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Permit - CITY OF T I G A R D ELECTRICAL PERMIT PERMIT #: ELC2002 -00208 ; � DEVELOPMENT SERVICES DATE ISSUED: 5/8/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103AB 04900 SITE ADDRESS: 12276 SW 114TH TERR SUBDIVISION: WALNUT GLEN ZONING: R -4.5 BLOCK: LOT : 007 JURISDICTION: TIG Project Description: Install 3 branch circuits for AC and Air cleaner. 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: DON VENNERI BOONES FERRY ELECTRIC INC 12276 SW 114 TER. PO BOX 628 TOGARD, OR 97224 WILSONVILLE, OR 97070 Phone: 503- 443 -1965 Phone: Reg #: g®49OS LIC 88482 ELE 3 -223C FEES Required Inspections Type By Date Amount Receipt Rough -in PRMT CTR 5/8/02 $60.15 2720020000( Elect'I Final 5PCT CTR 5/8/02 $4.81 2720020000( Total $64.96 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1-800- 332 -234.4. Permit Signature: (T> Issued B enAl•-44.4L-- 41 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: I �� Call 639 -4175 by 7:00pm for an inspection the next business day May -02 -02 09:54A boones ferry electric P -02 Electrical Permit Application A 7111111111111rIIIIIIIIIIW7Date eived: S��j /Q Permit nq���a � — © " " , City of Tigard D appl. no.: Expire date: y► tt Ciry Address: 13125 SW Hall BRerd ued: By: Receipt Phone: (503) 639 -4171 ���� Fax: (503) 598 -1960 e no.: Payment type: Land use approval: 1` i' 6 PE:I \IIT 1 & 2 family dwelling or accessory U e mercial/industrial 0 Multi- family (.3 Tenant improvement ❑ New construction U Addition/alteration/replacement U Other: ❑ Partial JOB SITE INFORMATION Job address: l 2 Z 7 6 S r.. I Tarn c e Bldg. no.: Suite no.: Tax map/tax lot/account no.: Lot: Block: Subdivision: Project name: V en h .„r; l Description and location of work on premises: 3 c,. /c) 1<o / - 1 C 4 Ai cit-mi.- Estimated date of completion/inspection: A .r, I p� CONTRACTOR APPLICATION FEE S('IIED[LE Job no: Fee Max Business name: Description Qty. (ea.) Total no.lnsp $ p n n Q c Ferry E l e r i C Ne w residential - dltgle armada per Address: • . • ;. . . dwelling intL Includes attadard garage. Cll.. W1 l s o v111 • StateO R ZIP: 971 7 • Service included: Phone6 82-49 3 6 I Fax: § Elec. bus. 11C. no: _ 8 2 - 7 9 4- - mail: 10o0 sq. ft. or less 4 Each additional 500 sq. ft. or portion thereof CCB no.: 884 g 2 Limited energy, residential 2 ` letTO lie. no.: • • • • ; Limited energy, non 2 . Brit t• ' Each manufactured home or modular dwelling iffrim o lip. upervisi T3mt, ici an (re. wired) Date Service and/or feeder 2 L icense Services or feeders — Installation, Su name (print): - n Herron g alteration or relocation: PKOPERl 'ON'NEIt 200 amps or less 2 201 amps to 400 amps 2 Name (print): Don V er i nor i 2 401 amps to 600 amps Mailing address: S I7 A 601 amps to 1000 amps 2 • City: I State: 1 ZIP: Over 1000 amps or volts 2 Phone: ►; 9.3 - i 9 6 s 1 Fax: j E -mail: Reconnect only I Owner installation: The installation is being made on property I own Temporary services or feeders - Installation, alteration, or relocation: which is not intended for sale, lease, rent, or exchange according to 200 amps or less 2 ORS 447, 455, 479, 670, 701. 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 Ci 1 State: 1 ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: i' 2 Phone: Fax: E - mail: Each additional branch circuit: L. PLAN REV'IEW (Please check all that apply) misc. (Service or feeder not included): irrigation circle 2 or irri pump pup g ❑ Service over 225 amps-commercial O Health -care facility Each 2 U Service over 320 amps- rating of I &2 O location cation Each sign or outline lighting family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, U System over 600 volts nominal more residential units in one structure alteration, or extension* 2 U Building over three stories U Feeders, 400 amps or more *Description: U Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable in any of the above: U Egress/lighting U Other: Per inspection L ( I I Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Permit fee $ 6 - 0 , / 5 Not all jurisdictions accept credit cards. pkase call jurisdiction for mere information Notice: This permit application review v $ Plan re (at %) Visa U MasterCard expires if a permit is not obtained State iew surcharge (8%) $ y 8 `''C 'redit card number : -__ / within 180 days after it has been r g Ex accepted as complete. TOTAL $ 6 `f , 9 6 Name of cardholder as shown on credit card $ Cardholder signature Amount , 440461 (6)0/COM) CITY OF TIGARD 24 -Hour BUILI Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested AM PM BUP Location / 2[ (p //z-7 zg L Suite MEC Contact Person Ph ( ) Z 2 4fci PLM Contractor Ph ( ) SWR BUILDING Tenant/-. ELC , - — Og Footing Lt Cf ?j — ELC Foundation Access: Ftg Drain ELR Crawl Drain \ Slab Inspection Notes: SIT Post & Beam r� Shear Anchors ` ` Ext Sheath/Shear . e Int Sheath/Shear Framing Insulation Drywall Nailing Firewall ,�terr (..} Fire Sprinkler 1 \� 1 ""' 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 Fire Alarm 111 PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: ❑ Unable to inspect – no access Fire Supply Line ADA Approach/Sidewalk Date �� Inspe or Ext Other: Final DO NOT REMOVE this Inspection record rom the site. PASS PART FAIL