Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00293
I 4 DEVELOPMENT SERVICES DATE ISSUED: 5/22/03
.74A �� 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S115AA-07900
SITE ADDRESS: 10530 SW TITAN LN •
SUBDIVISION: BERKLEY ESTATES ZONING: R
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Install (2) branch circuits to AC and air cleaner.
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:
HIEB, ALVIN A OREGON INTEGRATED CONTRACTING
10530 SW TITAN LN 19239 MECHANT PL
TIGARD, OR 97224 OREGON CITY, OR 97045
Phone: Phone: 503 - 880 -8649
Reg #: ELE 3 -534C
LIC 150266
FEES SUP 3853S
Description Date Amount
Required Inspections
[TAX] 8% State Tax 5/22/03 $4.28
[ELPRMT] ELC Permit 5/22/03 $53.50 Rough -in
Elect'I 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 rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: 6771otAx„. Permit Signature: y C r /�
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
Jlg-ctrical Permit Application Received _ FOR OFFICE USE ONLY . : .
�j Electrical
Date/B : -0 b E Permit No.: 00 5- Ctj a 93
City of Tigard Planning Approval Sign
Date/B - Permit No
13125 SW. Hall Blvd. Plan Review Other
Tigard, Oregon 97223
A m � DatDate/B Permit No.:
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 Post - Review Land Use
pil t i l l Date/B : Case No
Internet: www.ci.tigard.or.us ee � Contact FM ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method. Su I • lemental Information.
�,; :' ,;. , ?• : ?`= � : " 4= , . PL'AN' ; feiti checklaii:thit a - 1 r ° `
-_. --,�� ,.. _ _ -._. - _ := TYPE�OF:�WORK � �� . ._. . _ ;,�;,; �:� . � _�' PP Y)`���; ..
� ❑ New construction ❑ Demolition � ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
'5 =, :"K : _, ` ,CATEGORYrOF-CONSTRUCTION;;< 'i.`." -� . ,; =' I & 2 family dwellings four or more residential units in
,R'1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ 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:
:- r.ii. ; 'H i JOB;SITE'INFOR11'IATION fid:LOCATION 7- ':i• , ; : - Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 1 0.30 .3 La ` h ;- a -, ):EE* CHEDULE?;''- ._ s:z ?,:.n�°
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
New residential- single or multi - family per 1
Cross street/Directions to job site: l dwelling unit. Includes attached garage.
O V (' h kal V • 6 h L / Service included:
1000 sq ft. or less 145.15 4
0 G3 -€ Dv-% 7-1- 4-4 11 Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
%', ; l :; i ':;i >r ':.' .WORK: t, ._ • ' ' ;,`:,' service and/or feeder 90.90 2
� Services or feeders - installation,
L Q' i r C OV1 ./ t -h041 e V' , Re Cep -1 de alteration or relocation:
- 5.e- A t r C. lean ev 20 amps to or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
®SPROPER1;Y :OW.NER ,; >�` :. ": "- TENANT:� .'
• -." P., 601 amps to 1000 amps 240.60 2
1 Over 1000 amps or volts 454.65 2
Narne: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
: is , APPLICANT :; ,;;: j:-; ; : , : ;�`- ® ',: :,'' , Branch circuits - new, alteration, or
•Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of J
service or feeder fee, first branch circuit / 46.85 2
Phone: Fax: Each additional branch circuit / 6.65 2
E -mail: Misc (Service or feeder not included):
` ;G a "' r ' CONTRACTOR' °'gig' - Each pump or irrigation circle 53.40 2
3g ,_, , � n :.. .. - _ , - ' -' Each sign or outline lighting 53.40 2
Job No: i-lt ' G i A I / Signal circuit(s) or a limited energy panel,
Business Name: alteration, or extension Page 2 2
t�t' o n J vt +GCd4 Co4 Description
Address: j 9 Mer Gkw - t f 1 _ ✓
/n � /� Each additional inspection over the allowable in any of the above:
City /State /Zip: 0 r45 p ^ 0i{r/ t biz ggOgs Per inspection per hour (mrn.Ihour) 62.50
Phone: - a -R 0� - 8 / , 649 Fax: / investigation fee:
15,0.2 £ Lic #: D ) - 4 ` , !� 3 Other: .. :, :
CCB Lic. #: � _ , �! ;� , ' _ - <t';i ElectHcahiPermit' #F.ees * = 00�;,;� "lr' ;' ;; '`
Supervising electrician —' �� / Subtotal $ 5 S,
signature required: 0 Plan Review (25% of Permit Fee) $
Print Name: 3 j L= VE I. ' >,l?((S Lic. #: ,..3 -S State Surcharge (8% of Permit Fee) $ 4-/.,;1% TOTAL PERMIT FEE $ 57, 7 g
Autho • - • �� ----- 2 Notice: This permit application expires if a permit is not obtained within
Signature: , 411111W Date 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name) T (
PP
i:\Dsts\Permit Forms \ElcPermitA .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:
n Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
n Boiler Controls
n Clock Systems
E Data Telecommunication Installation
n Fire Alarm Installation
HVAC
n Instrumentation
F l Intercom and Paging Systems
n Landscape Irrigation Control
Medical
n Nurse Calls
0 Outdoor Landscape Lighting
n 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
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested , . a 7 AM PM BUP _(�
Location C D Cad T�Gt
.�. / Suite E - 3' Q 0 2S
Contact Person Ph ( ) i PLM
Contractor Ph ( ) S $eY- 8(n < SWR
BUILDING Tenant/Owner GI s 3 - d 93
Footing
Foundation " . ELC
Ftg Drain Acees f �� r ��� T "�"" – ' � ELR
er7'IQi1-
Crawl Drain a
Slab Insp ctlon Notes:. A l SIT
Post & Beam ` �r f/ / .S`� �� % 1/1 7- '/��,� - _t7
Shear Anchors G�
Ext Sheath/Shear l � ! � 79:7C-
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
T FAIL
MECH AL
Post & Beam
Rough -In
Gas Line
m*e Dampers
Fin -
` PART FAIL:
RICAL --- -` -
Service (/
Rough -In
UG/Slab ��
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA
Approach /Sidewalk Date 7(6 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL •