Permit C ITY OF TIGARD' ELECTRICAL PERMIT
PERMIT #: ELC2003 -00323
DEVELOPMENT SERVICES DATE ISSUED: 6/4/03
'^' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110BB-06500
SITE ADDRESS: 11999 SW TREEVIEW CT
SUBDIVISION: REDWOOD VISTA ZONING: R
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Installation of (1) branch circuit for new a /c.
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:
ATKINSON AMERICAN ELECTRICAL SERVICE
11999 SW TREEVIEW CT PO BOX 1057
TIGARD, OR 97224 SHERWOOD, OR 97140
Phone: Phone: 204 - 9864 PAGE
Reg #: LIC 00101587
SUP 4106S
FEES ELE 36 -59C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/4/03 $46.85
[TAX] 8% State Tax 6/4/03 $3.75 Rough -in
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Muniapal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be d• • - '• .ccordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more t.: 180 days. ENTION• Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in '.AR 952 - 001 -0010 ough OAR 9 - 001 -0100 You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 -.32 -2344.
' �/ Permit Signature: Issu - • By: I,. � rai / / `2 // 9
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 INS ALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: .& .�_l�I�� /� DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application ., FOR OFh7CE USE ONLY Received Electrical
Date/By: Permit No.:
�I of Tigard Planning Approval Sign
City g Date/By Permit No.:
13125 SW Hall Blvd. Plan Revie Other
Tigard, Oregon 97223 Date/By: Permit No.: -
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us ,_14„ el 1 Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ 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,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ I & 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.
The above are not a . , licable to tem . ora construction service.
Job site address: 1111 1 Siv T,eecLLe.fr) `- FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential-single ginc ud attached multi-family per 1
.l dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: I Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
/d- 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 I ❑ TENANT 601 amps to 1000 amps 240.60 2
/J� Over 1000 amps or volts 454.65 2
Name: !C/ 7 /f j .1$ Reconnect only 66.85 2
Address: 55,0,114.1._ 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
❑ APPLICANT ❑ CONTACT PERSON Branch n h amps 133.75 2
circuits 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 ,L `
service or feeder fee, first branch circuit / 46.85 Tl .sjl 2
Phone: I Fax: Each additional branch circuit 6.65 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 circuit(s) or a limited energy panel,
Business Name: ((y� 1l 1(�, row alteration, or extension Page 2 2
Description:
Address: P. bt k l -- -7
city/state/zip: / Each additional inspection over the allowable in an of the above:
y/V j Per inspection per hour (min. 1 hour) 62.50
Phone: 5 2 / 2/ Fax: 5-5-V -jfD Investigation fee:
CCB Lic. #: /) /(f 7 Lic. #: 3 Z - rto e Other:
Electrical Permit Fees*
Supervising electrician Subtotal $ W.. frf
signature required: Plan Review (25% of Permit Fee) $
Print Name: Nvul Vifit ic. #: izfo f State Surchar a 8% of Permit Fee $ 3, 75
- TOTAL PERMIT FEE $ c) .
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*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 Tigard
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
n Burglar Alarm
Garage Door Opener
LI Heating, Ventilation and Air Conditioning System
Vacuum Systems
r
Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
• Audio and Stereo Systems •
O Boiler Controls
Clock Systems
O Data Telecommunication Installation
Fire Alarm Installation
E HVAC
El Instrumentation
0 Intercom and Paging Systems
El Landscape Irrigation Control
0 Medical
0 Nurse Calls
Outdoor Landscape Lighting
O 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 . S AM PM BUP
Location l / ! [ /4/� -P_P�l C " mot". suite MEC
Contact Person ' Dr Ph ( ) 3 - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC .3 "
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
Fire wall
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire larm
� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
-� PART FAIL
SITE Please call for reinspection RE: fl ULnabbll o inspect — no access
Fire Supply Line
ADA � Q j
Approach/Sidewalk Date Inspector pector �` y c ��s Ext
Other: v `� J
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL