Permit ELECTRICAL PERMIT
t`' *CITY OF-TIGARD
PERMIT #: ELC2004 00468
,,,,14. AS DEVELOPMENT SERVICES DATE ISSUED: 7/29/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111AA
SITE ADDRESS: 14374 SW 90TH AVE
SUBDIVISION: GREENSWARD PARK NO. 2 ZONING: R-4.5
BLOCK: LOT : 051 JURISDICTION: TIG
Project Description: 2 branch circuits for AC and plug.
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
r
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: 1 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:
KETO, ROY + JILL HILLSBORO ELECTRIC
14374 SW 90TH AVE 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97224 HILLSBORO, OR 97124
Phone: Phone: 503 - 439 -9666
Reg #: ELE 34 -4399C
LIC 134481
FEES SUP 4941S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/29/2004 $53.50
[TAX] 8% State Surcharge 7/29/2004 $4.28 Rough - in
Elect'I Final
Total $57.78
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 44.
Issued By: ;` / `_� Permit Signature: O7 aff J A
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
From:HILLSB0R0 ELECTRIC LLC. 206013680 07/28/2004 10:18 #547 P.002
El Permit ApplicaIht
Received Electrical ` /c/
L.e� A DateB : /2 .;, r .Tii MUal JC*1 / ficial 1
Permit No.:, jam 7(/ NI —
City ' Tigard �D , Planning Approval Sign •—
y g e � Datc/By: Permit No.:
13125 SW Hall Blvd. 0 Cb 0 Plan Review Other Tigard, Oregon 97223 °� ® ti •1+ nate/S : Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -19 0� Post - Review Land Use
� /zm�t %ta w ., ,,...;,10 A , Date/By: Casa No.:
Internet: www.ci.tigard.or.us ,4 , , %, �l Contact Juria : See Page z for
24 -hour Izlspection Request: 503- 639 -4175 Name/Method: I J (�, Supplemental Information,
• TYPE. OF WORK' • ' • PLAN REVIEW Please check all that apy)
MI ew cons ion lip =1 iTa)INiC.)i ` ` = . a•lmem-fee+•14Qy
commercial 0 Hazardous location
1M Addition /alteration/replacement Other: ❑ service over 320 amps - rating of 0 Building over 10,000 square feet,
•CATEGORY OF• CONSTRUCTION : : : : • ' . : ,: . • 1 & 2 family dwellings four or more residential units in
10 1 & 2 -Famil dwellin_ n Commercial/Industrial Ci System over 600 volts nominal one structure
❑ Building over three stories 171 Feeders, 400 amps or more
I. Accessory Building ■ 0 Multi - Famil _ ❑ Occupant load over 99 persons Manufactured structures or RV par}
I. Master Builder NI Other: ❑ Egress/lighting plan , ❑ Other:
. S sets of plans with any of the above-
J OB SITE IN.FO1tMATION and':LOGATION ; '
�� The above are not a licablc to tern orar Construction service.
Job site address: i 2-0 I s( S ) C i "(`)- s t) . •... ••• • - -: •.. •_ ER PE SCHEDULE!" • " :i
Suite #: Bid! ./A •t. #: Number of ins • ections I er . ermit allows
Pro'ect Name: Description Qty Total
street/Directions ' job New residential - single or multi - family per
Cross dwelling unit. Includes attached garage.
Service included:
1000 sq, ft. or less
Each additional 500 sq ft. or portion thereof 33,40
Subdivision; Lot #: Limited energy residential
Limited energy, non residential 75.00
Tax map /parcel #: Each manufactured home or modular dwelling
5. �' •+a: service and/or feeder 50.90
,. , ;� „ ,��„ „ DLSCRIFTTON '�.0)F "W+�RK��'-�ci :, �.. , w:;,.: •,.
Services or feeders - installation,
l i alteration or relocation:
200 am.a or less 80.30
201 amps to 400 amps 1.i V
401 am .8 to 600 am.s i .1
NI /I' d R Y'0„ . .ER ,::.';; s ®.;TENATIT`'::° • z,: _ `. r ; r : k a .: 601 amps to 1000 amps 0 . �
Over 1000 am .s or volts
Name: N ; ) _ ; —
A d d r e s s : n ` c`,, Cry , k'. it ! _ Temporary services or feeders - installation,
alteration, or relocation:
Ci /State /Zi.. , . , ,�•? , r't .
. • Fax: i •. • r � : MI
® 6 b 4 to 600 a 133.75
- Branch circuits - new, alteration, or
extension per panel:
A. Peeiorbranch circuits with purchase of
Address: service or feeder fee, each branch circuit
B. Fee fin branch circuits without purchase of
service or feeder fee, first branch circuit
Phone: Each additional branch circuit 6.65
E -mail: Misc.(Service or feeder not included): 111 _ •
s "; NTRAC� .O . ... i :': t "t, "i < ?' C;ia: Each pump or irrigation circle 53.40
;ik: � ' . ?- .., e.fa R . i 1* .,, . .'' 1 i;':;�.. Each si or outline lighting •
Job No: al eras on o rt e a) or a limited energy panel, 111 �� •
Business Name: , r alteration, r xtensian
� 5 h n ► � J�. L 1.' Description:
I ■ _�
Address: "`` - .
- ' .. i . l
Each additional Ins ection over the allowable In an of the above:
City /State /Zip: 1.411`'S;Inc, oe. ci7 - Per inspection per hour (min.1hour) MI s2.5o
ax - , - •7O Investi:ation fee: ME
Other;
CCB Lic. #:13 g ( Lic. 3 - z.191-199C_. V
. - .:; ' ;EleGfnc Pei - rntt;Fees * a ?.'itV:-, :.':
Supervising electrician ' Subtotal $
si„ ature re. wired: / # t• Plan Review (25% of Permit Fee) $
Print Name: — 7,: State Surchar:e 8% of Permit Fee 111M, .
Authorized r' ', Notice: This TOTAL PERMIT FEE $
permit application expires if a permit is not obtained within
: Signature . �/.�,t� \ t. • Date ` �' � ,� - 180 days after it. has been accepted as complete.
^� \ - L ) *Fee methodology set by Trl- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElePcrmitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection tIne: r503) G39 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171
MST
BUP
Received Date Requested — Z� AM PM BUP
Location ) (f 3 7 �v 14 1 l4-!J` _ Suite 4 .5 V OS02_
Contact Person Ph ( ) () C 3' 0 7 PLM
Contractor Ph ( ) SWR • L�/
BUILDING Tenant/Owner 6 � Gd ° bg
Footing
Foundation ELC
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
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
PAS T FAIL
C AL
Post & Beam
Rough-In Line P<I / / e-
Gas Line v
Smoke Dampers
1e RT FAIL
CT L •
h Rough-In
UG /Slab /,
Low Voltage r
Fire Alarm
+�" einspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
i 4 PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
D a Inspector .A11, ' / Ext
Approach/Sidewalk � P
Other:
Final DO NOT REMOVE this Inspection record from t ' Job site.
PASS PART FAIL