Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00460
��I� 1r DEVELOPMENT SERVICES DATE ISSUED: 7/23/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S133DA - 05100
SITE ADDRESS: 12730 SW GLACIER LILY CIR
SUBDIVISION: AMART SUMMERLAKE ZONING: R -
BLOCK: LOT : 073 JURISDICTION: TIG
Project Description: (2) Bathroom remodels, (3) 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: 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:
PULITO, GERALDINE K+ S &A ELECTRIC, INC.
BENNETT, EARL C PO BOX 218
12730 SW GLACIER LILY CR BORING, OR 97009
TIGARD, OR 97223
Phone: Phone: 503 - 658 - 5358
Reg #: ELE 3 -520C
LIC 148014
FEES SUP 4833S
Description Date Amount
Required Inspections
[ELPR.MT] ELC Permit 7/23/2004 $60.15
[TAX] 8% State Surcharge 7/23/2004 $4.81
Total $64.96
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 - 3322-2
Issued By: / Permit Signature: _ -� c>s \O
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
Electrical Pe rmit A A. • �1Cat10I1 FOR OF USE ONLY • Received 7 Permit No , . 6
Date/By: Permit N :(/
City of Tigard Planning Approval Si
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 ' A Post - Review Land Use
. I Date /By' Case No..
Internet www.ci.tlgard.or us �R ' c J Contact 1G See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method ) 1 Supplemental Informa
- • TYPE OF WORK,- .. ' 4;,;; . '" ,-;' PLAN (Please check that apply)'.
n New construction n Demolition ❑ Service over 225 amps- ❑ Health -care facility j
Addition/alteration/replacement ❑Other: commercial ❑ Hazardous location
❑ Service over 320 amps - rating of ❑ Building over 10,000 spume leer,
CATEGORY OF: CONSTRUCTION . I & 2 family dwellings four or more residential units in
& 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure
c
A y �'
Cessot Building
Multi -Famil ❑ Building over three. stories ❑ Feeders, 400 amps or more
T y ❑ Occupant load Duet 99 persons ❑Manufactured structures or RV par t
Master Builder Ti Other: ❑ Egress/lighting plan ❑ Other
JOE SITE'INFORIVIA'TION audIOCAT ON Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address. /27.30, ,), 5.,,; & Lac t hl L.A.—\ Ct( ; . - FEE *; SCHEDUI_;E' ' .
Suite #' • Bldg /Apt #: Number of inspections per permit allowed
Protect Name: If- '5 02) Description Qty Fee (ea) Total
New residential- single or multi - family per y
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included,
1000 sq ft of less 145 15 4
Each additional 500 sq. ft or portion thereof 33 40 I
Limited energy, residential 75 00 2
Subdivision: Lot #: Limited energy, non residential 75 00 2
Tax map /parcel #: Each manufactured home or modular dwelling
- 4)ES 3RIPTIQN OF'WORK • , „ service and/or feeder 90 90 2
_ ;--� Services or feeders - installation,
' 1 i � X'C CJ"O t. _ ___ alteration or relocation:
200 amps or less 80 30 2
201 amps to 400 amps 106 85 2
401 amps to 600 amps 160 60 2
a cn PERTy:OWNut.r ^;:•„ , li ' J 1z.ENAN:T; ' . -,, `; 601 amps to 1000 amps 240,60 2
Over 1000 amps or volts 454.65 2
e: I 1 'TC ' – l =.,l`: N C =-� , Reconnect only 66 85
Address: Temporary services or feeders - installation,
City /State /Lip: ... ( v� 9_,&:(,..-,e 2 0 amp o or less 1 � � �. _ 200 amp or less 66 85 I
Phone: Fax: 201 amps to 400 amps 100 30 2
E [] APPLICANT - 401 to 600 amps 133.75 2
;CONTACT- PEI:SQNi, 2, Branch circuits - new, alteration,or
Name: 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: B Fee for branch circuits without purchase of 2
service or feeder fee, first blanch circuit ' 46 85 i� �
Phone: 1 Fax: Each additional branch circuit ,.2-- 6 65 ,k0 2
E - mail: Misc,(Service or feeder not included)
' '" WONtfRACT(a1;;'• _ - : +'' , ' Each pump or irrigation circle 53.40 2
Job No: ,� Each sign or outhp- lighting 53.40 2
�23 Signal circuit(s) or a limited energy panel,
5 i� CT2 ; - Description: ii ti or extension Page 2 2
Business Name: / , 1�� D escripuon:
Address: () O .17--.5:))( r9_ -
City /State /Zip: 2 t c-, n l� 9 -7�9 Each additional inspection over the allowable in any of the above:
_ / � J Per inspection per hour (nun I hour) 62.50
Phone:503 k4 �3I CY_J / Fax: [72� - 7 L5 "7 Investigation fee-
CCB Lie. #: Other
i ";;:+ ;Electr'ieMII.er iiif':Fee's'* :..'=k : t >t
Supervising electricia _ Subtotal S ( , 1 5 .–
signature required: � �� , ,, ,--- 2 � Plan Review (25% of Permit Fee) $ -----
Print Name: /(�,, , � � S,/.,44..i 96,33_5 State Surcharge (8% of Permit Fee) $ , ("5 1.
TOTAL PERMIT FEE L
r
Authorized'`' Notice: This permit application expires if a permit is not obtained within
Signature ' c Datt f ? w Oy 180 days after it has been accepted as complete.
11) *Fee methodology set by Tri- County Building Industry Service Board.
)---5 k \ f1C1�� k —� y
(Please pent name)
i \Dsts\Permit Fornu \ElcPemutApp.doc 01/03
z'd di,z :EO i7o E2 Inc
CITY OF TIGARD 24 -Hour
BUILDING Inspectionllne' -(503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested — '7 AM PM BUP
Location / 7 .3 d --1A. Jl24 Suite MEC
Contact Person Ph ( ) f 7_30 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC e;16 / X0 4/6 D
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
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
EE TRIAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
SI ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 0 5 Inspector .dg 4_4 / Ext
Other:
Final DO NOT REMOVE this inspection record from the Jo , ite.
PASS PART FAIL
•