Permit CITY OF TIGARD AL PE
., PERMIT
PERMIT #: E ELECTRICAL PE -00509
,41# DEVELOPMENT SERVICES DA TE ISSUED: 8/13/2004
" ' � I li 13125 SW Hall Blvd.. T igard, OR 97223 (503) 639 -4171
PARCEL: 2S 103 DA -02201
SITE ADDRESS: 10975 SW PARK ST
SUBDIVISION: DERRY DELL PLAT 2 ZONING: R -3.5
BLOCK: LOT : 023 JURISDICTION: TIG
Project Description: A/C circuits add GFI pkg & plug for furnace.
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: 2 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:
DISANTO, JAMES & WENDY HIGHLAND ELECTRIC COMPANY INC
10975 SW PARK ST PO BOX 655
TIGARD, OR 97223 TROUTDALE, OR 97060
Phone: 503- 598 -3952 Phone: 220 -1935
Reg #: LIC 109850
SUP 2431S
FEES ELE 26 -962C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/13/2004 $60.15
[TAX] 8% State Surcharge 8/13/2004 $4 Rough -in
Elect'I Final
Total $64.96
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 By: j Permit Signature: s, rt 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:
Call 639 -4175 by 7:00pm for an inspection the next business day
FROM : Hi ghLend. ELect. Co PHONE NO. : 665+7436 Plug. 12 2004 07 : 07PM P2
* .. .
Electrical Per . /4 J ed ig FOR 0 F10E US cal E ()NIA
Receiv lcctri
Datem 51' - 13 — OV a Permit No.,66c.aaaYay
1‘,ED4 t No.:
ry
Planning Approval Sign
City of Tigard 112ECE,Iv Date/F3y: Pcrmi
1 3 1 25 SW flail Blvd. II • Plan Review Other
Tigard, Oregon 97223 nate/Hy: Pcrmit No.:
Phone: 503-639-4171 J3 58 2- . • • , Post Land Use
Internet: www.citigard.or.us , . t
D „_.., -..— Contact luris El Sec Page 2 for
24 Inspection Requese51130M
ON Name/Method: 11 C c Supplemental Information.
BUILDING DI
iS6MUOV480grgfg.'girirM6i5'..farrA16101' gitakVai
111 New construction D Demolition 0 Service over 225 amps- Health-care facility
commercial 0 Hazardous location
111 Additionlalterationlreplacement Other: 0 Service over 320 amps-rating of D Building over 10,000 square feet,
Vr ' .. TAVOLVIAteaggillOrae,SI I & 2 Wilily dwellings four or more residential units in
ill 1 & 2-Famil dwellin . 111 Commercial/Industrial 0 System over 600 volts nominal one structure
fl Building over three stories 0 Feeders, 400 amps or more
• Accessory Buildin . • Multi-Family 0 Occupant load over 99 persons 0 Manufactured structures or RV park
Hi Master Builder III Other: D Egress/lighting plan 0 Other_
-- v. ... . Submit sets of plans with any 4:tithe above.
Viiiuix• ,..';'!Agi :0. ;.., ft 1111E•ON 'AVM .11 , The above are not a. . livable to tern . . tar construction service.
Job site address: 0•7 4 1TAW 4 gria ' 1 "ilbr -". 1 4.-- ' -1 11 1 . 3a=gr i ''. V' . f ,'• '41
; ,.....I . ' . nal ' .45:V&A!!ri. ll oi.:,:),,, ....:.-. 41-1 . ,L./..rt! ' - i... • -: i.:.•_•
Suite #: Bldg./A • t.#: _ Number of inspections per permit allowed
Pro'ect Name: . Description Qty Fee (ca.) Tow
New residential-single or multi 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 .
I
Limited energy, residential
' Limited energy, non residential 75.00 2
Subdivision: Lot #:
1 • 75,00 • : 2
Tax ma • • arcel #: Each manufactured home or modular dwelling
7 ,.7, : 42 . i . ..•-' , ..7 1 M . ,CiiIiiifeiV.':.:''SEreq.:Vi.' TaLanq service and/or feeder 90.90 .. 2
Services or feeders - installation, • •
4 C ci.t.rzwitt. , ,/.1 Fc. ,/ , 0L-- alteration or relocation:
200 amps or less 80.30 2
, ___; , _ , . ,,_ .. 106.85 2
minitaiir mummuim 40 20 amps ; t 4 amps amps 160.60
2 -
FINIP.M175777570:2Engialnki,..7‘7L,Y,..:egri*-70gm 601 amps t° IMO a — 240.60 • . 2
Over 1000 amps or volts 454.65 . 2
Name: , „ Z41114;111111111111111111 Reconnect 001Y 66.85 2
• • 71. . Temporary services or feeders - installation,
•
alteration, or relocation!
Ci IState/Zi . : ,.057fijfr ',AA_ — 2?-3 200 amps or less 66.85 • I
Phone: ' ; - . ' "5 Fax: 201 amps to 400 amps 100.30 2
133.75 . 2
rEE*M I..:.1:110filtAIiiiiP.Stii 4° '
Br aniPs
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
i -
service or feeder fee, first branch circuit 46.85 2
Phone: -... Fax: Each additional branch circuit 6.65 • 2
E-mail: Misc.(Service or feeder not included):
' A pump or irrigation circle 5340 2
IFEMERL . eiNg f4i.i ;': .41 : . raiiniMOMMFMalltarA P -411 ".
Each sur or outIme_4htme 53.40 ' ' 2
Job No: , circuit(s) or a limited energy panel,
alteration or extension Pc 2 L 2
Business Name: ./,,gr AIKOPr A
i a OLL.
- /.4 - ......A_,_ T>escription;
Address: (9 46 C s _ -
Each additional inspection over the allowable in any of the above:
Ci /State/Zi • : .., .,, . _ 1 , I, d , 06 or - Per inspection per hour (min. 1 hour)
62.50
Phone: D.g...0—/ / 3 IMIIIWASISIENINI Investigation fee: ..
Other:
CCB Lic. #: /09 I S-'M Lic. #: a_.,4,— " 6 7-C
RMigvioviingiOVIA iMk__,,,M-;!i.'kitIa
Supervising electrician n . Subtotal $ • ', I .',..:-
si u ature r . • uired: •U COL ' l Plan Review (25% of Permit Fee) S.
Print Name: ,) , L - ,_ _ , 4_, Lic. #: ;... I State Sureb _e 8% of Permit Fee $ •t - 4
TOTAL PERMIT FEE $ • 4 fa:
Authorized / / /4# // - s/ 6 ' -04 Notice: This permit application expires If a permit is not obtaine
', ■ ' ,
Signature: A.,:...."4„.,,.. g Date; 180 days after it has beat accepted as complete.
*Fee methodology set by TrI-County Building Industry Service Board.
6 CA_ C4„, Lei
/ (- —
(Please print name)
imseocrnas Forms \E/ePermit.App.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (60) 639 -4171 MST
BUP
0 Received Date Re sted — A M PM BUP " �2 T �
Location / 7 75 ra Suite MEC� U " 6d -:-
Contact Person ?42..4...iza Ph ( ) 66 - 3 7a.c PLM
Contractor Ph ) SWR
' (() I f 0 r 8
BUILDING Tenant/Owner y ELC
Footing ELC z c q -- 0 d 507
Foundation Access:
Ftg Drain C 4 -S ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall Fire Sprinkler 1 J 1 N v\v\h bN -,-)-4 oA 4 \ �j�_ �`� A�)J , V io `i' o
Fire Alarm P `Gk( q f11L <PNI 5 Dri 10 'Y N
Susp'd Ceiling 1 ,, 1 7� tw y� L �
R her: b OvV f� (J`v (I\ S (h \ .` 17 t3d1 ' 14
Final
PASS PART FAIL
Post & Beam
Under Slab
Rough -In
Water Service _,, ,, t , ;
Sanitary Sewer ` ' ; De '1
Rain Drains ' `° � v � t~ ' 0 , v
Catch Basin / Manhole MR UrblaRVX)•> ■ W
Shower Pan iinir1� 1Ant TAII P.S 1 10
Other: ,`
Final \_90•\\._ ro \40 , V X11
PASS PAR
MECHANICAL
Post & Beam
Rough -In
Gas Line D .� l/
Seuoke Da • = s - !� q . I
in.
PARTIM i F
ELEC - ICAL
-o gh-
Rough -In �°
UG /Slab
Low Voltage
Fir Alarm
PART FAIL
� 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date a ,' S Inspector / / / � d ' Ext
Other:
Final DO NOT REMOVE this inspection recor . rom the J , ' site.
PASS PART FAIL