - . e/A /1