Permit 4, --- CITY O F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00522
"velll DEVELOPMENT SERVICES DATE ISSUED: 8/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 104AD -03802
SITE ADDRESS: 12630 SW WALNUT ST
SUBDIVISION: ZONING: R-4.5
• BLOCK: LOT : JURISDICTION: TIG
Project Description: Temporary service
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: 1 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:
SMITH, NANCY SELINA OWNER
12630 SW WALNUT ST
TIGARD, OR 97223
Phone: 503 - 692 -5436 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/21/03 $66.85
[TAX] 8% State Tax 8/21 /03 $5.35 Elect'I Service
Total $72.20
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: 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
Electrical Permit Application FOR OFFICE USE ONLY
Received Electrical ��,, Q� ""
Date/By: 3 1 9 41 1 9`)'11, Permit No. Ek dOZ — v O 52 2
City of Tigard Planning Approval Sign
Date/By: Sign
No..
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 /a Post - Review Land Use
�r' +� Date/By: Case No.:
Internet: www.ci.tigard.or.us ■ �, e l Contact Juns ® 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)
J New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement LI 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
jI 1 & 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 applicable to temporary construction service.
Job site address: )a2(o3 p St.) l,// 4 kne-r ST FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: ,/fp/Ic'/ it QED( Stn / Description Qty Fee(ea.) Total
New residential - single or multi - family per 1
Cross street/Directions to job site: dwelling unit. Includes attached garage.
lAr(5si 0 r 421.57 , 0l✓ (,,/<YLPUT 5 j Service included:
1000 sq ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
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 OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
7 ?r»P, [le 2 A /._E2 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
IZE PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: AAA nl e / SP-) / 17-1 Reconnect only 66.85 2
Address: 06, 3D , S' i, ) WA I- n1 if % S- Temporary services or feeders - installation,
alteration, or relocation: I
City /State /Zip: r16 A ,- D� r17 2 2 3 200 amps or less 66.85 (p (, .
Phone: � 0 3 109 a 5 Y- 3 (, Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
El APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: Sal in r 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
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):
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,
alteration, or extension Page 2 2
Business Name: O(dm /2 Description.
Address:
Each additional inspection over the allowable in any of the above:
City /State /Zip: Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
Other:
CCB Lic. #: Lic. #:
Electrical Permit Fees*
Supervising electrician Subtotal $ ( (a • 'LC
signature required: Plan Review (25% of Permit Fee) $ 5, 3 .S
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $ . a D
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 ' f •
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
Garage Door Opener
I I Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
D Audio and Stereo Systems
O Boiler Controls
Clock Systems
D Data Telecommunication installation
D Fire Alarm Installation
D HVAC
n instrumentation
n intercom and Paging Systems
n Landscape Irrigation Control
O Medical
Nurse Calls
Outdoor Landscape Lighting
D 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 r.
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested — 2-2-- AM PM BUP
Location / 30 - Suite MEC
Contact Person aA U Ph ( ) 6 Ala r S 13(p PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner • ELC — 0()5
Footing
Foundation ELC
Access:
Ftg Drain ELR
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 121
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
�ervice�,
dough -In
UG /Slab •
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for --inspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Dat - c / I' /L ✓ Ext
Approach/Sidewalk Inspe ; ��_�.
Other:
Final DO NOT REMOVE this Inspection record from the j site.
PASS PART FAIL