Permit - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00176
•
V I r
A DEVELOPMENT SERVICES DATE ISSUED: 4/7/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S1046C -BW006
SITE ADDRESS: 14179 SW WALNUT LN
SUBDIVISION: BAILEY WOODS ZONING. R -7
BLOCK: LOT : 006 JURISDICTION: TIG
Project Description: 200 amp. Tempory power: Job trailer
RESIDENTIAL UNIT TEMP SRVC /FEEDERS . MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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:
BUENA VISTA CUSTOM HOMES ROSS ELECTRIC INC
6932 SW MACADAM STE C 2870 SW 221ST AVE #203
PORTLAND, OR 97219 HILLSBORO, OR 97123
Phone: 503- 443 -6033 Phone: 503 - 642 -2800
Reg #: LIC 157891
ELE 34 -436C
FEES SUP 4232S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/7/04 $66.85
[TAX] 8% State Surcharge 4/7/04 $5.35 Rough -in
Elect'l Final
Total $72.20
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 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: C� 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: -3a
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY •
City ill Tigard Received
Plan Revi• 1i PermitNo.. - , / / t % /
13125 SW Hall Blvd., Tigard, OR 97223 Date/B : /
Phone: 503.639.4171 Fax: 503.598 1960 W- Date/13 : Other Permit.
Inspection Line: 503.639.4175 E f I.„ Date Ready/By. I� ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
TYPE OF WORK ` i . i :PLAN .REVI
ew construction ❑ Addition/alteration/replacement Please check all that apply
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
OService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
' ' ' CATEGORY. OF - CONSTRUCTION '' • ' - of 1 - and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder [Other: ['Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
'' JOB SITE - INFORMATION AND ".LOCATION =' 4 -, 0Egress/lightingp1an RV park
9 ❑Health -care facility ❑Other:
Job no.: Job site address: y S �✓ L JAt-i ��- L.4 Submit 2 sets of plans with any of the above.
City/State/ZIP / 4r� 12 q 7 2 23 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no. 9 P roject name: J 06 -r4, /e•- FEE* SCHEDULE . ;fir,'," , •
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: (,J /'hd S O✓t 9 D New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: (3A i t 1. W p/ S Lot no.: 6 Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: 7 Limited energy, residential 75.00 2
Limited energy, non - residential 75 00 2
DESCRIPT,IQN, -OF 'WORK " , - , .,,} . Each manufactured or modular
dwelling, service and /or feeder 90 90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
"" t -' '❑ TENANT ' ,. . 201 amps to 400 amps 106 85 2
❑ PROPERTY OWNER ' " `
IV 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 2
Reconnect only 66.85 2
City/State/ZIP:mpora vices or feeders installation, alteration, and/or
Phone: ( ) 1 Fax: ( ) Inr.•
I 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
- , , ,i,:i' APPLICANT` ; , 1 - .- = - CONTACT PERSON " " A. Fee for branch circuits with
service or 2 ` branch circuit
fee, each 6.65 2
Business name:
l 7 a l'1 l4 V f S''1�A C GC S T o m 140 14, e S
B. Fee for branch circuits
Contact name: 3 at ( ?uss e / without service or feeder fee, 46.85 2
Address: 6i 3 2 ` � ` ik A 01A A / 6 t4.4
each a d'I branch ch c i t
l J V f'G C.- Each add'I branch circuit 6.65 2
City/State/ZIP: for - L 4 .__d / 97 Z l r/ Miscellaneous (service or feeder not included)
Phone: (sp'S) 7 /e) Q , a r Fax : : ( ) ( Pump irrigation circle 53.40 2
Sign or r outline ne lighting 53.40 2
E -mail: Signal circuit(s) or limited -
a CONTRACTOR energy panel, alteration, or
C ' extension. Describe: Page 2 2
Business name: I VSS � l - C 4 rt c....
Address: -as 7 0 S,,,, 4A1,..., J4 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Li, J JS' bd I C 0 f P, n h.3 Investigation per hour (1 hr min) 62.50
Phone: (G03 ) 6 y a- -ag bt5 Fax: (503 Ay); S O l__c Industrial plant per hour 73.75
ELECTRICAL PERMIT 'FEES*
CCB Lic.:'LS" 0I ] Electrical Lic. ? [- Suprv. Lic.: Li )\5 Subtotal (.f��, g
Suprv. Electrician signature, required: Plan review (25% of permit fee) 6
i
Print name: 9-,eve..... SS Date: 7 � p �I State surcharge (8% of permit fee) 5. � `
TOTAL PERMIT FEE - 7a - 2.-b Authorized signature: '� j- 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.
i \Building\Pemuts\ELC- PernutApp doe 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information ti
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL°WOR.07VL:Y:, __•__ I
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*
❑ Other:
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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
•
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i• \Building\ Permits \ELC- PencdtApp doc 04/03
CITY OF TIGARD 24-Hour
BUILDING BUILDING Inspection ' 03) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
r BUP
//
Received �• 2 l Date Requested /DI /2 -z9 5z AM PM BUP
Location / 4� ' 2a-bi/ /I Suite MEC
Contact Person Ph (.2_3) C. «2- Z Khz) PLM
Contractor Ph ( ) SWR /-
BUILDING Tenant/Owner �� / 76
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ' fi -�-7 A SIT
Post & Beam �l/�- .I .Y�
Shear Anchors
Ext Sheath/Shear
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
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL — T 5 r'RJ 1ZVE
Servic =
Rough -In
UG/Slab
,Low Voltage
/Fire Alarm
F gp PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA � � '1(it'
Approach/Sidewalk Date Inspector Y v "t Ext
Other:
Final O NOT REMOVE this inspection recd from the Job site.
PASS PART FAIL