Permit CITY,OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00689
.,, ' ilk, DEVELOPMENT SERVICES DATE ISSUED: 10/27/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S136CD -02200
SITE ADDRESS: 07850 SW DARTMOUTH ST
ZONING: C -G
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: (1) branch circuit extension.
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:
•
COSTCO WHOLESALE CORPORATION SHARP ELECTRIC
ATTN EXCISE TAX DEPT 111 2856 NE 65TH AVE # E
999 LAKE DR VANCOUVER, WA 98661
ISSAQUAH, WA 98027
Phone: Phone: 360 695 - 8015
Reg #: LIC 156982
ELE 37 -1011C
FEES SUP 4893S
Description Date Amount ,
Required Inspections
[ELPRMT] ELC Permit 10/27/200' $46.85
[TAX] 8% State Surcharge 10/27/200' $3.75 Rough -in
Elect'I Final
Total $50.60
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 -2344.
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
City of Tigard ' - to
97223 , A 1 , iftatut 14o.,
13125 SW Hall Blvd.,15gard, all. i ?Um Review / a ev -/ — : PeoleM
Ptiona: 503.639,4171 Fax 503.593.1960 . I 1 , '
,_"_i I 1::::ii Due ; : ;A i -;.") 1 ''''' — --t RI see Page 2 for
Inspeedon Line: 503.639.4175
'' - -- - Notif2edfidethoe: " Suppitmemal Warm:knee
Internet www_eitigard..x.us
TYPE OF WORK PLAN REVIEW
' -.-':,-.`-: apply:
0 New COttatnICtiOn 0 Additiotaiteratiothepiazeracat
0 Service over 225 =Ps. email °Hazardous location
0 Demolition li 2/ t ier e ? 0 in . OServiee over 320 amps - sating flituildng over 10,000 sq. ft,
CATEGORY OF CONSTRUCTION of I- and 2-family dwellings 4 remora new omidebtial
— OSystem over 600 volts nominal ones in One StraCtge
ri 1- and 2 dwelling gCommemial/inclustrial 0 Accessory building
ORuilding over three =jog Eireedera, 400 mope or more
El Mai-family 0 Master builder 0 Other: DOommtan load over 99 persons EiMaaufnetured An:tomes or
JOB SITE DiFORMATION AND LOCATION DEDressaightin Plan RV park
— — ElOtnnc
74111 T113.; CY-5673) kr address; 7 0;to frIrrini o ti S rl abmit Etcalth-care 2 sets acil pl with say of Me abovn.
Cty/Slate/7JY: •r , e,g 07,13 The above are not applicable to temporary construntical service.
FEE* SC/EMILE
Suite/bldg./apt no.: Project name: Da:celll= QV.
— cross street/directions to job site: New residential single- or raniti-fandly dwelling unit
Includes attached garage. _ -.
— 1.000 so. ft. or less 145.15 4
Suhdivisiort Lot no.: Pa_ addl. 500 sq. ft_ or portion 33.40 1
Limited mow, residential 75.00 2
Tax map/parcel no.: - Limited miergy, noreasidential 75.00 2
DESCRIPTION OF WORK "ra manaactured or Mai& ,
• i I' ' Aa
_ / .. ■_; i ( : Brierfall Servdwelling, service andfor feeder 90_90
fir/ Services or feeders a
instllation, alterati on, tuta/or relocation 2
200 amass or less 80.30 2
I 201 amps to 400 amps 106.85 2
0 PROPERTY OWNER I 0 TENANT
401 ampere 600 amps 160.60 2
Nan= 240.60 2
i 601 amps to 1,000 amps
L.12__&-es2L____________ 0,=1,000 amps or volts . 454.65 2
Reconnect only 66.85 2
City/State/711: Temporary services or feeders "..- institilation, alteration, and/or
reteeenti‘ a
Phone: ( ) Fax: ( ) 200 amps or less 66_8 . 1
Owner hastallation: This installation is being made on property that I own wIrirh is not 201 amps to 400 amps 100_30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. '. 401 amps to 600 amps 133.75 2
_
Owner signature: Date: Branch 'circuits - new, alteration, or extension, Per Panel
0 APPLICANT 1 0
CONTACT PERSON A.Foe for brunch circuits with
• service or feeder fee, each
Business name: breach circeit 6.65 2
—.-4
B. Pee for brauch circuits
wirliaruz service or feeder fee, I 46,8 ti C ( b 2
Contact name:
each branch cilT.Oit
Address: — Each add'l breath circuit 6.65 2
City/StatetZ1P: • 1 Alascellancons (service or feeder not included)
Pump or irrigation chyle " 53.40 2
Phone: ( . ) Fax: : ( ) Signor outline lighting , 53.40 2
E-mail: Signal circuit(s) or limited- 1
CONTRACTOR energy panel. alteraticm, or
• • • I 1" - 0
Business name: s ...n., extension De;seribe: Page 2 2
-
Al - - lairiarr ' • / ab --- E—
:... : . • Each additional ' - • - , .st over allowable in an of the above
Addiess
Per inspection 62.50
CitY/StaterZW: \PM) e UVoi a (4) 41 MI6 of .. per bout (1 kr min) 1 62.50
Filmi o . # • — 410 I Fax: 0 0 _ OM _____Indostdal plant per hou 75
r I 73.
ELECTRICAL PERMIT FEES°
CCB Lic-: Electrical Lie.: Suprv. Lie.: . Salatetal Li 6, 0
Suprv. Electrician signature, req .. . r .
P lan review (25% of permit fee) .
Print name: irip gin r
Ir 4 / Pi ate: AVEZIII State anteharge (a orPerwit fee) A , W frt
15 ' - . - ' . il- ig • M BINIIIINIEINIFIrA i TOTAL PKRIVIFI FEE „Kr) . 6c
This permit tog:esti:on expires Us penult le Dot ebtaine- .ruble 1r
, days after it has been accepted as COMplete
Print I ArgAl , 1111 11,111111 II Ili 111 Date: d ' Fats coontodedogY rec by Tri-Couaty Building Industry Sri Board
" j f I'. Noraber °fir:pectic= per permit aUceicd.
avaeggeetiaSAELC•renttAPPOU
12151
■ .
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION " Business Line: (503) 639 -4171 MST
j BUP
/
Received Date Requested / _ AM PM BUP
Location 7 $? 3 ) Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 4 f- j (a
Footing
ELC
Foundation
Access:
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 h/C, 4 .A
Fire Alarm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS SITE ❑ Please call or reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line d-AAJtA/71 ADA Approach /Sidewalk Date d Inspector Ext
Other:
Final DO NOT REMOVE this inspection record m th job site.
PASS PART FAIL