Permit .� 4. CITY OF TIGARD ELECTRICAL PERMIT
� d� TIGARD PERMIT #: ELC2004 -00499
DEVELOPMENT SERVICES DATE ISSUED: 8/9/2004
13125 SW Hall Blvd.. Tiaard, OR 97223 (503) 639 -4171 PARCEL: 2S112CB - 03600
SITE ADDRESS: 08438 SW ASHFORD ST
SUBDIVISION: ASHFORD OAKS NO. 2 ZONING: R -7
BLOCK: LOT : 050 JURISDICTION: TIG
Project Description: (2) branch circuits for AC.
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:
HEISERMAN, RICHARD H +JOAN NE ROBBEN + SONS HEATING
8438 SWASHFORD ST 2214 SE 8TH
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 639 -7477 Phone: 233 -5841
Reg #: LIC 1884
ELE 26 -1133C
FEES SUP 3567S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/9/2004 $53.50
[TAX] 8% State Surcharge 8/9/2004 $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. Speaalty 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 • - direct ques s to • U C at (503)
246 -0699 or 1 -000- 332 -2344.
Issued By: Permit Signature: ' /�.J�'
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
Electrical Permit Application FOR OFFICE USE:ONLY
t' c st Received . /
Cit Ot• Tigard - Date /By: '/ /oi 1343 Permit No. 16� ' +Qc 9
1'3125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 4714 a l I Date/By: Other Permit:
Inspection Line: 503.639.4175 ' I,� Date Ready /By: . . ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / i 6 Supplemental Information
f ,:.,- � ��.. ,, -:. -: - -.. Ytl'E OF waRK.....� -, .::...: 3.Ws - �:
.., ,. ,,.. ...... .����:;,: -r:- mss; >,.,. - . _.. e.= . ........ ......���:;�'
❑ New construction ® Addition/alteration /replacement Please check all that apply:
CI ID ,Demolition ❑ Other: v Hazardous Service over 225 amps comm'1 Haz ard location
_ �„� ❑Service over 320 amps rating ❑ Buildng over 10,000 sq. ft.,
,�,-., s °G;•: '` CATE CONSTRUCTION ¢ of 1- and 2-family dwellings 4 or more new residential
® n ° 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder ❑Other: ❑ Building over three stories ❑Feeders, 400 amps or more
, _ -.,u -, ., , �\ , ❑Occupant load over 99 persons ❑Manufactured structures or
_:;._; ;, � .: H :'" " RV
14:Hi3 SI .0IsIFORMATi,,O AND LO CATION Egress/lighting P
�• ` � � -:, a -.. .- � � - - ess /li htin plan park
Job no.: Job site address: 8438 SW ASHFORD ST. C] Health facility Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: TIGARD, OREGON 97224 The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: HEISERMAN ,: ' i; - -44ii:° -" EE'"" C IibOL`E� j_ ,' , , .
g
Description Qty. Fee. Total
Cross street /directions to job site: HALL AND ASHFORD New residential single or multi - family dwelling unit.
includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
...,. energy, non-residential 75.00 2
Limited nergy non entia
§. „� ,�. .., �r� ',....v. . -. - a, a ,..... ° , ,�����' �du���_x , ig, . _.. Each manufactured or modular
NEW CURCUIT FOR AIR CONDITIONER dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. .o ',; ... ,_ °.v_, T.r r ', 201 amps to 400 amps 106.85 2
PR®PET�T" OkYNE i t " „� ����” _ 44 s t s
® R al:::;0` TCN'-1NT
,,.a at sa : e:.. 401 amps to 600 amps 160.60 2
Name: JOANNE AND RICK HEISERMAN 601 amps to 1,000 amps 240.60 2
Address: 8438 SW ASHFORD ST. Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: TIGARD, OREGON 97224 Temporary services or feeders installation, alteration, and /or
Phone: (503)639 - 7477 Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
WWII: � :.,;�•:;, ,; ,'> A. Fee for branch circuits with
..�". --�: ti= AP1'I:�;iC `� �CONTAC° ,. P`ERSON
' € �w;.:. -. z ; r: %` " ,, ri ::..: -.. <r. -ter.. r N.
service or feeder fee, each 6.65 2
Business name: ROBBEN AND SONS branch circuit
B. Fee for branch circuits
Contact name: RANDLE NELSON feeder _
without service or feeder fee, i 46.85 1 g 2
Address: 2214 SE 8 AVE each branch circuit
Each add'] branch circuit / 6.65 (p 10C 2
City /State /ZiP: PORTLAND, OREGON 97214 Miscellaneous (service or feeder not included)
Phone: (503) 233 - 5841 Fax: : (503) 238 - 8849 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
a �R' "iR; energy �; «� -. �-�„; AU MS. �aG .(7,N�RACTt)R "..:'�ro�..�...,> ` ".F ° iY - gYP anel, alteration, or
extension. Describe: Page 2 2
Business name: ROBBEN AND SONS
Address: 2214 SE 8 AVE Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZiP: PORTLAND , OREGON 97214 Investigation per hour (1 hr min) 62.50
Phone: (503) 233 5841 Fax: (503) 238 8849
Industrial plant per hour 73.75
T' :t1 ^t I I EG'IRxCA ERtafitl'' F>;ES, *� >
.( CCB Lic.: 1884 1,a \ Electrical Lic.: 26 -1133C , \/ t Suprv. Lie.: 2429S I Subtotal 53
I Suprv. Electrician signature, required: l � ( Plan review (25% of permit fee)
Print name: L arry ' 1 c z Date: 8/9/04 State surcharge (8% of permit fee)
TOTAL PERMIT FEE 5 - 7 7g
Authorized signature: 7:/e, 1 !:' 1, This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: 4Pt e- A # Date: 8/9/04 * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i'\ Building \Pemits \ELC- PermitApp.doe 12/03 440-461 5T( I 0 /02 /COM /WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Y-7"..--i.3 BUP
Received ate equested AM PM BUP
Location l � 1 3 :1 / Suite MEC
I Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR L
BUILDING Tenant/Owner ELC,6v% "'2 6 7
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain .
Slab Inspection Notes: SIT
Post & Beam
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 LkC) \�cC--
Post & Beam Lk
C
Slab
Rough -In
Water Service
Sanitary Sewer . C (
Rain Drains
Catch Basin / Manhole
Storm Drain ) lyi
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers •
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
S Rein S ART FAIL
spection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line .
ADA / 6
Approach /Sidewalk Date Z ! Inspecto -a .. Ext
Other:
Final DO NOT REMOVE this inspection recor . from the job site.
PASS PART FAIL