Permit 4 " . .. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00682
,01 # 1 . DEVELOPMENT SERVICES DATE ISSUED: 10/26/2004
rI II 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 - 4171
PARCEL: 1 S 133CD -01700
SITE ADDRESS: 11768 SW SWENDON LP
SUBDIVISION: COTSWALD MEADOWS ZONING: R -25
BLOCK: LOT : 015 JURISDICTION: TIG
Project Description: Kitchen remodel (8) branch circuits: recess lights, outlets, swithch GFI, microhood, DW, disposal,
range reconnect, outside WP.
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: 7 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:
RIDER, MARILYN Y AND THE ELECTRIC GROUP
JAMES M 4726 SE MILWAUKIE AVE
11768 SW SWENDON LOOP PORTLAND, OR 97202
TIGARD, OR 97223
Phone: Phone: 503 - 232 - 2499
Reg #: ELE 24 -445C
LIC 43851
FEES SUP 2085S
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 10/26/200' $93.40
[TAX] 8% State Surcharge 10/26/200' $7.48 Rough -in
Elect'I Final
Total $100.88
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 Notifi :tion Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these r or dir• ct quest;.n. to OUNC at (503)
246 -6699 or 1 -800- 332 -2344
Issued By: 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
Cit ' y g of Tigard Received _ / i ) 4_, Date/3 • / .....1 (/ /(/ PermitNo.:� a c6 ' ,r
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 -i � ' i� Date/By: Other Permit
Inspection Line 503.639.4175 . Date Ready/By Iuris ® See Page 2 for
Internet www ci tigard.or.us Nonfied/Method: 'r/ fr Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction %Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service ['Hazardous over 225 amps, com'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
X 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-family 0 Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.: Q4f 92 Job site address. /1 6g S tt) S we,vc °4-) (,,d ❑Health - care facility ❑Other.
p Submit 2 sets of plans with any of the above.
City/State /ZIP: TI GA es n o 2 eTloej -✓ The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: (40(wi S e
y Description I Qty. I Fee. I Total
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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/I
1li i +! R c�e ( - t` t - Swt l c 4 dwelling, service and/or feeder 90.90 2
w e?wr.v ereess 10 - 1 - f - ink ! Services or feeders installation, alteration, and /or relocation
6 R - 1Mt`t:..- v('todd - Vw- )15-pc,, 'c ° 0,1„5.4 1?ece. -�V • dkki.( WP 200 amps or less 80.30 2
13] PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160 60 2
Name: i y c -c 2 601 amps to 1,000 amps 240.60 2
Address: / / - 6 S S Lc.j S We-..)0o-ti Lco e9 P Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP' T . c i , c» D.e ce- -- Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) 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 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
IS APPLICANT ❑ CONTACT PERSON A Fee for branch circuits with
service or feeder fee, each 6 65 2
Business name: 71.1-E L t GT A i a c „� 1p / .UC branch circuit
B. Fee for branch circuits
Contact name: -- D,41 U to J (_ &is Cy.) S (--= without service or feeder fee, , 46 85 y( `/j) 2
Address: each branch circuit
Each add'l branch circuit 7 6.65 %Sir 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or imgation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 11.1_&-- &. L e- T rt 1 62 4Ot4 to 14,1G _
Address: - 3/7 2 (, 5 /r7/ L w2 K /< I C 4 t Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Tot I C 6, Q' r✓ 6(9ti 4' 7ZI2 z Investigation per hour (I hr min) 62.50
Phone: ("j) 237 z 4' 99 Fax: (Sa3) 23 Z 3/ l0 9 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 3 5 / Electrical Lic. 6 c/ y C Su. . Lic.: 2,0,S117.5 Subtotal qg Yo
0 Suprv. Electrician signature, required: / Plan review (25% of permit fee)
ur
State surcharge (8% of permit fee) '7 , 1'
Print namepz,, io JPv S n /J eg tiS .c./ Date: /c2 /ill/ TOTAL PERMIT FEE f 00. 6 g
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.
t\ Building \Permits\ELC- PermitApp.doc 12/03 440-4615T( I 0/02/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*
El 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
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Cl Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\BuildmgTertnns\ELC- PertmWpp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: 003) 639 -4175
INSPECTION DIVISIOAI Business Line: (503) 639 -4171 MST
BUP
Received Received / Date Requested / � - — 4 7/ AM PM BUP
Location /1 - 76 g \e Suite MEC
Contact Person Ph ( ) G - Z' 3 PLM ?Oo — OD 41
Contractor 0 V:16-0 Ph ( ) 3 m N 11140 SWR
BUILDING Tenar tt/Owner 1 CA v ( g 0) ` 5 `1 am/ ELC c PsOD — CO 6FD—
Footing W` p � 1 3 J � �Y\ °���^ ELC
Foundation Access: ` ,�\\
Ftg Drain C O Yfl /3C/ ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
b4. tr , �1� ���', t
Insulation \ �
Drywall Nailing �' �_��L �`��
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final .t t
P FAIL JJJJ �r�
PL
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
(.1%,(
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
ECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
-, ELECTRICA)
Services J
Rough -In
UG/Slab
Low Voltage
Fi e Alarm
S
- .. )ART FAIL
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date/7 2 Inspector I - Ext
Other:
Final DO NOT REMOVE this inspection reco from the ' b site.
PASS PART FAIL