Permit 4 CITY OF T ELECTRICAL PERMIT
gym. NL � ;� DEVELOPMENT SERVICES PERMIT it: ELC98 -0436
__'� ='�L� 13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE ISSUED: 07/30/98
' PARCEL: 1S133DD -04400
i SITE ADDRESS...:11577 SW SHOREVIEW PL
SUBDIVISION •VILLAGE AT SUMMER LAKE PARK 3 ZONING:R -4.5
BLOCK • LOT :083 JURISDICTION: TIG
Pro.j ect Description : Installation of electrical service and 3 branch circuits.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 1 W /SERVICE OR FEEDER: 3 PER INSPECTION • 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
MASSOUD MOLLAGHAFFARI type amount by date recpt
11577 SW SHOREVIEW PL PRMT $ 75.00 DEB 07/30/98 98- 307847
TIGARD OR 97223 5PCT $ 3.75 DEB 07/30/98 98- 307847
Phone #:
Contractor:
MASSOUD MOLLAGHAFFARI $ 78.75 TOTAL
11577 SW SHOREVIEW PL
REQUIRED INSPECTIONS
TIGARD OR 97223 Rough —in Elect' 1 Final
Phone IS: 524 -5578 Elect'1 Service
Reg It..:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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: Or • . ires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 'x'-0010 through w' 952-901 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: (0 �`'� %�C' Issued : : 01 IL;/
OWNER INSTALLATION ONLY
The installation is being made on prope ty I own which is not intended for
sale, lease, or rent. - i
OWNER' S S I GNATURE : _i L/ ,;! '/ ,I ///3"/" DATE: 2- 310 - " J r
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
•
CITY OF tIGARD Electrical Permit Application Plan C eck # A_
13125 SW HALL BLVD. Rec'd 11,0 •
TIGARD OR 97223 Date Recd _?�
Date to P.E.
Phone (503) 639 -4171, x304 Date to DST ...-----'
Inspection (503) 639 -4175 Print or Type Permit # �L - f 04
Fax (503) 684 -7297 Incomplete or illegible will not be accepted Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) M d.IQ )1DL 41
Service included: Items Cost Sum
I
�l '/ I \ per n
Address f'�J' 7 - 7 � /��y ��� � 4a. Residential - pe unit
City /State /Zip -77 A-4. U D 2. C/ 7 2-3 Each additional 500 sq. ft. or
�� ^ 5 - portion thereof $25.00 1
Commercial ❑ Residential Limited Energy $25.00
Each Manuf'd Home or Modular
Dwelling Service or Feeder $68.00 2
2a. Contractor installation only:
(Attach copy of all current licenses) 4b. Services or Feeders
Electrical Contractor Installation, alteration, or relocation p0
200 amps or less $60.00 O' 2
Address 201 amps {0 400 amps $80.00 2
City State Zip 401 amps to 600 amps $120.00 2
Phone No.. • 601 amps to 1000 amps $180.00 2
Job No. Over 1000 amps or volts $340.00 2
Reconnect only $50.00 2
Elec. Cont. Lice. No. Exp.Date
OR State CCB Reg. No. Exp.Date 4c. Temporary Services or Feeders
COT Business Tax or Metro No. Exp.Date Installation, alteration, or relocation
200 amps or less , ,� $50.00 2
201 amps to 400 amps $75.00 2
Signature of Supr. Elec 'n 401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone No.
4d. Branch Circuits
New, alteration or extension per panel
213. For owner installations: a) The fee for branch circuits with
purchase of service or OU
Print Owner's Name 4SSOd b /Y1O AG H F\FFMI feeder fee. � .
Address 1 I s'W' sXOrev,�P p . • Each branch circuit 3 $5.00 2
� � 1 b) The fee for branch circuits
- (s
City -' State D. Zi q 71 2 3 without purchase of
Phone o. 52,1_5 S 7r J service or feeder fee.
First branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circui $5.00 2
intended for sale, lease or rent. 4e. Miscellaneous
/ /j �/ � _� < <
(Service or feeder not included)
Owner's Signature .t s ! Each pump or irrigation circle $40.00 2
Each sign or outline lighting $40.00 2
3. Plan Review section (if required):* Signal circuit(s) or a limited energy
panel, alteration or extension $40.00 2
Minor Labels (10) $100.00
Please check appropriate item and enter fee in section 5B.
4 or more residential units in one structure 4f. Each additional inspection over
Service and feeder 225 amps or more the allowable in any of the above
System over 600 volts nominal Per inspection $35.00
Classified area or structure containing special occupancy Per hour $55.00
as described in N.E.C. Chapter 5 In Plant $55.00
Submit 2 sets of plans with application where any of the above apply. Jr. Fees: 75' °°
Not required for temporary construction services. 5a. Enter total of above fees $ ,
5% Surcharge (.05 X total fees) $ ,
NOTICE • Subtotal $
5b. Enter 25% of line 5a for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if required (Sec.3) $
NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK Subtotal $
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY ❑Trust Account # < D ,-15
TIME AFTER WORK IS COMMENCED. $
Total balance Due
I: \DSTS \ELC96.APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
c.- / t3 7 Date Requested / Er _al — o p
BLD AM PM
� (S
Loca ion . /I5 7 7 JAA-tc -Le&) ,' / Suite MEC
Contact Person - /'l l 44477 / Ph 1''86 6 PLM
Contractor Ph far., SWR �S
BUILDING Tenant/Owner iJ � 36
Retaining Wall ELR
Footing
Foundation S5, _ Q /� �j FPS
Cr Drain 7 x: - ^ 1 w SGN
Crawl Drain nspection s:
Slab y(�,. SIT
Post & Beam /
Ext Sheath /Shear 6Z' Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire Sp . I
Fire Sprinkler IN
Fire Alarm /�
Susp'd Ceiling /
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
T FAIL
( €LECTRI
Service
Low Voltage
Fire Alarm
F e PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk yk?/94e Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
2 �
-Hour Inspection Line: 639 -4175 Business Line: 639 -4171
-- qq
d � 6 Date Requested 45 BUP 9 AM PM BLD
Location l 15 77 S U i c S •/ / ffiSuite / MEC
Contact Person r ,G Ph ,0, 6 PLM
Contractor n c-556 ci "- O Ct/ vl Q_Y Ph S`i2.' I - 3 7 Fr SWR
BUILDING Tenant/Owner afgP QCf_ O C 7 6
Retaining Wall R
Footing Access: ' / r
Foundation �'}'�/' ' �• FPS 411 �
Ftg Drain / SGN f
Crawl Drain Inspection Notes: ' Al 0 (4it,
Slab SIT
Post & Beam edged 1G ar �m Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall ,' - /
Fire Sprinkler S/4 L - wf D Y k-- i�//� D oi c(/ j9 C, ^ "JAS
Fire Alarm �/
Susp'd Ceiling
Roof
Misc: /�
Final n . IS - / � me Y - 4 4 .SS
PASS PART FAIL / - PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL / I
MECHANICAL
Post &Beam C I� e G F C 1— 10 S If `4 K Of / 4 W d` DA 6 I Q l i X o,
Rough In l�0 u G Fci - PDr l..r f
Gas Line U
Smoke Dampers
Final
BASS ''N FAIL
l ELECTRICAL ' J
Service In d
Low Voltage
Fire Alarm ' �`
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk ? /b CJ
Other Date _ ` R Inspector at J &1_r?/�. Ext �'lV�
Final
PASS PART FAIL . DO NOT REMOVE this inspection record from the job site.
ARD BUILDING INSPECTION DIVISION MST
ur Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
7 - 3/ h ? 3.3Date Requested "3" 3 -(11 J AM PM BLD
Location II Ti 50k) 3k�'vii ,GO , L Suite MEC
Contact Person r Ph - e 66(/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC ` ? n 4 G
— o436
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: ,�Q .�� SGN
Slab Po ` � �� SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling ,� / ` /
Roof / GD / 1,0n � i — �c s
Final
Misc: S
v
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
FAIL
Servi
Rough In
I
Low age
Fire } Alarm
PA , PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
A /
Approach/Sidewalk
n 2 1 ,/ 5�
ot oach /Sidewalk
n r Date �,/✓ - Inspector A Ext /1
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .
4 CITY OF T ELECTRICAL PERMIT
gym. NL � ;� DEVELOPMENT SERVICES PERMIT it: ELC98 -0436
__'� ='�L� 13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE ISSUED: 07/30/98
' PARCEL: 1S133DD -04400
i SITE ADDRESS...:11577 SW SHOREVIEW PL
SUBDIVISION •VILLAGE AT SUMMER LAKE PARK 3 ZONING:R -4.5
BLOCK • LOT :083 JURISDICTION: TIG
Pro.j ect Description : Installation of electrical service and 3 branch circuits.
- -- RESIDENTIAL UNIT - - -- -- -TEMP SRVC /FEEDERS - - -- MISCELLANEOUS
1000 SF OR LESS • 0 0 — 200 amp • 0 PUMP /IRRIGATION • 0
EACH ADD'L 500SF...: 0 201 — 400 amp • 0 SIGN /OUT LINE LTG..: 0
LIMITED ENERGY • 0 401 — 600 amp • 0 SIGNAL /PANEL • 0
MANF. HM/ SVC /FDR..: 0 601 +amps -1000 volts.: 0 MINOR LABEL (10)...: 0
- - -- SERVICE /FEEDER - - -- - - -- BRANCH CIRCUITS -- -ADD'L INSPECTIONS-- -
0 — 200 amp • 1 W /SERVICE OR FEEDER: 3 PER INSPECTION • 0
201 — 400 amp • 0 1st W/O SRVC OR FDR.: 0 PER HOUR • 0
401 — 600 amp • 0 EA ADD'L BRNCH CIRC: 0 IN PLANT • 0
601 — 1000 amp • 0 PLAN REVIEW SECTION
1000+ amp /volt • 0 > =4 RES UNITS > 600 VOLT NOMINAL..:
Reconnect only • 0 SVC /FDR >= 225 AMPS..: CLASS AREA /SPEC OCC.:
Owner: FEES
MASSOUD MOLLAGHAFFARI type amount by date recpt
11577 SW SHOREVIEW PL PRMT $ 75.00 DEB 07/30/98 98- 307847
TIGARD OR 97223 5PCT $ 3.75 DEB 07/30/98 98- 307847
Phone #:
Contractor:
MASSOUD MOLLAGHAFFARI $ 78.75 TOTAL
11577 SW SHOREVIEW PL
REQUIRED INSPECTIONS
TIGARD OR 97223 Rough —in Elect' 1 Final
Phone IS: 524 -5578 Elect'1 Service
Reg It..:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon 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: Or • . ires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952 'x'-0010 through w' 952-901 -1987. You may obtain a copy
of these rules or direct questions to OUNC by calling (503)246 -1987.
Permittee Signature: (0 �`'� %�C' Issued : : 01 IL;/
OWNER INSTALLATION ONLY
The installation is being made on prope ty I own which is not intended for
sale, lease, or rent. - i
OWNER' S S I GNATURE : _i L/ ,;! '/ ,I ///3"/" DATE: 2- 310 - " J r
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++