Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00863
DEVELOPMENT SERVICES DATE ISSUED: 11/2/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S1146C -02300
SITE ADDRESS: 10283 SW RIVERWOOD LN ZONING: R -7
SUBDIVISION: RIVERVIEW ESTATES NO. 2 LOT : 060 JURISDICTION: TIG
Project Description: (2) 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: 1 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:
WILLIAM & WALSH OWNER
10283 SW RIVERWOOD LN
TIGARD, OR 97224
Phone: 503 - 504 -2770 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 11/2/2005 $53.50
[TAX] 8% State Surcharge 11/2/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57,78
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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: �f/ � 7 / Y Permittee Signature: �/ G� +►
� u d�
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 503 - 639 -4175 by 7:00 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.
ElOctrical Permit Applieation ,� FOR OFFICE USE ONLY
ini � �CUW D
City of Tigard NOV Date/B : // :f Q Permit No.: �� QO • r r Q l'i 2 2005 Date/B Review Other Permi
Date Ready/By: INIE ® See Page 2 for
CITY OF TIGARD Notified/Method: Supplemental Information
TYPELOFCWURIOIVISIQ PLAN REVIEW ,
❑ New construction 0- Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ['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
6 24 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑ Other: ['Building over three stories ['Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address: 002k y / ❑Health-care facility ❑Other:
/ �pZti` /S t VPl u, -4/ sl Submit 2 sets of plans with any of the above.
City /State /ZIP: �J'
/ I �� / /) g7,2? y The above are not applicable to temporary construction service.
! /
Suite/bldg./apt. no.: L./ -/ Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I ••
Cross street/directions to job site: ` r � d _. 4, /, New residential single- or multi- family dwelling unit.
/ ci G l Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: / — f Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
el i �� CA (4) C0 e -f ✓ Limited energy,
map /parcel no.: gy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK • Each manufactured or modular
// r pt5 /91/4._ dwelling, service and/or feeder 90.90 2
/�i Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY - OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
L
Name:.C� /' � / ` 601 amps to 1,000 amps 240.60 2
Address: l 7e) '! J/ p Over 1,000 amps or volts 454.65 . 2
t Gtltt Reconnect only 66.85 2
City /State /ZIP: / ! ® q 97 V Temporary services or feeders installation, alteration, and /or
t ojcr,'r� Q ,'(
Phone: ( ) J q Fax: ( ) relocation
; �� �� f / 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 exchan e, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75. 2
Owner signature:0/` Date: / '(JS 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, 1 46.85 �O L�! 2
Address: each branch circuit
Each add'l branch circuit / 6.65 6o 4 3 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 -
CONTRACTOR energy panel, alteration, or Page 2 2
extension. Describe:
Business name:
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ' ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT 'FEES* '
CCB Lic.: Electrical Lic.: • Suprv. Lic.: . Subtotal �3 5
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) V Z
TOTAL PERMIT FEE f 7 �/
Authorized signature: ' 6
This permit application exp if a perm i s 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
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N o .' kIty L1'. /P77' v ic.7Periorire - : i
• CITY OF TIGARD ., ..
BUILDING DIVISION PERMIT #: ELC2005-00863
13125 SW Hall Blvd., Tigard, OR 97223 •
. DATE ISSUED: 11/2/2005
Phone: (503) 639-4171 '
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/4/2005 TIME: 7:08AM PAGE: 16
SITE ADDRESS: 10283 SW RIVERWOOD LN CLASS OF WORK:
SUBDIVISION: RIVERVIEW ESTATES NO. 2 LOT #: 060 TYPE OF USE:
PROJECT NAME: WALSH
DESCRIPTION: (2) branch circuits.
OWNER: WALSH, WILLIAM & BETH 1 PHONE #: 503-504-2770
CONTRACTOR: OWNER PHONE #:
/ .
Inspection Request Scheduled For:
I Date: 11/4/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 020403-01 503-504-2770 N
Corrections/Comments/Instructions:
_ ./..
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" PASS. PARTIAL APPROVAL 0 CANCEL r NO ACCESS
I I FAIL 7 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
1 7 ...■••••
I nspector: Date 1/ of.- Phone #: (503) 718-
Date:
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