Permit it Y O F T I GA R® ELECTRICAL PERMIT
PERMIT #: ELC2005 -00052
L1,LVELOPMENT SERVICES DATE ISSUED: 2/1/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S110DD -05600
SITE ADDRESS: 10640 SW HIGHLAND DR
SUBDIVISION: SUMMERFIELD NO.4 ZONING. R -
BLOCK: LOT : 156 JURISDICTION: TIG
Project Description: branch circuit.
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: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JOHNSON, BOB PIONEER GAS FURNACE
10640 SW HIGHLAND DR 3615 NE BROADWAY
TIGARD, OR 97224 PORTLAND, OR 97232
Phone: 503 - 649 -1744 Phone: 503 - 249 -5000
Reg #: ELE 22- 177LHR
FEES LIC 36102
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/1/2005 $46.85
[TAX] 8% State Surcharge 2/1/2005 $3.75 Electrical rough -in
NC or heating unit circuit
Total $50.60 Electrical final
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 ,1-8 00 -332 -2344.
Issued By: ,C� - y,16(� A. Permit Signature:
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. ELECN: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
..7
Electricalr'tDermit Application FOR OFFICE I SE ONL\
� Received
City —.—
i ty + of TlgllE:�� Dale /By2— 1 —ms Permit No. c GJO°
.. 13125 SW Hall Blvd., Tigard, OR ! •,, " . Plan Review -
Phone: 503.639.4171 F • tNolt .'q 98 t 7 r^'an' f 0 M '• Date /By: - C >ther'I'ctmic
Inspection Line: 503.63 Q " ' j J ., , Date Ready/By: , luris ®, Se Page 2 for
Internet: www.ci.tigarJ.ot @ us° �Q Notified/Method � e--\ Supplemental Information
' __Y E OF WORl\) PLAN REVIEW
❑ New construction dd tic ;nfftl t rr�(aement Please check all that apply:
�� th N� ❑Service over 225 amps. comm'l ❑ ❑ Hazardous location
El Demolition
❑Service over 320 amps - rating Buildng over 10,000 sq. ft.,
' C *yew CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
y
1- and 2-family dwellin* Commercial /industrial ill Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories El Feeders, 400 amps or more
El Multi - family El Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
/� 90 �/, I- //r ❑Ilcalth -care facility ['Other:
Job no.: job site address: 6 7 K/
an c � 2 sets of plans with any of the above.
, /r '
City /State /ZIP: d / D/�- 97225- The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 0 I Project name: 1/4giihnSQh FEE* SCHEDULE
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: New residential single - or multi - family dwelling unit.
Includes attached garage. i
1,000 sq. ft. or less 145.15 4
- Subdivision: Lot no.: Ea. add] 500 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
/ 5 Arnaet.
/ ', p dwelling, service and /or feeder - 90.90 2
• // ` N /! � ✓ -0 -L t Gt Services or feeders installation, alteration, and /or relocation
r r 200 amps or less 80.30 2
� < �7
san e side cr�'c��^oiio
❑' PROPERTY OWNER U / ❑ TENANT 201 amps to 400 amps 106.85 2
,�7 I 401 amps to 600 amps 160.60 2
Name: /O6 j ' 6 ei -- f e soP 601 amps to 1,000 amps 240.60 2
Address: � „S - Over 1,000 amps or volts 454.65 2
- Reconnect only I 66.85 2
City/State /ZIP: 'Temporary services or feeders installation, alteration, and /or
' relocation
Phone: (5-Z3 ) L `f l fc - 1 0- 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, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 ' 2
Owner signature: . Date: 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
• B. Fee for branch circuits
Contact name: without service or feeder tee, 1 46.85 4( 5
Address: each branch circuit /
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not in cluded)
Phone: ( ) Ftix:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuits) or limited -
CONTRACTOR energy panel, alteration, or e a.;t ss name: b eer .5 A e. P Business
5 ( J,C' `� Each additional inspection over allowable in any of the above
Address:
' / v ' `� ` rr Per inspection 62.50
City/State /ZIP: . 0 0/ - 7 1- /Q. _ OR 9 723 2 Investigation per hour (I hr nun) 62.50
Phone: (53 249 Soo0 Fax: (503 249 Q2/ _D Industrial plant per hour 73.75
v Cn v ELECTRICAL PERMIT FEES*
CCB Lie.: 3 t /Q 2, Electrical Lie.: 22_177 _ ic.: Subtotal i g5
r
Suprv. Electrician signature, required: ` C , ' (.., Plan review (25% of permit tee)
Print name: R 7L 6.... / �3 — / e State surcharge (8% of permit tee) 3.7 5
— . - Date' "I'O "1'AI. 1'F:RMI'1' FEE 56
Authorized signature: �� i�/ . t her mit application -spires if a permit is not obtained within IRO
days after it has been accepted as complete
Print name: s (e,, p )4t I Date: j_ 31 -6 5 ' Ice. methodology set by 'I'll-County Building Industry Service Board
— ✓ - '* Numhet of inspections per permit allowed.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
PRESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
';' WORK ONLY: •
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*
❑ P rotective Signaling
❑ O ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: 1603) 639 -4171 MST
BUP
Received Date Requested - AM PM BUP
Location /d (' %) f '✓ /` l-4 ,/ /pit.) Suite MEC a 00,5 6005o
Contact Person " Ph (SO 2 ) PLM
Contractor v_\11 Sp' Phf ) 0 SWR
BUILDING Tenant/Owner d . ELC ,605 " 0
Footing �— / 69 . ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation \4-1A �� " 1J V 1. A\-?* C� b
Drywall Nailing �a/t,
Firewall Fire Sprinkler n `�' dry ��
Fire Alarm 0
Susp'd Ceiling
Roof
Other:
Final
PASS
PLUMBING
FAIL 1 \-\ (0
Post & Beam
Under Slab
Rough -ln
Water Service
Sanitary Sewer
Rain Drains f
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
1AEC e Z'
Pos t eam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART
ELECTRICAL
Rough,
Low Voltage
Fire Alarm
111 PART FAIL
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SIT ❑ Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line a ADA D ' C `' �/ Ins ector I�� - Ext
Approach /Sidewalk � ✓ Inspector
Final DO NOT REMOVE this inspection record fro the job site.
PASS PART FAIL