Permit - CI TY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2002 -00668
a l l DEVELOPMENT SERVICES DATE ISSUED: 12/31/02
11. � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 1S136AD-06505
SITE ADDRESS: 10998 SW 68TH PKWY
ZONING: C -G
SUBDIVISION: WAY LEE
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: Install 200 amp temporary service.
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:
BANK OF SALEM R + R ELECTRIC
PO BOX 847 PO BOX 52
SALEM, OR 97308 TURNER, OR 97392
Phone: 503 - 585 -5290 Phone: F- 743 -4044
Reg #: 15f1- 743 -259
ELE 24 -121C
FEES SUP 1673S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/31/02 $66.85
[TAX] 8% State Tax 12/31/02 $5.35 Elect'l Service
Rough -in
Total $72.20 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- 3�2 -23
Issued By: Li tj:,4 �� , � _ 1 Permit Signature: r Cc'+DU `12'
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• 6 P • DATE:
LICENSE NO: / S 5
Call 639 - 4175 by 7:00pm for an inspection the next business day
12/30/2002 11:08 5037434044 RR ELECTRIC PAGE 02/03
Electrical Permit Application <) F I( 1 1,i l ):. i,
D a t e received
, i t . 'I, � City of TigariEC E I VE Pro ect/appl. no.: Expire ate:
Clly of Ti gar d Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639-4171
Dar issued: By: Receipt no.:
Fax: (503) 598 -1960 DEC 3 0 2002 Casa file no.: Payment type:
Land use approval: CITY OF TIGARD
iiiimmmiiiiiiiimi
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement t'Other. to ,,.. Sa,wws 0 Partial
Job address: j 0 i g $ W g o,.r..k toou/ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: : . _ _ oVr 'T'` Q,_ . Description and location of work on premi , 0 VILA. SCE ; •
Estimated data of completion/inspection:
r t)\ I It ■( ION ∎PI`IIt .%1 ION I VI '( 111;1)111.1
Job not Pee MIX
Business name: q.Jles e• , e .- Z vt-c Description . Qty, (ea) Total uo.iwp ,
Address: Q o ., S a N".. al..inafearsitoltl laetlyper
dare lineazdLLeWdesallacbedeDmege.
City: -(6t.), rise..- LStata :o IL► ZIP: 9 7312, sakoeI ded:
Phone: " jcf,3 _ j 44 [Fax:`Itf 3-eio 441E-mail: !o ter. ft. er leas 4
CCH no.: :L) & 5 q j Elee. bus. lie, no: - 4 I R l C Each additional 500 eq ft or patina thereof
Limbed energy, raidemfal 2
City/men lic. no.: f. 2_l 0 —� Limbed eomy, scut 2
f . l.2. 13 O 40_9 Each mandhatured home or module: dwelling
Signature of eupezvlafng electrician (required) Date Service and/or Surfer 2
SW *lea name (print} Q : CA. - fioease no: 141 ScrTicfner
rte irg—it � '
rl �
200 a pa or leas 2
Name (print): 201 antes to 400 amps 2
Mailing address: dot amps to 600 amps _ 2
City: I State: I ZIP: ova a Ipso amps 2
Phone: 1Fax: I E -mail: Reconnect only I
Owner installation: The installation is being made on property I o Teoporerysoniees or feeders - S
which is not intended for sale, lease, rent, or exchange according to a oe, o r o ,
ORS 447, 455, 479, 670, 701. 2
201 amps to 400 amps 2
Owner's s' Date: 401 to 600 amps
D u m b eheolts- new,alternetoo,
Name: o oL-
extension per pao
A. Fee for breach circuits with purcbeae of
Address:
=vice or Seeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee fir branch circuits without purchase
Phone: I Fax: E -mail: of service or feeder fire, dent breach circuit: 2
Each additional breach circuit:
Woe. (Service ur feeder not ineluded
O Sevier ova 225 arr>sseommarciai O r care utility Each puip or irrigation circle 2
O Service over amps- atieg of 18r2 O ilaaardous loradoo Each sign or outline lighting c 2 .
dwellings O Building over 10,000 square Beat bur or Signal circuit(s) or a limited energy panel,
Q System over 600 wits nominal mare residential units In roe 'Meant attention, or extension* 2
O Sudden over three stories d Feeders. 400 amps or more *Description: --
0 Ooarpault load over 99 pawns O Manuac4oed structures or RV poi Each addible: d inspecttoo Over tba allowable let any of the Fgresa/lightiu8 olds O Other: e above;
Per lospectice 1 1 ---
Sabath sets of plans with any oldie above. Investigation fee _ - I I
The above are oat applicable to temporary coostroctlon service. Other
Nee an fivisaicdom accept credit cads. plane call jurisdiction tar more information. Notice: Thi permit application Permit fee $ tl(n - $ S
*visa o ,,„_ la a Plan review (at _ %) $ ,. 5
Credit ...a nmuar�se� r. * 9' SoA 3q o(.� _ /a 3 1 dai r State surcha ge (8%) $
� & U. £ . at c`e 'R-4- Expires accepted as complete. TOTAL ......................... $ - 7 X1..2.-0
/j NL n. o wrItal own ere credit card
$ 0 a O
(� Cardholders gesture Amount
440-4615 (6A00lCOM)
•
CITY OF TIGARD 24 -Hour r�-
BUILDING Inspection Line!) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / 2- AM PM BUP
Location /b q g CO -Sr ak Suite MEC
/
Contact Person 1. 61d—e Ph ( ) 7 4 3 -C 7 2 PLM
Contractor Ph ( ) SWR nn
BUILDING Tenant/Owner ELC
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
Rough -In •
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA n�n
Approach/Sidewalk Date o 2, 03 Inspector � • _ s - Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL