Permit /''�;., CITY OF TIGARD ELECTRICAL PERMIT
' PERMIT #: ELC2003 -00741
DEVELOPMENT SERVICES DATE ISSUED: 12/24/03
" I 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S112BD-00100
SITE ADDRESS: 14640 SW 76TH AVE 067
SUBDIVISION: TIFFANY COURT APT. ZONING: R-12
BLOCK: LOT : 065 JURISDICTION: TIG
Project Description: Reconnect.
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON CO. HOUSING AUTHORITY OWNER
111 NE LINCOLN ST
#200 -L, MS63
HILLSBORO, OR 97124 -3082
Phone: 503 -846 -4794 Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/24/03 $66.85
[TAX] 8% State Surcharge 12/24/03 $5.35 Elect'I Final
Total $72.20
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1-800-332-23V.
.
Issued By: {J Permit Signature: O?ti Q,c, C.0( twV
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
CaII 639 -4175 by 7:OOpm for an inspection the next business day
DEC -24 -2003 WED 07 48 AM FAX NO. P, 02
w � 12/24/2003 09:01 FAX 503 9,60 �v CITY OF TIGARD la 001
E A r e t r i c a t I e 1 Ar A p p l i c a t i oo n volt olt 1 1 1 1 1 1'l l) \I,1
City of Tigard ' ULL 4 ' 2 � a W II a /� /r ()3 PcnmtNa: p3 ' Oa � `�y
13125 5'W' hall blvd., Tigard, OR 97223 _ Plan Review
Ro
Fne: 503,639.4171 Fax: 503 598,1960 ITY OF TIGARI �' I' DaOe�Y thh.rBcrnUa
1nspeetion Line: 503.6394175 - 'I I D. R.edy/tly: rarir, ® Sea rape 1. rnr
internet: www.oi,dgard -once$ BUILDING DIVIS{k1v j NwifledmtO*4i � - 14Mdhttl lacer,nalFOn
, .' T 1 �fr41 ,T"!["r . .. - .
' ��y'p�}rt,, iWW 7 ' ___ ;•• -TIC ill � �g�y + •,G,= ;: i �" •1
.
:WT _
'a v 0 ' 9 . Ake. .YCreltenf k� . 1 � , r ). +.'.� 1 � r. LL:. d : r I � r tl�l'1 � /i' r, -m,', .. �� „P•F,I f I
IN New construction - _ .. _.._ - Addition/alteration/Tapia anent Please c . eels aU tot apply:
C Service over 225 amps, commit D 1-tazardous location •
❑ DFtnntltiop Other G LI Service over 320 amps _ rating DBuildn R
g over 10,000 sq. ,
i 1 :G i J 1- and r
!! � of and Z.tSrtti dwellings 4 o mare 'WV residential
O t- and 2- tinnily dwelling II Co a ntereial/lndustrial Q Accessory building °System over 600 voles nominal units in one structure
rrr` over throe
?: Multi family Wilder ilder ❑ Other DOccuant load ove eve r 99 versoru Manufactured amps or sir uoniras s Or
_ t � ^, � []Oce • . 10 ({ " 1 l r 1 q ; , . , W ` r u'4 q P P AlM ,' ❑ggress/118716$piin P,V parK
Job no.: Job site address; j — '� Ciltealth -care facility 1 C AJ 1 n e c
o.r A 5ubmiti sets of plans with any of its above
City/State/LP: C The above arc not applicable to temporary construction Servlac.
- — SuitrJbldll, /apt, no.: Project r t1 t-� , outulpa� t ae. Tart
Crow au et/diirections to job site: -. 5 • yi i 2 1 . i, t4 7 ,41i fI ticw resadcntial Angie. Of mu dwelling unit:
Includes attached garage. - _
1,000 s ft or tens 145.15 4
Subdivision: Lot no -: Its add Sod q. ft, or portion _ 33, 1 -
-- _ Limited ens? . reddential 7L00
Tax man/parcel no.: Limited energy, non - residential 75.00 2
17 ” • -i s is H � c i „ :.,y a - I , ,r•r.,-.r�-cr..; .
1; 7 '+ 1 `'a..eL1.1; l0 ., t �: .� Fsclttmnuacturod
dwclline, service and /or feeder 90 -e90 2
Serileee or readers installation, alteration, and/or relecntion
200 amps or leas 8030 2
^^I� °r - -•,.. , .. ∎, •M• 7m : .Jl�6,r�i 201 amps to 400 amps _ 106.85 2
- - _ l
-•9° ^• . � .1 IL. ,l .5te., Y, Ili Ij,l.J. .., Y, t.,.L.trT' : 160,60
-7 P ; Il a 401 601 Amps to 600 a p Z Frame: try ., to 1,000 imp 240,60 ` _ 2
Addratea •� • 6 A • A ` , -L IS ?-,, • Over 1,000 u4,6 or volt$ 45
_ 1Zeconlucr only • 66.85 /� -�(� 2
City /Se re/ZJPt ( I I c..,b(',. + 0 i I G Temporary services or feeders installation, alter ChM, and/or
relOtaliOn
Phone: 43V) g L. /Lj ci 0 'ax: 60 ) • - L 7 s 200 amps or less 66.85 i
��
Owner inst:sllatian; This installation is b '. • • • e on property that I own which is not 201 amps to 400 amps 10030 2
intended for sale, lease, ttmt - , c • / ( ording to ORS 447, 449, 670, 701. 401 amps to 600 n ..9 131.75 2
Owner sig neturce .- -~ flare: /,2-2'/ ' , Branch circuits -• new, alteration, or extension, per Iranrl -
. i � l ' -- /1 -.,14/?,;{ ' , fray , V,a •' sir.+ A. Fee for branch aimuils wren
l" .S P c . 4 .i i r , - !T
. 1 4 4 . iii 1,1- ; r r.•� '.1,4;1.4 i,• { '
t n . a ,.. 1. .- r } : service or feeder fee, each
Bueittkss Derma ' I branch circuit 6,65 2
a c d ' r allil S. Fee for branch circuits
Coltlact name: . - .. 't. •, 7e i 'Without service or feeder fee, 46.85 2
_ II each broach circuit _
Addrtxr H �! / l G r Y - � E ach WI bcanob circuit 6 -65 12
City/RIM/ZIP! 11-1i l M ^ / y ' h' Mist oll•neous (service or feeder included)
PUm or irrigation circle 53.40 2
Phone:
(��C)%) • L /6a^ 1/4140 a°c: 1(IP?) . 6— L,17r5 ' Sign or outline li ghting $3.40 2
lye i 1.6 l.2 .6 , e,. ry ' �y. l m �rg{ 1, lt° Sl circuits) or limited-
'. s', 1 lt i Q t 1 1 : r � hilt C3 r glithink ti
Fdtr energy pancl, alteration, or
exta rion. Describe: Page 2 2
Business aa1'no1
-
Each additional Lns pection over 7tltpwabl. la any of the above
Address: per impaction 62.50
City/State/ZIP: Investigation p ar hour (t br min) _ ^ 62.50 OM
-
( ) l+ ( - irdusrrialpixns •erh0ar 73475
phone:
_,ui.vlu' rf., ..- -J iii27�'7. 7 7 .7,?,•:57,+l?�,w ? ie,ft.,•�ilr,;1,
CCB 1-1c.: Electrical Lie-: Suprv. Lic.1 : Subtotal 4 4,,,.g5
Suprv. ,I31e rician sietutlLte, required; Plan review (25% ofpmnit fen} __
Site surcharge (8°A Of perrl'ut. fee/ 6.3 C
Pant name: Ddte: —
— TOTAL PERNOT Ficic T -,
Authorized algraatutr. Tats parodic appI catteu aspires or 1 parade Ir not obtained with L8o
dayr an.- it hos bean eeo.ptcd taw complete
Print name: Date; • Foe mctbodology it byTri- County By iltilas tndasuy Scrvicc Board
•+ Number oriruptedom per permit; allowed
mar es ∎P• n raat.a►..; App,dod twos . 440.4etsT(1WO7(COMNVaii ,
CITY OF TIGARD 24 -Hour
BUILDING Inspectidi Line (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 1 AM PM BUP _
Location "1 46 4 D - ' I2 w Suite MEC
Contact Person Ph (— ) 84 (or' n c s PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner CEE (5 0
Footing ELC
Foundation Access:
Ftg Drain - ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof ee
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
CAL •
cue Nrce Ckp v
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Ej Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
"Ma a PART FAIL
SITE Please call for reinspec ion RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date/07 Inspector j' < Q Ext
Other:
Final DO NOT REMOVE this inspection record from t Jo siite.
PASS PART FAIL