Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00550
'fi "D VELOPMENT SERVICES DATE ISSUED: 8/27/2004
„�'�I 131 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 104CA -07800
SITE ADDRESS: 13263 SW HILLSHIRE DR
SUBDIVISION: HILLSHIRE ZONING: R-7
BLOCK: LOT : 078 JURISDICTION: TIG
Project Description: (2) circuit A/C outlet.
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/0 SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 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:
SCHEU RICH, LARRY G JR + LESLIE A GRF ELECTRIC
13263 SW HILLSHIRE DR 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 799 -5092 Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
FEES ELE 3 -484C
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 8/27/2004 $53.50
[TAX] 8% State Surcharge 8/27/2004 $4 Rough -
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 f 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
, lq s
� t • � �
Eleetrir< l rr t1 FOR OFFICE USE ONLY ���rmit a�II Received _ Electrical
\ Date/By:7� �y ,/ /n PermttNo.:a �;� a Lj
(/()5
lK Planning Approval Sign
• City of Tigard . CL� ` L Date/By: Permit No.:
• 13125 Hall Blvd. 1 44 �Q Plan Review Other
Tigard, Oregon 97223 . \G�` \t Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-594-0600' 5 Post - Review Land Use
Internet: www.ci.tigard.or.us Gj C -. ' o,,;11t1� coi tuct : J ase No.: ®See Page 2 for
24 -hour Inspection Request: 503 - •,, ; i175 " " Name/Method: l i (r , Supplemental Information.
•,•i::;ti; .1io ^:t;.. ,.l.. :' +z:'„1al,EEeQrW{JREC' ... ,. i?:`:. .. , . <i;: • PL'AN'REVIEW.(Please ctiecli`alGthat appl
S] New construction . ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
r - 1 � commercial ❑ Hazardous location
Addition/alteration/replacement l Other: [] Service over 320 amps - rating of ❑ Building over 10,000 square feet,
; ` ';'`. ; <rT `l lj.0 ,1 a RY♦:CI CONSTRUCTION •" `r: . 1 & 2 family dwellings four or more residential units in
gi I & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
Accessory l Multi-Family
CI Building over three stories ❑ Feeders, 400 amps or more
ry B . ❑ }�
I3 Occupant load over 99 persons 0 Manufactured structures or RV park
Master Builder El Other: ❑ Egress/lighting plan 1:1 Other:
.V.:,-R' -9 ) Submit sets of plans with any of the above.
YS' jJJN]+i1lVTl4l!Iudal:OCATTON''. ' :: •" '' ..r The above are not applicable to temporary construction service.
Job site address: I . 3 7..-V 51,0 H;1 I s t-, f -e, h r, ; .. . *' SCHEDULE' `:::.;`: , ;
Suite #: I Bldg./Apt. #: Ti /,, , Number of inspections per permit allowed
Project Name: SG.) e tAr j t✓/,j (1 C `j ZL 3 ncaeriptiou . I Qty Fee (ca.) Total t I
Cross street/Directions to ob site: • New residential single or multi-family per
dwelling nnit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision:
I Lot # : Limited energy, residential 75.00 2
Limited energy, non residential _ 75.00 2
Tax ma • / • arcel #: Each manufactured home or modular dwelling .
r " p . ° RTSOBli �rICIr • : • t r'. service and/or feeder 90.90
.r -
ei.`:1,Jf;..;.1w r !.'' yr ?� #; 'UI?:�'V..ORK'�... : �!:.. �.. ';'�:.":'r.'�
Services or feeders - installation,
alteration or relocation:
} 200 amps or less 80.30 2
C� (-i_- - r, , k - C.--/'
L / f (n-�',c x-' 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
F °: TIE A.iN '� ; c ,.c ' 601 amps to 1000 mps 240.60 2
?.wNl� ; ;> =, . { s N x =�. Over, 10(}0 amps o volts 454.65 2
Name: Lc. v-,--14 c_ 1.1P. i .i V' i C.-P) l 1 Reconnect only 66.85 2
Address: . 3 Z 0 3 1 .() H'71 S Y) )le, I.) 1', Temporary services or feeders - installation,
alteration, or relocation:
City / State/Zip: Ti , , 17 Z2.3 200 amps or less 66.85 I
201 amps to 400 amps 100.30 2
Phone - - � F 133.75 2
401 to 6 00 amps
CI 14/ ; 1' 1 ? + ?t "+ r •`' : ;; ®CPNTi#GT;PI ItS° C' ' ' 1 Branch circuits - new, alteration, or
N ame: extension per panel:
A. Fee'for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee far branch circuits without purchase of
service or feeder fee, first branch circuit J 46.85 LI k.,, `i s:)-•--2
Phone: • I Fax: Each additional branch circuit 1 6.65 ( spy 2
E -mail: Misc.(Service or feeder not included):
I`r - , w ; :, - r Each pump or irrigation circle 53.40 2
!,
, a..,MI r r I'r fr `.4 • s. S.. a:.... ., ...., %R•a k. �,;_ii! . ..1: '' ` . :; a . ! Each sign or outline lighting 53.40 2
t.
Job No: Signal circuit(s) or a limited energy panel,
• alteration, or extension Page 2 2
Business Name: G K-( .0 e .-
-- j r , Description:
Address: IL, PA r//(r t f t , Each additional inspection over the allowable in an of the above:
City /State/Zip: MLA 1 ) l� f_ 67- Per inspection per hour (min. 1 hour) 62.50 ,
Phone: 3 . zc i .- Lt./ / ,,,-i Fax: 51)3- 8 7 9 - S -1,-t-7 Investigation fee:
CCB Lie. #: -) ( Si Lic. #: 3- ef /;- 4- C_ ; other:
`I;;'' ': ;t: ? ° Electilcal.;Pecmtif Fees *;'
Supervising electrician Subtotal $ _3 , $ 0 _
signature required: �-•✓' t \ ` Plan Review (25% of Permit Fee) $
Print •
Name: g r 1 i ti ,,,, 5 Lic. # : Surcharge (8% of Permit Fee) $ 1 ..
-, S State Surch
r'
TOTAL PERMIT FEE $ -�s 7 7
Authorized Notice: This permit application expires if a permit is ant obtained within
Signature:- Date: 180 days after lt.has been accepted as complete.
*Fee methodology set. by Tri- County Building Industry Service Board.
' • ! ' . (Please print name)
:A n,.,tn...,r,ir Fm- me \FlrPrrmitAnn dnr 01 All
1 'd L17LS62BEOS 0 >:- 1 4 0 eI3 3219 e9O :OI .170 La 2nd
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lie :° (603) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
'� BUP
Received Date Requested 3 A / PM BUP
Location Suite .2400e71-605-6
�o
Contact Person 4- , Ph ( ) eg (a ' D d 77 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ./6 std
Footing
Foundation ELC
Access:
Ftg Drain )1
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
\ Insulation
Drywall Nailing
i rewall
ire 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
E N A T FAIL
AL
Post & Beam
Rough -In -
Gas Line
S oke Dampers
anal
FAIL
A
Rough -In
UG /Slab
Low Voltage
Fire Alarm
ina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call f•r reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA Inspector Ins Ext
Approach/Sidewalk Date. p
Other:
Final DO NOT REMOVE this inspection record from the Job
PASS PART FAIL