Permit CITY OF TIGARD ELECTRICAL
PERMIT #: ELC2004 -00656
,�i� DEVELOPMENT SERVICES DATE ISSUED: 10/13/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111 DD 09200
SITE ADDRESS: 15915 SW 87TH AVE
SUBDIVISION: CHESSMAN DOWNS ZONING. R -7
BLOCK: LOT : 018 JURISDICTION: TIG
Project Description: (1) Branch circuit.
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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WEISS, PATRICIA I GRIZZLY ELECTRIC
15915 SW 87TH AVE 3301 E 11TH STREET
PORTLAND, OR 97224 VANCOUVER, WA 98661
Phone: 503 - 655 -4995 Phone: 971 - 570 -8101
Reg #: LIC 56129
SUP 2643S
FEES ELE 37 -446C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/13/200' $46.85
[TAX] 8% State Surcharge 10/13/200' $3.75 Rough -
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 By27Ls 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:
Call 639 -4175 by 7:00pm for an inspection the next business day
Grizzlj Ele 380 -894 -8939 p.1
10/11 /LUU4 115: IA.l 5u:i (..1 Ur 11(.AtW nglvu2
Electrical Permit Application
City of Tigard Da` -/3 -‘14/ Pam t No.: r.. ( y � J ( ed
•
13125 SW Hall Blvd., I igard, OR 97223 Plan Review
Phone! 503.639.4171 Fax: 503.598.1960 --a: 'r _;,I Due/Dr Other Permit:
Inspection Line: 503.63 9.4175 �,!0 PateROrdyBy. ® See Tate 2for
Internet www.ci.tigard.or.us Notitled/Method; _. Supplemental tnrormatlon
. ... TY P
li' P O WURK` :.
pI:
r� ;'AN'
o
❑ New construction Additioo/alterEti Please cheek all that apply
❑Service over 2.25 amps. comm I ❑ I {azardous location
0 Demolition ❑ Other: ❑Service over 320 amps— teems QBuildng over 10,000 sq. tt_,
' " ." • :.'CATEG it.1y OF' CONitiwO 'ION,; of 1 and 2 - family dwellings 4 or more new residential
and 2- famil dwelling 0 Couunercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
]Bui lding over three atones 117 Feeders. 400 amps or more
❑ Multi - family 0 ..Master builder ❑ Other ❑Occupont load over 99 persons iUMnnufactured structures or • ' • • • • • . • :1.00 SITE I NFORMATION AND ;L¢ICATION ; , • :' ❑Egress /lighting plan P.v park
ri ❑Health - care facility ❑Other: -
Job no.: Job site address: tiro Submit 2 sea of plans with any ot' above.
City / State/ZIP: y The above ate not applicable to temporary construction service.
FEE` Minh „
So -
Suite/bldg. /apt. no.: Project name' oesertlw.a [ Qtr - I Pea l Twat
Cross street/directions to job site: Q ' r New residential single or multi faintly dwelling unit.
U j / L Includes attached garage_
1.000 sq. ft. or less 1 145.15 a
Subdivision: L no.: En_ ■dd'1 500 sq. ft or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited D : energy, non-residents/1 75.00 2
ESClUFTTON. OF WORIK,' • , . ; .: ; ;. i ' '' ' - ': l , .:. . Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Services or feeders Installation, alteration, and/or relocation
_ 200 amps or less 80.30 2
s
.. 00 lumps 16.65 2
''C PROPE fTY OWNER 1:' °...'1- TE T ._
IYAN amps to a
_ 401 as to 600 amps 160 . 0 ,
.amt : ' (I --r ` \t`� IA t ' . +J 601 amps to 1,000 amps 240.60 2
q (� Over 1 amps or volts 454.65 2
Address: I5 / / X �-, \
Reconnect only 66.65 2
City /State/ZIP: 'T` \ �� Q 7-2- y'' Temporary services or feeders installorloo, tl Iteration, and /or
Y 7 -- ).r ' Fax: ( ) relocation 60
Phone: amps ( ) (� j ) p 200 coops or less 66.85 1
_
w
Owner installation: This installation i s being made on property that I own which is not 201 amps to 400 amps J 00.30 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: Branch circuits— new, alteration, or extension, per panel
- ' .. : ...PUCAN ;' .. .. . CONTAG ...PARSON " cc circuits each I
A F ee f or b ra n ch
. service or f 6.65 ' - y
Business name: broach circuit
B. Fcc for branch circuits ' I
Contact name: without service or feeder fee_ t/ g5 /` 2
Address each b reach circuit s/
Each add'1 branch circuit 1 6.65 2
City /State /Zip: Miscellaneous (service or feeder not Included)
Phone: ( ) Fgx; ( ) Pump or irrigation circle 53.40 } 2
Sign or outline lighting 53.40
E -mail: Signal circuit(s) or limited -
° Ot'lTRi4C'1'OR- =
energy panel, 8lte ratio o, or
extension. 'Describe: Page 2 2
V�VV
Business name: ���- „:u, , 4L Lc Li
Address: Each additional inspection over allowable in any of the above t. . Pct' inspection 62.50
r City /State �
ZlP'� OL
(�� Investigation per hour (t hr min) 62.50 r
Phone: (�m� 0 t Fax: ( ) Industrial plant per hour 73.75
I . ELECTRICAL PERMIT :FEES*.
\ CCB Lic: r -4 Electrical Lie.: j - ti , ..4 Suprv. Lic.; - _,Ar pi - Subtotal ,/( 1/5
/ ��
J '• Suprv. Electrician signature, required: e a t ” _ Plan review (25% of permit fee)
State surcharge (8.31, of permit fcc) r, - 7 5
Datc:
A• Print name; 1 ;� r S . t A _ - - � . " . 0 +!i - TOTAL PERMIT > f � --d 6
1
x Authorized sig /
' . , rare' Thu permit applicado.r ocplrei Ira prrrntt k not obisN.N withie Mao
�./ - days emir it has Duce accepted as .s y Se
Print name: , ' { � Date: 6347 //j - m
F athodolvay sat try Tri Counq Building tndueay Service Board •
' f ( **Number of inspection per permit allowed.
,; taundinsV •'mnit.NEt.C- >'d*nienp0. 1 a40.a615T(16t071COM/W*R
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (5► c) 639 -4171 MST
L;of� BUP
Received Date Requ-sted l l.Y AM PM S( BUP
Location / 5 7/5 61 & ¢ : Suite MEC
Contact Person P ( ) PLM ?
Contractor • h ( ) SWR
BUILDING Tenant/Owner ELC
Footing ep. 0� �_ C7�
Foundation Access: .2b,'* _
v -� p _s -- ��►,y -,��j -�
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
T FAIL
ELECTRIgAg
Service
Rough -In
UG /Slab
Low Voltage
F rm
Reinspection fee of $ required before ne , ection. P -y at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line - r
ADA r
ir
Approach /Sidewalk Date / 2 "
1 0 nspector ∎__ Ext
Other: -
Final DO NOT REMOV this inspection record f o t. the Job site.
PASS PART FAIL
CITY OF TIGARD 24-H a. i
BUILDING Inspection . .,) 39 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
(c BUP
Received Date Requested /4 -"( AM PM BUP
Location 1 5 9 1 5 F 7 Suite MEC
Contact Person 0 i.C.GC -rc _ Ph ( ) PLM
Contractor Ce-di Ph ( 9 7 ( ) 5 -3 s? < SWR
BUILDING Tenant 41r .,fdOg Ot S.
Footing
Foundation ELC
Access:
FtgDrain I� {(� LI ELR
Crawl Drain
Slab Inspection Notes: / / n SIT
Post & Beam ( iA-r" %
Shear Anchors /, /
Ext Sheath/Shear Nillkdi
Int Sheath/Shear
CC-rt n N o C ' c — CO L n C'/ cam" a
Framing ! - 1 b
Insulation
Drywall Nailing -2-.01 _ , r _•• _;■'• 4t ?b 1- (k vt
Firewall `
Fire Sprinkler ��
Fire Alarm
Susp'd Ceiling I �{ 1., �r\� �,�(� /
Roof Other: 1 t' 1--� PN • v b' ` 1 L ( r ' ,"���, rc, +3 � 0 t
Final A 1
PART
I FAIL
MB ' - )/ \) ` L1 V � (,�1 L,) , � \I V�
7 ' `k \l\r It)
Post & Beam O, /-,
=_..tes-i) �/ 1 Y
Water Service
Sanitary Sewer d v N ,
Rain Drains
_/-
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
ZfellT FAIL
I Q
Post &m
Rough -In
Gas Line
Smoke Dampers
Final
PASS RT FAIL
V
I L
Service V? &
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART
SITE ri Please call f• r reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record fr n1 the ob site.
PASS PART FAIL
—