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11230 SW FAIRHAVEN STREET N W O cn C 'n m z cn i 11230 SW FAIRHAVEN ST CITY OF TIGARD ELECTRICAL PERMIT PERMIT#: ELC2004-00273 DEVELOPMENT SERVICES DATE ISSUED: 5/19/2.004 13125 SIM Hall Blvd., Tigard, OR 97223 (503) 6394171 PARCEL: 2S103DC-00818 SITE ADDRESS: 11230 SW FAIRHAVEN ST ZONING: R-3.5 SUBDIVISION: VIRGINIA ACRES NO. 2 BLOCK: LOT : 011 JURISDICTION: TIG Project Description: Repair meter base r— RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGNIOUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMI SVC/FOR: 601+amps - 1000 volts: MINOR LABEL 110): SEh'JICE/FEEDER BRANCH CIRCUITS —ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FOR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 10004- amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnoct onl 1 _ SVC/FDR>=225 AMPS: _ CLASS AREA/SPEC OCC: Owner: Contractor: GARY STALEY WILLAMETTE ELECTRIC INC 11200 SW FAIRHAVEN ST PO BOX 230547 TIGARD,OR 97223 TIGARD,OR 97281 Phone: 503-887-4002 Phone: 503-624-3631 Reg #: LIC 75059 ----- SUP 1965S _ FEES _ ELE 34-283(' Description Date Amount Required Inspections I I.I'ItMT] 1(PPrrmii 519/2004 $66.85 — I AX]8%State Surcharge 5/19/2004 $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 riles are set forth in OAR 952001-0011)through OAR 952-001-0100 You may obtain copies of these rules or direct questions to OUNC at(503) 24616699 or 1-800-332-2344 Issued By: �(:. }� �k 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: – `2 S- r LICENSE NO: Call 639-4175 by 7:00prn for an inspection the next business day Electrical PerWit Application FOR OFFICE USE ONLY i Received Electrical D&W/B — Permit No. _ - ,e"�;Z City of Tigard Planning Approval Sign DateB : _ Permit No. 13125 SW Hall Blvd. Plan Review _ Other -- Tigard,Oregon 97223 Date/By: Permit No. Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land use DateB : Case No_ _ Internet: wWw,ci.tigard.or.us contact Juris.: See Page 2 for 24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information. El �, .__.�_. , _ •'i iii`. New construction lition Service over 225 amps- Health-care facility commercial ❑Hazardous location Addition/alteration/re latemeCnt: ❑Service over 320 amps-rating of ❑Building over 10,000 square feet, x. 't" l&2 family dwellings four or more residential units in I &2-Family dwellingndusthal ❑System over 600 volts nominal one structure ACCeSSO BUlldln Building over three stories ❑Feeders,400 nrnps or more ❑Occupant load over 99 persons ❑Manufactured structures or RV park ❑ Master Builder ❑Egress/lighting plan ❑Other- W? ther:© 41 Submit—sets of plans with any of the abc ve. The shove are not applicable to tzinfinrary construction service Job site address: 117 3u S Suite#: Bld ./A to _ N_umber of ins ections eruermit allowed Project Name: h i Descrl Non _ Qty Fee ha.) Total New residentlal-single or midti-family per Cross street/Directions to job site: dwelling unit.Includes attached garage. Service Included: 1000 sq.ft.or less 145.15 _ 4 Each additional 500 sq.ft.or portion thereof 33.40 1 Subdivision: Lot#: Limited energy,residential 75.00 2 - Limited energy,non residential 75.00 _ 2 Tax ma0arcel #: Each manufactured home or modular dwelling '-' s -'0 T1 ' 'p —'"A••1 service and/or feeder 90.90 2 Services or feeders-Installation, �r f d•r /1 i ' t ' alteration or relocation: 200 amps or less 80.30 2 -- - - - 201 amps to 400 amps �^ 106.95 2 401 amps to 600 amps _ 160.60 2 p �N:jY Le - 6D1 amps to 1000 amps -- ---- 240.60 2 ame: Over 1000 amps or volts 454.65 2 Reconnect only 6&85 2 Address: ii 2y 5 r t,i y t s, l� Temporary services or feeders-installation, alteration,0ampso le relocation: City/State/Zip: E. civ,,/ � re 5 7 C L 3 _ 200 amps or less 66.85 i 201 ams to 400 ams 100.30 2_ Phone: -?��) ✓ r ; Fax: 401 to 600 ams 133.75 2 -- Branch circuits-new,alteration,or Narne: extension per panel: Address: A.Fee for branch circuits with purchase of service or feeder fee,each branch circuit f.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 lighting 53.40 2 Job No: -/717,7 _ Signal circuit(s)or a limited energy panel, Business Name: W. Ila—P+k y I e e�_tw c alteration,or extension Pae 2 2 Description. Address: 9710 S w T, ,& / r,- City/State/Zip: y-, 0/ 01 91 t L Each additional Inspection over the allowable in an of the above: _ Per inspection per hour(min. I hour __ 62.50 Phone: 6f- Ti.?/ I Fax: '�' 17-67,v- Z 5 3Y Investigation fee _ CCB Lic. #: 0 7j-,) ) 9 Lic. #: Y- t r i - Othet: Supervising electrician ____� Subtotal S b signature required: Phut Review 25%of Permit Fee S _ Print Name: ! d.. r. Lic.#: /S 6– - f State Surcharge 8%of Permit Fee S _ 3 TOTAL PERMIT FEE S — — Authorized Notice: This permit application expires If a permit Is not obtained within Signature: —i, Date:__ 190 dans after ft has been accepted as complete. `Fee methodology set by Tri-County Building Industry Service Board. (Please print name) i:\Dsts\Pemdt Fnrms\ElcPetmitApp.doc 01/03 Electrical Permit Application- City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Feefor All systems............................................................ S75.00 Check Type of Work Involved: Audio and Stereo Systems* B�rgiar Alarm f;arage Door Opener* FHeating,Ventilation and Air Conditioning System* EJVacuum Systems* 0 Other COMMERCIAL WORK ONLY: Fee for each system......................................................... $75.00 (SEE OAR 918-260-260) Check Type of Work Involved: ❑ Audio and Stereo Systems Boiler Controls Clock Systems ❑ Data Telecommunication Installation Fire Alarm Installation I4VAC Instrumentation Intercom and Paging Systems Landscape Irrigation Control* y Medical Nurse Calls ❑ Outdoor Iandscape Lighting* 7 Protective Signaling Other Number of Systems * No licenses are required. Licenses are required for all other installations i.U9sts\Pernnt Forms\EIcPermitAppPg2 doe 01/03 j CITY O=TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503) 639-4171 BUP — Received Date Requested / _ —� AM _— PM— BLIP Location ____; ..��- �/> I�...�—_-Suite -- _- MEC Contact Person _ -- Ph( ) ___ _ PLM Contractor _._ — __.___-_ Ph SWR — BUILDING i Tenant/Owner __ _ ELC0. Footing — Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes. SIT --- -- - - Poc.t& Beam ------- Shear _Shear Anchors -- -" - Ext Sheath/Shear Int Sheath/Shear Framing - -- ----- --- ------- --- Insulation Drywall Nailing --- - - —_ --- --------- - Firewall Fire Sprinkler - - ---- --- - ----- ---- . ----- Fire Alarm Susp'd Ceiling ---- — - Roof Other - -- Final PASS PART FAIL -- -- PLUMBING Post&Beam Under Slab - Rough-In - Water Service - - aanitary Sewer Rain Drains Catch Basin/Manhole / Storm Drain Shower Pan 01 her: -- - Final PASS PART FAIL MECHANICAL - —- -- ---- -- _ - Post&Beam - - Rough-In ----- - - Gas Line Smoke Dampers --- - Final PASS PART_ FAIL -- - ELECTRICAL Service - - Rough-In UG/Slab Low Voltage Fire Alarm AS PART FAIL Reinspecticn tee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. E — Please call for reinspection RE:__ _ __ Unable to inspect-no access Fire Supply Line App PP }:Mar Date Ins). Ext Other: Final DO NOT REMOVE this Inspection recond from the Job site. PASS PART FAIL