Permit CITY TIGARD ELECTRICAL PERMIT
,% PERMIT #: ELC2004 -00435
6111 DEVELOPMENT SERVICES DATE ISSUED: 7/19/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S104CB 02400
SITE ADDRESS: 13032 SW ASCENSION DR
SUBDIVISION: HILLSHIRE WOODS ZONING: R -
BLOCK: LOT : 070 JURISDICTION: TIG
Project Description: 1 circuit NC breaker.
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: 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:
HALLAM, DOUGLAS J + GRF ELECTRIC
CYNTHIAA 15460 SE PARADISE LN
13032 SVWV ASCENSION DRIVE MULINO, OR 97042
TIGARD, OR 97223
Phone: Phone: 503 - 829 - 4146
Reg #: LIC 76751
• SUP 1655S
FEES ELE 3 -484C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/19/2004 $46.85
[TAX] 8% State Surcharge 7/19/2004 $3.75
Total $50.60
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: Z, Permit Signature:
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
• Received _ i Electrical ,,, / p
•
, Date/B / n 12y + Permit No.: �LC .,., � vc, f ' 4/ ,/
Cit Cl of Tigard Planning Approval Sign
y g Date/B : Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/B : Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 i� Post - Review Land Use
Contac Case No.:
Internet: www.ci.tigard.or.us a 1J Contact 181 See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 '�" Name /Method: Su lemental Information.
- ' :.; TYPE; OF WORK. ',. ? ' PLAN REVIEW ( Please cheek -all that apply) `''
❑ New construction ❑ Demolition 0 Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
[ Addition/alteration/replacement , ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
`:
CATEGORY :OF 1 & 2 family dwellings four or more residential units in
[ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi - Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder 0 Other: ❑ Egress/lighting plan ❑ Other: -
JOB SITE'INFORMATION. ttid LOCATION • • Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: (.?, 0 3 - Z Sc.' L A 5 C evt h ,; :n b l '' °:FEE* SCHEDULE .
Suite #: Bldg. /Apt. #: ; l• eta ^� Number of inspections per permit allowed
Project Name: 7 /4--ii (� � e Description I Qty I Fee (ca.) Total
New residential - single or multi - family per j
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. R. or portion thereof 33.40 1
Lot #: Limited energy residential 75.00 2
Subdivision: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION IOF- ,WORK ': - ' f :. ' i:: s ervice and/or feeder 2
r 90 90 Services or feeders - installation,
I !ice - `.�,c.r. A. AG S Ke,e alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
. -PROYETI.WOWItiElt !'..1 RI TEN 1T. :, c `' , .r . w ;, 601 amps to 1C)°° amps 240.60 2
Over 1000 amps or volts _ 454.65 2
Name: . i d <4 1+74-- i !GI VV Reconnect only 66.85 2
Address: J L' . Z, 2 t 0 1 c f er^ I) K Temporary services or feeders - installation,
t. n alteration, or relocation:
City /State /Zip: T. . , .�, t , ,, c)-1-2-z--3 200 amps or less 66.85 1
Phone' ' Fes' 201 amps to 400 amps 100.30 2
Z 1 S( f > 401 to 600 amps 133.75 2
:❑. APt'LICANT. :0 CONTACTTERSON: = Branch circuits - new, alteration, or
extension per panel:
Name: s1� ads A. Fee for branch circuits with purchase of 6.65 2
Address: — service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 1 46.85 `fil. . ' 5 2
Phone: , Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
rr! Each pump or irrigation circle 53.40 2
!' ca G QB '' Each si n or o utline li htin 53.40 2
*,: R g g
Job No: Signal circuit(s) or a limited energy panel,
v alteration, or extension Page 2 2
Business Name: e IL.E . 0 __ j t __ Description:
Address:( o Pk Y(i C) w4 -e' 1-#1‘ Each additional inspection over the allowable in any of the above
City /State /Zip: M N ,^ � ' ? 19 L Per inspection per how (min. I hour) 62.50
Phone: 93 ' 1,ci , Lt i y-, Fax: '513 - $ Z-9 - 5 79—'7 Investigation fee: .
Other
CCB Lic. #: 7 & c f Lic. #: 3 - if e 4 C :Electrical: Permit Fiees*
Supervising electrician ^l Subtotal _ $ `1 . t' ` �
signature required: � �'
-- " Plan Review (25% of Permit Fee) $
, �
Print Name: �/ ,� } 1
Lic. #: Q j $ State Surcharge (8% of Permit Fee) $ -
TOTAL PERMIT FEE $ , �6." t + �
Authorized — / / 's� 6 Notice: This permit application expires if a permit is not obtained within
Signature: Date: I 180 days after it has been accepted as complete.
*Fee methodology set. by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\ElcPemtitApp.doc 01/03
•
I'd LirLS6213E0S 0 z- lgoai3 AXIS e62=8O 170 Si Int'
CITY OF TIGARD 24 -Hour �^
BUILDING Inspection Line: (503) 639 -4175 R� ST
INSPECTION DIVISION Business Line'. (503) 639 -4171 n
BUP
1
Received Date equested AM PM BUP
Location / 3 0 3oZ c 2 Suite ;. 'f -66 L /73
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/ -1-1 1 - 9 -06
Footing � c
S S — ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors ) m
Ext She ear I , ,
Int Sheath/Shear ‘2/1-1---1
Framing
Insulation
Drywall Nailing
Firewall
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
E W FAIL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
d ) ' FAIL
e
Rough -In
UG/Slab
Low Voltage
Fire Alarm
f� 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
— ART •ART FAIL
SITE 111 Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA ?/1/"/ Approach/Sidewalk Date Inspector L� %� ._ Ext Other:
Final DO NOT REMOVE this inspection record from th ob site.
PASS PART FAIL