Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00349
I DEVELOPMENT SERVICES DATE ISSUED: 5/24/2005
13125fSW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103BB - 08500
SITE ADDRESS: 12425 SW 122ND AVE ZONING: R - 4.5
SUBDIVISION: LAKE TERRACE LOT : 012 JURISDICTION: TIG
Project Description: 4 Branch circuits.
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: 3 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:
YOUNG, JOHN G VIRGINIA F REDS ELECTRIC CO INC
12425 SW 122ND AV 2002 SE CLINTON ST
TIGARD, OR 97223 PORTLAND, OR 97202 -2245
Phone: 503 - 590 -1988 Phone: 503 - 233 -6467
FEES Reg #: SUP 50105
LIC 4443
Description Date Amount ELE 26 - 152C
[ELPRMT] ELC Permit 5/24/2005 $66.80
[TAX] 8% State Surcharge 5/24/2005 $5.34 REQUIRED ITEMS AND REPORTS
Total $72.14
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 -' : .' 332 -2344.
Issued By: 4 , Permittee Signature:
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.
lay. 23. 2005'.: 1: 4Pivi.
, ,, _UjouOlvOu 1.41Y ur ILvAhu I No. 0036 P. 1;
'
Elect Permit Wication - Fon OF I I.( 'F. I.'S. I,;' CIN 1., 1,'
: Received ,...-- • ,
i . , Bigotries! AA
City of Tig S CPS ' ‘'N t ''' - . . Dtue/B . . A' OSH '0 f PerwritNo! if -00 - 003 .
s Plariniog Appmva i I
' Daleili : i I Sign
Formic No.: 2
13125 Svlle11 E: A.
TisAird, i
/ tegon 972.23 ti. . M
,, ,k 9 ., . r
FlitaiiiIMII Permit No.:
PhOESC: i 03-639-4171 1 503498-400 Land LW
, Internet; www.ci.tigartor.us c w. %, . I i . 1 II .
Or Si• Page 2 for
24-hour Inspection Requop 5VASgt121175 ---- • • ' NamelMelhod: i I ,,,, emental lohirmation.
130 ! ! •
,.',;:
...
• New construction 1U Demolition • service over 225 amp- • Fleahh-cc facility
commertial • Barordous location
P.P. Addition/alteration/replacement uj Other: . LI Service over 320 turipc-riting of 2 Building over 10,000 square feet,
:`:: ' .00' ".• : idilerkiiNII ''''.':Y.::'.;:': '! 1 la 2 Artily dwelling . four or nore residential units in
I & 2-Famil dwelliit IM Commercial/Industrial • 0 wk. 04- 600 "51151.4"i"Ii one structure
• g Building over three stories 0 Feeders, 400 amps or more
II Accesso Bulletin; IR Multi-Family Occupant load over 99 persons 0 Manufactured structures erf RV park
III Master Builder • Other: 0 Egreailligng plan : 13 °kr
. ...:.:'..:".: ' . :.'. -4 : .:141VOF . • .. rWinbidIZOCATIO •'''.:•;%! kiiiii Submit ' mu of plane with any of the 'bow,
site __. . A ce
- .. The above are notsipplieable to m ailmknstniction service.
Job addres , $ ,
- • -- ■' .:' '‘f' ';'".'?:''''' :In MI ::....:'
Suite #: 131d- JA .t.#: ; Number of inspections per permit allowed
. Project Name: , Deacripilon __. : Oty roc (cis.)
- -
New residsmiai-siove or mattlfaroliy per v
Cross street/Directions to job ,site: dwelling imb. ['glades attached garage.
Strvem Included: ,
MOO K. fl °tics • 145.15 4
Each edditionsi soo ft, . or portion thereof 33-40 --
' Limite4entrottossidentig. 75,00 2
Subdivision: . Lot tt$:
. Limbed perm& non residential 75.00 2
Tax map/parcel it: Each menufacrused home or modular (bottling
4i'l.-0 i,:, Or '', •, :;::, . arvice 5 rid/ 5( f{vdcl' 9E1.90 2 i
Services or keders - installation,
41 ,,,,AidIRM7 'Iwo.i ar relocation!
200 ampe or km 10.30 . 2
. - • - 201 LAO ro 400 amps 106-95 2"
• 401 am • . to 6001uu• 160.60 2
1 ."!* ' PrOni.:MARVER .. •: . :ii:le, ? ni maNADeri:i...:.; , , , ::: , .i..:.i :•.ri,,.:[.[:: 6arrs . , 0 1000 vngs 240-60 2
Over 1000 amps or volts 454,65 2 .
•
Name: 4 fn voti i /724.4 , Reconnect only 66.85 2
Address: Temporary lervices or feeders - initallstIon,
alteration, or re/station:
, 66,85
Ci /State/Zi • : . 2.00 amps or los . 1
Ph°Tle:94 '' ci0 I q 55 Fax! 201 amps to 400 amps
' - 100.30 2
133./5 2
=.,-=7.-j ....„ ... 401 to 000 arms
';111: ' i. ' - , .:•:i;!■:'1:Y. '..:''' i ''' :1 ''"i'" Branch circuits - new, alteration, or
Name: *mean Oa par panel:
— A Fee for branch circuits with purchase of
Address: soviet or feeder - foe, each *rich circuit 6.65 2
City/State/ZiE . IX Fee for branch circuits without purGIMIG of ,
• soviet or (ceder fee, tint hooch circuit i 46.85 2
2 .
Phone: -..,
I Fax: Each additional bracts circuit , 7 6.6$ ii,qc 2 :
... ----..
E-mail; mincocrviaTtelccecrout eteludedy
' Eschpurep or irrigation circle 53-40 2
\ ...,. RI;r t 'riiii...i . :4',...V ':.: ::
• Each .si p crr oath= I . i Sig
NL_____.............,.. _ 2
Job No: . Signal eireuCTO) Or a limited energy valid.
Rod's Electric Co. - alteration or vdcrOiort Page 2 , 2 -
2002 SE Clinton — Description: i
Portland, OR 97202 . . 1
503 Fax# 503 - Each addition's' las eetion over the alloivable in sus of the ahoy t ,
CCM 4443 Elec Bus# 28-152C ...., Per irispectian per hem/ (min_ I hour) 6230
Metro# 1896 Macs Ogaden fir
Other;
• - - • .:',.::*:::::*:...'...:; : .'*: •-';i
Supervising electrician ,. (------.......„ Subtotal S (.,i„ j.30., .
_ •
sigusiture required: Plan Reviewi25% cif Permit FeIL S
'- - State Surehar; e 5% of Perrnit Fee $ • a •
Print Name: j Lic. #: ,1 ::-.5 ,
•
TOTAL PERMIT PEE S - 7 , j •
Authorized Nonce: Thre permit amilication expires if a permit le not obtained wi . In
Signature: Data: 150 data after it has been accepted as ootopkte. •
•
• r..., ...4th .sdelery ve Av Trt-Countv llunclille lAduttry Scrrviec Board.
• ..
(Please print name)
1:T/eraVerrnit Fcirins\EIcrermitApp.40c: 01/03
.•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200 00349
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/24/2005
Phone: (503) 639 -4171 /�vN�j�Ipi�j�ll�
Inspection Requests (24 H ' : (503) 639 -4175 ...' � `:_..
INSPECTION WORKSHEET FO'' DATE: 9/1/2005 TIME: 7:14AM PAGE: 2
SITE ADDRESS: 12425 SW 122ND \ VE CLASS OF WORK:
SUBDIVISION: LAKE TERRACE LOT #: 012 TYPE OF USE:
PROJECT NAME: YOUNG
DESCRIPTION: 4 Branch circuits.
OWNER: YOUNG, JOHN G & VIRGIN' <` 14)4 IV b-r. PHONE #: 503 - 590 -1988
CONTRACTOR: REDS ELECTRIC CO INC PHONE #: 503 - 233.6467
Inspection Request Scheduled For: ' te: 9/1/2006 Pour Time:
Code # I - - - : - 1 - scription Cone, m # Contact # Message
199 Electrical final 01479" $1 ) 3 436467 Y
Corrections/ • - •- - ructions:
I ( \ Y\
---- PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C N o8 L.. G Date: — l. - 1 - 05 Phone #: (503) 718 - 2- 1440"