Permit - CITY OF TIGARD
4 f' ELECTRICAL PERMIT
` PERMIT #: ELC2002 -00608
. . DEVELOPMENT SERVICES DATE ISSUED: 11/18/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103AA -01910
SITE ADDRESS: 12330 SW 106TH DR
ZONING: R -4.5
SUBDIVISION:
BLOCK: LOT : 019 JURISDICTION: TIG
Project Description: Job #04 -2309 Install 2 branch circuits to furnace /heat pump.
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: 1 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:
PEARSON, RICHARD E + MARY ANN TR EVERGREEN ELECTRICAL CONTRACTO
12330 SW 106TH DR 23861 SE 442ND
TIGARD, OR 97223 SANDY, OR 97055
Phone: Phone: 503 -668 -4608
Reg #: ELE 3 -472C
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/18/02 $53.50
[TAX] 8% State Tax 11/18/02 $4 Rough -
Elect'' Final
Total $57.78
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 1-801 - -•2- 23444.
Issued By: �;u L z.c_ A '/ Permit Signature: K--).--, cam -, ^ /` ,, a' R
S
OWNER INSTALLATION ONLY 0_
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: ' \ C -�� /-- DATE:
LICENSE NO: 4,1 5 r / S
Call 639 -4175 by 7:00pm for an inspection the next business day
04/23/2002 15:21 FAX 5035981960 CITY OF TIGARD liP002
Y
Electrical Permit Application
Datcreceived: _ - 11
4 [ '(' �' City of Tigard Project/appl.no.: Expire date:
'! r ®
CityoJrigerd Address: 1312.5 SW Hall Blvd, tittt G Date t ss ued: B Y Receiptno.:
Phone: (503) 639 -4171 Case file no.: Payment type:
Fax; (503) 598 -1960
Land use approval: N
❑ Commercial/indastrial 0 Multi - family 0 Tenant improvement
1 & 2 family dwelling or accessory
New constriction ❑ Addition/alteration /replacement D Other. _ O Partial
JOB SITE INFORMATION
yob address: „mig Bldg. no_. Suite no,; Tax map /tax lot/account no.:
Lot: Block; Subdivision:
- Project name: Description and locution of work on premises= (( l`{ , FsL
Estimated date of completion/inspection: FEE SCIIEDLtitE
CONTRACTOR APPLICATION Max
Job no 0 / D ese p ato ° Qty . tom) Total no. Imp -
Business name: y e...,-, re _& El c, -- New tad
residential -*Veer i Per
Address: t .. - dwelhrrg wit Includes attached gara4e•
e_ Serrie eineluded:
City:
Stara C }2 ZIP: e-)U r ,� f[. or less _ 4
� E -mail' 1000 sq. Phone: < OiGS - �tlt�C Fax: ur� c 5c& — Each additional 500 sq_ ft. or portion thereof _
CCB no. - 3 1 \ I Elec- bus. lie. no: 3--1/4. .( ,
—• i �.� Limited onergy.restae[[[ial 2
_ Limited energy. -residential 2
alff 11 -1 3 _0-e-. Each manufactured home or modular dwelling 2
Service and/or feeder
re of supervising electrician (required) Date r� Servi « aor feeders - Installation, T —~
Sup. elect. namc(prin[) :C4A -mil 5 G 1� -tom �eP �eno_ J u1-� alteration or relocation
PR()PERT1 OWNER 200 amps or less 2
. c 201 amps to 4100 amps 2
Name (print): 1 �' , 401 amps to 600 amps
.+ 601 amps to 1000 amps 2
Mailing . dress: 4r.
Cit r , r ZIP: _ • over 1000 • . s or volts
2
Phone: • 1
Y f 111._ Sill Fax: - E- mail: Reconnect ect only I
Owner installation: The installation is being made on property I own ar Oly services or Leyden -
installatioa.alteration, orrdoratian:
which is not intended for sale, lease, rent, or exchange according to 200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps _ 2
Qrte7'
WS S i BtUre:e 401 to 600 am s 2
Branch clrafR9 - mew, aeration,
or extension per panel:
Name: , A. Fee for branch circuits with purchase of 2
service or feeder fee, each branch circuit
C 13, Fee for branch circuits without purchase
City: Cy: "State: Z2: of =vice or feeder fee, first branch circuit: t 2
Phone: Fax: E-mail: Each additional branch circuit ■ 1 to
or feeder not included):
PLAN Rti.�'IL« (Plea.: check all that appl.) M��'a*viEe 2
Health .stefacility Each pump or irrigation circle 2
D Service over 225 ass pasrrturrercinl Each sign_/ outline lighting �—
0 Service over 320 amps -rating of 1842 0 Hazardous location
family dwellings 0 Building over 10,000 square feet four or ' Signal eircult(s) or a limited energy panel, 2
mote residential units in one structure alteration, or extension*
- O System over 600 volts nominal
0 Building over three stories Q Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons Cl Manufactured structures or RV park Each addit(onal Inspection over the Alownble le any attic above:
❑ Egrasllightingplan U Other. Pa inspection r i I
Submit _ sets of plans with may of the above. investigation fee
The above are Pot applicable to temporary coasuudioa 6ef"ice. Other
a
Nat all
Permit fee $
*mien. c t credit cards. pleas` teal jurisdiction Poe mote iefermatiat Notice; This permit application Plan review (at `Yo) $
Ovisa a MasterCard expires if a permit is mat obtained Stale surcharge (896) $
err — / / within 1 80 days ttRer it has been TOTAL •
S
Ypres accepted as complete.
No of eatdbolder as mown on aecht card S
4Aaad15 (sioutcOM)
Cardholdo - sintwue wmoat
CITY OF TIGARD 24 -Hour
BUILDING •Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / AM PM BUP
Location f oZ 33 AD (e) Suite - lid.6 — U
c�
Contact Person Ph ( ) / .02 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/ // (I a 2 - 66 Og
Footing C� O Z d — 6 , 7 ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain 7Q / btC7
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 t
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 ART FAIL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
- ^� ti•7 1:1 1
Service
Rough -In
UG/Slab
Low Voltage
Fi - larm
�' ♦ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
r.:rr PART FAIL
El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date _ Inspector • ° Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL