Permit C ITY O F T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2004 -00301
DEVELOPMENT SERVI DATE ISSUED: 5/28/2004
'---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135BA-03302
SITE ADDRESS: 10520 SW CASCADE AVE
SUBDIVISION: OFFICE DEPOT ZONING: I -
BLOCK: LOT : JURISDICTION: TIG
Project Description: (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:
MARX, ERNEST L + BARBARA R DEKORTE ELECTRIC
TRUST PO BOX 12379
2140 VELOZ DR PORTLAND, OR 97212 -0379
SANTA BARBARA, CA 93108
Phone: Phone: 503 - 740 - 9769
Reg #: ELE 34-541C
LIC 159954
FEES SUP 4075S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/28/2004 $66.80
[TAX] 8% State Surcharge 5/28/2004 $5.35 Rough -in
Elect'I Final
Total $72.15
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1-800- 332 344.
Issued By: Permit Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
•
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
DEKORTE ELECTRIC LLC 5032882231 05/27/04 06:27pm P. 001
Electrical' Permit Application .°, FOR OFFICE USE ONLY` . - -.- :.: ...:.:
_ Received / Electrical
-, ` RECEIVED Date/13 : ' D ,J, Permit No ,,,Or x 1 ,1
C ity of Tigard Planning ppro .1 Sign
Date/By: Permit No.:
13125 SW Hall Blvd. MAY 2 8 20 ( Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503- ecH49($E TIG •' \ Post- Review Land Use
Internet: www.ci.tigard.or.us BUILDING D , " Contact Case No.:
�� �'�. r: -� Name/Method: Juni ul Supplemental See Page for
24 -hour Inspection Request: 503- 639 -4175 Namm e/Method: 4 ppll emental l Information.
gz,:,, . aget, sws i .� T h s 'I t{ i1JN tl r { Effi i "r,y hEit liZS S li �i`; . ° M IMOR- •: '
C • Pw constniction ❑ Demolition • Service over 225 amps- ❑ Health -care ddition/alteration/re•lacement Vilier: commercial ❑ Hazardous location
y�r;�r .rte o �p�� j . ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
'•t```' � �` o rimi 'o i( � T..' ; v NEE I & 2 family dwellings four or more residential units in
al 1 & 2- Family dwelling I omrnercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Fe eders, 400 am s or more
n Accessory Building ❑ Multi - Family p
I=1 Occupant load over 99 persons El Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
A.t .'1 r ; - 7 , - L en a . „ �: u " i7�'» ---- --
�+ •?�' �= �?, ' .'� � "SY'1�; t 0�t�t�i1(�ti�f��� ?s:'i1('��'�.
Suva s . Submit sets of plans with any of the above. The above are not a livable to tern •orar construction service.
Job site s: / D5 O 0 �' ! �yc
b to addres 4F� c_�x� � � or- " i � . i�;�''} "'�;a y �: , *, r e ... � _ _ • r w-- -" ; „ is Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: 6---(c._47 0a Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential- single or multi - family per
//�� ' dwelling unit. Includes attached garage.
C. el- rroo
/-"w / Coz �':e'sc` 4 Sli - `c Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
I Lot #: L imited energy, residential
Subdivision:
Limited energy, non residential 75.00 2 75.00 2
Tax ma s / • arcel #: Each manufactured home or modular dwelling
_ . ; . -'IG�w ?'`t "s; ! ' •SC iij fiC t S i A�y '�a§�si M �� • service and/or feeder 90.90 2
T, . Services or feeders - installation,
3`r i›. .1 CA.�: "t alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
?AV, • 41 , -y 'a M I Y a r f i � il`'pe ,,,y8 . g �' i 601 amps to 1000 amps m s
�l �° ��`:, r: �'.va�L �� £�.,s��F.��r;�'�.'�T'k�'"�s'li P P 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: _,.,- services or feeders - installation,
Cit /State /Zlj3 „r alteration, or relocation:
y t / "� 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
�: Q, r;r1 v n a 401 to 600 amps 133.75 2
ic. • P ` � c} mow-
t ' r ' `' 70-0332K Branch circuits - new, alteration, or .
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee; each branch circuit 6.65 2
City/State/Zip: B. Fee•for branch circuits without purchase of
Phone: I Fax: service or feeder fee, first branch circuit 1 46.85 1-164 Each additional branch circuit 6.65 Vfi "Jt 2
E -mail: Misc.(Service or feeder not included):
2 ' i. : + NA . p : " 5 tiros t „ lr, t= ; 7.4 Each pump or irrigation circle 53.40 2
''°` ,� r t &"' �,? ` ` Each sign or outline lighting 53.40 2 •
Job No: 09 .. i q Signal circuit(s) or a limited energy panel,
Business Name: . . & 6. (C alteration, or extension Page 2 2
Description:
Address: do 6044- /2-37?
City /State /Zip: p7-7_,O �2E ll e7 2f Z Each additional Inspection over the allowable In any of the above:
e - Per inspection per hour (min. 1 hour) 62.50
Phones '7 4 ' < 76 9 Fax: ?...._? Investigation fee:
COB Lic. #: r99 Lic. #: 3 S�rc - Other.
Supervising electricl "It n$ � `-: �1 ;���;t�� °a =�:I��*?��•����'K�•: a .�`��r�M�l"ks'” °���?��;x���`:t : : • ;
signature required[ ,wi Subtotal 5 0 F, SD
Plan Review (25% of Permit Fee) $
Print Name: A - /> - 77 Lic. #: - State Surcharge (8% of Permit Fee) $ —7,„) Y, . �
TOTAL PERMIT FEE $
Authorized d Notice: This permit application expires ifa permit is not obtained within
Signature: 7 t i C'� /4-6' Date: 6 - `Oy 180 days after It has been accepted as complete.
*Fee methodology set by Trl -County Building Industry Service Board.
/6?6- l)e - ft
(Please print name)
i:\Dsts\Permit Forms\ElcPetmitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Ling: (503) 639 -4171 MST
BUP
Received Date Requested 6 - 1 AM PM BUP
Location / D 5- I / Av-u-e Suite MEC
Contact Person ~e-z4 / Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC do q-4636/
Footing (J�
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam /WM
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 01 ✓ Fl 1Y/r1/
Drywall Nailing
Firewall
Fire Sprinkler
f. I
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
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
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
00* PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA • -7-
Approach/Sidewalk Da 0 y Inspector frineeteelq Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL