Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00388
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DEVELOPMENT SERVICES DATE ISSUED: 6/25/03
,I 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S135AA -01400
SITE ADDRESS: 10215 SW HALL BLVD
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -N
BLOCK: LOT : 037 JURISDICTION: TIG
Project Description: Temp. power. (1) 200 amp.
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:
INTEGUMEND LLC BY SCOTT COLLINS MD BOONES FERRY ELECTRIC INC
& MARIA ROSS MD PO BOX 628
9495 SW LOCUST STREET WILSONVILLE, OR 97070
PORTLAND, OR 97223
Phone: Phone: 682 -4936
Reg #: SUP 3170S
LIC 88482
FEES ELE 3 - 223C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/25/03 $66.85
[TAX] 8% State Tax 6/25/03 $5.35 Elect'l Service
Rough -in
Total $72.20 Elect'I Final
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 -33 -2344.
Issued By: Permit Signature: 1 / / ,/'
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: / 7
Call 639 -4175 by 7:00pm for an inspection the next business day
Jun-23-63 02:06P P.O1
_
-- - _.... _ �� � aoo3 - qua , c. . 7
'-;. '. Electrical I
Permit
I u I� f! ° (`_ ' > I 1) Dlteroodved• , -O', Permit no. ••L „ Sri - i• Li
f
_a -its ® it Projecfhppf_no.: Axpiro4atc:
\-- CityolTagard AddreSS: 13125 SW Ha Blvd, Tigard, OR I 9'7743 „0 Dateiaaur4 lay
Phone: (S03) 639 171 JUN 2 V U 3 e) 125321111111
Fax: (503) 5911 -1900 Cue MB no.; Payment type:
CITY OF TIGARD
Land use approval :.,_ 1 „, r-% 1 s t r r- I t r t C I /l lv
/YT m Dc rC ► r l
DTI; 01 P1:'lf T
0 1 tit 2 farnily dwelling or accessory 0 Commeroial/industriai U Multi - family 0 Tenant improvement
O New construction O Addition /alterrtionfreplacemcnt 0 Other. _ O Partial
JUH) SITE INFORMATION
Job address: j 2, / 5 -w A-1�J1 %/u B • _ - no.: Suite no.: Tax ma. tax lot/account no -:
Lot: ---- Block: Subdivision
Pro'ect name :. �� • 9 - ri on and location of work on
�� �. ..{ Pd premises: O vv.. -h 0,_\ d +y- v, . to �
Estimated den.'.:: � f'? L> iu L...: Ck • o....4 e rn, s ✓ c I; dyl
C.0 f• 1 RACTOR APPLICATION EEL SCHEDULE
Blaine pdirt0: s~S <� >, a f °�Y C� c f r L � �l
Address: r 6 gu, 6 ?A dwtl samthedgmnge. a \
Cy: lr vv',1 s'o vt u,' 1 t @ Stara: 0 - ZIP: 9 70 7. set,lexladelleiL
Phone:6 a 2. - + 3 4 Fox: 6.4Z - 7 3-es E -mail: 1000 6d- R. or!**
so0 sq. rt,
F
CtYB n0 : • 1. F3 Bloc. bun- tier A0= ace adduiata1 of portion !Meteor _ ��
City /m y . G , . , 0 s _ Ling/Mau �Limi_ : •nxideeriar 2
r//i/ � 4L4aL24+M ' qy _�� 2
$i l i..! "si .. elecsidan - cited bate 2
Sep_ clog. name (Friot) gemtwzrig Settlers err- -. `74111,
alteration et eelecmooc
P1(OP1,1(11' Olt t:It 200 crept at1me
�. Name (print): 201 mope t. 400 -
A9aili f ddtets _ 401 . to bop , .
601 woo to 10. • , ••,. ___IMO
City: I State: ZIP: r 1 000 • , .. or vain MIIIIIIIId
• Phone: Fax: E -mail: e y MIIIIIM MEM
Owner installation: The inalailation La being made on proptaty I own Tempolatytanlore esrbolnra-
Which is not intended for sale, lease, rent, or exchange awarding to lenallaslon,stteratinaertaloesnter
OR 447, 455, 479, $70, 701. 200 am . • or tnE
201 amps to 400 . • e MINININIIII
Owue(s slgnatury - -- Date. _— 4111 • 6" ' '„ __i MEM
1::1( IN.". ER , -. Thin - awn, allot action,
Name: -
or exte.aion pot root
A Fee for branch tiataiu with purchase of
II
A diems: -- service or feodec lbe, each branch circuit
City E=11111 2.311 ti, Fes for branch clrtwta without purchase
Phone: of terict or feeder ire, filer birch circuit
IIIII 2
Phone: Email: �h odditlon■l erode
PL.■\' IIL%'11 Vi (Pic;ue .heel; ;iii dint :1p)1170 . we.(Seraceottod41rwel _.- :
❑ &Mar over 22.5 ampa•otermmraai Q Hsalm•o nciaaiiity Eatn • woo or " • . cadmic IIIIII 2 -
Q Sat+.ice ova 320 satase-retins or MC Q Haratbvt luceoon Each to re tidily fE : • IMIIMINIIIII 2
family dwellings ( J yrldin g over MOM rqurgc tan et,tror SlSnal drum it (c)oralie:Aled energy mod, 11111 2
O S over 600 volts nominal more tmald�t /alunitsin one Structure altttuion,orextension*
O Evild6tg overtblea .ic .. 0 F41cdetr 400 amps or mote •Desoto @on:
0 Oocupron load ova 99 pantie U Maaufacosrrd'trot-torrn or RY a ,ir ., ..
Egttasllielxrng plan 0 Other.
W E� sdditbwl ro> recflop t.�r the atlo+taWe err any or tic nook
Per laspuuon 1-- ""
Saittoit , seta or bleat with any ortbe above. hnveao ga.ioa ice
The abtorc wet pplicalAc aspottatyeonstroctioaservice• Otter
- ,t.% -
14d1 art lorist6o�. a man <a do. pia*. au +dlcdoa fee....* kdorm.i1 . Notice: This permit PCrrmir fee .... $ 66. 1'
pti application
U v.sa 0 M+asonCer4 expires If a permit is not ubtaiped Plan ICView (at _ %) S
lei: _ within 180 days Act it bas been State Surdtarp (8%) .... $ .1
c t41r easel -
>v� rs..bo1d.r..s.w41.41 c - — acuvtod as complete. TOTAL ... $ �1 a .41[7 - .
"........- _ $ •
Cherries .►aawtee — eareeor
404e13 rboo2oM0
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST -
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 6 N° AM PM BUP
Location Suite MEC
Contact Person Ph ( ) ` G / PLM
Contractor Ph ( ' ) (Q g ' Y936 3 fo SWR a Q�
BUILDING Tenant/Owner _��e �i ' _4.. ' ELC 3 — ° v 3 o U
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall-Nailing
Fi rewal I
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
rVIC �
ough -In
Slob
Low 2
Low Voltage l)/v igcf /
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL