Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00815
DEVELOPMENT SERVICES DATE ISSUED: 12/23/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 10X8 -03400
SITE ADDRESS: 09870 SW FREWING ST 56
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: R-12
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Reconnect only.
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:
FINKE, ALEX AND LOTTE I OWNER
PO BOX 23562
PORTLAND, OR 97223
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/23/200 $66.85
[TAX] 8% State Surcharge 12/23/200' $5.35 Elect'I Service
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 the - :t Uliect questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: / / Permit Signatur-: ■
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
Electri Permit Appli �4 ® FI
FOR OFCE`USE ONLY... ,
City of Tig b ard PerrrutNo.: �� D ate iv e /f7 t�� U /, v L [;, -ate! /" �!
13125 SW Hall Blvd., Tigard 23 0� Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 c) �O Q ® 1 Date /By: Other Permit: II
Inspection Line: 503.639.4175 � C , a'
^' `C` ■�,• Date Ready /By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us � G1ka" a Notified/Method: - /U Supplemental Information irNAIIS
V Y rI g ORK PLAN REVIEW
❑ New construction d1iitiion /alteration/replacement Please check all that apply:
❑Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition ❑Other: ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION 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
Multi family ❑Master builder ❑Other: ❑Building over three stories EFeeders, 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: 92 70 5 W k /A/ , ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: 77 ic, /op, / ?'r� � a,�. The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: I V Project name: e / .t.C4 �
FEE* SCHEDULE
�'" t Description Qty. Fee. Total **
Cross street/directions to job site: New residential single - or multi- family dwelling unit"
c i /7 Includes attached garage.
(((/// / / / / / / / ii, 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'1500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
I dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY OWNER El TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Ai,ir/, b— (&) k�_,-- 601 amps to 1,000 amps 240.60 2
Address: 'p, (); g - � .
2
' 6 Over 1,000 amps or volts 454.65 2
r � Reconnect only 1 66.85 2
City /State /ZIP: / /' - c&� /O�'' �� e Temporary services or feeders installation, alteration, and /or
Phone: (a), • 7'" / / Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installatio being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, le t, or e ange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature. Date: % 2 3 /O) Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
k------- B. Fee for branch circuits
Contact name: & � 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)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
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:
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal K`�
Suprv. Electrician signature, required: Plan review (25% of permit fee) ?
Print name: Date: State surcharge (8% of permit fee) . `
TOTAL PERMIT FEE "7_ 6
Authorized signature:. • This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri -County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PennitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
Burglar Alarm
Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial 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
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
•
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\Building\Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line;. (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested — AM PM BUP
Location 9 a - 'J4 (J- 'rl Suite* MEC
Contact Person a-e- 7 Ph ( ) . PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC BOO 5
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing C
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
Low Vo
Low Voltag -
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspects n RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date " Inspe r / C Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL