Permit C ITY O F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00412
I1� DEVELOPMENT SERVICES DATE ISSUED: 7/8/03
i
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S104AD -03501
SITE ADDRESS: 12820 SW WALNUT ST
ZONING: R - 4.5
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: JOB NO. 23725
Kitchen 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/ FOR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 12 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
LAURA GRAHAM ROSE CITY ELECTRIC CO INC
12820 SW WALNUT ST 4012 NE CULLY BLVD
TIGARD, OR 97223 PORTLAND, OR 97213
Phone: Phone: 287 -6164
Reg #: SUP 2127S
LIC 3567
FEES ELE 26 -113C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/8/03 $160.10
[TAX] 8% State Tax 7/8/03 $12.81 Elect'l Service
Elect'I Final
Total $172.91
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: _jpj
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
`% 'a -
a�
Electrical Permit Application ,� - , FOR OFFICE USE ONi0.Xr
(m 1 ,- !lei Electrical /4
J-1 ' :l,4 PemtitNo.e 4o2DD33 DD y7.
City of Tigard Sign
a : t t , Permit No.:
13125 SW Hall Blvd. ruff .Revic other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 See Page 2 for _� ' g pt t Ra ew , p1p� Land use
G•.. J I Aji „ oh �4 ,4 . . 't . i i . Case No.: t...4 Internet: www.ci.tigard.or.us ' .� ( . P - -,
24 - hour Inspection Request: 503 - 639 - 4175 Name/Method: Su . , Ientental Information.
_, __ , inEIE OF; WORK i BAN. a f i o . . Ittisl:iiclikkalll�tl"uit a ' i .'
New construction ❑ Demolition ■ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
Addition/alterationheplacement ❑ Other: ❑ service over 320 amps of ❑ Building over 10,000 square feet,
' `l l'I 'I I:' .1',6.i'i' ..:'(:A ' GORY, . OP NSTRUCTION: I & 2 family dwellings four or more residential units in
1 & 2- Family dwelling _ Commercial/Industrial ❑ system over 600 votes nominal one structure
ACCCS Building Multi-Pamil ❑ Building over three stories ❑ Feeders, ore amps or more
rY Y ❑Occupant load over 99 persons ❑ Manufactured structu•es or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan 0 Other.
I :'1'..:! .11:: I IPOl ATION. IOC , is Submit acts of plans with any of the above.
Fi e — The above are not applicable to temporary construction service.
Job site address: l 2. S c t :nri 'SMEDULE-
Suite #: I BldgJAt n.#: Number of inspections per permit allowed
Project Nam: y e J/� coil / � Description Qty Pee (ea.) Total i
Cross street/Directions to job site: New residential - single or nmld -tam0y per
dwelling unit. Includes attached garage.
Service included: ,
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft or portion thereat' 33.40 1
Subdivision: 7 Lot #: Limited energy. residential 75.00 2
Limited energy, non residential 75.00 2 I
Tax man /parcel #: Each manufactured home or modular dwelling
DESCRIPTION O ' WQRK service and/or feeder 90.90 2
Services or feeders - Installation,
• alteration or relocation: (��`
200 amps or less 1 80.30 b) _ 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
044) • OWNER : : ;!'•i , I f ❑ TENIANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Yl
Name: a Y I Reconnect only 66.85 2
Address: t2 2.0 `�_. Q,L u, Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip�lgq,t� f Of q7?i � 200 amps or Ices 66.85 1
Phone: �J Fax: 201 amps ID 400 amps 100.30 2
401 to 600 amps 133.75 2
r inaf2ANT Q'cONTACT PEROM.. _
' � Branch circuits - new, alteration, or
Name: extension per panel: ((�
A. Fee for branch circuits with purchase of '/ 7 '
Address: service or feeder fee. each branch circuit _ 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
'
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 — 2
E -mail: Misc.(Service or feeder not included): `
Each pump or irrigation circle 53.40 2
CU CT'
r Each sib err outli ligh tine 53.40 2
Job No b/l a. Signal circuit(s) or a limited energy panel,
Business Name: ROSE CITY ELECTRIC CO IN on, or extolsi on
'pion; Pagel 2
Address: 4012 NE CULLY BLVD
x' URT LAND OR 97213 7 213 Each additional inspection over the allowable In any of the above:
City /State/Zip: Per inspection per hour (min. 1 hour _ 62.50 L
Phone: 503 2 8 7 6164 Fax: 501 2 2 7 1 n h n anon fee:
CCB Lic. #: 3 5 6 7 Lic. #: 26 1 1 'i C i; Elect it ei l alt'' 1 D tJ
Supervising electric Subtotal S _ f
signature required � P lan Review (25% of Permit Fee) $ (Z� ( I
Print Name: R L Co th an I Lic. #: 2127 S State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE S L '72— ( I
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after It has been accepted as complete.
*Fee methodology sct by Teti- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms\ElcPcrmitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
V r,e
Received Date Requested / / /al AM PM , •BUP
Location 282 0 5" �Os /Av r Suite • MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
DIN T enant/Owner ELC
ELC . oo3- oo y�2_,
Foundation Access:
Ftg Drain ELR •
'• Crawl Drain
- Slab Inspection Notes: SIT
POSt & Beam •
Shear
Ext Sheath /Shear
Int Sheath%Shear
`\ ',Framing '
.;Insulation
Drywall Nailing
' Iirewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof •
•
Other: '
AgiDA
SS PART FAIL •
PLUMBING
Post & Beam
Under Slab 1
Rough -In •
Water Service
Sanitary Sewer '
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
T FAIL
�LE,CTRICA
e
Rough -In
UG /Slab
Low Voltage •
Farm
PART FAIL El 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 (04A, , ' CJ�
Approach/Sidewalk Dat Inspector Ext
Other:
Final DO NOT-REMOVEthis inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPEOTION,l,DIVISION Business Line: (503) 639- 4171� �� • MST r oD Vz-/
Received Date Requested L AM L 4 PM d /BUR.
Location _ j G�1 �l-L//� ,
Suite t 1 MEC" 003
Contact Person rlQ. ,G14A 0. Ph ( 9 ) (%1 ELM
Contr. 56 Ph ( ) 7 000-C25
= UILD Tenant/Owner ELC 3 - V/ z-
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain N/00//vrm&70---•
S lab Inspection Notes: - SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear 9
Ina Sheath/Shear —c am , , , / „ „ / ! c� /� `,� f �( C ' n / C
Framing 1Qf /V�� -Gt l// try /J J moo!" /�/ I A
Insulation ,0144/, y ^ � �- / fl47 2 003 00306 ( � ) Drywall ailing �C/ e� (y'
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
G
, � ir EC
G: PART FAIL
s :11■Ce
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
n-
•401 PART FAIL
N L
ost at steam
Rough -In
Gas Line
Smoke Dampers • FAIL
OWE /
Rough- e f' e C /i G �)7 t f / tom / G /lb.
Rough -In l� 'e
UG /Slab
Low Voltage
,..(01 arm
a
PASS PART
111 Reinspection fee of $ required before next inspection. Pay at City-Hall, 13125 SW Hall Blvd.
SITE ❑ Please call fir reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Dat — Inspector Ext
Other:
Final • DO NOT REMOVE this inspection record from thejob site. •
PASS PART FAIL