Permit CIT OF TIGARD ELECTRICAL PERMIT
}:.*^ PERMIT #: ELC2004 -00726
DEVELOPMENT SERVICES DATE ISSUED: 11/12/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S133CD-05300
SITE ADDRESS: 13579 SW FEIRING LN
SUBDIVISION: COTSWALD MEADOWS ZONING: R
BLOCK: LOT : 051 JURISDICTION: TIG
Project Description: Panel change.
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:
HUNTER, ROBERT M +TERRI D T &T ELECTRIC
13579 SW FEIRING LN 4120 SE INTERNATIONAL WAY
TIGARD, OR 97223 SUITE A-105
MILWAUKIE, OR 97222
Phone: 503 - 579 -0653 Phone: 503 - 652 -7610
Reg #: LIC 150973
ELE 26 -1105C
FEES SUP 2184S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/12/200' $80.30
[TAX] 8% State Surcharge 11/12/200' $6.43 Rough -in
Elect'I Service
Total $86.73 Elect'I Final
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- 32 -2344. /
Issued By: E� Permit Signature: v C.ec - - --
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: -f, 15
Call 639 -4175 by 7:00pm for an inspection the next business day
, . W I R C ENE
Electrical Permit Application , t 200k FOR OFFICE. USE ONLY
City of Tigard 0 Received ' ah• ��
r D!liy: / Pe rmit /I ia- Peit Nn.:a./r . 041/`OD 7i2. 0
1 3 125 SW Flail Blvd., Tigard, OR 972 -, 3 QFT��N v�,✓v�
Phone: 503.63Q4171 Fax: 51)3.5981 I) C ITY �,v1 Plan Review
— —
pp�� r Datt/By: Other Permit:
Inspection Line: 50.3.039.4 1 75
P BUI
Ina � �' 1 � Date Read /8 • L� 't .nr Ready /By: tuns- � El S Page 2 for
Intcn let: www.ci.ligarti.or.us NotitiediM / 74 etbod: Supplemental furunnatnun
TYPE OF WORK PLAN REVIEW
❑ New constructionL Addition /alteration /replacement Please check all that apply: •
❑ Service over 225 amps, cumm'I Ell la7ardouv location
❑ Demolition ❑ Other:
CATEGORY OF CONSTRUCTION ❑Service over 320 amps - rating ❑ Buil ring over 10,000 sq. i't.,
of 1- and 2- family dwellings 4 or more new residential
1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Buildin over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑ Master builder El Other:
JOB SITE INFORMATION AND LOCATION ❑Occupant load over 99 persons ❑ anted strut:tures or
['Egress/lighting plain RV park
Job
no cot, '�1 0 Job site address: 1551q SW F�t tZ,IN i ❑Health -care facility ❑Other; �„_ - _
Submit 2 sets of plans with any of the above.
Cily /Stale /ZIP: 77 6 f}'I Q 2 The above are not applicable to temporary construr_ lion service.
Suite /bldg. /apt. no.: Project name: FEE • SCHEDULE
Description Qty. Fe,. 'r'a
Cross street /directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 st ft. or less sq. 145.15 4
Subdivision: I Lot no.: Ca. add') 500 sq. 0. or portion ■ 33,40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential - 75.00 Ell
DESCRIPTION OF WORK
Each manufactured or modular
- PA - 4 , 3E-L , -tf) 0 �� dwelling, service and /or feeder 90.9(7 2
Services or feeders installation, alteration, and /or relocation
200 amps or less I 80.30 . s r 2
❑ PROPERTY OWNER 1 . ❑ TENANT 201 amps to 400 amps 106,85 ; 2
Name: '� �N`� 401 amps to 600 amps 160,60 1 2
601 amps to 1,000 amps III 240.00 El 2
Address: 9T t �G L Over 1.000 amps or volts 454.05 2
City /State /LIP: Reconnect only 111111 66,85 2
Temporary services or feeders installation, alteration, and /or
Phone: (r ) •e 6, i,55 LFax: ( ) relocatio
Owner installation: This installation is being made on property that 1 own which is not 20 amps (0
or
less 66.3; 1
201
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps to 400 amps 10(1 3(1 2
401 amps to 600 amps 133.75
Owner signature: — Date: Branch circuits - new, alteration, or extension, per panel 2
❑ APPLICANT £ & I Elect , , C , ox A, Fee for branch circuits with
Business name: ' service or (ceder fee, each
1120 SE International Way #A105 branch circuit 6.65 2
-
Contact name; 1 - Milwaukie OR, 97222 Id Fee for branch circuits
wiihoul service or feeder fee,
-
Address: Phone: 503/652 -7610 each branch circuit 40.85 2
Fax: 503/652 -7612 Each add'I branch circuit 6.65 2
City /Stifle /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax:: ( ) Pump or irrigation circle 53.40 2
L -mail: Sign or outline lighting 53.40 2
Signal circuit(5) or limited -
CONTRACTOR energy panel, alteration, or
Business name: T & T Electrical, LLC extension. Describe: Page 2 2
Address: 4120 SE International Way, Suite A105 Each additional inspection over allowable in any of the above
City /State /ZIP: Milwaulde, OR. 97222 Per inspection 62.50
Investigation per hour ti hr min) 62.50
Phone: (503) 652 - 7610 I Fax: (503) 652 -7612 Industrial plant per hour 73.75
CCB Lie.: 161187 Electrical ic.: 2G -I IOSC ELECTRICAL PERMIT FEES*
Suprv. Lie 473IS
A
� Subtotal 8o, 30
Sttpty Electrician signature, required: II . G • F i i i1 /' ( P )
� , Plan review (25% of c i trait lee
!'r int name: D. mil-R U NI •VtA LL_, - Date: Suite surcharge (8% of permit fee
Aathoriz.ed signature: ••• TOTAL PERMIT FEE &O "/
This permit application expires If a permit is not obtained within IRO
Print name: '�-RtY F /�E Date: , F ^� ,Q I-1 days after it has been accepted as complete
" Fee methodology sat by Tri County Building industry Service Board
tn- tding ,Pcno611,,I.C- ps,n,,,Ap,doe 12/07 ' Number of inspections per permit allowed
44U -461 yr( IUiO2/C'OM.'W(IR
Z - d Z 19LZS9EOS 311 ` i ea r•Igoa i 3 1 1 1 LO : 6 17002 2 1 A0
CITY OF TIGARD 24 -Hour
BLULDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business IinA> c- (503) 639 - 4171
BUP
Received . Date Requested / AM PM BUP
Location / 0s 7 f - Y1- 1 uite MEC
Contact Person U Ph ( 1 4 PLM
Contractor /4 Ph ( / ) SWR
BUILDING Tenant/ vim ' / ELC 470-7
Footing T /4 /:' ! ELC
Foundation Access: I
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: / SIT
Post & Beam L 7��—''LP_'L !deist'
Ext Shear Sheath/Shear ea th /Sh ear J's
Ext eah /h
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam f
Under Slab a
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 A, .
�� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
411117.1 ✓ ,
PART FAIL
SITE ❑ Please call for reinspection RE: 111 Unab pest — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ( Inspector E7ct
Other:
I
Final DO NOT REMOVE this inspection record f the job site.
PASS PART FAIL