Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00788
�I
DEVELOPMENT SERVICES DATE ISSUED: 12/9/2004
c � ) 13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639 -4171
PARCEL: 2S 112CD -H G024
SITE ADDRESS: 16068 SW 77TH TERR
SUBDIVISION: HAMBACH GROVE ZONING: R
BLOCK: LOT : 024 JURISDICTION: TIG
Project Description: Temporary Service.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
LEGEND HOMES GARNER ELECTRIC
12755 SW 69TH AVE # 100 2920 SW 247TH AVE #A
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503 - 620 -8080 Phone: 503 - 591 -1320
Reg #: LIC 121159
SUP 3707S
FEES ELE 34 -305C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/9/2004 $66.85
[TAX] 8% State Surcharge 12/9/2004 $5.35 Elect'I Service
Elect'I Final
Total $72.20
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: ; .V Le Permit Signature: 'g p�
OWNER INSTALLATION ONLY V
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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
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01/23/2003 02:50 6427925 PAGE 01
Electrical Pe rmit A licati .
d FOR OFFICE ITSE ONLY • CA of Tlgfl3�i Received
13125 SW Hall blvd., Tigard, OR 9722 � "' Y Er Dam/s 1 / ' ,
Rhone_ 503.639.4171 Fox; • 503.548.I960. 7 ; „ ..,.. F , P1aaReview i i
i fi Dat R Other permit
Inspection Line: 503,639 - 4175 ' _Rl� --. tiara ed /Meth
Internet www.ci.tigard,or.ua DEC 0 9
rrr r �, 200 Noq fied/hfetbod: See Page 1 for
rk e?Sr��� 1l'"{,In, ,7 �'�'dl � t °'li, 4 or�,sr�v�rsr ,�r�,^•,r�,nirlrlx l� rf I SapplemantAl Information
Clarnldr L1tu.� �wJ 4 ±�i'k,�a i Ft o+f rxr 4r,) Iln'I�l.� " {a„ r '� r , r. ,: J 'I �l �( ?�., r a ,•'Oy Z .`, ?lr'r 1
1 I lg • . ;fl a� �}�'I l '•,2,,�• ' I r ¢{. W::.�4�i7 r,} I11 T
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��� New construction uaA • fir a94d ki1efl - " ;': !; "
• c
0 ;Demolition • molit ❑ � o �� p e Please check all that apply_
V' "�; e i iu r fi {r ; � ��77��yy Other: w ❑Service over 225 amps, canvtl'1 ' CJi azardous location -
rl:t1'ic ai�19N't15 `r 5� l 45��' 0t � . °�W'< ¢ rgJ'/ r w� 1 f� d In of g . EiBuildng over 10,000 sq. ft.,
�' !� �'r' �� � �'t,w�,t�n ^� � � Serviceover320• a —tatin
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Fa,.ls•x- rlh s me AL - t "Ic is � a puff jr� r yi 5 ,; of 1- and 2- famil dwellin 4 or mere new residential
❑ 1- and 2- family dwelling ❑ Co mm ercial/itldustrial 0 Accessory building ❑System over 600 volts nominal units in one auucture
0 Multi - family ❑ Master builder % Other: D&rtlding over the smries ❑Feeders, 400 amps or more
j?fi�' M1 >, irl,rf rn y� r r r �f +li f " �� rti� "'a? ' cti rmkr� , *,,° rt, _,, , r. r R . Occupant load over 99 arse
t..r,« i+�1a4r. i s h�+tFr,;l z � 'lt�l,�a i _ t !gtfih`�ig,�i�r;i�s n��Ad, t �v" ig >��," l E, sn P t1s OMmufacturad structures or
c,� r rs:.^: ;,Rtw K�y;H „r,l �'h �til - ,, .�.� •T�' {'�ir�;g Ofigress/lighting RV park
Job no.: • Job site address: ,/0 r0 • � I ❑ Health -care facility ❑Other:
c X71 ��v Y�t� Subrm 2 sets of plans with an
Ay/ tat I• : y of the above.
e J. .4! /. 0 s, 0 2 . 2 . The above are not applicable to temporary construction service.
Suite/bldg. /apt.no.. Project name: ? +,,' '�� f 1 �� t�� It`d rye` r At ic'ai 1•,.,,; rid ;;' .
C street/dircetions to job site: Destrrpcion Qty. Fa. Total •”
. New residential single- or multi - family dwelling unit.
Includes attached garage_
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• 1,000 sq. ft. or less 145.15 0 •
Subdivision: Lot -no.: (94-- Ea. add'1 S00 sic .ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
DTI} r } R fr F ti7' 6 'T7r Z l {� 9 f z '� {. L rlRted ener
lft�',>:ly�i� �y(ili, �if i � '� 1 i 7 �yi�rL�{ci , .A, A s a ., . , r wa? �?2�' k'C y � y " ^/ °r k Each manufactured or modular
l 75-00 2
� � ., z� utg , � l e s r1`i� ��'�`'� �rla1 lt � , , �! i�y��`' � ) j ! � r�,�a k
i . _ dwelling, service and/or feeder 90.90 2
A A , "AMA go Services or feeders installation, alteration, And/or relocation
200 amps or less 80.30 2
° "1` 3 t'�Z ' tip i °:FffS f' ,f r
1:211.d.1,...06• r 1 i Y6r fP y� � , �1 r� l l �i" l" QrI (�1� r q7 ��(l t t [, r Oil 201 amps to 400 a
3.7i rt - �'SS�tf..k"t. fY%FCIv,SI.YUf tr,�tY." 7fT Rr `L ky'• ,� GII r �, 2 U ,gvIJ{A� � yyd9 yj ' 0, amps t�6.gS 2
If.,ro•Y,:, rr,>. �' 401 amps to 600 amps 160.60 2
aInc: _ `• 24 A I♦1I , /1 601 amps to 1,000 amps 240.60 2
Address: - l LL �� over 1,000 amps or volts 454.65 .. 2
Reconnect only 66.85 • 2
City /Statc/ZrP: 1 ` ��� 'temporary services or feeders installation, alteration, and/or
Phone: (Sin) ,, ^; • : F aX: ( ) 200 a thou . •
200 amps or less MI 66.85' 1.
Owner installation: This installation is being made on property that 1 own which is not 201 at to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature Date:
dt Bniteh circuits — new, alteration, or extension, •, er . aael
�r��r yk �kt r �ti �'CYr vu r � ,tm i' I :• MTV � r�l Tyr � ' f,� + irh l?� n� r",,, :J"�.'0 ' l. >F� v�a r r -�'
I11I1 4 .„ •S,w Fee a� INO.fAi; , i y. :) , nl o J ,,,r i)i 2 �.. , el � , ro1d r �0, R •i1 ,1. -- , t. A. Fee ice o r fe circuits c ,
servic or feeder fee, eac
Business )same: branch circuit 6.65 2
- B. Fee for branch circuits
Contact name: �� without service of feeder fee, 46.85 2
Address: each branch circuit
Bach add'1 branch circuit - 6.65 _ 2
City /State /ZIP: Miscellaneous (service'or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53 -40 2
1?'tl p m j y � Signal circuit($) or limited -
) l(? 1 , 1 r l r aili r4, 71 li ti ) tiM' q rr h_z_ ( 16 ,14: 1�t' 5' jY S L' II 1 2 �l lfi energy panel, alteration, , Of
A mw s ar it iy
T. ltai� , ,,, kSUgS...-. 1._ ,„ .lrr kt.: T '
extension. Describe: Page 2 2
Business name: . EL.GZ rgj -
Each additional las. ectlon over allowable in any of the above
Address:
g 2.0 ,S(A) -. 2- - 74 • - Per inspection II 62.50
City /State /ZIP: ' l� ! t ( t ov o f 01?, C ( 23 Investigation per hour (1 lir min) 62.50
Pha e: / industrial plant per hour 73.75
tl (� ) l0 3 � 5 Z P' �I ) C7 11 � 2� � 5 p < fe:o r '^ v t _ _: ;, :.r . , ',7 ; r•:,r
pyi,;.,•+?.,,,,, ar; * .r tai i ".: -.,,' -,,,,. tl t..y ` . . . .:f
CCB Lic.: ::..., •,..
r Electrical ic.: U/ ti s
I : H f ' El il Li _� fit: / S /�' ' • • � • � S u bt o t a l ,.
Suprv. Electrician signature, required: —Wit � ,!
�1� �1/ Plan review (25% of permit fee) f
� i_ / 5 i
Print name: �. C m.,,,,-
Date: / �_ State surcharge (8% ofpermit fee) 3 r l
� TOTAL PERIA/T PEE - �• � V
Authorized signature: This permit applica ex a u mit i s trot obtai eA within 180
deyi After tion It hlu been if acce of complete
Print name: • Date; Pse nathodolegy Tri ounty Bitag Indvsay Serv Be ard
" Nu:13er of iUSpecti oa x per pergdt C allowe
ir�uilding\PemuralELC-Permits pp.mc 17/03 A40 4615T(lO/U4/COM
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business LirW: (503) 639 -4171 MST
BUP
Received Date Requested /ol. — 1 4 7 1 AM PM BUP
Location _- Suite MEC
Contact Person Ph ( • ) PLM
Contractor Ph ( ) 6 SWR
BUILDING Tenant/Owner ELC " QO y v07e?
Footing
ELC •
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler •
Fire Alarm
Susp'd Ceiling
Roof
Other:
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
ice -)
Rough -In
UG /Slab
. Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date, ,- Inspector ‘ Eat
Other:
Final DO NOT REMOVE this inspection record rom t ob site.
PASS PART FAIL
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