Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00719
DEVELOPMENT SERVICES DATE ISSUED: 12/16/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 1S136DC - 03200
RESS: 11720 SW 72ND AVE
IP
..
SUBDI VISION: ELNOLA HEIGHTS ZONING. MUE
BLOCK: LOT : 008 JURISDICTION: TIG
Project Description: Upgrade 200amp panel.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 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: 1 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:
KAUFFMAN, VAL L H MORRIS ELECTRIC INC
11720 SW 72ND. AVE. 7051 SW SANDBURG ST, #100
TIGARD, OR 97223 TIGARD, OR 97223
Phone: 503 - 620 -1357 Phone: 503 - 639 -2334
Reg #: LIC 1838
ELE 20 -39C
FEES SUP 30065
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/16/03 $80.30
[TAX] 8% State Surcharge 12/16/03 $6.42 Rough -
Elect'I Service
Total $86.72 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: ,�� i, t G(; 1� Jl c� l/� Permit Signature: &122L �( 7 1 c1
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:
Call 639 -4175 by 7:OOpm for an inspection the next business day
s
4 ' ` `,. 70414
Electrical Permit Application . OFFICE USE ONLY
RECEIVED �
Date received: j,: 1'-� .-J LC� 6,
j Permit no.: - 7
4 „c... 11 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard,-OR, 9.72 23,, Date issued: Bit Receipt no.:
Phone: (503) 639 -4171 U j
Fax: (503) 598 - 1960, Case file no.: Payment type:
CITY OF TIGARD
Land use approval: CU !LOIN ^ nlv!clnnl
TYPE OF PERMIT
•
11 & 2 family dwelling or accessory -JCommercial/industrial ❑Multi family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: . 11720 SW 72ND AVE Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: I Subdivision:
Project name: KAUFFMAN I Description and location of work on premises: POWER FOR DISHWASHER .
Estimated date of completion/inspection: I • r. ,_, r -
CONTRACTOR APPLICATION • • FEE SCHEDULE
- Job no: -- — 7"0 - 4 I 4 Fee Max
Business name: L.H. MORRIS ELECTRIC INC Description Qty. (ea.) Total no.insp
New residential - single or multi - family per
Address: 7051 SW S ANDB RG ST #100 dwellingunit .Includesattachedgarage.
City: T I G AR D I state: OR I ZIP: 97223 Serviceirrcluded:
Phone: 639- 2334IFax:620 7405Eamil: woo sq. ft. orless 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 1838 I Elec. bus. lie. no: 20-39C Limited cncrgy, residential 2
City/ tro lief Limited cncrgy, non - residential 2
` O Each manufactured home or modular dwelling
• Si re o pervising cic rician (re tied) Date Service and/or feeder 2
Sup. elect. n. • (print)GARY PEOPLES License no3006S Sery ices or feeders— installation,
alteration or relocation: i r
PROPERTY OWNER 200 amps or less 1 80.302.1-
Name (print): ��, �� 201 amps to 400 amps 2
401 amps to 600 amps • 2
Mailing address: 601 amps to 1000 amps 2
City: 1 State: 'ZIP: Over 1000 amps or volts 2
Phot3 6,a0/3571 Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps r 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fec for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail:
Each additional branch circuit:
. .. PLAN REVIEW (Please check all that apply) Misc .(Serviceorfeedernotincluded):
0 Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1 &2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited cncrgy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension' 2
O Building over three stories ❑ Feeders, 400 amps or more •Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other: Per inspection
Submit _ sets of plans with any of the above. Investigation fcc
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee S 80.30
O Visa O MasterCard expires if a permit is not obtained Plan review (at %) S
Credit card number: / / within 180 days after it has been State surcharge (8 %) S 6.42
Expires accepted as complete. TOTAL S 86.72
Name of cardholder as shown on credit card
Cardholder signature Amount 440 -4615 (6 /00 /COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection -Line? (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
//// BUP
Received 1 / / 6-'56 Da et Requested / —2 - —0 q AM PM BUP
Location / / 7 7 c Suite MEC
Contact Person � 37 /diTc Ph (, P ?O - 5 Les PLM
Contractor Ph ( ) SWR C�
50 e BUILDING Tena A�'� L C .� -40 7`
•
Footing f
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: . SIT
Post & Beam L' eta
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
ELECTRICAL
service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Fin ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SI ❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line Date 1 0 Inspector `\ L 66 Le Ext
ADA
Approach/Sidewalk
Other:
Final D NOT EMOVE this Inspection record from the job site.
PASS PART FAIL