Permit C ITY OF T I G w VH R D ELECTRICAL PERMIT
• PERMIT #: ELC2004 -00190
DEVELOPMENT SERVICES DATE ISSUED: 4/14/04
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171 PARCEL: 1S133AC
SITE ADDRESS: 10905 SW BRIARWOOD PL
SUBDIVISION: HAWK'S BEARD TOWNHOMES ZONING: R-25
BLOCK: LOT : 030 JURISDICTION: TIG
Project Description: Temporary service & (4) branch circuits for sales trailer.
RESIDENTIAL UNIT . TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT 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: W /SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 0 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:
DEREK L BROWN & ASSOC ELECTRUM INC
4949 MEADOWS DBA SPECTRUM ELECTRIC
LAKE OSWEGO, OR 97035 2050 VISTA AVE #100
SALEM, OR 97302
Phone: Phone: 503 - 361 - 1256
Reg #: LIC 116453
SUP 29I9S
FEES ELE 24 -353C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/14/04 $77.50
[TAX] 8% State Surcharge 4/14/04 $6.20 Elect'I Service
Rough -in
Total $83.70 Elect'I Final
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 tha =! • - -. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in o • - 952 - 001 -00 rough OAR 957 0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -800 32 -2344.
Iss ed By: ` _ �;i' ,�j : , Permit Signature: ) : �� 1 "
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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: • - - — DATE:
LICENSE NO: 9 3s
Call 639 -4175 by 7:OOpm for an inspection the next business day
Permit Application i `� 1. r l c i :� %1
ty of Tigard �� Penmit No: ... —.A. 4 a
13125 SW Hall Blvd, Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4 " , '' i i �. Date/By: Other PeRO1t`
Inspection Line: 503.639.4175 _ _ _. Date R i ,.../7 0 See Page 2 for
Internet: www.ci.tigardor.us Notified/Method: 1 C0• Supplemental Information
TYPE OF WORK PLAN REVIEW
® New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, corn, ['Hazardous location
❑ Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ® Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
CI Multi - family 0 Master builder ❑Other
❑ Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION .1 ❑Egress/lightingplan RV park
Job no.: Job site address:jj 905 Sbf/ /' /.4/'ul ❑Heath -care facility ❑
Submit 2 sets of plans with any of the above.
City/State/ZIP: �G A r �/ �2 9 2 0 1-23 AL The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: J `� I Project name: FEE* 'SCHEDULE
Description I QIy• I Foe. I Total I ••
Cross street/directions to job site: New residential single- or multi-family dwelling tmit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 1 Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF. WORK Each manufactured or modular
/ / dwelling, service and/or feeder 90.90 2
: :�� 'c• = /��.� 1 dr r A Services or feeders installation, alteration, and/or relocation
200 antes or less 80.30 2
• PROPERTY OWNER I ❑TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/StateJZIP: Temporary services or feeders installation, alteration, and/or
I Fax: ( ) relocation
Phone: ( ) 200 amps or less 1 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 antes 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 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT. 1 ❑ CONTACT PERSON „ A. Fee for branch circuits with
service or feeder fee, each s. 6.65 2
Business name: brand circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax:: ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
' CONTRACTOR - - energy panel, alteration, or
Business name: s tl` _` aNN ��Gl, c. extension. Describe: Page 2 2
Address: 420 — U S7A Ail( -5:f. '/OU Per � additional inspection over allowable in 62.50
of the above
City/State/ZIP: A/1* »- 0O, 99302 Investigation per hour (1 hr min) 62.50
per hour 73.75
Phone: (S ) 36/ ash Fax: ( So 3) j V 6 / — at / Industrial plant ELECTRICAL PERMIT FEES
: Electric Lic. S Lic. ^� •
CCB Lic.
//'��5.3 �/ �' I Suprv. : �2�3'S Subtotal 7 2 So
Suprv. Electrician signature, required Q // / I Plan review (25% of permit fee) 4, a,,�
Print name: � ++ � r � / � j9' . ` Da ! te: y�L���� State surcharge (8% of permit fee)
'f ft' , �(,(�N ro TOTAL PERMIT FEE 83 • 7(6
Authorized signature: This permit application expires if a permit Is not obtained within 180
days after It has been accepted as complete
Print name: Date: • Fee methodology set by Tri- Cotmty Building Industry Service Board
— •• Number of inspections per permit allowed.
CITY OF TIGARD 24 -Hour
-BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested '2' '0 AM PM BUP
Location � J �ll uite / 1 3 () MEC
Contact Person � _��14 . hL _ Ph ( ) '14 - 4/(97 PLM
Contractor P� ) SWR
BUILDING Tenant/Owner 64.aler G� 774A-r 7 ence ) Z 1 ?'()
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam (.2
Shear Anchors ' n
Ext Sheath/Shear {1
Int Sheath/Shear
Framing
Insulation
"'
Drywall Nailing 5 / 5 •Ot' 4-41414 —
Firewall
Fire Sprinkler /'' � /
Fire Alarm v ��G�1/(1�'`'���f C / `r !. 2J;
Susp'd Ceiling
Roof 114A-1 /111-24/
Other:
Final
PASS PART FAIL h PLUMBING * 6- F A41
Post & Beam
Under Slab
Rough -In APO 4 Ate ` %,���' ' �G�2� p L �T/L 1U
Water Service ��4 � -- ,
Sanitary Sewer � ��' 2 �!
Rain Drains
Catch Basin / Manhole •
Storm Drain r
Shower Pan e 1 / • /r--G'C,T G Q 4 /( j ' a 6t tj'li!
Other:
Final A GGLjXX Za Tfa 1V
PASS PART FAIL
MECHANICAL /ZO'/" , — z: . 4J
Post & Beam l04 l -
Rough -In
Gas Line
Smoke Dampers
Final
PASS T AIL
Service 'Tt, ,4/
Rough -In
UG/Slab �
Low Voltage � D A " `
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: fl Unable to inspect - no access
Fire Supply Line / O
ADA D ` ;� - Inspector /''�� , -��` Eat
Approach /Sidewalk p
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY -OF TIGARD 24 -Hour
=- BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 4 1- 4 5- 'O<‘ AM PM BUP
Location /09 Q o aJLt ( ) CO a Suite 30 MEC
Contact Person Ph ( ) f6060 'el P9 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner LID) D T I 4 i 7P 0
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final C �
P ASS 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
Smoke Dampers
Final
PASS PART FAIL
LF - ICA
- oug - n ••-
UG/Slab
Low Voltage
Fire Alar
Fi Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS' PART FAIL
s 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date i 610 Inspector . 1 4 R" 6TES Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL _—