Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00634
_� h DEVELOPMENT SERVICES DATE ISSUED: 10/1/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103CD -04400
SITE ADDRESS: 13530 SW 121ST AVE
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Kitchen remodel (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:
BROWN, MICHAEL J + OWNER
RIES, JUNITA M
13530 SW 121ST AVE
TIGARD, OR 97223
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/1/2004 $53.50
[TAX] 8% State Surcharge 10/1/2004 $4 Rough -
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 dire questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: g Z� Permit Signature: Ac e
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
iect Pe Aat EIV E
City of Tigard r � ti Dopey / a dig ! - > : 6 CC4:1 ,iY f26
13125 Sw Hall Blvd, Tigard, OA 97223 m} 1 r 11 .1. : the Review Other Pack
plione:503.639A171 Fax: 5033911.1960 JJl. Weft
Inspection Line: 503.6.:.9.4175 ,1- ') . DeaReedaf0lr f Per e2ter
Internet tigara CITY OF Ti C �+�ry x ebratielea - r j s opleaeraallanrnuttea cheek • ❑ New c o tlf ttu cti on — Derek* ov er u 1 Oeazednw location
p Demolition ❑ Other psanice ova � � ov 1 Q a .,
•`' :• - cTWO** camel;RUCrIl, t = .• -:: .•.;_ •.: Be
� [731+ over 600 volts nnnial will in ass structure
2 - family dwel mg ❑ 1 ❑ AoaasOty over twee aeries o>' e. e0o asps or coon
❑ Multi -family , ❑ Mester builder ❑ Other OC oepm bad ova 99 Omens A cares or
;
• s:;�nee I1 F?R11iA?ION : w1� I.0 ; ` .: 0
lob no.: I Job site address: /5 . Z!,(.7. 0 2 j- Cdr Sabath" sub of picas al* any oldie above
City /swe/ZIP: -77,10,, P� Zaa3 The above as not applicable to hempoe constr ctae service
... •
Suitribldg. /apt. no.: 'project nerve: are4des I Fee. l TwM f ••
Ghost tit eet/diroctioas to job site: New re desdd sink or onitiAmily dwells, eeh.
)mats attaches prop.
1,000 sq• h. et lei 145.15 4
Subdivision: .� I Lot no.: Ea. WI 500 sq. R or portion 33A0 1
Limited any, reddstiel 75.00 2
Tax map/psrcel no.: Limited maw, naa-asidertbl , 1 , 75.00 2 ,
. . ..� or • t)I'1 - - . .. Each ssadbcmte0 of modeller
i Tat of Services r be i and/or Made 90.90 2
Serviees r tasters istatiitstti ltaaliey ssAlar rdwWr
200 amps or len $030 2 • - - - .:... 201 asps to 400 asps 10615 2
. ' 10 TRQl • ON !N>i I ' •• • ;` . J •' • .! _ ; • • • ''' ,5"1" let. . .. • ' 401 saps 10 600 ewps 160.60 2
Npp1E. / 601 am1lsie 1.000 Imps 240.60 2
5-2-. Over 1.000 mem or Roomed mks 454.65 2
/.3 5-W, 7? / '7Z �fi� ve 6645 2
city/State/ZIP: �la/ OG� 1 Z-3 Twapetery seMows or laden i ad'r, alteratbo, and/or
Phone: 1593 5w ` 0 -7 1 Fax. ( ) 200so s •
2 b ea t r 6625 1
Owner insgllattan: This installation is btaq made on pwpowq thst I own which is not 201 amps io 400 sops 10030 2
intended for sale, lease, toot, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 asps 133.75 , 2
Owner signature: Date: �— Drama amid -vow, sllaratls& or saw -rim, per panel
- • A. Fee fwrbramdh cirenits with
.. - GO ?AC " ' ar tlsde[ 8e. s ari •
Business name:// / ' -/ _. bawl circuit
6.65 2
B
�i /% u i J ' B. Fee fa booth masts
"� widow service or fender fee,
Contact name: .rL� --$ '' w � deceit 46.$5 2
Address: 7/ Ale 5 ri) c.--7-- _ Earl nit, beach circuit 3 - 6.65 - , 2
City/Stmd21P: p _ ,p. 9 7 • rz•• MaaRssutn (service or baler rat included)
Pu or initiation cads 53.40 2
Phone: / ax:: .� / s or man I itimg 53.40 2
E -mail: bps' e{rarh(!) or healed-
. r.. • .. -.• ;. -. CO ►CtOR' . ° :.. i ' . • - I: ' :'. ; ..' . . . , C Peet
Pap 2 2 • aloeallon. or
Rosiness dame: -
Each stitloaal tap II= over sMSwMle Y of the above
_
Address'. . .S7 S� : 9 ..v 5 .►.. _- • Per 6z s0
City/State,�: .4; - / b�so hoer vos per (I brain) 62
rim —39 -4439 FiDC ( ) ' — T plant to* 73.75 latleatrisl
t Lc.: 4#787 ' Electrical L3c.: , - i. . , Sup". Lit.: S
1x Subtotal
Supra/. Electrician uiw*tnr4 �� , ;/ '
• rice review (l5% etpemnit fee'
''Z
Print /figr ��-� GY1' I Date: /z d'S'C Saw svttMae (IPA of permit fee) ' .,
` TOTA . PEitaai= FEE rl
Autborized signature: ma permit opelinisa s s = -a>4a 1 his beat in.:wool ego meserer
Print names I Date: • - Fe gestbadolop set by 1 i. •C. e y Ballasts Industry Service Beard
" Number of iaevsedo-r per
PAW14 ewrsiadalalanei UM . ca0405 (relt2[0t1/0/0
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (593) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location /352 b Ave. Suite MEC � b - 0 g
Contact Person 8.+ If Ph ( ) $ 49- PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 1111320 .20c ^ DV63 f
Footing
Foundation Access: ELC
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
L./
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
PA S P_ RT FAIL
1 -
Post & = - -
Rough-In
Gas Line
Smoke Dampers
m
RT FAIL
ELECTRI
ice
Rough -In
UG/Slab
Low Voltage • G L.., l�
F' e Alarm
a Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA l '�
-2S% / /
Approach/Sidewalk Date Inspector ri Ext
Other:
Final DQ'NOT REMOVE this inspection record from the J b site.
PASS PART FAIL k , 1�