Permit b ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00417
. �� i • DEVELOPMENT SERVICES DATE ISSUED: 7/12/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103AA 01914
SITE ADDRESS: 10490 SW JOHNSON ST
SUBDIVISION: COTTONWOOD PLACE ZONING: R
BLOCK: LOT : 015 JURISDICTION: TIG
Project Description: 2 branch circuits for AC and plug.
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: 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:
DEBRA BAKER SOHLER ELECTRICAL CONSTRUCTION
10490 SW JOHNSON ST 41131 SW BURGARSKY RD
TIGARD, OR 97223 GASTON, OR 97119
Phone: Phone: 971 832 - 0807
Reg #: LIC 158285
ELE 34 -667C
FEES SUP 594S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/12/2004 $53.50
[TAX] 8% State Surcharge 7/12/2004 $4.28 Rough -in
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 am 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 -3 2 -23
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: 6
Call 639 -4175 by 7:00pm for an inspection the next business day
R. .tTt I
Electrical ermit Application, FOR OFFICE USE ONLY
City of Tigard u E lI V E
13125 SW Hall Blvd., Tigard, OR 977vi Datd6 i1 'C .JD 00 /7
Phone. 503.639.4171 Fax 503.598.1960 1 rte Ray
I c, � � �� • DatdBy Luis' l Other Permit
Inspection Line: 503.639.4175 JUL 2U -• �i Date
.�.a Ready/By:
i I liz See Page 2 for
Internet www.ci.tigard.or.us Notified/Method: � l Supplemental Information
- tea � :I.r0 PL AN ' : � [�,.r�.w. • "n ' " ' Please check all that apply:
ID New construction ` � Addition/a(tetattodieplacment •
❑ Demolition Other ['Service over 225 amps, comm'l ❑Hazardous location
- - ::• :, -.,:'. ,� �:.-� ._,.. - ,:...,; ❑Service over 320 amps -rating OHuildng over 10,000 sq. I
t. r,
.. 4: :. .,;"C ;t)giVP§ RFJ IO . _.: 7 ' , i.: . - of 1- and 2- family dwellings 4 or more new residential
' /!' 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder Other: over three stories ['Feeders, Feeders, 400 amps or m
'.Js'..: % . _ • -f -1 . •. y . .�„-; _ - . _ ['Occupant load over 99 persons OManufactured structures c tt `JOB' ON_ t7G�A TOF _ . -_ ❑ Egress/lightingplan RV park
Job no.: 1 9 G- Job site address: S r.✓ S ❑Health -care facility ❑Other:
1 v v o � � c7 N 5 Submit 2 sets of plans with any of the above -
City/State/ZIP: 1 1 f 9 7 , 7 3 The above arc not applicable to temporary construction service.
/ :_;�'r. . : '•;c:?Fj3L"•°::_ 5 iEDULE
Suite/bldg. /apt. no.: Project name: t s : . . . ... .
/ C Description p sr dso 1 Qty. I Fee I Total I
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Fa. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non-residential 75.00 2
, ... •. . _ •..... r- �',. � .,. r.,: " f�._ �. 16_1�` ":_" •: . •_ ` y , .. . _ Each manufactured or modular
/ dwelling, service and/or feeder - 90.90 , 2
t ' C Q " - }0 I c. Q Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
"= r r . . -• •' 201 amps to 400 amps I06.85 2
. W NL ' : ` `-' 0 : 401 amps to 600 amps 160.60 2
Name: D2.- 6T I J G lc, it 601 amps to 1,000 amps 240.60 2
Address: /D 9 9 0 S 4✓ , It Al So tti .s'--i Over 1,000 amps or volts 454.65 2
Reconnect only City/State/ZIP: / / ,,_.,..,/ / 9 7 -, . Temporary services or feeders installation, alteration, 2
erati and/or
� 03) 6 7 0 — 7 850 I relocation
Phone: / J Fax: ( ) 200 amps or less 66.85 1
Owner installation: This 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 amps W 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
�:' ?. 7 :ikPii et&f -' r_o{., �"" i 4 - r •'• U A'ti[ . `)? A.
°': :; • ' %` • • I' '`. : t' Fee for branch circuits with service or feeder fee,
each 6.65 2
Business name: 5 o leIt F_ )42...c-4"1" t eta ( C-0 r1/4„ r 4-, branch circuit ,
B. Fee for branch circuits
Contact name: Tn .2.. 5 L 1e4e without service or feeder fee,
Address: Li/ I ? S v- , i r q rt �C 2 each branch circuit 46.85 �/6. 8 2
/� Ea ch add'] branch circuit I 6.65 6,G 2
City/State/ZIP: /-r. S , • vs/ ' 0 rz 9 7 / Miscellaneous (service or feeder not included)
Phone: ( 47/ ?.� _ 0 - Fax: : (S-63) 9 8 5— / 0 7 $ Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E-mail: • Signal circuit(s) or limited-
" ti u• ' , t4 ,- (50 ,-7, :;: ,,- ;:: '' -':•.' z " ener panellt,aerad
• =� :.: ~� �i ,:; • : r:'= _. ... '` ,: ' .._ � ' '' .. -. on, or
� /� extension. Describe: Page 2 2
I., Business name: Co h )° -„ El e -r r Q-A J (-e N S �•, - -
Address: �i Each additional Inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Investigation per hour (I hr nun) 62.50
Phone: (qp/ ) E ) — 6 8 0 —2 I Fax: (S ) 9 8 5" /0? q _ Industrial plant per hour 73.75
CCB Lic.: ( 8 ,28 S- Electrical - .: ? a 7 .. Lie.: ; : 1{.... Sectored
S3 co
Suprv. Electrician signature, rtxl� _ / �IQ JJ 1/ ` � - Plan review (25% of permit fee) r
Print name: : ` I Date: � v State surcharge (8% of permit fee) L/ t r� Q)
• TOTAL PERMIT FEE 5 Authorized signature: This permit application expires If a permit is not obtaithin ISO
days after It has been accepted as complete
Print name: 3 I Date: ' .47 0 • Fee methodoloy set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
, .\HttitdiagSPnanaiS-LC -P,, kkACOAOC 12/03 - eR' en, ttin
Z - d BLOT- S86 - EOS JaT4o5 a ° dEE :ZO +70 BO Inc
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
•
INSPECTION DIVISION BusinessLine: (503) 639 =4171 MST
�� q BUP
Received ` 0 DDate Re uested �� PM BUP
Location /0 � -- 44. 151c 1 Suite MEC
Contact Person , te,64, ., Ph ( ) J4fV c7 PLM
Contractor Ph ( ) SWR , /
BUILDING Tenant/Owner LC0h� 7 / 7
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: y • SIT
Post & Beam
Shear Anchors -2.13I
Ext Sheath /Shear 'QA. C a
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
C4)
PLUMBING O
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
PA RT FAIL
ECTRICA
ervice
Rough -In
UG /Slab
Low Voltage
Fire Alarm
in I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SIT 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA ^ n �(
Approach /Sidewalk Date ) 2-1 0" `� N� L Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL