Permit : - + C �TY OF TIGARD
ELECTRICAL PERMIT
PERMIT #: ELC2004 -00354
2 4 6541i6/ LVELOPME'NT SERVICES DATE ISSUED: 6/15/2004
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103CB 05200
SITE ADDRESS: 12163 SW HOLLOW LN
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R -4.5
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: A/C CIRCUIT AND W.P. PLUG
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: SIGNAUPANEL:
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:
SHELLY, JOHN SOHLER ELECTRICAL CONSTRUCTION
12163 SW HOLLOW • 41131 SW BURGARSKY RD
TIGARD, OR 9797223 GASTON, OR 97119
Phone: 503 -913 -4461 Phone: 971- 832 -0807
Reg #: LIC 158285
ELE 34 -667C
FEES SUP 594S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/15/2004 $53.50
[TAX] 8% State Surcharge 6/15/2004 $4 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: 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
Juri 14 04 04: 00p Joe Soh ler 5 0 3 - 9 8 5 - 1 0 78 p . 2
.
.
' ' - - - . • ..
'ElectricAPerrilit-Applioathin . FOR OFFICRUSE ONLY ' '''.' ' . -
\ ' I .if..i.
Received
Cit of ligaM h ' '' Permit No.: Fi (9 354
Date/By:
13125 SW Hall Blvd' iTigard, OR 97223
Phone: 503.639.4171 Fax: 5031598.19604 20 0 Ar..,,,,,e0,i P Review
Other Permitrfikang-rt) a ----
Inspection Line: 503.639.4175 i-' ' - v ial,. v 4111 Date Re Rim 21 See Page 2 for
Internet: www.ci.tigard.or.us O F TIGARD Notified/Method: , Supplemental Information
4 5 ,14) : 41 ria..i ... n :: -.'- A N•: Y.. itW :. ' ..'':-' •.'::-! :::.." • ' •
0 New construction Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
0 Demolition Other:
... . OService over 320 amps - rating 0Buildng over 10,000 sq. ft.,
.
6i"-- ,...6i, .., :-.
, 0
. ...,.■:.,,,, ,:lt .......`..,„ . . „,„. .,
CO l , t , 4:;: .. :-:; 4 . - .: n . - 4:1011;:;:4.::: ,.• .C..A:.,Y.F . 3: - .::.,:.",..,z1f..4:... 17 ., - ..., i ,:: :',!::.'i',-.; :..:.....:.1 of I- and 2-family dwellings 4 or more new residential
1 - and 2-family dwelling 0 Commerciallindustrial 0 Accessory building DSystem over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
0 Multi-family D Master builder 0 Other:
DOccupant load over 99 persons EManufactured structures or
.'"'•Fi,t.N.'-.!1•'..'''',',""..:* [I RV. park
. :::i1:i.',: , 1* , •:'!i:,..., ...t ..• ...,:....:•-...;„.. ..“:...,,,,...:., • -.. i" .......•• ,...:..,,,.,..,, .. :-...::. ',.. , I...i :......:. Egress/lighting plan
_
Job no.: j. Job site address: va /6? 5 i-l I 1,,,,,,„., Lez.....,67 ['Health-care facility COther:
Submit 2 sets of plans with any of the above.
City/State/ZIP:
7 e„...( (-) tC- T 7 ._2 3 The above are not applicable to temporary construction service.
...1i;.1..Aiil;i0.‘,i,•44:10:4';:;;.;
Suite/bldg./apt. no.: Project name:
Description I Qty. I Fee. I Torsi I -*
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 I
Limited energy, residential 75.00 2
Tax map/parcel no.:
., Limited energy, non-residential 75.00 - 2
it3i1,1!Pi 4 *.S%.4 1 .:,* . P.i*:'.' s * . :1.0 " : ' ''ii, 1: :' :- . 1 ?. :. • 1 T.i. " !;: : ri;'..,,' Each manufactured or modular
• dwelling, service and/or feeder 90.90 , 2
.
- _ —._ Services or feeders installation, alteration, and/or relocation
_
..-.:...
, . ./4 (" C. ,C, R.. C.. ti I T AA/ o 6 pi 200 amps or less 80.30 2
, e, , q
...-....,-,,i - :-i,:! ' .,-, .--. -,'.-, -• ,-..- 1 , ' , .....t....i: , .. , ;,......:::., , i -. 7.;.: ,- ,;:1)ii1: - ,:,•. - ,,.,.. .....,-;.)....'. . !-.....,•• • - .
..4.,..:•: 201 amps to 400 amps 106.85 2
401 amps to 600 amps .i .A9,NPRTY'Ot?wv..-: t • : .::'. , :„--. .EB • .TA;0(ANT .... ,,,. ,.,1 !...,,
160.60 2
Name: 37 L ,j .
_ . 601 amps to 1,000 amps 240.60 2 . l
Address: ) • a / y 5 (-4-G I 1 , k .... L. ....., C-- Over 1,000 amps or volts 454.65 1 2
Reconnect only 66.85 2
T . 7 --.,2_? Temporary services or feeders installation, alteration, and/or
relocation
Phone: (s-, 9 - / 5-0 8 Fax: ( )
200 amps or less 1 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
Aft i "I::: 66,5I:k
ifit.ikti,St#4.;l,:l A. Fee for branch circuits with
'--•:'':' a: , r;1911141•114 4 ••'tr:It ,4,1■••0.a.V•••! !l::,'' ,'":! • j- .T.''..r ,!•....., - ,,,.... .,,,... • '..
rvice or feeder fee, each
Business name:
5 o L kW._ -0 hcfri.-...,,, I ( 7,,,s- i--..... branch circuit 6.65 2
, B. Fee for branch circuits
Contact name: .... .e.._ SO IA 11!_4 without service or feeder fee,
46.85 /./6 2
each branch circuit
Address: L 'h t ? / 5 Igo r?.-5 icy I< 4 Each add'l branch circuit I 6.65 6 ,6„5 2
City/State/ZIP: G. ... 4_ 1‘...) d re 9 '7 ct 7 Miscellaneous (service or feeder not included)
/ Pump or irrigation circle 53.40 I 2
Phone: (1 71 ) 8 3 g _ 0 8 0 -7 Fax: : ( 5,53 ) Is (0 7( 9
Sign or outline lighting 53.40 _ 2
E-mail:
Signal circuit(s) or limited- 1
: ,:,• 1 .-1,';', 1 .' , ,t.:71;:,:!:■ . ,• , ;•,:t . ::9::' , ...'Volsitiattiox . t..::! ; „ !;,;';;: :.•;•-:`, !1:..:- i energy panel, alteration, or
extension. Describe: Page 2 2
Business name: L. &,_,,c
e.._..c....--1--ri , r., / Cr, r S 7
Address: t--/ / I 3 1 S '--) 0,, r, a/ l , kd Each additional inspection over allowable in any of the above
/ Per inspection 62.50
City/State/ZIP: 6.- 5' 1 ,r•J e ) 7 (/ / '', Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: ( 4 7 7/) g 32 — 2, 0 7 Fax: (- ) '9 8 s —/ o 78 ,
;'':i
CCB Lic.: /5 5- Electrica' c.: 3 Li-667c . pr . Lic.: .."--?i/._ S
Subtotal 5- 3, 5-0
Suprv. Electrician signature, reg .. . /
rm
review (25% of permit fee)
Plan re
-
State surcharge (8% of permit fee) y, ,2 8
Print name: . OG (•-/ i . 1/ r / L
t - S 5 Date: i i
/ y
TOTAL PERMIT FEE 5 78
Authorized signature: 444 c f. 41 ...c„..,
This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: Date: C/t /,./ 0 V .. F i t y oun Industry Service Board
i: \Butlding \l'ennitslELC•PcrmitApp doc 12/03 4 0-46 1 5T(10/02/COMAVEI3
CITY OF TIGARD 24 -Hour
BUILDING ; Inspection (503) 639-4175
INSPECTIOff DIVISION Business Line: (503) 639 -4171
MST
BUP
Received Received Date Requested I7 — AM PM BUP
Location _ I2 / b3 Ht LLOGJ (A01 Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner .J 0Ptill 57R 103 ELC 2 coci ^ ob3✓
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation _ f P / f N4
Drywall Nailing
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
• - Alarm
�` %�" Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
440 PART FAIL
0 Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line 4 � % � /
ADA Approach/Sidewalk Date �" t Inspector ' "L Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL