Permit • • Si'' ''' - -xis, -i--,,-.2
O F I -AR �=
PERMIT #: ELC2004 -00382
X1 l DEVELOPMENT SERVICES DATE ISSUED: 6/24/2004
. -11. I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 1 S125DA -07900
SITE ADDRESS: 09161 SW 69TH AVE
SUBDIVISION: KINGS VIEW ZONING: R-4.5
BLOCK: LOT : 074 JURISDICTION: TIG
Project Description: 1 branch circuit for AC.
RESIDENTIAL 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 amp: SIGNAUPANEL:
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: 1 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:
PAINE, JEFFREY C DMIS ELECTRIC
9155 SW 69TH AVE 8502 SE STARK ST.
TIGARD, OR 97223 PORTLAND, OR 97216
Phone: 293 -1379 Phone: 503 - 516 -8393
Reg #: LIC 118073
ELE 37 -742
FEES SUP 4542S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/24/2004 $46.85
[TAX] 8% State Surcharge 6/24/2004 $3.75 Rough -
Elect'I Final
Total $50.60
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 -0s 0 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246-6699 or 1 -80• 32 -2344.
Issued By j i ,�1 /- /L ,,/ „,_i G' Permit Signature: .� ,,,
OWNER INSTALLATION ONLY
The inst. ation 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
,,.,. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00382
It',. DEVELOPMENT SERVICES DATE ISSUED: 6/24/2004
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 1S125DA -07900
SITE ADDRESS: 09155 SW 69TH AVE
SUBDIVISION: KINGS VIEW ZONING: R -4.5
BLOCK: LOT : 074 JURISDICTION: TIG
Project Description: 1 branch circuit for AC.
RESIDENTIAL 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 amp: SIGNAUPANEL:
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: 1 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:
PAINE, JEFFREY C DMIS ELECTRIC
9155 SW 69TH AVE 8502 SE STARK ST.
TIGARD, OR 97223 PORTLAND, OR 97216
Phone: 293 -1379 Phone: 503 - 516 -8393
Reg #: LIC 118073
ELE 37 -742
FEES SUP 4542S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/24/2004 $46.85
[TAX] 8% State Surcharge 6/24/2004 $3.75 Rough -
Elect'l Final
Total $50.60
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 -0699 or 1 -000-33 -2344. ' / C %�J��'� ? ___
,
Issued By: e4oe_ Permit Signature: ..)c � C OWNE
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: 4 /5 V.,1--5
Call 639 -4175 by 7:OOpm for an inspection the next business day
E a1 Permit Application FOR OFFICE USE ONLY
City cif Tigard Dac�ed /MD 8 I Permit No. / i...4� , 0038i
.
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
//,�iryr ' Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 J Date/B
Inspection Line: 503.639.4175 • �► '' I I Date ReadyBy: Jug: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE =OF. WORK ' • ° PLAN .REVIEW
❑ New construction tRI Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
.CATEOORY:OF .. 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
1:1 Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
- JOB SITE INFORMATION AND LOCATION - • `` +f ❑Egress /lighting plan RV park
A Job no.: Job site address: A ,9/55 s� 6 .9 4 �• ❑Health-care facility ❑Other:
p 9 Submit 2 sets of plans with any of the above.
7/ City /State /ZIP: Fa rt- 0 2 , J The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE f
Description I Qty. I Fee. I Total I „
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
' DESCRIPTION-OF WORK- Each manufactured or modular
- /9 / - / / G t r 2 O 4- `i ^ 4 - C dwelling, service and /or feeder 90.90 2
J'rG�OV 40 (/ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
0 PROPERTY OWNER •. ❑ TENANT • 201 amps to 400 amps 106.85 2 • 401 amps to 600 amps 160.60 2
Name: j . I e 601 amps to 1,000 amps 240.60 2
Address: ' S aC en e, 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
Phone: ( Gi33 2 53 — /3 79 Fax: ( ) 2 a
200 amps or less 66.85 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 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: D �/, branch circuit .
�{ B Fee for service circuits
Contact name: Uas
without service or feeder fee, / 46.85 �/ (�� 2
Address: f$ � 2_ 5 E .S' ,. each branch circuit , D
Each add'l branch circuit 6.65 2
City/State/ZIP: Pew /«.e,e.( 972-/ 6 Miscellaneous (service or feeder not included)
Phone: (5 ) 3 -57 6__ Fax: : ( ) Pump or irrigation circle 53.40 2
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: S ex_ yyr (9-Cete
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Investigation per hour (1 hr min) 62.50
Indu plant per hour 73.75
Phone: ( ) ;044 Fax: y �/� /0 _1 _O y ELECTRICAL PERMIT FEES* • . CCB Lic.: `/ 0 Electrical Lic.: 3 - 7-7i/2 . Suprv. Lic.: ii 4.2s Subtotal [i
Suprv. Electrician signature, required: C e ,a✓; , f� l /` Plan review (25% of permit fee) r
Print name: V QS f (e P [�� Date: 2 ,
6 / � 04_ State surcharge (8% of permit fee) 335
TOTAL PERMIT FEE 7.57;i
Authorized signature: This permit application expires if a permit is not obtained within i80
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.
i:\ Building \Pennits\ELC- PennitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard -
, Page 2 - Supplemental Information • ` +
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: -
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WO t NLY:
Fee for each commercial 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
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING _ Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: 1503) 39 -4171 MST
BUP
Received —C1/75:5- Date Requested 1 ✓ A PM BUP
Location �D « ti" ` Suite MEC
Contact Person h ( ) a 93 - /37V PLM
Contractor Ph ( ) SWR // //
BUILDING Tenant/Owner aoo'7' d d-3o
Footing
ELC
Foundation Access: TA -IL025 Fen. y
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes:,y / -- - -- SIT
Post & Beam r > Y'v • •
Shear Anchors
Ext Sheath/Shear ��� 61/1
Int Sheath/Shear
Framing
Insulation l - 2.o o q.- 004-0(.0 Qa S e/z / y (
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm qa% , �,. • 0 G /�
Susp'd Ceiling —
Roof z J �S CO-/.
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 tkro
Rough -In UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S FAIL
SITE El Please call for reinspection RE Unable to inspect — no access
Fire Supply Line
ADA `
Approach/Sidewalk Dat Inspector Ext
Other:
Final DO NOT REMOVE this Inspection recor rolm the job site.
PASS PART FAIL