Permit • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00469
DEVELOPMENT SERVICES DATE ISSUED: 7/31/03
a 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 103AC -01700
SITE ADDRESS: 11180 SW FONNER ST
ZONING: R - 4.5
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Extending /adding 4 branch circuits.
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: 3 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:
SCHULTHEIS, ERIC D + OWNER
11180 SW FONNER ST
TIGARD, OR 97223
Phone: 503 - 620 -1605 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/31/03 $66.80
[TAX] 8% State Tax 7/31/03 $5.35 Rough -in
Elect'I Final
Total $72.15
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: Ac L Permit Signature: / 7n
U G
OWNER INSTALLATION ONLY
The installation is being made on pr Apel,44,(Xi( perty 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: 0- ?/(7) , -(A
Call 639 -4175 by 7:00pm for an inspection the next business day
�® . - FOR OFFICE. USE ONLY - . r ,, :.
Electrical Permit Applicati_o'nv Received Electrical �/ e/
Tigard ‘U Date/By: / 31/43 PermitNo.f- /— t�� - 3'19P t2 7 b 9
City
CIS of UU °O Is m Planning Approval Sign
: Permit No.:
13125 SW Hall Blvd. ,l`, 6 1 Plan Review Other
Tigard, Oregon 97223 ,G R a �� Date/By: Permit No.? M) 73.- UV31
F Post- Review Land Use • Phone: 503-639-4171 Fax: 503-598-1960 G ; , ' ° °" Q 4 " 1w��a�® Date /By: Case No
Internet: www.ci.tigard.or.us et , e7 ' I Contact Juns : Z See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 '2-• W Name/Method 'T ( 6- Supplemental Information.
,4` 4 , f` =,,:� �.,„ t .. - _ -_ - _ -rz`r,, M �;�s r ='�zK ..!, 4 ""`.e a; ' c _ -- ., ,.: - + k: »% ".5.•
P�._ .,�:��� , >�;, e�.�� °'. "�` *TI'PE.OFGWORK`� - :� %z� >s .,::��:_, � � ' .. . t �.:..: P,. LAN�KEYIEW( Pleasecheckallrtt %ataPP1Y).,p'. :
.i
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
I , Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
,<<im y : i =CATEGORY OF`'CONSTRUCTI�®N ->; -: j: >'•.';�� +!'- 1 & 2 family dwellings four or more residential units in
1 W & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
Accessory Building ID Multi- Family ❑Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
" ` ;: 70B StIrti =INFOR =A TIO LO
N and 'C :ATION ' " .' ` , `' '":`= Submit sets of plans with any of the above.
';: ° The above are not applicable to temporary construction service.
Job site address: I( ( 6C) (,A.) r i C r- Si • ; s . , • 1. <° , ; FE'E* SCHEDULE ' ' 4 ° :;4.'° ..
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total 1
New residential - single or multi - family per
Cross street/Directions to job site: }} � . , _ dwelling unit. Includes attached garage.
' q � -- w�q (AA - to/iii e e. 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
!a ;A. ' `e: _, :, i4D
; i N. OF A W®RN. , , , , -= ° ' . °''', service and/or feeder 90.90 2
� / Services or feeders - installation,
? ' i t e'i d i r Q / «d� V ' alteration or relocation:
b 1-ot, 1C f ,� r - C _ �..p 200 amps or less 06.85 2
lJ i '_ 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
6,1 0 • OPERi OWN ER °T , - : . TEN LL N ` ` ` rill `': 601 amps to 1000 amps 240.60 2
9PR a. ..,
ell( � Over 1000 amps or volts 454.65 2
Name: En i c t CU l lr e (/L e' ` S ( i l 1 �/-►/ t't PJ.S Reconnect only 66.85 2
Address: / 1( 0 ) 'fran f.'' _,1. Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 1 L �� DR- g '7-2Z3 200 amps or less 66.85 1
Phone: S03.0,0 - t tk(JJ Fax: 201 amps to 400 amps 100.30 2
.8
401 to 600 amps 133 75 2
LMANT'.' ' ' 4a '' j . M. ( l CO P A
NTACT SONig.:Ali Branch circuits - new, alteration, or
Name: C_0 /( .e l/i J (,( 101 0 S extension per panel:
, _ A Fee for branch circuits with purchase of
Address: ._ -� service or feeder fee, each branch circuit 6 65 2
City /State /Zip: - CC ( lwt-e Z B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit / 46.85 .-S,5 2
Phone: Fax: Each additional branch circuit ?7 6.65 / ' , C[.5 2
E -mail: C-S ei,((,c t `fail eA S e Qa lt� /I I ( ✓I t L . • 0 1, . Misc.(Service or feeder not included):
„',_, Each pump or irrigation circle
:ter >' r '�E ;:iriC . °- CON Me... ORS Y- -.,,.. ie l :41: - 2
2
- Each sign or outline lighti 53.40 ng 53.40
Job No: (9 LQ )yU2A • Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: Description
Address:
Each additional inspection over the allowable in any of the above:
City /State /Zip: Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee -
Other.
CCB Lic. #: Lic. #: _ .� -, & * F• i f ;li
_,�� ° »v . ,: � y�,�. -. ���;El .� �'` _ �r�:'� °.� -':.
Supervising electrician Subtotal $ (o & .5(Q
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ 3
. TOTAL PERMIT FEE $ 7'Z - /5
Authorized �� , Notice: This permit application expires if a permit is not obtained within
Signature / _ -- A , / .1/ . L Date: .' . 102 ( 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
4 S (Iii (,� (`If l !-/s ,Aro
ase print name) q
c \Dsts\Permit Forms \ElcPetmitApp.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:
ri Audio and Stereo Systems
n Burglar Alarm
I Garage Door Opener
In Heating, Ventilation and Air Conditioning System
I Vacuum Systems
ri 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
F Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
ri Intercom and Paging Systems
ri Landscape Imgation Control
n Medical
in Nurse Calls
pi 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 x
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
Received �4 +"1 IV! Date Requested % --2'3 AM PM BUP
Location ! // 3 97 Suite MEC
Contact Person L�O 6'1� Ph ( ) PLM
Contractor Ph ( ) SWR //
BUILDING Tenant/Owner ELC . 3" — .04/Z1
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam .
Shear Anchors
Ext Sheath/Shear ,
Int Sheath/Shear
Framing
Drywall ywal
Dywall Nailing (2 (..---
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof 's
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
I'ELECTRIQAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line /
ADA
Approach /Sidewalk Date c �7 Inspector i_ ■. • • Ext
Other:
Final DO NOT REMOVE this inspection record om the job site.
PASS PART FAIL
@,o® 0 H %.00 0 0 %.71IPM1 s-r -o ovuo
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Cate Requested 8''. S PM — BUP
Location / / ( 8d pt Suite 4124 c; — d 4 15 - 0
Contact Person Ph ( ) LM ' d C1 "37-1
Contractor Ph ( ) SWR .
C�
BUILDING Tenant/Owner �-� a Lf "_ 0.5 Cv � A" �' / /
Footing
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
ExtSheath/Shear ._._._..--_ .__..._..__..______.___..__.___ _.._ _____.___._ _ __.___._..__..__.____._____.__ __.____,
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fi reveal I --^ (7 `
Fire Sprinkler � � � ` / L/ `�'2 � C c (!
Fire Alarm 1
Susp'd Ceiling
Roof /7 J eV . !�
Other: � v2 --/- _ � j` f S / � ! •
Final
PASS T FAIL
UMB 1 r /X r� 5 - ter( /c v v c' /--/ Post eam
\
Under Slab A ,
In /^-( so /c q y f O /L
19ativice P Sanitary Sewer
Rain Drains
Catch Basin / Manhole c7 // ��� /a /C
Storm Drain '
Shower Pan
0 t h - :
QS*- • -T FAIL
774
.\
P Beam \
■
uh -In`� V(\).0.3-
Gas me //
Smoke Dampers , p ./
47. iy t Y • i '5
7_'e- PART FAIL �' -
- CT: 0. \I / C n
Servic- - Ci r ,/,.A •
U� . fib K ►, � cc��
• oltage -‘'`
Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
i : , - El P q P Y tY
i� T FAIL
S it ❑ Please call for reinspection RE: I I Unable to inspect - no access
Fire ADASupply Line g r L 5'�›
Approach /Sidewalk Date ., Be epe tov Ext
Other:
Final Df• NOT ''E`'OVE this inspect ! .gt record from the I p site.
PASS PART FAIL