Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00259
*r DEVELOPMENT SERVICES DATE ISSUED: 5/8/03
��� �i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S101 AD -02900
SITE ADDRESS: 12755 SW 69TH AVE 100
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT : 031 JURISDICTION: TIG
Project Description: Alter (5) branch circuits for lighting & outlets.
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: 4 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 J R + 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 - 648 - 4552
Reg #: LIC 121 159
SUP 3707S
FEES ELE 34 -305C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/8/03 $57.50
[TAX] 8% State Tax 5/8/03 $4.60 Rough -
Elect'l Final
Total $62.10
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)
246699 or 1 -80 -2�.
Issued By: � rw
� Permit Signature: f
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: 3
Call 639 -4175 by 7:OOpm for an inspection the next business day
06/20/2001 03:48 6427925 _ _ PAGE 01
N .
Else triCalPer iKn
Date received:Gj _R-03 Permit no.: � + O - 00,2 " "; • MAY 0 7
rd Projectlappl. no.: Expire date:
f T iga 2003
� �II GARD Date issued: By l lteceiptno . :
Address: 13125 SW Hall Blv
BUILD —
Ciryafgard Phone: (503) 639 -4171 BUILDING DI VISION Payment type:
Case file no.:
Fax: (503) 598 -1960 -
Land use approval:
TYPE Of PERMIT
g Commercial/industrial 0 Multi- family O Tenant improvement
O 1 & 2 family dwelling or accessory
O New construction Addition/alteration/replacement O 0 Partial Partial Other. -
.1O1t S1'1'1: INFORMATION
Job address: 1 2.7 5 6 ,1 five - it 4, Bldg. no.: Suite no.: Tax ma tax lot/account no.:
• Lot: Block: Subdivision: HI �\ C i rayai +s
Project flame: Description and rotation of work on P remises: ( ``z�JJ
Estimated date of tom . letion/inspeetion: FEE SCHEDULE
CONTRACTOR RACTOR APPLICATION
Job no: 1)kacri ion — �' t;aEI Total Pia
Business name: Ale t. ' . : ' _eel L. New resideetlaJ- siogleor imth4tamltyPee
Address: 4 2 q g .. 7'"` a` attached garage.
®i s� StateZ.312_ ZIP: q ..71,E ft or less 4
Phone • ,- r�!' r / mail: 1000 sq . ��—
Each additional 500 s • . ft. or • • mien thereof
CCB no.: / - Elec. bus. tic. no: • O 4r t invited energy, residential MOM
IiC, n0.' Limited energy. non - residential 2
Each manufactured home or -modular dwelling 11111111 2
� � // ' : Service and/or feeder
�rrr.-: C . fiTfr • het(" r .uired) aired) Date
..., ..mot. • .i_,_..: , -77—.S. Servt or f eeders — instal lation. .
IIMEgalM J i License no: 76 a1teratlon 4r retocatloft 1111 PROPI
PROPERTY OWNER 200 amps or less __ 2
201 amps to 400 amps - 2
Name (print): _ - 4. t] AA _ '_ 401 amps to 600 amps
ME BR
Mailing address: 601 stn . s to 1000 am • a
City:
State: ZIP: Over 1000 amps of volts �_
I +ax: E -mail: Reconnect only ?hone: py or feeders -
Owner installation: The installatioa is being made on property I overt te,,orrelocation is not intended for salt, lease. rent, or exchage accoding to 20o amps or less
__
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: _ ..
Ike: 401 to 600 am .. =MI 2
ENGINEER Branch circuits - new, alteration,
or extension per Pallet:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit I L 2
City: State: ZIP: B. Pee for branch circuits without purchase
of service or feeder fee, first branch circuit:
Phone: Fax: E -mail: Each additional branch circuit: C_IMINM WMAT�
PLAN flrV11.:11' (Ple:i.c check :ill that MOO Misc. (Service or feeder not included): NM �
O Service over•225arttpa-co
amps-commercial O Health-care facility Each pump or irrigation circle 2
o Service over 320amps -rating of 1&2 0 Hazardous location Each si gn or outline lighting
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel.
C1 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over t stories 0 Feeders. 400 amps or more 'Descri • tint:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
O Egress/lightingplan 0 Other: Per inspection
Submit _ seta of plans with any of the above. Investigation fee
The above are not applicable to temporary conatrucdon service. Other
Permit f $ S7
Not all jurisdietiom accept edit cards. please call jurisdiction for more infonsa lea. Notice: This permit application Plan it fee
eve (a[ %) $
Visa '' ® a 0 Mask:K rA 2 I- ' OgEX3 expires if a permit is not obtained - 4,0 `�d 6 within 180 days after it has been State surcharge (8%) .... $
tedit �? p
accepted as complete. TOTAL $ " 2..
ardhlder on -• t card 117
m' _ c o . `�� . $ IOC • Cd.., . - aigaature Amount 440-4615 (&oo/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION • Business Line: (503) 639 -4171 MST
BUP
Received Date Requested S '7 AM PM BUP
Location J • 7. S,c (7 *t" - Suite / 6 MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) 6 X- • s 3 ,2 SWR
1�/1
BUILDING Tenant/Owner 1 ► ► AT \Y ./ L Cp 1 p ELC 3 b °%S/
Footing
ELC
Foundation
Ftg Drain Access: ELR I7h3 co/36
Crawl Drain r ,, ..�
Slab Inspection Notes: UtO A `� SIT
Post & Beam �
Shear Anchors
Ext Sheath/Shear ,,g
Int Sheath/Shear 0 _ &* k mac)
Framing I ? _
Insulation �?O ,r oo A J5 C D _ l e A. •
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling P .
Roof ` (2 Z
v ,1
Other: Yi
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 t/
UG/Slab
Low Voltage
Fire Alarm
r Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
. PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date -5# 03 Inspector P2Vd (4t, Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL