Permit C I TY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00172
DEVELOPMENT SERVICES DATE ISSUED: 4/7/04
13125 SW Hall Blvd.. Ticlard, OR 97223 (503) 639 -4171
PARCEL: 2S112CA -04100
SITE ADDRESS: 07996 SW ASHFORD ST
SUBDIVISION: DURHAM ACRES ZONING: R -
BLOCK: LOT : 021 JURISDICTION: TIG
Project Description: 2 branch circuits, wiring for a/c & furnace.
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:
POTTS, TERRY L +JOHNNIE R WEST SIDE ELECTRIC CO INC
7996 SW ASHFORD ST 1834 SE 8TH AVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: Phone: 231 - 1548
Reg #: LIC 13306
SUP 2663S
FEES ELE 26 -I35c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/7/04 $53.50
[TAX] 8% State Surcharge 4/7/04 $4.28 Rough -in
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 O: ' ' - -e -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 -. 2 -2344.
Iss ed By: ` ■1- I r i `� . Permit Signature: e
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: 0 S
Call 639 -4175 by 7:00pm for an inspection the next business day
flue 11 03 Duff Mer ep 503- 625•£3517 p.
Electrical Pt . FOR OFFICE USE ONLY `
•
�' � O� J ^
I [late/B It, P nni t No.: f �. ..- � —
� 7.
City of Tigard APR 0 6 2004 i la ealy: . ' I Sign
na tr/rsy Permit No.:
13125 SW tIall Blvd. pion Review Other
Tigard. Oregon 97223 CITY OF TIGARD rains. PermitNo.• _
f_ 503 - 639- 4171BUI IPP3: 9M2)N post new hand tivc
u il., * ;,,e •)i ;y y, I i Ci , Conta __ Case No.
Ju
Internet: www,Ci,tigar(1 -onus l bra {I Conlin ris. ties. Fo t 2 for
24 -hour Inspection Request: 503 -639 -4175 �� ° " Nansc/Mcthod� i Supplemental [promos lion.
TYPE OF WORK " • • . PLAN REVIEW (Ple check all that apply)
1J New construction cm • olition 0 Service over 215 amps- ❑ HenTth care facility
commercial 0 Hazardous Location
Addition /alteration/replacement ❑ n r_ 0 S crv i lx over 720 amps - rating Of ❑ Building over 10,000 square [cot,
11,, ww CATEGORY OF CONSTRUCTIO 18c 2 family dwcllinp: four or more rcidcntial units in
M 1 & 2- }'anvil dwelling t oinmercia t?dustrial — 0 Building over three stories. 0 Feeders, 400 amps Or runic ILI Accessory Building; n Multi -Fami y El occ es load over 99 persons 0 Manufactured structur or RV park
D Master Builder ❑ Other; 0 Egress/Iightinr, plan 0 Other;
• • •• 30t3 SITE iiNI»ORMATION and x. :4 ION Submit _ sets et with any of the above,
The above are not applicable to ternpoeary conStreletio0 ierviec
Job site addre mo d& I__NOV N S+ .• ._ • _ • .. .1?'LtE- SCHEDUL • .
_ Suite #: __ 1 Bldg. /Apt -#l=: Number of inspectiotruerhermit allowed
Project Name! , -, ;1 . if f ' w ,p r 'yc_ C fi'r nr Description _ 04 Fee Or) Toast
Cross strcetfDu to job site: New residential-stock or Inettr_famrly per - -�"
J dwelling oak. Includes .uncured garage.
Service t.drrdcd:
1000 sq. ft or tests 145.15 _ 4
Fyeh additional 500 sq. ft. or portion thereof 3140 ,•,_- t _
. - - - ........_� �Lhnned encr r eorsidenbal _ _ _ S OO 2
Subdivision: —. - .. .. _ _ I Lit : . -. _ l arced enc residential 75.00 _.. 2
Tax map /parcel #: Bach manufwrwc t home or modular dwelling
— � DESCItIPTION.OE WORK service and/or [ceder _ 90.90 2
— Services or feeders - lnataselon,
1�r �.r-t' A e._ U, f •'._Ct, C — alteration or relocation:
700 amps er less _ - _ _ 80.30 2
. - - .,.... —. 201 amts to 400 an st - ,, , - 1%135 2
401 amps to 600 amps . . 160.60 --- - .Z..
1;i PROPERXY.OWNER I TENANT .. 601 imps to 1000 amys 240.60 2 --
Over 10 amps of .0119 4S454.65 7
Name: \, : , c 4 l i. 00 r . r _
' Reconnect only —
- 6 , , 7
Address: - • L - 1 „} - a Temporary services or feeders - instan:Won,
'• aktrotioo, .r relocation:
City /State/Zip: ; ., otI' 1 ) 7 _ 200 amp.. or lens 6,.85 __ 1
—
,� : � � 201 amps to 400 am rr 100.30
Pklonc: PP LiICA NT 1- _ _T ax: aol to too amps _ - 133.75 2
CON'T'ACT PERSON )larch circuits - now. alteration, ar
e xtension p ane):
Name: VV6 Sc ( ?6 t ✓Lac_ t � - , p
L/� t�, S 2
6.65 2
City/State/Zip: �p ��
A. ate for branch circuits with purchase o r
Addrs
: 1: 3 4 , S& g'' i 2 = _ i 3, Ser,.iee M feeder _hl nch etruil - ---
sic for branch circuit% vrithoul purchase of
( 4R.46.10 _ . service Or LtcAC� f rt� Hirst, branch intact `
Phone: Z • - 1 ' ^ig Fax: 7 1 --n b `j 7 t Rich additional branch 4irC(nt ‘ ti 65 r 415' 7 _
E -mail: al ..+
a e. iCN',tec1'y/�G . co t^'1 Mi3G(Service or kola no* mcluded)'
CW11f� L 14'hOR ..... Gach p um p in igarlon eirele 53.40 _ _ 2 • •
.. - t-ach ton or 5r4tlim lightmtr I 53.40 2
Job No: - Cl citeui or,a limited energy panel,
Business Name: - alteration, Or extension _._. Pa,8c 2 ,2
-_ r)eseriptiorr
Address:
--- " '- Each adlditronal inspection over the allowable in ant the atbotc:
City ty lState L.Ip. _ •_ . . , Y inspection per hour (mm,. t hour) 62.50
fee: _
Phone: Fax: PoYecilgatinn e: -
_... Olhes:
CCB Lic. //: I _ 1,ic_ II: Z6.11..3 5. -�_ , . lliectrical Permit Fees"
Supervising electiicia t Subtotal S 5 2.2,_, <,;(..,
signature required: Plan Review (25% of Prmit Fec) S -_
Print Name: e..• • • •i• #: In Z S . . State Surcharge (8% of Permit Fee) , S 4 . Z.. '
- . • . _ TOTAL PERMIT FEE $ i 7,_,, 7
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: _____ , 180 days after It bus boron accepted as complete.
'[Fee Inethodolopy act. by Tri-County Building Industry Service Board.
(Pirate print name)
i:'lstsTerttltitForrn.s 1CpcnnitApp.doc 01/03
.
2 'd LL90- 9EL1EOSI .00 ot-J oai3 apIS zsaf eSZ :LO 4.0 90 Jdl=1
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 7 CJ c r!p 0,4A
' r� Suite MECO1 - DD /62--
Contact Person �.� Ph ( ) - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC OD a'i - 601 7
Footing
Foundation ELC
g Access: 0,0 � ELR
Ft Drain v.�
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
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
FAIL
Post & Beam
Rough-In Line
Gas Line _C
Smoke Dampers
ART FAIL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI Please call or reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA r d I L /G /� l ��y
Approach /Sidewalk Date Inspector Ext
Other: •
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL