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1 1705 SW ANN ST
CITY OF TIGARD ELECTRICAL PERMIT
Y PERMIT#: ELC2003-00552
DEVELOPMENT SERVICES DATE ISSUED: 9/4/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCFL: 2S103BA-00116
SITEADDRESS- 1 1705 SW ANN ST ZONING: R-4.5
SdBDIVISION: LERON HEIGHTS
BLOCK: LOT : 016 JURISDICTION: TIG
Project Description: 200 amp panel
_ RESID_ENTIAL 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 arnp: SIGNALWANEL.
MANF HM/SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
_ SERVICE/FEEDER BRANCH CIRCUITS ,_ ADD'L INSPECTIONS
0 200 arnp: 1 W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 arnp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCrI CIRC' IN PLANT:
_ PLS
601 - 1000 arnp: N REVIEW SECTION
1000+amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL
Reconnect ons — — SVC/FDR>=2.25 AMPS: — CLASS AREA/SPEC C:,C:____
Owner: Contractor:
ERWERT, ROBERT E TRUSTEE TRI STAR ELECTIC INC
11705 SW ANN ST PO BOX 231175
TIGARD,OR 97223 TIGARD,OR 97:281
Phone: Phone: 503-860-5249
Rey #: ELF 34-620C
LIC 153559
FEES SUI, 8325
Description — Date _— Amount Required inspections
I f:LPRMTJ ELC Permit $80.30 --
1'ANj R'.'S,State Tax v 1 i; $6.43 RoughS
_ Elect'I Service
Total $86.73 Elect'I Final
chis 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&ys 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
'.-800-332-2344.
Issued By: � e _� _ Permit Sinnature:
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?ern,it Application 111111 Ewa
date received Permit no.:
Pity of Tigard I vjece/appl.oo. Expire date: -
City of Address: 13125 SW Hall Blvd,Tigard,OR 97223 Wit issued By. Receipt no
Phone: (503) 639-4171Case file no Paymit t--yr-
Fax:
pe:
Fax: (303)598-1960 —
Land use approval: --- '17ERt\A 1 T E-,'.-.C—Z•00 3- p p�`'S 2
J Multifamily J Tenant improvement
7-JJ
1 &2 family dwelling or accessory UCommercial/industrial partial
New construction IU Addition/alteration/rcpl ace mens J Ocher: ______.—
Job address: fl
Bldg. no.: Sui'.e no.: Tax man/tax lovaccount no.: 0_1 Le
Lot: Block: Subdivision �� +1�1 '�
Proj!:t name: 7fhscription and location of work on premises:
Decimated date of completiodinspectio t:
Fee fYha
)� Deacripllon (sw) Tohl ro.l
Business narnw: j•Q t f1{ewrm�ewhi 4nekorwrid rarity Per
Address: uvtceedasardl.Irrrhdraamr#o�Rarrgte.
_ State:Q zip: 9,101 15 �"e 4
City: '��G�t A2 r•� I!!T it :a less
Phone: �A. Fax: PO-VP mail rel- tisch adtutbnai soo sy n n►Lon thereof
CCB no.: I Elec.bus.tic.no: - - Limited �gy, re,.iknial 2
CltY/metro lie.n0.' �.I/ �_��
—La mted energy, nun-msidmrial 2
Earn manufaaurc'd horse ra modular dwelling 2
_ Dab �-+ Service andiot feeder
Si tore of WPtT1iams a ion 1 aired) — -- - Serrlcese�rce4err-imhrlatlow,
Sup elect name(prim) �L%Aid �tk Lioeare ao' alteration orrewcatION:
20U or leen 2
201 &=to 400 amen 2
Name(print): (-'T- �►JE�-T -- 401 amts to� � 2
Mailing address: I Q 601 amps to 1000 amp; 2
City: (� State: ?.IP ��, 3 Orer IU(h)e a roan =42
Phony. ax. E-mail:
Recrnnect only1
Teaspaeary aerrlrea far feeder.-
()Wf1ef installation: The installation is being made on property I own Itaau�lies.albratlea,sreiatatlsa
which is not intended for sale,lease,rent,or exchange according to 20u iced : _
()RS 447,0'.55,474,670,701. ml to 40t1 2
Uwvtur s aw
l3atc: 401 to 6W 2
�nhac,cheadb-new,shersHoe.
eir ettetethftos der pact:
Name: n Fee for branch circuit,vl*purchm of
Address.
service at feeder fee.each!ranch circus _ 2
State: ZIP: B Fee Por Mau:h circida wflrart pachaae
— of amvice a feeuer fee.Lina Irmch circuit 2 _
Phone: Fax: Email: ,;�,d,y,�„d eaaach circuit:
IIQae.(8er.ke a teener oor Iseladed):
J Itealth tam ta,deN F,acla Pm�rlgarx!n cncle - 2
J Senxt oveY 125 anpaatsitrhaeW Inch Agit m ardtne hghtirh� _
J Service aver 1-30 amps-rating of 1a:2 J Ht>atdnut h,ntitm — _.
pmih, daelhnp J Ftuilding over 10(1(1(1 square tett four t„ st"I rrreurll+t m a horned anergy parr?, 2
more residential units at one gbwwtr sheraam or extellsvir* ,
System aver MIO�r,lb nominal — __.-
J ttutltttng ova duce Nares J Ferdas.MIO amu or more exit atm
J(kcupant Mrd over 99 p:rwha J Manuficlwed muco m or RV Md' Farts dNt1mr1lmpredes over the anowa►1r in anv or the abort:
J 1-4n�cltfdnMs plan J Otho
.Structs _ _ ata of glia tarhh m7 of Ow above. 1 fee --
list.bore art idol t1//MeaMe to litarora�)ecoastractk►o aerrfce.
(After
_ Permit fee .
SAl Jw�
via crn sa arrM card',p*ktw call whrd+Nm"as are info
all W%diaoagramianc
n. Nae: This permit applicatim Plan review(at 'b) $ _
�j vim J MaNed aid res expiif a permit is not obtained State surcharge I'3°tl
-- -- __L — within IRO days af*h has been [-.Z--
rreda rid *aosn Y _ occelited as Complete. TOTAL. ..... ......
Naso of a atreanh er . card s
440461!(6,10'OM i
- t'arAwlda slstrhWte '_— Alerraa
CITY OF TIGARD _ ELECTRICAL PERMIT _
PERMIT#: ELC2003-005`,.
DEVELOPMENT SERVICES DATE ISSUED: 9/4/03
13125 SW Hall Blvd., Tiaard. OR 97223 (503) 639-4171 PARCEL: 2S103BA-00116
SITE ADDRESS: 11705 SWANN ST
ZONING: R-4.5
SUBDIVISION: LERON HEIGHTS
BLOCK: LOT : 016 JURISDICTION: TIG
Project Description: 200 amp panel
RESIDENTIAL UNIT TEMP SRVCIFEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: -11 •• 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
rl 230 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:
" SECTION
PLAN REVIF!
601 - 1000 amp: _ _ —_
1000+ amplvolt: >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVC/FDR>-225 AMPS: _CLAS:.' AREA/SPEC OCC-
Owner: Cr actor:
ERWERT, ROBERI EIRUSTEF OWNER
11705 SW ANN ST
TIGARD,OR 97223
Phone: Phone:
Reg#:
FEES
Description Date Amount
— Required Inspections
IEL.PRMTjELCIlennit 9/4/03 $80 'jt) -------.
ITAX1S",,StateTax 9/4/03 $6.43 Rough-in
Elect's Service
Total $86.73 Elect'I Final
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.
iiIssued 8y: /,J'c I_l�/L� � c� LL�3. `..___. Permit Signature: zo CL-0
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: __ ' h,, DATE:
LICENSE N O: — ------ - - -- — ---— -- —_—
Call 639-4175 by 7:00pm for an inspection the ne.:' business day
FOR OFFICE ItNE ONI.N
Electrical Permit Application Received( Electrical
Date/By: .3 PermitNcIaCJ,4V5 00
Cit of Tigard Planning App oval Sign
Date/By: Pernut No.:
13125 SV.' Hall Blvd. RECEIVED Plan Review Other
Tigard,Oregon 97223 DateB : Permit No.:
Phone: 503-639-4171 Fax _J04l i Post-Review Land Use
Date/By: Case No.: _
Internet: www.ci.tigard.or.us Contact Juris.: 0 See Page 2 for
24-hour Inspection Request:`-?j.M91iURRL) Name/Method: _ Supplemental Intormation._
BUILDING DIVISION
-
� 'tEat�1�-'� —Ne
w construction _ _ Demolition Service over 225 amps- B Health-care facility
commercial ❑Hazardous location
dition/alteration/re lacement Other: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet,
1&2 family dwellings four or more residential units in
&2-Familydwellin J 1� Commercial/Industrial ❑System over 600 volts nominal une structure
$uildlri Multi-Fam11 ❑Building over three stories ❑Feedets,400 amps or more
g y __ ❑Occupant load over 99 persons ❑Manufactured structures or RV park
El Master Builder Other: ❑Egress/lighting plan ❑Other:
Submit sets of plans with any of the above.
`�`''= "*' - -Wo--- I'he above are not applicable to temporary construction service.
Job site address: 245 W 'N
Suite#: Bld ./A t.#: Number of ins ections per permit allowed
Project Name: Descri tion Qty I Fee(ea.) Total
Cross streeUDirections toob site: New residential-single or multi-family per
J d.velling unit.Includes attached garage.
Service Included:
1000 sq.ft.or less 145.15 4
Each additional 500 act.ft.or portion thereof 33.40 1
Subdivision: LOt#: Limited energy,residential 75.00 2
_ Limited energy,non residential 75.00 2
Tax map/ afcel#: Each manufactured home or modular dwelling
service and/or feeder 90.90
Services or feeders-Installation,
i r:`4/J alteration or relocation:
L7 G /�/�,= 200 amps or less 80.30 2
201 amps to 400 ams 106.85 2
401 amps to 600 ams I60.60 2
601 amps to 1000 amps 240.60 1
/ _ Over 1000 amps or volts _ 454.65 2
Name: cj,�i`S/- R'r lam. r�w L:�C' Rer,mnect only 66.85 2
Address: j j Temporary services or feeders-Installation.
alteration,or relocation:
City/State/Zip: T/ (j A 0 L/2 l 1-72 2 _ 66.85 1
� 200 amps or less
7 � l.' F�Yf ( aX: 201 ams to 400 amps 100.30 _ 2
Phone:
�� 401 to 600 ams 133.75
Branch circuits-new,alteration,or
Name: extension per panel:
Address: r� A.Fee for branch circuits.pith purchase of
_ 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):
Each pump or irrigation circle 53.40 2
Each sign or outline light nz 53.40 2
Job No: _ G ,( ��L NL Signal circuit(s)or a limited energy panel,
Business Name: alteration,or extension Pae
Description:
Address:
- -- Each additional Inspection over the allowable in any of the above: r
Clt /State/ZI Per inspection per hour(min. 1 hour) 62.50 _
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other
Supervising electrician Subtotal S
signature required: Platt Review(25%of Permit Fee) S
Print Name: Lic. #: State Surcharge 8%of Permit Fee S t
TOTAL PERMIT FEE I S
Authorized ('' (j ��, Notice: This permit application expires if a permit Is not obtained within
Signature: dLyyr C t,,J ; 180 days after it has been accepted as complete.
204h` *Fee methodology set by Tri-County Building Industry Service Board.
(Please print name)
1:\Dsts\Pminit Ftmne\ElcPermitApp.doc 01/03
Electrical Permit City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Feefor all systems............................................................ $75.00
Check Type of Work Involved:
Audio and Stereo Sys, s*
Burglar Alarm
L J Garage Door Opener*
aHeating,Ventilation and Air Conditioning System*
DVacuum Systems*
0 Other_ _---
COMMERCIAL WORK ONLY:
Fee for each system......................................................... S75.00
(SEE OAR 919-260-2uOl
Check'rype of Work Involved:
Audio and Stereo Systems
Boiler Controls
Clock systems
ED Data Telecommunication Installation
n Fire Alarm Installation
HVAC
Instrumentation
intercom and Paging Systems
ElLandscape Irrigation Control*
Medical
Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
Other -
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit For=\E,cPertnitokppPg2.doc 01/03
CITY OF TIGARD 2.4-Hour
BUILDING Inspection Line: (503) 639-4175
MST
INSPECTION DIVISION Business Line: (503) 639-4171
BUP
Received __ °�` Date Requested__ f r - AM - PM_—__-__ BUP _
Location ___— 7 Q S_ _Suite -- MEC
Contact Person -- - __ Ph d •S� PLM __---
Contractor _— —..— _ _ Ph(— ) SWR —
BUILDING TenantlOwner ELC
Footing ELC
Foundation Access:_ T v
Fig Drain '1'12-1 *kA/ ELR _
Crawl Drain SIT
Slab Inspection Notes:
Post&Beam -- -
Shear Anchors
Ext Sheath/Shear - --- --
Int Sheath/Shear
Framing --
Insulation
Drywall Nailing ---
Firewall /
Fire Sprinkler —
Fire Alarm
Susp'd Ceiling - - —
Roof _
Other: - -
Final
PASS_PART FAIL
PLUMBING
Post& Beam
Under Slab ----- -
Rough-In
Water Service ------ - - - - _
Sanitary Sewer -
Rain Drains -� -
Catch Basin/Manhole
Storm Drain —�- �- -—
Shower Pan
Other: --
Final _ _ -
PASS PART FAIL—
74
MECHANICAL % - ---- -
Post&Beam l -
Rough-In — ---- ---
Gas Line _
Smoke Dampers ----- --
Final
PASS PART FAIL
jEWCAL
Rough-In
U&Slab
Low Voltage - -- - - - -- --
Fire Alarm
F1 [] Reinspection fee of$- __ _____required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
_PASS PART FAIL r
SITE Please call for reinspection RE:-- _ ,u Unable to inspect-no access
Fire Supply LineADA `
Approach/Sidewalk (Date 1C`/� F L� - inspector __77-1 Ext
_---
Other:_-
Final DO NOT REMOVE this Inspection rocord from the Job site.
PASS PART FAIL