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CITY OF TIGARD _. ELECTRICALPERM:T
PERMIT#: ELC2004-00E i8
DEVELOPMENT SEF',VICES DATE ISSUED: 9/23/2004
+ 13125 SW Hall Blvd., Tigard. OR 97223 '503) 639-4171 PARCEL: 1S135CD-00201
SITE ADDRESS: 09575 SW LEWIS LN
SUBDiVISI' BOETC'IERS ADDITION ZONING: R 4.5
Blt-1LK: LOT : 005 JURISDICTION: TIC,
Project Descriptrun• Pnnel changes In house&garage.
RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCFLLANEOU_S
1000 SF OR LESS:— 0 - 200 amp: r''UMPIIRRIGATIO:4:
EACH ADD'l. 590S!-: 2.01 • 400 amp: &3N/OUT LINK I.rG:
LIMITED ENSRGY: 401 - 600 amp: SIGNALWANEL:
MANF HMI SVC/FDR: 01+amps -1000 volts: MINOR LABEL (10):
SERVICE/FEELER BRANCH CIRCUITS ADD'L INSPECTIONS
0 200 ami: W/SERVICE i:^ PFEDER: PER INSPECTION:
201 - 400 amp: 1 st"V/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ _ PLAN REVIEW SECTION
1000+ arnp/volt: —4 RES UNITS: >600 VOLT N00,11NAL:
_ Reconnect ops___ SVC/FDR—225.AMPS: _- CLASS AREA/SPEC 7CC:
Owner Contractor.
LEWIS DAVID E + MARSHA E TRS WEST SIDE ELFCT!K CO INC
95/5 SW l-E\MS LN 1834 SE 8TH AVE
POR Tl AND OR 972' PORTLAND, OR 91214
I Phone: Phone: 231-1548
Reg #: LIC 13306
--- - - SUP 26635
FEES _ ELF 26-135c
Description Date Amount
Required Inspections
1l:LPRM1-1 [I.0 Permit 9/23/20014 $160.60 - - ---
ITAXI Mo State Surcharge 9/21 lnru_l $12.45 (~ ugh-in
_ Flect'I Final
Total $17-1.45 ,
This Permit is issued subject to the regulations contained in the Tgard Mun0l)al Cude,State of OR.Specialty Codes and e'I other applicable laws
All work will be done 1n accordance with approved plans. This permit will expo 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 t)flow 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 direct questio,,.r to OUNC at(503)
246-6699 or 1-800-332-2344.
Issued By: �%J-d. ,- ' G _ Permit Signature: '1
12
OWNER INSTALLATION ONLY _
The installation is being made on property I own whichK
is riot intended for sale, ase, or rent
OWNER'S SIG:J.ATURE: —__—.—_�---- ---- _ `_-- DATE: -----___--
CONTRACTOR INSTALLATION ONLY
SIGNATIJRE OF StJPR. ELEC'N: DATE:_- __—.--
LICENSE NO:
Call 639-4175 by 7.00pm for an inspection the next busir,�ss day
'ectrical Permit Aop�licatiod IV ED
CityKill UN
Tigard ltaceived a/ rennit N.:C e/- Q
3125 W Fedi Blvd..Tigard,OR +7223 '�' � � 20 [)sic/A n-
P4n rkviaM/ Udwr Permit:
Phone: 503.639.4171 Fax: 503,5y8,I960 ,ITY OF TIG; 6'Ie1nr:
Inspection Imine: 503.0 1y.4175 Ak�k
Date Rrr1y/By tom; f4 seepage 1 for
Internee www,cimprc or.us F3U1ttTh1r n1V Notiticd/MetlNd Sapplemenfel lnformurioe
- TYPE OF WORK FLAN REVIEW -
❑New constru tion dclitiort/alicration/replacement Please check all that apply:
❑Um
eolioion Other: ❑Service over 225 amps,commit ❑Ha»rdrus location
Mum ice over 320 amps rating ❑Buildr,d over 10,000 sq.ti,
C.ATEGURY OF CONSTRUCTION _ of 1_and 2-family dwellings 4 or more new residential
and 2-family dwelling ❑Commercial industrial ❑Accessory building ❑System over 600 volts nominal units ui one structure
Fm
Multi-(Arttily Q LJ Building over three stories ❑Feeders,400 amps or num!
Mls;tcr builder ❑Other,
-- ❑Occupant load over 90 peranns ❑Manutietured stntcturrs or
-_ JOB SITE{ INFORMATION AND LOCATION j]Egross/lighling plan RV bark
.:,)'j. 1( e > Job site tultliCss: r .J `� ❑Health aro facility
Job no ❑(hirer._------,_,u�--_--
G _ ��s--_- S Submit L seta of pluna with any of tlu shove.
City/State/zlp: r c• , Cr z z M 'the above aro not applicable to temporary consarrctron service.
Suite/bldg./apt.too. Projtx l Hoerr:L� �---r-E-r-+-3--CSI-I�E-DULE _ °•
t=Jrl ✓ nes.rtpU°a _L"1 ram_ r.w
Cross strmt/direetions to jab site- New residential single-or multi-tamlly dwelling unit.
------ Ineludea attached pruge.
1,000 sq.R.or fess -T 145.15 4
Subdivision - • - - -�~ Lot no.: Lia.add'I SW sq.fL nr pardon - 33.40 1
Urnited energy,residential_ 75.00 2
Tax map/parcel no.. _ - -
-- Limited once ,non-residential 75,0 2
DESCRIPTION OF WORK F-wh manufactured or modulur
/� dwelling,service and/or feeder 90.90 _ 2f2.=�-►V� fir'�'S'f' e/r Servivs or feeders tustallatlou,alteration,and/or relocation
He amps or less 7 80.30 r�� 2
_
-- L] TENANT 201 amps to 400 umps i 06.85 2
- rR�rFRT�r aWNh_R I __ ----- --- ----- ---
,
-- - -� - ---- 401 amps to 600 amps 160.ti0 2
Name: ` C. - > _ _ 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps a volts 454.65 2
City/StstePLIP; T Reconnect only _1__16 11 1 2
temporary services or reeders lasultadon,alreradou,and/or
-----� ---
Phone:(t'a ) `c ? 5 �-I F.ax.. rcbcafton---) -
200 amps or less 66.85 __ I
O-mer installation:This installation is being made on property that I own which is not 701 amps to 400 amps 1 W.3U 2
Intended for sale,lease,rent,or exchtuigr,acnording to OR 447,449,670,and 701. 401 amps to 600 s 133.")5 2
Owner signature _ Datr. _ _ Branch circuits-new,alteration,or extonalon,per panel
_L'U APK,ICAN_T -- 0 C0 NTA(7F PRRS 014 A.Fee for branch circuits with
Husincss name: service or feeder fee,each 6,65 2
_branch circ:url
--- T' U.Ia fbr branch cm urn T-
Contact name:-` without Yervire or feeder fee, 46,95 2
such brunch circuit
Address: -•--
-----
Fach add')brwic h circuit 6.65 2
City/Sta tcMfi: Miscellaneous(serylee or feeder not Included)
Pump or irtigation circle 53.40 2
Photic:( ) _ Fax: ( ) Sign or outline lighdnit 5340 2
Fs tTlail: Signal circuit(s)or limited.
CONTRACTOR energy panel,alteration,or
-�-"'� --"- extension.G>cacribe, Page 2 2
Business name:WEST SIDE ELECTRIC CO.
addltlonol Inspection over allottiaMe in any of the above
Address- 1834 SE 8TH AVE. Each
Per Inspection 62.50
City/State/ZlP: PORTLAND,OR 97214 hlvestigation per hour ri hr nda) v G1,50
Phone:(503)23).1348 Fux:(503)736-0677 - Industrial lent er hour 73.75 _
ELECTRICAL PERMIT FEES"
CCB Lia: 13306 Electrical L' 26-135C Suprv. Lie.: 26635 — Subtotal I
Suprv.Electrician signature,required: Plan review(25%of permit fee)
Printname�e.� �� �.�w� r �v1 Uatet / Z tL. State surchartte(1i%uftx-rmilfeo) '
r TOTAL PERMIT FEE Z L'
Authorized SlgrltltUte: This Dr,mit appllcapon expires it a permit is not obtained within sera
days oRr.it Iia%been acceptrd err cmntdule
Print name: Date: Pee nen nM.bgy+er by Til County Uulldlnx tml,ruy Sarvlos bnanl
.. •�tvornberr,rind,eceio.,�verDemiioul'.�.veJ
i�p„dAinp Vnr,w�lfiLr.rr.,»I npp Au. 1?m) u6e0 t try t WeyCOnt/wF.A
� 'd LL90- 9CL (8091 'U0 ot.l�vai3 aPTS �saM d20tb0 b0 12 deg
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP --
Received _-_ Date Requested____�_ AM________-_ PM--____ BUP
Locationquite- __ MEC
Contact Person -�- --7 %�?�s _.r Ph(--- -) 31 /JJ PLM -- - ------- _-
Contractor_ Ph ( ) SWR _
BUILDING Tenant/Owner _�- ELC �-��U��G
Footing ELC -
Foundaticn Access:
Fig Drain ELR
Crawl Drain
Drain —_
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Sheaf
Int Sheath/Shear V
Framing -- -- - -- - -- -- ------ -
Irsi lation --
Drywa'l Nailing - --- - - ---T
r=irewall
Fire Sprinkler --- --- - - ----- ---- i
Fire Alarm
Susp'd Ceiling -
Roof
Other. -- --------- --i---- --- ------------- --
Final --- -- - -
PASS PART FAIL
- - --- -�—
PLUMBING- — -_- -J--_
Post& Beam
Under Slab - - -- -- - --- ----�. _— ---_...T- ---
Rough-In
Water Service - - - - - - - - - ---
Sanitary Sewer
Rain Drains - - -
Calch Basin/Manhole
Swrm Drain - -- _ -- -
Shower Pan
Other: `--
Final
PASS PART FAIL
MECHANICAL_
Post& Beam
Rough-In - - - - - -------— -- _
Gas Line
Smoke Dampers ------
Final
PASS PART =AIL --
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
a 11 Reinspection fee of$-__. ._.required before next in ection. Pay at City Hall, 13125 SW Hall Blvd.
PAS;a1' PART FAIL
l i Pleai a call for reinspe tion RE: __ _ _ Unable to inspect-no access
Fire Supply Line --- -
ADA _� L
Approach/Sidewalk D�- A- Irospector _ Ext
Other
Final DO NOT REMOVE this Inspection record the job site.
PASS PART FAIL