Permit • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00401
DEVELOPMENT SERVICES DATE ISSUED: 7/1/2004
-AL 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S11466 -13100
SITE ADDRESS: 16465 SW 104TH AVE
SUBDIVISION: SWANSONS GLEN NO.2 ZONING: R-12
BLOCK: LOT : 072 JURISDICTION: TIG
Project Description: Job 179 Circuit for A/C
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:
MORENO, JACOB SOHLER ELECTRICAL CONSTRUCTION
16465 SW 104TH AVE 41131 SW BURGARSKY RD
TIGARD, OR 97223 GASTON, OR 97119
Phone: 503 - 598 -0299 Phone: 971- 832 -0807
Reg #: LIC 158285
ELE 34 -667C
FEES SUP 594S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/1/2004 $53.50
[TAX] 8% State Surcharge 7/1/2004 $4 Elect'I Final
Total $57.78
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 By: " �'� pJ Permit Signature: _Ad �i „r / _ _
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
Jun 29 04 06:21p Joe Sohler 503 - 985 -1078 p.2
ECEIV ,
.11.1/1G%.1./. a a.i 1 ci. MIL Hp l / ucauoQ FOR OFFICE USE ONLY
City of Tigard ;JUN ' 2U04 Received
13 125 SW Hall Blvd., Tigard, OR 97223 Daffy Permit No.:4e ‘962)y_ L f„
Phone: 503.639.4171 Fax 503.548.1960 T1GAR _ Date/ By: J�/
OF `' : DatelBy: OtherPermit:/h//i R�
Inspection Linn. 503.639.4175 LI�Y , "�� Date Ready/By: Juice
ice
t � �y
plVl. ®gefor
Internet: wwwci ttgard.or.us pU1LD1NG Notified/method:
_ .
1 pp See Pa
t
I ' ` Add ition/alteration/re Addition/alteration/replacement her
:: -. . E' OF : WORK: :,.
e
. .PLAN REVIEW - ..
❑N ew construction ' -
p nt Please check all that apply:
[]Service over 225 amps, comm'1 ['Hazardous location
❑ Demolition ❑ Other
CATEGORY OR CONSTRUC ; ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft
of 1- and 2- family dwellings 4 or more new residential
v 1 and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder
['Building over three stories ['Feeders, 400
❑ Other. amps or mon
7UI3 S ITE'1NF Olijyl KITOjir' . AND�I; CATION - ❑Occupant load over 99 persons ['Manufactured structures ol
... ['Egress/lighting plan RV park
Job no.: 179 ) Job site address: i (o `.165 []Health care facility ❑Ot}ter:
S W CO11 6 Submit 2 sets of plans with any of the above.
City/State/ZIP: . q
t 1 a f ci 6 g 4 7o1,-. y The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: / r Project name: ;. FEE* SCHEDULE. .
/ r , Desertptien 1 Qty. I Fee I Tetaa f -'
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. addi 500 sq. R. or portion 33.40 l
Tax map/parcel no.: • Limited energy, residential
75.00 2
-
DESCILiRTiON a1F WOBiI . . Limited energy, non- residential 75.00 2
1' Each manufactured or modular
/T C i c P /,. 4.24 dwelling, service and/or feeder 90.90 2
r� Services or feeders installation, alteration, and/or relocation
r 200 amps or less 80.30 2
. ' .- `0PROPERT'Y O . " I - CI _TENANT amp 40 arrtps 106.85 2
111111 '''' WNER 401 20t amps to to 600 0 amp 160.60 2
Name:
li { O Y9 U two 601 amps to 1,000 amps 240.60
Address: ) / 2
l 7 �� S �] ([� y � — //C., Over 1,000 amps or volts 454.65 2
City/State/ZIP: 7' / O .2#.2 Reconnect only 66.85 2
/ / G t C7l Temporary services or feeders installation, alteration, and/or
Phone: (>63) 5 -- 0 9 7 I Fax: ( ) relocation
Owner installation: This installation is being ade on property _ o 200 amps or less 66.85 '
c 1
intended for sale, lease, rent, or exchange, according to ORS 447 449, 6 0, and 701 not 201 amps to 400 amps 1 2
Owner si 401 amps to 600 amps 13375 2
gnature Date
Branch circuits new, alteration, or extension, per panel
: , _ ttP PYiICANT : :: ONTA:Cr •PERSOt(' .` A. Fee for branch circuits with
service or feeder fee, each
Business name: 5' o �� �iP c.1 -- r et? Cep 6.65 2
r
Contact name: �n >� / _ without tom+ s � B. Fee for circuit
circuits
n t-eNe ut service or feeder fee.
Address: y 1 I S, t�-1 each branch circuit
1 e, t e a rc k (�- Each add branch circuit d 6. Co. ,�`� 2
City/State/ZIP: /., . j n vv U o: GS 2
G T' 1 q 7 / l -7 Misce llaneous (service or f ee d er not included)
Phone: ( 71) 3 _o p, G Fax = (Sa3) 9 S' - () ? Pump or irrigation circle 53.40 2
Si
E
Sign or outline lighting 53A0 2
Signal eircuit(s) or limited-
'. ..:COPITRACI'0 _ energy panel. alteration, or
Business name: Se E l eCT rr r.c . ' S 21--, extensio D escne: Page 2 2
Address: Each additional inspection over allowable in any of the above
City/State/ZIP: Per inspection 62.50
^� Investigation per hour (1 hr min) 62.50
i
: Phone ( 7, 8 3, - o go 7 L Fax (S G 3 ) , s - —lcl
■
p Industrial priori[ per hour 73 - 75
Cl
CCB Lin.: t (125 S'" Electri • = ic.: l /` r . - ;" 'ELI�CPitICAL PERMIT. Pt;ES*
: 3 t / --rte s a. rv.Lic. � q_5
5 Subtotal ! rj 0
Suprv. Electrician signature, 1 P W M ' J Plan r eview (25% of permit fee)
Print name: ( 14„-le S S Date: (n/,--2 D , / State surcharge (8% of permi IT
t fee) v
Authorized signature: AA , - TOTAL PERM FEE 7 7S
e: / v 1
This permit appiicarion expires a permit is no obtained within ISO
Print name: S O t t ut. Date: • 4 v • Fee methodology et by i-C
days after it has been accepted as c
S, , Nt , ee methoy Tramry Building Industry Service Board
Number of inspections per permit if allowed
08 ui 1 dioglpamita1El .C- PcmitAtn,d« 12/03 . en.na, „ n n.vrn..mrro
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 A MST
BUP
Received �� to Requested � AM M � ` O U BUP
Location 4' <4 / 0 ` Suite fglIP c , , 4:fi0S 6 - - 6te,
Contact Person Ph ( ) 6 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC C' (1 9 i 64) 1. Pi
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain �, (; (;
Slab Inspection Notes: 4' SIT
Post &Beam K�
Shear Anchors --z-Jo _ od LL 0 '
Ext Sheath/Shear '1
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING j
P
4. 2
ost & Beam ,/
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P RT FAIL
ECHANICAb
Post & Beam
Rough -In 0,1(/
Gas Line
S Dampers
i _ ■ RT FAIL
TRIC
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
"et*. PART FAIL
SITE ❑ Please call for reins•ection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA � j dt/�
Approach/Sidewalk Date Inspector L > 7 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL