Permit /.\ CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00608
•
DEVELOPMENT SERVICES DATE ISSUED: 9/23/2004
13125 SW Hall Blvd., Tioard. OR 97223 (503) 639 -4171 PARCEL: 1S135CD -00201
SITE ADDRESS: 09575 SW LEWIS LN
SUBDIVISION: BOETCHERS ADDITION ZONING: R-4.5
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: Panel changes in house & garage.
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: 2 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
LE1MS, DAVID E + MARSHA E TRS WEST SIDE ELECTRIC CO INC
9575 SW LEWIS LN 1834 SE 8TH AVE
PORTLAND, OR 97223 PORTLAND, OR 97214
Phone: Phone: 231 - 1548
Reg #: LIC 13306
SUP 2663S
FEES ELE 26 -I35c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/23/2004 $160.60
[TAX] 8% State Surcharge 9/23/2004 $12.85 Rough -in
Elect'I Final
Total $173.45
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 ByL / '/ 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
tt $iectri Permit JjIVED FOR OFFICE USE ONLY
e:iey of Tigard SEP 21 2004 0 Received : „, p2/ /Er Permit No.: e (.e ,2Grl 0106 0
13125 SW Hall Blvd.. Tigard, OR 97223 Pion Review
Phone: 503.6394171 Fax: 503.598.196(C Fry OF TIGA' „lhl „t`i� yBy :rnr
Line: ne: 503.639.4175 T• On 0 See
Internet: www,ci.tifftrd,or.us BUILDING DIVI =” . Notified/Methed:
Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ddition/altcratiodreplacement Please check all that apply;
ID Demolition Other ❑Service over 225 amps, comm'1 ❑Hamedous location
❑Sctvice over 320 amps rating ❑f3uildng over 10.000 sq. ft.,
CATEGORY OF C TI
ONSTIWCON .. of 1 • and 2- family dwellings 4 or more new residential
g _i_ and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑Sysrom over 600 volts nominal units in one stnuture
Multi-family ❑Master builder ID Other: 0 Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structural or
JOB SITE INFORMATION AND LOCATION • ❑Egtcss/lighting plan RV path
Job no. 1. it 9 0 1 Job site address: C/ < 7 S S t J • -J , S ! L►•, . ❑Health-care facility ['Other. Other.
Submitl, sets of plans with any of the above.
City/State/ZIP: ( C. c- n ' C q 7 •Z Z S The above are not applicable to temporary construction service.
—
Suitelbldgiapt. no.: , I Proje et name: L, �_, t ', 1 ,, _ Imo" SCYi IUY.0 --
Description ,� °iy.1.. rr« I - rout
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 no.: 1'sa. add"! 500 sq. ft. or portion 33.40 1
Tax map/parcel no. Limited energy residential ' — 75.00 2
Limited energy, non-residential 75. 2 _
DESCRIPTION OF WO)RK • Each manufactured or modular �-
• G ��Gr �IC) cn ` , dwelling, service and/or feeder 90.90 2
4 t S� 4 / • 1, eT• :. . Services or feeders Installation, alteration, and/or relocation
200 amps or less 'Z 80.30 ) k f, /-(' 2
PROPERTY OWNER 1I. TENANT 201 amps to 400 amps 106.85
160.60 2
2
• -- 401 amps to 600 amps
Name: ` C" • w a S .. ' 601 amps to 1,000 amps • • 240.60 2
Address Over 1,000 amps or volts 454.65 2
City/State/ZIP: /ZIP: Reconnect only 66.85 2
Temporary services or feeders installation, alteration, and/or
Phone: (� , ) 6 ._? S 7 C_ i _I F. ( ) relocation
200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 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 133.15 2
Owner signature: _ •• . -- _ _ _ __ Date: Branch circuits– new, alteration, or extension, per panel
❑ APPLiCAN•l I • 0 'CONTACT PERSON ' ' A. Fee for branch circuits with
Business nano service or feeder fee, each
branch circuit
6.65 2
Contact name: 13 Fee for branch circuits ' ^—
�� without service or feeder fee, 46.85 2
Address:
each branch circuit
Each add'l branch circuit 6.65 2
Ciry /Statc/ZIP: Miscellaneous (service or feeder not Included)
Phone ( ) - Fax: ; ( ) Pump or irrigation circle 53;40 ' 2
Sign or outline lighting 53.40 2
Ii - snail: _ _ Signal circuil(s) or limited-
- .
CONTRACTOR energy panel, alteration, or • extension. Describe: Page 2 2
Business name: WEST SIDE ELECTRIC CO.
Address: 1834 SE 8 AVE. Each additional Inspection over allowable in any of the above
Per inspection 62.50 _
City/State/ZIP: PORTLAND, OR 97214 Investigation ga per hour (I hr min) 62.50
Phone: (503) 231-1548 'Fax: (503) 736 Industrial plant per hour 7315
ELECTRICAL PERMIT FEES* _
CCB Lie.: 13306 Electrical L' • 26 -135C 1 Suprv. Lic.: 2663S Subtotal l
Suprv. Electrician signature, required: Plan review (25% of permit fee) _ ' �
Print name.)Z K c - — CZ vti wee ZK Date: ' `? ' 4L..../ Slate surcharge (gars ofvermit fee) 1 Z , � j
�( TOTAL PERMIT FEE i 7 l • L /5
Authorized signature: 1
_ 'I'bis permit application expires trA permit In not Obtained within iso
Print name: day, alter It has been sleeeptcd y complete
.�, - -. T ...--- ^ Da te: • P ee met set by'hi•County Duildiog N
Indtetry Service Don
• • Number of inspections per peanut allowed
i:\fl dinp1PtrttriL .0 •PerntikApp.doc 12/03 NO 461 St(10/02/COMIIVe
2 ' el LL90- 9ELrEOSI '03 0T- 120aj3 apes 'isap d20t4 b0 T2 daS
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION ; Business Line: (503) 639 -4171 MST
BUP
Received Date Re•uested AM PM BUP
Location � iAIi Suite MEC
Contact Person Ph ( ) a 3 / J /5" V e PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC .2-60 '/ - 6640'
Footing
Foundation - ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
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
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
<Age PART FAIL E Reinspection fee of $ required before next ins•ection. Pay at City Hall, 13125 SW Hall Blvd.
40 ❑ Please call for reinspe tion RE: , — Unable to inspect — no access
Fire Supply Line igi ADA
Approach/Sidewalk Date / & I Inspector Ext
Other: 1.
Final DO NOT REMOVE this inspection record 1 o the Job site.
PASS PART FAIL