Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00537
u,ji� DEVELOPMENT SERVICES DATE ISSUED: 8/25/2004
^ 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S111 DC -06500
SITE ADDRESS: 09480 SW BRENTWOOD PL
SUBDIVISION: SUMMERFIELD NO.9 ZONING: R -7
BLOCK: LOT : 499 JURISDICTION: TIG
Project Description: Alter (2) & add (2) circuits, rec. in storage rm, GFI in garage, shop lights, change out paddle fan in
dining.
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: 3 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:
CLEMENCE, FORREST & SHIRLEY GARNER ELECTRIC
9480 SW BRENTWOOD PL 2920 SW247TH AVE #A
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503 - 620 -0848 Phone: 503 - 648 -4552
Reg #: LIC 121159
SUP 3707S
FEES ELE 34 -305C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/25/2004 $66.80
[TAX] 8% State Surcharge 8/25/2004 $5.34 Rough -in
Elect'l Final
Total $72.14
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 re 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: l/, / �E� /� Permit Signature: S: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:
Call 639 -4175 by 7:00pm for an inspection the next business day
10/08/2002 01:05 6427925 PAGE 01
Electrical Permit A p FOR OFFICE USE ONLY
City of Tigard r l� l D a c e B e a • / ON . O M Pe mitNo..‘,..." ( C O 'W5Y
13125 SW Hall Blvd., Tigard, OR 97223 " plan Review
Fax: 503,598.196 p Permit:
Phone: 503.639A171 '14UG 2 4 '"'M " � D ate/B
2004 ' •4,1 4 Date Ready/By lurk; See Page 2 for
• Inspection Line; 503.6,39.4175 ,- r.
Notifte4 4ethed: Supplomentat Intormation
Internet: www.cl,tlgsrd.or•ua CITY • -
a, >" t ^.'rr 9'"1gnrI• , y . 1•.1 , ntr +t L > " 7• � JnG l';,¢� '''.:',7 f a
°J P161. ±�Kk��c � 1 _
4 4�� t n 7 1, �, , I rt • i, ilk 1 k Y ip L4, ,' , y " I i , `I+`. hl . r ut ,,
�f i'"' s, 1Z tt �, :,ltw•0, 1 3xJfnwu,at.iiw lit n, . k:l � 1. it e . ... ;1 1 �" "r 1M .1''
❑ New construction) i Addition/alteration/replacement Please check all that apply:
❑Service over 225 amps, conun'1 DHazardous location •
❑ D emolition Other: 20.4 s - rata ❑Bunting over 10,000 sq. D.
QServiee over 3 mp S
�{i 2 � r �'T�"SU {t iQ�{ 1} �'tr . t ,�11�1 ar � �l ti i t4 C , i 'ir�'CS�� ��i�: � r A II v 'nv t e 1'l� � i '1�"�Fw'�?��� ��
�y�, t�,7rr q a�. 4 p��` 1° 22'(( `' ' ETIESr E 4t '" z L 1 1, ,�,, A4 ,� of 1- and 2- Family dwellings 4 or more new residential
LM�U.1. Ir. N2 Tit4S1!' iui. hA . 1 1.,•;1t' + �1i5,.ie s , f a. J !!1><!lv ahnt
► ?l 1 - and 2 -famil dwellin l/industrial ❑ Accessory building S over 600 volts nominal units in one Strlrettlre
y $ ❑ Commcrcia ['Building over three Stories []Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons DManufacmred structures or
,;r , ` p T,D1% yIr tq pw� sJ t t' i trt "�'n>r ,ir`di.�atrt t�s j; t { , 1 + 1 Fi'\� iA si'`)l, b( k''p I,,''�u RV park
a l:� k,.
elEof 3 " 1 A ; t ^ S 4, , . ', t t, S A [ i 6'1 i 1 ),,�`. ! ''''14, + =�' �' ;'''''" ❑13gr ces/lightingplan
�l .Rr�w .utu - Y1,,utf,��!�.x -1,. t,.%u� s Yta� .�;d�,?,u�c�r�.,sL.,tl�ls.'�� 1,,� A!s�,s s��,�" ,1...S..ihK. W �.. El Other:
Job po.: rob site address: Uf FO S W ree.4-w trJ p( , ❑Health -care facility
Submit 2 sets of plazas with any of the above. •
City /State /ZTP' 1 0 The above are not applicable to temporary construction service,
Suite/bldg. /apt. no,: Project name: il� B t „ ..
Description Qty. Pee. Tool ,
Cross street/directions to job site: 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 500 sq. ft, or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited idential 75.00 2
3 vii s m uu t C t ���P 4Sri , F1 ul m ted energy, non-residential
i, &At f � iF' 4 � .v f wµ,4 � �1 s �saat' .. .i .., ap" ie 1 ' ;v 'y1 } ,. alt t�;hrkl I Ea menu factored or modular .
dwelling, service and /or feeder 90.90_ 2
{ er 2 1 r i z Ct'cut -- J 4-"C - i'v '4 - 2fir' G 4°1 Services or feeders installation, alterntion, and/or relocation
6-i Pi I to �e J�Il1.a r 1.i , i'v -c Ot l , ►[ Nt✓1 200 amps or less 80.30 2
f 1D6.85 2
p I a �M +a�c� It a�a nix • + r k ry, H o k o a Moe o, t " it 201 amps to 400 amps
(e ltd y y r .�[t�{{,,I'�' :� e r c k� 6 Y i.ra �l ^ ; " I. } i . 1, a `0A'-, AA.�.W`..., 4a• s 160.60 2
Y�:d����a•ra�t'i�. • > sldi:: Rr�Lv:�dl.uyr'u'. n +• `ai;na�: -L rw u:: 40] amps to 600 aLnps
Name: ,r s f -" _A -.- / A I : _ 1 h . 4)/ del amps to 1,000 amps 240.60 - 2
Address: s t-+- 7 0 S� gV e,FC7wcC ! i Over 1,000 amps or volts 454.65 2 �
Reconnect only 66,85 2
City /State/ZIP: - 6' Temporary services or feeders installation, alteration, and/or
i relocation
Phone: ( 6031 (0 20 -' r K4- Fax: ( ) 200 amps or leas _ 66.85 1.
Owner installation: 'I his 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
,
r,�` a 1 < <� t v t a a c, ,bra . t y 41E } . l ' r i i T l a ` n a d .. r? , y':` A. Fee for branch circuits with
no,rI1.14. g.. 1'A .11 . i�cn oi�; .4,1 s � � F : .2. Ar. 1 ,a eZl4 hna �r..k,ta'l n : :'ft - 1 +9 ,i 'i�' :� '
service or lea fee, each 6 -65 2
13usitiess name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, { 46.85 2
. each branch circuit �-
Address: Each add'I branch circuit 6.65 _:,; '
City /State/ZIP: Miscellaneous (service ur feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sig or outline lighting 53.40 2
E- ill Signal circuit(s) or energy panel, alteration, or
t limited -
F I . T' 1 g 1 1 ` u �.h 1 1 `a MtO. 's . s�a..t iV, °1•" ,.: ` " L:0 '• ''
ri f { '� extension. Describe: Page 2 -2
Business name: (s Ji wi• EL N / C
Address; ' g 2 - 0 ` j ( 2. G( 1 `' A . 4 4. 4 • Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP 1 ' k ('5 6 (>V 0 Q 1::■)- Cl -71 Z Investigation per hour (1 in min) 62.50
Phone: (.4 (J ( 4 C•-(' F - . ) ( 4.7 V' 2c• Industrial plant par hour 73.75
- 7(' - )/ l ' i lu l rri, _rot +o_ ...'.61.7.3i... e', .1 7 i " :16 1 c +' '''i ^. v I_. '.
CCB l is Z Electrical Lic. ' t _3. �. S Lic.: « - Subtotal 6 6
Suprv. Electrician signature, required: .���2 /' /// Plan, review (25% of permit fee)
Print name: ,nom Da 7 State surcharge (8% of permit fee) d ' c/
G ~� 1 5 � I � • -Tt2[ O / Z / / o TOTAL PERMIT FEE i -7� J '�
Authorized signature: . ln
This permit application expires if a permit is not obtae within 180
---- --°- -- days after It has bean accepted as complete
Prirntname. Date. • fide methodology set by Tri- County Building Industry Service Board
-- Number of inspections per permit allowed
c\ Build )sg.5srmitslBLC.PcrmiiApp.doc 12/03 4n0.4615T(1W r¢CaIWEB
1T 0. r fl-C%_0.irivr 1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Lihie: ( 1 503) 639 -4171 MST
;
60%-; 3
Received Date Requested AM d '7 — BUP
Location T � � Q It ) Suite MEC
Contact Person Ph ( ) -4 ,s L PLM
Contractor Ph ( ) SWR /
BUILDING Tenant/Owner ELC �i 7
Footing
Foundation ELC
Access:
Ftg Drain ELR -
Crawl Drain /�
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear UMW
Int Sheath/Shear •
•
Framing
Insulation
Drywall Nailing
Firewall P rt t1//1-/
Fire Sprinkler V�
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
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
4140 ink ❑ PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
E l Please call for reinspection RE. ❑ Unable to inspect — no access
Fire Supply Line e 0 i� 4 , ti p f
ADA / Z-D ` r
Approach /Sidewalk D a t e Inspector r Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
•