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6804 SW Oa!,, Street
��� �� �����® ELECTRICAL PERMIT
PERMIT#- ELC2002-Ou240
��,�� DEVELOPMENT SERVICES DATF ISSUED. 5/29/02
�, 13125 SW Hall Blvd_ Ticiard OR 97223 (503) 639 4171 PARCEL: 1S136,AD-01100
Sl rE ADDRESS: 06804 SW OAK ST
SUBDIVI- 7N: VILLA RIDGE ZONING: R-4.5
BL LOT : 001 JURISDICTION: TIG
Proiect Descrip n: Install new 200 amp. service.
_RESIDENTIAL KNIT _TEMP SRVC/FEEDERS _—MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGWOUT LINE LTG:
LIMITED ENERGY: 401 60C amp: AI_:
MANF HMI SVC/ FDR: 601+amps - 1000 volts: MINOR
LABEL FL (F(10):
S_ER_VICE/FE_E_D_ER _ _BRANCH CIRCUITS �T _ _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+ amplvolt: v� >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: _ ______SVCIFDR >= 225 AMPS: CLASS AREAISPEC OCC:
Owner: Contractor:
LARSON, MARYAN NE DICKINSONS ELECTRIC
6804 SW OAK ST 8449 SW BARBUR BLVD
TIGARD, OR 97223 PORTLAND, OR 97217
Phone: Phone: 246-3550
Reg#: LIC 65534
SUP 3100S
ELE 2.6-140C
FEES _ Required Inspections
---- ----__
Type By Date Amount Receipt Rough-in
PRMT CTR 5/29/02 $80.30 2720020000( Elect'I Service
Elect'I Final
5PCT CTR 5/29/02 _ $6.42 2720020000(
Total $86.72
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR. Specialty Codes awl all nftic., 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-OCl-QO10 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to
1 i _
Permit SiynatuIssued By:
re: �
OWNER INSTALLATION ONLY_ r
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 S'JPR. ELEC'N: ��_ ..' DATE:- _
LICENSE NO: --
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
------�' Date received:
City of Tigard Project/appi.no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd,'rigard,OR 97223 Date issued: �- By: 616 Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 ,If(` Case fiIcl'' Payment type:
Land use approval:
c
..) I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
J New construction U Addition/a1lt r;uinnhrnlacrnu lt1 J Other: U Partial
JOB SIVE INFORMATION
Joh address: = 111t1p. n.. 'uiir io --.- Tax map/tax lot/account no.:
Lot: I Black: Subdivision
Project name; h ; m and location of work on premises; C tts"_=
Estimated(late of corded . i vi in 1 - -
(ONTRACt011 AMICAT9cllipat
deb no: l ,• Max
— � Dewriplion qty. (w.) Iota( no,insp
Business name: ',)I< /i 2t i// ( �
'T'
�- IVr•r i-midenlial-single or multi-famih per
Address: (/z rtr� JJC(�Y�. L dnellinguult.lot lailmanachedgat•age.
City: vig y State:Cr34r' 7.1 Pr'l7/ 1 Serviceirlelotkd:
r r/er--- 1000 stl fl of
lim:h additional 51x)sq.It or portion thereof
CCB no,: / rlcc. us.tic.nae // 2
_( ., ; C ( I.iomedenergy,residential
City/metro lic.no.: / I.inutedenergy,nan-residential 2
Each manufactured home or modular dwelling
Signolurr-of su icing elect 1c Ile(rct ui ed) _ I)me 71 0 lr Service and/or feeder _ 2
Sul).elect.name(print) c, ii f - Servlceaorfeeden
Su -Installation,
I License no: S alteration or relocation:
2fID amps or less '-
201 amps to 4(N)amps -'
Name(print): 401 amps to6(N)amps '
Mailing addresiV G �(- ) - Ent antpsto 1000 amps '-
(`jty; State: 7.I P: Over 1000 amps or votes 2
Phone: I'u%: r-mail: Reconnecta»ly
Owncr installation:The installation is)zing made on property I own Temporary services or feeders-
which is not intended for sale,lease,rent,or exchange according to installation,aherrlion,orrelornllon:
200 amps ur less 2
ORS 447,455,479,670,701. 201 amps to 4tx)ar»ps --- 2
Owner's si mature: flute: 401 to 600 nm s 2
Branch circuits-nen,alteration,
or extension per panel:
Name: A. Fec far hrnnch circuits with purchose of
Addr ss: �— service or feeder fee,each hr:mch circuit 2
- - —
Cit SIa1r IP: Ii. Fee fat branch circuitswithout purchase
City. of service or feeder fee,first branch circuit: 2
Phone ; � I reel(: Each additional branchcir.uit:
Ilse.(Service or feeder not Included):
J Service ever 225 amps coouuerval J I lealth-care facility Each pump or irrigation circle _ _ 2
U Service over 320amps-rating nf I,@2 U Hazardous location Finch sign or outline lightin�- 2
--
fornilydwellings UBuilding over ln,lNNlsquarefeet fouror Signal(ircuilts)tit alimited energvpanel,
2
U System over((x)oohs nominal more residential units in one structure alteration,or extension*
_
U Building over three stories U Feeders,400 amps or more •Macrition: —
J t)cc•npanl load over 99 pervms U Manufactured structures to RV park Each additional Inspection over the allowable In any of the alcove: _
J 1'.greWlightingplan U Other- _ Per inspection
Submil tins of plans with ant•of the above. Investigation fee
1lie above are not applicable to temporary construction$Mice. Other
Permit fee........ ............$ a
Not all)utudiclions accept credit cards,please call)uriulloion for more information Notice:This permit application Plan rCV1eW(al
U Visn U MasterCard expires if a permit is not obtained -- —
Credit card number L_� within 180 days alter it has peen State surcharge(8%) ....$
expirev accepted as complete. 'TOTAL .......................$ :Y
Name of cerdhol r at shown on credit card s
T--_ sar'dhdaeer algnatnre J�- --Amount 440.461~(6RG COM)
ELECTRICAL. PERMIT FEES: LIMITED ENERGY PERMIT FEES:
— —_ - - —
TYPE OF WORK INVOLVED -RESIDENTIAL ONLY
comL;_ _
— Restricted Energy Fee... ................................... ............. $75.00
Comlete Fee Schedule Below:
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
included: Items Cost Total Check T} )e of Work Involved:
esidetial-per unit $145.15 'l ❑
1000 sq h or less Audio and Sterno Systems'
Each additional 500 sq,ft or t ❑
portion thereof 033.40 Burglar Alarm
Limited Enargy $75.00
Each Manufd Home or Modular 1 ❑ Garage Door Opener'
Dwelling Seivice or Feeder $90.90
Serv:ces or Feeders ❑ Heating,Ventilation and Air Conditioning System'
Installation,alteration,or relocation
200 amps or less $80.30 ) 7 ❑ Vacuum Systems'
201 amps to 400 amps $106.85 —_-
401amps to 600 amps $160,60 2
601 amps l0 $240.60 2 ❑ Oil-
.
amps 2
Over 1000 amps or volts $454.65
Reconnect only $66.85 2
Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONL-Y
Temporary Services or Fe
Installation,alteration,or rely der Fee for each system............................................•.•.••••.• - $75 i)0
$66.85 2 (SEE OAR 918-260-260)
200 amps or less
201 amps to 400 amps _ $100.30 _ 2
401 amps to 600 amps $i33.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, ❑ Audio and Stereo Systems
see"b"above.
Branch Circuits ❑ Boiler Controls
New,alteration or extension per panel
a)The fee for branch circuits ❑ Clock Systems
with purchase of sorvice or
feeder fee. T $6 65 ❑
Each bra ich circuit 2 Data Telecommunication Installation
b)The fee for branch circuits ❑
without purchase of service Fire Alarm Installation
or feeder fee. $46.85
First branch circuit _ -- ❑ H-VAC
Each additional branch circuit $6.65
Miscellaneous ❑ Instrumentation
(Service or feeder not included) f '1
Each pump or Irrigation circle $53.40 -- L J Intercom ani, . jing Systems
Each Fign or outline lighting $53.40
Signal circuit(s)or a limited energy ❑ Landscape Irrigation Control'
panel,alteration or extension _ $75.00
Minar Labels(10) __ $125.00 ❑
Medical
Each additional Inspection ever
the allowable in any of the above $62 50 ❑ Nurse Calls
Per Inspection —
Per hour _ $62.50$73.75 F-1OutdoorLandscape Lighting'
In Plant
Fees: ❑ Protective Signaling
Enter total of above fees $ , ❑ Other — --
g%State Surcharge $ -_ -----.Number of Syslem5
25%,Plan Review Fee $ No licenses are required Licenses are required fnr all other installations `
See"Plan Review"section on -
—
frontofappli,ition - -- Fees:
(Total Balance Due $ - Fnter total of above.fees $—
E -� Tnist AccountM_ _J 8°,:State Surcharge $— -
-------- Total Balance Due $
All New Conimercial Buildings require 2 sets of pians.
iAdsts\formi\eic-facs.doc 08/30/01
i
CITY OF TOGARD 24-Hour
BUILI)ING Inspection Line: (503) 639-4175
MST
INSPECTION UVISION Business Line: (503) 639-4171
BLIP
Received Date F'e fisted. AM_iA — BLIP
Location __tel Suite_*_ MEC
Contact Person _ _____. Ph(— ) PLM _
Contractor -- - Ph(--- —) off- SWR -
BUILDING lenanVOwner -._ _- _—_-_- _ ELC -4=�1
Footing ELC
FoundationArse,s: , _ �
Fig 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 WFc F �Y
Fire Alarm
Susp'd Ceiling
Roof
Other' _--_--
Final
PASS PART FAIL
PLUMBING_
Post&Beam
Under Slab -
Rough-In
Water Service - - ---- - --- --- --_
Sanitary Sewer
Hain Drains ------- - -- — - -- - -
Catch Basin/Manhole
Stor n Drain ---- - ----— -------
Shower Pan
Other. --- ------- -- -� - —
Final
PASS PART FAIL - --
MECHANICAL
Post RBeam - - -------------- --- -- � .T---,� - --
Rough-In
Gas Line
Smoke Dampers
Final
T FAIL
LECT i
�ServFc_e — --`---
Rough-In
UG/Slab
Low Voltage
Fire Alarm
final -PART FAIL F-1 Reinspection fee of$ �- required before next inspection. Pay at City Hall, 13125 SV
,.,'Hall Blvd
nPlease call for reinspection RE: _ [� Unable to inspect- no access
Fire Supply Line
ADA
Approach/Sidewalk Dab Inspodor. T � :;,C — Ext
Other: —_—
Othe
c.41
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL