Permit r , CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00544
„iii DEVELOPMENT SERVICES DATE ISSUED: 8/26/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S133DD 11400
SITE ADDRESS: 11847 SW 125TH CT
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 ZONING: R -4.5
BLOCK: LOT : 151 JURISDICTION: TIG
Project Description: (2) branch circuits for 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: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ROBERTS, JOHN C MIKE'S ELECTRIC
11847 SW 125TH CT 11070 SWALLEN BLVD
TIGARD, OR 97223 BEAVERTON, OR 97005
Phone: 503- 819 -6120 Phone: 503 - 649 -6991
Reg #: LIC 50209
SUP 4230S
FEES ELE 34 -18c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/26/2004 $53.50
[TAX] 8% State Surcharge 8/26/2004 $4 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 a orth in 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 99 or 1.800 -332 -2 /
Issu d By: K Permit Signat . .' w'�j,/ /i
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: ° �� 5
Call 639 -4175 by 7:00pm for an inspection the next business day
Sent By: MIKE'S ELECTRIC; 591 7847; Aug -25 -04 5:49; Page 1/2
VOA' 41/ LwJ 14; 1a rAA buJ01561liti0 CITY OF TIGARD I lhuuz
♦ -- ■ • • 1
Electrical Permit Applicg ' 1 OFFICE 1. O ■1.V
�+ , Date/By 96 d / &Tect itNo•:C 0 �6d T !
Ci of Ti gar v� V Plimni„gA• " vii `1 Sign
tY g �� Date/By: PemtitNo.:
13125 SW Hall Blvd 2 gli Plot Review Other
Tigard, Oregon 97223 QUC7 Date/By: Permit No.:
Phone: 503-639-4171 Fax 503-598-1960 _ Port - Review Lind Use
mt t www.Ci.tigard.or.us
• Iate See Pep for .
24 -lwur Inspection 503 - 639»4175 . ` i �_� Ne Conceal - - J , .�
1 rne/Matl:od t'(lJ SuDplanttml:lrnfo rweNop.
e - Inillg +i tr�e G1' 81' 17' ; . . 745 L:�!i 77 / Cam, . _ . flA "[..�♦ J , '.7.
` -,.l- or �•I
,.. , " N
� a
■ New construction ■ Demolition
^'L� . Giw Addition/alterati t .laoement .IN Other: C j_) ' 4e het, , - t l J. t1 T " 14 .. { � !, (. . ' .. d es In •
IT 1 & 2- Farnil dwell' - 11. Commercia}/Industrial G / j
[■ Acces • B uildiu l: [i Multi -Farm . b occupa,, ; ;r . e. or Rv park
li Master Builder IU Other: ❑ Egress /Howe,plan RINIENCI.21 14717.1 /.74,?aZg,'.it; :., t Submit gets ofpi.I.. : •I.; arty of the obeys.
Job site address: 11847 S W 12 5th C t . The above are not a. !legit to tem . o • cenatrortion service. • ': ;I I' ^';7 ... ... ....
Suite #: Bldg.1Apt. #: _ Number of inspection! per permit allowed
Project Name: R o k e r t5 _ Deoeription • 1 (N Poe (t+.) Total 1
Cross Bb �Cf/DiteCttoT2$ to - Site: New re9Headat -single or inultit mI1y per
dweWog snit• Ineleder attached garage.
Service included:
1000 sq. It. or lam 145.15 4
Each additional S00 sa It/ melon eion thereof 33A0 1
Subdivision: I Lot # Limited energy, reaIdrn sal 7540 2
_Umitrd non residential 75.00 2
Tax ma .1. - ccl #: Each mo n ed It or modular dwcll)n%
o (D1� T':►L1 .n . 5.1 t { selves s dlor feeder 99.90 2
Services or feeders - Installation,
I, - -ii• alteration o►Mocatiooi
h • ! . - a • r sale 200 amps or less I10.30 2
201 amps.o 19 !mffs 106.85 2
401 amps to 500 amps 160.60 . 2
igi '. = .,t.ati ,i:.. %.2. 'r' othi 601 amps le 1000 amps 140.60 2 _
a
ctv��er� 1000 amps a volts 454.65 2
Name: John R, ,T e an _Roberts ` K .0 0etoot, only 66.85 2
Address: 11847 S W 12 5 t h C t . Temporary services or feeders - installation,
alteration, or rdoeatloo:
Ci /State/D.*:Ti:ard OR 97223 goo am or 661S 1
3 lone: • 7 201 em- m 400 —s 100.30 2 40i lo
�� 1z 2 ( � r �" ;l l Branch amps 133.75 _ 2
ti -�� � Branch circuits - new, slteradon, or
Name: extension per web
A. Fee f o r b r a n c h circuits w i t h pu vbase of
Address: service or feeder Eca, molt branch wt 6.65 2
•
Ci. /State/Zlr: B. Fee for branch circuits without purchase of
service or reader foe, first brawl circuit 1 46.85 4 6. 8 5 2
Phone: Fax: Zak additional branch circuit • 1 6.65 h h 5 2
E-mail: Mise.(Servite or fader not Mended)!
i 1 , 1 a I:a ;h pomp 0 Or 0 W 53.40 .. _ 2
Bach sign of eddied lighting 53.40 2
Job No: Signal v c, il(s) or a limned energy panel,
Business Name: Mike's Elect s' Description; or exun�ion Past 2 2
i` . Desmpbon,
Address: 1} 1 ;1070 S W Allen Blvd
C/Zl Beaverton Q R 9 7 0 0 5 Each additions) Inspection over the allowable in mix of the elelbow e
G1 /Stat
F insprcbo hour (rein. 1 hour) 62.50 _,
) 3 Phone: 6 4 2_ 91 Fax 0 3.6 41 .19 0 2 baveatimtion fee: p� L y
CCB Lie. #: • • • • Laic. #: - : • dies. .... -, 11? ' t' Y' ' ,! 'uIiGY ...'1 -6k., J r .N?.. I'.7 Mir' , x 1 •= :
Supervising electrician,„ y Subtotal $ 5 35LL
signature required: l d'' ' / � Pla Review (25% o Per mit Fee) $
Print Natndi o u 11 -. s J M 1'11 - Lia 4 2 ' 0 S _ State Surcharge (8% of Permit Feel_ S 4.2 Fr
EE
TOTAL PERMIT F S a,7 s
Authorized Notice: This permit application expires if a permit Is not u t t t la
Signature. Date: 110 days after is boa been eccepted no complete.
*gee metheJolbgy eat by TN-County Building Sndustry Service Board.
(Florio print ammo)
ilDstskpermitFo nsMcPermlt App -doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received Date Requested 0 — 30 AM PM BUP
Location l 18 /41 / S l& Suite MEC
Contact Person Ph (C1 JI) PLM
Contractor Ph ( ) SWR
JILDI Tenant/Owner ELC 60 - 6 OS '/5/
oo ing
Foundation Access ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors : � �3
Ext Sheath/Shear
Int Sheath/Shear L��x -r.C� C ! NvC�
/ /' (� tem
Framing 2- DLO Z ~ —� S n to�l`�r
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
S PART FAIL
- MBING
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
PAS FAIL
LEC IC
Service
Rough -In 61/.
UG/Slab
Low Voltage
Fir arm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date a d Inspect) . A •A ∎ d af Ext
Other:
Final DO NOT REMOVE this inspection record from the Jo ' site.
PASS PART FAIL