Permit CIT OF T I GAR D • ELECTRICAL PERMIT
no PERMIT #:
DEVELOPMENT SERVICES DATE ISSUED: 8/27/03 3 00538
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S133DB-00800
SITE ADDRESS: 11586 SW SHEFFIELD CIR
SUBDIVISION: BRITTANY SQUARE NO. 2 ZONING: R -12
BLOCK: LOT : 032 JURISDICTION: TIG
Project Description: Installation of (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:
JOHNSON, PHYLLIS R + OWNER
BRANDT, JOHN J
•
11586 SW SHEFFIELD CIR
TIGARD, OR 97223 .
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/27/03 $53.50
[TAX] 8% State Tax 8/27/03 $4.28 Rough -
Elect'I Final
Total $57.78
This Perm' ' ued subject to the regulations contained in the Tigard Muniapal Code, State of OR. Specialty Codes and all other applicable laws. All
wor be done in . • ordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
fo more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
fr-rth in OAR 952-001-001e through OAR 952 0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
800- 332 -2344.
Iss b - d By: r _ � ; Permit Signature �! ,
OWNER INSTALLATION ONLY
The installation is being made on prop rty I own hich is not inten ed for sale, lease, or rent. p-
OWNER'S SIGNATURE: x t^- r.�-�^r T DATE: v /�
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Eleirtiitical Permit Application ,., ., FOR OFFICE USE ONLY
Received O Electrical
Date/By: f 2 3 Permit No.: G C e c ; _ g
C1 of Tigard Planning Approval Sign
`J b Date/By: Sign
No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Internet: www.ci.tigard.or.us �i�rme• ,� i`I�I 1 Date/By: Case No.:
^ ■ 7 R. Contact ,u;is ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: / 4 � Supplemental Information.
TYPE .OF W ORK . • . , . _ = PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑
Addition/alteration/replacement ❑ Other: Hazardous
❑ Service over 320 amps- rating of ❑ Building ng o over er 10 10,000 square feet,
, - CATEGORY' - CONSTRUCTION . ' 1 & 2 family dwellings four or more residential units in
El 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
Job site address: 119bli, Sat She!l oL C; T 9ptrA— The above are not applicable to temporary construction service.
r - r - � � FEE* SCHEDULE
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total i
Cross street/Directions to Job site: Take. i3-141 Sou' h New residential- single or multi- family per
Ce Scl,olk F ern S kef4e'" dwelling unit. Includes attached garage.
o
y I Leo on �rr'i t ct*- La l tsr+ Service included:
C 1000 sq. ft. or less 145.15 4
1. Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
D ESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
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
[PROPERTY OWNER 1'E TENANT - 601 amps to 1000 amps 240.60 2
- Over 1000 amps or volts 454.65 2
Name: So ■r. 1'. f rar,d.-F- :Sr Reconnect only 66.85 2
Address: \\ S, SW she•Q161 Ow Temporary services or feeders - installation,
Cit City/State/Zip: I alteration, or relocation:
y p lijc -d.. D(- q�aa3 200 amps or less 66.85 1
Phone: 503- 52i- g305 Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
PPLICANT ' , -- ❑ CONTACT PERSON
[A
Branch circuits - new, alteration, or
Name: Same ,a_6 lzbt i e. extension per panel:
Address: 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 YY/ 2
Phone: Fax: Each additional branch circuit / 6.65 4 , 41 C 2
E -mail: Misc.(Service or feeder not included):
• "' - - CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: � � Signal circuits) limited energy panel,
Business Name: rh),(7 alteration, or extension
si on Page 2 2
Description:
Address:
City/State/Zip: Each additional inspection over the allowable in any of the above:
p Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other:
Electrical Permit F ee's*
Supervising electrician Subtotal $ 6 Std
signature required: Plan Review (25% of Permit Fee) $
Print Name: 1 ic. #: State Surcharge (8% of Permit Fee) $ 4 / , tk 1'
TOTAL PERMIT FEE $ 6 7 • 7 g'
Authorized / n/ Notice: This permit application expires if a permit is not obtained within
Signature: / _, , _ /i - : /, Date: 1� Ja, / �� 180 days after it has been accepted as complete.
f *Fee methodology set.by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of 'igard• i
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
•
❑ Garage Door Opener
El Heating, Ventilation and Air Conditioning System
El Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
•
Boiler Controls
Clock Systems
•
❑ Data Telecommunication Installation
0 Fire Alarm Installation
HVAC
0 Instrumentation
•
Intercom and Paging Systems
El Landscape Irrigation Control
❑ Medical
• ❑ Nurse Calls
• ❑ Outdoor Landscape Lighting
0 Protective Signaling
n 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
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Lino: (503) 619-4171
BUP
Received Date Requested //— /3 AM PM BUP
VP Location / ( s o P 4 ' ' L Suite MEC
Contact Person Ph ( ) PLM
Contractor / w Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 - 0 c s 3 e
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
)6 7
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
Fire larm
in Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI ❑ Please call for r • inspec ' • n RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / / a Inspector &i e'I Ext
Other:
Final DO NOT REMOVE this inspection record from the jo site.
PASS PART FAIL
CIT OF T I GAR D • ELECTRICAL PERMIT
no PERMIT #:
DEVELOPMENT SERVICES DATE ISSUED: 8/27/03 3 00538
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S133DB-00800
SITE ADDRESS: 11586 SW SHEFFIELD CIR
SUBDIVISION: BRITTANY SQUARE NO. 2 ZONING: R -12
BLOCK: LOT : 032 JURISDICTION: TIG
Project Description: Installation of (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:
JOHNSON, PHYLLIS R + OWNER
BRANDT, JOHN J
•
11586 SW SHEFFIELD CIR
TIGARD, OR 97223 .
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/27/03 $53.50
[TAX] 8% State Tax 8/27/03 $4.28 Rough -
Elect'I Final
Total $57.78
This Perm' ' ued subject to the regulations contained in the Tigard Muniapal Code, State of OR. Specialty Codes and all other applicable laws. All
wor be done in . • ordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
fo more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
fr-rth in OAR 952-001-001e through OAR 952 0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
800- 332 -2344.
Iss b - d By: r _ � ; Permit Signature �! ,
OWNER INSTALLATION ONLY
The installation is being made on prop rty I own hich is not inten ed for sale, lease, or rent. p-
OWNER'S SIGNATURE: x t^- r.�-�^r T DATE: v /�
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day