Permit CI TY OF TI GARD - PERMIT #:. E LC2001- 00173 -
r� DEVELOPMENT SERVICES . DATE ISSUED: /2/01,
r� 11 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6394171
- • PARCEL: 2S112CB- 16000
SITE ADDRESS: 15301 SW 84TH AVE
SUBDIVISION: HAMPTON COURT , ZONING: R -7
BLOCK: ' • . • LOT : 009 JURISDICTION: TIG
• _ Protect Description: Installation of one branch circuit for new a/c unit:
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: r 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC.OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L B 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:
•
RENEA BERGER SHARPE ELECTRIC INC •
15301 SW 84TH AVE 22605 SW RIGGS
TIGARD, OR 97224 . BEAVERTON, OR 97007
Phone: 624 -2308 Phone: ' 642 -7937 -
Reg #: LIC 000815 •
SUP 3344S
- ELE 34-217C
FEES • Required Inspections
Type By ' Date Amount Receipt . Rough -in
PRMT CTR 4/2/01 $46.85 2720010000( Elect'I Final
' 5PCT CTR 4/2/01 $3.75 27200.10000(
Total $50.60 •
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•
•
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 req uires you to follow rules adopted b�theOregon Utility Notification Center. Those
rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0080. You may obtain oopi- these rii1 •rdirect questions to OUNC at (503)
246 -1987:
PERMITTEE'S SIGNATURE y. iL,lAL � ISSU • BY , . �
OWNER INSTALLATION ONLY
The installation is being made on property Town 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 >
•
Electrical Permit Application �e 2,
A.,
Date received: G( Permit no.: �:o/ c/J 5
5 1 City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 • Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
X"1 & 2 family dwelling or accessory 0 CommerciaUindustrial CI Multi- family CI Tenant improvement
0 New construction ( Addition/alteration/replacement CI Other: 0 Partial
JOB SITE INFORMATION
•
Job address: / I SW $ / I Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: .ISubdivision:
Project name: LA- Dp scription and location of work on premises:
Estimated date of completion/inspection: " /5/
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
r L �L
Business name: ShetrPe G e � Description Qty. (ea.) Total no. insp
S oP A" f1 New residential - single or multi-family per
Address: C ) i dwelling unit Includes attached garage.
City: . /4 '19 "1. tate:OK I ZIP: 4 70 O 7 Service included: .
Phone:S03 le ' 7931 I Fax: . I E -mail: 1000 sq. ft. or less 4
i,' / S/ ce I 3."-/ - (A 7 c-___, Each additional 500 sq. ft. or portion thereof
CCB no.: Elec. bus. lie. no:
Limited energy, residential 2
City/metro lie. no.: A5-3/ Limited energy, non- residential 2
A /di 1 _ !1/oj/6 ( Each manufactured home or modular dwelling
Signature of supervisi g electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): L • • 4 a License no: 3, N q.$ Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less • 2
Name (print): .i)Led..- ��y��C� Q�/ 201 amps to 400 amps 2
Mailing address: /,s j( *,) $ [¢ 401 amps to 600 amps 2
J 3 601 amps to 1000 amps 2
City: /( ?UZC' I State:O I ZIP: 97a _2 it Over 1000 amps or volts 2
Phone: ( 9.30 d i Fax: I E -mail: 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, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER 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: I State: ZIP: B. Fee for branch circuits without purchase I Ci Q S
fee, first of service or feeder feerst branch circuit: Y 2
Phone: Fax: E -mail: -
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service orfeedernot 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&2 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,
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Other. Per inspection I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other J
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ T G " • ��
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 3 • 7S
Expires accepted as complete. TOTAL $ ;5 D • epo
Name of cardholder as shown on credit card
$
Cardholder signature Amount 4404615 (6 /00/COM)
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP
k +1) Date Requested 7` AM PM .BLD
•
Location 1' 3O/ v g7TM Suite MEC
Contact Person // Ph (U) - c� 2, PLM
Contractor 34 ,9 - P h SWR
BUILDING Tenant/Owner ELC - CZ 03
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN •
Crawl Drain • Inspection Notes: •
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 -it&
PLUMBING
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
j
_ Service
Rough In
UG /Slab . . -
Low Voltage
Fire Alarm .
1 411._ PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ j Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ j Please call for reinspection RE: [ j able to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other - Date V 9 D/ Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.