Permit I
�+► CITY O F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00331
DEVELOPMENT SERVICES DATE ISSUED: 6/10/2004
' `---' 13125 SW Hall Blvd.. Tiaard. OR 97223 (503) 639 -4171
PARCEL: 2S 102 B B -00409
SITE ADDRESS: 12070 SW KAROL CT
SUBDIVISION: KAROL COURT ZONING: R-4.5
BLOCK: LOT : 008 JURISDICTION: TIG
Project Description: Installation of (3) branch circuits for a /c, furnace & exterior outlet.
Job No. J19968
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: 2 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:
BRICKEY, JUDY F WEST SIDE ELECTRIC CO INC
12070 SW KAROL CT 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 620 -4676 Phone: 231 -1548
Reg #: LIC 13306
SUP 2663S
FEES ELE 26 -135c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/10/2004 $60.15
[TAX] 8% State Surcharge 6/10/2004 $4.81 Rough -
Elect'I Final
Total $64.96
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 • • • OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -669• • r 1.800- -2344.
Issue' By: , �.., : _ ' �_ —�, Permit Signature: C s� l 6
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
•
Tit i ....__.... .......
•
1 Permit AgE
siZEIVED FOR OFFICE USE ONLY
City 'or ni igard
4 Received /, gr 6 ,
. -Fp Pcroin MI.:E ■•••• ex,33/
Dote/lly t•C _
I :10.5 SW Ilall Illvd., Tigard JUN 0 8 200
, OR 97223 "-Ptin,..1.6_;.icw
Plit.nic: 503.639.417-1 Fax: 501•593. Idh0;.--„
BUILIDYINOGF DTrViASiON d41(
,bi -1)iiiciliy: • (Ms:r l'ermil:
Inspection 1.ine: 503.(.19.4175 . . ,,-,13 jp, Aar 12.„, .1):.;1:14.cady/Ily: .110.0 liti See Page 2 for
illi Cr I iiell
al WWW.6,rl i )
.lr. U S Nonliccl/Mellsid: /1/ Supplemental Information
____.... .. . ,
TYPE OF WORK PLAN REVIEW .. ... ......._____
til New emistruetion XAddition/altcration/replaceinent Please check all that ;ipply:
[7
riService over 225 amps, c‘imm'l El lavanlotis location
1.)cniol it ion 0 Other:
DSinviec over 320 amps rating Eilluildng aver 10,000
CATEGORY OF CONSTIO.ICTION ()I'l- and 2-Iiimily dwellio; 4 or more new residential
000 Vlts E.]Syster n over o nominal units ill Ulll: NO W illee.
.nnily dwelling [..] Corninercial/inillistrial 0 Accessory building
[illiiilding over three stories Eveeder3 400 in npS Or I nOrt:
[ 1 Milill-f;Jmily El Ma;;Ier builder 0 Other:
Doccopailt It over 90 pc!NMIS [M U11111110 WO ;t1"tillitIrl!!; 0 1"
.1011 SITE INFORMATION AND LOCATION Eli.g••s•/liglitil); plan RV park
---.... . . . •
ii''' DI lealth-e
Job no.: 31z:zed" . 1 Job site address: i 7 te , 70 5 , ...) i/4.....„-_,, i (-(-- •
are
Submit 2 sets of plans with any of the above.
City/State/ZIP: ' ------- t . ,_ . The :ihove. are not applicable to temporary contoriletion servic.
e
.. ...____ __....4.6.5,...-." ._ q - 7 .7.- 2- --_'-' .. , Fry* s
.._ _........... . ...........__ _____._.....
, curemuLE
Suite/b1(11;.hipt. no.: 1 Project mime; i ‘, 6 L , / 4 ,-.„ _ 6 Ics
. .._.. A ......,,,,... ......_._.122.. ....,-,... I TWA' [ **.
CrOS5. StreCtAll red ions to job site: New;:Cisiciclitial mitiale- or multi-family tiWelli lig n n it.
Includes attached garage.
1,000 sq, ft. or lesti 145,15 4
. . .....___....
.____. ...
. 1 1 ,ot no.: Ea. atlill 500 Sq. 0. or portion 3340
______ 1
• 1,i miled energy, residential 75.00 2
Tax map/parcel 00.:
1.inlited energy, non .esidential 75.00 7 .
DESCRIPTION OF WORK 1:411:11 manufactured or modular
.,.- /..7 dwelling, service and/or Feedef 90.90
7 ,,
\ e. 4 c__ 1-- c4 CC-. 1( L--x , e, '' V.: ____.....
Services or lecitloo : ins n
tallatio, alteration a
. nd/O ' i'010eatiot
7.00 amps or less 3.
0 L rri„.e . . . 010 2 ---- .
- ' 201 arnp illp
s to 400 ati 6 .6 2
5
Pli()PE.RFY OWN - E - 1 - 2 -----"." - I . El 'rENANT 10 . ... _._
401 r to 600 amps I 60110 2
Name: / C t.....
. ...:S.7-- r.S ‘...4,C' ( ,--/ 601 1151115 to 1,0 Lim
00 ps . . 2 lit) . 2
_._......... .
Address: C •
r ..( l.. ■,. ',-,-R, Over 1,000 amps or v.115 454.65
.---.
Reconnect only 66.85 2
. _.,_......
City/State/ZIP: relopor;rey set•VICCS 01" ref:der S inStilliali4/1 Alley: 1 rion, ant/or
relocation
Phone: ( ) b . 7 c - L--( 6.. .7 6.., Fax: ( L . 200 anips or less li6.85 I
Owner installation: This installation is being made on properly that I own which is nut 201 amps to 400 amp . 100..10 2
intended for sale, lease, rent, or exchange, accordine, to ORS 447, 449, 670, and 701. .
401 amps to 1100 amp:: 133.75 2
Owner signature: ... . ..._.,. ._.... . Date lIcanch circuits - new, alteration, or extension, - PO panel
........_........ • .._._ .. ....____
0 APP1,1(7ANT I 0 CON'rACr PEIZSON A. Fee for branch Ciral4S with
service or feeder fee, each
.0 2
13uS 6
ineSs name: branch circuit .....______ .....-. -
. -_..
m .. It. Fee for branch clIVilliS I
. --
contact nae: withou 1C
/ service or Oritn ( I 5 *-)
each branch circuit 6.8 .,
Address: .......
1i.ach Ltdd'l In circuit 2_, 6.65
- City/State/ZIP: Miscellaneous (service or feeder not included)
_.... .... .. . ..... ........_ ___....
.......... _._ ....____ ___.____..... ___......
Pump or irrigation eels: 5140 2:
Phone: ( ) I Fax: : ( )
._....... sip or outline lighting 5.1.4)1 2
t•nli I: signal ciretlii(s) or limited-
C7ONTRAC:TOR energy panel, alleratioit, Oe
• •-•• • ' •'•-•--- e.tomion. Describe: Page 2 2
Business name; WEST SIDE ELE(."1'121(: CO.
_.... __... .
Each additional inspection oVer :illt)w111111' in IllaY of the above
AddiCSS: l S34 SE 10 AVE.
.---.--._.... Per inspection 62.50
City/State/ZIP! PORTLAND, OR 97214 Invktglir,at ion per hour (t tii imin 0 SO
_.......
_.....__..... - -
Pliolie; (503) 231-154X Li ux: (503) 73(1407 Industrial plant per hoar 'W.')
_.. ELECTRICAL PERMFP FEES*
CC13 Lie.. 13306 . -- 1 FlecIrical I 26-I35C: t Suprv. Lie.; 2663S C
I 6 / -
_ r .--, _
t n e
_ ___.. . ..........._
Suprv. Electricitto signature, requited: ,) , .. Plan review (25 M per'iii) Fee)
-
---. I ..' .-A-4...A......•
11 N -- E ---..
'---) Slow milehariN OM of p.. hut ...,e,
Prinam: - .- -- , e''. Date: 6.. (
- A l ,.._,E._ ....• , , ,o•-•-■■ V.. ,..e. ( ,._.,
.. - TOTAL PERMIT FFF
..
Authorized signature:. This permit appliention expires it 0 prrmil is not ithenined iVi( l nili lali
. .. .
days atter it has been accepted ns complete
Pt
tilt tli.M1C: f )are: - 1 ,,,,,11, iiy l',;-( Ituililing huhu:try Survirc Dom LI
" Nitinbcr a inspectium per permit allowed.
i ■Buildingl1.01■1i6E I .1. Pe-olbir Api) (1,1c 12/11.1 44C) asisr( I 0/02/('OM/ Mill
2 • el LL90-9EL (E0S) '00 0T-11.0a13 aPTS 'asail e9T:LO 'I'D RD unc
CITY OF TIGARD 24 -Hour . ,.
BUILDING Inspection Line: (803) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7 AM PM BUP
Location I x-07 0 1�it' L G7�, Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC dree
Footing ELC 20+64 _ o0 33/
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors j
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation 0 lief) FAQ.. P wV 40 11/
Drywall Nailing
Fi rewall
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
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
PART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
vrial7 SI El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
7 .. a J � f � /�
ADA � / , , / - t
Approach/Sidewalk Date V Inspector f l Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD . 24 -Hour
BUILDING Inspection Liie: (503) 639 -4175 (
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date _R- • uested AM- - _ PM - — BUP -
Location U 0 ��� % I _ Suite MEC
Contact Person Ph _ ! ) 3 - o 1 s PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC °d %=�
Footing ELC AML
Foundation *A&
Ftg Drain A,CC @SS: p `; z•40(4 ELR
Crawl Drain
Slab Inspection ► • es ._I• _.t ,:. • SIT
Post & Beam • �:u `
aka
Shear Anchors Rirr4 4rogg i " ' ` '
Ext Sheath/Shear , v , j ' " ''_ �r `` •. `_`° l
Int Sheath/Shear
Framing -
Insulation
Drywall Nailing � �E
Firewall
Fire Sprinkler
Fire Alarm t!\V-T2 -
Susp'd Ceiling V� J
Roof
Other: \A Qv b� L-ca4
Final
PASS PART FAIL
,:.PLUMBING
Post & Beam
''Under Slab S�AACC LL
Rough -In A1Vc7 W ( bbck
Water Service 1� D
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
•
ervice
Rough -In
UG /Slab V' • •
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART �FAIL�
SITE , Please call for reinspection RE: ►�/ Unable to inspect - no access
Fire Supply Line
ADA
Date inspector V 1't( 1 � - Ext
Approach/Sidewalk
Other:
Final D NOT REMOVE this inspection record from the job site.
PASS PART FAIL