Permit .�i�,l CITY OF TIGARp ELECTRICAL PERMIT
PERMIT #: ELC2004 -00149
DEVELOPMENT SEFVICES DATE ISSUED: 3/25/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103CC 00500
SITE ADDRESS: 13825 SW 121ST AVE
SUBDIVISION: ZONING: R
BLOCK: LOT : JURISDICTION: TIG
Project Description: Moving a meter
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: 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:
ANDERSON, JOHN D + NORTHSTAR ELECTRICAL CONTRACTORS
KENT, SUZANNE M 19450 SW CIPOLE RD SUITE 107
13825 SW 121ST AVE TUALATIN, OR 97062
TIGARD, OR 97223
Phone: Phone: 503 - 612 - 0840
Reg #: LIC 90454
ELE 34 -359C
FEES SUP 661S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/25/04 $80.30
[TAX] 8% State Surcharge 3/25/04 $6.42 Elect'I Service
Elect'l Final
Total $86.72
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- 800 - 332 -2344.
.
Issued By: Permit Signature: 4/ /
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
03/24/2004 15:46 5036120891 NORTHSTAR PAGE 02/02
. Electrical Permit-Application 01 l l(1 I ►.I ,
Dat recei ..� Permit �"
' �� �' City f Tigard RECEIVED _.t. /0 -0 / 1
.., ° t! Pro no.: Expire date:
Coy of Tigard Address: 13I25 SW Hall Blvd,Ol OR 97223 Dare issued
Phone: (503) 639 -4171 t 2 4 2004 Receipt no.:
, '
Fax: (503) 598 -1960 CITY Case file no.: 1'ayrnent type:
OF TIGARD
Land use approval: BUILnINC DIVISION:,
I1 I'E. oi. 1 I•
0 1 & 2 family dwelling or accessory Q Commercial/industrial 0 Multi - family ❑ Tenant improvement
Cl New construction Addition /alteration/replacement A Other: cA:J -06 reY.3 Partial
JOB SITE. INIO10I \ ION
Job address: '3 ..P.,5 S w . 3 Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot Block: - • 92 i
Project name. r l rjd l , Desc 'ption : id ' sr 'o[1 Of orl on r S f &M i I y ! t��
Estimated date of completion/inspection: .. j7 % . M EM
(.ON I I( 1C701-t ‘PPI I( 11 ION I.11. 5C111.i11 i.i
Joh no: MY Or Je.. 094r Fee Max
Business name: py(!a. dtilr on ( Cif I Description Qty. (a.) Total no. his
Y • O Ii 1 � l -e eurand441ilyper
Address:
_ 5 t • 0 dwr1B .g�r.aaindesatlachedgarttge.
City: Ti'
ZIP:
• 1. Fax ,./ --0' ■ , AP p.,....„ IMO a
or 1000 R. o l e as 11
___�
CCB no.: 4 •2_1, 1 '12 Elec. bus. lic. no: — Each additional S00 sq. R or portion thereof
i Limited energy, residential MM... 2
City /metro lic r Limited ter_. ■ non- residential =111111111111111 2
./ rj Each manufa Me or modular dwelljmg Ell IMO
Signature of a • - • . _ electrician required) _!� S a ad/pr feeder arn
Sup. elect- name (. r, • Ar C9 . S e, : E4' J License no: /ed, Services orfeedars— taataltatioe,
site on or relocadeut 9
P1201'1 OWNF12 2Wanlpeorless P' � 2
Name (print): 201 to 400 amps ___ 2
Mailing address: 401 am..: to 600 : ��� 2
601 amp? to 1000 . —_— 2
City: State: ZIP: Over 1000 amps or volts =MIEN 2
Phone: Fax: E mail: Reconnect on! __ - MEMO
OWaer installation: The installation is being made on property I own Tensfurary service, or feeders- . ■
which is not intended for sale, lease, rent, or exchange according to installs >irta,�teratloa,orrelocati II
ORS 447, 455, 479, 670, 701. 200 e"'. or tees 2
201 arm.. to 440:.. 111M1__ 2
Owners signature: - - -. Date: 401 to 600 am.s ___ 2
E: (, I N I: I R Brunch circuits - new, alteration,
Name: _
or extensioa per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee each breach circuit 2
City: J State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2
Lash additional branch circuit __ —NMI
P1.t's RE:vIF1% (!'!carve ch,tt all that apply) Misc. (Service or feeder sot laetaded):
❑ Service over 225 amps-commercial 0 Health -care facility Each pump or irrigation circle ■■. 2
O Service over 320 amps-rating of 1 &2 Cl Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 Syetem over 600 volts nominal more residential m.ita in one structure alteration, or extension" 2
O Building over three stories Q Feeders, 400 amps or more 'Desert 'don:
Cl Occupant load over 99 persons Q Manufactured structures Ot R" park Each additional inspeottoe over the allowable is any of the above:
0 Egress/lighting plan 0 Other
• Per in.. -coon
Sablait _ sets of plans ,with any of the above. Investigation fee
'Me above are not applicable to temporary construction service. Other
Not all juri:dicuoec swept orod m
tt cards. Please call jurisdiction for more infeahtion. Notice: This permit application Permit fee $ 3^
Q vin' la MasterCard expires if a permit is not obtaiuncd Plan review (at _ %) $ {
credit card nutter! - / / within 180 days after it has been State surcharge (8 %) $ ( 47-
- �.0 • �
Name of ca dliolder as shown on credit card Expires accepted as complete. TOTAL s , 6 7Z' O ,7
S C O /
t ardnolder signature Amount
440.46)5 (yOWCOM)
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 Suite MEC
Contact Person 1G? Ph ( ) l a- - v g 4 / 0 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation , ELC
Access:
Ftg Drain ,%4Zet-etA-'66/ ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing r' ,, � l
Insulation t \ b — /� esd ! $� ii1G yu, V -t`� NI. � Gil
Drywall Nailing �oJ
Firewall 1 \" "4 - (TA
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
41 Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final C_3 �r
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
N
UG/Slab
Low Voltage
Fire Alarm
%�� PART FAIL LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please - II fo reinspe ion RE: Unable to inspect - no access
Fire Supply Line / //'
ADA
Inspecto
d .�!
Approach/Sidewalk D � cto
Other:
Final D I NOT REMOVE this Inspection record fr m the Job te.
PASS PART FAIL