Permit CITY O r r T I GA R D ELECTRICAL PERMIT
�_ .� V PERMIT #: ELC2004 -00030
DEVELOPMENT SERVICES' DATE ISSUED: 1/22/04
cal I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135DD-05102
SITE ADDRESS: 11993 SW PACIFIC HWY ZONING: C -G
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 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+ amplvolt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
GLADSTONE, HELENE D TRUSTEE DRYER ELECTRIC INC
150 IRON MTN BLVD PO BOX 86369
LAKE OSWEGO, OR 97034 PORTLAND, OR 97286
Phone: Phone: 503 - 771 - 5667
Reg #: ELE 26 -1142C
LIC 153466
FEES SUP 2876S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/22/04 $53.00
[TAX] 8% State Surcharge 1/22/04 $4.24 Rough -
Elect'I Final
Total $57.24
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246-6699 or 1 -800- 332 - 44.
Issued By: � ( Permit Signature: a40 �j._e/yc
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Vi f - 7
,/ . 6(.. - — --/ - -; .
E1ectricai. Permit Application WV, 01: E10E LSE ONLY
Tigard RECEIV .1, L : r s1B*- .."eel •
r
• ..ter :i
City of ig t
• [ket
13125 SW Hall Blvd. sdt Na:
caaw
• ri• Oregon 97223 J : d 200 tNa:
Phone: 503 -639 -4171 . Fax 503-5984960 il iiIIIIIIIIII Internet; �vww,citigard.orus ' ., j - : .I ° l GAR y cmNa:
24-haur Inspection Request 503-639-41 , ' =''' -. E c edInd: Sea e>L+z for
- .. I 1 . =WORK. -- L''•` ..I 19'Rl it°i� _ :...: •„ [t;,.' '.j,,� .�;w,. %.6..i. w
O Demolition New construction � • Service over 225 amps- • Ham. _ c
alter on/replacement [H Other: comme
gc � a -,f� ❑ S 2 f am e dwellings s�saing of Q Bu>l o - 1 of 10,000 t tad in
i CaBBX,I 1 & 2 family dwfin a m ,t mitt in
1 &.2 Family dwelling ;: Commercial/Indistrial g System over 6O0 vote nominal own Magi Master oiy B B Building ing 11 Otiten q C 0 p I p �o moo maim
Ms$blari7der ■ Otber: C� 61� p s°'�"n aravp,ac
�:�',. red? it ' c • :.- 1 rl : � . •. r .Submit .._.acts of pleas with wry attire abseil.
'
- The above mister app service. '-
'ect N N umber at ca Lions per wade gaped
Cross . to job sits New > 1
:4?- 1000 q. R 1417) 4
• Subdivision: Limited mm e.wendmral potoandseeat 1 33.40 1 '
United 1 ZOO
Tax maa/oarcel #: I Lot #: ,.,ms , l 7510 2
Bads maw6snned hoots or modular dwelling ( •
D .: of • s • . 1: , : omen service are Otter 9090 2
8erviea er Was Wooed.%
abrade' er ralsaufnat
200 saps or lea 50.30 _ 2
201 anus to 400 sma . IO6 tS 1
401 twos • 600 amps • • 160.60 2
12 :BROPEINIVETIMER _ ::` ' 601 amps to 1000 amps VOA 2
Name: C GT R Gl Over on a ty ar volts 4.14.65 2
Ramon 66,81 2
Address: 1 l t7 4 2 ) g 3 6 141 vJ Temporary ta+laa or feeders - tnsmtl.doo,
City /State/Zip: -Dy f( C112•13 1 '� ''� a: t
Phone: , J Fax: 201 ones to 400 asps 10030 1 2
- E `ELIEtADi'r - -- • KS I� ET. PERSON aotm600aw�. I 13375 I 2
Name: — Breath dreolt: - new, alteration, or
adsdon per pond:
A d d r e s s : A. F e e flaheamb eataits wills purchase of
orgies or seeder Use. nick bomb eaeaos bbd 2
g
C /S . `
: - • : a Fee fes aasehc>speo withwithout purchase of
4b
Phone: Fax: — service or feeder flee. firsthand: 46.35 VG _ 2 6
E -mail: her .
•
_. - Job N', �':. _. co ; r _ eel. ; ' sl�waldwo .._..�.__.... _ - 53.40
Business Name: DRY ^ E L EC�C d]� RASE? er . ' —.^ -- ei2 mem
Address: OT2 NE GULLY BLVD CITY
City/state/4x =' UKTLAND , OR 97213 Each aadmaaal .. • . _ _... over dm amble la of Ow abyss
• Phone: t - --_ 6290 �NI
6 16 F ax: Sni 9R9 inn Itnestbradon Eke
CCB Lic. #:153466 I Lie. #: 26 -114 -- _ _ im
Supervising elect ��_ z "' o�: t1 ; __ 0i053
lLa Subtotal s �r'3
Plan Review (23% ofFmtat Fa) S
Print Name: 'e: t (I13.10t 1 I Lie. r , a8 State S dsa (8%afPamaFee) $ 4.
• - Authorized
- TOTAL PssM1r VIZ $ 5 ,2
Signaaawc Maus Maus . TAW permit appiadoa. aphis if s per.ltl, steOtdoed
D Mem der tt boo bon aeea.pneel tea e,
•
"ed>Qem°ddou set byTriCouwty Balkan industry Servile* Beast
• - Meanprdncwme) •
i. LDats,Pse tFam Ecpertn thpp.doe 011ai
Case Activity Listing 9:08.0 1 vl: 4AM
TIDEMARK Case #: ELC2004 -00030
COMPUTER SYSTEMS. INC.
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
. ELCC001 Application received 1/20/2004 None DONE MAIL 1/22/2004
BB
s
ELCC003 Permit created 1/22/2004 None DONE BB 1/22/2004
BB
ELCC775 Rough -in 2/18/2004 None PASS HFY 2/19/2004
HS
ELCC799 Elect'l Final 2/18/2004 None PASS HFY 2/19/2004
HS
ELCC500 (F)Issue permit 1/22/2004 None DONE BB 1/22/2004
BB
ELCC800 Case Finaled 2/19/2004 None DONE HS 2/19/2004
HS
•
Page 1 of 1 CaseActivity..rpt
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
•
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 2- / 7 AM PM BUP
�
Location N 9 3 7G� A06,641 Suite MEC
Contact Person Tit Ph ( ) _/3 / 31 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner k\-1- \t Th - CP 0 0 p , ELC 7 -- 0c2 3 e 7
Footing ELC
Foundation Acce�sr
Cr l Drain eA Jam ,, 1 �� -) O � \ ELR
Crawl Drain K�Ci '� Y1/'6 �
Slab Inspection Notes: r SIT
Post & Beam 9 7�]e eavi �GKlif -titil
Shear Anchors � } �-�
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Othe (\
Final
PASS PART FAIL
PLUMBING
Post & Beam f,
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
L
Service
6ugh-Inj
UG/Slab r ee!
Low Voltage
Fire Alarm
; PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI fl Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 7 O Inspector � I - . + a — -- - Ext
Other:
Final DO NOT REMOVE this Inspection record rom t = ob site.
PASS PART FAIL