Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00256
411 DEVELOPMENT SERVICES
(503) 639 -4171 RVICES DATE ISSUED: 05/17/2001
- 13125 SW Hall
PARCEL: 2S 104AD -02801
SITE ADDRESS: 12945 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (3) branch circuits for bath remodel.
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: 2 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:
JOHNSON, ERIK SHAWN + HEBERLE ELECTRIC
JEANNINE LYNNE 19680 SW NEUGEBAUER RD
12945 SW WALNUT ST HILLSBORO, OR 97123
TIGARD, OR 97223
Phone: Phone: 503 - 628 -2095
Reg #: SUP 3053S
LIC 42841
ELE 34 -160C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 05/17/2001 $60.15 2720010000( Elect'I Final
5PCT CTR 05/17/2001 $4.81 2720010000(
Total $64.96
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 - 2344.
Permit Signature: 04 0 p , 'a,it A l sei Issued By: - 4 r‘c
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: 0 4 .
Q ,[ C 77 - JY\ DATE: -
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Applicati o i . .
Date received.' /7 0/ Permit no.: - ou,
�' '`Y'I'I'i", City of Tigard ,. Y g RECEIVED ProjecUappl.no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
MAY i 7 2001
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: COMMUNITY egaMIBIT
- TYPE OF I'LItMIC
mar & 2 family dwelling or accessory ❑ ontmercial /industrial U Multi - family ❑ Tenant improvement
U New construction. �ddition/alteration/replacement U Other: ❑ Partial
. JOB SITE INFORMATION
Job add'ess: vi L,I T ck, wfl-li,_),c,i--- -r- ----- Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision:
Project name: gyp} -1-i' I Description and location of work on premises: t1-l; v,� P.--...---4,-:-,___
Estimated date of completion/inspection: •
CONTI1ACTOR APPLICATION :.= ,, . ILE SCHEDULE: is
Job no. NEBERLE ELECTRIC Fee Max
Business name: Description Qty. (ea.) Total no. insp
19680 SW Ne npphauer Road New reesidential - s ormulti- familyper
Address: Hillshnro Oregon 97123 -9446 dwelling unit. Includes attached garage.
City: 1 State: I ZIP: Service Included:
Phone: 628-2095 1 Fax: 628-30 7I(FeEmaii: 1000 sq. ft. or less 4
CCB no.: 4 2 8 41 I Elec. bus. lic. no: 34 - 16 0 C Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: 1072 Limited energy, non- residential 2
— :
- ) — J C - 47 / Each manufactured home or modular dwelling
' : natur ,
'':: rvis' :._'electricia . Date Service and/or feeder 2
p. y L. Hebe Leense no:3053 -5
Services or feeders— installation,
Su ale t): J e f f r e
`' ' 1'1(01'l.RTY OWNER 20 erationo less ocallon:
4
• - 200 amps or less 2
(� t C `' , _ , 201 amps to 400 amps 2
F
-�►�-'r lt_1t'rry 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: S -gtZ3 I Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to Inslallatlon , alteration, orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
• 201 amps to 400 amps 2
Owner's signature: Date: ' 401 to 600 am s 2
ENG IN L' ER Branch circuits - new, alteration,
Name: ' or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
■
City: State: • ZIP: 13. Fee for branch circuits without purchase ////
Phone: Fax: E-mail: of service or feeder fee, first branch circuit: I 'fb.. 2
Each additional branch circuit: O
'''PLAN I4LVIL11'•(Pleilse rli eck• n11. tha ...Z......_.113......, t. • apply) Misc.
U Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of I &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,0(X) square feet four or Signal circuit(s) or a limited energy panel,
U System over 600 volts nominal more residential units in one structure alteration, or extension* 2
U Building over three stories ❑ Feeders, 400 amps or more •Description:
U Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspection over the allowable In any of the above:
U Egress/lightingplan ❑ Other. Per inspection I I 1 I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ 7. 1 �
U Visa U MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: _ ' / / within 180 days alter it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 - 4615 (6100/COM)
PLEASE FAX PERMIT # /RECEIPT TO 50 3 - 628 -3076 ASAP. THANKYOU.
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 Hour- Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested ` 3 AM PM BLD
Location / `J u .1 5 w G/a /y 5f Suite MEC
Contact Person .
Coo Ph 6 7 S o3 ' PLM
Contractor D /4yrer) Coo5 I , Ph SWR
BUILDING Tenant/Owner ELC 0001 -40 1 io
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: /
Slab rim re. yYJa / SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
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
PASS PART. FAIL
JCTRIZ�4,L
Service
Rough In
UG /Slab
Low Voltage
Fire rm •
SS ART 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: I [ ] Unable to in - no access
Other Date
Approach/Sidewalk - � 3/ Inspecto / I - L / /�/� Ext
Final
PASS PART FAIL _ DO NOT REMOVE this inspection record from the job site:
•
$z'
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 • Business Line: 639 -4171
BUP
Date Requested 2' AM PM BLD
Location / Z 7 G ( r , h "` 11 Suite MEC
Contact Person L Ph 7 JZ J v PLM
Contractor e ✓ie CJ�c�YJ Ph SWR
BUILDING Tenant/Owner ELC 'Eva ZS
Retaining Wall ELR
Footing Access:
Foundation FPS •
Ftg Drain SGN
Slab
Crawl Drain Inspection Notes: Gr, & o e► o
SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
_ Framing
Insulation
Drywall Nailing .
Firewall q
Fire Sprinkler
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
PASS PART FAIL
Service
Rough In
UG /Slab
Low Voltage
._ Fire Alarm
r7
' • AS ` . 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 _�n /�/ .,
Otheoach /Sidewalk Date / Y/ l/! I nspec t or C� / L , E x t
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •