Permit ELECTRICAL PERMIT -
CITY TIGARD RESTRICTED ENERGY
DEVELOPMENT H B Tigard, SERVICES 1 639 -4171 DATE ISSUED: 02 00026
13125 ED: 3/4 02
SITE ADDRESS: 11950 SW KATHERINE ST PARCEL: 1S134CD-03600
SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5
BLOCK: LOT: 063 JURISDICTION: TIG
Project Description: Low voltage to A/C.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: • HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
•
TOTAL # OF SYSTEMS:
Owner: Contractor:
FRANKI BACCELLIERI
11950 SW KATHERINE
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 3/4/02 $75.00 2720020000 Low Voltage Inspection
Elect'I Final
5PCT CTR 3/4/02 $6.00 2720020000
Total $81.00
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 rule are set forth in OA:
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or d' ct questions to O C at (503)
246 -1987.
Issued by ; Permittee 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 7:00 P.M. for an inspection needed the next business day
T- ,
Electrical Permit Application �, R - •
ta+ "r t►
Date .
i , a received: /J a v Permit no/ v aw .
5 . 1 1llt City of Tigard - 1C� �'� -
I Proje no.:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, O 3 Expire date:
Phone: (503) 639 -4171 .. Date issued: By: Receipt no.: i.
Fax: (503) 598 -1960 Case file no.: ,
Payment type:
Land use approval:
� fie. a r -
Y � � wt.�_� T YPExOF� I ' l _ RMIT �� � t `� � �������r f� �., �. V , �; -
❑ I Si. 2 family dwelling or accessory ❑ Commercial /Industrial •
❑ New construction >4-Addition/alteration/replacement' Multi- family ❑Tenant improvement
y �
'�"MK.�.S% ..'i' r s y •. tS §a �J t
lhcr ❑Part al
t
lob address: ` OBSITE ; t 'F�j w_ `J _
� t',A¢ S Bldg: no.: Suite no.: Tax map /tax lot/account no.:
Lot: (Subdivision:
Project name: (.Description and location of work on premises: t-
Estimated date of completion/inspection: L - L 4..s VO t {' / 14 /G
4V4', CONTRACTOR APPLICATION Y ° °
- ... l e ,.,ti..a wc4 t ti
Job no: �: tv ti
:. ¢ ; FEE SCHED 1 ¢ 4 ,
Business name: /�{ r�t4e11A11tul
Description Qty. (ea) Total no. insp
Fee Max ,
Address: C�'`t - krS'
(ti7 ?cs S✓ 7 v... at (21 N eIlingdentiIncIudgleormulti- family per
dwelling unit. Includes attached garage, t
City: State:0 - I ZIP:Q 70 6 Z Sericeincluded:
Phone: 692..-(g-� Fax: / ,. � �� lg)9 I E -mail: 1000 sq. ft. or less 4 r
CCB no.: S \ 9 3 Elec. bus. lie. no: 31 _ 4 --a Each additional 500 sq. ft. or portion thereof
City /metre lie. no.: Limited energy, residential
• Limited energy, non- residential 2
/ C2
Each manufactured home or modular dwelling fi
Signature o st ervising electrician (required) Date Service and/or feeder
Sup elect name (print): Te 2
� l q1� License no: +. Services or feeders - installation,
` " 1 r , 2 1 alteration or relocation: ai
4 ,, t � OWNER ` * " „>
°r.' tCl,...°,? pq s� _. 200 amps or less
Name (print): . 201 amps to 400 amps 2 ”
Mailing address: 401 amps to 600 amps 2
City: 601 amps to 1000 amps •
2
State: I ZIP: Over 1000 2
•
amps or volts .
Phone: 'Fax: 2
I E - mail: Reconnect only
1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to
200 amps or less
installation, alteration, or relocation: s,
ORS 447, 455, 479, 670, 701.
Owner's signature: 201 amps to 400 amps 2 a
Date: 401 to 600 amps 2
2
:F + • r'p' ''''ENGINEER .
:• t r ,.er ' t � <, t ;.r - : ; x Branch circuits - new, alteration,
2:ixl*i
Name, or extension per panel:
Address: A. Fee for branch circuits with purchase of
service or feeder fee, each branch circuit '
2 '
City: 1 State: I ZIP: B. Fee for branch circuits without purchase
r
Phone Fax Email of service or feeder fee, first branch circuit:
2 _
f lea , , .. Each additional branch circuit: h,
{. r rt ; 'p LAN_'REVIEW (Pse check allatliat app ' 4 r„. '
rr, Misc (Service or feeder nut included)
o Service over 225 amps-commercial ❑ Health-care facility
Each pump or irrigation circle � ,
Service over 320 amps - rating of I &2 ❑ Hazardous location Each signor outline lighting
ID Service
family dwellings ❑Building over 10,000 square feet four or Signal circuit(s) or a limited energy 2 '
❑ System over600 volts nominal more residential units in one structure alteration, or extension* gY panel,
❑Building over three stories
❑ Feeders, 400 amps or more 2 r
i
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park *Description:
❑ Egress/lighting oad over ;1'
❑ Other. Each additional inspection over the allowable in any of the above: - r `,
Submit sets of plans with any of the above. Per s I I I x-
The above are not applicable to temporary construction service. O vestigaion fee ; ? a _.
Other ? c�..:
Not all jurisdictions accept credit cards, please call jurisdiction for more information\ Notice: This permit application - - $ 7�� v(� - = w Y
❑Visa ❑- MasterCard — - P ermit f ee -
P lan review
Credit card number: expires if a permit is not obtained (at _ %) $ , �, .
______/____L__ rc
within 180 days after it has been State'suhar e (8%) 6 :
Expires g ( ) v�
TOTAL $ $ 10 - .,?
Name of cardholder as shown on credit card ' accepted as complete. '
Cardholder signature V - ..o
Amount ''ti'-
440 -4615 (6/00 /COM)
CITY OF TIGARD 24 -Hour.
BUILDING - 4 -• Inspecti?t Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Request -d 3 -2- AM PM BUP
Location /
A 1 � P Suite MEC 16 ec 060
Contact Person /1 e t- Ph ( ) & 9)' / 6�PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner LC
7 jz CV I 3s
Footing ELC
Foundation
C @S S -)--a-13T--- Ftg Drain ) ELRs!)b,t?- 000
Crawl Drain
Slab Inspe tion Notes: SIT
Post & Beam �_ __ Z
Shear Anchors fl J
Ext Sheath/Shear `i� v
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam /
Under Slab %
Rough -In 7 /
Water Service
Sanitary Sewer
Rain Drains --..„ \,...)
Catch Basin / Manhole
Storm Drain
Shower Pan •
Other:
Final
P'% ktik FAIL
: HANI t
Rough -In .
Gas Line
S oke Dampers
e-r FAIL
,a 1 W
:r -
Rough-In
UG /Slab '
Low Voltage
• e Alarm
PART FAIL 0 R einspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blv�.
Ell Please call for reinspection RE: 111 Unable to inspect — no access ,;;�
Fite Supply Line ,,....1 6 1 , A -
ADA =,- g Approach/Sidewalk Date I Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART • FAIL