Permit A: CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00525
411.7%, DEVELOPMENT SERVICES DATE ISSUED: 8/23/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112CB -12700
SITE ADDRESS: 15070 SW 81ST AVE
SUBDIVISION: PP1991 -017 ZONING: R-4.5
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: New 200 amp service.
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: 1 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:
CORBIN, GARY S AND TERRIE T & T ELECTRIC
13950 SW BONNIE BRAE COURT 4120 SE INTERNATIONAL WAY
BEAVERTON, OR 97005 SUITEA -105
MILWAUKIE, OR 97222
Phone: Phone: 503 - 652 - 7610
Reg #: LIC 150973
ELE 26 -1105C
FEES SUP 2184S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/23/2004 $80.30
[TAX] 8% State Surcharge 8/23/2004 $6.42 Rough -
Elect'l Final
Total $86.72
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:1 r Permit Signature: C e,k)
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 7:00pm for an inspection the next business day
•
Aug 23 2004 12:04 T&T ELECTRICAL 0 5036527612 p.2
EC IEIVED
E1etica1 Permit 'Applicatib
I
City of Tigard
I..... � 2 3 , t Received t (��l Permit No.: ����a(� �J 13125 SW Hall Blvd., Tigard, OR 97223 7 � Phone: 503.639.4171 Fax: 503.598.!960 ; Date/By Plan Review d
air ^j� iO I ' _ Date/BY Other Pemu t:
Inspection Line: 503.639.4175 CITY 1 F _a;t .` i Date Ready/By:
Internet: w ww ci tigard or us BUILDi lvo6fied?vlethod I ( - � S see 2 for
n
V Supplemental information
t ^.�Il� (� 1 y;�1ra ! ter. t',"71i T i p„ f° 'Pa r � t i �i , /
hj �''Np'2�� - •✓�"rt "fit y "ty a�, i :ji.' �X (�{ 1
1 .3...tr ._ i. .M.b :•lt ..� 'L ,' ! , y�41 1. e � . '•1� 1 4aF�'Jr
It ts. l _ ' ...., ;� SF F, �s ' ' E
❑ New construction v f Addition /alteration /re.lacement Please check all that apply:
❑ amps, comm'I Service over 225 am
P ['Hazardous location
❑ Demolition 0 Other:
. ,::.'. ; Iti4 '?,�' .., .>; t r,"Ml w ' rT'"�1p ?� > i, R'i lWir 0 *7', j oo , •, .; ❑service over 320 amps - rating B
` ?i!i''Si -� • :. :. s1 't r l: l n y kj,`�• Can rt�J�u ta,i ° a 1, I1 sg 1 s s P g ❑ u ildng over 10,000 sq. ft.,
i ' .,ief,, �ffi �i L4 - ,NtOmi ) 4111; y: .4 : . 2ie of 1- and 2- family dwellings 4 or more new residential
.. � 1- and 2- family dwelling ❑ Commercial /industria ❑ Accessory building DSystem over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other.
en + i �u��s ycs�nl�e , 1 ' u r ,� y �; y _. �, ❑Occupant load over 99 persons ❑Manufactured structures or
. � =�,,ie : ,:, a � . ;�•;,( ❑ Egross/tightingPlan RV park
Job no.: q014 , e Job site address: I ZD 5 W ['Health-care facility ['Other: " I `�T Submit 2 sets of plans with any of the above.
City /State /ZiP: ii ► • The above are not applicable to temporary mporary construction service.
Su ite/bldg. /apt. no.: Project name: . -'s�} , m 'I ';', / 791 It t , . ,:.,W,'1.:1,,.....,. r . .
Description Qty. Fee 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: I Lot no.: Ea. add'! 500 sq. fl. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
( ?i " , r:, lI z "_ ,,, ,,,, r , c �, ac " s�s to , lxnp , g , ' ��� � ii, yy jj o , � sq-241%.:. , „m� . 1 Limited energy, non - residential 75.00
', !tail Y'Sisess tiffs f143
: ,e N ,l, I' � . -g � �i rn ` A l i ' 2
oi , ..z( Each manufactured or modular
- ,. dwelling, service and /or feeder 90.90 2 I
sG G� U '^ Services or feeders installation, alteration, and /or relocation
{ 200 amps or less i 80.30 th, bO 2
..: , nr • ti? , - "' a i , n tae. 1 r Iirmr,1' �t
:S �ai�?a h � sr s G J i is x .: I t T 201 amps 2
y ,n, l� �� +- hx ; ��s p to 400 amps 106.85
Name: C e , Co 7 5 , ,� t 401 amps to 600 amps 1 60.60 2
RIM t J `- 4r I i of 601 amps to 1,000 amps 240.60 2
Address: ' r - ti — 1 0 tAr4 b ro. AV 4 , Over 1,000 amps or volts 454.65 2
City /State/ZIP: ii el , p viri r � r7 v Reconnect only 66.85 2
K.
Temporary services or feeders installation, alteration, and /or
Phone: ( ) I F ax: ( ) relocation
Owner installation: This installation is being made on p operty that I own which is not 200 amps or less 66.85 I
intended for sale, lease, rent, or exchange, according to •RS 447, 449, 670, and 701. 201 amps to 400 amps 1 33 . 7 5 2
401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
t �,
U .. Vi 4 e r7 _ '' l xD e..l tj J4• 1a ;cNt {m. o, , •-
• . "�txr, g ,� , 1 l � a ' • -. '' A. Fee for branch circuits with
Business name: service or feeder fee, each
branch circuit 6.65 2
Contact name: B. Fee for branch circuits
Willow' service or feeder fee.
Address: each branch circuit 46.85 2
Each add'! branch circuit 6.65 2
City/State /ZIP: _ Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
E-mail Sign or outline lighting 53.40
2
'; ,� , t 1 ,:: T & T Electrical, LLC Signal circuit
. ; ,, „ „ i( s) or limited-
t i -; ,,IN 1 Il;'. energy panel, alteration, or
Business name. 4120 SE International Wa
extension. Describe: Page 2 2
Suite A -105
Address: Milwaulde, OR. 97222 Each additional inspection over allowable in any of the above
City /State /Z1P: - Per inspection 62.50
investigation per hour (t hr min) 62.50
Phone: (503) t e 2 , , (,p I t' I Fax: ( ) s 2. e 1 t p ' Industrial plant per hour 73,75
CCB Lie.: E Lic.: . jaly; „'t'aiiv a3l�w aa>= `*
I�J - I I V �1AiY� ' (��5 Suprv. Lie.: 4I1? I S Subtotal g
Suprv. Electrician signature, required h II/ Plan review (25% of permit fee)
Print name: D ill j l � ' t..t � �J I � V/ �tB I Date: �� ( 61 "� State surcharge (8% of permit fee) / , 4-2_ 4-2_ 1 / I i r'► f `� �'�"( TOTAL PERMIT FEE �
Authorized signature:
n`/ 1 This permit application expires If a permit is not obtained within l 150
Print name: Ti - V l I Date: t / 1 7/0 dayr after II has been accepted as complete
` { * Fee methodology set by Tri -County Building industry Service Board
'* Number of inspections per permit allowed.
i:■Bu i tding\Permils■nr.C- PemvtApp.d 12103 440- 4615T(10 /02/COM/WEB
■
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION' Business Line: (503) 639 -4171 MST
BUP
Received / Date Re nested g O` e l AM PM BUP
Location t " 70 (2t /'1-(P - Suite MEC
Contact Person Ph (
)(; C 02 ¥ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal l
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 FAII
MECHANICAL O VsV ) 0L- ) 3 5 0 I a f
Post & Beam n M cC C c��� ��y_� D
Rough -In
yr �► =- -
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ECEC�R�C�
. 44 7
/y �� ��
R • -In el". 6
UG /Slab
Low Voltage It Fire Alarm
`�— Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
SITE Please call for reinspection RE: II Unable to inspect - no access
Fire Supply Line G / �'
ADA e/-2 /0
Approach/Sidewalk Dat Inspector 1L� Ext
Other:
Final DO NOT REMOVE this inspection record rom the Jo site.
PASS PART FAIL