Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00063
D EVELOPMENT SERVICES D ATE ISSUED: 2/10/04
c � ' � I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 112 CC - 0019
SITE ADDRESS: 15985 SW AVON PL
SUBDIVISION: DURHAM OAKS ZONING: R
BLOCK: LOT : 019 JURISDICTION: TIG
Project Description: Temporary service for construction trailer.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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:
BUENA VISTA CUSTOM NOMES INC ROSS ELECTRIC
6932 SW MACADMA AVE SUITE C 23810 SW DRAKE LN
PORTLAND, OR 97219 HILLSBORO, OR 97123
Phone: 503 - 443 -6033 Phone: 519 -5700 CELL
Reg #: 166132 -2800 34 -436C
LIC 118821
FEES SUP 4232s
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 2/10/04 $5.35
[ELPRMT] ELC Permit 2/10/04 $66.85 Elect'I Service
Elect'l Final
Total $72.20
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. Thos 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 NC at (503) -6699 or
1- 800 - 332 -2344. V , G..., 4
/
Issued By: . _/ Permit 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: 44 -3 5
Call 639 -4175 by 7:00pm for an inspection the next business day
02/04/2004 08:39 5036425815 ROSS ELECTRIC INC PAGE 02
Electri Permit A licatio o Received FOR OFFICE F'SF: ONLY
<j Electrical
� ` DatJB : �. e I Permit Na,: C-„.. . , i �. ‘ City of Tigard Planning Approval Si
Q Datc/By Permit No.:
13125 SW Hall Blvd. `� b ��� Plan Review other --
Tigard, Oregon 97223 %
CC� , �Q Da te/B Permit No,:
Phone: 503-639-41 Fax; 503 - 598 -1960 lc G'' - . N • ''''' ost•Revicw Land Use
Internet; www.ci.tigard.or.us ' 4 ' ' ' l' ° ' r ' '' \ Co nt ac t Case No.:
24 -hour Inspection.Request: 503- 639 -4175 Named See Pa
� . !� "* I Jun Page 2 for
O N ° Name/Method: / tat • I Supplemental Information.
:•:TYPE:•OF'WORK:: - , — : , .leasech' a7t;tbOt . Y:.:7!"
New construction Demolition • Service over 225 amps- • Health -care facility
Addition lacement Other Commercial 0 Hazardous location
❑ Service over 320 amps - rating of ❑ Building over 10,000 square Feet,
. ' : '.: `.CATEGORY OF! CONSTRUCTION . ': _ I & 2 family dwellings four or more residential units in
, 1 & 2 -Famil dwellin t ] Commercial/Indus'tr [al ❑ System over 600 volts nominal one structure
Accessory Building Multi- Family _ ❑ Building over three stories 0 Feeders, 400 amps or more
❑ Occupant load over 99 persons 0 Manufactured structures or RN park
(" Master Builder Other: ❑ Egress/lighting plan ❑ Other:
': ' , ;MUTE. INFOCA.xfp1' iiintiLOC,ili:TION '. • • Submit _ sets of plans with any of the above.
rob site address: 159 �l� ►�'(7d L The above are not a rpllcable to temporary construction service.
Suite #: Bld,g. /Apt #: : .:... „� Fes* SCHEOICIL�',;: :•' _::.::,s::., .:,.).,;
Number of inspeetiousper permit allowed
Project Name: Descr - Qty Fee (ca.Lf Tour 1
Cross street/Directions to job site: — New residential- stogie or mufti- family per
dwelling unit. Includes attached garage.
Service iacloded:
1000 sq. ft. or less 145.15 4
Each additions! 500 sq. ft or portion thereof 33,40 1
Subdivision: Lot, --- ' Limited energy, residential 75.00 — s 2
- — Limited energy, non residential 75.00 2
_Tax map /parcel #: Each manufactured home or modular dwelling `
ESCRW ON • OF service and/or feeder 90.90 2
�i .� , � J • • � ' Services or feeders - installation,
., t_ _41 4 '. ' / alteration or relocation:
11. Ni 200 amps or leas 80.30 2
20l amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
:PRO'I'ERTY •6)WNER •:.•. • .:.r. •:. •�: .; ... � • .1:.....; 601 amps to 1000 amps JAO,60 ' 2
Name: • Over 1000 amps or volts 454,65 2
Reconnect only 66.85 2
Address: Temporary services or feeders , installation,
City/State/Zip: -'— alteration, or relocation: �� g ‘ 1
200 amps or less 66.85
Phone: F ax: 201 amps to 400 amps 100.30 2
APPLICANT C .. 401 to 600 amps 133.75 — 2 -
, CONTACrp pj o = Branch circuits - new. alteration, or
Name: extension per panel:
Address: -- _ A. Fee for branch circuit with purchase of
service or feeder fee, each branch circuit 6.05 2
City/State/Zip: B. Fee for branch circuits without purchase of
Phone: Fax:
service or feeder fee, first branch circuit 46.65 2
_— Each additional branch circuit 6.65 2
E -mail: _ Misc.(Scrvice or feeder not included):
CONTRACTOR r . Each Dump or irrigation circle 53,40 2
Job No: Each sign or outli ligh ting — 5140 2
Signal circuits) or a limited energ panel,
Business Name: .8055 6 �- -R '-� attention, or extension Page 2 2
Address: $70 54 F ive .3 Desmptinn:
Ct /Stat /Z i :i ( -{y 0 �7t Each additional Inspection over the allowable in any of the above:
Phone:5:13 (o Q 5Z+l / – _ Acr i"apectior' per hour (min. I how) 62,50
in
Z �C]d �'aX:W� t �z —'
invest/piton fee: _. f y ..
CCB Lie, #: Is Lic. #: 3 Y 34.r✓ ` _ o ther:
Supervising electrician , Eleettical :,Ponlit'Freei :::;::; �.,
'"!�— �1(�p Subtotal S J D �
si • afore re • uired ��� ( � ' � .
Plan Review (25% of Permit Fee) $
Print Name: ' VC ROSS Lie. #: 2 State Surcharge 8 °/
Lie.--i., 6 ( o of Permit Fcc) $ S • 35
_
Authorized
TOTAL AL PERMIT FEE S 7A • do
Notice: This permit application expires i a permit is not obtained within .__.
Signature: Date. _ ISO days after it has been accepted as complete.
*FCC methodology set by Tn - County Building industry Service Board.
— (Plea pant name)
i;1Dst5■Permit Forms \ Elc Pc rmitA pp. doc 01/03 •
CITY OF TIGARD 24 -Hour
•
BUILDING Inspection Lir*: -(5i;') 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 2 — ( ( AM PM BUP
Location 15 /3'ty,A, PL Suite MEC
Contact Person Ph ( ) 6 c l 2 SD v PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC L 6 6 6 63
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing hh \I
Insulation ,l Y ��� ) ? (�) a,` 1 (� D l �/ �. (�
Drywall Nailing Imo/ i� K��% I N
Firewall ' 0 14 I ►�-+ P V c, ,),I � I- ��w -im
Fire Sprinkler
Fire Alarm S
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service 4,2
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 Alarm S/�-
-
Final LI Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date / G y Inspector ��� Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL