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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Lin;,: 6394175 Business Phone: 639-4171
Date Requested: _ I rf C� A.M. P M. _ MST:
Location:i_ Z�) Ll �. �� (. _ BUP: _
Tenant:_._ � Suite: Bldg: _. MEC:
Phone:
Contractor: �E L -Y�-�- - _� PLM:
Owner: j Phone:
_ SIT:
BUILDING BLDG(con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Uoveribemee Sewer/Storm
Footing Roof UndFI/Slab Rough-1n Ceiling Water Line
Slab Framing Top Out Gas bine Rough-In CtG Sprinkler
Foundation Insulation Sewer Ilood/Irtct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain chain A/C DIG Slab
Sheer/Sheath Fire Spkh/Ahn Crawl/Found Dr 1[cat Pump Low Volt.
Approved Approved Approved Approved
AI)pr/Sdw'Ik Not Approved Not Approved Not Approvedrove Not Approved
FINAL FINAL FINAL I FINAL
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all for reinspectio �r-1 ReinspectAn Ice ofSi � required before IlnaM
next inspection �f, e to inspect
Inspector:_ / _ _ Dutc _! _f t� Page
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Phone: 6394171
Date Requested: _— �� A M. P.M. MST:
Location: � � f — BUP:
Tenant: _ Suite: Blld;: MEC:
Contractor, �/�'I– �`' _ Phone: �' Jc�S --
��, ae PL-M:
Owner:_ /� (� Phone: ELC:1,7 7
ELR:
_ SIT':
BUILDING BLDG(con't) PLUMBING MECH—ANICAL --- ELECTRICA �) SITE
Site Post/Bearn Post/Beam Post/Beam Sewer/Stone
Footing Roof UndFl/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Linc Rough-In IIG Sprinkler
Foundation Insulation Sewer Ilood/Duct Reconnect Vault
Psmt Damp Drywall Stonn Furnace Temp Service MISC.
Masonry L:eiliug Rain DI-win Psi: UG Slab
Shear/Sheath Pire Spklr/Alm Crawlfl'ound Dr I lent Pump Low Volt _
Aprroved Approved Approved Approved Approved
Appr/Sdwlk Not/,ppro-ed Not Approved I lot Approved ved Not Approved
FIN:if FINAL. FINAL FINAL FINAL
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C^11 for reinspectio i ❑Reinspec'ion fee of S reqnred before next inspection O Unable to inspect
Inspector: _ llate: / Pae of
CITY OF T ELECTRICAL_ PERMIT
DEVELOPMENT SERVICES PERMIT #: ELC97-0807
DATE ISSUED: 1/10/97
13125 SN Hell Blvd., Tigard,OR 9/223 (503)639.4171
PARCEL: 2S1O3,AC--05300
SITE ADDRESS. . . : 1`7W;1 SW 113TH PL.
SUBDIVISION. . . . :HUMHOLT CREEK ESTATES ZON NG: R--4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :OO4 JURISDICTION: URB
Pro.j ect Descri pt ion : Installation of one ll) branch circuit to eM st y SFD.
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- -----MISCELLANEOU3------
1.000 SF OR LESS— . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADD' L 500SF. . , : 0 201 -• 4012) amp. . . . . . . : 0 SIGN/OUT LINE_ L-TG. . : 0
LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LAPEL ( 1) . . . : 0
----SERV I CE/FE.EDER----- -----BRANCH CIRCUITS------- ---ADD' L INSPECTIONS-----
0
NSPECTIONS-----
0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PIER IN`,F'ECTION. . . . . : 0
201 - 400 amp. . . . . . : 0 i st W/0 SRVC OR FDR. : 1 PER H00 . . . . . . . . . . . : 0
401 - 6O0 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. , . . . . . . . . . . 0
601 - 1000 amp. . . . . : 0 ------------------PLAN REVIEW SECTION-.._-_-_____-___--_._
1000+ amp/volt. . . . . : 0 / =4 RES UNITS. . . . . . . . : > 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR ) = P25 AMPS. . : CLASS AREA/SPEC OCC. :
Owner- : --------------------------------------------------------- FEES --------_--_--__
JOE FEYDER type amount by date recpt
12731 SW 113TH PLACE PRMT f 35. 00 TJH 12/10/97 97-3O1589
TIGARD OR 97223 SPCT $ 1. 75 TJH 12/10/97 97-301569
Phone #:
Contractor: ----------------------------------------------------•-------------
Jp'C ELECTRICAL SERVICES INC IS 36. 75 TOTAL
4120 BE INTERNATIONAL WY
STE A-107 _ --- -- - REQUIRED INSPECT1nN5 -----
MILWAUKIE OR 9'7,?22 RDugh-in Elect' l Final
Phone #: 654-3..3,25 Elect' 1 Service
Req #. . : 093774
This persit is issued subject co the regulations contained in the Tigard Municipal C.de, State of Oregon Specialty Codes and all other
applicable laws. All Mork will be done in accordance with approved plans. This perait will expire if Nark is not started within 189
days of issuance, or if work is suspended for torp than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by
the Oregon Utility Notification Center. Those rules are set forth in OAR 952-901 AAIB through OAR 952-001-1987. You vay obtain a copy
of these rules or direct questiors to OUNC by calling (583)246-1987.
C'ermittee Signature : �h (lC i^ 61-ss�_�ed By : J
INSTALLATION
The installation is being made nn property I own which is not intended for
sale, lease, or rent.
OWNER' S SIGNATURF: _.- --._----__.. DATE: -----
LLl
J -------------------------CONTRACTOR INSTALLATION ONLY-----------------------------
SIGNATURE
----------------------------SIGNATURE OF' SUPR. ELEC' N: -_��l'o � DATE:
I.. I CENSE NO: L!I�- --------__. ....._
++++•f++++++++++++++-r++++++++++++++++++++++++++++; +-+++J ++++++++++i-+a-++++++++++++
Call 639-4175 by 7:00 p. m. for- an inspection needed the next business day
+++++++++++++++++4+++++•f++++++++++++++++++++++++++++f+++++i-+++++++++++++++++4-+F
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CITY OF TIGARD Electrical Permit Application Plan Check# ►� �
13125 SW HALL BLVD. Recd By, T. u-rt
TIGARD OR 97223 Dato Recd 1 zj.�O?
Date
Phone (503) 639-4171, x304 Date to DST I
Print or Type
Inspection (503) 639-4175 Permit#_E U_`: 0 W7
Fax (503)684-7297 Incomplete or illegible will not be accepted called ?YuYtA.Uc;
1. Job Address: r4. Complete Fee Schedule Below:
Name of Development _ Number of Inspections per permit allowed
Name(or name of business) �c � . Fie Service Included: Items Cost Sum
Address 9'731 n, ,ya Cz 4a. Residential-per unit
C 1 ajo sq.ft.or less $110.00 _
City/State/Zip a t (1Ct k C d i` / 7�a Each additional 500 sq.ft.or
�✓ portion thereof _ $25.00 __ 1
Commercial El Residential Limited Energy $25.00 -Each Manuf'd Horne or Modular
Dwelling Service or Feeder $68.00 �_ - 2
2a. Contractor installation only:
(Attach copy of all current license;) 4b.Servlct►a or Feeders
Electrical Contractor 1 N�' /PC' l CCeX/� �i 1 C Installation,alteration,or relocation
Address /dO ` l e t7 C, f Cir7Q/ 467
I 200 amps or G) $60.00 2
201 amps to 4amps $80.00 2
Cjty_ft,!r I Lk Ctc4.Kt,c State Zip. - --7 401 amps to 600 smos $120.00 2
Phone No. 1n5-4 3 3 9 S _ Ent amps to 10)0 amps $180.00 2
Job No. /OJ/3 Over W,'^-os or volts $340.00 2
Elec. Cont. Lice. No. ._3 - Exp.Date Reconnect only $50.00 2--- -�
OR State CCB Reg. No.ZjZY,5 4 W Exp.Date 4c.Temporary Services or Feeders
COT Business Tax or Metro No. ,�e[,_9U Dat Installation,alteration,or relocation
�. 200 amps or less $50.00 - 2
Signature of Supr. Elec'n 201 amps to 400 amps $75.or
401 amps to 600 amps $100.00 2
Over 600 amps to 1000 volts,
1. cense No.� S _Exp.Date see"b"above.
Ph(tie No. 62,54- 33x5
4d.Branch Circuits
New,alteration or extension per panel
2b. For owner Installations: a)The fee for branch circuits with
purchase of service or
Print Owner's Name fo rde►fee.
Address Eb.,h branch circuit $5.00 2
City-'_ State Zj b)The fee for branch rircuits
P_._ without purchase of
Phone No. service or feeder tee.
First branch circuit $35.00 � 2
The installation is being made on property I own which is not Each additional branch circuit $5.00 _ 2
intended for sale, lease or rent. 4e.Miscellaneous
(Service or feeder not included)
Owner's Signature _ Each pump or irrigation cii^le $40.00
Each sign or outline lighting $40.00
3. Plan Review section(if required):* Signal circuits)or a limited energy`
panel,alteration or extension $40.00
Please check appropriate item and enter fee in section 5B. Mina Labels(10) --
4 or more residential units In one structure 41.Each additional Inspection over
Service and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal ^r inspection $35.00 -
°= Classified area or structure containing special occupancy Per i our $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: rte,
Not required for temporary construction services. 5a.Enter total of above fees $
J 5%Surcharge(.05 X total fees) $ -1-NOTICE Subtotal $
5b.Enter 25%of line So for
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review If regujred(Sec.3) $ - ---
NUT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ ------
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 1P0 DAYS AT,ANY
TIME AFTER WORK IS COMMENCED. ❑ Trust Account#
a
Total balance Due
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RECEIVED
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DEC 0 9 1997
COMMUNITY MVFIONV :.