11571 SW SHEFFIELD CIRCLE 11571 SW Sheffield Circle
CITY OF TIGARD __-ELECTRICAL PERMIT _
PERMIT#: ELC20(-3-00070
DEVELOPMENT SERVICES DATE ISSUED: 2/13/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PARCEL: 1S133DB-03300
SITE ADDRESS: 11571 SW SHEFFIELD CIR
SUBDIVISION: BRITTANY SQUARE NO.2 ZONING: R-12
BLOCK: Feenel- Mr-rve LOT : 057 JURISDICTION: TIG
Project Descnptiun: q14
RESIDENTIAL UNIT TEMP SRVCIFEEDERS _ MISCELLANEOUS_
1000 SF OR LESS: 0 200 amp: PUMPIIRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGNIOUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 200 amp: 1 W/SERVICE OR FEEDER: 7 PER INSPECTION:
20" 400 ainp: 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— 22.5 AMPS:_ T--- CLASS AREPtSPEC OCC:
Owner: Contractor:
MITCH SWANSON NORTH BY NORTHWEST
11571 SW SHEFFIELD CIR ;.,26 S 15TH ST.
TIGARD,OR 97223 ST.HELENS, OR 97051
Phone: 503-579-1056 Phone: 503-348-0505
Reg#: 1_Ic 142140
--- 1:1 1 5-5017
_ FEES ---�_ til 1, 4s 1";
Description Date Amount
FI t I'crnut I t n t Required Inspections11 PRMT
� j ,. ---- $93.60
�l;%Xj 80.State•rax 11 ni $7.48 Ftp
— _ Elect r Service
Total $101.08 Flect'I Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,Stato of OR.Specialty Cedes and all other applicable laws. All
work will be done in accordance with approved plans. Thfs oermli will expire if work is not started within 180 days of issuance,or If work is suspended
for more than 190 days. ATTENTION: Oregon law requirs you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth 19 OAR 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)24M699 or
1-800x332-2344.
Issued By: t k-IC144 jT Permit Signature:
OWNER INSTALLATION ONLY __
Tie Installation is tieing made on property I own which is not intended for sale, lease, or rent
OWNER'S SIGNATURE: DATE:_.
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. EL.EC'N: DATE: -?` -'-5 -
LICENSE NO
Call 639.4175 by 7:00pm for an inspection the next busi less day
_Electrical Permit Application '
_—tea .— "DatoSy:
Llcclncad C- _ Permit No.:�[Cr�/O g-aw f�1
Planning Approval Sign
City of Tigard Date/By-__ Permit No.: -__
13125 SW Hall Blvd. Plan Revew Other
Tigard,Oregon 97223 Date/B : _ Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960Post-Revicw land Use
-Date/By: _ Case No.:
Internet: www.ci.tigard.or.usContact Juris.: ,,t SLe Page 2 for
24-hour inspection Request: 503-639-4175 Name/Method._ _ Supplemental Information.
TYPE OF WORK _ PLAN REVIEW Please check all that apl)Y) A�
ty
New construction lition - Service over 22> ;+s Mazar o Fre cation
— commercial ❑i:azardous location
Addition/alteration/replacement Other: []Service over 32U amps-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I &2 family dwellings four or more residential units in
I &2-Family dwelling I LJ Cbmmercial/Industrial ❑System over 600 volts nominal one structure
❑Building over three stories ❑Fccders,400 amps or more
Accessory Building_ [ Multi-Family ❑Occupant load over 99 persons ❑Manufactured structures or RV park
Master Builder Other: ❑Egre.s+'lighting p:an ❑Other:
JOB SITE INFORMATION and LOC.-TION Submit _sets of plans with any or the above.
The above are not applicable to temporary construction Lem Ice.
Job site address: _ FEE*SfaIEDULE
Suite M _ Bld ./AntA _ � _-_ Number of ins cellons er ermit allowed
Project Name: Description -- tpv J Fre(ea.) Total
—
Cross SlreetJDliCCt10n5 t0 job site: ,�T New residential-single or multi-family per
C dwelling unit.Includes attached garage.
r Service Included:
I 145.15 4
I(N)0 aq.il.or leas
Each additional y sq,it,or portion thereof 33.40 _ 1
Limited energy,residential 75.00 2
Subdivision: -_ - Lot M Limited energy,non residential 75.00 2
Tax ma / arcel #: Fach man, Loured home or modular dwelling
DESCRIPTION OF WORK service and/ar fee ler 90.90 2
Services or feeders-installation,
alteration or relocation:
200 amps or less M185 2
201 ams to 400 amps IOG. 2
401 amps to 600 amps 16^..60 2
PRPERTYOOWNER TENA454.45 NT 601 amps to I0(Nl amps _ 240 65 2
— - Over 1000 amps or volts 2
Name:
_ ho TL�, >i_� r'Y�d _ _ -^ ---_- Reconnect only 66.85 2
Address: Temporary services or feeders-Installation,
--- -- alteration,or relocation:
Cit /State/ZI v 200 amps or less - - - 66,85 1
-
Phone: 9-1 -/--&—6-- - Fax. 201 amps to 400 ams _ 100.30 2
401 to GOtI amps 133.75 2
APPLICANT --_� I El CONTACT PERSON ' _ Branch circuits-nev,,alteration,or
Name: extension per panel:
--— -- ---- ---"'- A.Fee lot branch circuits with purchase of
Address: _ _ __ _ _ __- service or feeder fee,each branch circuit 4.65 2
City/State/Zi — B.Fee for branch circuits without purchase of
— -------- service or Feeder fee,first branch circuit 46.85 2
Phone: _ I-aX: Mach additional branch circuit 6.65 2
E-mail: Misc,(Servire or feeder not included).
_- Each punip or irrigation circle 53.40 _ 2
CONTRACTOR _ Each sign or outline lighting _ 53.40 2
Job No: Signal circuit(s)of a limited energy panel,
�7 alteration or extension Pale 2 2
Business Name: L)" tiC� —- —_ nescfiption
Address:
Fach additional Inspection over the allowable In an of the ahovt:
City/State/Zip: S, �r/5 �--� _`I�Gw)I Per inspection r hour 21jj I ho __ 62.50
Phone: - L) C—�7 rd] Fax: Investi alion fee
CCB Lie. M lq,�Nt, Lic. M -Sc: other: _
_ .�— Electrical Permlt!'ees*
Supervising electrician (f.' Subtotal 5
Signature required: (// "~� — —_ Plan Review(25%of Permit Fee) S
Print Name: �; h Li'c. #' LfS1 5 _ State Surcharge(8%of Permit Fee)_ 5
— T—ti� -� TOTA L PERMIT FEF: $
Authorized Noticr: This permit application expires If a permit Is not obtained within
Signature: Date: ____ Igo days after it has been accepted as complete.
*Fee methodoloRv set by Tri-County Building Industry Service Board.
-- --- (Please print name) --------
i:\Dsts\Permit Forms\ElcPermitArp dnc 01/03
1?IccU ira! Permit ALpjicatiolt - ('its' of"Tigard
Pat;( 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Feefor all systems............................................................ $75.00
Check Type of Work Involved:
nAudio and Stereo Systems*
Burglar Alarm
F] Garage Door Opener*
Heating,Ventilation and Air Conditioning System*
Vacuum Systems*
Other
COMMERCIAL WORK ONLY:
Feefor each system.......................................................... $75.00
(Sl;h OAR 918.260-260)
Check Type of Work Involved:
Audio and Stereo Systems
l3oiler Controls
Cluck Systems
Data Telecommunication Installation
Fire Alarm Installation
IIVAC
Instrumentation
Ir-rcom end Paging Systems
Landscape Irrigation control*
Medical
pNurse Calls
DOutdoor landscape Lighting*
Protective Signaling
LJ Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i\I)sts\Permit Forms\lilcPcmiitAppPg2,dnc 01103
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
_ � BUP -
Received --_._ Date Requ ted__ ` , AM-._ PM_ BLIP
LocationLS L Suite---------- MEC
Contact Person Ph PLM _.
Contractor Ph SWR —
BUILDING. _ Tenant/Owner __�___ -� yi 4z-ej,,^- _ ELC
Footing 7 ? �' ELC -
Foundation Access:
Ftg Drain �� Q( t t��= �` : S ( c. ELR
Crawl Drain _.
Slab Inspection Notes: h SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear -
Int Sheath/Shear
Framing -------_-_r_—.
Inst,lation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:__ _ _—___ -- .-___. ---------_.--- -----_Final
PASS
PASS PART FAIL -_----- - ---__. - - --------- ---------- — _�. _--_------
PLU_MBINa
Post&Beam
UnderSlab —--- -- - - - --- ----- --------------- .._..-.----- -- - -
Rough-In
Water Service ----- -- --- - - - -- - - -- ---.- - --._.. -- ---- _.
Sanitary Sewer
Rain Drains ----
Catch Basin/Manhole
Storm Drain ------- - _. -- . . ------- -- _ ---- - ---
ShowerPan
Other: — ------. _ . _ - -------- -_-- - _ -- ---- -
Final - —_----- -
----
PAS PART._FAIL
CHANICAL --
Post&seam 1
Rough-In
Gas Line
Smoke Dampers
Final
-PdSS�PARI FAIL
LECTRICA _-
--
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee ofrequired before oext inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS PART FAIL
SI ---- Please call for reinspection RE:,__— �. _ Unable to inspect-no access
Fire Supply LineADA
Approach/Sidewalk fDo% ` � �� lnapector � �_ IEut--
Other:
Final DO NOT REMOVE this Ir4sapection record from the jots site.
PASS PART PAIL