10775 SW NORTH DAKOTA STREET-1 IS VIo)jV® HillON MS 51106
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10775 SW NORTH DAKOTA ST
C I Y Y OF TIGARD ELECTRICAL PERMIT
PERMIT#: E 201263-00600
DEVELOPMENT
SERVICES DATE ISSUED: 9/20l2GJ4
13125 SW Hall Blvd..Tigard,OR 97223 (503)639-4171 PARCEL: 1S134DA-01902
SITE ADDRESS. 10775 SW NORTI1 DAKG rA ST
ZONING: R-4.5
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Wire pump house.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION:
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: 1 W/SERVICE 0I2 FEEDER: 2 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:
WIEMER,THEODORE E + WILLAMETTE ELECTRIC INC
PATRICIA M TRUSTEES PO BOX 230547
10775 SW NORTH DAKOTA ST TIGARD,OR 97281
TIGARD,OR 972.23
Phone: Phone: 503-624-3631
Reg#: LIC 15059
---- SUP 19655
FEES ELE 34-283C
Description Date Amount
— Required Inspections
IF,LPRMT]ELC Permit 9/21/2004 $93.60
ITAX]8%State Surcharge 9/20/2004 $7.49 Rough-in
Elect'!Final
Total =101.09
This Permit is issued subject to the regulations oonta+.ned in the Tigard Municipal Code,State of OR Specialty Codes and all other applicable laws.
All work will be done in nocordanos with approved plans Thi;,permit will expire if work is not started within 180 days of issuance, or N work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification(;enter. 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)
d ''468699 or 1-800-332-2344.
Issued By: JL / ,� Permit Signature:_ .Sze
rn
_ OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
0 OWNFR'S SIGNATURE: DATE:
UJ
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: _ _ _ DATE:--
LICENSE
ATE: .—LICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next business day
SEI' 20 2004 9: 40AM HP LASERJET 3200 P, 2
Fiectrical Permit Ap V,I
City of'f igard tit
13123 SW Hall Blvd.,Tigard,OR 97223 Pan Itsvww _
none: 503 619.41 11 Fax 503.599 1960S
2 U �oo DawBy. _ Odw PW
Inspection Line 303 639 4173 C G Dau Ready/By: ro: ill A"pqa:„
; L
Internet: www.c:tigard.orms ,ITY OF T'Arlr'% Nodnew.madtnd: Supplemental lnt.:rmadon
New cnnsw.ction Addition/alteradon/replaceawd Please check all that apply:
❑I)emoliti a 0 other: ❑Sr.vice over 225 amps,corrun'i ❑liasardous location
[]Service over 320 amps—rating []Fluildng over 1000,0sq.Or,of I•and 2-family dwellings 4 or more new residential
I-ar i 2-fancily dwelling CommerciaL'industrial ❑Accessory building [:]System over 600 volts nominal units in one structure
L, �!ultl-fawly Master builder Other: []Building over three stories ❑Feeders,400 amps or more
❑Occtrpsnt load over 99 persons [lManufrctured structures or
0EgressAightins pion RV park
Job no.: q lob site address I e fi�{�W TM 0. ❑Health-care facility []Other:LO- _--
�l ____ Subntit-I sew of plans with any of the above
City/State/ZTP: 10A Oka Is 0 OL It*t �Z 3 The above are not applicable to tctrapora y construction service
S1litelbldgJapt.no.: pfOJECt natll0: T–
me r'_ — rn..e.lpu.■ Qq. Iw rwr
Croda street/directions to Job Nice: Now rail dendal single-or mold-hmlly dwef�l.l unit. --
-- Includes attached prays.
1,000 q.ft or less 143 I5 `— 4
Subdivision' Lot no.: Ea.add'I 300 sq.1t.ar portion 3140 i
Tax reap/parcel no.: -- Limited energy,reaidentisi 75.00 2
United energy,non-residential 75.00 2
Each manufactured or modular
dwelfinll,service and/or fender 90.90 2
%&LA , QOs..,.,,,,` I y4A.Q.. Services or feeders lnstaltaUna,alteration,and/or relocaden
200 amps or less _ 9030 2
201 artpa to 400 amps 106.85 2
401 amps to 600 amps _ 160.60 2
NEW: t� 1.!_ 0— _— 601 amps to 1,000 amps 24060 2
Addm;a: ,1 .� Ova 1,000 amps or volts _ 434.63 2
—�! �. a Reconnect only _ 66.85 2
City/State(ZIF: _ To nporary services or feeder inatadlatlon,alteration,and/or
)
Phone:( ) PA
Fax: relocation
( _ 200 amps or lona 66.85 1
Owner Installation:Ibis installation is being made on property that I own which is not 201 amps to 400 arrps _ 100.30 _ 2
intended for mile,lase,tent,or exchange,according to ORS 447,449,670,and','Oto 401 amps to 600 d 133.73 2
Owner Signature: Date: Branch elm["—new,altemdon,or extenelon, err panel
A.Fee fhr branch circuits whit
service or feeder fhe,each O
Business name: brsrch circuit l! 6.63 r3#_ 2
Contact name: ^� A.Fee for brunch eircuiw
wilhout service or lbeder fee, ,-t
each branch circuit 46.83 2
Address: Each wW'l branch circuit 1 6.65 2
CityrStateiZIP: Mlsed ionaom sortrka or fade►not hadvided
L Phone:( ) Fax: :( ) or imiption circle — 53.40 2
X — Sign or outline lighting S3.40 2
E-mail: Signal circuity:)or limited- —
snap panel,alteration,or
extMF,.cm Descnbe: Page 2 2
tz Business name: (�, �4&%d ti t_>�l`I R t c /,t,I __
'j v Lesch addldooil Inspection over avowable Is any of the above
ro Address: A 20— Z �_ Per inspection - _ 62.50 —
WCity/StataZ[P: T-4 1A�d ek 1� — hrmfftillaliai per bour(t lrntin) -- 62.30 T
_j Platte:( t S _ Fad( ) g t t�_ ,4 s Industrial plant boar 73.75
CCH Lic.: ,ru��_ Electrical Lic.: ;y_2&3 L Suprv. Lic.: 9` s Subtotal
Suprv.Electrician signature,required: >r — Plan review(75%of prrmit No)
State wachieve(11%of panrdt foe)
Print name: N Pl Date:
TOTAL.PERMIT 1►EE
Authorized signature: Thea rmit a licadoe a l m N e - `•--- -
tx PD tap patnit d meso ebtda.a»♦tots inn
dayr after it ha be.•s»eyssd"tempuo
Print flame: Date: • Pte methodology aatbylld-G.unt'Bu9dins tadm•rr Servke Board
••M"Nbar Of taspeetinns per pem.:.albwad
}coatielerrermsstetc-r.r,.rlulppdot nese 440-MI 1000VOOKWn
CITY OF TIGARD 24-Hour
BUILDING , Inspection Lina: (503)639-4175
MST
I 78 CTION DIVISIOII Business Line: (503)639-4171 _
BUP
Received ")� Date Requested _AM _PM_--__ BUP
Location — `' � _ �u- Suite f MEC
Contact Person —_I-A, 1 i T /,,v, -�- ._ _ Ph PLM� _--
Contractor __ Ph( ) ______ --._ SWR --� t
BUILDINGTenant/Owner ,_ ____—_-- (9wm-4-"r'� s-0
Footing — ELC — --
Foundation Access:
Ftg Drain ELR
Cra, '")rain
Sla. Inspection Notes: SIT -- ---
Post&Beam — —
Shear Anciors
Ext Sheath/Shear
Int Sheath/Shear
Framing — — -----
Insulation
Drywall Nailing — - — ---— —
Firewall
Fire Sprinkler
Fira Alarm
Susp'd Ceiling --
Roof
Other: _ --
Final
PASS PART FAIL —
PLUMBING
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
0. Smoke tampers -- -- —
Final
N
PNIS,PART FAIL ---- — -- ---- ----` — --
_KEC CAL --- —_-- _— - _-_
J S�gh
WLow Voltage —�— -- ------ ----- --- - ----- ---- —_
FJre Alarm
44�)
(� Reinspection fee of$ __--_— required before next Inspection. Pay et City Mall. 13125 SW Mall Blvd.
PART FAIL
Please call for reinspection R�: —. _ �� oiA�':D( t -no access
Fire Suppiy Line
ADA
Approach;Sidewalk Dab � d Inspector
�
Other: _
Final — DO NOT fit MOPE this Inspection m the job she.
PASS PART FAIL