Permit ✓` CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00432
DEVELOPMENT SERVICES DATE ISSUED: 7/16/2004
13125 SW Hall Blvd., Tislard, OR 97223 (503) 639 -4171 ,
PARCEL: 2 S 114 BA -02800
SITE ADDRESS: 09680 SW SERENA WAY
ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.2
BLOCK: LOT : 111 JURISDICTION: TIG
Project Description: Wire for A/C and furnace.
Job # J20391.
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: SIGNAUPANEL:
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: MLT�kLE WEST SIDE ELECTRIC CO INC
9680 SW SERENA WAY 1834 SE 8TH AVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: Phone: 231 -1548
Reg #: LIC 13306
SUP 2663S
FEES ELE 26 -I35c
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 7/16/2004 $53.50
[TAX] 8% State Surcharge 7/16/2004 $4.28
Total $57.78
This Permit is issued subject to the regulations co ntained 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
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: 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit App Relation FOR OFFICE USE ONLY
City of Tigard onie/ / / b - p y �� Permit No.: G i-C„ ZDDy - vo y,�.
13125 SW Hall Blvd., Tigard, OR. 97223 PlrlSt Review
Phone: 503.639.4171 Fax: 503.598.1960 �'^,' " ,,y , l" I + r Other Permit;
Inspection Line: 503.639.4175 , ' Data Ready/By: M RI Sae Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: supplemcotallnformation
TYPE OF WORK jib ., :. ° PLAN REVIEW
❑ New construction Addition /altcrxtion /replac� T� A ) Please check all that apply:
v1 I ❑Service over 225 amps, comm ❑Hazardous lucntioi
El Demolition ID Other: , no nl I ., Di'I9 0 N
C,, ` ,� ['Service uvia• 320 amps rating 0 13uildng over 10,000 sq. tt.,
CATEGORY OF CONS RUCTION of 1- and 2- family dwcIlinga 4 or more new residential
•
1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
• ❑ Multi-family ❑ Master builder ['Building over three stories ❑Feeders, 400 amps or more
_ ❑ Other: °Occupant load over 99 persons ['Manufactured structures or
JOB • SITE INFORMATION AND 'LOCPr11ON ❑Bltress/lighting plan RV park
., t _SG oTritalth-care facility ['Other: .._
Job no.:., � 3c1 ( Job site a '�� 5C , , . vre( L,Jiz � Submit .2. sets of plans with any of the above.
Ci ty ` r .3 /Stale/ZIP: ' C- 7. The above are not applicable to temporary construction service.
C 4 t L _ — , - — FEE' SCHEDULE
Suite/bldgJapt no.: Project name: . ; � _(e ei • D erarpuaa [ Qa. I Fu- I Total J -.
Cross street/directions to job site: New residential single- or multi family dwelling unit.
- Includes attached garage.
1000 sq. ft or less 145.15 _ 4
Subdivision: Lot no.: Fa. add'I 500 sq. R. or portion 33.40 _ 1
• _ Limited energy, residential 75.00 2
'fax map/parcel no.: Limited energy, non-residential ' 75.00 2
DESCRIPTION OF WORK , Each manufactured or modular
A dwelling, service and/or feeder 90.90 _ 2
�,
4 ( `,. ( E✓t Cr 4 Services or feeders installation, alteration, and/or relocatio
200 amps or less 80.30 2
'ROPERTY OWNER 0 TiN1ANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: - .e) i - f 601 amps to 1.000 amps 240.60 2
_ Over 1,000 amps or volts 454.65 2
1
VV'- Reco nnect only 66.85 M 2
City /State/ZIP: Temporney services or feeders installation, alteration, and/or
relocation - Phone: ( f) 14 ( — / - 71 Pte ( ) 200 m _ a or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 401 amps to 600 amps 133.75 2
T
Owner signature; _ Dale: Branch circuits - new, alteration, or esteuslon, per panel
❑ APPLICANT I 0 . CONTACT_ PERSON ' A. Fee for brtunch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit -_
----. B. Fee for branch circuits r
Contact name: without service or feeder fee, I f 46.85 /_ : 2
each branch circuit V
Address: --- Each add'l branch circuit ( _ 6,65 C _/,..S 2
City/State/ZIP: Miscellaneous (service or feeder not Included)
Pump or irrigation circle 53.40 2
Phone: ( ) cox:: ( )
Si RJt or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: WEST SIDE ELECTRIC CO. _ __
Address: 1834 SE 8 AVE. , Each additional inspection over allowable lo any of the above
• per inspection 62 :50
City/State/ZIP: PORTLAND, OR 97214 Investigation per hour (111r thin) 62.50
•
Phone: (503) 231 -)1548 rnx: (503) 736.0677 Industrial plant per hour 73.75
ELEC - rEICAL PERMIT FEES
CCB Lie.: 13306 Electrical Li • 26 -135C Suprv. Lic.: 2663S Subtotal 4 - 5,
Suprv. Electrician signature, required: - Plan review (25% of permit fee)
Prim 7 Z; / 7 // 3/0/./
State surcharge (8% of hermit fee) Lj
TOTAL PERMIT FEE `7r 7 8
Authorized signature: This permit application expires it a permit la not Obtained wltbla 180
dop after It Nix been accepted no complete
Print name: I Date: • Fee metbadoway act by Tri- COw,Iy Building Indumry Service Board
- " Number or iatpections per permit allowed.
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTI ON DIVISION Business—Lin— (503) 639 -4171 MST
(7)
BUP
Received ' ® D to Requested / BUP
Received AM PM BUP
Location '9 -e-a■ Suite C � `F —Cd V74:7
1,
Contact Person . Ph ( ) 7 1/ '.C? 7' t 2 _ PLM
Contractor Ph ( ) SWR '1
BUILDING Tenant/Owner - LC ,- ()C2L( --GP 3 2_
Footing
ELC
Foundation Z
Ftg Drain Access: /��7k/" ELR
Crawl Drain '�I�
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear � O M A
Framing �
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
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
P RT FAIL
E CHAN AL
Post & Beam
Rough-1n
Gas Line
Dampers •
PAS PART FAIL
LECT• AL
Se -
Rough-In
UG /Slab
Low Voltage
€farm
PART FAIL
111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: - Unable to inspect - no access
Fire Supply Line /-
ADA
1 2 Approach/Sidewalk D v Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site..
PASS PART FAIL