Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00254
' DEVELOPMENT SERVICES DATE ISSUED: 5/7/03
All 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134DA-04600
SITE ADDRESS: 11325 SW 108TH AVE
SUBDIVISION: DOREEN COURT ZONING: R-4.5
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: Install (8) branch circuits 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: 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: 8 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:
KOEHMSTEDT, MATTHEW + PAMELA KAY TICE ELECTRIC
11325 SW 108TH PO BOX 15009
TIGARD, OR 97223 2139 SE BELMONT ST
PORTLAND, OR 97293 -5009
Phone: Phone: F- 231 -3372
Reg #: QM -8801 166
SUP 2586S
FEES ELE 26 -126C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/7/03 $93.40
[TAX] 8% State Tax 5/7/03 $7.47 Rough -
Elect'l Final
Total $100.87
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 d irect questions to OUNC at (503)
246-6699 or 1 -800- 332 -2344. /1
Issued By: /)(2AL, , Lr l Xd/ Permit Signature: Ql'1 o io 42QL(' rY
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: 25 C�—
Call 639 -4175 by 7:00pm for an inspection the next business day
05/06/2003 07:31 503 -S72 -8290 TICE ELECT.SERV.DEPT PAGE 02
10/10/00 TUE 09 :00 FAX 503 698 1980 CITY OF TIGARD wain
Electric tre ri nit Appic ttioo.
• A
Date re S -O 3 Parrett no.: -o U< ,/
1 !" ; .#11 City of t Tigard J � ProjeeVappl.no.; Expire date;
Ciryaf'l igard Address: 13125 SW`1-fall .Blvd, Tigard, OR 1972 3
Data issued: Bre I Receipt
Phone: (503) 639 -4171 .. ptn --
Fax: (503) 598.1960 • CITY OF TIGARD Casa tile no.: Payment type:
Land use approval: BUILDING DIVISION - -
. a l i•k; 01 I'i:ItMII'I'
1 .
1 M 1 2 family dwelling or accessory Q Catmnerelalhudustrial 0 Multi - family ❑ Tenant improvement
J New construction XJ Addition/alteration/replacement 0 Other ❑ Partial
.!O8 SlIl'. INl Ok 1A"t'1ON
Job address: y, [ ; e Av- .Bldg, no.: Suite no.: ax • tax lot/account r.o.:
Lot: • Block Su• • ivision:
• • _ :1 , u _ _ rr : 4',c; „ lion and location of work Ott premises: , en r- ..•e
Estimated date of corn. ietioWjns• lion:
CONTILtf."1 Olt !l'PI:II'AI IIIN 1 k,l: S(11E1 /1il.l? '
Job no; 21•.061 f Br!! Has Business name: Tire T J. ctric Co.
New w#dmioZ. singe Qty. no. iswy
Y ormttt- fsnllyper
Address: p
T-b 15009 dared gliac.inoadiiiitichtdearne,
City: • • .. - State: 1 . ZIP: • a a . SenissWduded:
Phone: • — ` :: 1 ax: . • / 02311111111111111111111111 10DO ,. ft orlon d
CC B no.: • • P.14. bun_, lit. no: ,_ BacDiddNicee1300akft of III.MIE
Glty /m trD li:- no.: Unshed :, , wig
2 01 4 • led usat , aoa•reeidaatid MEM
- '. , 05/0 /$03 Each mann attired • or modulardwelling ■■
Sign • ure of • pelvis in- electrici - •ulred Date Serviasandiorreoda 2
w • _ Gceusorso: • =d kesorfeeders— installation,
1r1tUI'1'ltl f [!!% NI. It 200 • orlon alt°ntlmorreloation:
2
Name (,rint): ita • aso400mu. III. _ — 2
Atailin_ address: • • 01 a •4Ioe00 r..5 �w��
601 -a to 1000 .-a IIIIIIIIIMIIIIIIMI 2
ZIP: Over 1000 or volts ININIM_ 2
Pax: E Reconneatanty _ 1
• Owner installation: The installation 'is being made on property I own Tacapoeaysordoworfesdsa• -
which is not intended for sale, lease, rent, or exchange according to insyaAatloaraitsrst {n°, armband=
ORS 447, 455. 479, 670, 701. 100iri - a
. 2O1 amp, to 400 sings
Owners Si ; , re: . • ' Date: - 401 to 600 nip - 2
ENtil- l :l':ll Woods eircaitt -new, , • , n,
or extadlon per pans):
Name: A. Fee for branch circuits with purchase of
II
Address: • service or fa:drrfoe, oath branch circuit
ZIP: B. Fes for branch ckturita Without porchasas
Phonts: of service Or Cadet foe, fits, brseoh circuit ��
Ea rls additional branch circuit
!'LAIN 141 IEW (1'ia:a dunk all (ha apply) 111111
3 Salvia over 223 arrgs•wrt:merwal C2 Health -um factli ty 1
O Service over 120aRrtlitatiisgof 119a D HrxudariloaaU°a Etarhrt or outline ti Min
nevi Sy dwellings p Building over 10.000 square feet four or Siguil circuls(t) or a !united energy parssi. '
O System over 6C0 volts nominal more realdondal oohs to oneatreaure etta.tion,orextonaion I 2 J
0 Bilildingovertiveestories t1 Feeders, 400apipsorams •t l ,loo:
O 0,:cu and toad over 99 Ieo o f i . .
p 'MOM Q Mmuramerad atnicwra of RV pant � �t�oeul serpaaeo° over allowable nay of tit asiwva:
a Bg ess/lieuingpian Q Other, _ Peri. • -- no
Submit sets of plant with nary attic( above. lnvwst • e4on fee
The above are not appllcsble to coostractiou sank.. Other _
r,., 5:1 J u,,,,g clom accept ;lads, &Aro can judadiabon few more in(nrwdoe, Notice: This permit application knit fee t , 93 , 40
i i; Viisa C Masts expires if a permit is not obtained Plan review (it -- 96) S
r.
cdit card number: ' 4+10 0014. 6247 / 01104 within ago days after it has beau State surcharge (BM) . $ 7 47
I :r - c .: ° ” a accepted as complete. TOTAL $ O .. &7 -
— T �1. % b
1 % _.,, s 100.
Car. 0 ar. aiYn;NJSC Ar.ouAi 440-461S 15A10/C '.:
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Litfe: (503) 639 -4171 MST
/ BUP
Received Date Requested 7' AM PM BUP
Location (1.3 oZ 16 A-4 -- Suite MEC
Contact Person Ph ( ) , I PLM
Contractor Ph ( ) SWR —0.4 BUILDING Tenant/Owner ELC 3 —0 . 4 -s -4 /-
Footing
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: � 1, l n SIT
Post & Beam C / i �^C F C>
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing 1 (� �1
Insulation 14' u l_\ (' - 1� u ) �� 6-r, 4N, id
Drywall Nailing 1 C l �(
Firewall Fire Sprinkler D ` - ' VL■A C-)tIN V O 1 \ V
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
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage rV L�Z--
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PAS PART FAIL
SITE E Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line /
ADA D `
Approach/Sidewalk O Insp Ext
Other:
Final DO NOT REMOVE this inspection record from the j b site.
PASS PART FAIL