Permit CITY OF TIGARD
CARD 4
' 1 ELECTRICAL PERMIT
PERMIT #: ELC2004 -00635
D EVELOPMENT SERVICES D ATE ISSUED: 10/4/2004
411 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S102AB -90004
SITE ADDRESS: 09210 SW CENTER ST 4
SUBDIVISION: THE WILLOW BEND CONDOMINIUM ZONING: R-25
BLOCK: LOT : 004 JURISDICTION: TIG
Project Description: Reconnect.
•
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASSENBERG, JANNETTE K OWNER
P.O. BOX 185
SHERWOOD, OR 97140
Phone: 503 - 625 -5938 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 10/4/2004 $5.35
[ELPRMT] ELC Permit 10/4/2004 $66.85 Elect'I Final
Total $72.20 .
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 questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: Permit Signature: %t, ` �� --
„e6(4Zz.ree,... OWNER INSTALLATION ONLY /
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: S=.-- ,.� _.Z. lti___.! - ' DATE: G'e — q ''4
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
gl ED . . .
Electrical Permi . t ,. t kicdriu* FOR OFFICE USE ONLY •
City of-Tigard OCT 4 2004 A Received „.
Date/B : l'o a VI v Permit No.: EZe 29y-d
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598-b0-
i AI y OF TIGARD . e. :0V4Ilit
...- Date/B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: EZI See Page 2 for
BUILDING DI
Internet: www.ci.tigard.or.us Notified/Method PA I M Supplemental Information
VISIO.,--w- ‘,1_,..
,....:... -.,,.„ .,_•- .-,..... .- .m,:w. ,, ,Avr skvgio r,, vr4NAT ,s tzses i14 -
",' - ,, 4t ;.A11 .- :-a•weax,, igt-,•-•:i5,-,5!4 - : • ,. -•
El New construction 0 Addition/alteration/replacement Please check all that apply:
OService over 225 amps, comm'l EHazardous location
0 Demolition A Other:
['Service over 320 amps - rating 0Buildng over 10,000 sq. ft.,
...a.t0.1.4, V 4:Z tr
PAV 11 of 1 - and 2 dwellings 4 or more new residential
,.
0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building ESystem over 600 volts nominal units in one structure
DBuilding over three stories OFeeders, 400 amps or more
PO! Multi-farnily . 0 Master builder 0 Other:
DOccupant load over 99 persons 0Manufactured structures or
VVVETaRitt s4 kb ,11 04141151 , 7 1 "'"'FleMir:% 1-
Egress/lighting 0 plan RV. park
DHealth-care facility , 00ther:
Job no.: Job site address: St eciu,E,e__ S 7-.
Submit 2 sets of plans with any of the above.
City/State/ZIP: The above are not applicable to temporary construction service.
SuiteNdg a617 Project name: e 4.674 ,,,. , M :•'...' '; '
..-
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
in, WIZ i':::::, 11110t*.AW.WORWS. i 5,51:ii* gaitatalte Each manufactured or modular
dwelling, service and/or feeder 90.90
Services or feeders installation, alteration, and/or relocatio
200 amps or less 80.30 2
*;1 " W ritatifiViMille• il i, MiafiWt 201 am s to 400 a s 106.85 2
4 Artz4 - ':',:4,, ' r. WaiAt.,:lieitl..-a4-44-illit",1&-a-i.,-ol„i , 401 amps to 600 amps .
160.60 2
Name: -r
Addres; e 17-75 ---e ''(-1,-re'!--bi 'PI 601 amps to 1,000 amps 240.60 2
(
Address : 4J-- 13a x / gS
c s - 74, ri.4) _ _ A 9 ...7 / cz
Phone: (5:03 ) 6, ,...c- ce:7 I i ('/ Fax:( ) Over 1,000 amps or volts
Reconnect only 454.65 2
/ • 66.85 64,es 2
City/State/ZIP:
Temporary services or feeders installation, alteration, and/or
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 exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
ilalrii: yiMAlatAialiNI..'''ti' g7LsigaTVT':, itirOciA '!,iitir '.: ,i:z.,,,A71. A. Fee for branch circuits with
6.65 2
Business name: t, ) / // 4 to g en d letr branch circuit
B. Fee for branch circuits
Contact name: ,7--,_ 24 n ,11-;., edee_s:seka-ei-1 without service or feeder fee,
46.85 2
/ • each branch circuit
Address:
Each add 'l 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-
-Iri-i, . frAgtaVtartdiVWM1SV,M).-r VAtW energy panel, alteration, or
... I.A ..,, .1k.v
extension. Describe: Page 2 2
Business name:
Each additional inspection over allowable in any of the above
Address:
Per inspection 62.50
City/State/ZIP: -- Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax ( ) Industrial plant per hour 73.75
ON :'.i-VICKUT.r.APOWIZRAS:a7M;77;`_77:: Y!
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal
64, P5
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) =5, 3 5
Print name: Date:
TOTAL PERMIT FEE 9 .. ). Authorized signs ),..L.a..? ..e..
t9 .2 .2 0
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: , 4 e7 , --(., , 4) Date: ( 9 _V/ . Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per pennit allowed.
i: \Building \Perrnits1ELC-PermitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
F IDE p E } 14
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:
g O �-m+m'+N M ORKRIW ' _ n.. di :r k .
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.\ Bwlding \Permits\ELC- PemutApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
> BUP
Received Date Requested ` - 9 /
AM PM BUP
Location / I Suite / MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR �
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain A ess:: 6.11/1 ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam 1 6
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation d t �/` f 7' a ,., ^ / F ,
Drywall Nailing ,GC�J , Y
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof s If - 1 i it)
Other: -
Final 4 /1 ` a A A. f ' CO ' PASS PART FAIL , /� IlfA
PLUMBING , � - �., , I �d M /14 Z56/1) Post & Beam ��// y�/� •
Under Slab I/ x,4 /6- / 1l 1 < J
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL I .
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL.
Service
Rough -In
UG/Slab
Low Voltage
arm
�" Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: I fret4.656az--Y Unable to inspect — no access
Fire ADASupply Line J L ( ( �� Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL