Permit � , - ELECTRICAL PERMIT C ITY O F TI GARD RESTRICTED ENERGY
4
DEVELOPMENT SERVICES PERMIT #: ELR2003 -00002
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13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/8/03
SITE ADDRESS: 14050 SW RIDGEFIELD LN PARCEL: 2S109AA -05900
SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R -7
BLOCK: LOT: 037 JURISDICTION: TIG
Proiect Description: All encompassing Low Voltage.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
RICHARD DOEL OWNER
12981 SW TEAROSE WAY
TIGARD, OR 97223
Phone: 503 - 296 - 7676, x227 Phone:
Reg #:
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 1/8/03 $75.00 Elect'I Final
[TAX] 8% State Tax 1/8/03 $6.00
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Total $81.00
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.re'quires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set fort in OAR,952-�901- =0010 throuc
,// i %/
Issued by / i P ermittee Si nature • ff
Y 11 _4x.111 / i .1 g l '! . j /C
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 7:00 P.M. for an inspection needed the next business day
Electrical. Permit Application FOR OFFICE USE ONLY
R ��v Electrical s �,-
' I D R ate /B Q — — Q' Perm No. :/— kJ °� �(/(� 2Q Z
Cit of Tl and Planning Approval Sign
y g 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 n/d i t� Post- Review Land Use
Internet: www.ci.tigard.or.us y Case No.:
g �� e. l� C on Date/By:
Juris.: ®See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
;.;:4 s - ; v li . g T_ ._E O. OjtIO M. ..,: Siiti . .., <... ia: BEAN gIVIEW (Please c(teck;ill`thit li* MV
aNew construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of El Building over 10,000 square feet,
q i , r r" _' , ? t„ �ACATEGORX OF CONSTRUCTION= . "_, " i „_ 1 & 2 family dwellings four or more residential units in
)1g. & 2- Family dwelling ❑ Commercial /Industrial ❑ System over 600 volts nominal one structure
El Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons El Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
r ,, . a - SITE INFOATION au. ..... T =ION ; . - . 1 g �; Submit sets of plans with any of the above.
JOB RM
-= �n � ,/ The above are not applicable to temporary construction service.
Job site address. i t-IDSD t/ 6 (�' t L ! , ��/ WO , W ' :: .8? ,, ,$ z : ,,,,,, , ' a.... ' D, ' ' iiu . .. , . - ,, o-ek
Suite #: Bldg. /Apt. #: ! Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
New residential- single or multi- family per 1
CrQSs str- e_ II Irec ns to 0b S te: dwelling unit. Includes attached garage.
(F l�J it , r( Service included:
i �
/ 1000 sq. ft. or less 145.15 4
^,, Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: t✓G.0 =r!
(AA y ,,n� Limited energy, residential 75.00 2
+ 6 dt Lot #: �� Limited energy, non residential 75.00 2
Tax map /parcel #: WV 0 _WO Li 75---- Each in Each manufactured home or modular dwelling
i ;, <; ir& " „ i , ,: ; 7 D t ST OF { . ;. 7i service Services anor d/or feeders feeder installation 90.90 2
`ESCl2IPT�0 RK �r -
CiS -f— ACV/ 0 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
PRO
PERTI'�OWNER -'' ' I. NAN €?., .::
,� 601 amps to 1000 amps 240.60 2
'” ; Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: /2qtt S a.SL_ t/4 Temporary services or feeders - installation,
at-- alteration, or relocation:
City /State /Zip: / ` �A / 7 Z-7 200 amps or less 66.85 1
Phone s
) � [ &- ,(y 't Fax: 201 amps to 400 amps 100.30 2
v 401 to 600 amps 133.75 2
El A_PPIICANT ,ate „ , .
. .. ii," -' _ , COSTyACT =PERSON'P . Ez:. 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
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
Email Misc.(Service or feeder not included):
� , } ^,fi ' CONTRACTOR '$` Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2 -
Job No: Signal circuit(s) or a limited energy panel,
Business Name: L alteration, or extension • ' - e 2 2
Description:
Address:
City/ State/Zip: Each additional inspection over the allowable in any of the above:
y p : Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee: .
CCB Lic. #: Lic. #: Other:
2 ;, . ? x tgr Electri Permit FeeSi .,;. 1 # ' t `
Supervising electrician Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $ g/ , Od
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
-- (Please print name)
i:\Dsts\Permit Forms\ElePermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information "' •..r
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $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 I
COMMERCIAL WORK ONLY:
Fee for each system $75.00 •
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
D Boiler Controls
D Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control
0 Medical
n Nurse Calls
Outdoor Landscape Lighting
n Protective Signaling
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
WILDING Inspection Line: (503) 639 -4175 ; n ' � '-tea'
B.JIiLDING P � ) �--•
INSPECTION, DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested, Co i AM PM BUP
Location 1 - Rc -'- ( -e-- L cL Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
_•"" - BUILDING Tenant/Owner . ' - ELC
_ -Footing
Fouriiiation ELC
Access:
Ftg Drain i r E11:1 - 0
Crawl 'Drain
Slab__ Inspection Notes: SIT
Post {& Beam
Shear Anchors - .
Ext_Sheath /Shear
Int Sheath/Shear
Framing
Insulation f
Drywall Nailing x 4•
Firewall • r
- 'Fire Sprinkler
-
_ Fire Alarm
Susp'd!Ceiling
Roof
.
Other:-
Final _ . -
PASS PART FAIL
PLUMBING ' I •
- Post'& Beam
Under Slab
Rough -In \
/
Water Service / i
Sanitary Sewer f
Rain Drains `'" ' /
Catch Basin / Manhole je l 1 f /,,,� �, / o " !� E.
Storm Drain .� ;. V .:': \
Shower Pan `�,
Other: i
Final `�, 7
PASS PART FAIL - -
MECHANICAL
Post & Beam '
Rough -In t • ,
Gas Line �_ (a #c
Smoke Dampers v
Final
PASS- FAIL ,
ELECTRICALS A 4 ..
Service -°°"` •r "N. x � - -
Rough -In Ri IA / j -. .
UG /Slab i
o
Low Voltage
Fire.Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART • FAIL _
SITE 0 Please call for�feinspection RE: / 11 r � Unable to inspect - no access
Fire Supply Line ��/ //
ADA Date - T C 3 Inspector ^ ~Y� - / �'�� /' Eut
Approach /Sidewalk 7 P ` -
Other:
Final DO NOT REMOVE this inspection record from m the�job site.
PASS PART FAIL .
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