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Permit A CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2003 -00235 ,.i. DEVELOPMENT SERVICES DATE ISSUED: 4/24/03 =Ir• 13125 SW Hal l Blvd.. Tigard, OR 97223 (503) 639 -4171 � 7 � PARCEL: 2S 101 AA -08700 SITE ADDRESS: SSW 68TH AVE SUBDIVISION: WEST PORTLAND HEIGHTS ZONING. MUE BLOCK: LOT : 029 JURISDICTION: TIG Project Description: Job #03 -04262 Temporary 200amp power install. 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: SIGNALJPANEL: 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: PER INSPECTION: 201 - 400 amp: 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 >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: ROTH, J TJR + THERESA AMP ELECTRICAL CONTRACTORS INC 12600 SW 72ND AVE, STE 200 1573 SE HOLMAN AVE #3 TIGARD, OR 97223 DALLAS, OR 97338 • Phone: Phone: 1- 503 - 831 -0585 Reg #: LIC 117422 ELE 27 -65C FEES SUP 4783S Description Date Amount Required Inspections [ELPRMT] ELC Permit 4/24/03 $66.85 [TAX] 8% State Tax 4/24/03 $5.35 Elect'I Service Rough -in Total $72.20 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 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 direct questions to OUNC at (503) 246 -6699 or 1 -800- 332 -2344. Issued By: J Vt _ LAIL2 Permit Signature: Gl ,c240 " 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: 47 K 3 S CaII 639 -4175 by 7:OOpm for an inspection the next business day APR -23 -2003 11:26 FROM: TO:5035981960 P.001/002 u4/23/2903 11:11 FAX 5035981960 CITY OF TIGARD r 001 Electrical Y'enn1 Applica FOR art ir✓k_ csE oN LY • • . }:ti•• J►i • •r ... i.- 7Y.w..v� iii /_O • + • I r N .�{iC. - # / -00 \ , i City of Tigard i � /� X�E hsAwp Sips 13125 SW Hall Blvd... � t �o5' T' S V i O 1 l Re Other Tigard. Oregon 97223 . ' t Detefi Petit xo.: Phone: 503.639.4171.`'"`P�=99&.1: � ` rP� , ' • ed:eview [.and use - �,, • , r�:, c tI -, - case No.: Internet: www.ci.tigard.or.us 224-hour Inspection Request: 503.639-4175 : - ^ ` �`�� COAL !Ws.: •:' sae rasp 2 o tbr G \ .� \�G • femn Sn�pentaf srhlfotton_ 7,4t . ::i: r:Z62!Vt.. ! •• e. :1..', . e Peal It A-27,41 4:Af •_ '"15; ' :e:rniR ••: 'If „•. • , 'jr 1 le Tb At .. c ; : ,., I New constriction el Demolition la S@+nec over 225 a mps- at Hmlth -van facility commeselal 0 addit9on/alt:erAtio - .laaement other: o 320 B Hazardous location ' .. -. , �-+7ti• • :1 ?Nl - e o c: • &.‘' w f# ; %!w "Kft.,;+ 1 %2 family dwellings amps-rating �fourromoro residential u� in PI 1 : 2- Fa7r111 a • : I1/ Cvmattereiai ndustrial . ❑ Sysomn over coo volts manila' moms= ij II - .. • 3uildin ; IS Multi-Famil Balding over three stories In Far,, e00 amps or mow D Occupant load over 99 persons D ManuSsetored tosure a at RV park L Master Builder W Other. D EStesa#stiegplan CJ Other: °- '', o 5 x� r o • ,v: r oo . lid; 7., 0. or! -< H " f' Submit s of ploaswitb of the �O�Pral�7'h^ : _.:,.�, f any above. Job site address: , rte ' t The aboro or • • t .,, feeble to tem .. eaustraetlou .. ,�g� �Z Suite #- ?dumber of in • - • Dos . . 1 owed . • 'tat Name: Po % nett; • too Qv I mowed Cross streetlDirectaoasro job site: Plats ® t agz° °r'J :�' Per SA) i.� !4 �C. d. W 1°.1r i4 Q- Sartre a dada± sanded garage. 1000 No. 11:Irkss _ 145.15 4 8ochodditional 500 aF it or maim thereof 33.40 t Subdivision: Lot #:. 90.90 2 L maim. nos teesideodal 75.00 2 Tax ma • • excel #: `a" �sAO 2 _ yy Fsgam home or modular dtvo�g f r 3 4 1 •5 ,,.. a 2 _. i 7 a c e '�F `-"' T + service as nn fader — �-�� 1 - :- � Services or feeds s _ <m aloe. _ TE ' f owe, To 1 llamado* or education: 200 emus or leas II 50.30 2 201 en o s 41400 Napa - 10615 2 401 to 600 ... - 160.60 2 Tai : ___;-.T.:,-;7; t4 o !.7 '. a4 ' n: , • r I. is .-,�,•.. �; 601 to 1 moos _ � '' "„:,�',� ��' >. 000 240.60 2 . t va1000amotorv 454.65 2 Name: , 6685 2 .Address: Temporary. 6erviat or &Mars - inat>tllatlou, II Ci /Slat . • : altw2tloa, or rotoaabenl 200 .... or leas e� 6625 , , p 1 i Phone: Fax: 2otfinystego.mpe - am 100.30 MIMI 2 . �R- , I q ., -1;1:c y !' I(. �o ti s �t • ti 4^� '^:'r �O1 es 600 .. . 13315 2 W _J== ... . • . .;.. itI� Breach err der — D- Derv, aitorfWep, or Name: _ datendon per panel: Address: A_ Fa fly branch circuits with purebass of »foe or feeder • eacb •• d aut II 6.65 Ci /State/Zi • : a Fos far branch sir i t •,.. ,. jaae at illariMillil Phone: Fax: service or feeder flees eon bronco cfwft Each add'eiena] bomb oilent [♦ 6.65 ` L Ell E -mail: 1► (Sorvioe or feeder not included): © ...:'� 1�1tt d c ., ct . `;t 2 , • . . • -. .- C 33.40 Job No: d -- p Fiat - ' or • iae 1, • •, 53.40 -p Business Name: i ,,t,. or a IaniOad energy MIMI II Address ;,lJ 7 3 S _ c : " NI II C /State /Z • : r9-/ -a 0 q 3 y Eacb dditiopel in . anion asst the allowable in , Of the above: Phone: 0 , 7 D$,y. ETIIS=ArrignigM3 tiggiliilli 62- � II CCB Lic. #: / 74/ 2 2 IFEEINEMMIIIIIII 01he -: 1 I� r - _ Supervising electrician ... _ u T :: ,�Yrri �a . ai _,. •fire . eft / ii Print Name: o . r" a st = , TOTAL PERMIT PEE S , ZO Authorized I•lodoc Tido paretic app1entlen aspires if b permit is not obtained maths Signature; Da= 180 days After It bas been aempied as compl.tz - 'Fm metbodoiogy sat by Tri- Conley goading Industry Servlea Board. (Please punt tome) isVpstsWormitFmr oUElePenrarApp.doe 01/03 CITY" OF'TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP - Received Date Requested AM PM BUP Location �� 6g• Suite MEC Contact Person 1a 1 f Ph ( ) ' 3 I " .5515 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain '� ;, �.,� — ELR Crawl Drain Slab Inspection No es SIT Post & Beam )(- p r4 -T 0 - ) � � to )_ Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS 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 - ELEC - ICAL 115Z' 0 Roug -In , UG/Slab • Low Voltage f? Fire Alarm /Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PART FAIL SIT ❑ Please call for reinspection R • ' Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date c=.2 Insp..... r A �� -��� • ♦ Ext Other: Final DO NOT REMOVE this Inspection record om the ' site. PASS PART FAIL