Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00592
i I DEVELOPMENT SERVICES DATE ISSUED: 9/17/2004
�! 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S 111 AB -01500
SITE ADDRESS: 09170 SW ELROSE CT
SUBDIVISION: ELROSE TERRACE ZONING: R-4.5
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Installation of A/C unit.
Job # 263.
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:
CRAVEN, RICHARD EARL + SOHLER ELECTRICAL CONSTRUCTION
MARY NAN 41131 SW BURGARSKY RD
18867 S FOREST GROVE LOOP GASTON, OR 97119
OREGON CITY, OR 97045
Phone: Phone: 971- 832 -0807
Reg #: LIC 158285
ELE 34 -667C
FEES SUP 594S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/17/2004 $53.50
[TAX] 8% State Surcharge 9/17/2004 $428 Rough -
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. 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- 332 -2344.
Issued By: j a Permit Signature: ,_e V D
OWNER INSTALLATION ONLY v
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
• 1.f &G‘LL -ita 1 01 11111. H.13 pricil1A ® FOR OFFICE USE ONLY
City of Tigard �� D -/ -o e Pernit No. :� LC J 09 - 0o1 qL
13125 SW Hall Blvd -, Tigard OR 97 t Plan v ie y
Phone: 503.639.4171 Fax: 503 ":. '.1, is '" • +. Ii Other' Permit
Inspection Line 503.639.4175 • \ � '.0 r, j. ',•� j.. Date R ady/By: J i ®SupplSee ement Pace : For
Internet www.si.tigard.or.us Notifiied/Meihod:
ed:
O New construction VI Addi /. :� -. ron/replacement Please check all that apply:
❑ Demolition Qih ``�� OSe rviee over 225 amps, commn'I ['Hazardous location
z 2,r , _ . •. _ , ..., OService over 320 amps - rating ❑ Buildng over 10,000 sq. fl
...... :,.
.`: 1- - ..
.:Cep' -A 14 :. TJeT . -. _.. • ...._ .- .. .... of 1- and 2- family dwellings 4 or more new residential
'I! I - and 2- family dwelling ❑ Commercial/indust vial ❑ Accessory building DSystem over 600 volts nominal units in one structure
El Multi- family ❑Master builder Other OEuitding over three stories OFe edeas, 400 amps or mor
QOecupant load over 99 persons OManufactured structures o
:« , � ,TO B .SlFI . ON r ' I;N CA. '1(U , ' E1peSdligh Plan RV park
Job no.: I Job site address: (]Health -care facility Ocr
Oth
Submit l. sets of plans with any of the above.
City /State/ZIP: e1 ) 2 0 5' t, The ab ove are not applicable to temporary construction service.
lo st cr. s
•.
Suite/bldgJapt no.: ( Project name: 4./C - ; :e' >.a rtt"l►;` ': Wj! -SE E Uk. :' :'_ ' -
;pdon Qty ( I : real
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: I Lot no.: Ea. add" 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
_ Limited energy, non - residential 75.00 2
''''''''''' ; ,. + •, CRIPTI @}9 :(]R 9 !O � - r. k - • F`' c : < Each manufactured or modular
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 arrgrs 106.85 2
R..r? / 7 .a / w�E '.: t ' ;;::. .... - �.- . :: -.. =: _...:" ,C •- !I AIVT:.. .. • 401 amps to 600 amps 160.60 2 •
Name: / C G, n - G1 C r c V 2.i 601 amps to 1,000 amps 240.60 2
Address / s i.-./ t: / r Se- C.f, Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: 77 , ,,d L + ? Temporary services or feeders installation, alteration, and/or
Phone: ( ) el 7 0 -_ e t , S a I Fax: ( ) relocation p
200 00 amps or less 66.85 1
Owner ins It llat on: 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.
40I amps to 600 arms 133.75 2
Owner signature: Date: , cu - cults - new, alteration, or extension, per panel
s . {„ A. Fee for branch cireui s with
l ei(
II /� r� T ��;4. '' service or feeder fee. each
Business name: 5 t� re F 1 e_e.� - r e 0 ( L S ' :. branch circuit 6.65 2
Contact name: / - B. Fee for branch circuits
Cr, without service: or feeder fee,
To ( t �e each branch circuit
Address: l 46.85 ' o, 2
! 3 ( S � ' 6., rC y ,rt k C! c Each add'l branch circuit I 6.65 6,S 2
City/State/ZIP: C Stn tn.! ( J g ! 9 7 / f / Miscellaneous (service or feeder not included) -
Pump or irrigation circle 53.40 2
Phone F� ( 97J) 0.),. - 080 I Fax: : (5 9 8 . s --_1 0 7 1 5)
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
..", - 1 _::":;: ,: •..; 01,g• ACTOR. ` ':,'::-1 :',..: :Y1...: , energy Panel. alteration. or •
C, r✓ S 1-,
extension. Describe: Page 2 2
Business name
Se 4lei? E� l e c -r1 c.t3.' C
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) l Fax: (tiG 7 ) ' 7 8 s - - i a 7 8 Industrial plant per hour 7335
, :.>;EES* . .
CCB Lic.: l 62 S j• Electrical L' .: ? q - 6G 7 d Su ic. % 1
Subtotal 3
•
Suprv. Electrician signature, requir A., . ,. . - `` . `� Plan review (25% of permit fee)
• - r Date: State surcharge (8% of permit fee) L1 D X
Print name
r9 i'V n 11 YI -S C q 11 G,l c y TOTAL PERMTT FEE S7 7
Authorized signature: / I _ / / L � a ` This permit application expires if a permit it not obtained within ISO
Y r- M 1:_4(,,,,q days after it has been accepted as complete
• Print name • - 1:1-4 / k ik/it. Date: dology set by Tri- Co+mty Building Industry Service Board
• Fee metho •. Number of inspection per permit allayed
clBu7dm ¢Peinmitati3t.GPemutApp.doc 12/03
�S - „ ,,rt,L.n�C
a' d BLOT- SSE-EDS JeTHQS apt' e6E :90 170 LT doS
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: . (503) 639 -4175
INSPECTION DIVISION Business Line: ( 3) 639 -4171 MST
O BU'
Received Date Requested 9 '— AM` 'PM UP
Location c g/76
EJ Suite e '
Contact Person Ph ( )
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access:
Ftg Drain `� t ( (y) /� ELR
Crawl Drain C _
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing 1 C s s
Insulation ® FL)?-/°-1.
v -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling AA±Nt Roof �� AlM F p
Other:
Final r P - - - 5
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 111—F -
PASS PART FAIL
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
ri
4 PART FAIL
ECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
rin- ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S - Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA Date 2� Inspector Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection re d from the job site.
PASS PART FAIL
i —