Permit A . ;, CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00768
4: i A, DEVELOPMENT SERVICES DATE ISSUED: 12/3/2004
" '�' II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
• PARCEL: 2S 111 AD -06800
SITE ADDRESS: 08875 SW SCHECKLA DR
•
SUBDIVISION: SCHECKLA PARK ESTATES ZONING: R -4.5
BLOCK: LOT : 022 JURISDICTION: TIG
Project Description: (1) branch circuit. (Repermitting work that was originally permitted in 1998 but never inspected.)
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+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
DAVID TURZILLO OWNER
8875 SW SCHEKLA DR
TIGARD, OR 97224 •
Phone: 503 - 624 -2661 • Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/3/2004 $46.85
[TAX] 8% State Surcharge 12/3/2004. $3.75 Rough -
Elect'l 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 0 : a 1 332 -2344.
Issued :y: / I I 4 4 i _ Permit Signature: �t
• OWNER INSTALLATION ONLY •
The installation is being made on property I own which is not intended for sale, lease, or rent.
C_
OWNER'S SIGNATURE: k p-� ` DATE: 70 - - 3
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application I)I( 01:1:1( I SI O\ 1.1
Cl f Tigard Received / Permit No.:
1312 S W Hall Blvd., Tigard, OR 97223 i[ + Dan a i f � — / �� �_
, Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 , p � DawB .
Inspection Line: 503.639.4175 --2241,-
. 'i . Date Ready/By: 3Wi • - 85 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method a • Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ 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 I- 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
❑ Multi - family ❑Master builder ❑Building over three stories ['Feeders, 400 amps or more
❑ Other: DOccupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION RV
❑Egress/lighting plan park
Job no.: I Job site address: g$- SW s k( 2 ❑Health facility DOther:
S Submit 2 sets of plans with any of the above.
City/ State/ZIP: T l�rr,r� ' � 1a of The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name:
FEE* SCHEDULE
Description I Qty. I Fee. I Tara) I
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 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
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 0) A u 16k. TV g t LI...O 601 amps to 1,000 amps 240.60 2
Address: $B75 S W SGheci�I R I D Q Over 1,000 amps or volts 454.65 2
O Reconnect only 66.85 2
City/ State/ZIP: --r � ) oft I as 4 Temporary services or feeders installation, alteration, and/or
Phone: (ci, 3) ba,t' -a.6 b Fax: ( ) relocation a ction
J � � 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not ' 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
-
B. Fee for branch circuits •
Contact name: without service or feeder fee, / 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name:
E_ extension. Describe: Page 2 2
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Investigation per hour (I hr nun) 62.50
Industrial plant per hour 73.75
Phone: ( ) I Fax: ( ) ELECTRICAL PERMIT FEES'
CCB Lic.: Electrical Lic.: I Suprv. Lic.: Subtotal L/$. g/
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 3.•7 5
TOTAL PERMIT FEE 5;0,(O
Authorized signature-
gn I 1 �- This permit application expires if a permit is not obtained within 180
AE
1 days after it has been accepted as complete
Print name: - D A v t& 3 V RZ 1 LL I Date: l a/ 3 ) 0 4 • Fee methodology set by Td-County Building Industry Service Board
•• Number of inspections per permit allowed
1:\ Building \Perm its \ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM/WEB g°
- err - 4 - `4 /9,
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: •
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
. ❑ Burglar Alarm
O Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
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
❑ Outdoor Landscape Lighting*
❑ Protective Signaling •
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pennits\ELC- PamitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection : tne: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 63 4171 MST
BUP
Received Date Requested /--/ AM PM BUP
Location • ! , A , �__ _ _ 1.4 Suite -1dD L i - 00 /271
Contact Person lei � j Ph ( ) 2 4-2-606./ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner LC o7D6 / 7
Footing ELC
Foundation Access: CM1/) Ftg Drain 6D ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Framing ath/Shear 11 PA-Ai :Sc) P
Insulation
Drywall Nailing J
Firewall A/C , v./ 11 i4-p P 3c'
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer AllrAINFOJEW
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS -1 FAIL
HAL
Post & Beam
Rough -In
Gas Line
Smok : Dampers
in
MI *ART FAIL
.a��'' L
Service
Rough -In
UG/Slab
Low Voltage
Fir: larm
i
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection R : / 0 Unable to inspect — no access
Fire Supply Line _
ADA
Approach/Sidewalk Date / z . D Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record the Job site.
PASS PART FAIL