Permit CITY OF TIpARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00025
DEVELOPMENT SERVICES DATE ISSUED: 1/21/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103BB -08400
SITE ADDRESS: 12415 SW 122ND AVE
SUBDIVISION: LAKE TERRACE ZONING: R-4.5
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Install (2) 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: 1 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:
LEWIS, LINDA ANN TEAM ELECTRIC CO
12415 SW 122ND AVE 9400 SE CLACKAMAS RD
TIGARD, OR 97223 CLACKAMAS, OR 97015
Phone: 503 - 590 -7544 Phone: 557 -7180
Reg #: LIC 47336
SUP 4416S
FEES ELE 3 - 225C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/21/04 $53.50
[TAX] 8% State Surcharge 1/21/04 $4.28 Rough -
Elect'I Final
Total $57.78
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- 344.
�L Q Permit Signature: )) �a
By: �/� � /
Issued B lam tc -/ �C� g ��/
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: (:- /`f X65
Call 639 -4175 by 7:00pm for an inspection the next business day
uI/ 1 C JAN X 16.2004 r 3: 451 : 1851 bTEAM ELECTRIC lit ur 11lJAKU NO.257 P . 21 u 4.
R C
. Elechcal Permit App cation FOR OF VI( 'F. !ISL. ONLY
City of Tigard JAN 1 4'2004 Rtceivee _1 3 inin
13125 SW Flan Plan R eview
Blvd., 71gard. OR 97213 : / _ 0 _ h
Phone: 503.639.4171 Fax: 5035�9> it OF TIGARD 4- , N Plan R Other Pernik;
InapectionLine: 503.639.4175 mom ,.sJL . . • ! J� i Di m R eady/Sy: El Storage 2ter
l wwr,ei.dgard.or.us ^ - Notified/Medmd: 5 114mantellhtertounon
;.c. cur .a, ,� ,�. 1.�,r ie �w -�., [-.. •iu�l , l • ° a,�,.. ,dy,i:�'!�'�,�riR ;�; -mac' r,7�i� Ili � .' , xr i t' _ . `r,�•..a• r
�;�p ' 'h ,�11'��'� : �i .'r',�' �q ,4ye " _ qtr Iq; "11: •4 r �s t'�, i ,,, �� r P. c. �- r',s�.�
S'��F- 7.1T'.fi l i�` "I c :, ,il. •:J.k , .��'C.n „� Y - : ' 1 �,' i d ' w1 "N it;. ` �' ' i • '
r..l i v ' r. .nP��r1 ,. , _, 3`: , "w : � • „,•. _ ! v.it�•'ur�:r•.�� �•�� .. a • I.
❑ New Construction W Addition/alteration/replacement Please deck ali that apply:
0 Demolition 0 Offer. ❑Service over 225 loops, commit Dldazardous tactician °,� �IJ . .7,14)&1'. ti 1 p , x '„ I lq t •j I ` D9erviee over 320 amps - =big ❑Buildng over 10,000 sq. ft.,
, di � .. , t 4 n ,t 'Ali' r,y��.� EE i-1,a � e ° of I- and 2 -Fier
�I.� �: �,c =1a �t>A� � � • ;er��_ u�u� ... � • i;� .N3' G•,�f1 ��,� mlly dwCl'lihrP a or morn new recidenmi81
/ :/ l- and 2 family dwelling ❑ Commerdaliindusniai [] Accessory buildipg ❑syate n over 600 volts noa1nel units in one emicn,re
DBtdld ng aver dais Stories ❑Fetders, 400 amps or more
C] Multi farai]Y 0 Master bander ❑Other
❑
r ' Occupant load over 99 persons ❑'Manufacnned saucer or
34 ���i . . i'Pj i6ls '", a k. r. .� f' .r N i_il.i', :t;F: d ' m � r r Fate 1 �; � ..'' "f - , I...." •.10"m ill h;J 5i ,� ;l
a u .'l -"�taan'I'+� L sd•��
ClEgressllighthilPlan ,RV park
Job no.: ' q Job site address: Z4 • SL) / C. . . /QJ ' ❑Health re feciluy ❑Other:
�; Submit 2 sets epics with any of the above.
l l
City/State/Zr?: Y .C) Cl q Lb' Z3 - The above ore not applicable to temporary construction service.
Suite/bldgJaot. Project name: � .I S "�u .,' * 1 D,,1�;�:9:a o:IM. 7'Pi
, 1. ' „:
bopblkp Qy. Fee Soul "
Cross street/directions to job site: New residential Siege- or multi - family dwelling unit.
_laeludcs attached garage. _
' 1.000 se. tt or lose _145.15 ' 4
_
Subdivision' Lot no. �. addl 500 eq. ft. or portion 33.40 1
Tax map/parcel no. Limited energy, residential 16.00 2
r
y q�.k,� �� p t Limited energy, non ttsidential _75.00 2
h. 64,1, 1?� Ir 4 , �r..,v, , 1f� �,+ ', p m7.1. '.�� 1 ,.O r. . 5 ' X .t r
� � + `l: `sue if l la. : ,�l' t.� i w: i - ' ao4 Each manufactured o modular
t�
l �1\ (� dwelli service and/or feeder , 90,90 2
"- ►M,a fl 6F is r N "� .. - Services et feeders insm]lati on, alteration, end/or relocation
gE F I/ 14 C. I 12414_175 200 amps or iei 80,30 _ _ 2
a:•q: .y.: .. ul. P p iIl ii; ,,:, t;,r ".y nµ °ii, r'r 'r9 r�� veer, 201 snips to 400 amps 106.95 2
rl+ ci:` . ,. !.:.: 1: a1= 1`� Jq�t I l,i ii
/ 1;7Jr- l!a 1 �1ia�i 18 � ' 7'_c?' ! , -;') @f ke;,, ,.r,. 401 amps to 600 amps 160.60 2
Name! 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 anr or voila 454.55 - 2
-- - Reconnect only 66.55 2
Ct y/Stete/ZIP: Temporary services or feeders installation, alteration, audlor
Phone: ( ) I Fax; ( ) r eroceden
Owner ths�alladan: 'This instaiIation is being m ade on - 20 carp or
400 66.55 1
6 property tat I own which i s not ?Al smrr; to 400 amps 1 10090
2
intended for sale tease neat, or exchange, according to ORS 447, 449, 670, and 701, r 401 snips to 600 amps U3.75 2
Owner signatures
. . Date• Breach clrcuics -new aharatto =tension, per panel
4
Ot ;.. , •• 1'71 : ', 4 .1• 1 , �. n ! w ' T' ' ' ' 111 e'i �I� J , ry j ..- C& . n{.... ,:; :r 4 :r • service ice or r circuits with
yi i't!IU.d Jed ::,aua,wd�8d• , tl I li� t , _' d', 1!, I. L1!!N { '- '„�•.��_�. q M
' service or feeder f ee. each 6.65 2
Business name: branch circuit
Contact � B. Fee for branch circuits ,/'
wirlloat service err Feeder•fee. 1 46.85 ij , OC 2
Address each breach circuit
r t�
Each add'l branch circuit / , 6.65 6, e�' - 2
City/State/4P: . necellantiouit (service or feeder ant Indyded)
Pun" Qr irrigation dock 53.40 • 2
?lion= ( ) Fax : ( )
•- Sipco or outline lighting 53.40 2 1
PArati�1: Signal circuit(c) or Irrrrtcd-
,' w: r. 1 ' 7 i; LH!: {' :F7r iK °_ °Itt.lr '. '.41.315111161iM +11 4 .1.;y'u ,Isli,. enorb alteration, or
Business earn= /r, 4 EL,Ef/LJ c, ncteltaion. Dm-critic: Page Z 2
Address;
9 V /1 3 C r /1n �ir /1 "wG As ]Each additional Inspection over er allowable in any or Ens above
�✓v(. Per inspecdon 62.50
'v City /State/ZIP; r Je 1 pD $ �� 17,L 1,5 Investigation pa hour ( hr min) 62.S0
J ' FhOae �Q3) 7 r a _ FaX: ) 7 ?� l ` lndaseial plant per hour 73.75
L CCB Lie.: q
1-73 (0 Electrical LtG Z ' �..� �' flP l � S • � ,sf. tau'. -=H vrl,� r:;,l? :1�1g8���?ir' °.;Rt�aia al,l��,i
- 3 id S rv. Lis: d44 Subtotal 3. so
Stiprv. Electrician dignalum, required)( " - /v /_oy _ planreview (2S% ofpemhit.&e) -
Print �c_ /�9> c rt roE
L � � 5 I N 1 1 I State BurrhArBe (89. of permit foe) +7
'' Dare: / t� TOTAL PERlar FEE s - 7 g
Authorized sigenrvre: �yyj t �, i 0 / .. �L���. _
f f , T1tk permit aNpueedao explra ire permit la not maimed within ]so
Print name: Date: • prat+ melbodoleg a ct b it en bean Builds accepted st sty Service • 6Y Y tmD�Buildi»g industry Lord
- err Number et inspections per permit allowed,
z,nekusg,►enr eaa.eiupp.do. mica .awB,rr(roroatcorvwas
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: - ;503)639 -4175
INSPECTION DIVISION - Business Line: (503) 639 - 4171 MST
rr BUP
Received Date Requested Z �P AM PM BUP
Location / a /s Lao, a, 'id /9 — Suite MEC
Contact Person (,'a ( ) <577 -1 43y?-- PLM
ractor `M .3( ) SWR
ELC
NG Tenant/Owner
-DDOa,Jr
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ,, " SIT
Post & Beam 5' B e '
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm I ' ` • -` . ' ,+ O� -\ k 1, G •
Susp'd Ceiling
Roof ^ \lam
Other: V Cf �U 1 S l0 RLP‘C 1D C. �� RA
Final
PASS PART FAIL
PLUMBING C y��tnn �A
Post & Under Slab J' �-0� �` �� "� 1 , t\ clob
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
J J b
Low Voltage r
Fire Alarm
C�SB' Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / ' r O Inspects) IL_ 41 - — ■ - Ext
Other:
Final DO NOT REMOVE this inspection record fr i the job e.
PASS PART FAIL