Permit CITY OF TI GARS ELECTRICAL PERMIT
PERMIT #: ELC2004 -00419
"V DEVELOPMENT SERVICES DATE ISSUED: 7/12/2004
13125 SW Hall Blvd.. Ticiard. OR 97223 (503) 639 -4171
PARCEL: 1S136AD-04000
SITE ADDRESS: 11507 SW PACIFIC HWY D
SUBDIVISION: VILLA RIDGE ZONING. C -G
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Electrical TI, (4) branch circuits.
Job No. 9811
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: 3 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:
SMITH, EDITA M AMP ELECTRIC
833 NW 170TH DR 1701 BROADWAY #324
BEAVERTON, OR 97006 VANCOUVER, WA 98663
Phone: Phone: 360 910 - 5805
Reg #: LIC 78152
SUP 3869S
FEES ELE 37 -56IC
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/12/2004 $66.80
[TAX] 8% State Surcharge 7/12/2004 $5.34 Rough -in
Elect'I Final
Total $72.14
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 set forth in • ° r. 952-001-0011 ro !h OAR 952 - 001 -0100. You may obtain copies of these rules or direct questio • - - _ •
24 6699 or 1 -800- 332 -23
Is ued 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: — , -,e 0 • DATE:
LICENSE NO: gg6 91/4
Call 639 - 4175 by 7:00pm for an inspection the next business day
.Electrical Permit Application FOR OFFICE 1:5E ONLY'
r
City of Tigard � 9/7 o 7 Permit No.:. E��Q - =!
13125 SW Hall Blvd., Tigard, OR 97223 Phut Review
Phone: 503.639.6171 Fax: 503.598-1960 /, '' I j ` _ Date/ . Other Pantie
Inspection Lint 503.639.4175 '. . Pale Ready/By: iwir • See Pages for •
1pternet www.ci.tigard af.us No05edlMetbod: ( ®
Supplemental Information
_ .I 2:4t-'11,7-, i . i 7 _.fr s - - t �k.•. -- � 1 :t ,.l
�'''. -• _ ,^ .— �. :. _ i. " 1`i._ :T - .; . '� > : 3YS� +_a : �' i �,� -z.Y � .. �ti . am '
0 New construction ►: . •; tion/alteratio /replacement Please check all that apply:
❑ Demolition ❑Other ❑Service over 225 amps, comm'l 0 Hazardous Location
pservice over 320 amps - toting OBuildng over 10.000 sq. ft.,
, 3: ., , ..r;, : .r . }i� -,� ; . .-- . .Yf - •) ' r ' y of 2 dwell' W more new residential
.�4 �r,.r,r'• >a�l� _ - ._� �:, t:' �i-: u - ` . i; �c.'° •fybv7Y '� 4
a 1 - and 2rlimlily dwelling t 5 6 uminieseial/industrial 0 Accessory building OSystem over 600 volts norniaal units in arse Structure
OBuildmg over three stories ❑ Feeders, 400 amps or more
❑ Multi ❑ Master builder ❑Other:
[]occupwd load over 99 persons ❑Wtanufoctured structures or
-'- 4 .:I _ . n , ,,, ,' . OED lighting plan RV. park
Job no.: 9e" / Job site address: / /5 7 � 1 / R C Hvw pH�g 2 core tf plans ❑other.
tC/ 1 Submit 2 sees of plans with any of the above.
City /StaWZlP: l 0 Wyz- -6 Citti2- n ,, / The above are not applicable to temporary construction service.
Suite/bldg apt. no.: � I Project name: K(f .. -- -. -,V..0-17t2..*. t J ' _ , r: ' . :
Qty. Fee . Total
Goss street/direCtions to job site: ,4 '1 Gr. ,f' 9 w New residential single- or multi -family dwelling unit.
Ine[udis attached gars
1,000 sq. ft. or less 145.15 4
1
Subdivision: I Lot no.: Ea add'l 500 sq. R or portion 33.40 1
Tax map/parcel no.: • Limited energy, residential 75.00 2
Limited energy, non-residential 75.00 2
Each mamtfactwed or modular
dwelling, service an. nor feeder 90.90 2
Services or feeders installation, alteration, aadlor relocation
200 arnps or less 80.30 : 2
- ' -' . - ,.,'.. - - - - - - T..-" 7777 ;._.. : ; , - :... ",.;÷:,i , 201 amps to 400 amps 106.85 2
•
77.1r4 )1. fi t / ' 7 601 amps
s to 1,000 amps amps m 2 0.60 _ 2 2
Name:
Address: g3 5 IJj J7 = D2 . over 1,000 amps or volts - 454.65 2
Reconnect only • 66.85 2
CityiState/Z1P: iJan - W 02 ? 77° 6 Temporary services or feeders installation. alteration, aadlor
I Fax: ( ) relocation _ .
Phone-. ( 200 amps or less 66.85 l
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 ants 100.30 I 1 2
intended for sale, lease, tent, 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
.. ': , •::r` . _ : ,_ — - :i.' - ,; y_ — .., ^7 r:.," " ; - AFee
- -. = _ __ ��. { service or feeder fee, each
Business name branch circuit 6.65 2
• - i B. Pee for branch circuits
Contact nay: ` without service or feeder fee, 46.85 u Qs 2
Address: tech branch circuit / l 6 . W
_ _ Each add'I branch circuit 3 3 6.65 I. /9,7 2
City/State/MP: Misddanea:5 (service or feeder not induded)
•, • . Pump or irrigation circle 53A0 2
Pht> - - J Pte' - Sigp or outline lighting 53.40 2
E-mail: _ ` . wSiigwnnall circuilpanel, t(s) or limited -
- .:,; ",, : �,I,. {'I ^ �_S _fJ-. :, ,,Tr - ' +dr ".TU : „:. ti en g atteration,or
`' - •.i _` s
,.. � �_:_ - '"'� � .:' � J ' u ��• ' ��a ...--- _LS. u'�^ ''' '�`�'�
a�
Business name: �yiii' /i &C �G. ?/L !C extension. Describe: Page 2 2
Address: / i 7 D / e ^ � / /J_A ' / -1/ ? - V Each addition' inspection over allowable to any of the above
�,/ f/� �� i� Per inspection 62.50
City /State/ ZIP: k L44 �j �� 3
t/ % 6 lnvestigarion per hour p to udn) 62.50
_ Oboe= i ,. 66 � '� ' � 5 ' 1 F C340) 0) 2 y /� ? f- Industrial plant per hour 73.75
CCB Lie.: 7 & /S2 Electrical Lit:.' 56/C I Suprv. Lic. 7c S ` ` . 6 - �1`_' •.
Suprv. Electrician signature, required: Plan review (25% ofpennit fee) t r J y
State surcharge (8% of permit fee)
Print nmmeTC it 2 (..16-1471-Dare ..7_1 -- O rare. PERMIT is 2.1 1 7 (
Authorized signature: . This permit apprteati•o:ipiree If • permit 4 not otxaine within 190
nays a fter 4 bn �eea aeee as co mple te
Print name: I Date: • Fee medwdouogy set by TO-County Bolding industry Service Board
' •• Nwnber of inspections pa permit allowed.
i:i5wldinefemttut19.•Pamwappaae 12/03 440461511101051 0W VPE
/5/%-2
CITY OF TIGARD 24 -Hour T
BUILDING ' Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested 7 - 2-g AM PM BUP
Location . - Suite MEC
Contact Person Ph (, 3 "� - . 80� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Ow� ner ELC a g--0 d Li( 7
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
AAIMIk
Slab Inspection Notes: SIT
Post & Beam ■`��'
Shear Anchors
Ext
Ext Sheath/Shear
ear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall fv''"1
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
PASS ART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line V
ADA
Approach/Sidewalk Date 7- � 0 Inspector ( �� Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL