Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00424
,.ill, DEVELOPMENT SERVICES DATE ISSUED: 7/14/2004
`' ? --° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 1S136DD-01300
SITE ADDRESS: 06855 SW BAYLOR ST
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Electrical TI, (20) branch circuits.
Job No. 4154
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: 19 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:
MALCOLM ESLINGER DAVID JEROME ELECTRIC
11575 SW PACIFIC HWY ' PO BOX 751
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503- 620 -9515 Phone: 648 -5144
Reg #: LIC 36051
SUP 2877S
FEES ELE 34 -119C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/14/2004 $173.20
[TAX] 8% State Surcharge 7/14/2004 $13.86 Rough -
Elect'l Final
Total $187.06
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
suspende. : _ han 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules a •- set forth in 0' e 952 - 001- 001 thro gh OAR 952 - 001 -0100. You may obtain copies of these rules or direct .uestions to OUNC at (503)
246 ..99 or 1 -800- 332 -2 + , .
yaw— / 0 � / / / lid ��
Issu -d By: , __ ,jo Permit Signature: �.���
OWNER INSTALLATION ONLY I
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: _.- - • Agit,M DATE:
LICENSE NO: 0
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application J
Fen OFFICE US '' .,
City of Tigard /
'13 $ W Hall Blvd , Tigard, OR 97223
� Permit No .� - /
Phone: 503.639.4171 Fax: 50 3.598.1960 ,t,.,, Plan Review IM �� 4� ^DOY
Inspection Lire: 503.639.4175 1111 }� Date/B4 Other Permit:
Irtemet• www,ci.ttgard onus e Date ReaeyfB
I! ~ NohficdlMeth � Supplemental information
!2! sec Page z rot
G�M1 i* =6! ¢i,jr •r • , i
) " t -h • } � tf' I ?*MI 'ri i r ldti i i t �� +llil ji+1 �''t��+ fl Vt fMi1,• i . 4 ; v t , r '�"__
g New construction ' dditi u r �( , `!, •4t,1l' ,,�� - 1 I, l • 1 d','�f Z ;,i h.• i ai 3" .1 r, r' 1. ? , 1 •,'; ,. _`
Q on/alteration/replacement Please check all that a `
I�D apply:
molition D r
Other: 1_J Ser:icc over 225 amps, conlrrr l DHazardous location
, ilk` 0)
+ „G •t �, iLii T Sad i 1''�'id , _'i(` ? Sa� ..;Y /a �lA I� ' y� w i i r i�, - ,..� { of 1- ar, 0Scrvlce over 320 amps - rating
I . �uiA.,, r � Ma. 3 .'rv'.m>nn:r..•cly. � � ; !•i ;+; t� N t '.rE{•i,:li�0 , f d 2- fanUly dwellings 4 or more new residential
g ❑l
.
ri 1- and 2- family dwelling rot" ommcrcial,lmdustrial Q Accessory building I I ❑System re
over 600 volts nominal units in one structure )
0 Multi- family ❑ Master builder (]13uildinR over throe stories ❑Feeders, app a or more
:; :s •;i•� � ��, [... 0
>R �:' j[t�:. ,.l o :Ti sa�r•' +� `iii,. ii rt ra '" { i �;�,,�� ❑Occupant load over 99 persons ❑Manufactured s tructures or
,� d t t•.,� :ilk?i.et,dat R ,t, r n , i"' %t ❑Egress /li htit
, Job no.: � u�, [ S g plan RV park
'* Job site address.6S Sc. �, ❑ ❑Other:
City /State/ZIP: Sub Health•carc 2 sots of pla facility ne with any of the above,
The above are not applicable to temporary construction service
1 Suite/bldg. /apt. no.: Pro ect
] name: jl tiVrtiiilLi ij n :aim n 19 "° I i l .....:: ...
Cross strcet/directions to job site:' rlMtriptfnn Qty. Tec. 7onl I '"
_ New residential single- or multi- family dwelling unit,
includes attached garage.
I Subdivision:
_ 1.600 sq. ft, or less 1 45.15 4
f Lot no.: Ea. add Limited 500 sq. R. or portion 33.40 1 I
1 Tax tnap /parcel no.: Limited energy, residential
i+' $� ltd} l4 tvo L ; t . v l un rm sf punnmm�yltg` li` fiMlt , � Limited energy, 75.00 • 1111
aLry. d�n!titzo�>i ".U1µ!<' 1 ���{ntr;. gY, on- res;dmtial 75.00
L.K..C• i^ „Uw v, I, Each manufactured or modular
1 C� G.� t dwelling, service and /or feeder I 90.90
Services or feeders installation, alteration, and /or relocation 2
I i r tune n t�, 200 amps or less
t0 t^ ti T 4 ass 1 80.30 2
, +:tw it. • '' t .`4 ' .1Ltil 1 NP "R' t 1(IRI d r ° ri ' v i 201 amps to 400 am
, mac / ttq :• , . .t..,11 �,1 i `�a `z amps l Ofi.85
�
H
- v f i......„ 5 - 601 401 amps to 600 amps 160.60
_ amps
Address: p. to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.6S J 2
Cit y / Stat e /ZIP: Reconnect only 1 66.85
2
Temporary services or feeders installation, alteration, and /or 1
hone: ( ) relocation
Fax: ( )
Owner installation: This installation is being made on property that I own which is not 200 amps or less 66.85
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 20 1 a 1
Owner signature:
amps to 400 amps 100.30
gti aturc 401 amps to 600 amp 133.75
Date
:S , yt 1 ; l �`; ( " r T k1� fit, tl iiC�t ,, C�ta (en�rni M � : r „ , Branch circuits - new, alteration, or extension,
•�11......�1 + ^+.. mt!C i '} -. �1 - ill i�K1ti�lt F ri'>l 1 e� lr �i an tt� ,Z . s6, nsion, per panel
• +.ot ° " ° ` t,r nr.. add�;;� .i „i I;a'. I ulii A. Fee . for branch circui w ith
Business name: service or feeder fcc, each
branch circuit - m ilt
Contact name; B. Fee for branch circuits
Address: without service or feeder fee,
each branch circuit / 46.SS
Lf= iry /State/ZIp: Each add'I branch circuit In 6.65 ragiEla
Miscellaneous (service or feeder not Included)
Phone ( )
Fax: : ( ) Pump or irrigation circle
j E - mail: 1111 53.40 MUM
Sign or outline lighting
r 53.40 2
�rttl,l n�t , 1 �, 'r +r ipe ^'"W', n { „ _ 11 Sigma! circuit(s) or limited -
���L 'a i tiL l i i' -�' .• n l edt ` .. + � 4 f ' ' e ''. , :. il- '
i Business name: y -{��� = .1•, u. r l• ��gY Panel' Alieratlott, or
Y�� 1TY7 � extension. Describe: Page 2 2
Address; • D ` --t
• / . Each additional inspection over allowable in any of the above
Per :nspcceton 62.50
City`5tate/7.Ip l 13 .. + 4 411 ( 11111111.1111
Phone: �'q� ) ,, _ Investigation per hour (I hr min) 62.50 I
P (9 3 Co`�v i `{ Fax: (�3 (� (46. 7 10 ? t Industrial plant per hour 73.75
CCB Ltc.: 0 t • Electrical Lic, �{ (L•�.J - LS ��yr
.
3 l " � 1 R ` Sttprv. f a� Nfa .'J': ,k ii. i ;i � is , i =,i ,.'1 ' ?1F?�,Mill t a -r, „` , ;,. :,, ,:,.lgii
ic.:
Suprv. Electrician signature, required. ` � • Subtotal 73, a
_ r ( Plan review (25% of pemnit fee)
Print name: `< I '
J aaJ'0l 63 Date: State surcharge (8% of permit fee) /3 - g &
Authorized signature:
TOTAL PERMIT FEE r
This permit application expires If a prrmit f not nb tgi a n
Print name: -"____-
Date:
day after it has been accepted as complete
' Fee methodology set by rri- County Building industry Service Bon rd
.Building \P itAELC•PraiiApp.doc :2/01 " Number .?f inspection:: per permit allowed.
480.4515T(i nto2/COM/W£a
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested l / 3 AM PM BUP
Location Suite MEC
Contact Person ' Ph ( ) / " Co 9 ck PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 1 � 6 / - l & 4/a
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: a SIT ��
Post & Beam , ®-G( �' Mt
Shear Anchors
E*t Sheath/Shear MEW
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall I s �i>n fVI
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
." V-**
Roof
Other: Co"
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
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
Fi ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
IZZO PART FAIL
SI ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
APP DAoach /Sidewalk Date , ) 3., Inspector � " "Y � ( Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL