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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00711 a I DEVELOPMENT SERVICES DATE ISSUED: 11/5/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2 S 102 C B - 03900 SITE ADDRESS: 09955 SW GARRETT ST SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: R-4.5 BLOCK: LOT : 011 JURISDICTION: TIG Project Description: Add (1) GFI plug and (1) regular plug to half bath addition. 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: 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: JERRIE ROUSSE OWNER 9955 SW GARRETT ST TIGARD, OR 97223 Phone: 503 - 419 -7498 Phone: Reg #: FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit 11/5/2004 $46.85. [TAX] 8% State Surcharge 11/5/2004 $3.75 Rough -irk Elect'l Final Total $50.60 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 . - set fort i 9 A R 952 -001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these rules or direct questions to OUNC at (503) 246 4699 or 1-800 -332 - , 44 Issu= • By: —' 1 �24L Permit Signature: )( OWNER INSTALLATION ONLY The installation is being made on property I own w - not intended for sale, lease, or rent. OWNER'S SIGNATURE: 4104 _ i - - • DATE: 11 �d A CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day Er ical Permit Application FOR OFFICE :USE ONLY ', Y'. ' Received C" y of Tigard Date/By: ©ay t, Permit No 0 — ... 7/ 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review Phone. 503.639.4171 Fax 503 598 1960 � // � �, �i�i (t Date/B Other Permit Inspection Line. 503.639 4175 g.= - d!! I Date Ready/By Jug H See Page 2 for Internet. wwwci.tigard.or.us Notified/Method: /ap, Supplemental Information t; ,��� ° ;" E`R'3 »^a '..k"t:F, ; &" -' ;L t °, Y'k��_ « " « . f,. •�t<"w. ^7F > ..:,B�F - ,' ,.�'4'..°i4,`<y , .^ °Sf..: ., *. :�b� �;,'-'„t. ; :.�' = wA„ '� >'t'� _ '` .t'47-1 . ; > > ik OF zR'®R 1 t.,._r, y ° '.., _ �.. - .,�. ,: i'I AN_ '13% —W�3s .�.; .:,.i� „� � ,-. �; �a1��€. e�'d��^�r:,�����- �:�.•�.';� «�• e�r,n�: - ....'�' r.�sY�'z�`� ... �a: a7 r,. G ..,�`�',�.�__� H . _,s�;i?.v, b «�:�. g.�_ �.,�_ _� , , , ❑ New construction El Addition/alteration /replacement Please check all that apply. ❑ Demolition ❑Other: ['Service over 225 amps, comm'l ❑Hazardous location i . d. h may $� EService over 320 amps — rating EBuildng over 10,000 sq ft , ” ' ' t ' �'�3?i� ','seses�> z 14iT 61 'O GOL�'�T� �'^ :rr' a'��,'ssz�� �' " ?�'"�' "' 2• ° of 1- and 2-family dwellings 4 or more new residential �', M1 �h., ; �i�"3'.ez � �.�,...:.. . �.�. ,;,�7.. z = ;'# - _ y weg RI 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑Building over three stones EFeeders, 400 amps or more El Multi ❑Master builder ❑Other: ; a alr...t�� �a�a' =, �s �-zzu; ^ - x.� ;a t;«ma: ,x. -d�- " € ;,: �,'m ['Occupant load over 99 persons ['Manufactured structures or ' - ^ ,_ , ' ''' *;JOB'h'r. IT';E It�fI' +,Olt 'TI(N ANiOire T� ° ' .: `�" i' ; 2 :5, `' . ❑ Egress /lighting plan RV park raw , ' {d ' zl>s >,r.— -i-L, .-ti r s �it °; ✓ %-,,, b" ,0.-&,:., -A4'4, s .;sus -u. d..a , ;'1 Job no.: Job site address C'' s5 5(,✓ 171 Y.rc l+,S` ` ❑Health -care facility ['Other Submit 2 sets of plans with any of the above City /State /ZIP: T , ur d / �� �� / 72_2 3 The above are not applicable to temporary construction service Suite/bldg /apt. no.: J Project name: ! ,' "-';' ,' ° J° '.° n: ''°' SCH;EDTFEE Ee* rL , , Description Qty. Fee Total l Cross street/directions to job site: p' ofc A 14.1, j New residential single- or multi - family dwelling unit. i Includes attached garage. 1,000 sq. ft. or less 145 15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft or portion 33 40 1 Tax map /parcel no.: Limited energy, residential 75 00 2 - _ Fy , e Limited energy, non - residential 75 00 2 Y - 740 , " .,. riiip RIToisF a k- y ;fir "° , g=Z ', w ; ' ,. t , ,0,k,- 4. , ) , _,,„ 4 ,�, ,,.,,. s,,' Each manufactured or modular t1 dwelling, service and /or feeder 90.90 2 add 5T / � -- 1 I (Ad! it' 0 ine V6' i(.1tC t� Services or feeders installation, alteration, and /or relocation / 5k--/ I +�11 r411 1 1 cIIn — 114 1461 �' bAr� l it1cfl D� 200 amps or less 80 30 2 s . . t - ' -.�,v , °-f , "'i ;. �. ., � �, ,. 201 amps to 400 amps 106 85 2 - »t::` , .� . x' 'F< K�a _: 401 amps to 600 amps 160.60 2 Name: TP is o c R 0 (IS5L 601 amps to 1,000 amps 240 60 2 Address: `! C �' S 5 ■„/ 6,,, e 1 s "( Over 1,000 amps or volts 454 65 2 Reconnect only 66 85 2 City /State /ZIP: 7 ar-d /0 g/ 7 �3 Temporary services or feeders installation, alteration, and /or ( relocation i_ v( Phone: (5 o3) �A - 7 t � I l b y�/ Fax: ( ) 200 amps or less 66 85 1 Owner installation: 'Dis installation is being made on property that I own which i not 201 amps to 400 amps 100 30 2 intended for sal- •a(e, rent, o - ` y nge, according to ORS 447, 449, 670, • •d 71 401 amps to 600 amps 133 75 2 Owner signatur:. A ' 4 1 Date: / O Branch circuits — new, alteration, or extension, per panel �` if: " ° ° w , ie , ' =`'� 4 "" 3 ' - "a - A. Fee for branch circuits with �;''' -� ,`~"7s�;.`� AP.PUI@'A1V'�'" t, T ,' ,;�''' fe ®CONsTA� PER,S® � � ,> service or feeder fee, each 6 65 2 Business name: branch circuit B Fee for branch circuits Contact name: without service or feeder fee, / 46 85 / /' 2 each branch circuit 4 ri7 Address: Each add'l branch circuit 6 65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or imgation circle 53 40 2 Phone: ( ) Fax: : ( ) Sign or outline lighting 53 40 2 E -mail: Signal circuit(s) or limited - ri,� . 1:7'4,0V3,-,--','t ` �'�`' :: �: 'CONTRAC`T R. :' �` =. f , ;. ° - ; . e nergy Panel, alteration, or a .._„'., , ," _�. .� �,»sa .�,.- ..� >�€= F�.�.:- 'F g'- 33 -n:'e' ,�eet,ie �X,T;. -�. �� 0 a e xtension Describe. Page 2 2 e 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 man) 62 50 Phone: ( ) Fax: ( ) Industrial plant per hour 73 75 i 1-W Iffrl1TytFOM7t.,e ..«' 1 Suprv. Lic CCB Lic. Electrical Lic.: Su - p Subtotal 0 , �7 Supry Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) 5. 7 TOTAL PERMIT FEE 3Z1 ,� Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Prmt name: Date * Fee methodology set by Tn- County Building Industry Service Board "* Number of inspections per permit allowed I \Budding\Perrruts\ELC- PerrrutApp doe 12/03 440- 4615T(10 /02 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: MilWATZSW4WW=INW: VA% IOW 7 1 Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations \Buildmg\Pemuts\ELC- PermdApp doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Ling:• -(503-) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested / 1 -" /d AM PM BUP Location J ' a Suite MEC Contact Person ?Y) Ph ( ) � / — 7 PLM Contractor I Ph SWR BUILDING Tenant/Owner ELC 2 0 y- 7 l Footing ELC Foundation Access: • • 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 C\ I \` �4�1� L IN/ l ' l b Susp'd Ceiling l Roof Other: Final PASS PART FAIL PLUMBING =`v 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 LAL S ough- UG /Slab Low Voltage Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SPAS PART FAIL SITE ° _ °" 0 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line .ADA - Approach/Sidewalk Date -/ / ° ° / !nape or Ext Other: Final DO NOT REMOVE this inspection record fr the Job site. PASS PART FAIL