Permit A CITY OF TIGARD ELECTRICAL PERMIT
, PERMIT #: ELC2004 -00001
I
DEVELOPMENT SERVICES DATE ISSUED: 1/2/04
I '- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171.
PARCEL: 1S126DC-04800
SITE ADDRESS: 09495 SW LOCUST S A
'SUBDIVISION: LEHMANN ACRE TRA ZONING: C -P
BLOCK: LOT : 004 JURISDICTION: TIG
Project Description: add 2 branch circuits.
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: 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:
BAKER, JAMES + WILLAMETTE ELECTRIC INC
MATHESON, ROBERT T + PO BOX 230547
BAKER, DIANE R - TIGARD, OR 97281
PORTLAND, OR 97223
Phone: Phone: 503 - 624 -3631
Reg #: L1C 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/2/04 $53.50
[TAX] 8% State Surcharge 1/2/04 $4 Rough -
Elect'l 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- 2 -2344.
9 .
Issued By: 1 �L �,,74,� Permit Signature: � i ih
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: /966 '5 5
Call 639 -4175 by 7:00pm for an inspection the next business day
.., .
Electrical. FOR OFFICE USE ONLY . ... , , , , .
Received Electrical ..■
•-•., ,, A
Date/By: i - p_- c)(-) L) 3 Permit No.: 1, 940# e
City of Tigard JAN 0 4 ,, , Planning Approval Sign
4:004 Date/By: Permit No.:
13125 SW Hall-Blvd. Girl( OF Tit:, Plan Review Other
vi
Tigard, Oregon 97223 auti ii4fiti Date/By: Permit No.:
Phone: 503-639-4171 Fax: ..0"3-5,8-470/[4,910 Post-Review Land Use
' • ke)///s4. , 1 & Date/By: Case No.:
Internet: www.ci.tigard.or.us , .1 Contact Juris.: g See Page 2 for
24-hour Inspection Request: 503-639-4175 ' ' Name/Method: Supplemental Information.
,,:' ; ",:*::' 1 0t7gaVeFF. , ;P:.LANACtE,84EWIPI640iaailriiiifiliD134 t::%tr.'-:,i'3*.
El New construction 1E1 Demolition 0 Service over 225 amps- 0 Health-care facility
commercial 0 Hazardous location
IN Addition/alteration/replacement 11] Other: 0 Service over 320 amps-rating of 0 Building over 10,000 square feet,
;. 1;" 1 & 2 family dwellings four or more residential units in
0 1 & 2-Family dwelling 2 Commercial/Industrial 0 System over 600 volts nominal one structure •
111 0 Building over three stories 0 Feeders, 400 amps or more
Accessory Building E Multi-Family 0 Occupant load over 99 persons 0 Manufactured structures or RV park
11 Master Builder 0 Other: 0 Egress/lighting plan 0 Other:
' rsTIONII4fEOCATION:a;;•L-:,';'c::'• Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: ei it 9 -c SC,/ L,c, c L,, c r Si f.,.;,:an:-,4','-t-.5`,TEV4sompioEgliicifMtMIZAVW.4
Suite #: A— Bldg./Apt.#: Number of inspections per permit allowed
Project Name: je„ 1 e , , 6.,,, Ak, .Th, 10 ,./ Description Qty Fee (ea.) Total
New residential-single or multi-family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: , Lot #: Limited energy, non residential 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
,
.',:,..,:',','.,'.,:ir.^ ,
serer i c ices n o d/ r o feeders installation, 90.90 2
1111 ev. ,Nu." / a 0 ,),-- 71: alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2 .
401 amps 10 600 amps 160.60 2
fit:OURT.Y.t!OWNEW-t;',N.'ItOli-liattNOTV:i0iAA-VO4.00-iti 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City/State/Zip: 200 amps or less 66.85 I
Phone: Fax: 201 amps 10 400 amps 100.30 2
TEMPPLICAN, T) l' al , O)NTA7C . VMR:SiONKi , ,..'' 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: extension 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 L,, .C
service or feeder fee, first branch circuit I 46.85 7c, :::: 2
Phone: Fax: Each additional branch circuit ' I 6.65 (9 4 2
E-mail: Misc.(Service or feeder not included):
Z.,,AW",',2-MVAPASIRActoNle-TiOterilti44::it;EZVZS444,V Each pump or irrigation circle 53.40 2
Each sign or outline lighting _ , 53.40 2
Job No: 4 13 4 7 Signal circuit(s) or a limited energy panel, I.
alteration, or extension Page 2 , 2
Business Name: 0 11(4 6 ,,41. c t eci Atc I '-' <— Description:
Address: ,C) / 2.7 d cy } -
Each additional inspection over the allowable in any of the above:
City/State/Zip: T ,./ tit et V) 0 )-- 9 2" Z ci"/ Per inspection per hour (min. 1 hour) 62.50
Phone: c,.--z_ L -- t ) Fax: to 2 - 'I - 2 4 Ti. Investigation fee:
Other: • ,
CCB Lic. #: ?-c-6 v-ci Lic. #: 3,4 - ----3 e--- . .
znxtp,:txtztgoAtg*Ieifiieaut'iiiiteEeat4*oaf
Supervising electrician A.4,.....„... Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: 04-,.,.. r; Pe_ Lic. #: l b ti C State Surcharge (8% of Permit Fee) $ - '4 , tk
TOTAL PERMIT FEE $ ' 3 , 9-
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
(Please print name)
i: \Dsts \Permit Forms\ ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
Heating, Ventilation and Air Conditioning System
Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
Instrumentation
n Intercom and Paging Systems
El Landscape Irrigation Control
n Medical
n Nurse Calls
n Outdoor Landscape Lighting
n Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
I: \Dsts \Permit Forms \ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspectidh Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM BUP
Location 9, '(\) \-0 Suite MEC
Contact Person Ph (_ ) PLM
Contractor )1 \k11 1 ---0 Ph j 0 ' ) (f) 3 (c \ SWR
BUILDING Tenant/Owner EL J "— Q (
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 1 t PTV �'' �a 1^6 - .Plizl\ts ‘Jojk V !J 6/ 33 - 5 -0 L\Y OColotrl
Drywall Nailing
Firewall
Fire Sprinkler Q to i 1 ,� ��
Fire Alarm z AL S Co °t LK ��S 14 v &qt144
Susp'd Ceiling (�,,
Roof Other: A % C-1 I )at) \f (i ( a1 • t∎ c�N , o P\ ccl
Final 04LJ4 At t . r lP 15c\= X 001j a+�
PASS PART FAIL
PLUMBING
Post &
Under Slab
(5- I - ) 1 A V m✓A 1 ' 1 V_v Go Nr OlNo 1 0 f+ d
Rough -In ►_ '%\> ► I t t D ► l ■
Water Service -
Sanitary Sewer --- 7)4V" j DO LI \ iJ I o u �„� �M1
Rain Drains J b �v r
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final e � CJ ON)
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PART FAIL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
qinal) Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
--- ART FAIL
SITE 0 Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line 11
ADA I 1 —
Approach /Sidewalk Date Inspector 4,44 i Est
Other:
Final DO NOT REMOVE this inspe on record from t the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received I/Gl 3 , 1..- Date Reque d / `Z OcA AM PM BUP
Location `l 94/9-5 ' ��t,G [:L Suite 4 MEC
Contact Person Ph ( ) PLM
Contractor Ui,P]/C � e ti , Ph ( ) e24 (3 / SWR
nn
BUILDING Tenant/Owner z - ll 40 - 0 060 L
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear 3
Framing 1"��-fj
Insulation / 01 1 riff-6,M47/1e>0 ,& yy rN /L� /5
Drywall Nailing ° V ✓ �li-
Firewall
Fire Sprinkler
Fire Alarm \-\\ UV
Susp'd Ceiling
Roof L7 W_ 1 P
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
PASS PAR ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE . ❑ Please call for reinspection RE: 111 Unable to inspect - no access
Fire Supply Line j
ADA
Approach/Sidewalk Date / Inspector P� �'�c/�L L� Ext
Other:
Final DO NOT REMOVE this inspection record f om the b site.
PASS PART FAIL