Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 00411
DEVELOPMENT SERVICES DATE ISSUED: 7/8/2004
AA I'l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S133CD-08800
SITE ADDRESS: 13865 SW CRIST CT
SUBDIVISION: COTSWALD MEADOWS NO.3 ZONING: R-25
BLOCK: LOT : 111 JURISDICTION: TIG
Project Description: Job No J20333
NC and gas furnace
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:
JOHN TYSON WEST SIDE ELECTRIC CO INC
13865 SW CRIST CT 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 443 -6156 Phone: 231 -1548
Reg #: LIC 13306
SUP 2663S
FEES ELE 26 -135c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/8/2004 $53.50
[TAX] 8% State Surcharge 7/8/2004 $4 Elect'I Final
Total $57.78
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 �/
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 Application FOR OFFICE USE ONLY . .
City of Tigard U u EC E j V E D K °CO VOQ
Permit Nu. O " /
13125 SW H Blvd., Tigard, OR 97223 Plan Review J
Phone: 503.639.4171 Fax: 503.598.7960 JUL � �► �,rt�u I ;�� N D . Other Permit
p 7�� /35'
U
Inspection Line: 503.639.4175 5 ,, . " Date Ready/By: Juris: ®1e-e j•µgt• x for
Internet: www.ci.tigard.or.us Notified/Method: • Supplemental Information
TYPE Olt l G01(2ICi ilaE+ni✓ PLAN REVIEW
❑ New construction Additio a te?ulivn /ro placement please check all that apply: •
El Demolition Other: ❑Service over 225 amps, cotrtm'l ❑Hazardous location
QScrvice over 320 amps - raring Dr3uildng over 10,000 sq. ft.,
CATEGORY Ol' CONSTRUCTION of 1- and 2- family dwell inp; 4 or more new residential
P. - and 2- family dwelling ❑ Commercial /industrial 0 Accessory building ❑System over 6110 volts nominal units in one structure g.,
•
Mul[i family ❑ MaSier builder 1:1 Other: ❑Building over three stories 0P 400 amps or more
. ❑Occupant loud over 99 persons ❑Manufactured structures or
•
JOB SITE INFORMATION AND LOCATION QP_gress/lighlingp1ant RV park
Job no.: LL T Jab site address: (� / ❑Health -care facility ❑Outer:
S�.G 7 y �� ✓ J �� r i * '��` • Submit 2 sets of plans with any of the above,
City / State/ZIP: , (1- • - . ,Y � ' z a _ _ - The above are not applicable to temporary construction service.
LL ' �� PEE* SCHEDu7LE
Suite/bldg. /apt. no.: Project name: .
� - /Z
- , r w....k ' _ iteterhnlan I Qtr. I fee. I Total I ..
Cross street/directions to job site: C .,..‘ -I- a( New residential single Or multi - family dwelling unit.
-- Includes attached garage.
1,000 sq. ft, or less 145.15 4
Subdivision: Lot no,: Ea. add'I 500 sq. ft. or portion -� 33.40 1
Tax map /parcel no.: I,imited energy, residential 75.00 T 2
Limited energy, non - residential 75.00 2
DESCRIPTION ION Ok WORK _ _ Each manufactured or modular
dwelling, service and /or feeder 90.90 2
ti-/ iV`•' . ( G .`, t "t t i- i-,...,_(-.4...Q L-E' Services or feeders installation, alteration, and/or relocation
lJ 200 amps or less _ 80.30 2
P ROPERTY OWNER 1 0 'TEN'T 201 amps to 400 amps 106.85 2 •
[[ 401 amps to 600 amps 160.60 2
Name: 46 5'6 �� ` , ` ; Pt v 601 amps to 1,000 amps . • -
240.60 2
Address: Over 1,000 amps or volts 454.65 2
y �� Reconnect only 66.85 2
City / State/ZIP: • Temporary services or feeders installation, alteration, and/or
Phone: ("..,1:y) 4_ -6 [_sb Fax: ( ) relocation
200 amps or Less 66.85 1
Owner installation: Thia 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, according to ORS 447, 449, 670, and 701. 401 to 600 amps 133.75 2
Owner signature: bate: Branch circuits - new, alteration, or extension, per panel
-
la APPLICANT j la CONTA P ' A. Fee for branch circuits wi/
° - service or feeder fee, each
BuSinCSS name: branch circuit 6.65 2
Contact name: R� 13. Fcc for branch circuits
_ without service or feeder fee, --
each branch circuit 46.85 C , , 2
Address:
ti an
Each add'l branch circuit ( 6.65 ‘ 4.1 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax; ; ( ) — Pump or irrigation circle 53;40 2 -
- . . Sign or outline lighting 53.40 2
E - mail: _ Signal circuit(s) or limited -
CONTRACPOR . energy panel, alteration, Or
0 extension. Describe: Page 2 2
Business name: WEST SIDE ELECTRIC CO.
Address: 1834 SE 8 AVE Each additional inspection over allowt in any of the above
•- --•--- Per i nspection 62.50
City /State /ZIP: PORTLAND, OR 97214 Investigation per hour (1 hr min) 62.50
Phone: (503) 231 -1548 Fax: (503) 736 -0677 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: 13306 Electrical L • 26 -135C [Suprv. Lie.: 2663S Subtotal
Suprv. Electrician signature, required: Plan review (25 %of permit fee)
1 _
Print name: e v, G� �: r. -.k :. A _� Date: 7 /- ( L( Slate surcharge (8% of permit fee) 7. �
TOTAL PERMIT FEE 5 7, 73
Authorized signature: This permit application expires It a permit is not obtained within 180
days after It has been accepted as complete
Print name: Dune: • Fee methodology set by Tri- County Building industry Service i3ounJ
.w Number of inspections per permit allowed.
i :\ Building \Permiu\L'LGPennitAPpdoe 12/03 440-46 IST( le/02/COM/w7,D
a LL90- 9CL(EOSI '03 ot,.moai3 a pig 'tsar eS0:80 ITO LO Inf
CITY OF TIGARD th
BUILDING DIVISION PERMIT #: ELC2004 -00411
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/8/2004
Phone: (503) 639 -4171 �iim �,� N61 � +I
Inspection Requests (24 Hrs.): (503) 639 -4175 e__..
INSPECTION WORKSHEET FOR DATE: 4/15/2005 TIME: 7:08AM PAGE: 62
,,.. //v tGer i , ,_ r-0
SITE ADDRESS: 13865 SW CRIST CT CLASS OF WORK:
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT #: 111 TYPE OF USE:
PROJECT NAME: TYSON - `
DESCRIPTION: Job No J20333
A/C and gas furnace
OWNER: JOHN TYSON, PHONE #: 503.443 -6156
CONTRACTOR: WEST SIDE ELECTRIC CO INC PHONE #: 231 -1548
Inspection Request Scheduled For: Date: 4/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 004634 -01 503 -453 -4822 Y
12..' od
Correct'ons /Comments /Instructions:
C__-. iS <— s _. o A / -..
/ O/V l * A lvi , A..( 30 p
P __ 7 )l S Cety& --c5z "-- o -Y1'1 l/' I ) S e-Cs 1
, dip
VA PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/ '--
D
Inspector: r " �� �,% Date: / Phone #: (503) 718-
_ r I 'let