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12580 SW KAREN ST
CITY OF TIGARD ELECTRICAL PERMIT
t PERMIT#: ELC2004-00344
DEVELOPMENT SERVICES DATE ISSUED: 6/11/2004
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S104AA-03800
SITE ADDRESS: 12580 SW KAREN ST
ZONING: R-4.5
SUBDIVISION: BELLWOOD
BLOCK: LOT: 028 JURISDICTION: TIG
Project Description: Installation of(1)branch circuit for hot tub.
RESIDENTIAL UNIT i EMP 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 HMI 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: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amphiolt: >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
STEVE SUTTON OLIVERS PRECISION ELECTRIC CO
12580 SW KAREN 17035 SW HIGH HILL LN
TIGARD,OR 97223 BEAVERTON,OR 97007
Phone: 503-590-2936 Phone: 503-579-7747
Reg #: LIC 41435
SUP 2539s
FEES E,.E 34-5210
Description Date Amount
_ Required Inspections
11 I.I'RMTj ELC Permit 6/11/2004 $46.85
IA X 18%State SUrcharge 6/11/2004 $3.75 Rough-in
F
1 1 1'RMTj Imestiga0on 6/11/2004 $46.85 Elecctt''/l Final
Total $97.45
This Permit is issued subject to the regulations contained in the Tigattl Municipal Code.State of OR Specialty Codes and all other applicable laws
All work will be done in accordance with app oved 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 foAtwaLl6_R 952-001-0010 through OAR 952-001-0100 You may obtain copies of these rules or direct questions to OUNC at(503)
246-6699 of 1-$00-332.2
Permi Signature:
Issue�By: 9
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:-1� �-'
�3T
LICENSE NO: -- -
Call 639-4175 by 7:00pm for an inspection the next business day
T
Electr ed Permit Application
Date received: Permit no.:
City of Tigard Project/appl.no.., Ex ire c ale:
City(if T;ard Address: 13125 SW Hall Blvd,Tigard,OR 97223 'Date issued: H�: Receipt no.:
Phone: (503) 639-4171 - r
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
li➢,l &2 family dwelling or accessory U Commercial/indust-ial U Multi-family U'tenant improvement
U New construction U Addition/alteration/replacement U Other: _ U Partial
Joh address: Z-SFCU S 1— A::.r Bldg.no.: Suite no.:_ 'tax map/tax lot/accounl no.:
Bhxkms_ Subdivision: -
Project name:yup _ Description and location of work on premises: j} Milt
Estimated date of complellon/ins pection:
Job no: Fee Max
Business name. s % r _ Descri tion Qty- (ea.) !'0121 no.ins
it ti It-
New tealdewtlal• k or trrehi-(sully per
Address: 17,0!3,3- :TIJ MicI _ awe111rrgrelt.Indo
rJartachedgarage.
City: -, State:t)R Zip: ) ServiveMrcladed
Phone:SV 3 s 9j ) Fax: 5 75 510 E-mail:o7 Cl i'/ p ,P IINNI sq ft.or less Y 4
Hach additional Soo s .ft.or portion thereof
CCB no.: q/ j S— Elecbus.lic,no: • q-Sx.l (0-- Limited energy,residential 2
City/metrolic.no.: dit Limited energy,non-residential _ 2
Each manufactured home or modular dwelling
�- " - Service and/or feeder 2
Signature of supervising electrician(required) I)ate� j
Sup.elect.name(pmtint), License no, C J cesorfeeders-indalleiIon,
tlon orrelocation:
mps or less Z
Name 1print): 5T mps a,41x)nmps�� mps to 600 amps '_Mailing address: _ mps to 1000 amps z
('ity: � � Slag 7_IP'. Y Over 101x1 amps or volts- -� —— 2
Phone:�;e, ZciIm, Fax: - - E-mail: Reconneetonl - - i
Owner installation:The installation is being made on property I own Temponryservlcdorfeeders
which is not intended for sale,lease,rent,or exchange according to insla mps(it■Neratlon,orrclocaeon:
ORS 447.455,479,670,701. 2Wamps to 4W - 2
2111 amps to 4(1(1 amps _ ?
Owticr's signature: Date: 401 to 600 ams 2
Branch circuits-new,alteration,
or extension per panel:
Name: A Fee for branch circuits with purchase of
Address: set vice(ir feeder fee,each branch circuit _ 2
City: Stale: LIP: 0 Fee t)r branch circuits without purchase )
----- --- - of,ervice or feeder fee.first branch circuit,-TI
ircuit, 2
Phone: Fax: E-nrtil:—
Fac!i additional branch circuit
lythe.(Service or feevier not Included):
U Service over 22.5 amps-commercial U Health-care facility Fach pump or irrigation circle 2
U Service over 120 mops-rating of 1&2 U Hazardous location Fach sign or outline lighting _ 2
family dwellings U Building over 10.000 square feet four or Signal circuit(sI or a litnited energy panel.
U System over 600 volts nominal more residential units in one structure alteration,or extension' __ Y 2
U Building over three stories U Feeders,400 amps or more •Ikscri tion:
U Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable In any of the above:
U Egre-Mightingplan U Other I let Inspection
Submit_—sets of plans with any of the above. 01 M%ligauon fee.
The above are not applicable to temporary construction service. izw: -__. --- - -------
^Ln all junrdictitxrr crept credit cards,please call jurisdiction for mere inlixrroatim Notice:'Ibis permit application Permit
J Vi^a I1144dsteerrCard expires if a permit is not obtained
irdn raid nuntlie'r l r� fi k�C Ile i�Lt within 180 days aller it has been State surcharge (R`7r) 4 ''f
`Name nr�rjtir l er Expires TOTAL ..............._......R - __�'_
accepted as complete. --
o as drawn mt credit Gird �
Crrnlholder signature Amount � � �G� 4404615(6AM'e1M1
Electrical Permit Application
rlDjatceived:4y / I Permit no.:
City of Tigard Pro.iect/appl.no.: __— Ex ire dale: — —
Cit gof Fi0 and Address: 13125 SW Hall Blvd,'rigard,OR 47221Date issued B keceipt no..
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payinent type
Land use approval: _.
Til l & 2 fancily dwelling or accessory U Commercial/industrial U Multi-family U Tenant iniproven)ent
J New construction U Addilion/alteration/replacetenl ;.J Other: - U Partial
.1011 S1 I F.INI-ORNI'Vi ION
Joh address: `SFu S i`� l)CA12.Liv —_ Blde. ntr.: Suite nu.: Tux reap/tax lot/account no.
Lot: Bkwk: _ Subdivision: __..-
Project name.s { r — rDescription and location of work on premises:
Estimated date of cot tletion/inspe.clton.
Job no: �1 _ I"� Max
J�1 y ly'1�ee a
Description CIY (ea.) Total na.ins
Business name: �,�
New residential-IYs6k or muhhfamlly per
Address: L76 3 — :5k) &1 dwelling unit.lnckWm attached prow.
City: Stale:()P_ ZII': l�'�,� Servicehiclut":
Phone:
`I y Fax: I(11r%q rrorless �
_ -- _-. _—
Hach additional 500 sq,li.or portion then of _
CCB no.: / 3 r- Elec. bus. hc. no: �/ S�1 '("— 2
Limited energy,residential
City/irrietrolic.no.: Limited energy,non-residential '- _
YY� Each manufactured home or modular dwelling
Signa' tune of supervising electrician trey rcd) Uate _ Service and/or feeder _
Sup elect.nanre(print r License no: J Serrlmorfeeden-installation,
alteration or relocation:
20(1 amps or less
201amp%to 400 amps 2
Name(print): `-�fC �� 2
_. 401 amps to 600 amps
Mailing address: ry,,, �. _ _ 601 amps to 1000 amps 2 —
City: ?1. —^ Slal ZIP: over I000 amps or volts '-
Phone: ;r, - '2!C13t, Fax: E-mail: Reconnectonly I
Owner installation:The installation is Icing made on property I own 'remporary,servicer or feeders-
which is not intended for sale,least,,rent,or rxrha+age according Itt
instailadon,alteration,or relocation:
'nn amps or less 2
ORS 447,455,479.670,701. 201 amps to 400 amps 2M
Owner's signature: Date: to i t„rnu ams — 2
Branch circuits-new,alteration,
or extension per panel:
Name: —_ A I•ee for branch r ircuits with purchase of
Addr,ss: service or feed4 r fee,each branch circuit 2
City: Stale: ZIP: i B Fee for branch,ircuits without purchase
of service or feeder fee,first branch circuit: 2
Phone: Fax: E-(nail: Fath additional branch circuit.
Misc.(mice or feeder not included):
❑Service over 225 amps-commercial U Health-care facdity Each pump or irrigation circle 2
Each sign or outline fighting 2
U Service over 320 amps-rating of 1&2 U Hazardous location d? g g —
femily dwellings U Building over 10,0100 square feet four or Signal circuit(s)or a limited energy panel.
U Systrm 0 over 6 0 volts nommal more residential units in one structure alteration,or extension• 2 _
U Building over three stories U Feeders,400 amps or more *Description
U Occupant Ionil over 99 persons U Manufactured structures or RV park Each additional inapertion over the allowable In any of the above:
U F.gress/hghhngplan U tither -__ pet Inspection
Submit_-sets of plan+with any of the above. Investigation fee
The above are not applicable to temporary construction service. _ Other _
Penni e
Not all junwticlioru accept credit cants,please call jurisdiction fa rtkxe inkimratiar Notice: 11lis permit application 1#41
U Visa y21masterCard expires if a permi!is not obtained Plan PCy
f e fel 1 c within 18(1 days atter it has been State surcharge(8%1 ....$ _. 7
('relit cud numlKr (i-�__._1—Z S�__ J'1 y
tixpires TOTAL. ....................... �-
�,wtq;�,� tl ecceptedascomplete. [/
Nana n0 Fuphnlder u shown nn credit cid i `` (}' � �7 T S
-- — 4-r).u,I S t hAM'I)M 1
Cardholder sitinanue Amount
i CITY OF TIGARD MASTER PERMIT
I
DEVELOPMENT SERVICES DATEISS TI4 00078
ED: 5/3 2004
13125 SW Hall Blvd.,Tigard,OR 97223 (503)6394171
SITE ADDRESS: 12580 SW KAREN ST PARCEL: 2S1f'4AA-03800
SUBDIVISION: BELLWOOD ZONING: 1�-4 5
BLOCK: LOT: 028 JURISDICTION: TIG
REMARKS: Replace existing covered patio with new sunroom.
BUILDING
REISSUE. CUSTOM STORIES FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: a FIRST: of BASEMENT: at LEFT: 5 SMOKE DETECTORS v
TYPE OF USE: SF FLOOR LOAD- 40 SECOND at GARAGE: at FRONT: .'0 PARKING SPACES: 2
TYPE OF CONST. 5N DWELLING UNITS: 1 THIRD sf RIGHT: 5
OCVALUE: 36.000,00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: n if REAR: 15
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: RAPS:
LAVATORIES: DISHWASHER6: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATC'I BASINS:
TUSISHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GRE/.SE TRAPS:
OTHER FIXTURES:
MECHANICAL _
_ FUEL TYPES FURN<100K: BOIL/CMP<3HP: VENT FANS: CLOTHES DRYER:
FURN>=100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS JUTLETS:
ELECTRICAL
RESIDENTIAL UNIT _SERVICE FEEDER TEMP SRVC/FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS, 0 - 200 amp: 0 - 200 amp: WISVC OR FDR: PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500Sr: 201 - 400 amp: 201 - 400 amp. 1st WIOsvoron SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 600 amp: FA ADDL 9i CIR SIGNAUPANt•_. IN PLANT:
MANU HMISVCIFDR: 601 1000 amp: 601+ampa•1000v: MINOR LABEL:
1000.amp/volt
PLAN REVIEW SECTION
Reconnect only -4 RES UNITS SVCIFDR> 225 A. >600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL.REST RICTED ENERGY
A.SF'RESIDENTIAL B.COMMERCIAL
AUDIO B STEREO VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOM/PAGING OUTDOOR LNDSC LT
BURGLAR ALARM: OTW BOILER HVAC: LANDSCAPE/IRRIG. PROTECTIVE SIGNI_:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL OTHR:
HVAC DATATELE COMM: NURSE CALLS: TOTAL.0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 723.43
This permit is subject to the regulations contained in the
STEVE SUTTON PATIO INNOVATIONS,INC Tigard Municipal Code,State of OR Specialty Codes
12580 SW KAREN 5320 NE SANDY and all other applicable laws All work will be done in
TIGARD,012 97223 1 ORTLAND, OR 97213 accordance with approved plans This permit will expire
if work is not started within 180 days it issuance,or If the
work is suspended for more than 11`0 days
Phone: 503_590-2936 Phone. FAX 282-1426 ATTENTION Oregon law requires you to follow rules
Reg 0: �11
adopted by the Oregon Utility Notification Center Those
240121345 rules are set forth in OAR 952-001-0010 through
952-001-0080 You may obtain copies of these rules or
direct questions to OUNC by calling (503)246-1987
REQUIRED INSPECTIONS
Fooling Insp
Electrical Rough In
Framing Insp
Electrical Final
fFnspectinor
By : ` Permittee Signature
Call (503)630"4175 by 7:00 p.m. for an inspection needed the next business day
! Buildinp- Permit Application ,
City of Tigard S ��i�,Aed Pem,it No.
13125 SW Hall Blvd.,Tigard,OR 97223 0� Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Datc/B $ u,l:^r Permit:
Inspection Line: 503.639.4175 ate Readymy Jurir ® See Attached Checklist for
Internet: www.ci.tigard,or.us e.d/Method: Supplemental rnformatlon
TYPE OF WORK REQUIRED DATA: I-AND 2-FAMILY DWELLING
❑New construction r❑ Dernolition Permit fees"are based on the vale^of the work performed.
Indicate the value(rounded to the n,tarest dollar)of all
Addition/altctation/replacement ❑Other: J — equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation:
I-and 2-family dwelling
❑Commercial/im ustrial
Number of bedrooms:
[1 Accessory building ❑Multi-family
- -- — Number of bathrooms:
❑ Master builder ❑Other:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: �j 5 f-{?./1 New dwelling area: square tett
City/State/ZIP: , )( Ci-7� 3 Garage/carport area: square feet
r --
Suite/bldg./apt.no.: P1 ect name: A+4.c,Y..-, Covered porch area: square feet
Cross street/directions to job site: neck area: square feet
kny f?r, C I Z-7 t Other structure area, square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees'arc based on the value of the work performed.
Indicate the value(tounded to the nearest dollar)cf all
Tax map/parcel no.: F�o 3 [ equipment,materia s,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on tiis application.
Valuation: $
Existing building area: square feet
�- New building area: square feet
PROPERTY OWNER ❑ TENANT Number of stories:
Name: ��� (� _-- Type of construction:
Address: Occupancy groups:
City/State/ZIP: +C �, ) q-7 3 Existing:
Phone:(%;n) tj( 1( - l(} 3 Fax:( ) New:
APPLICANT NTACT PERSON - —
_ NOTICE
�a `` { All contractors and subcontractors are required to be
Business name:
Get , V Lr rv,Jc� 1ie� r t
licensed with the Oregon Construction Contra,aors Board
Contact name: Yln�( K ('_ _i__� under ORS 701 and may be required to be licensed in the
Address: A-j► e,\ jurisdiction in which work is being performed.If the
City/State/ZIP: -7-7 V-) (2, C1 '-] 2_ 1 3 applicant is exempt from licensing,the following reasons
_apply:
Phone:(56' ) ZS —_�, t Fax: :(fj 35) -e gv1 - Ll I�, _
E-mail: �.� t �, '_C ;, 1L t� -
CONTRACTOR
Business name: BUILDING PERMIT FrES•
Address: _- Please reefer to fee schedule
City/State/ZIP: _ --7 7
Fees due upon application
Phone:( ) Fax:( ) ---- i
Amount received
CCB tic: t,'Z-7
-- Date received:
Authorized signature: / J` This permit application expires If a permit is not obtained
__ within 180 days after It has been accepted as complete.
Print name: - lj,��' bate: c' • Fee methodology set by Tri-County Building Industry
— Service Board.
itBuildinatPermiu\aUP•Pernd1Appdoc 12/03 440.4613T(II102/COM/WEB)
Building Division
Plan Submittal Requirement Matrix
Commercial & Multi-Family - New, Additions or Alterations
City of T4ard
Type of Submittal # of Plans
(Includes new,additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 2
(must include location of all accessible parking)
Plumbing(site utilities) 2
Building 1
Fire Protection System 3**
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to icclucst
additional sets of plans for distribution purposes (for contractor, City of Tigard,
Washington County, and Tualatin Valley Fire & Rescue)
* For over-the-counter commercial tenant improvements, submit 2 sets of plans.
** "New" lire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "Y technicians.
i:iBuilding\Forms\COM-PlmiSuhReq.dnc 12/24/01
Electrical Permit Apt�lStlon Qty
City of Tigard eceived Permit No, ?" �d7$1
�) Date/B
13125 SW Hall Blvd.,Tigard,OR 97223 �`GP� Plan Review
(�\ —
Phone: 503.639.4171 Fax: 503.598.1960 ��( O Date/By: Other Permit:
O1�1'
Inspection Line: 503.639.4175 v`L�\N4 Date Ready/By mra ® see Page t for
Internet: wwwci.tigard.or.us Notirted/Method Supplementallnl'ormution
--�T TYPE OF WORK PLAN REVIEW
❑ New construction AdditiotUalterationireplacement Please check all that apply:
❑D
❑
Demolition Other Service over 225 amps,comm'I ❑hazardous location Y ❑Se,vit a mover 320 amps-rating ❑Buildng over 10,000 sq.t't.,
CATEGORY OF CONaTRUCTION of 1-and 24,;rvly dwellings 4 or more new residential
❑ I-and 2-family dwelling []Commercial,industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi-family ❑ Master builder ❑Other ❑Built:mg over three stories ❑Feeders,400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB S, INFORMATION AND LOCATION. , �`-' ❑Egress/lighting plan RV park
LL'^ ❑Health-care t:uiltty [:]other
Job no.: Job site address: _
Z 1519 C �1 W T`Cir C t 1 Submit 1 sets of plans with any of the above
City/State/ZIP: The above are not applicable to temporary construction service
7 .
� ---- EEE* SCHEDULE
Suite/bldg./apt.no.: Project name: --- -- ,.
__. Description - Qty. Fee. Total
Cross street/directions to job site: New residential single-or multi-family dwelling unit.
- Includes attached garage.
1,000 sq.ft.or less -�— 145.15 4
Subdivision: Lot no.: Ea.add'I 500 sq.ft.or portion 33.40 1
Limited energy,residential 75.00 7.
Tax map/parcel no Limited energy,non-residential 75.00 2
ARMEach manufactured or modular
- -
dwelling,service and/or feeder 90.90
LA,_)IServices or feeders Installation,alteration,and/or relocation
- -----
200 amps or less 80.30 2
Y dWNER _!__y El TENANT 201 amps to 400 amps 106,85 2
G 401 amps to 600 amps 160.60 2
Nettle: 601 amps to 1,000 amps 240.60 2
Address: — Over 1,000 amps or volts 454.155 2
Reconnect only 66.85 1 2
City/State/ZwIr ,r4 1 014 r Temporary services or feeders installation,alteration,and/or
Phone:(c)O$) 2C 3(, Fax:( ) ---- _- relocation
200 amps or less 66.85 1
OwnetWItallation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps 133.75 2
Owner signature: _1' Date: Branch circuits-new,alteration,or extension,per panel
CONTACT1rFRSON A.Fee for branch circuits with
service or feeder fee,each
6.65 2
Business name: branch circuit
---- B.Fee for branch circuits
Contact name: without service or feeder fee,
-� each branch circuit 46.85 2
1
Address: _ Each add'1 branch circuit 6.65 2
City/State/ZIP: — Mlscellaneous(service or feeder not Included)
( ) ( ) Pump or irrigation circle 53.40 2
Phone:
Fax' ' _ Sign or outline lighting 53 40 2
E-mail. Signal circuit(s)or limited-
;re->
i ";r, energy panel,alteration,or
_ extension.Describe- Page 2 2
Business name:
Address: Each additional Inspection over allowable In any of the above
— Per inspection 62.50
City/State/ZIP: C� ( `'�— Investigation per hour(I hr min) 62.50
_4
Industrial plant pet hour 73 75�___��
Phone:(7y l) vj�r(- - so Fax:( ) ELECTRICAL, PERMIT FEW
CCB Lic.NXElectrical Lic.: �y Suprv.Lic.: j Subtotal
Suprv.Electricil's'iWaktie,required: l� /,P/'/ Plan review(25%of permit fee)
Print name: Date: State surcharge(8%of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires If a permit Is not obtained within 190
days after It has been accepted as complete
Print name:'tD I 1 `Y)Oc.-_ Date: 3- I , (� Fee methodology set by'rri•County Building Industry Service Board
Number of inspections per permit allowed.
i'Building,PerrnhfiELC•PeriotAppdoc 12/07 1 110.4613T(IOI03/COM/wEa
il}
Electrical Permit Applicition - City of Tigard
Pape 2 - Supplemental Infr,rmation
LIMITED ENERGY PERMIT FEES:
_ItESIDENTIAI,WORK ONLY: _
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other: _
COMMERCIAL WORX.ONLY:
Fee for each commercial system....................... $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ }'ire Alarm Installation
❑ FIVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
Nurse Cally
❑ Outdoor Landscape Lighting*
L] Protective Signaling
❑ Other
Total number of curnmercial sv ctenrs:
*No licenses are required. I irenses are required
for all other installation,
i\Dw1dmg\Pe"ws\BLGPeMtAPP dx 04,07
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GORGE ELECTRIC INC
PO BOX 806
HOOD RIVER, OR 97031
Electrical Signature Form
Permit #: MST2004-00078
Date Issued: 5/3/2004
Parcel: 2S104AA-03800
Site Address: 12580 SW KAREN ST
Subdivision: BELLWOOD
Block: Lot: 028
Jurisdiction: TIG
Zoning: R-4.5
Remarks: Replace existing covered patio with new sunroom.
Your company has been indicated as the electrical contractor for the permit indicated above. in order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
STEVE SUTTON GORGE ELECTRIC INC
12580 SW KAREN PO BOX 806
TIGARD, OR 97223 HOOD RIVER, OR 97031
Phone #: 503.590-2936 Phone #: 5.41-386-2468
Reg #: ELF 14-211(' 1
LIC 111706
"S111, 2004t--
AN INK SIGNATURE IS REQUIRED ON THIS FORM A/144 S
X -
Signature of Supervising lectrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24-Hour
BUILDING inspection Line: (503)639-4175
MST _
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Received _—__--___Date Requester..--(5' AM—____._PM _ _ BUP —.._
Location 01 1S —I2-- /�-
4Lt Suite_----- MEC
---
Contact Person __ —— Ph (_ ) _ _ __ PLM
Contractor --------- Ph( --) 170 "- 0�–��o_—� SWR ._.--
BUILDING —�—_ Tenant/Owner _.__--__�� _�_ ELC o�0����
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes- SIT
Post& Beam
Shear Anchors —
Ext Sheath/Shear
Int Sheath/Shear
Framing --- --- ---- ---- -- -- - --- - - -- _ - -_
Insulation
Drywall Nailing -----------------...--
Firewall
Fire Sprinkler - ------ —
Fire Alarm
Susp'dCeiling -.____._ -------._----- - ----_..----- _.___.- --_.__—__
Roof
Other: _.._.-T—_ - ------- -- - -----------
Final
PASS PART FAIL
----_ - _-- - - - _--- ---___--- - --_ __- -- ---_..-_..-._------------
_ost&BeamPLUMBING__
P
Under Slab --------- __ _ --_-- --_-__----- - -------
Hough-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
PASS PART FAIL - - - ------ ___-----_._. ___--- __ - ------- --
ELECTRICAL
Service
Rough-In
---- ---__ —____------- ---.__..__._.
UG/Slab
Low Voltage
Voltage
Fire_Alarm -� -
I%_ [J assPART FAIL Reinspection fee of$__-__- required before next inspection. Pay at Gtty Hall, 13125 SW Hall Blvd.
SITE F Please call for reinspection RE:_ -____ __-___ —_- Unable to inspect-no access
Fire Supply LineADA r.
Approach/Sidewalk Date L_v �1- Inspector �'�li�' l_'_�1 � ' _ Ext --_-_---
Other' -----
f rwl O NOT REMOVE this Inspection record fron11 the job ate.
PASS PART FAIL
CITY OF TIGARD 24-Hour _
BUILDING Inspection Lin 03)639-4175 MST Q� / �0d
INSPECTION DIVISION Business (503) 639-4171
BUP _
Received Date Re uesteo_7_ __ AM_.— _ PM __ BUP
Location ��__._ Suite MEC
Contact Person - Ph(—) S ep+d -7�o'�� PLM _
I (,,ntractor_ _--- ._----- Ph( ) SWR ----- -
BUILDING _ Tenant/Owner ELC
Footing _
Foundation Access: _ ELC
Ftg Drain 5' C Lr C� () "SS (� �5 ELR
Crawl Drain
Slab Inspection Notes: n z SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing —
FirewAll
Fire Sprinkler
Fire Alarm
Susp'd Collin
Roof
PASS, PART FAIL — - - ---
PPOW
MBING
Post& Beam
Under Slab
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
PASS PART FAIL
ELECTRICAL _
Seivice — ---- ------
Roigh-in _
UG/Slab - ---
Low Voltage
Fire Alarm ----
Final []
PASS PART FAIL Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE I j Please call for reinspection RE: Unable to inspect--no access
Fire Supply Line
ADA � �(„
Approach/Sidewalk Date - --� Inspector _ —Ext
Other:
Final DO NOT REMOVE this �Inspectlon recorl frorm 'the job site.
PASS PART FAIL