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Permit CITY O F T ELECTRICAL PERMIT l w y PERMIT #: ELC2004 -00587 DEVELOPMENT T �, SERVICES DATE ISSUED: 9/16/2004 13125 SW Hall Blvd., lard, OR 97223 (503) 639 -4171 PARCEL: 25111 CB -01711 SITE ADDRESS: 10125 SW HOODVIEW DR SUBDIVISION: HOOD VIEW ZONING: R-3.5 BLOCK: LOT : 010 JURISDICTION: TIG Project Description: Replace wire to ceiling fan, plugs & switches. Demo old 220 curcuit to back patio. Repair splice to hall bath fan. 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: ROGUE VISTA PROPERTIES LLC HOOD TO COAST ELECTRIC 2305 -C ASHLAND ST PO BOX 793 ASHLAND, OR 97528 LAFAYETTE, OR 97127 - - Phone: 503 - 880 -8221 Phone: 503 - 835 -7209 Reg #: ELE 36 -78C LIC 1272941 FEES SUP 4877S Description Date Amount Required Inspections [ELPRMT] ELC Permit 9/16/2004 $46.85 [TAX] 8% State Surcharge 9/16/2004 $3.75 Elect'I Final Total $50.60 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -800- 332 -2344. Issued By:' A SW Permit Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: r � DATE: '9 /6 act LICENSE NO: 9g ?s Call 639 -4175 by 7:00pm for an inspection the next business day E4pd c tr " cal Permit Application FOR USE O � city of igard Received J _ , Date/13 : 13125 SW Hall Blvd., Tigard, OR 97223 . i 1 Plan n Review , j , I Phone: 503.639.4171 Fax: 503.598.1960 / ou�,di� ; �, i e:j( g ' Date/B : Other Permit: Inspection Line: 503.639.4175 Date Ready/By: 0 See Page 2 for p " 1 �.� Y Y� Juris Internet: www.ci.tigard.or.us Notified/Method: �' (j Supplemental Information v rYP E O � - g : : �. , a ., ; ;' . 4 .. : : :. . AN' :It E. � ' E W ' .'' Addition /alteration/replacement Please check all that apply: . m 3"a"., ; �$:2Ae? »s rr� tra _r:.:.� "'�`s' .. ..e�'-«,"....,. ^e' 1' .:: i �;� � �_,q�� �.5 -. de� - � _ -, ❑ New construction M ❑ Demolition 12 Other: • EService over 225 amps, comm'l ❑Hazardous location _- � -,. � ^ El Service over 320 amps - rating EBuildng over 10,000 sq. ft., n r 79ar a t RAgreO ' ; � ; � A of 1 - and 2- family dwellings 4 or more new residential g r 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure ❑ Multi - family ❑Mster builder ❑Other: Building over three stones ['Feeders, 400 amps or more e. , ,.,r,- - - , a:� , . ❑Occupant load over 99 persons ❑Manufactured structures or it , : QB _ > O IS O A. O 4 ❑Egress/lighting plan RV.park 4 / p ❑Health -care facility ❑Other: Job no.: Job site address: /e/ Zs ,44 I vi ti.-J Submit 2 sets of plans with any of the above. City/State /ZIP: - .42 6 I b / The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: '� ^ .-� °g . ,i- s t ? ��' ,. . .. - Description Qty. Fee. I Total Cross street/directions to job site: D„Rk -r o Ka.b1� T 0 New residential single - or multi - family dwelling unit. Includes attached garage. /40.61 ti t' .e i /+° 6,Se.. 0 ..1 Co g agR-- 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: mrv�,� .ate. ,z_ ,� Limited energy, non - residential 75.00 2 � . , -,,. E RT `p-' Q I, U , ry >, ' � Each manufactured or modular dwelling, service and /or feeder 90.90 2 e. p 4. -4, w ; Re.S Ta Ce.,. /;:t7 AV/ /' ,Q /ace p /uy rsw > t C4(.- S Services or feeders installation, alteration, and/or relocation 201 amps to 400 amps 106.85 2 beer) 0 O�ct 4a C /',eCu/ f , -,,,'A. , , -,,,'A. , To Back f Q-) //7. � aA � A 200 amps or less 80.30 2 �� ��%� �.� •�� � �.- �= -«t �� �°° �-� ‘4„1// ., <��°' . � raQ'tPit�.j,ERTTeaiVal _ 1 _ f " i '1$Ek �1�1 ,^, w .. ,.w 'Fzts. . . ai�:&ss 401 amps to 600 amps 160.60 2 Name: ll R A j 2 '€,k ie. 601 amps to 1,000 amps 240.60 2 Address: 'Pc) 11'a / 6II Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: J,Afa /pl O Temporary services or feeders installation, alteration, and/or '- 200 amps Phone: (s'` ) ) F2 2/ Fax: ( ) relocation D Ol/ mps 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 R s ma �rt"e as�.,a;`ei m .e }6,3d s €a^ar ; � � m `A�° LI A:IAy kz ., �l ( ©N ,: A. Fee for branch circuits with "- '" " tea.t', � : ^` . v `t'.` " CT ?.H ,• 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 - � P 2 Address: each branch circuit Each add'l branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: • Signal circuit(s) or ,. limited - ' . , . 'r ; Ar LL x Flg ra POR ui: `V 7 , p'* '� ;� in energy panel, alteration, or , = 'xi. .� .. . r i _ .r T .L..., " 4 ? :a ta,.. a V:grg ` Z ' I ' ,, Fs 1, $ }i: / J extension. Describe: Page 2 2 Business name: {7,ah To Loa. 51 /e ,,e/ -c_ Address: p 7y j Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: z _„ . ,( ,,, . Q/< / 77/a7 Investigation per hour (1 hr min) 62.50 Phone: (2.$ 332 _ s- 5-y 3 Fax: ( ) Industrial plant per hour 73.75 CCB Lie.: /27a 9/ Electrical Lie.: y 8 775 Suprv. Lic.: 3 c -78� Subtotal d��. 9 . � Suprv. Electrician signature, required: / Plan review (25% of permit fee) i ,/ Print name: T r ,� 1( l , j .,76 State surcharge (8% of permit fee) g , 7 7 J ` I Date: / U Y TOTAL PERMIT FEE 50 &O Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board °° Number of inspections per permit allowed. i:\ Building \Perrnits1ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB Electrical Permit Application - City of Tigard 1 4 I Page 2 - Supplemental Information ' 2 LIMITED ENERGY PERMIT FEES: ar , :... -�a 7 18510 (043 -x 1r -;. Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: 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 is\ Building \Permits\ELC- PermitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (5 ' 03) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested --3-e 3 AM PM BUP Location I a i a s (i o Suite MEC • Contact Person Ph ( ) 3 E as 1 PLM Contractor Ph ( ) SWR �/ � O o BUILDING Tenant/Owner 67 5 - ELC A 6d T D& Footing � V L� ELC Foundation Ftg Drain (58i ' ELR Crawl Drain -� —� '_` ; Slab Inspection Notes• _ SIT � � Post & Beam _ Shear Anchors Ext Sheath/Shear :.f Int Sheath/Shear �� M 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 ELECTRICAL - Service Rough -In UG /Slab Low Voltage VC( L >Q Fire Alarm /1 / PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE. • Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA r' Approach/Sidewalk Date Inspector .1.--2., Other: Final DO NOT REMOVE this inspection record from the j site. PASS PART FAIL