Permit • r CITY OF TIGARD . .
t
�A"a;� ;� DEVELOPMENT SERVICES . PERMIT * }..
- Ei_C97- X173.1
��i� j lll DATE ISSUED: . 11/04197
:-4— = = A • , . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 .
PARCEL: 1 S 7.36CA - 05:2:0Q1 . ,
SITE ADDRESS... 2111.15 SW 78TH AVE , • V , . ' • -
SU1BDIVISION....:FAIRVAI_E • ZONING sF -4. 5 ...
BLOCK., ... e . . t. LOT, ..... .... , . :005. • JURISDICTION: TIG ,
P'ro .i ect , Description: Install a NO AMp .or less service /feeder and nine (9) branch
circuits to an existing single faaily dwelling. '
- -- RESIDENTIAL UNIT - - - -- ---TEMP SRVC /FEEDERS -= - - -- • ----MISCELLANEOUS-.-----
1000 SF OR LESS - 0 • 0 - - 20171. amp.. : 0 PUMP /IRRIGATION... o : e+.' .
EACH ADD' L 500SF...:' 0 201 - ` 4gt0 amp, e•; .,.: SIGN /OUT LINE `TG..: 0 '
LIMITED= ENERGY ° 0 • - .401 - 00 atop— . ... :. 0 SIGNAL /PANEL..- : -. 0 : . •-
MANF. • HM /. SVC /FDR.. E. 0 . 601-1- amps -1000 volts.: .0 MINOR 1_ADEL (10).... : 0
. - - --- SERVICE /FEEDER• - = - -- ---- DRANCH,CIRCUI'TS- '• - ---_ • -- _ADD ?L .INSPECTIONS - = ---•
0 - 200 amp.....,,, .: 1 W /SERVICE OR FEEDER: 9 ' PER INSPECTION.. — : 0
.201 - 400 amp... . 0 . 1st W /O. SRVC OR FDR.: 0 • PER HOUR., . , ...... : 0 .
401 600 .amp,— . 0 V EA ADD' L B.RNCH C I RO: 0 I N PLANT.... — — — : 0
601 -• 1000 amp.....: 0 - - -- ' PLAN -REVIEW SECTION---- -----
1000+ amp /volt.....: 0 5 =4 RES UNITS.... . . . .: V) 600 VOLT NOMINAL.. i
Reconnect only.....: 0 SVC /FDR > = 225 AMPS..: CLASS AREA /SPEC 0CC.':
Owner4 - ••------- - - - - -- --- ____- ________....____..__. --- • FFS
D ARREN ERICKSON type amount by date' r
1.1115 SW- 78TH AVENUE-- - ___ - _ == PRMT =.$ - 1 I71c,..00 (31- .O__ /.1714_L 7 97 -3.17(171F,E,,F'. — --
T I GA RD OR' 97223 •SPCT $ 5. 12 GEO 11/04/97 97-- 300662
Contractor - •- -- - - - - -• .- • -• -- --- _ •-
OWNER $ 110..25. TOTAL . , • . .
, ' --- - -• - -- REDLY' RED INSPECT IONS ; - •-- •• - - --• -
. . V Rough- -in Elect' 1 Service '
Phone lv: Underground Cove- Elect''l Final
Reg 1..: 999999 ' . . •
•
This pernit is issued subject to the regulations contained in the Tigard municipal Code, State of Oregon Specialty Codes•and'all other .
applicable laws. All .ork will be done in 'accordance,,mith- approved: plans: This pernit Will. expire if work i5,not'started within 180 ,. •
days of issuance, or if work is suspended for core than '180 days, ATTENTION: 'Oregon law requires you to fa1-lew the' rules;, adapted by,'
the Oregon Utility Notification Center. Those, rules are set forth in OAR 952- 01 -0?i10 through OAR 952 -OP1 -!987: Ycu cay obtain a copy '
Of. these rules or direct questions to GUN by calling (503) 46- 1987. - .
Aer'mi %tP'e. Signature : Issued• B y 4. . 4 /. ,
- - -- - .. - -- - `I NST I O N L Y - -- - -t7- - ..- _. _. -7 -_- - -. - .
The instal lation 'is ,k'ieirrg.' Made -.on property': t.property': 'I awn which ',i,s pot i:nte-n:dedfor
gale -,,' - lease, or rent., V .,, .• ' .
OWNER' S SIGNATURE: . . . DATE -
• ------------ CONTRACTOR CONTRACTOR " INSTALLRT'ION''ONLY� -- --. _s_�. - • -_ -; _. _._.....--- .;___._.___._._.__._ •
SIGNATURE.- OF SUPR,. i=!_EC'; N p ,D . /�
sI G z .
___� _ ATE ° f�_ < /
LICENSE NO , - .
+-r• + + + +,F•_F +-6--F- 4- :++ + +-!'-I-+ -1-1 -='•- 1--F-1 1 -0-+- i-- I-- F+++ 44. 1 .{_+-F...}:{:.1- .- 1-.d-4;+ -1 -i -14.4:+- 1- i- i-c!^i- ++4;-: -.4..- .71-1-: { - { - 1-
Call 639--•4175 . b;' 7;100,'6. -.m. .for, an.., needed 'Ihe rent business day . '
•-i+ : -:- +-; ++•++++++ + ++++ + +- i- +.+ +-k. +:F..+f.-_.4 -- +-?-++++ + + + ++-:-•1-+ + + ++ +++ + + + ++ + + + + + ++ ++++-F•-i- +++ +++
i. . . .. .�
CITY OF TIGARD Electrical Permit Application Plan Check #
13125 SW HALL BLVD. Rec'd By •
TIGARD OR 97223 Date Rec'd
Date to P.E.
Phone (503) 639 -4171, x304 Print or Type Date to DST
Inspection (503) 639 -4175 Incomplete or illegible will not be accepted Permit it �� �3/
Fax (503) 684 -7297 Called
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development Number of Inspections per permit allowed
Name (or name of business) `NA u - -t V►'t. C CIS o/) Service included: Items Cost Sum
I
Address tI 1 I ) S S w ^? $ S-F 4a. Residential. per unit
1000 sq. ft. or less $110.00 4
City /State /Zip I i 3 carri o 12 /7 Zz Each additional 500. sq. ft. or
Commercial ❑ Residential L1� portion thereof $25.00 1
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 60 i
Address 200 amps or less $60.00 2
201 amps to 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 •
20Q amps or less $50.00 2
Signature of Supr. Elec'n 201 amps to 400 am $75.00 2
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
License No. Exp.Date see "b" above.
Phone Nc .
4d. Branch Circuits
' New, alteration or extension per panel
2b. For owner installations: a) The fee for branch circuits with 95°
q � (,. purchase of service or
Print Owner's Name_ 1 ) c Pre WI Cr i C/CSO/7 feeder fee.
Address I I I f S S w 11+13 s+ Each branch circuit $5.00 A � 2
Ci Ti o, d St ate (S a Z �Z13 b) T w i t ho for branch circuits
ty qq P q without purchase of
Phone No: 639 -39 6/ or c_e°I1.3r 7$'V 757c 3 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 2
intended for sale, leas or rent. 4e. Miscellaneous
Owner's Signature IL
(Service or feeder not included)
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. 5. Fees: /y{ -
Not required for temporary construction services. 5a. Enter total of above fees $ Ll�'�
5% Surcharge (.05 X'total fees) $
NOTICE Subtotal $ ` J `
5b. Enter.25% of line 5a for •
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 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 1 1 a
TIME AFTER WORK IS COMMENCED. Trust Account #
Total balance Due $
I \DSTS \ELC96 APP Rev 9/96
CITY OF TIGARD BUILDING INSPECTION DIVISION' '
"24 -Hour Inspection Line:: 639-4175 - , . Business Line: 639 -4171 MST
BUP '
Date Requested F 0-7) A M PM BLp
Location ` / //$ 7� Suite MEC
Contact Person / - P,r/` I Ph 4-77 --, g,/ PLM •
Contractor . Ph SWR •
AI BUILDING Tenant/Owner. ELC �
Retaining Wall • . ELR
Footing Access: -
Foundation . FPS -
Ftg Drain -
SGN
Crawl Drain Inspection Notes: V -. _
Slab ' - - SIT
Post & Beam . ' . -
Ext Sheath /Shear • .
Int Sheath /Shear : -
. Framing - V
Insulation
Drywall Nailing
Firewall .
Fire Sprinkler f"
Fire Alarm
Susp'd Ceiling
Roof -
Misc: _... _..
Final — —
PASS PART FAIL
PLUMBING. -
Post & Beam - V
Under Slab - . •
Top Out - .
Water Service
Sanitary Sewer • .
Rain Drains _
Final
PASS PART • FAIL - V
MECHANICAL
Post & Beam
Rough In •
Gas Line
Smoke Dampers
Final
FAIL '
CTRICAL
ervice - •
Rough In - .
- UG /Slab - . '
Low Voltage . .
Fire Alarm �'L
Final
4 :7 4 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 �q .,,,
Other Da te �/ , , IY _ Inspector ■ _ �. _ - Ext
Final V
PASS PART FAIL V DO NOT REMOVE this inspection record from the job site.
•
CITY OF TIGARD BUILDING INSPECTION DIVISION` • MST
24 -Hour Inspection Line: 639 -4175 , . Business Line: 639 -4171
/I_ BUP . • .
Date Requested - 1P/'I /t AM ' PM V . BLD -
Location i I ( S At).--L Suit MEC
Contact. Person V Ph . PLM
Contractor Ph ' •SWR nom►
BUILDING : Tenant/Owner ELC q 7' v l 1
Retaining Wall ELR '
Footing V '
Foundation ACCe Q J�ca G F
Ftg Drain J SGN
Drawl Drain Inspection Notes: I n
Siab. v SIT - •
Post &Beam - k
Ext Sheath /Shear l
Int Sheath /Shear, _
Framing -
Insulation . • -
Drywall Nailing •
Firewall
Fire Sprinkler ( - n/ _.,. a • G 7 o-O
Fire Alarm
Susp'd Ceiling
Roof o //
Misc:. - - _.. , . — lam. ? '
Final -
PASS PART FAIL V V
PLUMBING .
Post & Beam •
Under Slab
Top Out . V _
.
Water Service V •
Sanitary Sewer - '
Rain Drains
Final V
PASS PART FAIL •
MECHANICAL
Post & Beam -
I Rough In V •
Gas Line
Smoke Dampers • _ V
Final -
PASS P FAIL - • V I
ECTR CAL V . .
Service
Rough In • " •
UG /Slab •
Low Voltage .
Fire Alarm .
- ASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer V
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 1 - 3125 SW Hall Blvd
Catch Basin • [ ] Please call for rei spection RE: [ ] Unable to inspect - no access
- Fire Supply Line
ADA ,
Approach /Sidewalk
Date Pizt Inspector Ext
Other
Final ,
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
. • CITY OF TIGARD. INSPECTION DIVISION . • - MST •
• 24 =Hour Inspection Line: 639 -4175 Business Line: 639 -4171. • . •
• BUP •
Date Requested AM PM • BLD. -
Location I I I IS -- ?g - t‘ . ).4-(}42. . Suite MEC •
Contact Person Ph PLM •
•
Contractor p.1 Pant \ rSi/fCa Y \ Ph (D 3q- 3 - ?40 I - SWR .
BUILDING Tenant/Owner - ELC 97-(la
. Retaining Wall - . , ELR
Footing Access: V I C 2 J + FPS •
Foundation - „ S ? „ ^ 1_ - Ci 2 ,
Ftg Drain r(,� 1(�'I " SGN
Crawl Drain Inspection Notes: ,
•
Slab SIT •
Post & Beam
Ext Sheath /Shear ' '
Int Sheath /Shear • '
Framing •
Insulation `
Drywall Nailing • 7 _ _ . / /
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling . 6^ 6
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 - .
FAIL' .
C ,
Service .
Rough In
UG /Slab .
Low Voltage -
�jlarm . . _
•
PASS PART . FAIL '
SITE .
•
Backfill /Grading -
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hail Blvd
Catch Basin
Fire Supply Line' [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk r D Inspector Ext
Final . . • .
PASS PART FAIL DO NOT REMOVE t inspection record fro the job site.