Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00644
�6 DEVELOPMENT SERVICES DATE ISSUED: 10/6/2004
'�" , „� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103BB -10300
SITE ADDRESS: 12140 SW KATHERINE ST
SUBDIVISION: YE OLDE WINDMILL ZONING: R -4.5
BLOCK: LOT : 023 JURISDICTION: TIG
Project Description: Installation of (6) branch circuits for kitchen remodel.
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: 5 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:
KEITH WOLF BOONES FERRY ELECTRIC INC
12140 SW KATHERINE ST PO BOX 628
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: C�ogj 579 — /977 Phone: 503 - 682 -4936
Reg #: SUP 4918S
LIC 88482
FEES ELE 3 -223C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/6/2004 $80.10
[TAX] 8% State Surcharge 10/6/2004 $6.41 Rough -
Elect'l Final
Total $86.51
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules am set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1-800- 332 -2344. /
Issued By: el/t/ Signature: �A / e , 9 - 77on/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
E1Oc' �, 2004 9:OOA1�1 ca .B 00NES FERRY ELECTRIC No, 1916 P. 1/2
—•�-�— FOR OFFICE i, . 1 r
City o Tigard GEN ® Received
1 "13125 SW Hall Blvd, Tigard, OR 97±22 Plat jd /� y Permit No- ELC zoo y —OD 479X
Phone; 503.639,4171 Fax: 503.598.1960 2%4 /� , rut i , , �a Plaa Review
•, oU N,�; '+ Date/By; Other Permit:
Inspection Line: 503,639.4175 3C I :' j
rtttemet wwW c1 ttgard or us .. Data Rea By' Tura: RI See page 2 for
j 1 Noti73ed/Method: 77
iCv`�: {, � �.,,' A , r �G I G� - • Supplemental Information
, � �S�N �:� 1 k ♦ . , � J'!� � " {f 1'^. J� �7�81. ; `*�.^�' , � ^-{ 1 4 R i4T 1 .k -�
8 2..�, : 7: T Z, :rf' ,1t . aa : ; i ' ., �hi rf'7� 1; 3,..� ti�'yln Y r,I rN�� , : � 1r, Kc � r�, e ��;�ixC. '� + i:• ` '.�lC' R1 c.r� r l , . 'e�y +y {
,17:..._ Yx _:�.z: :,; ,..1,.,u _ ..W 1^r ,`k ';Id ; 'wY' .t ,i,. c " w'L � .� , :'. :! ,,,,?.i� ! fie,` `' r: ,$es -... & ., 1 , t om "`' { � ... . ,. r 6` , . :.. . . .
❑ New construction l ditiori /alteratiotz/replace711ent Please check all thatapply: -
❑ Demolition ❑ Other ['Service over 225 amps, comm'1
73345 z -+ , n,: s ,� r P ['Hazardous location
� .U6v, �'� ; .�i y � F �jy1 G r j ��' 'li' i 4 l'��) �j °(� (� d � � 1 /'�'s� 3�f� r 3.s E .--, t 4�, ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. t ,
'` � ' x:7 ; ; ��' 7 `h TI#. y Q „Egf �s yEr ; ,�'r;h � o6_y� of 1 • and 2-family dwellings 4 or more new residential
1 and 2- family dwelling El Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
builder ❑ Other: ❑ Master
�';
Multi-family b ❑Building over three stories ❑Feeders, 400 amps or more
� 'll �`l i it ' f � ( „fiy�P,j ryF ro j 1 i■ib T X��ts ' j ,�` "� q4 1 f Fr 'a IT.�if9' x ['Occupant load over 99 persons ❑Manufactured structures or
l.o-a_> ul .. a..1:•ry. ,;.,:,� aili 9, 1� / S hp Itr y .vli” .�” '. ` . R,. ti+ � y, '� €�,..;L., ..'
},�,�,,,..� /�, ❑Egress/lightingplan RV. park
Job no.: Job site address: /2 cL S w /Cod he f, e ❑ Health -care facility [Other:
Submit 2 sets of plans with any of the above.
City /State/ZIP: 7 , er, d 6 z
`7 7 2 ? The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: I Project name: 't '3 §..,.ua;.k I�'�r y� �NV y t.�r ti �. 11 ,� sk Y [ x t a` _ Iy' rV_ y
Descrlpeon ' Qty. Bee. 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: I Lot rho.: Ea. add'1500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
:`L : ` k; �y' 7 i.' 3 ^`' i x �""'`' m� 1' yr':. i :��` ^,<�di.r:yz�ercr ,� ^�,'::" ;.'a:; iYi; : .n
Limited ,
"�"aiWa "u •� " a t1 set r Y tut 'c `. ,:h^, 1. ` 76 Each d nu fact non-residential 75.00 1 2
a.J z. , _e. �,;�,,.,r..•.� � +.sa�?er.�� � �u, �,.���"a ,use{ r y. f5 °i�a� II'�E, s i. 3 .t:�, +f'i�ri�.f�" �.u:1i h martufaetuted or modular I
. i 4t h ge /no 4e 1 dwelling, service and /or feeder 90 "90 2
Services or feeders installation, alteration, and/or relocatio
• 200 amps or less 80,30 2
�� cc
il l d�.S 011-6F",S tl 7 f T Z f ,c � Y ,M?i ✓� T'�i F i Ai 7 'y 1 ,. ,,6
, ;52, ,t, .E,� �. dy �c� � � � :s� ° . �l • F ���..� : _ f � ��"- � {e ��� `� , .f, >f�' � �r � y3�^��� 201 a s to 400 atnPs 106.85 2
x " A '' ' " 401 am s to 600
Name: r in r. 1"/ a j � AE 77f 601 amps amps 160.60 2
mps to 1,000 amps 240.60 2
\ddress: S A A 776,972.6 / QA '
t3 Over 1,000 amps or volts 454.65 2
City /State/ZIP: ���c� econnect only 66.85 2
r 7t S 4) EX/A/E' Sr- Temporary services or feeders installation, alteration, and /or
Phone: (5 S7 ?— ` F7, Fax: ( .) relocation
Owner installation: This installation is being made on property that I own which is not _ 200 amps or less 66.85 1
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 6'70, and 701. _ 201 amps to 400 amps 100.30 2
401 amps to 600 amps rg 133.75 2
Owner signature: Date Branch circuits - new, alteration, or extension
1 s � n „c" {n .� �T x„.,.,�, �T� �Jl ,�, Y tY , r t� per panel
'' a�} <} 11. ', i �_2�,. `~f a� /�rdS1, _; t �;i".a�. "i16 ' 3 �b u i� �'���t � l t�f{�G V t ' ''C I i' y 0 ' °r A. Fee for branch circuits with
Business name sentice or feeder fee, each
branch circuit 6.65 2
Contact name: - B. Fee for branch circuits
without service or feeder fee,
Address: each branch circuit I 46.85 rt6. z S 2
Each add'l branch circuit S 6.65 3, ZS 2
City/State/ZIP; . Miscellaneous (service or feeder not incl'tded)
Phone: ( ) I Pax :: ( ) Pump or irrigation circle 53.40 2
E -ate; Sign or outline lighting 53.40 2
:.2'�;r.}{apR',. �Y ^'' Yom' g e t "�Ttn a T" -x Signal circuit(s)
r y S°l, , j�l. ti`�rv�' ra�, N (x, 2 7t p ,;n 3 t 7 t 6 1'b;Q a ,4 i 1 r 'gC �i" F 3T'f +4 rF '� a .,.. e r limited-
ti ntte r
k ._� N2 '�?::- .ka'�6„�,..,:n_iJl3 >, �0 ,L ':F Q�� { �,�5," . G, energypanel, alteration or
Business name: Boone s Ferry Electric extension. Describe: Paget 2
Address: P.O. $OX 628 — Each additional ins +action over allowable In any of the above
• eity/Statc /zzP WilsonVilie OR 97070 Per inspection 62.50
Investigation per hour (1 hr min) 62.50
Phone: (603) 682 -4936 I Fes' (503) 682- 7946 Industrial plant per hour 7375
,1 rte�,,, dd``
88482 a � ig Suprv. Lie.: 'r rtF`a"x7;:. � r'i 64 1 a1 r` ?1 s IESa' $il�'�. 7 + ".
I Electrical Lic.: 2 41 i 0 " bt � a _� � .,� i,
CC�L1C.:
S Subtotal sq. I 0
. Suprv. EIectrician signature, required: , l /p�i /p 7
r
Plan review (25% of permit fee) .--.-,
- •' 'Print rime: --1.'"1 H t t o n I Date: / O - S — O 4 State surcharge (g% of permit fee) 6. 1 1 9(
Authorized signature, TOTAL PERMIT FEE 96 , S
This permit application expires if a permit is not obutRed within ISO
Print [lame: days after i;t has beep accepted as complete
Date: • Pee methodology set byTri-County Building Industry Service Board
iABuildinglPermita..LGPern,itApp.doc 12/03 - '* Number of inspections per permit allowed,
440-4615T(10 /02/COM/ WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection bile: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
II BUP
Received ` 1 a- D to Reque t �yS AM PM BUP
Location LA( +0 (•J J Suite <Tr o ld() 5e_ 0 GGr 701
Contact Person Ph (7J) 9 � �. � rp_ 6 V - d U 9. 7"
Contractor ��ZIJ. , (3 ) e?- 0 SWR
BUILDING Tenant/Owner 3 T c `? 0 .0 9
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing 3 ( 1 �,l
Firewall K) 1 VII \ �° 3 1 13�,1I a on-) S U IN) prm\ fil
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS ART FAIL
Post & Beam
Under Slab
Rough -In
C--'
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole P/1(
Storm Drain
Shower Pan
Other:
FART FAIL
I1'C'AL :._
- os & Beam
Rough -In
Gas Line
S .' • e Dampers
ina►
41 "t1P PART FAIL
CTR AL
Se v -
Rough-In
UG /Slab
Low Voltage
- larm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• S - PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line .
ADA / J
Approach/Sidewalk
Date ) 7 V Inspector I t1� L� Ext
Other:
Final DO NOT REMOVE this inspection record from th :- ob site.
PASS PART FAIL