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Permit CIT OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00637 i ( + DEV SERVICES DATE ISSUED: 10/4/2004 h" '' I 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S 104CC -07800 SITE ADDRESS: 13628 SW ASCENSION DR SUBDIVISION: HILLSHIRE WOODS ZONING: R BLOCK: LOT : 097 JURISDICTION: TIG Project Description: Installation of (5) 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: 4 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: DONALD KEEN WEST SIDE ELECTRIC CO INC 13628 SW ASCENSION DR 1834 SE 8TH AVE TIGARD, OR 97223 PORTLAND, OR 97214 Phone: 503 - 596 -1281 Phone: 503 - 231 -1548 Reg #: LIC 13306 SUP 4654S FEES ELE 26 -135c Description Date Amount Required Inspections [ELPRMT] ELC Permit 10/4/2004 $73.45 • [TAX] 8% State Surcharge • 10/4/2004 $5.88 Rough -in Elect'I Final Total $79.33 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 14800- 332 -2344. / Issued By: 49; >• ' " Permit Signature: (7 /9/'/L/ % 70�/ 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 Electrical Permit A, � ` licatiun Cftroif Tigart� G � j ® Received 13125 SW hall Blvd., Tigard, OR 97223 ])NrrJ / d /r/ /0 Permit No.: E[ �+ ow v ODF 3 7 Phone: 503.639.4171 Fax: 503.598.1,9,�F 4 ii! 1004 „,,,,,..4 Ri ]'] °° Review U Datytl Other Permit: Inspection Line: 503.639.4175 Dam lteady/By: Jure: la See Page 2 for Internet; www.ci.rigard.or.us lqatifted/Method: 17 ` I Supplaegental Informat:A.. , r■ • 1 ■ III •••• /! Cg�5-'v k r"/$0� PLAN REVIEW . ❑ New construction A dition/alteration /replacement Please check all that apply: [Service over 225 amps, m ps, cnm'I ❑Hazardous location ❑ Demolition Other °Service over 320 amps rating ❑I3uildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential rl- and 2- family dwelling ❑ Commercial/Industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure []Building over three stories ['Feeders, 400 amps or mote. © Multi - family ❑ Master builder ] Other: JOB SITE INFORMATION AND, 1 OCA.TIO . ❑Occupant load over 99 persons ❑Mtulutacturcd structures or ❑A,pjesslligttting plan RV park , Toll no.a)? IL %� Job site address: . ; t.sj ALC .` t ❑ Heslth -core facility ❑ Other:__ Submit 2 sets of plans with any of the above. City/State/ZIP: - T he above a re not applicable to temporary i . c, c q ` Li- � /3�p a� � pp � construction service, Suite/bldg./apt. no.; Project minx: \'` , 4-, r . ^ n --- FEE* SCHEDULE L-.. ,„AA �+' l - Description L Qty_ l Mo. i _Thud I •• Cross street/directions to job site: NOW residential single- or mull - family dwelling unit. Includes attached garage. - 1,000 sq. ft. or less 145.15 4 Subdivision: 1 I Lot no.: 6a. add'1 500 sq. 0. or portion , 33.40 1 Tax map/parcel no.: _ Limited energy, residential 75.00 2 _ W Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured o modular ' r dwelling and /or feeder 90.90 2 ,,..,•\,,,,• „..,•\,,,,• : rn„ ,•• )4, A L L. � .. a_ '\' r Services or feeders installation, alteration, nntlior relocation 200 amps or less _ 80.30 2 • PROPERTY OWNER I - Q TEN r 201 amps to 400 amps 4 106.85 2 Name: /� �Li 401 amps to 600 amps 160.60 2 V � '. v \ r 2 - 1 _1111 001 amps to 1.000 amps 240,60 2 Address: _. 7 /36 v2 ,p- a& ,02,-,.c,_ /� / nom /r over 1.000 amps or volts 454,65 2 Reconnect only 66.85 2 City/StateJZIP: /��¢ ��-' -� 2 2 2..7 .2..3 Tetltporaty services or feeders ing(nllation, alteration. and/or • Phone: ( r �� ` �'� Li l Fes ( ; relocation 1 ) 200 amps or less 66.85 1 Owner ioy�lation: This installation is being made on property that I own which is not 201 amps to 400 amps �� 100.30 2 intended for sale, lease, rent, or exchange, uccording to ORS 447, 449, 670. and 701. 40! amps to 600 amps 133.75 2 ` _ Owner signature: Date: Branch circuits - new, alteration, or extension, per panel ❑ AI'PLICAN'I' 0 coN'rAcr PERSON ' • • A. Pee for branch circuits with --- service or feeder fcc. each 6.65 2 Business name: branch circuit Contact name 8. Pcc for branch circuits - without service or feeder tee, I Address: each branch circuit l 46'85 „ i� 2 -- Fach add'l branch circuit (.f 6.65 Z. . eV 2 City /StBte/ZIP: Miscellaneous (service or feeder not included) — Phone: ( ) l ax:: ( ) Pump or irrigation circle 53;40 ' 2 E t11Sil' , Sign or outline lighting 53.40 2 _ Signal circuits) or limited- CONTRACTOR . • energy panel, alteration, or • Business name: WEST SIDE ELECTRIC CO 7 , / a 1 y ) extension. i)esc Page 2 2 Address: 1834 SE 8' AVE. / Yt� /�tQ/�/ Each additional inspection over allowable in any of the above ------ — -- Per inspection 62.50 City /State/ZIP: PORTLAND, OR 97214 _ investigation per hour (t hr mho) _ 62: ti0 Phone; (503) 231 - 1548 Fax: (503) 736 -0677 0 1 __ industrial plant per hour 73.75 lop/ I' ELECTRICAL PERMIT FEES• CCB Lie.: 13306 3 / Electrical Li • 26, 1350 I Q Suprv. Lic. : c ps S Subtotal � 3 . _ Suprv. Electrician Signature, required; � f �� ,��` Plan review (25 % ofpermit fee) ` GI Prim name ''(‘ I � Date: / I • / 1 State surcharge (8% of permit fee); t e, TOTAL PERMIT FEE C e1 ' - 5 Authorized signature; ry This permit application expires If a permit tc not Obtained Within 150 Print name: days after It Las been accepted ae complete Date: • bee methodology act by Tri- County Building Industry Service Board - i:\nuildinglPernlSatfiLC•Permf - - ” Number of inspection% per permit allowed. telpp.dot 12/03 440.46] IT(10/Q2/COMAVett 2' LL90 -9EL (COS) ' 0z.,1z0aT3 aPTS 'Isapl d22: TO 1 Et) 100 CITY OF TIGARD 24 -Hour BUILDING Inspectigp Lire; = ) 639 -4175 INSPECTION DIVISION' Business Line: ` 03) 639 -4171 MST BUP Received Date Requested / r � AM PM BUP • Location _ - - • .. %A -!= =._. 11 • uite MEC Contact Person .oQ/2, Ph ( ) 5/(¢ °- (,3( PLM Contractor Q Ph ( ) SWR BUILDING Tenant/Owner ELC ROO -60 637 Footing Foundation Access: 04/6T-(-67-4'6--- 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 • - 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 larm 4.:417ri 1113 U Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: E Unable to inspect - no access Fire Supply Line ' ADA Date / / z 3 C> Approach/Sidewalk Inspector Ext Other: • Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL •