Permit CITY OF TIGARD ELECTRICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: ELC2004 00433
DATE ISSUED: 7/16/2004
1 ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135BC-00201
SITE ADDRESS: 10763 SW GREENBURG RD, II U
SUBDIVISION: ZONING. C -
BLOCK: LOT : JURISDICTION: TIG
Project Description: Branch circuits - 10.
Job # 663.
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: 9 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:
BELANICH, ROGER M WILLAMETTE ELECTRIC INC
BY SOUTH LAND CORP PO BOX 230547
PO BOX 711 TIGARD, OR 97281
DALLAS, TX 75221
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/16/2004 $106.70
[TAX] 8% State Surcharge 7/16/2004 $8.54
Total $115.24
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', Permit Signature: d j
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
14 2004 8:00AM HP LASERJET 3200 p.2
- ica1 Permit Application FOR OFFICE USE ONLY
City of Tigard R E C E O V ` R e c e iv e d Pernit No.: ( 2 / /t'!
Date : 1.3125 SW Hat Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 JUL , p ,, Ipjx ^' "' DateB : Other Permit:
Inspection Line: 503.639.4175 U 1 4 A I Date ReadyBy: Bl See Pale 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
1 , Ki� ,i �:J ^: �* - ice N of y -V, ai'h)1; 114 ylilti ^:� -'4' (i is
��#� a�i � q 't�l e; „ >'� �4 �i ,.�. �1, '�. {at � d +,' O'',.,..44,,,,..4. I' i „�1, �`;i, �, =
E s tg t t�yi ! ,A 3 t + t! ia< < „� t, t r ; .r,- figt;. lTdr co a. ti . s - tF.1 M :` .. «-,. :,, - - . , •
k , s � i�:, �� �i2�i <� t � �,t�` 'al : ��re�f;!{;;�s'ri�± �.i , ,s i`uo-ti .a, , ,, ,,.�� t,_ �, �',:,� ;.. ».,,. ;
El New construction g Additi�-. ••r - +a• fti l
g sit= itV Please check all that apply:
on /'alterarion/ieplaeemen'�
❑ Demolition ❑Other. ❑Service over 225 amps, comm'l ❑Hazardous location
r ,� u ['Service over 320 amps - rating DBuildng over 10,000 sq. ft.,
T l { t T g0 4tt s Sty 7 1 1 {,j,,l , b
� W R i j I A II : PCT e t ; 'd r it _ "` , +....„ t t . a A V a of 1- and 2-family dwellin s 4 or more new residential
fi Gldss $i . „ • . ' . Y g
❑ 1- and 2- family dwelling j4 Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family El Master builder ❑Other:
- s a u 7 5 1 €_ l 1 ❑ Occupant load over 99 persons ['Manufactured structures or
( '' m8 � s y� € ,Y 1 �TJS., Gig 8� £ ,b �'; ro - - t , r ,
1Iry �' illgry,, (+s t t3 r� atS∎9 i l f' ` =` k 1v ' 1 n I � ` I�l ' , ❑Egress /lightingplan RV park
�� r , W Cs t IRIIII Lai t Who �q. ,tat
Job no.: b4 3 Job site address: j 41l, 3 5w a ❑Health -care facility ❑Other
tF%� ( Kit Si g Submit 2 sets of plans with any of the above.
City /State /ZIP: a Q c9 9 ' -' l The above are not applicable to temporary construction service.
Suite/bldgJapt. no.: `t `'' Project name: /' 4 1L,;,�... ` ; : r.
B Cowl Description Qty, Fee. 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
Limited energy, residential 75.00 2
Tax map/parcel no _ t BB ry ; ppm a Limited energy, non - residential 75.00 2
i 1l16 �. ivo ? a 1 4tf ii1 1'�F ' � r , r�fP � ; �. tt l oa f }:Ci ,.,! a1 6 1 't� 6 N
, j. . ,:: u . 5. � ; iaursaunax lib .,1 asig. 4 I I 1 .11 . ,r:,d - .t
dwelling, service and/or feeder 90.90 2
Each manufactured or modular
�}�
1:211n,ct.... t I w+ e 42/1.A.../..."4"
j.tl+t Services or feeders installation, alteration, and/or relocation
r
200 amps or less 80.30 2 { . • , t
dig' 1�li'1 cx�iagtt ��!# ;s i • 1 f _ s rli, S ib � r..,' ". trt 201 a s to 400 a s 106.85 2
t i 3 , »G1 w r fi mP mP
s ` Y' a ' 420°11
0t amps to 600 amps 160,60 2
Name: C f.,0 L. •-- -AJ (. 6 601 amps to 1,000 amps 240.60 2
Address: </A Over 1,000 amps or volts 454.65 2
Reconnect only • 66.85 2
City /State/ZIP: r)5 ^h CI y. T 9- 2Z 3 f- S 3 Temporary services or feeders installation, alteration, and/or
p ) ?O - S j Z ll Fax: ( 3) 1<q 2 00 a
Phone: (
3 ( f � � � Y - 9 q Z 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
,e 1 , , rly,i rA^ a .� t aj , l a l � wariu air -ys'a re s� 1 a
" � { AA. 1 MIETh it : . l AA : 5L i ` t 3} 2 1 i a4..A AntrAN. 4) i .1: rt e n km l £ I, A. Fee for branch circuits with
t»� a`�x sry lennnmdnd • �� ! n 4 m s .. : , . ,. -sx- +„ ratTa ,1 ti..
service or feeder fee, each 6.65 2
Business name: e„ L. N 6 r) branch circuit
B. Fee for branch circuits
Contact name: with f f ��
S t. - a t 0.,k l 4 r1 rl C 1- without service or f 46.85 74 2
each branch circuit
Address: Each add '1 branch circuit `9 6.65 S � � ' 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) l Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
B -mail: Signal circuit(s) or limited -
l !' . t l' ifi : " r ' f lltl r t l g' r r m� r t, ply llE a s , - fll
tdl� ifE energy panel, alteration, or
]� rt 1 .a extension. Describe: Page 2 2
Business name: + (( 4 ,,t r-7-- c
/i Each additional inspection over allowable in any of the above
Address:
P 0 r o *. 2.? C `1 -.- Per inspection 62.50
City /State /ZIP: rl / g,,n O i (.3 2 I Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: (.Sti3) 42 4 - 3` s , Fax: (.10-3 ) `L( - Si VS--
1 l lit t jt e s tl�u c acv u,=:, �, x ...t...,. .' : *t::•'S . . iii
1 ' "s'Ite. +•saS.. �t; h,.h
,�t„�a, �.
CCB Lie.: S`, Electrical Lie.: 3i1.- 24'3 L Suprv. Lie.: fife 5 - S
Plan review 25% of ermit fee Subtotal i4 (, , 7
Suprv. Electrician signature, required: - ( P )
Print name: Date: State surcharge (8% of pes,uit fee) iat 5-c(
Y - G �� TOTAL PERMIT FEE 2y
Authorized signature: This permit application expires If a permit is not obtained within 180
days after lt has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per penult allowed.
is lBuiidinglPennits lELC- PcrminAppdoc 12/03 440 -461 ITt1a'O2cOM /WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection; Line; (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
�} BUP
Received Date Requested 0 — Z AM PM.. BUP
Location l 0 7 CP J ! - ' 1 • - It I (1 MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) foal 4 - 3(03/ SWR
BUILDING Tenant/Owner (.0 -1 () GC ELC U /-i3
Footing
Foundation ELC
Access:
Ftg Drain L 1 j / s x j"
V J / , 6 /' ELR
Crawl Drain �
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
*L k
Int Sheath/Shear
Framing
Insulation /� (5 ,� A
F .7 �
Drywall Nailing `° v ( f
Fire wall
Sprinkler
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
ELECTRIC AL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA j r Approach/Sidewalk Date Inspector M / - p i e y Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL