Permit 7
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00583
DEVELOPMENT SERVICES � DATE ISSUED: 9/18/03
s` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103CC -01700
SITE ADDRESS: 11990 SW ROSE VISTA DR
ZONING: R -4.5
SUBDIVISION: COLONIAL VIEW
BLOCK: LOT : 012 JURISDICTION: TIG
Project Description: Installation of (2) branch circuits
RESIDENTIAL UNIT TEMP SR 1C /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:
ZIMMERMAN, LIN A WILLAMETTE ELECTRIC INC
KATHERINE L PO BOX 230547
11990 SW ROSE VISTA DR TIGARD, OR 97281
TIGARD, OR 97223
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP I965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/18/03 $53.50
[TAX] 8% State Tax 9/18/03 $4 Rough -in
Elect'l Final
Total $57.78
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 Jules or direct questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: MA "�`//// Permit Signature: \ �/J �� e41 0-&-,
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 7:00pm for an inspection the next business day
F' w
Electrical Permit t S® Fort OFFICE: 1is ONLY
Received ��� ,C -�j Electrical j, LG2O / r � 3
Date/By: Permit No.: 'F 7,00
City of Tigard SEP 15 2003 Planning Approval Sign
g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGAR r, Date/By: Permit No.: .
Phone: 503- 639 -4171 Fax: 5 B fl MECDIVI a 'o ' Post - Review Land Use
u, G h ,�•�, r Date/By: Case No.:
—
Internet: www.ci.tigard.or.us - (l , ; . II� Contact tuns.: See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 ' - Name/Method: 'rl C9 I ® Supplemental Information.
'" TYPEiOF WORK-;�:s'1' , .; ,4 a r:. r,;. ( check all that apply) ` 9 r,, , :'.'4,1,!:
.�'� ,,;; ";: ? . ; e,� 1. •r iv;. =t � rr; PLAN REVIEW Please' hec ' ;r: r
New construction Demolition ❑ Service over 225 amps- ❑ Ilealth-care facility
commercial ❑ I lazardous location
Addition /alteration/replacement „_, Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
;', ',`'`• "' 1}:'!'i! - ;;CATEGORY,OF;CONSTR1. TJOiY:'':y.` i "{s' q :4? :,4Af', I & 2 family dwellings four or more residential units in
1 & 2- Family dwelling — Commercial/Industrial 0 System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
Accessory Building _ Multi- Family o Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder 1--t Other: ❑ Egress/lighting plan ❑ Other:
'::,;, -.'' k?'• • :i;: 'J,OB SITE INFORMATION`hndUICIATIO$!g!+ � .0. ' "tI/q`,''•' Submit sets of plans with any of the above.
The above are not applicable to temporaryconstruclion service.
Job site address: it q q U S e.- V 4 ' : i.'r ereF .4r : r: I ,);
o! ..i, p , "1'' ; y :
cs ; ,,'t . ;-�,;;.'�,, :'FEt, SG�IiEDU1?F.E„• ..; . , ,�!i�%;I�; i;i•;i� "s j :a+�
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: L /ti, 'L,,,,,.,... e..„ ,k- Description . Qty Fee (ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. f. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map/ parcel #: Each manufactured home or modular dwelling
ViAltii `' :Y: ::A f: ;.';, ; : :,! DESCRIPTIONjOF wotowtrigozolaio service and/or feeder 90.90 2
t' Services or feeders - installation,
4tidi, "`ex— Z v 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
i ' ; t: :Y+ T ? r� T' 601 amps to 1000 amps 240.60 2
• Over 1000 amps or volts 454.65 2
Name: L , "1 Z , M t4^ .e.. ate ...4./ Reconnect only 66.85 2
Address: I (q p o Ski 2p, v,, l-,., /3 „ Temporary serv,Ices or feeders - installation,
alteration, or relocation:
City /State/Zip: T 1 ,,4 Dti F.,1 z7_ y 200 amps or less 66.85 1
Phone: 6 26 - C Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
([ y)� 1 ®,CO - r, i s.0 ,` f Branch circuits - new, alteration, or
Name: extension per panel:
Addre ' A Fee for branch circuits with purchase of
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 9 c c 2
Phone: I Fax: Each additional branch circuit / 6.65 ( 4 - 1 - 2
E -mail: Misc.(Service or feeder not included):
T irj ,;' t 'i,. ' O i s , �s = ii !i* d i s iNe� "' ; 3'4'1; ' , 4 „ Each pump or irrigation circle 53.40 2 •
Each sign or outline lighting 53.40 2
Job No: g 8 g Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: W , I( et At V Fre rat r /, a Description:
Address: Po s Z30 s 2- -
City/State/Zip: • -N 5 A A►7 Qn Q Each additional Inspection over the allowable In any of the above:
! � e k- / Per inspection per hour (min. I hour) 62.50
Phone: 62.4 - 3 6 3 / • Fax: (2 4 - Z5 C iF' Investigation fee: _
CCB Lic. #: � - j _ Lic. #: 3y 2 6 - 3 L B other:
' ,�� „j ,.wT i s ' tt .� "�,;� i . ; �,, R
Supervising electrician ga ,.� �i_. . F' M M i.i3 ,.; r iag -
p required: / Subtotal $ co
signature r e Plan Review (25% of Permit Fee) $
Print Name: O rF ,, r , fe # ' /1 b S - S State Surcharge (8% of Permit Fee) $ 4 1, Ze
TOTAL PERMIT FEE $ S . _ 4 e ,
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:Wsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems
▪ Burglar Alarm
0 Garage Door Opener
ID Heating, Ventilation and Air Conditioning System
ID Vacuum Systems
O Other
•
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260) •
Cheek Type of Work Involved:
ID Audio and Stereo Systems
Boiler Controls
0 Clock Systems •
El Data Telecommunication Installation
•
El Fire Alarm Installation •
HVAC
E l Instrumentation
Intercom and Paging Systems
0 Landscape Irrigation Control
Medical
ID Nurse Calls •
❑ Outdoor Landscape Lighting
Protective Signaling
0 Other
Number of Systems
* No licenses are required. Licenses are required for all -
other installations •
•
•
iMsts\Petmit Forrns\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD ' 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
MST
INSPECTION DIVISION Business Line: (503) 639 -4171 BUP
Received /MVO �3 / ft '-t D Request AM PM BUP
Location *Se ,/ jI it k Suite MEC
Contact Person Ph ( ) PLM
Contractor LA): GIQIM Q-'f+ e_ E-f .Q2 Ph ( .3) 62 24(- SWR
BUILDING Tenant/Owner OW3 ` QO S83
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
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
m il i a-f °U Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS BART FAIL
SITE 11 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date l b Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL