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CITY OF TIGARD ELECTRICAL PERMIT
•` PERMIT 0: ELC2005-00168
OEVE AENT SERVICES DATE ISSUED: 3/21/2005
13125 SW Hall Blvd.,Tigard,OR 97223 503-6394171 PARCEL: 2S111DC-13700
SITE ADDRESS: 15845 SW OAK MEADOW LN ZONING: R-7
SUBDIVISION: SUMMERFIELD NO.11 LOT: 633 JURISDICTION: TIG
Project Description: Remove/replace 200 amp panel.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS MISCELLANEOUS
1000 RTL SS-� 0 - 200 amp: .
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNALIPANEL:
MANF HMI SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W/SERVICE OR FEEDER: 20 PER INSPECTION:
701 - 400 amp: tat W/O ERVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amp/volt: _ —71E—71ES UNITE >8 .
Reconnect only: SVC/FDR>=225 AMPS: CLASS AREAISPEC OCC:
Owner: Contractor:
BALTES,ROBERT 6 JEAN LH MORRIS EL'CTRIC,INC
15845 SW OAK MEADOW LN 7051 SW SANUBURG ST.#100
TIGARD,OR 97225 TIGARD,OR 97223
Phone: 503-620-2385 Phone: 503-639-2334
FEES Reg A: LIC 1838
Description Date Amount ELE 20-39C:
Slip 3006S
[ELPRMTI GLI'Permit 3/21/2005 $213.30
[TAX]80/6 State Surcharge 3/21/2005 $17.06 REQUIRED ITEMS AND REPORTS
Total :230.36
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 diract questions to OUNC at 503-246-8899 or
1-800-332-2344.
CL Issued By: � � Permittee Signature: V1`ap
Ix — —
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:
W CONTRACTOR INSTALLATION ONLY
W
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503-639-4175 by 7:00 a.m.for an inspection that business day.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
70992
Electrical Permit,Atplication
City of TigardReceived Permit No.:
9r�E u Date/B : ^-2) n Y /
I
3125 SW Hell Blvd.,Tigard,OR 2 F�✓ Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DOWDY: Other Permit:
Inspection Line: 503.639.4175 II!l 1 Date Rcadyl6y: larlr 0 gM yapg Ibr
Internet: www ci.ligard.or.us U Notific&'Hethod: g 1 left mom
ww
t�ttrty/tflMr' 4,
❑New construction XE RtkM1 cement Please check all that apply:
❑Demolition ❑Other: ❑Service over 225 amps,comm'I ❑Hanrdous location
[]Service over 320 amps-rating ❑Buildng over 10,000 sq.R.,
CA'T'EGORY OF CONSTRUCTION of 1-and 2-family dwcllinp 4 or more new residential
EBX-and 2-family dwelling ❑Commercial/industrial ❑Accessory building []System over 500 volts nominal units in one structure
❑Multi-family ❑Master builder ❑Other: []Building over three stories ❑Feeders,400 snips or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB S(1'E INFORMATION ANll LOCATION ❑Egreas/lighting plan RV park
Job no.: 70992 Job site address: 15845 SW OAKMEADOW LN []Health-care facility _
Submit_I sets of plana with any of the above.
City/State/ZIP: T ZGARD OR 97224 The above are not applicable to temporary comtruction service.
Suite/bldg./apt.no.: Project name: JEAN BALTES
Daacrlptien Q4'" fee. Ilhteal •
Cross street/directions to job site: New residentipl single-or multi-family dwelling unit.
Includes attached prage.
1,000 sq,ft.or less 145.15 4
Subdivision: Lot no.: G.add'I 500 sq.R.or portion 33.40 1
Limited energy,residential 75.00 2
Tax mep/parcel no.:
DESCRIPTION Olt WORK Limited energy,nm-residential 73.0(1 2
k —
' Each manufactured or modular
REMOVE/REPLACE 200 AMP PANEL dwelling,service and/or feeder 90.90 2
Services or feedors Installation,alteration,and/or relocation
200 amps or less 1 80.30 BO.3 0 2
1WROPEP'. Y OWNER is TENANT 101 snips to 400 strips 106.85 2
-- 0 401 amps to 600 snips 160.60 2
Name: JEAN BALTES 601 amps to 1,000 amps 240.60 Over 1,000 ari
2
Address: snips or volts _ 454.63 2
AS ABOVE Reconnect only 1 1 66.85 1 12
City/State/ZIP: Temporary services or feeders Installation,alteration,and/or
Phone:( ) Fax:( ) relocation —_
200 amps or less 66.85 1
Owner installation:This installation is being made on property that I own which is not 201 snips to 400 amps _ 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps 1 1 133.75 1 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
0 APPWCANT — jy�jj A.Fee for branch circuits wUh
service or feeder fee,each
Business name: L.H.MORRIS ELECTRIC INC branch circuit 1 6.65 6.65 2
B.Fee for branch circuits
Contact name: without service or feeder fee, 46.95 2
Address: each branch circuit
Each add'I branch circuit6.65 _ 2
City/State/ZIP: —__ FaMiscellaneous(service or feeder not Included)
X:
Pune or irrigation circle 53.40 2
R Phone:(503)631-1334 :( )
F- Sign or outline lighting 53.40
M E-mail: Signal circuit(s)or limited-
0014TRACMR energy panel,alteration,or
3
extension.Describe: Page 2 2 Business name: L.H.MORRIS ELECTRIC INC
a� Each additional Inspection over allowable In any of the above
� Address:7051 SW SANDBURG ST#100 —
Pcrinspection 62.50
J City/State/ZIP:TIGARD OR 97213 Investigation per hour(I hr min) 62.50
Phone:(503)631-2334 Fax:(503)610-7405 Industrial plant hour 73.75
CCB Lic.: 1938 Electrical Lic.: 20-39C Suprv.Lic.: 3006S Subtotal 213,30
Suprv. Electrician signature,required: Plan review(25%of permit fee)
Print name: GARY POPL
State surcharge(8%of permit fee) 17.06
�`ta� i`
TOTAL PERMIT FEE 230.36
Authorized signature: _ This penult■pptead"expires 11 a perish N set ebalaad within 190
days atter N bra beer scespssd a eyalI—
Print name. _ Date: � Fee methodology rot by Tri4)wAaty Bvn tg hlasry Snviee Bond
"l udlatr of hai n d, pas perni t allowed.
i\auildina\Perrmta\BLC-Pern*Apidoc 17/03 440461Sr(IOWCOWYM
CITY OF TIGARD
BUILDING DIVIft9 PERMIT 0: ELC200&00168
13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED: 3/21/2105
Phone: (503) 639-4171
inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 3/36"2006 TIME: 7:11AM PAGE: 13
SITE ADDRESS: 15845 SW OAK MEADOW LN CLASS OF WORK:
SUBDIVISION: SLIMMERFIELD NO.11 Lar#: 633 TYPE OF USE:
PROJECT NAME: BALTES
DESCRIPTION: Remove/rspiace 100 amp pend.
OWNER: BALTES, ROBMT&,EAN, PHONE C 603.61i>`1385
CONTRACTOR: LH MORRIS ELECTRIC, INC PHONE#: 503.639-1334
Inspaction Request Scheduled Foy: Date: 3/301M Pour Time:
Code # Inspection Description Confirm # Contact # Mesa9ge
199 Electrical final 9003729.01 503-980 6296 N
Corrections/Comments/Instructions: mel `a 3 GzOZ3$!5'
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kFPASS F] PARTIAL APPROVAL F] CANCEL NO ACCESS
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AIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED �)
Inspector: IA19 Dete: --:L� PhOi'Ni (i �1d-
CITY OF T I GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT*: PLM2004-00564
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 12/28/2004
SITE ADDRESS: 12460 SW NORTH DAKOTA ST PARCEL: 1S134CB-06200
SUBDIVISION: ANTON PARK ZONING: R-7
BLOCK: LOT: 924 JURISDICTION: TIG _
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES; OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Water service replacement.
FEES
Owner:
Description Date Amount
RDQ PROPERTIES, LLC [PLUMB] Permit Fee 12/28/2004 $72.50
2105 PEREGRINE CT [TAX]9%State Surchari 12/28/2004 $5.80
WEST LINN, OR 97068
Total $78.30
Phone:
Contractor:
D + F PLUMBING
4636 N ALBINA
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone: 503-292-0993 Water Line Insp
Final Inspection
Reg#: LIC 465
PLM 26-23pb
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F—
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 worts will be done in accordance with appra4ed
Wplans. This hermit will expire if work is not started within 180 days of issuance, or if work is suspended
for more that 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR
952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246-6699.
Issued By:,moi l fl Lfc� Permittee Signature: _C
Call (503)639-4175 by 7:00 P.M.for an Inspection needed the nextbusfniss day
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)638"175
INSPECTION DIVISION Business Line: (503)638"171 MST 8UPBUIDReceived _Date Requested l� _�'-�— AM �PM__ _
Location & MEC
Contact Person 2 Ph( _) gra - d `j 9 PLM 200 'OQ 6
Contractor— _ Ph(—) .. SWR
BUILDING Tenant/Owner _— ELC _
Footing
Foundation ELC
Fig Drain
Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors -
Ext Sheath/Shear
Int Sheath/Shear
Framing - A.
—
Insulation
Drywall Nailing
Firewall r
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Root
Other:
Final
PASS PART FAIL
PLUMBING _
Post&Beam
Under Slab
Rough-113 -
wlllldr ery
Sanitary Sewer /
Rain Drains -
Catch Basin/Manhole
Storm Drain - — -- -
Shower Pan '
Ot'aer: 100e
--
Final
PASS rPAF
-MECHAWICAL —
Post&Beam
Rough-In
IL Gas Line
Smoke Dampers -- -
F Final
PASS PART FAIL — —
ELECTRICAL _
J Service -
m Rough-In
C9 UG/Slab -� --
Low Voltage
Fire Alarm
Final Reinspection fee of E required before next in
PASS PART FAIL p Inspection. Pay et City Hell, 13125 31M Heil Blvd.
SITE _ [] Please cell r reinspection RE:_ UneW to Inspect-no access
Fire Supply Line
ADApab '
Approach/Sldewalk w�se�ef --
Other:
Final DO NOT REMOVE this IMapoitllllon 1000 fte M tM f ob alba.
PASS PART FAIL