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Permit CITY TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00320 Aigiva I ` DEVELOPMENT SERVICES DATE ISSUED: 6/17/2004 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110DC -02400 SITE ADDRESS: 11565 SW DURHAM RD SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G BLOCK: LOT : JURISDICTION: TIG Project Description: New 400 amp service at electrical room 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: 1 1st W/O SRVC OR FDR: 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: DOUG FRY COHO ELECTRIC INC 2423 REMINGTON CT PO BOX 40 WEST LINN, OR 97068 WILSONVILLE, OR 97070 Phone: 503 - 348 -2237 Phone: 503 - 582 -9774 Reg #: LIC 157169 ELE 3 -575C FEES SUP 3483S Description Date Amount Required Inspections [ELPRMT] ELC Permit 6/7/2004 $106.85 [ELPLCK] ELC Pln Rev 6/7/2004 $25.06 Ceiling Cover [TAX] 8% State Surcharge 6/7/2004 $8.55 Wall Cover Underground Cover Total $140.46 Elect'l Service Rough -in Elect! Final 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 -3 2 -2344 Issued By: 1 j _ � . if 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 n , „ n� r o P ✓ a lgAy , A6 ooh Electrical Permit Application ' . Date received: , 7 d Permit no.: f a --0032, ' c�rr- a v 3 1 r;. • • ®� _l in''' City of TigarRECEI al Project/appl.no.: Expire date: _ of Tigard Address: 13125 SW Hall Blvd, Tig OR 97223 City f g 2U�4 Date issued: By: Receipt no.: Phone: (503) 639 -4171 p� Fax (503) 598 -1960 �Ui� Case file no.: Payment type: Land use approval: CITY OF TIGARD BU'LDING Dl is ON r TYPE OF PERMIT ■ .I & 2 family dwelling or accessory Commercial/industrial 0 Multi- family 0 Tenant improvement e! New construction 0 Addition/alteration /replacement 0 Other: _ 0 Partial .,. JOB SITE INFORMA710N ... , Job address: \\ .5 10 j 4,, Lot: Bldg. no.: F Suite no.: Tax map /tax lot account no.: Block: Subdivision: Project name: i .. Description and location of work on premises: t, y , L , Estimated date of completion/inspection: _ e- , Lc,\ c.3 „ . CONTRACTOR APPLICATION . ; ; TTC SCHEDULE Job no: \ IF, 61,c— Fee Max Business name: • •ho E \ Q.. Description Qty. (ea) Total no. insp Address: • C `© tesitlential- single ormulti-family per llingunit. Includes attached garage. ® }� State:c4R ZIP: flp _ O dwe Se rviceincluded Phone: -'a- • I Fax: E -mail: loon sq. ft. or less 4 CCB no.: • \ -" 1 ' 1,,,,N 3'S��L' 'N ' Elec. bus. lic. no: Each additional 500 sq. ft, or portion thereof = = L energy, residential 2 /�/� � Limited energy, non - residential ___ 2 IWI/f_Il//' `� {� t..i --C Each manufactured home or modular dwelling IIIIII� ' gnature of supervisi ' elect an (required) Date Service and/or feeder 2 License no: 75/ —5 ServiceP orfeeders— installation, 11111 ■ 2 � alteration or relocation: � ' . � - ' PROPERTY OWNER 200 amps or less Name (print): le © 201 amps to 400 amps r-• a , , MEM 401 amps to 600 ampp =� 2 Mailing address: . EINESEMEMEIMMI 6 am s to 1000 amps State: Ott ZIP: 91 ( '-:=6t.) Over 1000 amps or volts 2 Phone: Fax: E -mail: Reconnect only �= 1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation: ORS 447, 455, 479, 670, 701. 200 amps or less IIIII. 2 • 201 amps to 400 amps ' __ 2 Owners signature: Date: 401 to 600 amps ___ 2 ENGINEER Branch circuits - new, alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit 2 City: State: ZIP: B. Fee for branch circuits without purchase Phone Fax: E -mail' of service or feeder fee, first branch circuit: ■■. 2 Each additional branch circuit: ___— PLAN `REVIEW (Please "check all that apply) Misc. (Service or feeder not included): ■■ 2 Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle O Service over 320 amps -rating of I &2 0 Hazardous location Each sign or outline lighting ___ 2 family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ■■■ 0 System over 600 volts nominal more residential units in one structure al terati on, or extension* 2 0 Building over three stories 0 Feeders, 400 amps or more *Description: 0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egressflightingplan 0 Other: Per inspection __ _� Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at %) $ , c• n c Credit card number: / / within 180 days after it has been State surcharge (8 %) $ ? t Expires accepted as complete. TOTAL $ i Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00/COM) • CITY OF TIGARD 24 -Hour BUILDING Inspections ne:,(503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested `- AM PM BUP Location Suite MEC Contact Person Ph ( ) PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC ?Def c0 32 Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam q r- A- r S im-VI (E Shear Anchors Ext Sheath/Shear , Int Sheath/Shear Framing Insulation �e Drywall Nailing r1' r f `� — 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 I Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL r jce -In UG /Slab Low Voltage Fire Alarm anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SS PART FAIL Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line ADA t� D ate Ins Inspector / Approa ch/Sidewalk P Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL