Permit -CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00666
��111 DEVELOPMENT SERVICES DATE ISSUED: 10/19/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134BD - 01700
SITE ADDRESS: 11735 SW HAZELWOOD LP
SUBDIVISION: ENGLEWOOD NO.2 ZONING: R
BLOCK: LOT : 105 JURISDICTION: TIG
Project Description: Replace panel.
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: 1 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:
POIRIER, MICHELE M KELSO ELECTRIC INC
11735 SW HAZELWOOD LP 545 SE 3RD
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503 - 579 -2527 Phone: 503 - 648 -6360
Reg #: LIC 116254
SUP 4270s
FEES ELE 34 -433c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/19/200' $80.30
[TAX] 8% State Surcharge 10/19/200' $6.42 Rough -in
Elect'l Final
Total $86.72
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: 7, Permit Signature: j e A \N
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
FROM KELSO ELECTRIC INC FAX NO. : 5036488211 Oct. 15 2004 03:54PM P2
■
El ecarric a l Perm1 Ain it ti c. ! 3 1( >E; usE a :v1.1 ..
IP • Electrical 7
City of Tigard 0.»s Amon)
Na. :� o — UZ'1 [Q!p Cv
13125 SW Hall Blvd T est Foli' 1 Nu/BY: nu Rsvttw ei
Tigard Orem 97223 Dere/BY; • _r
ant: 103.639,4171 Fax 503.598.1960 Post -km.1w Lind s.
IntcmcC w
ww.cl ti$a d.ar.us e .p •,- ii4 Da cmtut lea;,.: 111 No.: Irsp Request: 503 - 639.4175 • •° ' -
Nsr+6A►tethodr w $44 Page 2 for
Su•, tmcoralJo(urrnatiop. •
N .. ,rte''.:. �p .,iJ' 1 .�AM7. . i is: iii. .t. . =F "'�'+(;4.� ^ �+•.w��a' '
■ N construction { 'Ai NV: b" tis-care •11; r..
�� Demo itiort el Setvix over 22,SSrnpa- • atlth -ure fsdliry
Addition /Y 1■ er commercial ■ liatcrdots loxrlon M
C1 Scrvix owe 320 ups-rating I
'' ' ei'll15: o '.'G'O a1,li BEE xt S of • Building w over 10 =gout rl:c� I
1 1& 2 -Famil _ i E e fondly d s looter er rc rpldendal wi s In
dWCllin • • C4ErlmerCiel/I11dilstri8l d sy�am OW sea routs t,cnirnai one strleerc
a Access° Build Buildin over t hree storiet I
1A M ulti F BIII i1 $ reoac�, 400 imps or more
• Master Builder - °coup:tot over 99 persons 0M I
Other: tw :k
{ ' d.08 " $I�'iNFb ❑ E� sa/1 i fDtinq plan ❑Other; �
RMATIOAP.itd :1-0 A:T(OIN.: ? _+ :, Submit leer of plane with any of fha eLovr. j
Job Size
�1r b ow era a a !
2ddttSS: 1 E 7 �" � � T h e e .. i of Noble t0 Wm . . r0. •d on rviea.
Suite Bldg /Ap *,"` ..l "' r ' 'R E *' : A:WDE --> r:; `'.1! ;. netruc .... c :l) .
Project Name: Nutni,or otMs • idiom; or • crtnrt Allowed
Desert don •i.al Tots I
Cross sreet/Ditectio to job site: Maw restJaatlsyint[ or faslthlurnpY Per
dwell it s volt Ineludw at4abod garage-
WO to Inctucledz
1000 r0.. R or tsar
, ubd Subdivision: 1 1 r .j,( .- d ... l • , .r r a.. r L •: Y t L dp r r a �■
1 Lot 4: ' . L.. • :1 _ ■ Y •00 BEN
2X C12 parcel #. t rmRe4 a+sr4y, rWn re}retncyl
:
Each Inariukorure t boom or modulo 73.00 :
C '1rEMIO R WO' ,I ii " fiCalla drl alliej -
• .� 'O ..� i, : :t : r :.t :� ,. SatVlGt
•t / ,. 1 ! - S � ! Serried or taedart - iaetallatioo, 90 -90 1 2
alteration or Pokleatloar • ICC sin • ortas I 0.0.70 • 2
• u 'I .• 1L' :Z-401.5
60 :O 4 0 y
2
s ; PRDpER' -' (5�L? :. . -. :. '•: ® 401 atnw to CO WON — 6
. :. � j 1 a c: i 1_ 434.6 Li
Address: •� xla " t r... ,ir
Tporsry services er tpodets • lnzrtsltstloa
BS
atter•arkm or maculae:
L City/State/Zip:
Phone: 261 • 6 =
i llef-I Fax: 101 irons to 140a+aat 100.30
CAN:. Tit : :':i,.= -::r :` ®; ONT R o ai'-.11g i € j $rtuehcErCattit -stew 7 33.75
3 1
N2IxtC: , altorttloa, or 1 I f
ezteasloa perpeneir
Adel C55: cr A. Fcc far brrrcit circuits wish purchase of f
('aty�si3te /�i : avieo orrcadern -. cash •ranchcirw;c 6.65 1 2 I
d• Pei for b snob circuits without purchase or
Phone: fax: sarvicpr Enderia,.firts12ru c h a z . • :s 2
E-mail: Each utrfhlonallbrpotsd - .t MI 6 wa
Mir
; : . . _ c(Ssrviceorlalyder not in • • .•); .
' -- - _ :- - ::. ;a �t:,; .,': CONTRAC OR < :
10b NO: :i _ r ; . i :1. •., . Fade artirtit>�an circle 53.40 2
E.0. k 4i orouthatt li
l tisiszl S3.4D Z
Busine5s Na17ic: go at�.l iR
°r0. a �'
Address: s ` `�� -� a °; , ,r r•rr 7s,r
` State/Zi a
{ Cirvr • : mi A • • eb a • Quo° , laaaa�en over the atbwab a is
•
Phone: * a i = '` '� n ith i thwr - min• 1 h o i any artist above:
CCB Luc. : ! i ,, Lie. #: C — _ Larrsz3grdon f� °� s� so f ■ Supervising electrician J t : �`= :E :Pa7ntit ;+
signature re d; /� ' (i' :'� :aettf i .... ;
sib cuire AAA- ■ Su tote 1
I Print Name: o M�M 7 • Pkn Review (ZS•h of Permit Fat S
S titt S - • , • e : Y. of . arrsai't Fee S , .
Th1s tic wires If a pe
Acts. TOTAL
a;naattc • � ► / , -� + /
Si Notice PERMIT FEE S . 7 a
�� �- Date: f 5 di / I o d a patmk s PPIkation rtait is not obruaad within
•Feo methodology bo reams tad as telapiRI.
(?tease print c. c) ty Aui1dleg rodlt•ary **evict lee ■Sd.
T 0 0 I i i
elTierl r e to r r r, _ . _ _ • •
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (5D3) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested - AM PM BUP
Location j / ��r�� _ - - �— �ma Suite MEC
Contact Person Ph ( • )'7q3 ' j a 7,, PLM
Contractor H E/ / Ph ( ) ,1B ° b36 0 SWR
BUILDING Tenant/Owner ELC aO 'y- ZO tO‹°(e
Footing
Foundation ELC
Ftg Drain Access:
ELR �.
Crawl Drain
Slab Inspection Notes: 6 �� C V SIT
Post & Beam
Shear Anchors ( \ \ (� 0
Ext Sheath/Shear l- `�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing �i ,, /ems
Firewall S fr () 1 / NE(_/l F/'i/.�/ L—
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: ,
4 o 3 � ln f '
UG /Slab I 0
Low Voltage
F larm
grft PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
11404, Please call for reinspection RE: Unable to inspect - no access
Fire ADASupply Line _ •� /: D Ket ' . 11 - P C(igi,�1�1 �- 1 Approach/Sidewalk Date ! �� 'J Inspec Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL