Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00504
COMMUNITY DEVELOPMENT DATE ISSUED: 7/23/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S114BB -07400
SITE ADDRESS: 16233 SW 104TH AVE ZONING: R -12
SUBDIVISION: SWANSONS GLEN LOT : 015 JURISDICTION: TIG
PROJECT: BLAKLEY
Project Description: 3 branch circuit. AC and work 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
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: 2 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:
ROB BLAKLEY CANBY ELECTRIC INC
16233 SW 104TH AVE 790 S IVY
TIGARD, OR 97224 CANBY, OR 97013
Phone: Contact #: PRI 503 - 266 - 7878
FAX 503 - 266 -5543
FEES
Description Date Amount Reg #: ELE 3-112C
[ELPRMT] ELC Permit 7/23/2007 $60.15 LIC 26071
[TAX] 8% State Surcharge 7/23/2007 $4.81 SUP 2123S
Total $64.96 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: 4,114.4 `eiew
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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' . J e ct rii caI Permit ppflica x .n .
L007 TOR O F FI+CE USE ONLY Y
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City of Tigard U r_ .
13'12 j 5 W *11 Blvd., Tigard, OR 9722 t i I L A r •
' s i 9 D Datt/.By: o" 7/, 7 1 / Fern! No�LotOD 2 % ,
t: Plan Re ew
• 1?hooc. '103.639.41 1 Fax 503,59 !w
e c 3�`Ic�5I f +� Otlser Pcrsnita
Titsiection,I:ine: 503.639.4175 US 11-t�t v '- ' 1� Cetc/8':
sar�yt 7urut ® s •s ee 2 for
' :Internet t:Internet www.ci,t[gard.or,us DateR Notified/Melltoe: I Supplemental Inrrirteatlan
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' ��� , �. - 't" i1 , 4�. w. r: .a:;: ti.'., t . " '
' I] , Crew construction A Addition /alteratiur[/i l Please cheek all that apply;
[ .Demo1i ➢all (:I Other: []Service over 22$ amps, comm °Hazardous location
� , u t ,r• ryyyy �1,� 4 , ,, , ttk t [lo I. and 320 arras l rating Q e mo over r 0 sti it;; •
141 i j . ti ,ti.. ! jia':u 0 a ,i N . rtrl�, q! 616,4IA �.. r
' `��,.. u.. t 't~ �1,.i t 4 w. of 1 •and 2- family dwellings 4 or triers new residential ,
. 4 1 arid 2- family dwelling 0 Cotnutcrcial /industrial C'] Accessory, IA:Edit:4 : Mayas= over. 600 volts nominal units in one structure
Multi -famil El Master builder ❑ Other! • : °Building over three stories ❑Feeders, 400 amps•or more
�a . 2 7 ,f p'' t '' t Je; u � - m �, r 1 `: °'� t. ` t ' ' %7yu C�oaOtlpust 1084 Over 99 perao,is DMenuxctured atruensras Or
rt.t. ..k t '- :, . m., ? ; ti , ?, „uta t r.� ) a r ,1 ttz6' e w n ,t ,1;,', i ••t�t i k T e I F. ki r gil FB ggres
I s;lighting plan RV park
t: :t.4�X� ,tneiJ.- � v tin 7I •owe. r taQ„tl:ivt't .,� tE _�iY%' �'I
'Job nia.:.• Job site address: /t733 SyJ ) Qti 1: ' 0Hcaith -care facility ❑ Other ,
Submit z sets of plans with any of the above, •
{;ity /Statc/ZIP: The a are not b bove n applicable to temporary d � construction service.
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"rl1: r' k ,iStl q ''+. :.10.ip.?' ..i J ' . 'h u,y :. .. ',:•
Suitc/bldgdapt- no. name: f P roject i 1 e �. k r u �' i . ' ;�, i.._ ' :.
� - O,, rlpdon Qty. No f Total I ."
CraSS Street/4irectiat15 tp job site: New residential single• or multl- family dweikfRg unit. • • j" .•
1nelUdes attached garage _ _ _
1,000.1q. ft, or less 145,15 4 . .
.:Subdivision: Lot 11;11 Ei. add'1500 sq, ft- or portion 33, . . ! 1
-- Map/parcel n0.. 'Attired energy, residential 7100 . Z•' .
'Limited energy, non- residential 75,9Q 2
I. t ;p i1 ` 4 �C : �i� � r , ' ° 715 ' ,a,^ � 3 ` r tf 't ` i' , 'T ..,MV ! P enh tnanufaerrred or modutat
. / _ d,»r�. 6c1YSQG and/or fl CL1Gr 90 - 90 2 ,.
Seryice .
i 1 4 Y ��� JA+� p ar feeders inat let1on, attar and/or relocation
' 700 amps or toss 80,30 •
gi 'it ,c? .. nit .r iris , . w r " r •,,,,R• ut°trApte, 71 t ,r y ' r" 201 amps to 400 amps 106.85 . Z'
I • t7, 11 1, a' Hs
az'}3twil,' v .- r r T « ' , _ . , . ,l# ?..7. w • a5 ,. ' ' r ' Lsl : 401 amps to 600 amps 160.60 2
Nom' 601 amp [0 1,000 stripy 240.60 2
'Ad • • _ Over 1, amps or volts 454.55 lint •
• : Reconnect only 66,85
City /SUM/ZIP: - Temporzry services or feeders installation, atteratiou, am:1kt' ".
relocation
Ph011te :.(. ) Fax: ( ) 2 00 sirlpa or 1es3 T 66,35 ' i
• ' Owner installation; This installation ie being made on praperty that I own wliicb is:not • 110 drsips to 400 amps 100.30 2
. intended for•sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 70 491 g ips rn 609 amps 133.75 2
: :4ovner,signature: Date: gnilach circuits- new, alteratlo6, or trtonsion, per panel •
;a TmP;5' 1 T� .,' 4i? "S C• '-"tgl t ::: R e,l ?Wi ^ '- 1 „;. t tlig lrj ui
ar s <r tt . `t , Y 6 ,.,, 2, t eo- nt_ ;l' ii t,,4, 3'y %'!
rY. 4 �i� ' L ±t'r� , , lia 6 p � :`�c��� tt A, Fee for branch ctm r9 wait - .
' t<.' 1.: �r kFU tl��ra',' 1. I rr�1i�: i�;} �ti�. r.': t: G �i. �n?. L' u.. x�' Ili�lk,< r ''n•111.
64r or feeStr tee, each 6,fi5 I•'
•'Business name: branch circuit W .
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B. Fes for branch circuits •
` Contact 17101t; without service Or fet:dcr fee, ) / . , . , .
• each branch circuit 46'65 ' � S •
:44diess:- . Sack add'l branch circui 6.85 i �,' • : 2 .
. .,City /Statga2: Miscellaneous (service or feeder not Included)
Phone: ( - .' . r Fax: • ( Purr or irrigation circle _ 33.40 2
Sign or outline lighting I _ _ 53,40 I. 2 r.
E -mail. • • Signal circuit(s) or limited•
'q ' T . . e.'R7 ilk r?� t.rS ; w •x �y f, y .,, . �t:l!4!__ i'a g1i11' ?•�fe o .4.8, ene a
rgy pnel alteration or .
, ,
� i xl'! i `S l,:w-. ;aka,. -v ia:.' e. "'� 2 1
extension, Describe: Page 2 1
Business name: i o r c- TL. L
r _^ t Each additional inspection ov r allowable in any of Olt above '
Adt3resa;
, �
C __ - -' �i � r - _3 pet iriSpeetian 62.50
City /State/ZIP: n " �` el — q -, 0 k Pet
per hour 0 4 min) 62, MI
I — �`� '�� • 4 • Industrial plant per hour �•- �~ 73,7
1 1 ?State; ( , Z.l�i .1X5.7 \s, Fax (gig ) ZL ('' - � 5 y a r 1.: 4r4 S r i''i -
CCB Lic.. - 2_ , t• i t I Electric a .lc. •"3, .: 12 L 1 Suprv. Lie,: 'Z 12 3 S Subtotal I t
Suprv. Electrician signature, required: i \ Pt�n rev7cw ( �% of 1 +omit tee) -
3Cz
___ .... — _....,. h gr (VA Of per= Ire)
-- ' ` Dater ar _..... �-.-..
SCatC surcharge: print nE>a7a: l i ii • t .)_...... _ f 7 - _— TV TAX p.P..:ft1�� r FEE
Mt/V:0'17cd Sig11 ;inre: 1 — 71115 permit apAtiCt1 COn Pkplre3 it vc o It is h ot Uhtalantl Within tee
«;.^ A. —.. \-- ,,.. says art, It ha.l occa :tccepcetl cs cempteta
Date: l • Pet itetl:ooDla8y act by "En•Cnnt0 =' i4 4 tot) \ism/ Service Boa
Print narneF'
`.'> t�.a, • t. c _. - .. Humber ofilspact,' ac ^n:t': i:'
OBu 108.,Pc:7gSq\ei,C,-Pemus*.do t1/i5 • 440.45 IST(10vicoMWi.
Ed Wd9S : OZ LOOS OE • I of 2tt7SS99E OS : 'ON BNOHd ON I DI d13313 IlgNIO : 1,10L9
CITY OF TIGARD
BUILDING DIVISION I PERMIT #: ELC2007- 006'1
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 7123/2007
Phone: (503) 639 -4171 a u "h�ii�h�
Inspection Requests (24 Hrs.): (503) 639 -4175 � __..
INSPECTION WORKSHEET FOR DATE: 7/30/2007 TIME: 7:02AM PAGE:
SITE ADDRESS: 16233 SW 104TH AVE CLASS OF WORK:
SUBDIVISION: SWANSONS GLEN .LOT #: 015 TYPE OF USE:
PROJECT NAME: BLAKLEY
DESCRIPTION: 3 branch circuit. AC and work plug.
OWNER: PHONE #:
CONTRACTOR: CANI3Y ELECTRIC INC PHONE #: 503- 266 -7878
Inspection Request Scheduled For: Date: 7/30/20p7 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 053001 -01 503 - 266 -7878 Y
Corrections /Comments /Instructions: oti-
Ig
7//t 3 H k t o
�pU fey /4b t
PASS U PARTIAL APPROVAL CANCEL ❑ NO ACCESS
ri∎ FAI , ALL FOR. INSPECTION I I ADDITIONAL FEES ASSESSED
e
■ Inspector: ��a Date: � ( e� � l �� Phone #: (503) 718'
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: ELC2007 -00504
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/23/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 8/6/2007 TIME: 7:04AM PAGE: 62
SITE ADDRESS: 16233 SW 104TH AVE CLASS OF WORK:
SUBDIVISION: SWANSONS GLEN LOT #: 015 TYPE OF USE:
PROJECT NAME: BLAKLEY
DESCRIPTION: 3 branch circuit. AC and work plug.
OWNER: PHONE #:
CONTRACTOR: CANBY ELECTRIC INC RA Q ffiC PHONE #: 503. 206 -787t3
Inspection Request Scheduled For: Date: 8/6/2007 Pour Time:
Code # Inspection Description / onfir - Contact # Message
199 Electrical final 05341401 503.330 -6886 Y
Corrections /Comments /Instructions:
30 C
PASS ❑ PARTIAL APPROVAL ❑ CANCEL I NO ACCESS
7 FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ' N 6V Date: 4 11 , ‘ 4 0 .0 1 Phone #: (503) 718- iii4)