Permit =CITY OF T ELECTRICAL PERMIT
PERMIT #: ELC2001-00145
4.04 DEVELOPMENT B OPMENT r SERVICES o 1639 -4171 DATE ISSUED: 3/13/01
- 13125 SW
PARCEL: 2S1 13AD -01700
SITE ADDRESS: 16800 SW 72ND AVE
SUBDIVISION: ROSEWOOD ACRE TRACTS ZONING: C -G
BLOCK: LOT : 030 JURISDICTION: TIG
Project Description: Installation of one branch circuit for two switches. Job No. 1 -1224.
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: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BRIDGEPORT LAND LLC DYNALECTRIC
3939 NW ST HELENS RD 2904 SW FIRST AVE.
PORTLAND, OR 97210 PORTLAND, OR 97201
Phone: Phone: 503 - 226 -6771
Reg #: LIC 066793
SUP 2950S
ELE 26 -59C
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
5PCT CTR 3/13/01 $3.90 2720010000( Wall Cover
PRMT CTR 3/13/01 $48.65 2720010000( Elect'I Final
•
Total $52.55
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: Or- • • : law requires you to follow rules adopted Ckegon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 th • rt.! h 0 ' 9. -00 ;180. You may obtain copies o ese rules ordirect questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE / ISSUE BY:
.0/ 7"1 21t — i_,A.LL.2.0f
OWNER INSTALLATION ON
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: — f c DATE:
LICENSE NO: 4,\57
Call 639 -4175 by 7:OOpm for an inspection the next business day
Electrical Permit Application
Date received: 3/3 0 / Permit no.:0j/ �/ ,S
—_ wK. i
,� ..i n! City of Tigard Project/appl.no.: Expire date:
CiryojTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
. T''PE OF PER119IT
-
0 1 & 2 family dwelling or accessory Q' Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other. 0 Partial
JOB SITE INFORMATION .
Job address: / 6 5- p L i $(Ai • 7 2 " . Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: d f / ) 13 a Tti a r� I Description and location of work on premises: 2 5w / Tc ii,ey
Estimated date of completion/inspection:
CONTRACT OR APPLICATION ' FEE SCIIEDULE '
Job no: / 1-1-2 1 Fee Max
Business name: jp j/ I v Le c t r IC
l Description Qty. (ea) Total no. Insp
_ New residential - single or multi -family per
Address: Z �% ( i vf < . • l S7 dwelling unit. Includes attached garage.
City: () r t 4 P 1 State: I ZIP: q 72 1 Senkehicluded:
Phone: ZZ(, -6,77I I Fax: 2 -77W I E -mail: 1000 sq. ft. or less 4
CCB no.: I Elec. bus. lic. no: -,4c... Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
' (:)//)- 341 r / Each manufactured home or modular dwelling
Signature of supervisin elec 'clan (required) Date Service and/or feeder 2
r , Sup. elect. name (print):' e 4,0 r / DS', 17-2 License no: p S Services or feeders — installation,
alteration or relocation:
I'ROI'ERTY 011'N Ell 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: 'Fax: 1E-mail: r Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - -
which is not intended for sale, lease, rent, or exchange according to installation, alteration , orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 70L
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am. s 2
ENG I NEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: • 1 ZIP: B. Fee for branch circuits without purchase
Phone Fax E -mail: of service or feeder fee, lust branch circuit: 1 (4. iryrf 2
Each additional branch circuit:
PLAN REV] I %' (Please check all that apply) Misc. (Service or feeder not included):
0 Service over 225 amps-commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps- rating of 1&c2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant Toad 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 ( 1 1 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit c ards, please call jurisdiction for more information. Notice: This p ermit application Permit fee $ `/, t; i
0 visa 0 M expires if a permit is not obtained Plan review (at _ %) $
-- ` Credit card number , / / within 180 days after it has been State surcharge (8%) .... $ 3. `' �
Es accepted as complete. TOTAL $ Si
Name of cardholder as shown on credit card •
$
Cardholder signature Amount 4404615 (6r00/COM)
CITY OF TIGARD BUILDING INSPECTION DIVISION 3,52-P
24- HQsr..Ilnspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested AM PM BL ®r
Location 5 00 S 2 Z.ti' 4 Suite MEC
Contact Person L-e d t 64 J-/i2 V /nn Ph 15 65' / PLM
Contractor Py - t'( r Ph SWR /
BUILDING Tenant/Owner t/!" /
ELC Z_'v /y
Retaining Wall ELR
Footing Access:
Foundation / / FPS
Ftg Drain C l /1 roe .. EcAJ, Gl e
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING t e E
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
•
Smoke Dampers .
Final
PASS PART FAIL
ervice
Rough In
UG /Slab
Low Voltage
Fire Alar
Fin
PART FAIL
BackfilUGrading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: ] Unable to inspect - no access
ADA
Approach /Sidewalk Date 3/ Ins Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.