Permit C ITY OF TIGARD ELECTRICAL PERMIT
• PERMIT #: ELC2004 -00290
7 DEVELOPMENT SERVICES DATE ISSUED: 5/24/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S113AC -00103
SITE ADDRESS: 07204 SW DURHAM RD Q300
SUBDIVISION: PACTRUST ZONING. 1 P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install (6) 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: 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:
PACIFIC REALTY ASSOCIATES BRIDGETOWN ELECTRIC
15350 SW SEQUOIA PKWY #300 -WMI 22732 NW GILLIHAN ROAD
PORTLAND, OR 97224 PORTLAND, OR 97231
Phone: Phone: 503 - 621 - 7122
Reg #: LIC 103824
SUP 4177S
FEES ELE 26 -887C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/24/2004 $80.10
[TAX] 8% State Surcharge 5/24/2004 $6.40 Rough -in
Elect'I Final
Total $86.50
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: 4� � ;/' /
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
ElectricalPermitApplication
. 1 41 L II 1 0 D atereceiv - Permit no i _ . V
+ :�.- ai 1 .il i� II �`Y L�
•F uy;t ; :J I City of Tigard Project/appl.no . Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, � 2i 1004 Date issued: By11 ) I Receipt no.
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
CITY OF TtGARD
• Land use approval: Pltll�ttiitr /rlvr�ti�ll=PRING
• TYPE OF PERtdIT .
O I & 2 family dwelling or accessory Commercial/industrial ❑ Multi- family 0 Tenant improvement
0 New construction 0 Addition /alteration/replacement ❑ Other. ❑ Partial
JOB SITE INFORI>'IATION
Job address: . 7a b q-Sr v I C/i a.rrt a... _ Bldg. no.: Suite no.: Tax map/tax Iot/account no.:
Lots I Block: 'Subdivision: 5
Project name: C etus ur ».g - CF I J u Lc'dr Description and location of work on premises: (y) e� r p i....-40o1,--e .
Estimated date of completion/inspection: tr 2.51 vti-
•
CONTRACTOR APPLICATION\` •- " '7. FEE SCHEDULE .
Job no: 6. 1 3 7 O Fee Max
Business name: Br- i t F I t ts, .0 /T L -�> L pblon Qty. (ea) Total no. insp
Address: o/� - ] 3.��1 Lti CI J J • it-Ann. !2
New residential
.
dwelingumL Inclmlesattathedgarage.
City: • tip it - t - tt h rR I State: f7k-I ZIP: `I7 13/ serriceincludea: .
Phone: (..402-1 '712 2- I Fax:teX4 /23 1E-mail: btee(,)0r/dahtr. 1000sq. 4 • Each additional 500 sq. ft. or portion thereof
CCE no.: J 0.3 S zy" I Elec. bus. Etc. no: 2-(0 •' 74_
Limited energy, residential 2
City/ :tro lie. no.: 3(i» - _ Limited energy, non-residential 2
' " .-..6 -l_G_ sue''/ -2 / - 0. ' Each manufactured home or modular dwelling
Sig t c pervising electrician (required) (required) Date Service and/or feeder 2
Sup. elect. name (print): i('e , / rl S it!--e /1 s49 License no: 41 7 /5 Services orfeeders— installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 an to 1000 amps 2
City: 'State: !ZIP: Over 1000 amps or volts • 2
Phone: I Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Tempo rary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation,alteration , orre1ocatson
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to600amps 2
- ENGLNEER Branch cimuits new, alteration,
Name:
' ; or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP B. Fee for branch circuits without purchase
Phone Fax: of service or feeder fee, fast branch circuit / WG' `flab \ 2
E mail: Each additional branch circuit
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
0 Service over225 amps-commercial O Health-carefacility Each pump or irrigation circle 2
0 Service over 320 amps-rating of I&2 0 Hazardous location Each sign or outli ne lighting 2
famiiydwellings O Building over 10,000 square feet fouror Signal circuit(s) ora limited energy panel,
O System over 600 volts nominal more residen tial units in one structure alteration, or extension* 2
0 Building over three stories ❑ Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each adcfnionai inspection over the allowable in any of the abov
O Egress/lightingplan 0 Other. Per inspection I I I 1
Submit , sets of plans with any of the above, Investigation fee
The above are not applicable to temporary construction service. Other •
- Not an jurisdictions accept audit cards, please call jiuistrrtctiou for mote information Notice: This permit application Permit fe $ r�O r/C
',Visa O MasterCard expires if a permit is not obtained' Plan review (at _ %) $
Credit card numbmi' - " " -- • - ).aij ..— CS (/ /C)6' within 180 days after it has been State surcharge (8%) .... $ j a'. l i e
t_ s nett. K 5+e- nstc4( Expires
accepted as complete. TOTAI,
s ore of cardholder sho a t card P P $ �j (i • L'
'?+ fps z � ` ✓ $ $4" t �
/ Cardholder signature Amount 440-4615 (GNOfCOM)
2 'd EZTL- TZ9 -EOS PT Isuaa4S t te'1 d00 :z0 jO TZ ReW
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested 6 8 AM PM BUP
Location � Suite d MEC
Contact Person .�yl� Ph ( ) - 7 I PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner C 16
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation ''/ G ✓
Drywall Nailing '`� 7
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
•ugh -
/Slab l _
Low Voltage � "l r /l��6 l �f /A�f ,_1A L,) .,n i '1∎
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
i x i al FAIL
E l Please call for reinspection RE: Ell Unable to inspect – no access
Fire Supply Line
ADA
Date 6 2 / ) Inspector ector < Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL