Permit A. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00513
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DEVELOPMENT I i SERVICES DATE ISSUED: 8/18/03
(503) 639 -4171
PARCEL: 2 S 109 BA -04900
SITE ADDRESS: 14119 SW WAGONER PL
t. SUBDIVISION: HILLSHIRE SUMMIT NO. 2 ZONING: R -7
BLOCK: LOT : 031 JURISDICTION: TIG
Project Description: Install 1 branch circuit to pool heater.
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: SIGNAUPANEL:
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:
KAELIN, GREGORY A + SUSAN T OWNER
14119 SW WAGONER PL
TIGARD, OR 97224
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/18/03 $46.85
[TAX] 8% State Tax 8/18/03 $3.75 Rough -in
Elect'I Final
Total $50.60
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 questio.: to OUNC at (503) 246-6699 or
1- 800 - 332 -2344.
Issued By: _' .. _ ' i -� 1 y 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
� FOR OFF`(CE USE ONLY
Elec ical Permit Application Received GG
Electrical
Date/By D /2,3 t i Permit No a - O O f/
City of Tigard RECEIVE ►, Planning A.pr.val Sign
Date/By: Permit No
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 � ��((�� 11 DDate/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503°5'9'ti'!19'5 QQ 201 Post - Review Land Use
d�me .dltr i'r ? Date/By: Case No.
Internet: www.ci.tigard.or.us I'I
a�.1 Contact Juris.: ® See Page 2 for
.24 -hour Inspection Request: 506 RFISTIG ' ` ( Name/Method: - I � Supplemental Information.
I NG DIVISION
,TYPED OR '" y, >,.. %;,-,- ` PLAN REMW (Please check all•that apply) ,
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alteration/replacement El Other: ❑ Oth
_ Service over 320 amps -rating of ❑ Building over 10,000 square feet,
- rCATEGOR.INU CONSTRUCTION" , , 1 & 2 family dwellings four or more residential units in
®-1 & 2- Family dwelling 0 Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
El Accessory Building Et Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
,' ; JOB SITE INFORMA;HON and LOCATION - .. - • Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: Am, 5,,, t.- i # 0‘. 6 1 c 7;6,00 < .; . , , , 2 .: EEx GI-.FDUL,E -,a_: .,:x- -
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total l
Cross street/Directions to job site: New residential - single or multi - family per I
j I / dwelling unit. Includes attached garage.
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/i4o,.y,�.J» ,-J - // w5-#ft4.e= Service included:
/ 1000 sq ft. or less 145 15 4
/1 sit roc t ( - t9G.•-+ci 2- AA< 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
'... - - DESCRIPTION OF4VORIC 4 4 , '' .- service and/or feeder 90.90 2
'' // Services or feeders - installation,
l / O L,uad'Q Gttr....w6 6 t_iC 7zirCog - r.r..,.a...c 64,1.5' c- alteration or relocation:
/ 200 amps or less 80.30 2
OA 4-7:4,,s, an c is #4.8c.$.4.5 a 4c...... pc. c Pvr...P / / - L:olL2 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
, ❑ PROPEI2TX,OWNER' _ 1 ?'ENANT, ., - , sw.,,... , 601 amps to 1000 amps 240.60 2
Name: Over 1000 amps or volts 454.65 2
G ¢.K . 4.6c.iw Reconnect only 66 85 2
Address: iii// 7 .s..c.) w ,}Gocuc`Qr Ac Temporary services or feeders - installation,
Cl City/State/Zip: Z Z� alteration, or relocation:
ty p 7"/6,3,.6 , 0 2 S'� 200 amps or less 66.85 1
Phone: 5°3 5Zi1 754 I Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
❑ APPLICANT . II CONI'AC,T. PERSON -- ' Branch circuits - new, alteration, or
Name: extension per panel:
Address: A . Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit I ; 46.85 y4.- p 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not mcluded):
y : Each pump or imgation circle 53.40 2 • CONTRACTOR :,. ^x: Each sign or outline lighting 53 40 2
Job No: OW /\I£ g_ Signal circuit(s) or a limited energy panel,
Business Name: alteration, or extension Page 2 2
Description.
Address:
City /State/Zip: Each additional inspection over the allowable in any of the above:
Y P Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other:
, • : , • _ _ , ' .Electricaffermif e'es *, ' '
Supervising electrician Subtotal $ -'/( . X,
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ 3.7 b
TOTAL PERMIT FEE $ 5D . &
Authorized ' Notice: This permit application expires if a permit is not obtained within
Signature: � �- Date: I — / 8 ^ 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
G/ Ki4c G,.-
(Please pnnt name)
1:\Dsts\Permit Forms \E1cPermitApp 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 - t i,)
Check Type of Work Involved:
Audio and Stereo Systems
0 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:
n Audio and Stereo Systems
E Boiler Controls
0 Clock Systems
O Data Telecommunication Installation
O Fire Alarm Installation
n HVAC
fl Instrumentation
E Intercom and Paging Systems
El Landscape h Control
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting
El Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i: \Dsts\Permit Forms\ElcPemvtAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour w . ;
BUILDING Inspection Lin
INSPECTION DIVISION Business Line: MST
1 BUP
Received Date Requested / 7 AM PM BUP
Location / ( � /�'c -�JL (p L Suite MEC o `? n o, 3 - 003
Contact Person .o v Ph ( ) sa y. - a ) R' 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC (10n, - 6057-
Footing
ELC
Foundation Access: Q �n ELR
Ftg Drain E ain / ! ) d/(J
Crawl Drain
Slab Inspection Notes: SIT
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
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 - FAIL
Po - --
Rough -In
Gas Line G
S oke Dampers
in. L PART FAIL
NOM! AL
Service
Rough -In
UG /Slab
Low Voltage •
Fire Alarm
•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
ADAoach/Sidewalk Date i� / � Inspector C2 / / Ext
Other:
Oth
Final DO NOT REMOVE this inspection record from th b site.
PASS PART FAIL