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Permit
A„ CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00771 I n DEVELOPMENT SERVICES DATE ISSUED: 12/7/2004 rl II 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 25111 AC -02500 SITE ADDRESS: 09110 SW PINEBROOK ST SUBDIVISION: PINEBROOK TERRACE ZONING: R-4.5 BLOCK: LOT : 066 JURISDICTION: TIG Project Description: (4) branch circuits. Job No. R132806 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: MAYER, JAMES C E J BRIDGEPORT ELECTRIC 9110 SW PINEBROOK ST PO BOX 3037 TIGARD, OR 97223 CLACKAMAS, OR 97015 • Phone: 503 - 639 -9594 Phone: 503 - 969 -8646 Reg #: ELE 3 -593C LIC 160048 FEES SUP 5059S • Description Date Amount Required Inspections [TAX] 8% State Surcharge 12/6/2004 $5.34 [ELPRMT] ELC Permit 12/6/2004 $66.80 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. Speaalty 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 suspe • - • • • - han 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rule - are set forth in 0' ^ •52- 001 -001 • ro g IA 952 - 001 -0100. You may obtain copies of these rules or direct questions OUNC at (503) 24• -6699 or 1.800- 332 -23 •� / � / • Iss ed By: . I � I m mo 4 ' / 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: CON - CTOR N' AL .'TION ONLY SIGNATURE OF SUPR. ELEC'N: . ✓� .1 DATE: / / � LICENSE NO: � / Call 639 -4175 by 7:00pm for an inspection the next business day 31 Z .- 1-4-11-k, 5 L D'= ic b V 4,� C1i ; i e etu -iuu rCa uut. ripput;:uuvu i h'l Cuufl Phone: 503- 846 -3470, Fax: 503- 846 -3993, Inspection Request: 503 - 846 -3699 . lb w 155 N. 1�' A S u i te 350 -12, Hillsboro, OR 97124 www.co.washington.or.us O� ea Land Use Approval: - Project # Permit # "0077/ 1 .: -;INi ..Y -.i0.: '� �+- ..'�..�i� +�+�' New construction Addition/alteration/replacement ' Plasc that llxit that apply: ❑ o �� lacem ❑Service over 225 amps, eanm'1 ❑Hazardous location ❑ Demolition ❑ Other DSavice over 320 amps - rating ❑Buildng over 10,000 sq. f1-; t -g =" r "" :• ' t`° a -s of 1 - and 2 - family dwellings 4 or more new residential K `.a II. '': •, 1. :il .. ,.....,,' r. .i v.- .:�_ :_x : i3c� t. ; : ` .... , `t. .. _1 ['System over 600 volts nil units in one Structure s jg 1- and 2- family dwelling ❑ Connnercialfindustrial ❑ Accessory building ❑Bmidng over three stories °Feeders, 400 amps or more ❑ Multi- family ❑ Master builder . ❑ Other: ['Occupant load over 99 persons ['Manufactured structures or r - _ -. .. ,,s - • DS/Ilg3lmg Plan RV park . h _, .. �:., . ,..g.,(•;-.:.' oHeallh - fia'lity ❑otha� Job no. _ �, 7 Job address: 7 4 r • � j N2(�(Lel�1 4 brit 2 acts of plms with any of the above. q abov are mml to 3 COXSMICt • SCTVICC. • City/State/ZIP: � �b C. ( '7 2 3 - ` ,r._ - Suite/bldgJapt. no.: I Project name: • Inscriptbit Vtr• I. • cur New raldeatld slagle or as lti- faaally - per dwelling unit. Cross street/directions to job site: („ C Include ware footage for attaebed ftarage. . 1,000 sq. ft. or less 150.00 4 Ea. add'I 500 sq. ft. or portion 42.00 Subdivision: I Lot no.: Limited energy, residential 60.00 2 1 no.: Limited energy, multi-family 66.00 2 Tax rrlap/parce Each manufactured or modular 1 _` " - . Y . = . , . dwelling, service and/or feeder 102 00 2 E red Services or feeders iodination, 'heretic., ad/or edocatioa 200 snips or less '4- 90.00 2 201 amps to 400 amps 120.00 2 7 F 2 :3 r • • _ - - 9 17..:r% 401 amiss to 600 amps 180.00 2 t _.� .. _, _ ._ ... a a .. - .- -- - ;''''=": - ,5):1 601 amps to 1,000 amps 270.00 2 Ni_ ne: 3 1 r-. j[ LI Zi lz-4 — Over 1,000 amps or volts 504.00 2 Address: e/ /!cam - 5, tANA , F ive D (Z- Reconnect only 78.00 - 1 Temporary services or feeders lustallatioe, alteration, and/or City /State/ZIP: 7 Art in (L_ c ( . 7 - 2_1-3 relo atbn 200 snips or less 78.00 1 2 Phony (5n3 ) C.5 't - 1.514 I Fax: ( ) 201 amps to 400 snips 108.00 2 Owner Installation: This installation is being made on property that I own, which is not 401 suss to 600 arras I I 150.00 2 intended for sale, lease, rent, or exchange. Breach ea' calls- new, alteration, sr extension, per panel Owner signature: Date: A. Fee for branch circuits with _. �? service or feeder fee, each 8.50 1. t x _ _ • ` . _ _ branch circuit 2 `/ ¢� Business name: B. Fee for branch circuits � �\ 4 j° without service Of feeder fee, I 60•00 SOS Contact name: first branch circuit 2 Each add '1 branch circuit _ 3 sso - J / 5,. 96"--- Address: Miscellaneous (service or feeder net Included) City/State/ZIP: Pump or irrigation circle 60.00 2 Sign or outline lighting 60.00 2 Phone: ( ) I Fax: ( ) Signal circuits) or limited- E energy panel alteration, or 60.00 _ extension. Describe: �, . ' € .li!ii.,i .e; ,� ,-7 . ` 4 s & *1 - S ti ma' . -: r r.:-.4.L.4.. 2 / Isar additional iaspeedoa over allowable la say of the above Business name: A// ) C,- . (LT- E Ce c TR ( Per nspection I 90.00 1 I Address: ./ ->, e0 • Z j p k S Q 3 7 investigation fee (SEE COMPLIANCE) City/State/ZIP: C L 4-G kg- j-t ,4S Q i- Y' Other M . Phone: (St y, 9 — % C Y 104 Fax: ( ) Subtotal S l G• a o Lic. no.: 3-513 G + 5 //I( ccB tic. no.: ) d o Lf Plan review (25% of perm it fee) S 95 Supervising electrician , , PI(' ' State surcharge ( 8% � ) of t fee S 6; g signature, requited: 'v +� S c.3Tr C R, eiN e L c. A TOTAL PERMIT FEE S �7 Print name: Dat e: / a I C` � / rid perms application expires If a parade b ace Acetate Authorized I / I d 1 within 190 days after it bat a been accepted as complete signature: ✓ • 0� 111 • Fee st by Tri -Con ty Bu Industry service Bond Print name: -i- .,rr Date: l ©z� •• Numtmer of i ecpectiws a[bwed pet permit. �J ri g 440-4615T (7/03/COM/WEB) . CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (50 639 -4175 MST INSPECTION DIVISION Business Line: - d 3) 639 -4171 , BUP Received Date Requested / D. "1" AM PM BUP Location I i ' Suite MECOO - O A R Contact Person _ . . . • -' •h ( ) 3 c2 - q3 PLM Contractor s 6r;- Ph ( ) SWR BUILDING Tenant/Owner ELC aOO � f -.06'7 7/ Footing ELC Foundation Ftg Drain Access: 1.} t'n °"n' 1' 1 ELR Crawl Drain slab Inspection Notes: i SIT Post & Beam C�i! G - -7J Shear Anchors Ext Sheath/Shear � ; G a Ina Sheath /Shear l'<-k... e P #4i 3 U i / � Framing t/-�1`�Y Drywall ll Nailing '�v Dryll Nailing 17x1 !T M /T/ 30 Firewall Sp rinkler Fire M Aft A Sprinkler Fire Alarm Susp'd Ceiling Roof Other: ��-� •�p Anal 4e: t R;i'-- F P l s 2/4sT L-l� i'i PASS PART FAIL PLUMBING .S c-- T A-c /‹.. - f _ < L- Post & Beam Under Slab - Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan 01, 1/1" Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers PASS PA - ELECTRICAL Service Rough -In UG/Slab Low Voltage ,.. .Eice.Alarm PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. i ile ❑ Please call for reinspection RE: 0 Unable to inspect - no access Fire Supply Line ) l ADA r) Approach/Sidewalk Date IL I • v inspector v. , Ext Other: Final DO NOT REMOVE this inspection recor t h . m the Job site. PASS PART . FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line:. (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST / BUP Received Date Requested ` a/ d AM PM BUP Location W/ 2) /�-Z Y v? 44-4---k- -) . Suite (i a —00 gag Contact Person Ph ( ) 4 PLM Contractor Ph ( ) SWR BUILDING Tenant/ Ra 9- Malell q p / EL� ° L i - C ' c ' 9 7 f Footing 639 S [ lF ELC` Foundation Access: Ftg Drain ~/ � '' /t' /fG iq �9 e C. i V/ L / /�'ELR Crawl Drain C, a , 0 SIT Slab Inspection Notes: 1 Post & Beam - -- ___ Shear Anchors `/1 / a - 4 Ext Sheath/Shear �`t' f Int Sheath/Shear /�� t --II Framing , y r'L �� Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: (.., Final PASS PART FAIL V PLUMBING Post & Beam Under Slab 1 Rough -In • Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PA BART FAIL ,, AL Post & Beam Rough -In Gas Line Smoke Dampers n '( PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: 111 Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date L /d ' v Inspector * Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL