Permit 1 .•
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
l DEVELOPMENT SERVICES PERMIT #: ELR2004 -00134
13125 SW Hall Blvd., Tigard, OR 97223 (5031639 -4171 DATE ISSUED: 5/24/2004
SITE ADDRESS: 14675 SW 84TH CT PARCEL: 2S112BC -02100
SUBDIVISION: HAMBACH PARK ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
Project Description:
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
NESBITT, DAN & JOAN OWNER
14675 SW 84TH CT
TIGARD, OR 97224
Phone: 503 -968 -1881 Phone:
Reg #:
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 5/24/2004 $75.00 Elect I Final
[TAX] 8% State Surcharl 5/24/2004 $6.00
Total $81.00
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 95 001 -0100. You m y obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by Permittee Signature O
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 7:00 P.M. for an inspection needed the next business day
I
•
Electrical FermitApplication
Date receiv .v
Tigard Address: 13125 SW Hall Blvd, Ti d
,•�_�!" City of Tigard
. Permit no,: ��� • ,00 Ciry O 97223 Project/app), no.: /
1 Expire date:
Phone: (503) 639 -4171 �v Date issued:
Fax: (503) 598.1960 2 13y: Receipt no.:
l Case hie no.: `� lb. Payment type:
Land use approval:
TYPE OF PERMIT
10 &Si 2 family dwelling or accessory ❑ Commercial/industrial
0 Netr construction Q Addition /alteration/replacement 0 p h eqfamtly 0 T ti improvement ,
-�� ❑Partiai al
JOB SITE INFORIMATION
Job address: I , �
lttsrr�
Lot Block: a�� Bldg. no.: Suite no.: Tax m lor/secou nu.:
Subdivision:
Project lame: Description and location of work on premises: b a•% --tom
• a timat� :d date of completion/inspection: t:
Lo
ill
CONTRACTOR APPLICATION 4 -+- 5 b' t ■' ' '-r'- '
Job no: it FEE SCHEDULE
Btsincs::. name: mp X
Desert • Hon l e Max
residential - gleOrmtrld -farm per
( ea) Tots) n0-. Insp.
Ci �y:
dwollinglmit. Incladea attached garage
Ciry:: ZIP: Sorvieeu,claded: MIMI
1000 s of lc.ss
CC'B no_: Elec. bus. tic. no: Bach addi ft, tional 500 s9 ft or portion thereof
City /met ;o tic. no.:
Limited energy, residential
Limited ,non - residential MU = = �
_
Sig' uac,rc t f sq • raising electrician (required) Each manufactured home or modular dwelling .■��
Dote Service and/or feeder
2
Sup, elect.lame
License no: Services or feeders–installation,
PROPERTY Ol, •NER alteration or cations III Name (print): J-04:--1.1 J 0 20 amps or less
1 { t? " L 201 amps to 400 amps 1111
Mailing a ddre�L11 ✓ 1,......) : cl 'EL: * 401 at to bon amps ��_ 2
City: c' 0-,,e, State: 601 amps to (000 amps �� =� rl
Pl10ae s'S' Fax: Reconn 00ampsorvolts _
Temporary sevic
only
or 4 which is r. of intended for s • � , 1 , .- nt., o a
Owner installation: The installation is being made on property I own T
sage acco Ins �llatimyaltenation ,orre locati on:
w
ORS, 447, 455, 479, .70 01 / : 200 amps or less
owner's signature;
.. , _. �;% Dam: 5 .- / f / 201 amps to 400 amps _,
��
_ENGINEER] circuits. amp
401 to 6()O amps MU
Name: ' - - - - . . Branch . new, attoratlort a�� 2
or extension per panel:
Address: A Fee for branch circuits with purct�.e or
City: service or feeder fee, each branch circuit
Phone: Z IP' B. Fee for branch circuits without purchase
of service or feeder fee. first branch circuit: r.
��
.11' LAN R IEVI>v \l' (pleasc clue all that apply) tach additioratlbrenca circu i t �_
O. Serdce ovl r 225 mops- cortrmercial Misc. ump or irrigation feeder n circle
included): ■■■
O Service ovc r 320 amps-rating o f 1 c�2 Q tie;tlth-eare facility Each pump or irrigation Circle
Razanio'us location Each sign gnoroutlineli
O System eve :600 volts nominal O Building uvcr 10• square feet four or Signal circuit(s) or a limited _� 4
ens
mom resider il units in one strncture alteration, or extension" rgY panel. ��.�
0
O Building oN er three stori¢e 4 Feeders, 400 amps or more
Oca 'pant It ad over99 persons 4on: _
p 0 Manufactured structures or RV park Desrn
�
0 Ecrees/lighi,ngplan 0 Other ch additional inspection over the allowable in any of thoabove:
Submit sets of plans with any of the above, per ids • coon __
The al love are not applicable to rem investigation fee
parity cootst service. Other
r Not an jundictia is accept credit cant:, please call jurisdiction for more information,
0 Visa 0 !r astetCard Notice: This permit application Permit fee $
Credit cand mumd r expires if a permit is not obtained' Plan review (at %) $
____L. / c`pt�; within 180 days after it has been State surcharge (8 %) ....
Rune or' ardhotder as show on etetW card accepted 0-9 complete. TOTAL
camha si $
— $
aer
ttum Amount ^
440-4615 (6/00/COM)
2•G 8TL0 86S EOS Zui2eaH Rztezoadg d�O :2I �p I Few
CITY OF TIGARD -. 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION —
IVISION Business, Line: (503) 639 -4171 MST
BUP
Received f(0 Date Requested �// ( AM PM BUP
4 !r
Location It-4(6 - Suite MEC
Contact Person . Ph ( 1 16, I PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ►� ���� 4 -- 7.o 3 Li,
Foundation '� � %'
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: •
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
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
L 7
S
Rough -In
UG /Slab
Low Voltage
Fir- Alarm
.11? 0 Reinspection fee of $ required before next inspection. Pay at City Hall 13125 SW Hall Blvd.
PART FAIL
S Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA + �( 1
Approach/Sidewalk Date O ` 1 O Inspector Y ,4 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site. -
PASS PART FAIL