Permit ` CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00194
DEVELOPMENT SERVICES DATE ISSUED: 4/18/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110CA -00102
SITE ADDRESS: 15300 SW 116TH AVE
SUBDIVISION: ZONING:
BLOCK: LOT : JURISDICTION: KIN
Project Description: Relocate exterior light 12'. Job No. 66366.
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:
KING CITY, CITY OF TUALATIN ELECTRIC
15300 SW 116TH PO BOX 655
KING CITY, OR 97224 WILSONVILLE, OR 97070
Phone: Phone: 682 -2955
Reg #: LIC 00065650
SUP 3483S
ELE 3 -268C
FEES Required Inspections
Type By Date Amount Receipt Underground Cover
PRMT CTR 4/18/01 $46.85 2720010000( Elect'I Final
5PCT CTR 4/18/01 $3.75 2720010000( �ED
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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: ' / fi 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: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
It,c1- 8 -7 -I 1
Electrical Permit Application
Datereceived: /,p, p Permit no.: 62C i i
Z DD /
„ll''•I City of Tigard Project/appl.no.: Expire date:
City of Ti ;rd Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued:
Phone: (503) 639 -4171 Rtceiptna.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
O 1 & 2 family dwelling or accessory 0 Commercial/industrial O Multi- family 0 Tenant improvement
❑ New construction 0 Addition /alteration/replacement 0 Other: 0 Partial
JOB SI I I' 1 \I ORM tilt/ \
Job address: :_) _ -? C; ! _ j G ✓ / i ' /A/6 ei Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: Block: Subdivision:
Project name: 'Description and location of work on premises: / co PBi-'" EX ero,e- Zr6 /17' /2'
Estimated date of com letion/ins lion:
Job no: to L.6 pce lwx
Businesi name: `�" d , i Description ea.) Total no. .ta r-. E D
New rceeeetlol- single ar midti-fuoily per
Address: �S t‘.., �S dwellingtadt.Incla ealts ed
City: Ni., ', \s,znv; Prate: t4:4 b`1 4 1 ZIP: `t — 1 Servicelocluded:
Phone: 6Er; - aG � Fax: .. tin'(1 E-mail: 1000 9. ft, or less
4
CCB no.: 6s 650 ec. bus. lie. no: additional 500 sq. tt or portion thereof
Limited energy, residential 2
City /metro tic. Ito.: Limited energy, non- residential 2
1. -- •- 1 - ( I Each manufactured home or modular dwelling
Signature of aupervisin ectticlan (required -- Date Service attNor feeder 2
Sup. elect. name (petit): Services or feeders- instaliotlon,
Qvt r Lic ense no:
alteration or relocation: .
200 amps or less 2
Name (print): (' ✓ 7y /</A/6 C ` , T y 201 amps to 400 amps 2
/ ^ 401 amps to 600 amps 2
Mailing address: /5"--3 /y) _Su) i/ 601 amps to 1000 amps 2
City: k //1_76- e r y J State: 07 J ZIP: 9 a a/ Over 1000 amps or volts A 2
Phone: C 3 L/0cF2 ; f Fax: I E-mail: Reconnect only R.° k " )
Th
Owner installation: The installation is being made on property I own Temporary services orfeetkw_ n
which is not intended for sale, lease, rent, or exchange according to hastalbt8oa ,atterattoaa,ttrrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's si ature: Date: 401 to 600 amps 2
Branch clrenits - new, alteration, .
Name: or extension per panel:
A Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 1 State: • IMP: B. Fee for branch circuits without purchase J
Phone: Fax: E-mail: of service or feeder fcc. first branch circuit l 2
Each additional branch circuit
Mlsc. (service orfeedernotIncladed):
Ca Service over 225 amps-commercial ❑ Health-care facility Bac po mp or irrigation circle 2
❑ Service over 320 amps-rating of 1k2 ❑ Hazardous location Each sign outline lighting ' 2
family dwellings CI Building over 10,000 square feet four or Signal circuits) or a limited energy panel, -
❑ System over600 volts nominal mote residential unite in one structure alteration, or extension* 2
CI Building over three stories ❑ Fccders, 400 amps or more
❑ Occupant load over 99 persons O Manufactured structures or RV park Each additional kispecticat over the allowabk in any or the above:
Cl Egressllightingplan Cl Other
Submit _ sets of plow with any otthe above. Investigation fee
The above are not applicable to temporary construction service. - Other
Na aIi Jnrtedlcrloes *tear e.eeit cads, please can iwtaeeeioa AN more latoemaeiva Notice: This permit application Permit fee $ If 6.85
O Visa ❑ Masted expires if a permit is not obtained Plan review (at — %) $
Credit cord number: � I within 180 days after it has been State surcharge (8%) .... $ 3 35.
Name o ' earefrolder es shown on credit rant accepted as complete. TOTAL $ �0 . 6
S
Cardbokler die Amount 440-4615 (6nJolCOM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION • Business Line: (503) 639 -4171 MST
BUP
Received Date Requeste AM PM BUP
Location L 3 012 S '! ( f Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR ? c�,
ne c-
BUILDING Tenant/Owner ELC . 1 1 f �I
Footing `) 7�) �"�t la �p ,16 b ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam -Kk. I _1) (,T■rf
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 EXPIRED
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
Low olt Voltage '} , ' �c� ' I t
Low �`1 � 1-)"'� I) ►^1 � n-) L
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA I�
Approach/Sidewalk Da t� b J Inspe r Ext
Other:
Final DO NOT REMOVE this inspection record rom = job site.
PASS PART FAIL
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
1
l
t9bq f7 Date Requested AM PM BLD
Location 1 �3c�a Su) ''1&ft.' Suite MEC
Contact Person C rrni 4 Ph PLM
Contractor A Ph SWR
BUILDING Tenant/Owner ELd 2,421:0( —m6 Lgl.i
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 , > ` /� 7- �� /
Susp'd Ceiling (� /U G� �� G ` !Z
Roof —
Misc:� S
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
a SIVRT FAIL
CL
c -
_ Ig
• ab
Low Voltage
Fire Alarm
PA • PART FAIL
glITE
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
Other oach /Sidewalk Date c' / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.