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Permit 4, , CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00061 DEVELOPMENT SERVICES DATE ISSUED: 2/4/2005 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S104DB -03400 SITE ADDRESS: 13110 SW WELLINGTON PL SUBDIVISION: AMESBURY HEIGHTS ZONING: R -4.5 BLOCK: LOT : 034 JURISDICTION: TIG Project Description: Reconnect only. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUTLINE 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: BARBAY, JOHN OWNER 13110 SW WELLINGTON PL TIGARD, OR 97223 Phone: 503 - 590 -5280 Phone: Reg #: FEES Description Date Amount Required Inspections [ELPRMT] ELC Permit 2/4/2005 $66.85 [TAX] 8% State Surcharge 2/4/2005 $5.35 Electrical final 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 Utili o i ation Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of th s or direct • e o o OUNC at (503) 246 -6699 or 1 -800- 332 -2344. Issued By: Permit Signatu e: / / 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 Appli V teN FOR OFFICE USE ONLY a• City of Tigard Received ^�� �� Permit No.. � O 0 I Tigard, OR 13125 SW Hall Blvd., Ti Date/By g �oo� Plan n Review !/ eview Phone 503 639 4171 Fax. 503. 8.1960 �� ""sl rh\ D ate/By. Other Permit Inspection Line: 503.639.4175 ( �L n!. Date Ready/By Juns Fl See Page 2 for Internet. www.ci.tigard.or.us ` r(1 Notified/Method - Supplemental Information ; t' �d,. , .. '.F - . ; "„' _ , `:��j'Y. ■ JO , .'i.•:, 'r; . edvr: • „".p'a�• K :4i: r '�' " , ri;.;.na €� ` 61V _ A. _ r, .. ❑ New construction ❑ Al • t., Ai : on/replacement Please check all that apply: ❑ Demolition g ,)t (r ['Service over 225 amps, comm'l ❑Hazardous location ❑Service over 320 amps – rating ❑ Buildng over 10,000 sq ft , • :. CATEGORY f.OF , R UCTION; �x tL" "'= Il an of 1- and 2- family dwellings 4 or more new residential K1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building System 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 .'"/;= r•' . ,' , ' , - '1 . 1i .- , - ,,,_ : , - ,!;, OB_ ' r 3istiO: MJ TZO '' ANA' L O C 2 i _TroNY ; ;. . :, _ , ` �'.:, .. ❑Egress/lighting plan RV park Job no.: Job site address: 131 JO St,3 wet /01 Pi. ❑Health -care facility ❑Other Submit 2 sets of plans with any of the above. City /State /ZIP: 1 16A- (3 / 0 E, G(` 72.23 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: ' r•.. tz , r ,?,e�;F�s,`E: * °.� 0,1 ,'D:CI;I�E ;a,_' Description Qty. Fee. Total Cross street/directions to job site: 1 J 0_ hG C ? Oc. lr16110‘..,‘ New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 l Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75 00 2 1 ' , - `.;' , '' - -`!1"."':= , ::' ' ,,if' :. - "zy ?DESCRIPTION OF WORK ' S 1 . _ =:.-} '' 1 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 kt'i4E-Rty :, ci VER - . +.: -',..1:„":' rw , , ,p" Tr} + ” t ! , w ' 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 77 13 4, 134 601 amps to 1,000 amps 240.60 2 Address: 131 ` ® ,9Lt) (,t) e [f? n �ti P / Over 1,000 amps or volts 454.65 2 t9 Reconnect only g 66.85 2 City/State /ZIP: `"- 16 f)e b / 0 e_ ' 7223 Temporary services or feeders installation, alteration, and/or Phone: (5 3 S�D - S2 g O Fax: ( ) 2 2000 0 a amps mps or less 66 85 1 Owner installation: This installation •: se'. 1. made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, l , ren , ex s . 1. , • c. ordin: to • 'w 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature / Date: Branch circuits – new, alteration, or extension, per panel K ' , . 1 ,.: • APP CAN ; h : : - � ".I. � , . ,0-: 4 � f ] CON`P E RS • O &',,''.>.- A. Fee for branch circuits with ....- -' "" service or feeder fee, each Business name: aw,(if branch circuit 6 65 2 B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'I branch circuit 6 65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax:: ( ) Pump or irrigation circle 53 40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- • ": • 'ar" r°ta - ; r • 3;{' °-- + energy panel, alteration, or . _ 4 _" �• .i:., .. . t � �,C OI�TRACT:01t . ; . - "'s <,., .... `r� -� �w -�`•,. � `*s;. _� ;t extension. Descnbe• Page 2 2 Business name: at,),1)---,_ Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Investigation per hour (I hr min) 62 50 Phone: ( ) Fax: ( ) Industrial plant per hour 73 75 '..", '."..:0;E7,71-004.;:k ER1*t,tEE5ti "'r''`•:° '... 1 ` . CCB Lic.: Electrical Lic.: Suprv. Lie.: Subtotal pb, g t Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: Date: State surcharge (8% of permit fee) 3S TOTAL PERMIT FEE 7 .2 d Autholized signature: This permit application expires if a permit is not obtain ` 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\ Permits\ELC- PemutApp doc 12/03 440-46 15T( 1 0/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 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: U rg it . ,r W �ll'�.Vl� \1i 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 .\BwldingTerttuts\ELC- PetmttApp doc 04/03 CITY OF TIGARD , • 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION -- Business Line: 503) 639 -4171 ' -T �-y UP Received Date Requested _a AM - M ./ / BUP Location / 3 //d (,)LP,�'i / ; Suite MEC Contact Person (/ P , " ) PLM Contractor - P ( ) / / SWR BUILDING Tenant/Owner 4 ��a - 3�"t 4- / LC 003' o ( I Footing S g Sa o ELC Foundation Access: 15 Z f Ftg Drain ELR Crawl Drain • Slab Inspection Notes: 42, . _ �� -- SIT Post & Beam 1 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 I_ _ 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 T FAIL C L erica Rough -In UG/Slab Low Voltage Fir - m ' �� El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. (I1 PART FAIL S ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA � j Approach/Sidewalk Date - - L/ Inspector ` Ext Other: Final DO NOT REMOVE this Inspection record fr he job site. PASS PART FAIL