Permit A. CITY OF TIGARD ELECTRICAL PERMIT
i;' DEVELOPMENT SERVICES � �`i tir'Ocp
PERMIT D : E 9/2004 -00326
DATE ISSUED: 6/9/2004
ref l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S111 DB -KE011
SITE ADDRESS: 15095 SW 93RD AVE
SUBDIVISION: KESSLER ESTATES ZONING: R-4.5
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Temporary service for job trailer.
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:
BUENA VISTA CUSTOM HOMES ROSS ELECTRIC INC
6932 SW MACADAM AVE STE C 2870 SW 221ST AVE #203
PORTLAND, OR 97219 HILLSBORO, OR 97123
Phone: 503- 443 -6033 Phone: 503 - 642 -2800
Reg #: LIC 157891
ELE 34 -436C
FEES SUP 4232S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/9/2004 $66.85
[TAX] 8% State Surcharge 6/9/2004 $5.35 Elect'l Service
Rough -in
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 t fo • • OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246-0 9or1�00 -33 -- 44. /�'„
Issu d By: k _Il ___ ► Permit Signature: V���' �� /�r,.y,/
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: -.1_,. ✓� 7 -' r DATE:
LICENSE NO: , 3. 5
Call 639 -4175 by 7:00pm for an inspection the next business day
/16/08/ 14:21 5036425815 ROSS iLECTRICCINC / PAGE 01 , l
Electrical Permit Application - i crK OFt;1( F iiSl O \la''
• Received +
Date/13 / ' r• `ce✓ _ .
�11 Tigard Planning Appr.val Sign
Date/8 : Permit No,:
13125 SW Hall Blvd, Plan Review Other
Tigard, Oregon 97223 Date/B : Permit No,:
Phone: 503 -639 -4171 Fax 503.598 -1960 met-Review taro Use
Internet: wvrw.ci - agard onus : Case No.: .
24 - hour Inspection Request: 503 639 - 4175 Contact ew; ►o see page 2 n r
� � Sa,vlementallCormatiaa.
..`i''K. ..}i;5z,;,. '7.:4: .4 .�r:.1',. p�r�7� pt ig 4 c. - yy _ "'
.: w t _4 , ,,� ;,
..k•. 1, � .. .�4G ". ..SSrASI;I,,.' : .,�`` •�.. f�,5�" •r� . :p'�;.. : :;ni �;�yi3i »- .. ,,,tEr a �.+ , v im •• d x.O { 9d��:�. .J,� 3•�nn't �,'�� i z•�1 K,,,�; y.,��
ew construction 0 Demolition of Service over 225 amps- ■ Health•care facility •
• AdditiOrt/alteration/r lacelxtettt Other: commercial l 0 Hazardous location
❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet.
- ' ^ " : :s; y 7i it ac' 1 t, ,'! ?;4 . --' - C ,, : rd,c 1 l & 2 family dwellings four ar more residential units itt
' Z - 1 & 2 -Famil dwell' _ ■ Commercial/Industrial rcial/Indust EI System over 600 volts n o m i n a l one structure
❑ Building over three stories 0 Feeders, 400 amps or more
■ Access° Building • Multi - Family 0 Occupant load over 99 persons 0 Manufactured structures or RV park
0 Master Builder • Other: ❑ Egress/lighting plan 0 Other:
;fi ?!; ` ` .rq ; ° :,• a .. Submit seta of plans with any of the above.
tt3 b it t_ s a i The above are nott a Leabte to tern , construction service.
"J' ddress ISO / S �� 3 1� ..�� ",'�3 Y.+;�, � )r�'' d+yo +i. +ntvei 7S`!i i [ - 1
, 'rvv
k giii a`�.4tir i . ' a tr. ., .` -. ,.Atli "i�YdSi. f.a�''J' . k.�d^,9:+', ,, !:r
Suite #: '1 B ,/Apt• # :• Number of InspeEtions per permit allowed
Project Name: Ke .E..-1- F4 Phase. I Description • Qty 14e014 'rotAI
Cross street/Directions to job Site: New +tial- 9lugle or meld-family per
dwelling unit includes attached garage,
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 3i40 I
Subdivision: I (,east ' _ + - Limited energy, residential 75.00 2
F 5 t �r ! r! S Lot #: 1 1 Limited energy, non residential 75.00 2
Tax Ina / arcel #; Each manufactured home or modular dwelling
p;•' :?' :`i;: i ::iii; : :::^. ClartTre 1RM = .. ' =i! + O::iit; . savice aad/orfeeder - 90,40
( GI� '� Oh IG �(iVtS� fr G yr„ Services or feeders - Installation,
__Y f /y+/1 Te Y_t�an� alteration or retoeatim
Sev14_c c_ -'c-- Sr., -7v-i l -- 200 amps ar less 80.34 x
- 201 amps to 40o amps 106,85 2
401 amps to 600 amps 160.60 - 2
'V; 0 « c *:jai+ -' ti^ r 601 to 140a : 2 40,60 2
�7 rr�� ..,.a ac :, .ti4xc'_ Over t et or volts
Name: IS UC►'►6k V k4 6461-c6-, f k l^'te5 414,65 2
66.85 2 I
Address: 6/32 cut VVlcruacieuir+ A-Vr, l �,11. G Temporary services or feeders - installation,
City/State/Zip: IOcA - laq -mil OI ( 972F1 amps or less ( 66.85
� Phone: 03) i-1 /3— 47033 Far ('o3) V -2 3 tkrtra4
I � j 1
; a` t •: .. s=s; i - ', ° ° :..... ;5i *vii: a s • , • .! :' f�; ;, 2 44tta 600amps _ 133.75 2
Branch circuits - new, alteration, or
Name: 13 U ono V I S f - tt 6.4 tw' f -k.'vm- LS I 2 y )c extension per panel:
Address: 6' c) ?2 St 1 w, j-t -r. ci ),I C
A. Fee for branch circuits , each branch circuit 6.65 x
y /State/Zip: �°ouf 1 Lsv c1 ..,A OP\ ) Z14) B. Bee for branch circuits without purchase of
Phone: (S G3) 1 -i Lt?-- / � X33 1 Fax: (563) ''1 L} 3' ,2 �3 9clviee or fee r fee, first branch circuit 46.83 2
Each additional branch circuit 6.fi5 2
E - matt: c i Mise,(Scrvice or feeder not included):
;.T kJ', °r - .y'�AL.".� :t 1 •'•k ;t°{!C+L•'. rj�e :, nL?: `.�;, °�:,{ ;: : " t: -/, Each pwnpo •
�.. .�' :: A•.:.....',1,. r•. .,,,;,;tx ,, �..�.i'.� i M'h ��a r f..Y „' � ,. 53.40 2
Job Na: si or oatiine i a 53,40 2
Signal cireuias) or a limited energy panel,
Business Nae: t
m alteration, or extension . Page 2 . 2
Address i 51 t ,1, 2` Drscriptian
f /
"1hristatE/Z1 : i„O )•, f , , 012 t 71 - Each additional inspection over the allowable in an of the above:
Per inspection per hour (min. I hourL 6150
Phone:5'Z a~+ Z 2 (.")C.a Fax [, Irrv danfee:
CCB Lic. #: IS / Lic. #:.3 34.6 Per
°iOther! Supervising + , r� 3 ;�x;.. }�i. ° +.g,... ,,,rT, +�...M'Y. :st.. ,�K :�,
si_, attire re•uired• 1 g) Permit S . b
Plan Review (25% of mit Pee) $
Print Name: ,)-€alQ J 0 Lie. #: , ' 3 State Surcharge (re of Permit Fee $ , � �
TOTAL. PERMIT FEE S , y}
Authorized y� %� / /`���6 _ 7_ ' - )L.t _
Notice: This permit application expires if a permit is not wit hin
Signature: Date: - 180 days after it has been accepted na templets.
— )'<yic 'MGE. I / 'Fee methodology set by Tn -County Building Industry Service Board.
Please print name) -
i;tDats\Permit ForrrtelElcPermitApp,doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection t,irie :1503) 639 -4175
INSPECTION DIVISION Busine Line: (503) 639 - 4171 MST
BUP
Received 6/k- Date Requested AM PM BUP
Location /5
0 q5 q3 rd i Suite MEC
Contact Person /� Ph ( ) PLM
Contractor C 1 4 /CA / , � Ph ( ) SWR
BUILDING Tenant/Owner ELC of &24l -6"O�
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing `'J � u2 G R.CTVl4�1 : ��JE�J� g -6/V� �
Insulation Q �� )1\ �,.. �� (? '$ � f\
Drywall Nailing uJ °0n1� v tV
Firewall r 2 1 1 4
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof Q `'6. IN) -- TGAI Le- 1 s Na 2 p6
Fi r:
na 1 - C 1 ,5 V - (4 ' — A) 07 9 b�
PASS PART FAIL
PLUMBING 1��1J •
Post & Beam VV
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
CTRI
Roug -I "€
UG /Slab
Low Volta
Fire Alarm
IP Fi al ,/ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS) PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line ,�
ADA
Approach/Sidewalk Date .. j 6 - `)� Inspector Glk , V & v L Ext
Other:
Final DO NOT REMOVE this inspection r ord from the Job site.
PASS PART FAIL