Permit - CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES DATE ISSUED: 7/15/2004
j 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT #: ELC2004 00425
PARCEL: 2S 104DA -02500
SITE ADDRESS: 13355 SW 128TH PL
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R-4.5
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Install dedicated outlet for refigerator.
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:
OREGON ELECTRIC CONST /GROUP
1010SE11THAVE
PORTLAND, OR 97214
Phone: Phone: 503 - 234 -9900
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/15/2004 $46.85
[TAX] 8% State Surcharge 7/15/2004 $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. 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: 7�� Permit Signature: J e -e-- c' ■p
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
JUL -10 -04 09:04AM FROM-Oregon Electric Estimating 5032313587 T -799 P.001 /002 F -773
, • 'rElectrie ai Permit Application `�` - / , v r
OFFICE USE ONLY
City of Tigard Date received: - .3 Permit no.:.y(.CiiiN'd0Y 5
13125 SW Hall Blvd Pro ect/a• •I. no.: • Ex•ire date:
,,, Phone: (503) 639 -4171, FAX: (503) 595-1960 Date issued: 13 Recei no.:
Internet address: www.cl.tigard.or.us t°- M t Case file no.: Pa ment •e:
' 24 -Hour Inspection Re q uest 503 - 639 -4175
el 1 &2 family dwelling or accessory L
I U Commercial /Industrial 1 Multi - family p Tenant improvement
0 New construction El addition /a Iteration/re • laceme nt ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job Address: 13355 SIN 128th Bldg, No.: Tax map /tax lot/account no.:
Lot: Block: Subdivision
Project Name: Melody Graeber Description and location of work on premises: _ install dedicated outlet for refridgerator
Estimated Data of completion /inspection:
Will ou call for ins•ection.within 24 hours? Yes Q No ❑ Pro ect Contact Jose S.onber. 503 849 - 2754 Phone
CONTRACTOR APPLICATION FEE SCHEDULE
'ax no.
Job No.: 80782 Description Qty Fee (ea.) Toni map
Ne}n1 residenhal•singie or
multi- family per dwelling
Business name: Oregon Electric Group unit. Includes attached
garago, Sorvlca Included;
Address: 1010 SE 11th Ave. 1000 s.. a or less $ 145,15 $ - 4
City: Portland State: OR Zip: 97214 Ea Addl 500 SF or Portion _ $ 33.40 $ - 1
Phone: (503) 234 -9900 Fax: (503) 234-1001 I E -mail: Limited Energy, 1 612 Family $ 75,00 $ -
GCB no.: 203 EI= . bus. lie. no.: 26 -95C Limited Energy, Mut:i- Family $ 75.00 $ - 2
ci e lie. ' o.: 1995 Each manufactured home or ''` __ modular dwelling. Service
si nr �; • -.. 4.+M, �IIr -: 7/10/2004 andicrfeeder. $ 90.90 $ -
Service or Feeders -
A- - A License no 44605 installation, Alteration or
Relocation:
PROPERTY OWNER 200 amps or less _ $ 80.30 $ - 2
Name (print): 201amps • 400amps $ 106.85 $ - 2
Mailing Address: 40lamps 500amps $ 160.60 $ -
Ci State; Zi.: 601amps 1000amps $ 240,60 S - 2
Phone: Fax; E -mail Ovor 1000A or Volts $ 464.65 $ - 2
Owner Installation: The installation is being made on property I own which is T e pora S $ 66.85 $ - ,
I riot intended for sale, lease, rent, or exchange according to ORS 447, 455, T Services or
F - ry ]n taliatlon,
479, 670, 701. Alteration or Relocation;
Owners signature: Date; ,. 200 am .s or lees $ 66.85 $ -
ENGINEER 201amps - 400amps $ 100,30 $ - 2
Name: Over 401am.c- 000am.7. $ 133.75 $ -
!rant ircui . - lew,
Address; Alteration or Extension Per
Panel: A. Fee for branch
City' State: Zip: circuits with purchase of service
or feeder fee, each brunch
Phone: Fax_ E - mail: circuit $ 6.65 $ - 2
0. Poo for branch circuits
W /Out Purchase of Service or
PLAN REVIEW Foodor, 1st Branch CM 1 $ 46.85 $ 46.85 2
❑ Service over 225 amps -comm ❑ Health -care facility Each 3ddilOnal branch circuit $ 6.65 , $ -
❑ Service over 320 amps - rating of 0 Hazardous location Miscellaneous - (service or
feeder not included)
1 &2 family dwellings ❑ Building over 1 0.000 square feet four or Each pump or Irrigation circle 5 63.40 $ -
❑ System over 600 volts nominal more residential units in one structure Each Sign or Outline LlgllJng $ 53,40 $
❑ Building over three stories ❑ Feeders, 400 amps or more Signal Circuit(s) or Limited Energy
Panel Alteration or Extension^
0 Occupant load over 99 persons ❑ Manufactured structures or RV park _ , s 76.00 $
O Egress /llghtIng plan ❑ Other
- 0 oscri olio n:
Submit 2 sets of plans with any of the above.
The above are not applicable to temporary construction Service. Each Additional inspection over
the Allowable in any at the
Notice: This permit application Above. Per impaction
oxplre.; If a permit Is not $ 62.50 $ -
obtained within 180 days after it lnvessgoeom ion:
has been .CCepted 4-8 Other
complete. $46.85
Permit Fee
Plan review 25% $0.00
State Surcharge 8% $3
Total $50.60
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION „ easiness Line: (503) 639 -4171 MST
BUP
Received Date Requested g 2<3 AM PM BUP
Location / 3 3.5 "01 (5" Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR ,�1
BUILDING Tenan wn ELC l�O �7 ' O & t
Footing 7 • ELC
Foundation Access:
Ftg Drain ri 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
Roof
Final
PASS PART FAIL ��11
PLUMBING /i7
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
PART FAIL
C ICAO
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
411251 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SI 1111- ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA � �
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record rom the job site.
PASS PART FAIL