Permit CITY OF TIGARD ELECTRICAL PERMIT
• .. PERMIT #: ELC2004 -00553
,, i DEVELOPMENT SERVICES DATE ISSUED: 8/27/2004
' 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 111 AD -04900
SITE ADDRESS: 08930 SW PINEBROOK ST
SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5
BLOCK: LOT : 072 JURISDICTION: TIG
Project Description: Service change, (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: 1 W /SERVICE OR FEEDER: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
G
Owner: Contractor:
lam, DONNA T & T ELECTRIC
8930 SW PINEBROOK ST 4120 SE INTERNATIONAL WAY
TIGARD, OR 97223 SUITE A-105
MILWAUKIE, OR 97222
Phone: 503 -639 -1096 Phone: 503 - 652 -7610
Reg #: LIC 150973
ELE 26 -1105C
FEES SUP 2184S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/27/2004 $93.60
[TAX] 8% State Surcharge 8/27/2004 $7 Rough -in
Elect'I Final
Total $101.09
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 -0699 or 1 .800- 332 -2344.
Issued By: Permit Signature: j;A_ \ p
OWNER INSTALLATION ONLY 1
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
Aug 27 2004 7:42 T &T ELECTRICAL 0 5036527612 p.1
Ele I I )R I)I I C1 1 ).1
City of Tigard Da 7{ / - 0( 40ci Permit No.: 6- c y . 053 -
1 3125 S W Hall Blvd., Tigard, OR 97223 �^ � p
Phone: 503.639.4171 Fax 503.598.1960 v �0 = S *''r: v.i II Other Panic
Inspection Line: 503.639.4175 ,!1_141- il,• , -- ��' Dat
Plan Review
v
Re 2
Internet: www.ci.ti Id.or.us b F �iG' - odfedlM : l (r S See Page I for
$a v See Information
j j� n tr' 'e r r - a . �1.` A� r- 2; - 135 r , r - H" � i r .L , i "ai uy1 a ? k "•3 � : p1 1 4 �fi y 7 p a l, r Y c'�`.
,w .. � � ' x � � � . f . . 1 1 4 . . f t,!'_+s�,., Jb , . w..r.... .. .,1i TY l ,, _ , ; Yi {,�r�. �•� r. nw- �X'+. Hri���rvy ;�F
�t -�'
El New construction L Additio "a teration/replacement Please check all that apply:
❑ Demol i[ion ❑Other ❑ Service m ['Hazardous 225 amps. catn'I Hazardous location
!c.^;'r> !' .rv- rnnF r x'r J r ❑ Service over 320 am - ratim B itdn over 10,000 s .
} W trjz 'i •: v d t,a 'i ➢i ? , r i d 'j „ s c ? IfY0 . ham kIr s g ❑ 4 8 q
.h lgat�.+�� ,.... - y a +u ,,t,: s , I . . t .{. '� �,s,... I,:( i.W,a 4=` 3iKI :e,a K of I - ttttd 2 dwellings 4 or more new residents
it I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑ Muter builder 0 Other; ❑Building over three stories ❑Faders, 400 amps or m
r �, , z ❑Occu t !oad over 99 persons ❑Manufactured structure;
ellige i :�.lr { r( t.�i r y E rt�r I ..! t E �1 i xrn.13.! j ,S ''L'- n p RV' ark
14w�',..V:�-5 �: J . a:�r r!, r.� �ii.� �.�.ri ' : :) ,!T ✓I i r }v-T'Y.C, Y.i.--r3iMij.-i. j. i ti ❑Egresslligheingp p
f 1 ;ts
Job no.:G404 - 1540 Job site address: $ s I �i b • . ❑Health -care facility ❑Other:
Submit a sets of plane with any of the above.
City/State/ZIP: .I 4 ,, • The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: t. } 'r�X`'rN�aS Mti, S ' , p t a' . Nr? N , M1; s ,
Description Qty. Vim I Total I
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15
Subdivision: Lot no.: Ea. add'/ 500 sq. ft. or portion 33.40
Limited energy, residential 75.00
Tax map/parcel no.:
5 trF s I p Limited energy, non - residential 75.00
• said �”" s'3 Y.kLLl a r1rr fx�� E ,���iTr�'` LIf.l.iZI,5 i,� '4 1 tt t�i+� " {�C9 �- Each manufactured or modular
Seri' i dwelling, service and/or fender 90.90
-A-- Services or feeders Installation, alteration, and/or relocation
200 amps or less 1 80.30 gQ,39
ins :+} + 1 Z '} `" r':R: AFE/'.r'' fr�1�,G -rF ,. ; l t.s,.,l l " t
�dill 1
w, ll� , ...•'sxs.,i4alt.«.1.a ±!. ,i �r.r, s .r,. i, s;y�} �r;��L3� 40201 a amps to 400 amps 106.85
mps to 600 amps 160.60
Name:
• I rz 601 amps to 1.000 amps 240.60
Address: 9, a t a • e, .; - Over 1.000 amps or volts 454.65
City /State/ZIP: �> Reconnect only 66.85
" G 0 Be I Temporary services or feeders Installation, alteration, and /o
Phone: ( 51 , , -1 • • , Fax: ( ) relocation
200 amps or less 66.85
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75
Owner signature Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
f''`4�'s`P `:� tt:,, t` , r ��c ' r. � i t "�� i =1�^a'+ �f'''s r T : ` i ` r '� r �� ,1•;
,.., �..c3 . l •i. ;I._tFn_ r6w�...- .�u..l.�l.l_.l�wi- ..1.:, � „,SLI .:,!r , ',
. .., .�� ..'�g Lr?
service or feeder fee, each
Business name: _ branch circuit d� A 6.65 13430
Contact name: B, Fee for branch circuits
wtrhout service or feeder fee, 46.85
Address: each branch circuit _
Each add '1 branch circuit 6.65 j
City /State/Z1P: Miscellaneous (service or feeder not Included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 --
Sign or outline lighting 53.40
E - mail: Signal circuit(s) or limited-
. :-, of kh'.4 a,r - ,d17,:J q' ;3: q r , i s, , ^ gg',,���
' LLC 4i m' i f,2 ; > _i_r..td` s 1 3 °`Yi; If seer i t7 ti,.:i . i n " e i , i s ') energy panel' or
T & T Electrical, L
Bus
extension. Describe: Page 2
4120 SE International Way
Add Ste. A105 Each additional Inspection over allowable In any of the abot
Per inspection 62.50
City Milwaukee, OR. 97222 Investigation per hour (i hr min) 62.50
Phol Phone 503/652 -7610 Fax: ( 05) (052.'74c)1 2 industrial plant per hour 73.75
[ 60913 �� �Auf1 ?:';i:,� i ^ y l
CCB Lie.: Electrical Lie.: �. HO
Subtotal 3.4 Suprv. Electrician signature, required: r7/rj P lan review permit fee)
at / /[ i /' (25%
a Date: O g D� State surcharge (8% of permit fee) 7, q.q
• // //. . it TOTAL PERMIT FEE 101 • oti
u onze. signature.
. This permit application expires if a permit is not obtained within Ill
ir days after It has bar accepted es complete
sU � . Dale: of vi 0 • Fee me thodo logy s by Toun Indmtry Service Board
•• Number of inapecdoats et per pe C mul y a ll B owed .
i. NBuilding PerniiApp.doe 17/03 440.4615Tt IOl02/CUWIYER
i
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION _ Business Line: (503) 639 -4171 MST
• BUP
Received / 833 Da Re uested /b /� A PM BUP
Location n J7d'T Ic, Suite MEC
Contact Person Ph ( S P 3) 6•39 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC c;
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain ��
Slab Inspection Notes: l (_Q SIT
Post Beam _
Shear Anchors CZ) QL
Ext Sheath/Shear t�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler P Fi re Alarm P/ /1/4// Susp'd Ceiling f
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
- E CTRIZ`j1L •
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
4� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line J ADA 10 4 --
Approach/Sidewalk
Date ( Insp ec tor
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•