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Permit ,CITY OF TIGARD R® ELECTRICAL PERMIT HK PERMIT #: ELC2008 -00563 COMMUNITY DEVELOPMENT DATE ISSUED: 10/3/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S112CA-00800 SITE ADDRESS: 07895 SW GENTLE WOODS DR ZONING: R -4.5 SUBDIVISION: GENTLE WOODS LOT : 001 JURISDICTION: TIG PROJECT: MUTER Project Description: (1) branch circuit for blower to gas fireplace. 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: REGINA MUTER OWNER 7895 SW GENTLEWOODS TIGARD, OR 97224 Phone: 503 - 684 -5005 Contact #: FEES Description Date Amount Reg #: [ELPRMT] ELC Permit 10/3/2008 $46.85 [TAX] 12% State Surchar 10/3/2008 $5.62 Total $52.47 REQUIRED ITEMS AND REPORTS 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 throush OAR 952 - 001 -0100 . au -ma - obtain cosies of these rules or direct questions to •UNC at 503 246 6699 or 1 800 332 2344 Issued B ✓ /�� Permittee Signa 1dL ///6() 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 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. • Electrical Permit Application FOR OFFICE USE ONLY ,. fl 'City of Tigard �® A Received Date/By id y ✓) r``'�/�j� Permit No � � 13125 SW Hall Blvd , Tigard, OR 97 ,.i 't; V an Review 111 : 0 Phone 503 639 4171 Fax 503 59 :' 'M N Z I t- ') y Other Permit T I G A1iD Inspection Line 503.639 4175 c:\ ty :1 ": ady /By --- ���rr -�� ® See Page 2 for Internet www tigard -or gov � g —10 , t-. , r. , .. ` , ied /Method ��,r Supplemental Information ' • TYPE OF WORK d'! ® ea " 7736 Supplemental ' • ❑ New construction Addition /alteration/rep " Please check all that apply (submit 2 sets of plans whims checked below) ID Service or feeder 400 amps or more ❑ Building over three stories ❑ Demolition ❑Other: where the available fault current ❑ Marinas and boatyards - CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 2 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or ❑ Emergency system larger separately derived system ' JOB SITE INFORMATION AND LOCATION '. -. /j- ❑ Addition of new motor load of ❑' ", ° `E ", "1 - ", "1 -3 ", Job no.: iob site address: ' `,' - �DO t.�. i or more occupancy / v I J yW ❑ Six ix or or more e residential units ❑ Recreational vehicle parks City /State /ZiP: 7 d © g �} 7ZZ ❑ Health -care facilities ❑ Supply voltage for more than 777 ❑Hazardous locations 600 volts nominal Suite /bldg. /apt. no.: Project name: /11 ❑ Service or feeder 600 amps or more �� FEE SCHEDULE - Cross street/directions to job site: Description I Qty. I Fee. I Total I * New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq ft or less 145 15 4 Ea add] 500 sq ft or portion 33 40 1 Tax map /parcel no.: Limited energy, residential 75 00 2 ' ' DESCRIPTION OF WORK ' " (with above sq ft ) Limited energy, multi- family 75 00 2 5W/4°444' /0414 b4WIL_ residential (with above sq ft ) 0),I61,‘Ill Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 - 4 ❑ PROPERTY OWNER q TENANT '' 201 amps to 400 amps 106 85 2 Name: �J L4t 401 amps to 600 amps 160 60 2 601 amps to 1,000 amps 240 60 2 C /z J Address: 98'45' aj Over 1,000 amps or volts 454 65 2 City /State /ZIP: f ✓ " �� �7LZ / Temporary services or feeders installation, alteration, and /or -/ relocation Phone: (5'0) 68 o 00 6.— Fax: ( ) 200 amps or less 66 85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2 intended for sale, lea -, ent, or exchange, Ecording to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2 -, _ Branch circuits — new, alteration, or extension, per panel Owner signature: A Date: A Fee for branch circuits with ". '`' ❑'' APPL ANT ' . - u • i . :• -❑ CONTACT PERSON above service or feeder fee. 6 65 2 each branch circuit Business name: B Fee for branch circuits / Contact name: without service or feeder fee, 46 85 4 2 first branch circuit Address: Each add'l branch circuit 6 65 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular 90 90 2 dwelling, service and /or feeder Phone: ( ) Fax: : ( ) Reconnect only 66 85 2 E -mail: Pump or irrigation circle 53 40 2 CONTRACTOR' . ` ' ` ., • Sign or outline lighting 53 40 2 Business name: r Signal p a) e r tion or energy panel, alteration, or Address: extension Describe Page 2 2 City /State /ZIP: Each additional inspection over allowable in any of the above Per inspection 62 50 Phone: ( ) Fax: ( ) Investigation per hour (1 hr mm) 62 50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73 75 ELECTRICAL PERMIT FEES ' ' // ' Suprv. Electrician signature, required: Subtotal (p • 5 Print name: Date: Plan review (25% of permit fee) — C I ' State surcharge (12% of permit fee) 5 6 Authorized signature: .0.t.oL TOTAL PERMIT FEE 5 A, t e 7 y......3_0/ This permit application expires if a permit is not obtained within 180 Print name: R e . Ina v i c e r - Date: days after it has been accepted as complete. -' J * Number of inspections allowed per permit I \Budding \Permiis\ELC- PermnApp doe 05/23/06 440- 46I5T(1 I /OS /COM/WEB Information Notice to Property Owners About Construction Responsibilities Statement Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. [ORS 701.055 (4)] This statement is required for residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box and complete the following statement: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or \ _ I will be performing work on property 1 own, a residence that I reside in or a residence that 1 will l \_, reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I have read and understand the Information Notice to Property Owners about Construction Responsibilities contained on these two pages and I hereby certify that the information checked and completed above is correct and accurate. )p 4. l!� t 1 . ; ..� - ' -. h A— < ,t, ' I/— Print narof permit applicant Signatty of permit aplicant d c _C 'l Date /t± Permit #: t%-0261L— �/Z' This form is supplied to building •F 4, % - 7 5 - " b et/ permit offices by the Oregon ;< ' Add Kbf Construction Contractors Board, 'N . :R' --7. \ ��/� o 2�a as required by ORS 701.055 (6) , l r y Issued by: . �. Date: /g/3/6r This copy to issuing permit office Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ftESID'EiCit'a WORkbi∎if : Fee for all residential systems combined ... $75.00 Check Type of Work Involved: n Audio and Stereo Systems* ❑ Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: r COMMERCIAL WORK ON LY: 4 : • Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* ❑ Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I \Bu !dmg \permits \ELC- PermitApp doc 03/23/06 CITY OF TIGARD BUILDING DIVISION . „ „ ., PERMIT #: ELC2008-00563 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/312009 Phone: (503) 639-4171 "IWO Inspection Requests (24 Hrs.): (503) 639-4175 AA INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 10/15/200B 7:00AM 36 SITE ADDRESS: CLASS OF WORK: 07895 SW GENTLE WOODS DR SUBDIVISION: LOT #: TYPE OF USE: GENTLE WOODS 001 PROJECT NAME: MUTER DESCRIPTION: (1) branch circuit for blower to gas fireplace. OWNER: PHONE #: MUTER, REGINA 603-6845005 CONTRACTOR: PHONE #: OWNER Inspection Request Scheduled For: Date: 10/15/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 076706-01 503-705-8100 N Corrections/Comments/Instructions: . ------ ---.•■ V PASS 7 PARTIAL APPROVAL 7 CANCEL 7 NO ACCESS FAIL CALL F R INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: Date: 0 5 i 1 Phone #: (503) 718-