Permit ,,CITY OF TIGAR ELECTRICAL PERMIT
PERMIT #: ELC2004 00582
_ ���1' ° DEVELOPMENT SERVICES DATE ISSUED: 9/15/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (5031 639 -4171 PARCEL: 2S114BA - 06800
SITE ADDRESS: 09760 SW COOK CT
SUBDIVISION: COPPER CREEK ZONING: R
•
BLOCK: LOT : 010 JURISDICTION: TIG
Project Description: (4) branch circuits for kitchen remodel.
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:
ROSTAMIZADEH, AHMAD AND ARLO ELECTRIC INC
BROWN, MABEL M 50705 NW CLAPSHAW HILL RD
9760 SW COOK CT FOREST GROVE, OR 97116
TIGARD, OR 97224
Phone: Phone: 357 - 2350
Reg #: LIC 35763
SUP 3321S
FEES ELE 34 -118c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/15/2004 $66.80
[TAX] 8% State Surcharge 9/15/2004 $5.35 Rough -in
Elect'I Final
Total $72.15
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 se : • - 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -669! o r 1 -800 -332 -2 • • . /
i
Issue By: A ! __� Pe rmit Signature:VJj_/ _ %
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: _�l pG fi..°`
r ',c kP & 4. DATE:
LICENSE NO: 339-1
Call 639 -4175 by 7:00pm for an inspection the next business day
•
. ..
Electrical Permit Application . FOR OFFICE USE ONLY : ..
A . .
City of Tigard . Received 0
Date/By: / "Foy Permit No. se . , ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 A:PAO Date/B : Other Permit:
Inspection Line: 503.639.4175 ,,,a.lif. -I I ' Date Ready/By: • El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
r llaM- .t '.. .- . . ,
,- ,.:,, ,- .. , sA'` , C: - A4 - 4PA'Ad.1,^ Aia. :V‘r;r=.." -,-, -t: .:, , .
0 New construction 0 Addition/alteration/replacement Please check all that apply:
0
OService over 225 amps, comm'l ['Hazardous location
Demolition Other: E
ervice over 320 amps - rating OBuildng over 10,000 sq. ft.,
Sl ';'q:44ri - '''''' 7 : 4 :7AM: 4 611WIMR - 412 '' 11 - efaN ' •WW1 of 1- and 2-family dwellings 4 or more new residential
0 1 and 2 dwelling 0 Commercial/industrial 0 Accessory building [11System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
0 Multi 0 Master builder 0 Other:
ElOccupant load over 99 persons 0Manufactured structures or
-: ftg,Nnf.4 , 11 p Egress/lighting plan . RV park
- e!"7-4t- :::...:
Job no.: Job site address: ( i'76,0 5 e...60 le 6.1 , IDHealth facility ['Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: 7119 CLYV( 0 12 7 7 2- 1 `1-( The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name: „-- ••
Description Qty. Fee. I Total
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'l 500 sq. ft. or portion 33.40 • 1
Limited energy, residential 75.00 2
Tax map/parcel no.: .
i,,, L mited energy, non-residential 75.00 2
1 ,
, ... ':!,-sy.x.,...-,- „,-.4.74,:,,s1,4„621,'. - . , ,:: ,.,!4:,.-...,,.,:A,, ',71,:A ,iim --4 'k'A Each manufactured or modular
dwelling, service and/or feeder 90.90 2
te frPlake — Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
a:''Atpr::eW6Ekfir,*Z,ife;fWFV4fq;9SA:-WV:;:'rtiV-AA-V,IV 201 amps to 400 amps 106.85 2
Name: inahel 13rd ton 1 Amad/eosk/41;z4za(64 601 amps to 1,000 amps 240.60 2
Address: e i 7 (a 0 Ceok_ Ci- Over 1,000 amps or volts 454.65 2
Reconnect only • 66.85 2
City/State/ZIP: -- oR q 7 2._ 2. '-i/ Temporary services or feeders installation, alteration, and/or
ij relocation
Phone: ( 57 ) 6, 2. q_ qi Fax: ( ) 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 - 0 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
. -44%. flit .'",%,t4e# A. Fee for branch circuits with
6.65 2
Business name: . branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, i
46.85 4,g 2
an
each branch circuit
Address:
Each add'l branch circuit e3 6.65 /sr,95 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
76)--rfoxaci energy panel, alteration, or
extension. Describe: Page.2 2
Business name: 4,--lo glecil 'c, inc. - .,_ ....-2 , Each additional
Address: 50105 4140 inspection over allowable in any of the above eliyishd.40 Aka /co adz_ Per inspection 62.50
City/State/ZIP: Fest Grou6 C).-. 17 ti Q, Investigation per hour (1 hr min) 62.50
Phone: ( 5 q 36235 -/- 7 Fax ( ) Industrial plant per hour 73.75
Ift - i' '. -MnarartagtenVICEMONE2, 7 'Wel ; E' - '71 . 7 . 17:7 ,1.
CCB Lic.: . 5 -- 74,5 Electrical Lic.04--/i C, Suprv. Lic.: eft!rt Subtotal
Suprv. Electrician signature, required: 3 5 Plan review (25% of permit fee)
...-/
Print name: Date:
State surcharge (8% of permit fee) 5.,3‘
, .../
TOTAL PERMIT FEE 7p, . , 5
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri-County Building Industry Service Board
0 * Number of inspections per permit allowed.
i: \ Building \ 2 ertnits \ ELC-permitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 91'8- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
• ❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ .Instrumentation:
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is \ Building \Permiu'RLC•PemutApp.doc 04/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
ARLO ELECTRIC INC
50705 NW CLAPSHAW HILL RD
FOREST GROVE, OR 97116
Electrical Signature Form
Permit #: ELC2004 -00582
Date Issued: 9/15/2004
Parcel: 2S114BA -06800
Site Address: 09760 SW COOK CT
Subdivision: COPPER CREEK
Block: Lot: 010
Jurisdiction: TIG
Zoning: R -4.5
Remarks: (4) branch circuits for kitchen remodel.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for •
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
ROSTAMIZADEH, AHMAD AND ARLO ELECTRIC INC
BROWN, MABEL M 50705 NW CLAPSHAW HILL RD
9760 SW COOK CT FOREST GROVE, OR 97116
TIGARD, OR 97224
Phone #: Phone #: 357 -2350
Reg #: L1C 35763
SUP 3321S
ELE 34 -118c
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Supervising Electrician
If you have any questions, please call 503.718.2433.
etiN) ` g 9 : S63- 5-5.8-196o
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: 03) 639 -4171 MST
BUP
Received Date Re•uested ! 7 AM PM BUP
Location • _ -�- -G Suite MEC
Contact Person ( ) PLM
Contractor 'h ( ) S 7'g -350 SWR
BUILDING Tenant/Owner 6d tf -Do g.,
Footing ELC
Foundation CCeSS:
Ftg Drain 2 > P' ,/1 ELR
Crawl Drain SCR/VA G� f �4-
Rc
Slab Inspection Nbtes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing e'er ����� ce',�i
Insulation
Drywall Nailing f��4
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING i -c �! L� ®f`/GQ% Cc22 g e
Post & Beam
Under Slab
Rough -In
Water Service
-
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final ems■
PASS PART FAIL
MECHANICAL
Post& Beam •
Rough -In -
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL J
Service 0 � - � " Rough -In b �.
UG /Slab
Low Voltage
Fire Alarm
0i Reinspection fee of $ required before inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS !. RT FAIL
LI Please call for reinspection RE: Ei Unable to inspect – no access
—
Fire Supply Line /
ADA / �
Approach /Sidewalk Date llljjj" Inspector Ext
Other:
Final DO NOT REMOVE this inspection r = -d from the Job site.
PASS PART FAIL