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Permit A CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00561 ' i ` DEVELOPMENT SERVICES DATE ISSUED: 9/9/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S 103DC -00813 SITE ADDRESS: 11205 SW GAARDE ST SUBDIVISION: ZONING: R BLOCK: LOT : JURISDICTION: TIG Project Description: Alteration /addition of (3) branch circuits for addition of bathroom to garage. 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: 2 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: ANDERSON, BRUCE KENNETH OWNER HELEN ANN CATHERINE 11205 SW GAARDE ST TIGARD, OR 97223 Phone: Phone: Reg #: FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit 9/9/03 $60.15 [TAX] 8% State Tax 9/9/03 $4.80 Rough -in Elect'l Final Total $64.95 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to O ' ' at (50.) 246 -6699 or 1 800 332 2344. - 41eIr-- Issued B c Permit Si na . r le OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: - 7.0A/ DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day Electrical Permit Application • FOR OF FI CE LJS E ONLY Received Q Electrical s y ,� . Date /By: 9 9 4 15 Permit No.: C , ,? 3-005 - lo/ Qp City of Tigard Planning Approval Sign Y g Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503- 598 -1960 4 Post - Review Land Use Internet: www.ci.tigard.or.us rNi ! �1 Date/By: Contact Ju ' Ju .: .: �W ® See Page 2 for 24- hour Inspection Request: 503- 639 -4175 Name/Method: _ Lep, Supplemental Information. • ,in -. , •;: ��k! IV:M �N..._... M 4411Mat :M A�.� =� - y�x. ~W.,(liease ck4WI that.'` P_.P X� ��� t ❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility 17] Addition/alteration/replacement _ ®. Other: commercial ❑ Building over er 10,000 �_ --� � �, � _ ❑ Service over 320 amps- rating of ❑Building over 10,000 square feet, � � . C T ,C=© 4 0$,Ni 2 F,C'1 t��- �: 1 & 2 family dwellings � Y s four or more residential units in g Qi & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more El Accessory Building 111 Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other: _ -a'. "� �. Submit sets o plans with any o the above. ��� �, z .- -._ t STE�� ® �,.. The above are not applicable to temporary construction service. Job site address: il 12 ®S SA 1.1 • go4 ikifi e `'° ar a N aStttl$ DUi ,; °' ru i Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: Description Qty Fee (ea.) Total i Cross street/Directions to job site: New residential - single or multi- family per 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: I Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75.00 2 Tax map /parcel #: Each manufactured home or modular dwelling , , I - rn' i ff ; i ; Vt ; 3 RV : service and/or feeder 90.90 2 . , *. , 6 .,i , , . .T?E It IPTTO.IY,EQ WQR Services or feeders - installation, ACii � �� � p ill alteration or relocation: • 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 1A 401 amps to 600 amps 160.60 2 A OPtRr m= ` Q n+' z' ' ^� tom" " ; 601 amps to 1000 amps 240.60 2 Over 1000 amps or volts 454.65 2 Name: Ellice Iu d e r s o L Reconnect only 66.85 2 Address: a .O c,Q, J,) e G"A--1, -4 e s-. e Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: — r e e , pk , ,F' x'"'.)72.0 200 amps or less 66.85 1 Phone: ' 0' 7 e' "' '^. 8 Fax 201 amps to 400 amps 100.30 2 w .,...a_N..... w 401 to 600 amps 133.75 2 15 LT ; »v , "', - ' R Ar =+C -TAPE S v': ;?, , � � Branch circuits - new, alteration, or Name: extension per panel: Address: A Fee for branch circuits with purchase of 6.65 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 7G • ? 2 Phone: I Fax: Each additional branch circuit A I - 6.65 / 3. ■)() 2 E -mail: Misc.(Service or feeder not included): ,a , om , i escr s ` `a v Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: Signal circuit(s) or. a limited energy panel, Business Name: ry , I� D or extension Page 2 2 Descrptti on: Address: City/ State/Zip: Each additional inspection over the allowable in any of the above: Y P Per inspection per hour (min. 1 hour) 62.50 Phone: Fax: Investigation fee: CCB Lic. #: Lic. #: Other: yv Supervising electrician Subtotal $ &( . t signature required' Plan Review (25% of Permit Fee) $ Print Na -: / . #: St ate Surcharge (8% of Permit Fee) $ �, g / TOTAL PERMIT FEE $ d 93" Auth• zed / Notice: This permit application expires if a permit is not obtained within .: y J di 41/ 4.te: Y -1 :03 180 days after it has been accepted as complete. fl II + _ *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 Ej Burglar Alarm I I Garage Door Opener El Heating, Ventilation and Air Conditioning System n Vacuum Systems n 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 • Data Telecommunication Installation I Fire Alarm Installation n HVAC n Instrumentation El Intercom and Paging Systems E Landscape Irrigation Control n Medical ❑ Nurse Calls n 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 . • - BUILDING DIVISION PERMIT #: ELC2003 -00561 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/9/2003 Phone: (503) 639 -4171 amplii Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/5/2005 TIME: 7:09AM PAGE: 56 SITE ADDRESS: 11205 SW GAARDE ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: ANDERSON DESCRIPTION: Alteration /addition of (3) branch circuits for addition of bathroom to garage. OWNER: ANDERSON, BRUCE KENNETH, PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 4/6/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 003702 -01 503-639-0013 N \ Co r rrections /Comments /Instructions: V ( / ( t • ., PASS ❑ PARTIAL APPROVAL ❑ CANCEL f NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED / ,.- Inspector: 1/1-- _i . ,,„,.... K .- Date: - (f/( Phone #: (503) 718-