Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00519
.��i DEVELOPMENT SERVICES DATE ISSUED: 8/17/2004
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S101AB 01200
• SITE ADDRESS: 07275 SW HERMOSO WAY
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Add A/C circuit and 120v cir.
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: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 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:
KEYWAY CORP BEAR ELECTRIC
14820 SE JOHNSON # 101 P.O. BOX 389
PORTLAND, OR 97267 DONALD, OR 97020
Phone: 503 - 654 -6223 Phone: 503 - 678 -1355
Reg #: LIC 20919
ELE 24 -107C
FEES SUP 3162 -S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/17/2004 $53.50
[TAX] 8% State Surcharge 8/17/2004 $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. 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: - 1/4 2 . 714e , Permit Signature: tg - \ p
OWNER INSTALLATION ONLY C
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
17. 11:25AM BEAR ELECTRIC, INC
r` 1. N0. 610 P 2 �I
ypr�I ,/� yy, cal ��.��.i{y, �1O!, Application ri + '.,, :7 g yt n e 41 },4 tilt L) , ii N '
' 1. ��' • li ���.��1= °ll , :..A• 1 ..t 4. t Y. ;t l� , :�r{'. ^"r r._ � .. �� /h�Yf
Received B _ / Electrical � ,, (�
Date : •v — 4 _ � uN Permit No. . O � 'r CIJ / 0 5 / 7
1 1' : pr oval Sign
City Tigard ECEI
Czt of Ti�a>rd ,w,. T Permit No
13125 SW Hall Blvd. Plan Review Other
Tigard Oregon 91223 -. permit No.:
' 1 • cview Land Use
?how: 503639 -4171 Fax: 50 /� „.:6
3 -598 -1960 A E, il
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Internet: www.ci.tlg Or.11S ss Date/B : Case No.;
a TI I, ; ` riJl;(! ® See Paae2 for
24 -hour Inspection Kequest: u est: 503- 639 -4175 BUILDING DI . F , 15 3 ethod: fj j� Su. • lemental Xnfor
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i.r���I;r.y. TWEE- ,v�1'r -� , � � " >, 1�.. �.la„� �'^�i�'„ �•`�„""GC�' i "� 4X'�'[��,�;�pp Y�;` ar<
• New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health-care facility
commercial ❑ 14azardous location
P • ddition/alteration/re • lacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
p'a ``'il ; ^t ''EZ. , t,C.1:'M' •, o BOO . tl:" (s ' '0 ' ,'; 6„,., : ;l ;l;:,.!��,�, +i 1 & 2 family dwellings four or more residential units in 1 2- 1~arn>l d�vellin• 12 Coznzx�erciaUIndustrial ❑ System over 600 volts nominal one structure
il ❑ pudding over three stories ❑ Fenders, 400 amps or more
,II Access° Builditi: • Multi-Fifni jy ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
• Master Builder • Other: ❑ Egress /lighting plan ❑ Other:
y , f +t ; 4 , w NI v Submit sets of plans with any oldie above.
r ' ' t ' O :T''; b` 'Q �`�' "' "� `� i �Y�' Te above are not a !cable to tern ora construction service -
site address: S- uJ v i_ a . lr Ns� ]BE13 L r , k' 0
Job si �.: �,� ��x.�. �a.. ��,
Suite #: Bldg. /Apt. #_ Number of inspections per permit allowed
Project Name: Description Qty F ee T otal
New residential - single or multi-family per
Cross street/Directions to job Site: dwelling unit Includes attached garage.
7,2J- O C. . Service included:
10e00 n u or less 145.15 4
Each additional 500 sq. ft, or portion thereof 33:40 , . 1
Limited eneeev, residential - 75 -00 2
Subdivision: Lot #: !united energy, non residential 75.00 • 2
Tax ma. /. arcel #: Each manufactured home or modular dwelling
+�, , .�,,;° i :.:1Z e ;y;,. i it,1 ok
a, (�;�'l� O 7 R,:;,44) & ,.. :,, ',.;;r 2 service and/or feeder _ 90.90 2
�� Services or feeders - installation,
4 1 0 o ' • JCN . �•'" +f , O V . 1. - • • alteration or relocation: • •
200 amps or less 80.30 2
201 aro.s to 400 sm.s 106:85 2
401 amps. to 600 amps 160.60 2
ED ' , '® ' - i' 4' (,:or' =RMI tin MT t t ;•,1 e ,,, m 601 atn.s to 1000 am .s . 240.60 2
Over 1000 am •s or volts 454.65 2
Name: )( \ ANSZ CO-\p Reconnect only 66.85 _ 2
Address: / i _, r 4 -) 0 \ Temporary services or fenders - installation,
alteration, or relocation:
City /State /Zip: -\ ! -- 1,<._.6 7 200 am•s or less 66:85 1
2.01 amps to 400 am ps . 100.30 2
Phone: , �' 401 m 600 amps 133.75 2
i[;21 ,.: Mme: i:. , ';',1 i!h {' PI 1 i...6... • '` r+ y. 11. . i Branch circuits - new, alteration, or
Name: extensio per panel: •
• - - A. Fee for branch circuits with purchase of
Address: . service or feeder fee, each branch circuit / 6.65 (,. 2
City /State /Zip : B. Fee for branch circuits without purchase of
service or feeder fee st branch oiretiit I _ 46.85 i t g-5 2
Phone: Fax: Eaoh additional branch circuit 6.65 • 2
: h2' ($ervice.orr let nat.ina !tied: d ) __ ' . •
•
.i , + ... rl.'' 1s ,, F�1 •' tcih,`1rnwru i,; z ? I^s tY Each • uttt• or imaati c 53.40 2
Eac sign or gulling lighting 53.40 '2
Job No: er.f'r-N- Signal oircuit(s) or a limited energy panel,
� alteration, or extension Page 2 2
Business Name: j'e . r- ,.e mac. cl.li -L• Description:
Address: _ P6 e4) . 3g .
.City/State-/Zip: Each additional inspection over the allowable in any of the above:
y ip: IQQU c O. coo 1 O Per inspection pet hour (min. 1 hour) 62.50
Phone: - .7; —/ Pax: 4 -• ,74'.- / /act' Investigation fee:
CCB Lic.
9[ Lic #: Other:
• : . �'� - / o7�C _ ,;P ,Teti, ' `, . ` , � . , 6 e m' rR .•, E
_ � ' � i ', 'rte a � ` er �.rst�.� s.l
Supervising electrician / subtotal ..I S . S3.5-6 Si_ attire re. u: ed: �- Plan Review (25% of Permit Fee) g _ ' $
Print Name: ! llWrA State Surcharge (S °A of permit Pee) $ It 23
TOTAL PERMIT PEE S ,5 7 'R
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Dare: 180 days after it has been accepted as complete.
*Pee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsrs \P ermit Forms \ Bic PermitApp.doc 01/03 -
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business.Line: (503) 639 -4171 MST
BUP
Received Date Requested PM BUP
Location 7 7 J Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) �j 7 �- / . SWR
BUILDING Tenant/Owner ELC a 6D 4 / - "e Sl
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
•
Post & Beam •
Shear Anchors
Ext Sheath/Shear t
Int Sheath/Shear /^
Framing (_�
Insulation
Drywall Nailing KL 1/
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 / 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
Fire Alarm
PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
gh4 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line / ADA
Date g 2,5 d C / l I ""� ` t y
Approach /Sidewalk D Inspector Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL