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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00063 „ — DEVELOPMENT SERVICES DATE ISSUED: 2/7/2005 ! 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 - 4171 PARCEL: 25101 AD -02900 SITE ADDRESS: 12755 SW 69TH AVE 100 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING. MUE BLOCK: LOT : 031 JURISDICTION: TIG Project Description: (7) branch circuits. 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: 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: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 6 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: Phone: 503 - 591 -1320 Reg #: LIC 121159 SUP 3707S FEES ELE 34 -305C Description Date Amount Required Inspections [TAX] 8% State Surcharge 2/7/2005 $6.94 [ELPRMT] ELC Permit 2/7/2005 $86.75 Electrical rough -in Electrical final Total $93.69 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -800- 332 -2344. Issued By: T j Permit Signature: 72;f_ 931). OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N• DATE: LICENSE NO: Call 639 -4175 by 7:OOpm for an inspection the next business day FROM :GARNER ELECTRIC FAX NO. :5036427925 Feb. 07 2005 11: 37AM P1 • Electrical. Permit Alit • , • 1 ��� ' OR OFFICE IC'T LJSE•ONLI' Raceivad City of TigTigard Da�/s . - Q - .5 l p ermit N o.: C L Cr, ad.� 0� 13125 SW Hall Blvd., Tigard, OR 9722r- pp t Plan Review Phone: 503.639.4171 'Fax: 503.598.1 p 0' / 2005 ' t',` j , , ' f � ' '. Date/B - . Other Permit • inspection Line: 503.639.4175 (,-! ` ?! ., ' Date Ready/11y: 6a See page a [or Internet: www.ci.tigartLar.us CITY t/ Notified/Method Svbplemental Information .2':r.> �; ,� �� .x¢Mtr-,,r1-r } ? 'tgc�77 t t�rr T9i'A';�.05REWi t. ; rc .I l! vry kta . t, s .. r y a r a Giv,- .•'i.. • Jr r it , r In 1��, , I I c r r . �+` f1~ 4 i r , ::l t u , 1 .44 - r,gliu.e f •'J•;: �t11��.5 LiF_wili+ G��.t�'' �, �p- •,.�,.d�1 #HB,.:1.Mn..�..4 :i.8. t. �.. -,.. iR(�$��•�.It Ai � Ah+iF:�L���>� � �'r E] New construction • w Addition /alteration/replacement Please check all that apply. ['Service over 225 amps, eortlm'1 ❑Hazardous location El Demolition • ■Other: y °Service over 320•ampa - rating ❑ Buildng over 10,000 sq. ft., w r1 r1 ti j ii 7' 1 't ,i 4 F 4 'e v` d S� C9 L Vid'i �, i iy 0t v 1 �• �, ' ;'• 1 • �,� �1 of 1- and 2- family dwellings 4 or moe new residential [] 1 - , and 2 family dwelling P.. Commercial/industrial 0 Accessory building ❑System over 600 volts nominal units in one stniclure ❑Building over three stories ©Feeders, 400 amps or more MI ❑O Multi - family ❑ Ma ster builder ❑ Other _ Manufactured structures or ccupant load over 99 persons ❑ V1 ,, I,} r I t.70 r,•.r7r `mt , i r : 41 6 + LTrfiT• " + : ' 3 7 ar 4 epe tm ]m RV park d:,iikeAi T It i ,.. l i, i111L il,.' :?.1 'K".1.i7Arh4,1,:i. }1 .6..08 ,:,Si., ( ? i )I�i J.5: is .. % i,.. � �i : ,i ❑ gl? t i'. ,. ..K1 -LIB -� L�Ja �.,i .. �1 `�� _^ (° rc ❑He 1th care facility • ❑Other: -„_ xob no.: • Job site address: 'Z"]55 �� ��{ /�1/c. Submit ./ sets of plane with any of the above. City/Ste/a/ZIP: .0v) -t (,t,(el oQ D - The above are not applicable to temporary construction service. . t .. ' ,X e ':;.42.1 iti, ,Lde I ,t U _. : , , +. t. r . 'f'r r. . ... • ... Suite/bldg./apt. t10.: Project name: - ' D�ciptlen City. L8oa Total 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: 1 Lot no.: Ea. add'1 500 aq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no _ . i Limited energy, non-residential 75,00 2 Y r P C t � ,/ . vt 1 , ea l r ^dl +1. 1,r 1 �r . { r l ,,r i ° 0t. 4,f €m, 1 t fL.IT � i 9,, v. . v , , ,M r r�lf i}, 4,41 45 E� r ft. + 1 , ,. 4.' :itT.;:ii i 1' k ,i11 .• n2N t'6:6, :V. :, ..leiz a. ` ,r� `cJ 0Y2,. %su,hr: . lvltl.r,t,.i� ;.:-. iii. -_,y) u l,.: 1 fi r._.,.,.tc1,, Bach manufactured 'Or Trindular dwelling, service and/or feeder • 90.90 2 or b - ' v t C•t -ke-r --- to i.i ii BIZ✓ Services or feeders humiliation, alteration, and/or relocation ( C. t f a v l CZ k' 200 ergs br less 8030 2 • a l t a i l' C. 1 8030 2 I . • 1 ' 1 ° . xa �N r. ; '-rr- c • ,, �, \7 , , l Y k3lV i N y: 1 to 400 at tiPs �l, 1, ,, 1 , 5 I �Qt' /' 1 q n,�'t`-.��7.l it <il iK 1 {G t, 1 1 'K•'} �I. _II'��CJ IV'�1�5' I° r ti rl 20 n l. , 1: y ? ,14 �k rosi.metit4r• •-. , .54 amps 2 ;� l� *; li :Ir.� u1L�:.Li'�� r. a +.tim,.:,..,1Ji,� � �. 401 •amps t n 600 amp s 160.60 2 Name: o A 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 lnstaI1atioa, altexation, and/or relocation • Phone:. ( ) (g P -- . r (0 • . Fax: ( ) • • 200 snipe or leas . 66.85 T 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 OM 447, 449, 670, and 701 4 01 amps t 600 amps 133.7 2 • Owner signature: - Date Branch circuits - new, alteration, or eXtenalon, per panel 'a ' r ' t L , ° ;1 6 '�;�T';7' 'u i t�birrj I "� Cr 1' i - fe; i ' >j�`i tl i1 a. h i P r { F 6 �•'' S' �.7(.'• 'Ir A. Fee for branch circuits with 1 > r C `, :.L� i, �,iy14d s. to:.$14 . kt..it. :: :. }1TLit,.t:l� ., :`At:-� tt (...._, A .,. +_ /S,. Ikke . :) ..i4 • t.., la.,, ,,yt, .fit , n service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or fender tee, 1 46.85 ' fl o• j 2 each branch circuit Address: • _ Each add'l branch circuit Jr, 6. 65 » -i. ( � 2 • City /State/ZIP: M ^ iseellaaeuuo (service feeder not included) _ • - - Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) Sign or outline lighting ' - 53.40 2 7,;,,� Signal circuit(s) or limited- • { I ay • ',, rwr r-Y' ri a t •nr, 1 �' 4 1 , , � ii energy panel, eitcratien, or Fi 'Jhl : . 1.. U a 1 i.i.k tt. l _r 1 ; tzt'�lll )i Nit: LViiii..A.. � u!�i da �w is if% F..wl_ .Yl,11 _e : ri'1LnetCr 8 E 2 sw , .mil r > , t c u ., -- l' extension. Daccribe: F' g 2 Business name: -A-p___ V ~ = _ EL / - - Eaeh additional inspection over allowable irkany of the above A C%I ddress: "2 ,,� 2_ t. (A) 74 V - 14 Per inspection „. 62.50 .• City/ State/ZIP: f. (( -, ie. >o �O . OR_ 6 1'7 1 tom..- w Investigation per hour (1 hr min) I 62.50 ((� c�` 1j' -� Industrial p)ent per hour 73.75 (10 US) to L1 ��V Z - r , ) �� � � ez, "; ati. r »c 9i ,. aL :41I•I.,3. . • '.t :a r , ' ..!L CCB Lic_: 1 2['t . Z Electrical Luc,`? F Lie.. ?; . 7, ` Subtotal ii„. • l Suply. Electrician signature, rntluired: a /, �i Plan review (25% of permit fee) SLAW /" rJ / �, i tfe e �•^-t T te l mharge cm of perm ) Print name: . / 24...3 , _ -na i. Date: 2. -1 -05- TOTAL PBltivx)(I PEE 3' Authorized Signature: This permit appilleatton expires If a permit is not obtatnod withla tso days after It has been accepted ut complete Print name: Date: • Fee metbodolo®' set by Tri -County Building Industry Service Board ••• Number of impactions per permit allowed. iNauildin9\Petm ;ts\HLC- PtnnhApl 0109 4404615T(1 a/a2 /COMAVE0 CITY OF TIGARD 24 -Hour _ BUILDING Inspection L1ne: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received / Date Requested £ _ c_.3 AM PM BUP Location C � 7 5 Suite U MEC Contact Person Ph ( ) Contractor Ph ( ) SWR BUILDING Tenant/owner ELC B OGS -000 6 3 Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Sr Anchors Ext Sheath/Shear ear Int Sheath/Shear Framing Insulation P A • Drywall Nailing Nei Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL - — PLUMBING Post & Beam Under Slab Rough -In 1 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 Low Voltage Fire Alarm � Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. ASS PART FAIL SIT ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line / CIA, y ADA Date Z�7'3 - 495-- Inspector �& �` „t Approach/Sidewalk Other: Final DO NOT REMOVE this Inspection record from the Job site. • PASS PART FAIL