Permit ,,CITY OF TIGARD ELECTRICAL PERMIT
t PERMIT #: ELC2004 - 00128
f DEVELOPMENT II Tigard, 9 (503) 639 - 4171 DATE ISSUED: 3/18/04 Hall "� PARCEL: 2S104DC - 06800
SITE ADDRESS: 13870 SW FERNRIDGE TERR
SUBDIVISION: MORNINGSTAR ZONING: R
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Install (2) branch circuits.
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: 1 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:
SHOUKE REZVANI SPARK ELECTRICAL CONSTRUCTION
13870 SW FERNRIDGE TER 4508 NE 123RD
TIGARD, OR 97223 VANCOUVER, WA 98682
Phone: 503 - 449 -5972 Phone: 701 -7822
Reg #: LIC 143886
SUP 4394S
FEES ELE 26 -997C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/18/04 $53.50
[TAX] 8% State Surcharge 3/18/04 $4.28 Rough -in
Elect'I Final
Total $57.78
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. T . -e 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 0,1.1■•' at (5 46 -6699 or
1- 800 - 332 - 2344.
Issued By: Permit Signature: fitio'
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or re t.
OWNER'S SIGNATURE: DATE:
CONTRAfy OR I � : I ALLATION ONLY
SIGNATURE OF SUPR. ELEC'N:.J —- ��•:��L DATE:
LICENSE NO:
Call 639 -4175 by 7.00pm for an inspection the next business day
Electrical :Permi ED . .. ,
.,. .. ., :: . .FoRoFFIcEusE y.
, .,0N,,.:
. ...
City of Tigard Received
Date/By v sz fr'' " Permit No Z /21
13125 SW Hall Blvd , Tigard, OR 91390 i 8 2004 , an Review
Phone • 503.639 4171 Fax. 503.59871560 'ill A l A Date/B Other Permit
i _411,.. el Date Ready/By
Inspection Line: 503 639 4175 F TIGARD
I n „, ions El See Page 2 for
Internet www ci tigard or us Ul I . — Notified/Method Supplemental Information
ion DING DIVISION
0., ,.. t - l -'`',,,," 4 ,- ( ,•,'1 , r '4:4 , if- , i'-reZ.T.kiVit\i", -
423 - :tt-Wg,!...11 - 0.a.i.7-44,-4 , .Y., , ' , A":4.0,11a..,..,,i.i , v,t, ,, Ii0 , •.s'*.iM,7:."1./ , - -, -,:.,., ,,0 0- ': i -- ..,:.',.'-:: .- • .
III New construction Addition/alteration/replacement Please check all that apply
OService over 225 amps, comm'l pliazardous location
0 Demolition 0 Other:
S ervice over 320 amps - rating OBuildng over 10,000 sq ft ,
';;A:14,34V,ItV,4,4•Vail 0 itgia.Aiiie-AekEi.;,', of 1- and 2-family dwellings 4 or more new residential
ElSystern over 600 volts nominal units in one structure
1 and 2 dwelling 0 Commercial/industnal El Accessory building
EBuilding over three stones EFeeders, 400 amps or more
El Multi 0 Master builder 0 Other:
['Occupant load over 99 persons ['Manufactured structures or
..,,,,,,,,,,,, ,,,
wlaiii§ iwr obim -- • , - - . -, ---,
4:- 1 7 - , - f, J? ,,,,, v,,, K .,,-.. : „., n ['Egress/lighting plan RV park
1=1Health-care facility ['Other
Job no. Job site address: / 2 e 7 0 Siie / 1 " / ' 44' i 7. t : fr . Submit 2 sets of plans with any of the above,
City/State/ZIP r 4 e-,-, fi{2 9 7 2 z5 The above are not applicable to temporary construction service
V!AIV
Suite/bldg/apt no. Project name. .1..tife --w*iu.s.e, —.„=••'
DescriptIon Qty Fee. Total **
Cross street/directions to job site: rliax.-, .1,47,--- 64= ..,--; ,,, 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.:
Limited energy, non-residential 75 00 2
4 0 MC=3 ist
,,,,.',0,,k n ualf, - ..- ,r ,':A-s'ei- Each manufactured or modular
7 1.,,t, 2 $.' 0 v .f, ai G / 9( dwelling, service and/or feeder 90 90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
:* ':''-, 201 amps to 400 amps 106 85 2
' , ','1',S, ',', W•A " : , 401 amps to 600 amps 160 60 2
Name: -- d u-4,2_ / a 7 Von / 601 amps to 1,000 amps 240 60 2
Address: /3 eV 4 Su-1 fr .- Over 1,000 amps or volts 454 65 2
Reconnect only 66 85 2
City/State/ZIP: 7 --, ,, ,...- ,Z. rix. 9 .7,,,,T,z 3 Temporary services or feeders installation, alteration, and/or
relocation
Phone. (S:03) 1.-"tel---2 S 9 7,7._ 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 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
M,V, , if 4 ,41,fyiagf;, - .1, : i,S,1r), , ,V11 , "; , k Itarq ;:a.us,:itatizi.itit64-,, : .tvisto A Fee for branch circuits with
:7 'iY44. • a ,--t. li4 l'- '".":,,t't,l".0..arV,..11',,
2
Business name:
6 65 branch circuit
. •
B Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit / 46 85 qh 2
Address:
Each add'l branch circuit / 6 65 / ,45 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or imgation circle 53 40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53 40 2
E-mail: Signal circuit(s) or limited-
rd ,,,:e zpiErmax#40-okrit4-x,., energy panel, alteration, or
extension Describe Page 2 2
Business name: .. ,--1 4 (.7 (
Address • dr e 4/4 /2 .5'4-, cte...
t
Each additional inspection over allowable in any of the above
Per inspection 62 50
City/State/ZIP: Z,./,„„ frt.. Ai - 5 1 ,6,2_ Investigation per hour (1 hr min) 62 50
i
Phone ( 5'4.3 ) 70/ — 7,0. 2_ Fax. ( 21--) cep/ - v 6,2 Industrial plant per hour 73.75
itN
CCB Lic.. / Y3 (re 6 Electrical Lic.: 26' 741'( Supry Lic : y2 , 4 i e`
Subtotal . 5, 5 ,50
/06 /fr _
Supry Electrician signature, required / , .4 <4,1■.4i Plan review (25% of permit fee)
State surcharge (8% of permit fee) Yf ..z?
Print name: (.4",...„._ : - 4 , ,,i - e_. /z< Date: ...:73/e/,,,,3
TOTAL PERMIT FEE 5-7,7e
Authorized signature: -- 4,',..i.g.cd This permit application expires if a permit is not obtained within 180
..iNtw -' irab.— days after it has been accepted as complete
Print name. /46,14;; fr Zi,,- -4:1 Date /P //d' * Fee methodology set by Tn-County Building Industry Service Board
** Number of inspections per permit allowed
1 \ BuildIng\Pel mns \ ELC-PernutApp doe 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
pia Izt ort tiii . 3 o r s r. - ;
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
Vacuum Systems*
❑ Other:
Pa°•lla a' -gin
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
I 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
\Bmldmg\Pemuts\ELC- PeimitApp doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Receive A3 / . ¥7 bate Requested 3, 2 5 AM PM BUP
Location /307 n � ) -c-r Suite MEC
Contact Person Ph ( ) 1W- 7 "2 2- PLM
Contractor Ph ( ) SWR c/
BUILDING Tenant/Owner j — 06/ Z
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
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
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
m
:tea PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA L� `f
Approach /Sidewalk Date l Inspector fJ6� w Ext
Other:
Final DO OT REMOVE this inspection record from the job site.
PASS PART FAIL