Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00222
DEVELOPMENT SERVICES DATE ISSUED: 5/1/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112C6 -17100
SITE ADDRESS: 15111 SW 83RD AVE
SUBDIVISION: HAMPTON COURT ZONING: R -7
BLOCK: LOT : 020 JURISDICTION: TIG
Project Description: Installation of branch circuit for exterior A/C unit.
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: 1 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:
MARK DOBSON SHARPE ELECTRIC INC
15111 SW 83RD AVE 22605 SW RIGGS
TIGARD, OR 97224 BEAVERTON, OR 97007
Phone: 503 - 968 -9041 Phone: 642 -7937
Reg #: LIC 81518
SUP 3344S
ELE 34 -217C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 5/1/01 $46.85 2720010000( Elect'I Final
5PCT CTR 5/1/01 $3.75 2720010000(
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 .6699 or 1 -800- 332 - 2344. �Q
Permit Signature: ,�� " ._ (/ 1 Issued By: ,
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 7:00pm for an inspection the next business day
•
A Electrical Permit Application
Date received: 0.47 201— OD A a
` City of Tigard �/ O � Permit no.:
�, �: y b Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By:Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
A'1 & 2 family dwelling or accessory ❑ Commercial/industrial Cl Multi- family ❑ Tenant improvement
❑ New construction ( Addition/alteration/replacement Cl Other: ❑ Partial
• JOB SITE INFORMATION
Job address: 15/1/ SW $3 If g Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: (Subdivision:
Project name: �J 5 , !Description and location of work on premises: Oy ' l n /(,'
Estimated date of completion/inspection: 5/V 0/
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: If D I ' (I Fee Max
Business name: 5 f) . f' f c Ei—QGEJc7 4 �. Description Qty. (ea.) Total no. insp
� � � 5 a New residential - single or multi- family per
' Address: ] i dwelling unit. Includes attached garage.
City: 8/ -vet.. tate:eX 'ZIP: 4 70 0 7 Service included
Phone:So 3 i 793J ( Fax: " (E -mail: 1000 sq. ft. or less 4
CCB no.: �' / 6 / (Elec. bus. lic. no: 3-1 - oZ 7 t.„, Each additional 500 sq. ft. or portion thereof
Limited energy, residential 2
City /metro lic. no.: 01,53/ Limited energy, non - residential 2
, ate / . q /a 7 /O/ Each manufactured home or modular dwelling
Signature of supervisi g electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): L. ' • 6 � Licenseno: K -$ Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): M&L 0 /Sp/( 201 amps to 400 amps 2
Mailing address: / /!/ SW 8 4--V 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: i /a.i a (State (ZIP: 9 ?aa..// Over 1000 amps or volts 2
Phone: R'6 r- 90 q// (Fax: (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 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: ( State: 'ZIP: B. Fee 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):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps - rating of I &2 ❑ Hazardous location Each signor outline lighting 2
family dwellings ❑ Building over 10.000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection I I i
Submit sets of plans with any of the above. Investigation fee
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 $ y� . e?-5
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 3 r 7s
Expires accepted as complete. TOTAL $ •=5 . C C
Name of cardholder as shown on credit card
$ .
Cardholder signature Amount 440 -4615 (6/00/COM)
3- vet .�-.
CITY bF TIGARD BUILDING INSPECTION DIVISION •
MST — —
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP '
Date Requested 5--/ d AM PM BLD
Location / 57// g7 Suite MEC -
Contact Person Ph C PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC Z L Z_-
Retaining Wall EL R
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing _
Insulation / 1 6 / Drywall Nailing 3 6 4 C 6. /1 4 J
Firewall
Fire,Sprinkler
Fire Alarm g
Susp'd Ceiling /7 4
Roof
Misc:
Final
PASS PART FAIL
PLUMBING �S
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL •
Post & Beam •
Rough In -
Gas Line
Smoke Dampers
Final
PASS PART FAIL
"tLECTRg
Service
Rough In
UG /Slab
Low Voltage
_ . Fire Alarm
• RT . FAIL -
Backfill /Grading '
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection.. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ]•Please call for reinspection RE: [ . ] Unable to inspect - no access
Fire Supply Line
ADA / �.,-�
Approach /Sidewalk Date l ! / Inspector /yJ7 Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.