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Permit A 4 - ELECTRICAL PERMIT CITY OF TIGARD PERMIT #: ELC2004 -00352 DEVELOPMENT SERVICES DATE ISSUED: 6/15/2004 = 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 25111 DC -01400 SITE ADDRESS: 15920 SW ALDERBROOK CIR SUBDIVISION: SUMMERFIELD NO.8 ZONING. R - BLOCK: LOT : 461 JURISDICTION: TIG Project Description: Job No 04 - 226 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: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 5 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: JAN VANDERPOOL DEKORTE ELECTRIC 15920 SWALDERBROOK CIR PO BOX 12379 TIGARD, OR 97224 PORTLAND, OR 97212 -0379 Phone: 503 - 244 -5154 Phone: 503 - 740 -9769 Reg #: ELE 34-541C LIC 159954 FEES SUP 4075S Description Date Amount Required Inspections [ELPRMT] ELC Permit 6/15/2004 - $120.20 [TAX] 8% State Surcharge 6/15/2004 $9.62 Rough -in Elect'I Service Total $129.82 Elect'l Final 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: Permit Signature: f • 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 DEKORTE ELECTRIC LLC S032882231 06/14/04 10:13am P. 001 L' 1Gl;l.f r ertsimL tijJ_p.u.cia. pI1 a Received Electrical REG `!!I blj Date/By: Permit No GaO.J?-ev.3 City of Tigard Planning Approval Si Date/By: Permit No.: 13125 SW Hall Blvd. J1"N 1 4 2°" Plan Review Other Tigard, Oregon 97223 Tr Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 5'0,3-5 Post- Review Land Use Internet: www.ci.tigard.or.usBuILDIhIG D IVI t ty i ` '4t ' r iyi Date/By: Case No.: :'C Contact Juris.: El See Page 2 for 24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information. di,' °,3 -3;* - t . 'uc°' VI .a m''g 4' ;i " ' '.• egi R%5`'T ,� 3 Al RNSMONWIMM t' 3 IVAM., w construction [] Demolition ■ Service over 225 amps- 0 Health -care facility Addition/alteration / re. acement commercial l • Other: ❑ Building over location 10 on ?� p � ,�;: k , t .a 0 over 320 amps- rating of ❑ Building over 10,000 square feet, ' I ' a ' ' V M KOI 1 . � LCOEO�F I3v:*�� fA 1 & 2 family dwellings four or more residential units in e' & 2- Family dwelling • Commercial/Industrial ❑ System over 600 volts nominal one structure E Accesso Buildin • ❑ Building over three stories ❑ Feeders, 400 amps or more C . Buildin: • Multi -Famil 0 Occupant load over 99 persons ❑ Manufactured structures or RV park El Master Builder El Other: ❑ Egress/lighting plan ❑ Other: INF ' i ' P y '. " 4' ;O M r • " .;'. k 0l'. �.: L 1 ' a '�' Submit sets of plans with any of the above. ' The above are not a. Ilcable to tem.orar construction service. Job site address 5' e' ea zP ,,6 : ?i +W "d Fr. e . 3 u lr "` '�" _ LC Suite #: Bldg./Apt.#: Number of inspections per permit allowed Project Name: Description Qty Pee (ea.) Total 1 Cross street/Directions to job site: New residential-single or multi- family per dwelling unit. Includes attached garage. ' Service Included: 1000 sA. ft. or less 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 1 Subdivision: Lot #: Limited energy, residential 75.00 2 Limited energy, non residential 75.00 . 2 Tax ma. /rarcel #: Each manufactured home or modular dwelling :f4 , #: bE‘ t"`'i, , t (yl `+�4 da mram , service and/or feeder fi '' / .5 ; 90.90 2 // Services or feeders - Installati �� � alter or relocation: _ 200 amps or less / 80,30 ?' - 7 2 201 amps to 400 amps 106.85 2 p> 'y' 401 amps to 600 amps 160.60 2 . I PRQ , ., '.c'Oc;j �' '� t11 r ,�t± r' ,' ifiag E, 'iii .0 ' 60 1 a mps to 1000 amps 240.60 2 Name: 'I4--' V4A-Zj , ---�_ Reconnect nett amps or volts 454,65 2 Reconnect only 66.85 2 Address: e ,,q. -.t_ ' Temporary services or feeders - Installation, City /State /Zip: alteration, or relocation: 200 amps or less 66.85 1 Phone: 2- 5 .5 Fax: 201 amps to 400 amps 100.30 2 ' e+� tti* ?art 401 to 600 amps 133.75 2 ® '` :171.1 "..-: 15 itt ►�3� .ler �'r''-M:r Branch circuits -new, alteration, or Name: extension per panel: Address: •A. Fec for branch circuits with purchase of service or feeder fee; each branch circuit / 6.65 6.4j 2 City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: Fax: Each additional branch circuit 3.4, 2 E -mail: S 6:65 3 'fi�gg,, y� Misc.(Service or feeder not included): -F• ,41.f .i .�E', f'1 nkrli�rr:5 ©• ,u `' 11 ,r 71^ r7 ij> ztM'F V Each pump or irrigation circle 53.40 2 l � ` `° ` rrstl+. '" Each signor outline lighting 53.40 2 Job No: v T : Z' .- & ' Signal circuit(s) or a limited energy panel, Business Name: 6 ' -1-f -/ CC alteration, or extension Page 2 2 0- Address:fip 60- /2- T Description; City /State /Zip: p n 4) /)�E 1, Z Each additional Inspection over the allowable in any of the above: Per inspection per hour (min. I hour) 62.50 Phone 7'yO -- Fax: ZS' ZZ3/ Investigation fee: CCB Lie. #: /�`??5 Y. Lic. #: . - .S4,Ft'� Other: 11 '�; q 1 1 14,' 5 iF INTATM of t! iC I %:, '. y S: ' 1':!' i Llr cd�i'r"' , M a. o Supervising electr ` ''v 9 ��� �, / Subtotal S j 2c, 2 signature re aired c.-crL Plan Review (25% of Permit Feel S Print Name : / /1. 2., ' Lie. #: 4'e' 's State S urcharge (8% of Permit Feel_ $ .7,6 L TOTA1'. PERMIT FEE $ i 2-1.92. Authorized / Notice: This permit application expires if a permit is not obtained within Signature: /l 4 / e Date:"24K,y 180 days after it has been accepted as complete. "Fee methodology set.by Tri- County Building Industry Service Board. , gyp/ —Fc (Please print name) b o G . er r p d q ?tik- i:\Dsts\Permit Forms \ElePermitApp.doc 01/03 • CITY OF TIGARD 24 -Hour BUILDING Inspection Line: ,(5O3)•,.39 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST P jN(LSL- BUP Received Date J Req ested l/ \ � AM PM BUP Location 1 S 20 A- A 0 a 'f---^ Suite MEC Contact Person Ph ( ) :lo 1 1 Contractor C ' K� 5 k Ph (— ) - q L) SWR �, BUILDING Tenant/Owner EL cQ (f� °r� Footing Foundation Ftg Drain Access: . ELF � t` A - ' • ELR Crawl Drain • Slab Inspection Notes: , r- SIT Post & Beam ! u=.t'-.vv� _ � k v &if11 T' Shear Anchors �'� Ext Sheath /Shear + F., - r` 7 c^r • Int Sheath /Shear / Framing / Insulation Drywall Nailing Firewall v R Fire Sprinkler • Fire Alarm \` Susp'd Ceiling La Roof C i (v''( • V 1 111 . Other: ` ' �� 1 _ Final a\ C • V2 Q 00 M ()\ X1` l N s), To (�� �� 'PASS . PART FAIL Post & Beam Under Slab .Rough -In Water Service Sanitary Sewer c F ----- Rain Drains Catch Basin / Manhole Storm Drain Shower Pan �_ Other: /Pin ASS PART IL MECHANICAL . Post & Beam Rough -In Gas Line Smoke Dampers Final P PART FAIL LEC1RICAL . . Service Rough -In UG /Slab Low Voltage Fir larm in ❑ Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd. P ART FAIL SITE 1 M1 . ''_,` Ej Please call for reinspection RE: ri Unable to inspect – no access Fire Supply Line j Q Approach /Sidewalk Date \ 1 I " 0 l6 — Inspector \rA �« R 3 1 �� L IQ v \ Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL