Permit " ''CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00658
,.��� DEVELOPMENT SERVICES DATE ISSUED: 10/29/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S102DC -02000
SITE ADDRESS: 09360 SW EDGEWOOD ST
SUBDIVISION: EDGEWOOD ZONING: R
BLOCK: LOT : 018 JURISDICTION: TIG
Project Description: Rewire existing studio, (1) 200 amp or less panel and (12) branch circuits.
Job No. 507
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 1.00 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: 12 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:
BRADY, TWYLA FAITH WILLAMETTE ELECTRIC INC
9360 SW EDGEWOOD PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 10/29/03 $160.10
[TAX] 8% State Surcharge 10/29/03 $12.81 Rough -in
Elect'l Final
Total $172.91
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 -.n 180 .ay ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth i BAR 952 - 001 -00 I through OAR • 2- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -80, 332 -2344.
Iss ed By: ;A, 01 +� 4//, L /' 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: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: � - DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
•
Elect Application
FAR;OFFICE USE ONLY
Received to If a 3 Electrical
Date/By: ✓ Permit No.: 1L6 D -0,..5
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 Post-Review Land Use
G�i�tulll� µ�� "' l Date/By: Case No.:
Internet: www.ci.tigard.or.us . ' � Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
»a;;.r".'•74 21 1:xx= s �. _ �. �. he s �� � �. �'� :tau °. �'�'� ,xc; a'��>:�-�� `� � °�:. � � ��_��> €
a
. :.° E O O�RT� YT�1N, TIE „('lease =check, l l at Pl -Y
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
® Addition/alteration/replacement 111 Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
No�TEGO ,YQnQ, lvS``TIZi:co fir} «;. - ;,4; 1 & 2 family dwellings four or more residential units in
[S 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
�.,�°I' -- Submit sets of plans with any of th
�;� � � �`- ,�J;Q$.�ST�T;E �N��(1TIOh � a n d®���,:T I®_3� � � � .° " � b o P Y the above.
t t ton service.
"" Th a ve are not ap licable to temporary cons ruc
Job site address. `y 36 -S -' f J y z a. Sf $¢
-ka. ,:: i�.. �..s.R >R3N� 3Gf�_r- «.4L:k!s�_� ... #..'k'e'�'C .vt'.. :. �..Y'� . ���:x.u2. h�
Suite #: Bld /Apt. #: Number of inspections per permit allowed
�► '
Project Name: {,t - 624- >1 Description Qty Fee (ea.) Total
Cross street/Directions to job site: / New residential - single or multi- family per j
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
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
gil t - ^,ee IaE R P o Ofi J gf a i "`, .� service and/or feeder 90.90 2
Services or feeders - installation,
R e w 1 ' C E )L •• . , SA.. J' 0 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
�„ o . " "''� " = f "`�� 601 ; •" amps to 1000 amps 240.60 2
����PRt).PE�12�:Q�;�� �,vER�:.:�`:_;_ �l�Y��T� ��:,::�. P P
� �� / 1-1,0 `' t Over Reconnect only 66.85 2
amps or volts 454.65 2
Name: r Reconnect
Address: 9 J 3 6 0 S Gam' C cPy. C.- u J D' Temporary services or feeders - installation,
y a,
City /State /Zip: J ;' d , (� ♦ alteration, 00 ms o less relocation:
�l � 2 Z � 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
r .,.:a a C k a `""" " soO VT ` PJO+ Q 401 to 600 amps 133.75 2
`� ''- °I''�- ���. � '�.r , w '� °-'� Branch circuits -new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of Z 6.65 7 412 2
service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46 :85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
-i -� "m . Each pump or irrigation circle 53.40 2
" ` Each sign or outline lighting 53.40 2
Job No: 5 7 Signal circuit(s) or a limited energy panel,
Business Name: 44d .' 11, e ,1-1-e ¢ � alteration, or extension Page 2 2
/ C Description:
Address: P o l3• k 2304
,� ( /i 5'27.,-/ . �S �� Each additional inspection over the allowable in any of the above:
City /State /Zip: T' ; '2° i Per inspection per hour (min. 1 hour) 62.50
Phone: 5 „ .3• 62 V-.167/ Fax: ..c 6 2 9 Y d' investigation fee:
CCB Lic. #: 7.S 9 Lic. #: 3 y ZZr S' C__ Other: - g, . F" a e r cal" rm "t Fe ita Y � ' _t
Supervising electrician
P g � _ Subtotal $ /6
signature required: ) t&t;-. , / Plan Review (25% of Permit Fee) $
Print Name: d it N r 4 i" c. #: (9i 1 5 State Surcharge (8% of Permit Fee) $ / 2'
• TOTAL PERMIT FEE $ / 7Z =-
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)
i:\Dsts\Permit Forms \E1cPermitApp.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
❑ Burglar Alarm
n Garage Door Opener
Li Heating, Ventilation and Air Conditioning System
Vacuum Systems
E Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
n Nurse Calls
Outdoor Landscape Lighting
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
I (L BUP
Received /z3 ° 'Date Requested � ! Z T� 0 t i � AM PM BUP
Location • Suite • MEC
Contact Person nn -- -- I Ph (Z-'b 24 3 b.3 J PLM
Contractor . Ph ( ) SWR
BUILDING Tenant/Owner COP3 — c) 5 d"
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear •
Int Sheath /Shear
Framing
Insulation
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:
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 �j� /�/d �� -
Fir - _ _ m
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
)PART FAIL
Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA a. J v+�
Approach/Sidewalk Date °� y —�� Inspector s Ext
Other:
Final DO NOT REMOVE this inspection record from the job = te.
PASS PART FAIL