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Permit CITY OF TIGARD ELECTRICAL PERMIT ' PERMIT #: ELC2005 - 00462 • ittotts. �i� . DEVELOPMENT SERVICES DATE ISSUED: 6/29/2005 ,, 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 25111 CB -02900 SITE ADDRESS: 10049 SW LADY MARION DR ZONING: R -3.5 SUBDIVISION: MARION ESTATES LOT : 002 JURISDICTION: TIG Project Description: (1) hr. investigation. 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 FOR: PER HOUR: 1 401 - 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: PRATT, KERRY L + JULIE M OWNER 10049 SW LADY MARION DR TIGARD, OR 97224 Phone: Phone: FEES Reg #: Description Date Amount [ELPRMT] ELC Permit 6/29/2005 $62.50 [TAX] 8% State Surcharge 6/29/2005 $5.00 REQUIRED ITEMS AND REPORTS Total $67.50 • 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 -8002 -2344. Issued By: Permittee Signature: c- is j 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 by 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. ._ F ;5 b - 3 1 c° g ?— /q 6 i �� -i- Pr 503) . Electrical Permit pphcation • FOR OFFICE USE ONLY City of Tigard Date /By 9_0), 7 Permit No.: 6 - cczA)f Go /2 13125 SW Hall Blvd., Tigard, OR 97223 �r Plan Review Phone: 503.639.4,171 Fax: 503.598.1960 / � ,' xn pi' ?' i''� Date /By: Other Permit: Inspection Line: 503.639.4175 '- ' Date Ready/By: Juris: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: T Supplemental Information TYPE OF WORK' PLAN REVIEW ' • ❑ New construction ❑ Addition/alteration /replacement - Please check all that apply: ❑ Demolition ❑ Other: ❑ m ['Hazardous over 225 amps, com'I Hazardous location ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential ❑ 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑Building over three stories ['Feeders, 400 amps or more ❑ Multi - family 0 Master builder 0 Other: ❑Occupant load over 99 persons ❑ Manufactured structures or ' JOB SITE INFORMATION AND LOCATION t ❑Egress lighting plan RV park Job no.: Job site address: 1 0 () LI 9 S tN La eky (\/ a y VA^ 01ealth -care facility ['Other: Submit 2 sets of plans with any of the above. City /State /ZIP: vc9_ t _I 22 ®v.% o-g-. The above are not applicable to temporary construction service. Suite/bldg. /apt no.: Project name: e. (Q_.fYt ' cal Ik gp�C FEE* SCHEDULE rr ff � 7 Description I Qty. I Fee. I Total ** Cross street/directions to job site: 6,1 l.. V%r 0.6 S � 0 , a 6 - v.. et.A. •l New residential single or multi - family dwelling unit. Includes attached garage. S i.) i (( f d • o-vt VA c- D (vt a (� / 5. 1 O 0 P - 1,000 sq. ft. or less 145.15 4 Subdivision: 'YV a_ l/' t Qv 0_,A . Lot no.: Ea. add'I 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 DE CRIPTION OF WORK " . ' Each manufactured or modular ( S' ® 3 dwelling, service and/or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation E SQ ) 2 2 5 . - I I © 2 200 amps or less 80.30 2 ❑ PROPERTY OWNER .' I ' , O. TENANT ._ . 201 amps to 400 amps 106.85 2 " 401 amps to 600 amps 160.60 2 r . Name: `� � n cz;- .3u I t 4 - r C., 601 amps to 1,000 amps 240.60 2 Address: ' ©U (.-- K S u.J C k� MAC( V t I IA y Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: 4 (L A e ct_ I C, ,..p , °-) Z 2 y Temporary services or feeders installation, alteration, and /or Phone: 1 / relocation d3 f G — _2,2,- ax 5 * -7 3 - 6 ` / i 200 amps or less 66.85 1 _ Owner installation: This installation is being :r. e on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, exge, ac�ytrding to FF O RS 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 fee, 46.85 2 Address: each branch circuit Each add'l branch circuit 6.65 _ 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E -mail: 1 Signal circuit(s) or limited- CO; ' ' . ACTOR .. energy panel, alteration, or extension. Describe: Page 2 2 Business name: . /g ...._ Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Investigation per hour (I hr min) 1 62.50 (e 250 . Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* • CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal 4 I, 55D Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State- surcharge- (8 %- of-permit -fee)- 5,ot2 TOTAL PERMIT FEE (o 7 $D • Authorized signature: � This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: 1. f„1„t e y- a , / Date: to 21 /0 S * Fee methodology set by Tri County Building Industry Service Board 0 * Number of inspections per permit allowed. i:\ Building \Pennits\ELC- PermitApp,doc 12/03 Vv +' wr 440- 4615T(10 /02 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: y' x . " • Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* El Burglar Alarm El Garage Door Opener* El Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: C `COMMERCIAL-,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 0': Outdoor Landscape Lighting* *❑. Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC- PermitApp.doc 04/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP • Received Date Requested c 1 U_ AM PM BUP Location inV" '7/ i e MEC Contact Person Pti ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC, 00 S CO4 L Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear _ Int Sheath/Shear Framing Insulation Ze n� G �, Drywall Nailing ✓T� Firewall AY d ∎ f� / Fire Sprinkler L ��� , �� c Fire Alarm w. V c p v-- Susp'd Ceiling -- // � Roof S// - 7- ?'7` / I • Other: v / Final PART k tA. a y L- (.c_t_ 4D_ , J crct FAIL k & �/� e(.2 Q_c._ (C� Z r PLUMBING ��% � Post & Beam . Under Slab Af o ''' L� Y` D D-�c.[ GE-e.4 f' V .../1-6,4i/ GC— Rough-In � , ' ��\ Water r Service / s/-1-1-4 Sanitary Sewer Rain Drains Catch Basin /Manhole � i � • , it `- _ i Storm Drain — Shower Pan Other: . Final PASS PART FAIL MECHANICAL Post & Beam ' Rough -In Gas Line f Smoke Dampers Final P PA FAIL LECTRICAL Service Rough -In UG /Slab Low Voltage F 0 E ? ; Reinspection fee of $ required before ne inspection. Pay - -' Hall, 13125 SW Hall Blvd. SPART FAIL S ❑ Please call reinsp: tion RE: . 11 nable to inspect - no access Fire ADASupply Line - - -- - -- - -- — — - - � � D D I ns e cto /� / / Ext Approach /Sidewalk P IV - Other: Final DO NOT REMOVE this inspection record from the job site. • PASS PART FAIL •