Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00181
�� DEVELOPMENT SERVICES DATE ISSUED: 4/7/2006
"III 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S101 AD -02900
SITE ADDRESS: 12755 SW 69TH AVE 100 ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT : 031 JURISDICTION: TIG
Project Description: 3 BRANCH CIRCUITS TO A/C AND COMPUTER.
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: 2 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:
ROTH, J T JR + THERESA A + GARNER ELECTRIC
ZOUCHA, MICHAEL S 2920 SW 247TH AVE #A
12600 SW 72ND AVE #200 HILLSBORO, OR 97123
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 648 -4552
FAX 503 - 642 -7925
FEES
Description Date Amount Reg #: ELE 34 - 305C
[ELPRMT] ELC Permit 4/7/2006 $60.15 LIC 121159
[TAX] 8% State Surcharge 4/7/2006 $4.82 SUP 37075
Total $64.97 REQUIRED ITEMS AND REPORTS
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 By: LP' , 4/1/1 • Permittee 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:
LICENSE NO:
Call 503- 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FAX NO. :5036427925 Apr. 06 2006 06:53AM P1
FROM :GARNER ELECTRIC
. •
Electrical Permit A `v ED
von: OF ICE US�
City of Tigard C :ew 0� S OR 97223 i 20 11 Dele 6 /_ / L jO /2/
Phn: 503, 39.4171 Pax: 503.59819 u 4 r ., Plan e
h• I ], a?8� y: Miler Perak
Inspection Line: 503.639.4175.
D
Intemec www ct ngard ar us F TIGAH Date Ready/By: El Sae rage 2 for ------ ICY NobSed/Wlethod
b ( �In.", *. j ./lj z , R l n 1 ul l c, . �, . f, l: rl o r �1 .4L V+ � , r . r a ��_A^�n' }p r,r / gnpp1aafen information
- 11f..:�'1 .�V-i ;0:i. I.! -.'e: L I:�' ..*_ C it',
t L: - k.. : ;'.i I. ; :S I ; , L I IUi y' in ' I" jY „[: r ^ 9 i l i
A it,•Vyi, ""F !kV f •x : : :11: y " .
)./ Addition /alteration/ lac € _.,, .�r:.
❑ New construction ' - � L � ' �. •: : :. .
rep eitttmt Please check all that apply:
•
❑ Demolition • 0 Other ❑3erviee over 225 amps, co
� �l----1l rrtrn'I ['Hazardous location
�: ,` I :ra'l ?� 4 � ,r.'!u l J•...r t i 7 f t i ‘1,:C;';',,,...-.7. t , r , r, i i 6, 7 `r t 4 w ,; �-,tseMeenVer 320•attlp3- �rstn111 DBuildn over 10,000 S • ft..
Q
` •• .�- , -:� .:�..�_:' -- : :..,. �. -' �4:,_?� C- CZ�?a �,.� °l of end 2 - family dwellings 4ar more now residential
❑ 1 - and 2 family dwelling 10 Commercial/industrial • ❑ Accessory building • ❑system over 600 volts nominal units in one structure
• Muhl family • Adaetor er • three go
77,11 .fl' I lrl, ' i 1, r ' ! `i 'rl i -, , .. � � Och r , �OoeB:14°44ad 99 Per ❑M °Feeders, 400 amps mired aauc or
[::.i i 1 _, .'. ... ... .rl . , r.':r rr-rI 1 - -'' „ i' f .2 y I •Y : i .:,. ^. :Egrc1 itghtIxl$:plert '-BLV.Park ..
7vb no.: • 'Job site address: •1 27,E 5 j (O ei 1 • . ' ` =.1 11-1ealch -care facility L7Othpr . - -
• Th e above any of the•abeve... .... •• . , _ .... •
City /StatelZIP
Subrnit a sets of plant! with
` a • t•A.0 r . • .. r a ove arc not apphcable'rm temporary construction service.
Stun � t
t /bldg_/apt. ao : - P roj e ct name: grog I � ,N�S I ' ` ; , I, r e. f ld'' - •' , -a. k .. r ^'-'' - ) l ' ", - 7 ' ri•I' ' %..
non "= ....... • Qtr Se I • ots! I ' ' •
Cross stieet/directions tojoli:site: New residential single- or multi - family dwelling unit.
Includes attached garage.
• 1,000 sq. R or less 145.15 4
Subdivision: Lot no.: 13a sdd'1 sq.ft or portion 3.3.40 - 1
•
.. Littuto
energy, residential . 75
Tax map/parcel no
(, ; y l JI4 It ti l `' .
I r S rr P � . j i i y , r u , n _Limited energy non-residential 75.00
II
L.�.') iw .gi , 1 h .1111 I,. ,_ ., L..`rw ; L.,. , , t(., „e ,;, I , , r I 2
._ ,. � , 'r ..1!,i:: Bach trtaattfsctured or modular
4
4) I 11 dwelling, service and /or feeder 90.90 ' 7
" �� Services or feeders lesinilation, alteration, andior relocation
200 amps or less
4g.): � I I .; , II. 1I l II t ` ' I Ir' , ' i , , n ;; r r 3r::' 2 80.30 2
' I' , r O l amps tO 400 am}u 106.85
2 .
Nsme: ?....! n4 .9: 4Ol•ari7p5 IO 600 8 mps 160.60
- .i a lit 7J yV1e 5 _ _601 2 • anima ro 1,000.etrtps 240.60 2
Address: Over 1,000 amps ar volts 454.65 2
City /State/ZIP: Recmtnect only 66.85 2 •
• T Tetnpoirary services or feeders Installation, alteration, and /or
J
Phone: ( ) Fax: ( ) . relocation - -
l?wner Installation: 17sia installation is bean made on Z or lea _ 66 1.
lease ren • or •excltau g PA Y that I ovv v 1 not 201 amps to 400 amps 100.30 2
intended for sal
� k ge, accartiiug to OR5 447; 449, 670, and 70 _
OwAer signature 401 altos to 600 ands 133,75 •
If 1. I!�',at I I a ry A Po p t ' Date . Branch C1rcuitB - new alter8 , per panel 2
.7;i1;',.f „I.:i,.. : , - ,4 ; ; 1 a. .:. J I I 1 r I .- - Y c I � I A. Fee SOT brartl b circuits u+t r to
n, OZtena a
Business tarns: , - „ 1 : � t 11 1, service or feeder fee, each
branch circuit 6.65 2 •
Contact name: 13 • Pee for bricit circuits .
without service or feeder foe, tL
Address: - tech bggr oircuic I 46.85 Ti.j 2 .
TtaCh add'1 branch cirrcpit z - 6.65 ) 3 , 3P 2 ..
Cily /State/ZTP: Miscellaneous (setviceDr feeder not included)
Phone: ( ) Fax:: ( ) • I�Irup or irrigation circle 53A0 2
E - mail: Sil n ar outline lighting 53.40 2
'C `a�lllVr !g Itn�11 I4 4 � ' 11 r L , . tl 'l l i S � I'� a }. , ' i �� r � r Y 4t:, Signal CIrCUt��1I8 aT•i
„ _ -..1 , 111_ k ... r. ,. t 8Y Penal. alteration, or
r , r, , .I error
Business name: �- e. NS L -, i C r extension. Describe: Page 2 2
Address: !? �, ;� L, .,5 IA V f , i'ti i �� Ea ch additional Inspection over allowable in any of die above
I Pot inspcctimt 62.50
City/State/ZIP:
f -h L 1 51c' `' - o . C , ( - 1 - 7 1 2- 3 _ Investigation per boor (1 br min) 62.50
Phone: ():\) 6 ' 4 -' �'1 a acv Far .. ) (/..7 � -,e f 2. Industrial plantper 73.75
� ~ `' = ` ' °r" 171.,.
`" ' ' tC3 I g'r ve } ,'`i;� n! lib✓ . r,tx`..
CCB Lic.: i . 1 [ Electrical Lic. :n • .r..., r 5 �I . C _ a:J?
" 0 5ubtatal !_
Suprv. Electrician signature, required: �� / -
J ; // / Plan review (25 °i6 of permit fee)
Print name: '?��' - '`• , > _ ' `_) c_1 bate: - SffitiSWrcharge (8% of pemut fee) Cr, ��
i
Authorized signature: TOTAL PERMIT FEE
Thin perm t. appucaden expires if a permit ia tat obtained Il 1 o
Print name: Date' a days after it bas been accepted as complete
pee methodology set by T i Colmty Building Indust y Service Board
• '" Number of inspections per permit allowed.
:∎ aunding\rernauABLC- TunthAar,,dae IVO3 4°n.nFt srtlnsumnr,wwnn
r
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200&O0i81
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2006
Phone: (503) 639 -4171 1, 1 �I
Inspection Requests (24 Hrs.): (503) 639 -4175 "'IL
INSPECTION WORKSHEET FOR DATE: 4/17/2006 TIME: 7:05AM PAGE: 98
SITE ADDRESS: 12755 SW 69TH AVE 100 CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 031 TYPE OF USE:
PROJECT NAME: LEGEND HOMES .;
DESCRIPTION: 3 E3RANCF1 CIRCUITS TO A/C AND COMPUTER.
OWNER: ROTH, J T JR + THERESA A 4-, PHONE #:
CONTRACTOR: GARNER ELECTRIC PHONE #: 503 - 648 -45L2
Inspection Request Scheduled For: Date: 4/17/ 2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 028107 -01 503.64B.4552 N
6 Hi
Corrections /Comments /Instructions:
Fag
f.
5 1 ) 6 503- '��`�-s'61� No WRYLI
W c 4- 90 S wa
0 L a IA IL I y
1,./ PASS ❑ PARTIAL APPROVAL M CANCEL ❑ NO ACCESS
►'d CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: W Date: (ill d Phone #: (503) 718 - .1.1i'1•