Permit OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2002 -00344
DEVELOPMENT SERVICES DATE ISSUED: 7/23/02
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110DA -09200
SITE ADDRESS: 15287 SW 107TH TERR
SUBDIVISION: ERICKSON HEIGHTS ZONING: R -3.5
BLOCK: LOT : 053 JURISDICTION: TIG
Project Description: Install 1 branch circuit to AC.
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:
DENZIL DAVIS WEST SIDE ELECTRIC CO INC
15287 SW 107TH TERR. 1834 SE 8TH AVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: 503 - 620 -8504. Phone:
Reg #: 1 - 15006
SUP 1556s
ELE 26 -135c
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 7/23/02 $46.85 2720020000( Elect'I Final
5PCT CTR 7/23/02 $3.75 2720020000(
Total $50.60
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 a re 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: r )
Issued By:
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• nrk CA-7 . / DATE:
LICENSE NO: / 5 5 S
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Perm it Application OFFICE USE ONLY
Date received: `7 A3 /0- Permit no.:E C )(9 -000 v q
r.,f 1 City of Tigard , Pm ectiappl. no.: -_ Expire date: —
Address: 13125 SW Hall Blvd, Tigard, OR 97223 '
City ojTignrr/ Date issued: sly Rix eipl r i o , .
Phone: (503) 639- 4171 -- Fax: (503) 598 -1960 A, Case file no,: Payment type:
Land use approval:
TYPE OF PERMI'I'
& 2 family dwelling or accessory OCommercial /)ndustrial U Multi -family ❑ Tenant improvement
U cw construction U Addititrti /rt)teration/replacemcnt U Other: ❑ Partial
JOB SITE INFORMATION
lob address :. "7 c J 1 y .7 N — , Bldg_ no.: Suite no.; Tax map/tax lot/account no.:
Lot: 'Mock: JSubdivision: _
Projcct name: !>e- „ t•Z -,. ) / \t..\t...,„ 1D
r _ cscription and location of work on premises: % _i.v A (
Estimated date or cor ipietion /inspectio
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: j 1q_ - Fee Max
Business name: r % < Description Qty. (ea.) Total no.iasp -
E� � .:[..L.-;-L-1 � New r ridento .I -single ornnu f,.rolly per
Address: T.S /�
�,.�� 5L( � R ..--e. �..__ durellrngmtit .lnclader;Atmchcd
City. 0 rt' �, 1v Statc: ZIP; el - 7 4 1 Scrviiceindndedt
Phone: Z3 i .- i 5-L B I Fax:73b--04.77 1. -mail: 1000 sq. it, or Ica _ 4
f ;CB rut.: 1. 7,.3() Floc. bus. I K. no: Z 6 -- t ' j - L •
. - Ltach additional t: sq, I i. or t au tiun thereof
__.._ - -- Limited energy. residential 2
City/me o lie. no. _ -
y Li mited encrl;y, non resrlilmli;tl 2
7 r7 / tr
.. ...._ la o Lerch manul'ncrutcll home nr,u dwelling
Signature nr s icing electrician (required) natc Service and/or feeder _ _ 2
- .elect. name 7:!,..,_ Z.6473 Ib3 ^Servicesorfeeders- installation,
Sup. (print): 3 r ( License no:
Ait :ton or rnipeati
PROPERTY OWNER 200 amps or has 7
.
Name (print): 0,6A 'c 1 .a tii..5 201 Amps to 400 amps 2 - .
_ 401 amps to 600 amps 2
Mailing address: 15'2. Q, 5' I—) I
c 0 7� Jr-, , . _ out amps to 1000 amps 2
City: �• State: LII' G -
Y � � (ZYL 7 Z. 7. Over I OOO amps or onus _ __ 2 - ._
Phone: /,,, 0 ._ t 0 l! Fax; j E -mail: Rlxxmnoci only 1
Owner installation; The installation is being made on property i own Temporary services or feeders -
which is riot intended for stile, lease, rent, or exchange according to inalaIIatlun,aller,.11on , orrlioCntion:
ORS 447, 455, 479 670, 701. 200 amps or less — 2
2.01 amps to 400 amps 2
Owner's signature; Date: .._ 401 to non amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: .. -. A. Pee for branch circuits with purchase of
Address: survicu o r feeder roc. each branch circuit 2
City: rttltc: LfP' it, Fen for Inmwh eite,its without purchase e
2
. of service or f eeder fee, first branch circuit: 1 -1( . ,;&;
_ _ _
Phone: Fax: E-mail: Each additional brata:ll circuit:
PLAN REVIEW (Please check all that apply) mime. (Sortie e or feeder not included):
U Service over 225 amps- cornmercinl U Healt}r are lircility liseli pump or irriF_ation circle __ 2
C3 Service over 320 amps-rating of l&2 ❑ na-raniou.s location basin sign or outline lighting _- . ._ .._^ 2
family dwellings U Building over 10,000 Amin: feet four or Signal circuit(s) or a limited energy panel,
C.) System over 600 volts nominal more residential units in one stn,chne alteration, or exienslpn• _ 2
U tluiklin} aver three stories U I vtlers, 400 amps or more • I7csCriplilln: - _.. __
LI Occupant kraut over 99 persons U Manufatiurrtl strtiaute or RV park l :,aek additional inspection over the nllownbk: in any oril.eabove:
LI ligress/lighting plan U Other. ._ . •- -• her inspection - 1
Submit _ sets of plans with any of the above. Investigation fee
Trite above are not applicable to temporary construction service. Other
r -
: _
Permit fcc S L/ 1,4A
musts, all jurisdictions accept credit usls, plu .. call juris.liotinn for more infonnntinr Notice: This permit application '
Visa U MasterCard expiies if a permit is not obtained Plan review (at _ %) $
Credit card number: JJJ r� b � . Q3$ et I I5" g / 3L1(23 w ithin 180 days after it has been State surcharge (( %) $ •3r 7C
` -c �z 7„‹,e..1. -- lixpires accepted as complete. 7'O'IAL $ ci) . (v 0
Na / 1y / �,pf c�a er tuhu ucJ arJ S §Z9/ 4,0 —
_ r - t'nr.lhnlder signature Amount 440,4615 (6d001C()M)
2 ' el LL90- 9EL[EOS) '03 0T-41.0aI3 aPIS zsaM e80t6O 20 8T InC
CITY OF TIGARD 24 -Hour
, BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
J BUP
Received Date Requested / / / 7 AM PM BUP
Location 1 3 2, R' 7 / D 7 /4-1- Suite MEC
Contact Person Ph ( PLM
Contractor Ph ( ) / — 15 SWR
BUILDING Tenant/Owner ELC 2 — 2) 6 ' 3 '7
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
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 — - — 11.1 — — —
Roof /1)r 4i15' � -
Other:
Final 4 ) o 4 : 5
PASS PART FAIL
PLUMBING I i ,� A� r• r
-
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan / "(A/ Other: �� ()
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In L 6 i
Gas Line
Smoke Dampers
Final f
PASS PART FAIL
ELECTRICAL
cl \
Service
Rough -In
UG /Slab
Low Voltage
It
PASS PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE El Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA /
Approach/Sidewalk Date 0r. l " , Q Inspector a S Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• BUP
Received Date Requested /0-
AM PM BUP
Location rS 7 /0 7 `f" -- re J Suite MEC 6g — 3/0
Contact Person ( tp>iilk& Ph ( ) 8 s'e) PLM
Contractor Ph ( ) SWR D�3 y�
BUILDING Tenant/Owner ELC �'
Footing
Foundation ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: Q 2 v SIT
, 3 s 3
Post & Beam O
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
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 1
Rough -In
Gas Line
Smoke Dampers
PART FAIL
e e
Rough -In
UG/Slab
Low Voltage
Fire Alarm
in. PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date 86a 7 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL