Permit �1 IT OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00674
111.d DEVELOPMENT SERVICES DATE ISSUED: 10/21/2004
+L 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 - 4171
PARCEL: 25101 AB -01606
SITE ADDRESS: 07357 SW BEVELAND RD
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT : 017 JURISDICTION: TIG
Project Description: Temp power
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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:
TOM CLARKE JARMER ELECTRIC INC
12448 SW ORCHARD HILL RD 5105 SW 45TH AVE
LAKE OSWEGO, OR 97035 PORTLAND, OR 97221
Phone: 503 - 293 -1226 Phone: 246 -5381
Reg #: LIC 6924
SUP 4044S
FEES ELE 26 -144C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/21/200' $66.85
[TAX] 8% State Surcharge 10/21/200' $5.35 Elect'I 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 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 B / Permit Signature: i
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:OOpm for an inspection the next business day
Elez'trical Permit Application • l'OR °H AG: usI: ONLY
City of:d'igard Received Pemtit No.: (C�� 6 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 A ' ! " ��� Date/B . Other Permit:
Inspection Line: 503.639.4175 `' � Date Ready/By: Juris: VI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW •• .
•
`• New construction ❑ Addition/alteration/replacement Please check all that apply:
!� ❑Service over 225 amps, comm'I ❑Hazardous location
❑ Demolition Other:
1 ❑ ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
• CATEGORY OF CONSTRUCTION i of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling .Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑ Master builder 0 Other:
[' [Occupant load over 99 persons ['Manufactured structures or
• JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: leo l ' yep Job site address: 7757 51 46 24 ❑H�Ith care facility ['Other: Submit 2 sets of plans with any of the above.
City/ State/ZiP: ,.6, 472_ 4 The above are not applicable to temporary construction service.
FEE* SCHEDULE .
Suite/bldg. /apt. no.: Project name: ( � 1 �/ K 4 <4 p,' ,
Description Fee Total ••
Cross street/directions to job site: 7 J' ,g- 4"s ,C2 New residential single- or multi - family dwelling unit.
/�.,� Includes attached garage.
!._{/Gz - 5, 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
no.: y� Limited energy, residential 75.00 2
Tax map/parcel
2 5.)o ( is 0/4,04. Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
EMI /2 � �� dwelling, service and /or feeder 90.90 2
,' ` Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
• • ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation `�
Phone: ( ) Fax: ( ) 200 amps or less / 66.85 rah 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
. ❑ APPLICANT 1 ❑ CONTACT PERSON• A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
• extension. Describe: Page 2 2
Business name: TR2 £2 Et.Eo Tr2re. t Do C -
Address: s/ o .s 6-W '1 S ' - ST L0 0 Each additional inspection over allowable in any of the above
nn f Per inspection 62.50 _
City/State/ZIP: /''p-/Z j � it) 4 0 2 7 2 2 / Investigation per hour (1 hr min) 62.50
'/ Industrial plant per hour 73.75
Phone: j) 2 `f Co — ,S 3 tS / Fax: (s03) Z V �/ - U 3 7 ELECTRICAL PERMIT'FEES*
CCB Lic.: to. 92 L/ Electrical Lic.: Zoo /'UyG Suprv. Lic.: yogi/5 Subtotal ettoeo li'r
Suprv. Electrician signature, required: �-( t Plan review (25% of permit fee) fir--`'
ate: 6/ State surcharge (8% of permit fee) 5' 3',�
Print name:
�S 4 2 ��� /f'1 E / �� Z� TOTAL PERMIT FEE 72 s
Authorized signature: This permit application expires if a permit is not obtained 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.
is\ Building \Permits \ELC- PcrmitApp.doc 12/03 440- 4615T(10/02JCOM/WEB
■
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested // � � � AM PM BUP
Location '7357 L • , / Suite MEC
Contact Person Ph ( ) PLM
Contractor. _ Ph ( ) o � 3 SWR
BUILDING Tenant/Owner �2 (q c / , 4 ' '/ ELC 01� y -O 674
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
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
Service
Rough -In •
UG /Slab p /'
Low Voltage
Fir larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call fo einspection RE: Unable to inspect - no access
Fire Supply Line
ADA j ,
PP
A roach /Sidewalk Date L/ Inspector 44 — — • Ext
Other:
Final DO NOT REMOVE this inspection record fro the s b site.
PASS PART FAIL