Permit A, CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00221
F. DEVELOPMENT SERVICES DATE ISSUED: 05/01/2001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110AD - 05200
SITE ADDRESS: 14840 SW 106TH AVE
SUBDIVISION: LANG HILL NO.2 ZONING: R -
BLOCK: LOT : 045 JURISDICTION: TIG
Project Description: Installation of (10) each branch circuits with feeder for kitchen remodel.
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: 1 W /SERVICE OR FEEDER: 10 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:
WILSON, DAVE G HEBERLE ELECTRIC
14840 SW 106TH AVE 19680 SW NEUGEBAUER RD
TIGARD, OR 97224 HILLSBORO, OR 97123
Phone: Phone: 503 - 628 - 2095
Reg #: SUP 3053S
LIC 42841
ELE 34 -160C
FEES Required Inspections
Type By Date Amount Receipt Rough -
PRMT CTR 05/01/2001 $146.80 2720010000( Elect'I Service
Elect'I Final
5PCT CTR 05/01/2001 $11.74 2720010000(
Total $158.54
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: ,� // / Issued B /
g (/ , � l L� —n� 1 / y ' �G� �i�aL
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: /i , / ( /fit /(7) 1 - DATE:
LICENSE NO: 2-0/57 S
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical PerinitApplicati i
Date received: � � D Permit n 22 / ,
, > City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9, o Date issued: By: Receipt no.:
Phone: (503) 639 -4171 9C
Fax: (503) 598 -1960 n -
Case file no.: Payment type:
Land use approval: a °
„'" � L
5 .
TYPE OF PERMIT
J -1 & 2 family dwelling or accessory U Commercial /industrial U Multi - family U Tenant improvement
U New construction . Addition /alteration/replacement U Other: U Partial
JOB SITE INFORMATION
Job address: vtgy 9...4,3 I EA, – LA-- A Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision:
Project name: l,J I 1-St, I Description and location of work on premises: KdTC ,t r i!vt) f..-E 9 (......-
Estimated date of completion /inspection: ..J t,r`.t:.31_ Zoe) k
CONTRACTOR APPLICATION FEE SCIIEUULE
Job no utnlerl t r e� C� Fee Max
Business name: �GV Description Qty. (ea.) Total no. Imp
19680 SW N Road New residential - single orntulti- family per
Address: Hillsboro Oregon 97123 -9446 dwelling unit. Includes attached garage.
City: I State: I ZIP: Service included
Phone: 628 -2095 I Fax: 628- 307I(gnail: 1000 sq. ft. or less 4
CCB no.: 42 84 1 I Elec. bus. lic. no: 3 4 -16 0 C Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: 1072 Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/ fr* 2
Sup. elect. name (print): Jeffrey L . H e b e Leense no:3 0 5 3 - S Services r feeders stallalion,
PROPERTY OWNER
alteration or on:
1y� 21)0 amps or less � � . 2
�
Name (print): — 1d' V tt7 Li l l�fj 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: 601- _ 9 —7 Fax: I E -mail: Reconnectonly 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, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
. 201 amps to 400 amps 2
Owner's signature: Date: 401 to600am s 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 t o 6,6 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E - mail:
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc .(Service feeder not lncluded):
CI Service over 225 amps- commercial U Health -care facility Each pump or irrigation circle 2
U Service over 320 amps- rating of l &2 U Hazardous location Each sign or outline lighting 2
family dwellings U Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
U System over 600 volts nominal more residential units in one structure alteration, or extension' 2
U Building over three stories U Feeders, 400 amps or more 'Description:
U Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
U Egress/lightingplan U Other: Per inspection 1 I
Subunit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ • 1 ( . Rio
U Visa U MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number:
I / within 180 days after it has been State surcharge (8 %) .... $ 11 • — 14
Expires accepted as complete. 'TOTAL $ t 58, S
Name of cardholder as shown on credit card
$
Cardholder slgnatrue Amount 440 -4615 (6t00/COM)
PLEASE FAX PERMIT # /RECEIPT TO 503 - 628 - 3076 ASAP. THANKYOU. •
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested ` 3 AM PM BLD
Location / Weed S A✓ /G ( bt Suite MEC
Contact Person Ph ; 174922 - - PLM
Contractor Ph SWR
BUILDING Tenant/Owner plla u C 4,9 la /-100-4- ELC 200/-1' Z z(
Retaining Wall �.( ELR
Footing Access: v
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation /
Drywall Nailing 'e fie ee 1Y'Om )/P � r - t`Yq
Firewall
Fire Sprinkler it)
Fire Alarm
Susp'd Ceiling
Roof Q. / /� P !
Final S� F //mil ! , P vin
Final
PASS PART FAIL
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
fL
Rough In C X1-e'.
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISIO 37P
MST
24 -Dour Inspection Line: 639 -4175 Business Line: 639 -4171 4 %
BUP
Date Requested AM PM BLD
Location / ei 0 yu , S c•) /6G st ' ✓e Suite MEC
Contact Person .fit cf Ph C. it 24? 3' PLM
Contractor Jets Ph 241 -- J SWR
BUILDING Tenant/Owner
ELC 0 706/-- Z Z(
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: .4
Final /
PASS PART FAIL
PLUMBING fr7 / —
Post & Beam
Under Slab
Top Out
Water Service /
Sanitary Sewer /" f !
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS A RT FAIL
Ci I FCTRICA
Service
Rough !n ee/ e"-
UG /Slab
Low Voltage
Fire Alarm
Fi
ASS PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk 0 2 /
Other Date - D Inspector t.QiL/ E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
Inspection Description Date Passed By J Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rou . re eev,
Slab Electrical service r��r'
Crawl drain Electrical final WATA���
Underfloor insulation Era
Post/beam structural p
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing iI Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
4 Inspection Description Date Passed By
Drywall nailing
Post /beam mechanical
Suspended ceiling Gas line
Engineered soils
Welding Lab Final Mechanical rough -in
Concrete Lab Final Fire damper
Bolting Lab Final Duct work
Structural observation Smoke detector
Mechanical final
Fireproofing Lab Final
Final inspection
PLM - Plumbing Permit
BUP — Fire Protection System Permit Inspection Description Date Passed By
Plumbing underslab
4 Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in _ Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
4 Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls _ Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin /Manhole SWR - Sewer Permit
Engineered soils 4 Inspection Description Date Passed By
Engineering acceptance _ Sanitary sewer
Final inspection Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
is \dsts \forms \InspRecordBUP.doc 04 /17/01
CITY O F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00221
,:AI DEVE PMENa r S O R9 ICES 639 -4171 DATE ISSUED: 05/01/2001
AU
-- 13125 PARCEL: 2S 110AD -05200
SITE ADDRESS: 14840 SW 106TH AVE
SUBDIVISION: LANG HILL NO.2 ZONING: R -12
BLOCK: LOT : 045 JURISDICTION: TIG
Project Description: Installation of (10) each branch circuits with feeder for kitchen remodel.
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 HMI SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 10 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:
WILSON, DAVE G HEBERLE ELECTRIC
14840 SW 106TH AVE 19680 SW NEUGEBAUER RD
TIGARD, OR 97224 HILLSBORO, OR 97123
Phone: Phone: 503 - 628 -2095
Reg #: SUP 3053S
LIC 42841
ELE 34 -160C
FEES Required Inspections
Type By Date Amount Receipt Rough - in
PRMT CTR 05/01/2001 $146.80 2720010000( Elect'I Service
Elect'I Final
5PCT CTR 05/01/2001 $11.74 2720010000(
Total $158.54
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: ), / , , - ( Issued By:� ,
OVI/NER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent. t
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: (!) 2 (?) 41/ (1� - 7 - ) / 1) L � DATE:
LICENSE NO:
(2 7
Call 639 -4175 by 7:00pm for an inspection the next business day