Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00263
kr� DEVELOPMENT SERVICES DATE ISSUED: 5/14/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S125DD-07000
SITE ADDRESS: 09605 SW VENTURA CT
SUBDIVISION: WASHINGTON SQUARE ESTATES NO.3 ZONING: R-4.5
BLOCK: LOT : 078 JURISDICTION: TIG
Project Description: Job No. 2600 NC and plug
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:
BRUN, KIM E + SUSAN E HILLSBORO ELECTRIC
9605 SW VENTURA CT 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: 503 - 922 -9502 Phone: 503 - 439 -9666
Reg #: ELE 34 -4399C
LIC 134481
FEES SUP 4941S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/14/2004 $53.50
[TAX] 8% State Surcharge 5/14/2004 $4 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: ��Qi 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
F; ELECTRIC LLC. 5036013680 05/13/2004 12:20 #806 P.001
€Iectrical Permit Application Received FOR OFFICE CSE ONLY
Electrical
Date/By: _ Permit No- a� DO / 0 Z4o3
� j P Approval Sign
City of Tigard ' E C --�- E Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 ', 0011 Date/By: Permit No.:f lie„ IDL OAA
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 Post- Review Land Use
CIT " 04 : ,, i = � F 1 ; I ' D p ate/By: Case No.:
Internet: www.ci.tigard.or.us y ',y I Contact Juris.: ® Sec Page 2 for
24 -hour Inspection Request: 503- 639- 417A "' , = - "' " - 9 N Name/Method: Supplemental Information.
abv
• TYPE OF WORK_ . . - _ _ PLAN REVIEW (Please check all that apply)
0 New construction Demolition 0 Service over 225 amps - CI Health -care facility
commercial ❑ Hazardous location
E Additi o n/alteration/replacement _ Other: - 0 Service over 320 amps - rating of 0 Building over 10,000 square feet,
' CATEGORY OF CONSTRUCTION • • 1 & 2 family dwellings four or more residential units in
1 & 2- Family dwelling . _ Cornmercial/Industrial CI system over 600 volts nominal one structure
. 4
Accessory Building
Multi ❑Building over three stories 0 Feeders, 400 amps or more
xY A
CI Occupant load over 99 persons ❑ Manufactured structures or RV part
Master Builder
LI _.0 El Egress fighting plan 0 Other: _
. ; 1 . :Iv . JOB SITE INFORMATION 'and LOCATION- . , submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address:Cti L,, 05, c', I\ i .
,.:.r_ C - -' FEE *.SCHEritltE,J.''':1 -.' r ,
Suite #: • r Bldg. /Apt. #: _ Number of ins pections p er permit allowi
Project Name: q.-3 c;t „, Description Qty Fee (ea.) 'fetal
Cross street/Directions to job site: New residential- single or multi - family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or leas 145.15
Each additional 500 eq. ft. or portion thereof 33.40
Subdivision: I Lot #: Limited energy, residential 75.00
Limited energy, non residential 75.00
Tax map /parcel #: Each manufactured home or modular dwelling
• ., '`".F.!;;I'- . OF'WORk= '?.k:',/, r4.; service and/or feeder 90.90
Services or feeders - installation,
C 't I C c9.. �, p L t alteration or relocation:
200 amps or less 80.30
- 201 amps to 400 amps _ 106.85
401 amps to 600 amps 160.60
ROEERTYt1?G NER x:. •s"- : j [ i .T WANT i+,.r. 1 :.,41 .4 : ,;;i,"'ter SFr. 601 amps to 1000 amps 240,60
".yM 1 Over 1000 amps or volts 454.65
Name: 9, \ins\ I t1 , Reconnect only 66.85
Address: Temporary services or feeders - installation,
A C A : Cj '' v' - alteration, or relocation:
City /State/Zip: _ 200 amps or less _ 66 -85
Phone: ( -fl --/.... yt-- ')-.., Fax: - 201 amps to 400 amps 100.30
401 to 600 antes 133.75
":fl APPLII ; '�'r'> " i' - CONTACT, PER4611' : M: 's Branch circuits - new, alteration, or
r
Name: extension per panel:
Address: — A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65
City /State /Zip: B. Fee for branch circuits without purchase of 1 1
service or feeder fee, first branch circuit i 46.85 7 L �S
Phone: I Fax: Bach additional branch circuit 1 6.65 C.. t, c"
E -mail: Misc.(Service or feeder not included):
: �t r ' i':.ii�t, -; ; 1 � .• . i �:∎1 .', C•Q1r �T,R'1tC'rox °'' ::. ,. t �T, =I! c ' ,. ; - :y,•,,:li�t' Each pump or irrigation circle 53.40
'.'t"
-s''" ,H, ,; . Each sign or outline lighting _ _ 53.40
Job No: • Signal circuit(s) or a limited energy panel,
< , , _ Description: : extension Page 2
Business Name: 11,115100,
I >`L�► -1 � r Description:
Address: _ 1 N ' z • ez < � • , v.l i._ • e -
/State /ZI 1 Each additional inspection over the allowable in an of the above:
Clt
y p: 1- t tV'ADC)G - r) ! 97 I o2'4 Per inspection per hour (min 1 hour) 62.50
Phone 3) 4131 - (4ip Fax 3 60 I - 3f,, RD Investigation fee:
CCB Lic. i t ► �}-1 l Lic. -r `1ctC. J.:.,. . ' ' , y,. : --
, Electrlcal.'P.e1 ailf:aFtrlrw'...1, , k •fi .,,. ; -r
Supervising electrician , Subtotal $ '.5
si ature re. uired: I'j� "V x
Plan Review (25% of Permit Fee) S
Print Name: ..Tog 1 V t - ri Lic. #: t-} 15 State Surcharge (8% of Permit Fee) $ 4, a•
TOTAL PERMIT FEE $ .S 7 - SJ
Authorized I r��� Notice: This permit application expires if a permit is not obtained within
Signature; - / � Dater I'I - 6 180 days after it hes been accepted as complete.
V *Fee methodology set by Trl- County Building Industry Service Board.
( ` 1 +- c c
(Please print name)
i :\Dsts\Permit Forms\ElcPermitApp-doe 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 IIAST
INSPECTION DIVISION e • Business Line: (503) 639 -4171
BUP
Received Date Requested 1 AM 1-1 BUP
Location 7ta v V 1 ( X7 Suite MEC
Contact Person _ Ph ( ) 4 13 5 1 - 964 PLM
Contractor Ph ( ) SWR ,/
BUILDING Tenant/Owner ELC 0756 `t - Id d
Footing ELC 3
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SI
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 Ft N 1 > L - f p (tV
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains -
Catch Basin / Manhole - r
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
F : • larm
4Z)
El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SIT Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line •
ADA C `') v �„ n ytC�f1 Ext
Approach/Sidewalk Date v I / "� Inspector Tl I v`X) ��
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL