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Permit CI TY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00303 I n DEVELOPMENT SERVICES DATE ISSUED: 6/1/2004 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 1S125DB-10100 SITE ADDRESS: 09600 SW SHADY PL SUBDIVISION: THE RAZBERRY PATCH ZONING: R -4.5 BLOCK: LOT : 021 JURISDICTION: TIG Project Description: (1) branch circuit. • 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+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: POWERS, GLENN S AND WILSONVILLE ELECTRIC INC MARILYN J PO BOX 845 9600 SW SHADY PL WILSONVILLE, OR 97070 TIGARD, OR 97223 Phone: 503 - 244 -2951 Phone: 503 -638 -5353 Reg #: SUP 3854S LIC 75752 FEES ELE 3 -307C Description Date Amount Required Inspections [ELPRMT] ELC Permit 6/1/2004 $46.85 [TAX] 8% State Surcharge 6/1/2004 $3.75 Rough - Elect'I 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 or 1. 800-33 344. Issued By: e tAf 24 a rz. 441-41- Permit Signature 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 Electrical Permit Application FOR OFFICE USE ONLY City of u Received Tigard ,( PernutNo.: '^ • 13125 sW Hall Blvd., Tigard, OR 97223 Date/By: Q// 0 f ?A Plan Review /�(,�� ., ��� 1 OF Phone: 503.639.4171 Fax: 503 - , ;t l I DateBy: Other Permit: Insp Line: 503.639.417 F' Date ReadyBy: Jn` /_ - ® See P age 2 for Internet: www.ci.tigard.or.us Notified/Method: 1 �(X Supple menta l In formation TYPE OF WORK PLAN REVIEW - . ❑ New construction [ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ['Service over 225 amps, cornm'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 '2,1 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 fanuly ❑ Master builder ❑Other: ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ' ❑E plan RV park / ❑Health - care facility ['Other: er: Job no.: Job site address: q (� 00 S V\ S h ca_ P i Submit 2 sets of plans with any of the above. City /State /ZIP: T • c to © t . cn � r, ct 7 z 3 The above are not applicable to temporary construction service. Suite bldg. /apt. no.: Project name: FEE* SCHEDULE '; ; r Description I Qty. I Fee. I Total LC x .„ Cross street/directions to job site: TI 0 r'i 7 4,--ti. o4 p New residential single- or multi - family dwelling unit. n ,� I c,.cS Includes attached garage. TGt, V Kdl T r n 0v k S . .- 1,000 sq. ft. or less 145.15 4 Subd ision: �� y Lot no.: Ea. add'l 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 n dwelling, service and /or feeder 90.90 2 P vv. v∎V 0 A S �-C � R tom:_ e ` . G L-3f Ue.-3 Services or feeders installation, alteration, and/or relocation u r v\ ce..c -..c?— a. 0.i , C_o „ov; i- o v c , ., Y C., e.0 v% a Y24/0 amps or less 80.30 2 IA PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 4�' n 1 401 amps to 600 amps 160.60 2 Name: ∎� 1 e-h Y\ S • $. ar l ` 3 . F? © w esTS 601 amps to 1,000 amps 240.60 2 Address: 9 l0 0 o S . A p Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State /ZIP: Qur4 n q )_y3 Temporary services or feeders installation, alteration, and/or t relocation Phone: (o 3) 2 p9 1 Fax: ( ) 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 exchanggeaccording to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 X Owner Signature: g I J t�it -t-� r� Date: (�// (7 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 without service or feeder fee, / 46.85 r � Contact name: ' 2 Address: each branch circuit Each add'l 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 - CON RACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: �i /.. /, 1 LL < G �- Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City/State /ZIP: Q Investigation per hour (1 hr min) 62.50 i Phone: ( ) Fax: ( f .) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* . CCB Lic.: 7 75 Electrical Lic.: .3,- Suprv. Lic.: 5 Subtotal /16/ Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge �' (8% of permit fee) . 7 5 TOTAL PERMIT FEE , 60 Authorized signature: This permit application expires if a permit is 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 •• Number of inspections per permit allowed. i:\ BuildingTemtitAELC- PemiitApp.doc 12/0 V` " �. Scj� / 1 / /02/COM/wEB 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 ❑ 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 is Building 'Permits\ELC•PertnitApp.doc 04/03 JUN -07 -2004 12:37 PM WILSONVILLE ELECTRIC 5036388804 P.01 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE WILSONVILLE ELECTRIC INC PO BOX 845 WILSONVILLE, OR 97070 Electrical Signature Form Permit #: ELC2004 -00303 Date Issued: Parcel: 1 S125DB -10100 • Site Address: 09600 SW SHADY PL Subdivision: THE RAZBERRY PATCH Block: Lot: 021 Jurisdiction: TIG Zoning: R-4.5 Remarks: (1) branch circuit. Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: . POWERS, GLENN S AND WILSONVILLE ELECTRIC INC MARILYN J PO BOX 845 9600 SW SHADY PL WILSONVILLE, OR 97070 TIGARD, OR 97223 Phone #: 503 -244 -2951 Phone #: 503- 638 -5353 Reg #: MET 00002128 SUP 3854S LIC 7 52 AN INK SIGNATURE IS REQUIRED ON T EL. F % M .410 vaawki Alorri IOW Signature o' upervising Elec c77 If you have any questions, please call 503.718.2433. CITY OF TIGARD 24 -Hour BUILDING Inspection Lin . • INSPECTION DIVISION Business Line: BUP Received Date Requested 41151 AM PM BUP Location II -.�� �_! Suite MEC Contact Person Ph ( ) oq5/ PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC 42 ' ^ 2323 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 - •;RT FAIL 4 112:12:t■,' Servi Rough -In UG /Slab Low Voltage Fi - Alarm Fir; PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. • S • Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA �o cf Approach/Sidewalk Date `' v 1 1 ` 0 Inspector '' /Lbh,t Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL