Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00632
� i �� ' DEVELOPMENT SERVICES DATE ISSUED: 10/1/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134AC-05800
SITE ADDRESS: 10930 SW 109TH AVE
SUBDIVISION: HARTS LANDING ZONING: R-4.5
BLOCK: LOT : 029 JURISDICTION: TIG
Project Description: (1) branch circuit.
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:
MARES H, DAVID J CONDUIT ELECTRIC
PSC 78 BOX 552 DBA DUIT LEVEL TOOL CO
APO, AP 96326 19461 SW 89TH AVE
TUALATIN, OR 97062
Phone: Phone: 503 - 692 - 1428
Reg #: SUP 4501S
LIC 109669
FEES ELE 26 -905C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/1/2004 $46.85
[TAX] 8% State Surcharge 10/1/2004 $3.75 Rough -
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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: I/774 Permit Signature: _5_47_
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
Electrical Permit Application •
F E. US O \ Zy
Cty I ECEiVEL� A
Re ceived / ` 1i / -
13125 SW }ia11131vd., Tigard, OA 9722 Data �D _D `1 Prmit No.: e �.e /t � ' (/�/pI
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Inspection 503. ne: 503,639.4175 }(} h l�l Date Other Permit:
'Internet: www.ci.ti rd.or.us 2004 - • = °7, >uatlyiBy: I. 3a Dat
Notified/Method m See !' 2 for
,Ys ': ,.., rtw .. g te wr a .� _ Supplemental Information
. �. .r <• - .� ' .R� � Y° - ,
�5a::-ui.....lo, . , a�i tIM tl 6 try ° i O q" v s
.r • .e 4" : . .'. ''' ''. " J; ` �.'+ •n lc ai that anply:
El Demolition ❑ Other: ❑ Service over 225 amps, Comm' l ❑Hazardous location
,�, n
v � w''�' „„"” "'2051.051%1:1$0.14,t2-304504; ❑Service over 32 Over 10,000
m.. .a %,' �., F 0.:1144: ilydw lings ❑Bttr
" of I - and 2- family dwellings 4 or morn new residential
❑ I- and 2- family dwelling ❑ Commercial/industrial C] Accessory building ❑System over 600 volts nominal units in one structure
Multi - family ❑ Master builder C] Buiidng over three stories
.it -�,.�'� ..�. to w ,, _ d 0 i res ❑Feeders, 400 amps or more
ft!rU °:'c y 9f 1� '�� rt„F N,♦iYl $ T .. , • � ' ; ,� , ' y ,�,... Y; tai ,� ❑Occupant load over 99 persons ❑ Manufactured structures or
, ;! ,, . c1-r., - 'i �:?."�~� ,,,.�,� 9, 'bN ,. i +� ed sttvc
Iob no. 4 s °'' "' , r s kl i�a DEgressmglrting0lan RV park
�( I ..f s address: {,1 �- 1 ❑Health -care facility ❑ 0ther.
City/State/ZIP; �1 Submit 2 sets of plans with any of the above.
r C CL'r tit .- The ve abo are riot applicable to tem
PP porary cansuvohon Service.
Suite/bldg. /apt, no.: Project name: ,;, i`. " ' . "K>1 t
eus Cross street/directions to job site: Description Qty sue, total tx
New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft or less 145.15 4
Subdivision: 15a. add'1 500 sq. ft, or ponion 33.40
r¢y,
'Lot no.:
Tax map/parcel no.: Limited ene residential 75.00 -
d , rest 2
a 1, : :, i �% ,`; il:. r:: o t its ' qi` Limited energy,
75.00
� � i lt'� ° � • �v r; , ,nen- residential
,,� . ,� ,: ' � i�rr�r� q. j, :r>R $ ach manufactured or modular
dwelling, service and/or feeder 90.40 I 2
Services or feeders installation, alteration, and/or relocation
ter,„ -4 -. DD e� } 200 amps or less
80.30
�} ,r� � i "„Q- �.��.a . �;£1 � »p, � j �z"�j" Il ��a r .� '� r n " i� �' i115 S to 406 amps 80.3 2
nit�K.���. ;+ • .��' ;'.�' -� .�,," , . „'.'� ' .;�„° b . '� 201.am n Ps 106.55 2
Name; i cD 401 amps to 600 amps 160.6r) IN
601 amps to 1,000 amps 1 240 fi0 2
Address: 0 /00 \(--\_-; ► ,30 T d 1 � 1 \'� over 1,000 amps or volts
454.65 2 I
City/State/71[s; -Th r e.,....., o / Reconnect only 66.85 2
/ 'Temporary services or feeders installation, alteration, and/or
Phone: ( ) e ', <-1 — i JY' Fax: ( ) relocatlorr
or
Owner installation; This installation is being made on property that I own is not 200 amps to less 66.85 1
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
201 amps to 440 amps 100.30 2
Owner signature: 401 amps to 600 amps 133.75 2
�.....�, ...,... - Date;
n _, ��n' �� „ �„ f . , , , r. • ' W ,; -�� l , ky � � L �,�� � - - - Brarie f circa - new, alteration, or extension, per panel �
'���,: . . - : r , t1 s•Z ` Sx':54.4 Oi "4 4 A. Fee for blanch circuits with
t r m
Business name: service or feeder fee, each
branch circuit 6.65 2
Contact name: B. Fee for branch circuits
without service or feeder fee,
Address: each branch circuit 46.85 1111-- 2
City /S[atdZ1P: Each add'1 branch circuit I 6.65 2
Mlscollaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or inigation circle 53.40
2 •
E-mail: Sign or outline lighting 53,40 I 2
,` - � Signal cimuit(s) or limit
� •m'i ; �:� - - - dw;., • ir'� ........... . .�. 5�y ym ,••. i;Lt „ ^ . AIWA o limited-
_ y a y // 'w p' t ^;� a: t �' ener' panel, alteration, 0r
CI l't.a.. - e t t c ,, extension. Describe: Page 2 2
Address: r �� J
( LL # 9' ` �.. Each additional inspection over allowable in any of the above
City/State/ZIP: s /�� Per inspection 62.50
4 t lY Investigation per hour (1 hr min) 62,50 E
Phone: ( (0 Z _ i 42 I Fax: ( 6D3 ) 4Ei 2- , 3(' Industrial plant per hour 73.75 I
c ry
CCB Lie.; Electrical Lit.: „� 'pSt"r p , Lie.: . ” ice`, n •• �..` 4.t" t� � .0 011ei ? ataer ` r '' •
Suprv. Electrician signature, required: ,;,� � ,I Subtotal f_ Os
/l% Plan review (2S% of permit te e
_ _
State surcharge (8% ofei
nrrt fee)
i
Print name: f / i e Ci
, j it permit
r �Lt ' ¢' Date; -30.0 3 . ° S
Authorized signature: TOTAL PERMIT FEE
This permit application expires if a permit is not oat tined within I80
Print nettle: l DatC: • days after it has been Accepted as complete
Fee' methodology se by Tri County Building Industry Service Board
is�aaiiding■>crnritaELC_p;tpei,.dor 1201
' Number of inspections per permit allowed.
440- 4615Tt I0 /02'COMtwEn
l d �9Z9'pN OId10313 11(14NoD INV6Z :8 ti00Z '1 '3,00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lines (5Q3) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP -
Received Date Requested /6 AM PM BUP
Location 16 936 l Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/ to p / _ ELC
Footing 11 — '� � ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain -
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors r
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
t�
Fire wall
Fire Sprinkler
Cv
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
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
F' - Alarm
i Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
f, PART FAIL
SI Please call for reinspection RE: LI Unable to inspect — no access
Fire Supply Line
ADA l Y )4.- I m ftPP L GD q -
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL