Permit AilkoCITY OF T1GARD_, ELECTRICAL PERMIT
PERMIT #: ELC2004 -00742
wil DEVELOPMENT SERVICES DATE ISSUED: 11/18/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 101 AD -02900
SITE ADDRESS: 12755 SW 69TH AVE 201
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT : 031 JURISDICTION: TIG
Project Description: Alter (5) and add (3) 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: 7 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 121 159
SUP 3707S
FEES ELE 34 - 305C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/18/200 $93.40
[TAX] 8% State Surcharge 11/18/200' $7.47 Rough -
Elect Final
Total $100.87
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)
2466699 or 1. 800 -332 44.
Issued By: A %r Permit 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: 3 707 S
Call 639 -4175 by 7:OOpm for an inspection the next business day
01/02/2003 01:50 6427925 PAGE 01
gle lc' ?er'nut A hca ' 0 FOR OFF icr ilSt, ONLY
City of Tigard G ` Received ,, �/
13125 SW Hall Blvd., Tigard, OR Duda , m °7 • j Permit No.; _ , • • i/ — 7
Phone: 503.639.4171 Fax 503.598.1960. Plan Review
Q. 20 T(' B • Other Permit
hlspection Line: 503.639.4175 Nov 1. 4J . :2j, Date/ Date Ready/By:
Internet; www.ei.tigard.or.ua • 1`1 Xi Notified/Method: •
1 el Soo rage l nor
I 1r,+ t ,
_` Supplemental information
tW - s rr s �� � ? , t , t l y i / « � 1 I ti �■ a •� I . N i'+ i t �� ,.�P Er. :.ro*n�•,I { ,, r N
! . ' .., Ilt e `1 .ia LPi(t� ��,1 ' ?� _—v _.� �t { � � �'rd �xY� � a - > .. 'r''' •
El New construction % .. • . : teratioa/replacernent Please check all that apply:
❑ Demolition it Other ['Service over 225 amps, comet ❑Haiardoua location
' I '' `I'' ❑Service over 320
<' t': t ,G� } �, } � � kl ' f :: ; � ' ' l o- r t 1r c c 5 ' i ear f r r _ i c y` . 1 j+nZi '`f�Y LSwc � � "� }�,d 'gTnpS - rating ['Pundit; Geer• 10,0() sq. ft..
❑ l - and 2-family dwelling 1 1 -\ :I` '�"r•" :Ti. ,"` : � ?: .' of 1- and 2 - farnily dwellings 4 or more new residential
B Conmiercisl/lndustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑ Muster builder ❑ Other: OBuildies over three stories []Feeders, 400 amps or mare
ls� i Ipr° ` .. 4 n lJ : '•'''' � , cf i t II r-‘•:;;;77, i O CC load persona ❑ es or
7,7.,'''J.',4',"'. '1 ,..._ W. "7,I _i' -_d.l . 7, �1If i ! ^ : f �� . a ,••-r -� c 1tp�IIt 1 d over 99 at�t�{aCWred•StRiCtla
cii,.•. - a_. .,w , 1 .i._' - .�:.�' , . i ❑Hgteas/lightingPlan RV park
Job no.: Job site address: 1 2755 Sv✓ 64yrw Ave, 217.01 Submit t facility with any Of the 0 t hen:
City /State/ZIP: 4 0r4- talrIck j • 0 R Q'7 223 The above are not applicable to temporary construction service, ,
Suite/bldg. /apt no.: Project name: _�_. I;AVI : 1 �, cs. ..., '' ;s'VI°., i _:; ` ' . . :1. •• '
Deaertpuee Qty. . ken 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
Subdivleion: . Lot no.: Ea. add'1500 sq. ft. or portion a 33 .40 1
Tax no Afte 59 Cl tct.u� , (3 Gr limited energy, residential 73.00 2
r I I r . ! Limited energy, non-residential al 75.00 • .
. . ..,'"V-7. . : Y J „ -� � , . _ , . i I l . - 11 1 . . i . + rlU c t . 1 �'
L 1 Each m anufactutt:d or modular
i f ._ , q vue - - . /' � .� �� ! � ..J! u�. �_.._: L 11` t,. w..�.,.�. �. _ I.�. .is l ',y,.l; a ) ' 6 Fr ' t G E v �� — f"� „C— Z v 1 dwsllin:, service and/or feeder 90.90 2
Add 6 ' Y�CS f J f C - 1 Services or feeders installation, alteration, and/or relocation
m 200 amps or less 80.30 2
r.1:. 1,' . ? , L'. �.:.' ,= t!..';..i` , 3,:>L..ri: i a.'. 1 4 :5;2 .' ,, t = z j ! r. ' ; ' = r r.F 0t*?.i '�� 201 arms to 400 amps — 106:85 2
40/, to 600 amps
160.60 2
Name: . ,f 3941.0 t O hale ', 601 arrtps to 1,000 amps 240.60 2
Address: Over 1,000 amps or velfs 454:65 2
City /State/ZXP: Reconnect only _ 66.55 2
Temporary services or feeders •installation, alteration, and/or
Phone: ( relocation •
( ) 200 errrps or less 66.85 1.
Owner installation: This in&tallatiom is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for ea]e, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 : . , •s to 600 amps — 133.75 2
Owner sigpatttrc Date
u I ° � � r * - ., � {c ,. I F I Branch circuits - new, alteration, or extension, per panel
r •a
. C i. , ' ,,..C.i •ezal } , ' ..' i ,''.•::,.. - , ' '.:?..s.-.., 1 1 t , I � r t t . .. 4 i -+. I ' :; .. �. 1 .gi . 1 A ser erfeed feeder a each
- n, ... .i. _ m .. . f' ... r.u,! h .6; � k .i�:•er_.'� r,.L l �. - � t
"'` "u ,ri service or feeder f ee, each
Business name: - branch circuit 6.65 2
Contact theme: B. Fee for branch circuits
atithostt service or feeder fee,
Address: - each branch circuit 46.65 [{� 2
Each add'l branch circuit 6.65 e.ffe 2
City /State/ZJP: Miscellaneous (service or feeder nit included)
Phone: ( ) Fax : ( ) Pump a irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited -
m7 : ,;;,."77.p.":1",;,::'.17,-Fr.' .. 11 i, n , V 671
3 Ir r r t t t] 4 _ t .{ rl t .s- t r
. .z ,1 , s. ,..._.:: .: :J_ » -,.., -,._.,_e__4_,- - l ` � 0, ?n .e,.._� ,� e : t� �.: ,,I,.,t.� : ��`�,.v enagYPanel,altP.t3tnon,or
E- -� extension. Describe: Page 2 2
Business name: C
Address: 2q2- b J (/1/ 2, `i —1 4' 1 Anse . 44 ,! Each additional ins over allowable in any of the above
Per inspection 62.50 _
City /State /ZIP: l (s 60v-0 : OR_ G `1 1 a-. Investigation per hour (1 hr min) 62.50
Phone! (� ) C ( L( p er . - �^ Industrial plant per hour 73.73
CCB Lie.: ('� (� If • �"�� ..; I si,�c• . •�t,;�5�. ,. • �`•. • n „.r,�:y...^;t K
r Subtotal 9 3. 4(0
Suprv. Electrician signature, required: — r Plan review (25% of permit fee)
Print name: �� �-� ■ l Date: /7* /g D (1 State surcharge (8% of permit fee) � ' / 7 � - ti -7 "7 -
1 TOTAL PERMIT PEE Op " D 7
Authorized signature: This permit application expires tf a permit le not obr�teed within 180
d a fter it her bee acce ptxd as complex
Print name: ' . Data • Pee methodology set by Tri -County Building Industry Service Board
Number of inspections per permit allowed.
:tBwibiluaRnmdtffi.GPcmagyp.4ee 17103 440•0E13r(10/02/COM/WEB
CITY OF TIGARD
. BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 aoug ,
Inspection Requests (24 Hrs.): (503) 639 -4175 ` __..
INSPECTION WORKSHEET FOR DATE: ` TIME: And �-� �?�e PAGE:
Anj 1
SITE ADDRESS: / ' -' -5I4.) 1..0 41 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: '
L, 1-14 �jx +vre
OWNER: H 0 / 1 PHONE #: 563 — cU at) -g 08O
CONTRACTOR: � n E' PHONE #: 3 552..
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
•
Corrections /Comments /Instructions:
c O w R.A c..Q.so NZT I ►..L, PA v.A4 = CL I� >✓ .
•
1. -t oN
•
c --
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
A CALL AFAIL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: " ° N `�J Date: - 0 Phone #: (503) 718 - 2-44t,