Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00085
DEVELOPMENT SERVICES DATE ISSUED: 2/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 103 CA -04900
SITE ADDRESS: 11550 SW TERRACE TRAILS DR
SUBDIVISION: TERRACE TRAILS ZONING: R -4.5
BLOCK: 006 ' a . 1-1 1 085 LOT : 003 JURISDICTION: TIG
Project Description: l +al( (2) CIrcM,ift 5-Dr rteassa4 !ram 4 A /Ace_ irt,sert.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS 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: 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:
BLACK, GAROLD R NANCY E WEST SIDE ELECTRIC CO INC
11550 SW TERRACE TRAILS DR 1834.SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Phone: 231 - 1548
Reg #: LIC 13306
SUP 1556s
FEES ELE 26 -135c
Description Date Amount
Required Inspections
[TAX] 8% State Tax 2/21/03 $4.28
[ELPRMT] ELC Permit 2/21/03 $53.50 Rough -in
Elect'I Final
Total $57.78
•
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: Permit Signature: rid f -R/°Z 1 _ -,\ /
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
.
e gi-
Electrical Peg' z• . ; L IA Lion OFFICE USE ONLY
Date reecivrd: L5 Pe rmit flu.' ..d Zo 403'" 0 OW.5
„L City of TigarP (� (� 3 l'mject/appl. no.: Expire date -
Address; 13125 SW Hall Blvf glan Olt "; 23 p
c.rty ,.J/rgrrrA Date issued: -
nut.:
Phone: (503) 639 -4171 TIGARp
Fax: (503) 59t -1960 ca‘( OF 0 j siO C ase tile Itu,: Payment typo:
tr31�l� -
Land use approval: OING
TYPE OF PERMIT
►t & 2 family dwelling or accessory CJ Commercial/industrial U Multi- family U Tenant improvement
i . New construction U Addition /altcration/replaccment 0 Other, _ U Partial
JOB SITE INFORMATION
• lob address: 0 1_, l �ro. kip,. ; S 0'. Bldg. nu.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: 4, . W r . l o 4 !Description and location of work un premises: r 1 ,1-7"(---.
Estimated date of completion/inspection: , - ,1 r pt4v
CONTRA(TOR APPLICATION FEE SCHEDULE
Job no: J c-40
Feet Max
Business name: r /, Description Oty. (ea.) Total no. inrp
ec trL �o -
Address: 1 i 4. 5 . Y , • • I . Ne+ vr�fdcnlial- H11h�1eprmalB.Grtnityper
• Jw ellinguuit .Includecartached,ptrage.
('.ily: �G r�` Stale: i,Q ZIP; 4 /7Z1 ( -I -- 4:ervieciadaded:
Pltuuc:7 _ r x:736- r ,7 4 ,E-mail: ttxx) sq. ft. or to s
J � _ 4
C C13 no.: Elec. buy, tic. no: , - ' additional 5(x) sq. ft. or portion mentor 7_G • l 3S
1•irnileJ energy, residential •
City/ ro 1 • 0_: �. .
I•in,irtx) cncn ,y, norm csidu,liat 2
(ijp 3 Each nsmufacluruf hums or modular dwelling
Signal or tOrr' electrician (required) bait: Service and/or feeder 2
Sup. elm. u;une (print): 1 ,. " s e _ Z , ,, License no: 766 Sk Serriecsor feeders - iarlallation,
•
)PROPERTY OWNER alterali000r
200 amp or less 2
Name (print): ( a � _ [ , 7,01 amps m floe a►n,tr _
_ 2
900 Mailing address; a l - — /est • �.. ( 0 . our amps to 900 a ps 7
City: y: S41tC: %(P: G) Pm amps to 1 1 amps 2
7 3 Over tune amps or volts " z
Phone: <i_t„.Z .14 Fax; E-mail: RMOnucs :r only '
Owner installation: The installation is being made on property I own Temporary icesorfe t
which is not intended for sale, lea, rent, or exchange according to InSt*ilaIlon.allention.orreto (ion:
se
ORS 447. 455, 479, 670, 701. 200 amps or Ices 2
201 amisto400amx
Owner's signatory: _ Date: 2
401 act (�00 amps
ENGINEER Branch circuity - flew, alteration.
Name: or extension per panel:
A. roe for branch circuits with putt]wse of
service to rrriler fee, rx hl:i„ch circuit 2
City: - I State: I ZIP: lt. roc far branch Ciltauils withcud ,d,rthnsc /
or scrt•itr. or feeler fee. first hr hell cirwit: 1 �Vt 4S 2
Phone: Fax: E-mail:
PLAN REVIEW ( t•,;tch addition,,l branch eirouit: t ,
Please check all that apply) min. (service or feeder no t included):
O Service over 225 amps- conuhunjal U Hcilni -care facility Fad, pump or irrigation sin :lu 2
C) S,xvice over 320 amps- rJlinx ii 16:t2 0 I Hazardous location tch Six'. nr outline lighting - 2
family dwelling. 0 Buildity, over 10,00) square feet Lour or signal ciavii(s) or a limited cnc, ,
O System over G00 vnits rtotniurl mom residental emits in one structure alteration, or extension* Ny panel,
U Ruiklin)g over Ilfen aloricc U Fccdc . 400 snub: — z
car more •Descriptinie
U occupant had ova 99 pcusonS U Manufactured structures or 1W park — . v •
— Lath additional inspec4ionovertheagowableinwnyofthealroe:
❑ i'gress/tigining plan 0 01 hen
rer inspection - -
Submit _ seta of plans with any of the above.
ill vtrtiF(ttio,r Irr.
The above are not applicable to temporary construction service. Other
r Nnt all jurisdiuione accept crtylit yards, please wall jurisdiction fur mum ioformatinn.‘ Permit FCC $ c 3 , � O
Ncuico: T},is permit rthil application
U Visa U MasterCard
expires if a Plan revie (at
Credit cord ,q. „n,Rr P permit is not obtained ( _ %) $ _ —
- - / within 180 days after it has berms State surcharge (8 %) $ __ t - '..� $
Expires acce as complelc. TOTA
Name ni rxudltulder ns shown on credit gad $ 7. 7 g
Cudl.hirr ,imam„. S Arno=
440 -4GI5 (6100 /(.0M)
2'el LL90 9EL (E0S) •03 ot.12.0ai3 apiS 2 e21:80 CO ST qa3