Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00123
DEVELOPMENT SERVICES DATE ISSUED: 3/12/03
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S103DA -03700
SITE ADDRESS: 10865 SW. PARK ST
SUBDIVISION: ZONING: R -3.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 2 branch circuits to furnace and AC.
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:
DICKINSON, WAYNE A + TRACY M HILLSBORO ELECTRIC
10865 SW PARK ST 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: Phone: 503 - 439 -9666
Reg #: ELE 34 -433C
LIC 134481
FEES SUP 4240S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/12/03 $53.50
[TAX] 8% State Tax 3/12/03 $4 Rough -in
Elect'I 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- 332 -23 _
Issued By: y & Permit Signature: / , a _ _
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: 0-90
Call 639 -4175 by 7:00pm for an inspection the next business day
•
Electrical PermitApplzcadon , 1 k 1 I , , .., \
Date received: 3_ / / —0 3 Fetish rw. i t20 43
, a City of Tigard Proi«d/app'. no.: Baylis dase
c ity 4 1' rd Addzaus: 13125
Phone: (503) 63 W 7ZZ3 Dale started: Ma apt nn.:
Fax: (503) 598 -1960 Case file no.: Payaaear typo:
Land use approvaiMAR 0 7 7003
1,1'1 (11 1'1 Il. \11 1
al dt 2 tummy dwelling or : , MI) I 11 f-" r f ' 1. duatrial O Multi-family Cl Tenant Improvement
O New construction 0 Addition/alteration/replacement ❑ Other: I Partial
,Illlt 1111 I \1 flit \I ‘I U
lob addresser id; mir =MiS■ Bldg. no.: Suite no.: Tax , , lot/account no.:
Lot: Block: 3ubdiviaioa:
Pro oct name: , mpeffeiprogrffl Description and location of work on premises: MW
Estimated date of co . Won/ , lion:
( ( )\ I I t \ l i()14 \ 1 ' 1 ' I . I ( \ I In\ III •1 III III 1
, , , BA: Fall
B
NM i usiness name: H - .. . E - r i c LLC .: ®lyatl
Newredetedid -dgbKl fintayM!
Address: 21185 NW Eve r• teen Pkw Ste 104 dwelligeott.lesindrommeboloner.
. 11321=Ign ZIP: 97124 Senleeheloaeae
Phone4 9-9666 .. .: a &mail: loco ft. or tens 4
Each addidowtl 500 • a. or .. • , thereof =MO
CCB no.: 344;1 Elec. bus. lic. no: 4 -4
City lit.. no.: Unshed ,, redde.m! ��� 2
-,.,. M�� 2
��_ I,' 2..... - d Each roam factutod Mane or mvdat (Walling
of , ..., oloetrieim , pe Service color feeder �■ - z
sup. elect. name (per): J . - . ucesre not 4941 S 1 � (1‘‘ � I 1 i
► I' 1 SerdteaOrfeee° " bile
1' I t I 1t altmatfoeorreloca lost
200 or lean 2
Name (print): 201 to 400 2
Mailing address: 401 to 600 (��1
601 to 1000 1M M 2
state: ZIP: over 1000 or vole Nil 1111111111 NMI
Phone; Fax Recomreer • ' r � � i
t11000101011.: Ow= : The installation is being made on property I own Ta+�snvywnloeearffedue -
which is not intended for sale, lease, rent, or exchange according to , ar ael.�loae
ORS 447 433, 479, 670, 701. 200 roam
ce
leis 2
2.01 to 400 =Mw
Dane: 401 to 400 MIME 2
I . \ t. ; 1 \ I I It Branch cirvatts- new, .ltendio.,
ores rerp..eh
" A. f for brmob oiowits with pushup of II
Address: service or reedcr each Meech dwelt t 2
State: ZIP B. Fee fly blanch elm whltoas purahme
Phone: Fax: : of service or fonder for. broach Wit: '' 2
, .r - 'd ,5ni 11111I2TAIIIIII
1 ■ N. U P \ I I \\ i 1'Ir:ia• cln ,. I. all OM( a1,I114 1 Mime. (Service arfesder.athtddsik
O Savor ova 22 ooppoc�l O Heeabofecal* e fe Each • • • a • • .. • • d1e ■ .
5 ro 2
O Service over 320 ampresPos of let2 0 Hanndmrs location Farb ,r a omlmo MIM EMI
ft darolilup O Building over moo epee net bar or 81112$1 $1 dreutks) ore IMaieed ereti9 parcel,
O Sys owe 600 who .omiml wan reaidmtiel tmu® m ore shanties, err echelon' ■� 2
0 Building over due stories O Feeder, 400 amps or name ...
O occupant lead error 99 peeress 0 Mamtthctrred manna or RV pat Farb adittlaall h.Feetb.wer • Mosel& law eittnebeoet
U P4Peadilddelil Pee O Other _ lbr - : —i♦
BNad! teal apses wHlr ay off the Om. tier
The abalm. Ere tot *WW1* 1* to temporary eosetrnet melee. Other "
Not .n Jurisdictions scoop endh aids , Musa b a ea Mts4Potlae he awns iaear rioo_ Notice: This permit application Freest fee ...................... S ■Th
0 Visa 0 MasterCard empires if a permit is not obtsmed Plan review 01, 54) $ `------
Credit coed comber: I / within 180 da after it bas been State surcharge (8%) ..... S
- Ns= of serried ier as shown an wait ate >�°°n" accepted no complete.
TOTAL ............... W.. W. S s .7
S
Cardholder riposte Amami 404615 (ea)
I0 39Vd 0IaL3333 Od0S11IH 0896109E0S t :tt E00Z /L0 /E0
CITY SF TIGARD 24 -Hour
BUILDING �h Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION . Business Line: (503) 639 -4171
BUP
Received Date Requested v AM PM BUP
Location / o p s P Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) (3 16o SWR
BUILDING Tenant/Owner ELC J - L 162. 3
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam tl F K Arg i I S
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof y
Other: 6 J'
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
'tr.? ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- ASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date - /49' C✓ L ? Inspector :1 4 Ext
Other:
Final DO NOT REMOVE this inspection record from th ob site.
PASS PART FAIL