Permit •
- CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00316
I
DEVELOPMENT SERVICES DATE ISSUED: 6/2/03
�f II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S133DC-15400
SITE ADDRESS: 12945 SW LAURMONT DR
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK ZONING: R-12
BLOCK: LOT : 009 JURISDICTION: TIG
Project Description: Install (2) branch circuits to HVAC.
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:
MERCHAN ROSE CITY ELECTRIC CO INC
12945 SW LAURMONT DR. 4012 NE CULLY BLVD
TIGARD, OR 97223 PORTLAND, OR 97213
Phone: 503 - 524 -2283 Phone: 287 -6164
Reg #: SUP 2127S
LIC 3567
FEES ELE 26 -113C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/2/03 $53.50
[TAX] 8% State Tax 6/2/03 $4 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 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: L ��.G�il.� -CGCz_ , ..-4,72/(1., Permit Signature: c` _� Ll (,/. 77----
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
r :.,
•
x - 3'
Electr Per .1 � '4- j livf � n
FOR 01�:1r CE USE. ONLY'
Received Electrical
Date/By:4 - t)3 6 Permit No- :,-i _ 113 -06 3/1,
city of Tigard
Planting Approval Sign
Date/By: Permit No.:
13125 SW Hall Blvd. JUN 0 2 2003 Plan Review Other
Tigard, Oregon 97223 Date/By: - Permit No.:
Phone: 503 - 639 -4171 Fa 15T0 0g OgrIARD Post- Review Land Use
Internet: www.ci.tigard.or ° is ��9 DING DIVISI r 4 , ' ' i ° �'i � I�' I Date/By:
met Case No.:
T2 :. Contact Juris.: ® See Page 2 for
24 -hour Inspection � x � Request: 503- 639 -4175 Nam /Method: Supplemental Information,
.. , . i.1N E. OF;WQR1 I `I: 'III "PL . NT''I Ieas iidl ;itapp1+),. ; "''
New construction ❑ Demolition Service over 225 amps- ❑ 1- lealth -care facility
commercial 0 Hazardous location
ddition/alterati.on/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
;`i :ILi; ;;1 I;ILI'I- . : CAIIL'tGORy:OF'4 I & 2 family dwellings r residential four ar more s till units in
Cg.t& 2- Family dwelling IQ Commercial/Industrial ❑ System over 600 volts nominal one structure
• ❑ Building over three stories 0 Feeders, 400 amps or more
❑ Accessory Building Di Multi - Family ❑ Occupant load over 99 persons 0 Manufactured structures or RV park
❑ Master Builder ❑ Other: 0 Egress/lighting plan ❑ Other:
. ; • S ubmit sets of plans with any of the above.
;I,!.I.' .,, , ., 4013IS n ,o TION a; ;tiOCA osril
The above are not applicable to temporarmconstruction service.
Job site address: 17. j�-5 St .t ) LAW( m.Q'7 L 1 1/ ---- .fg. *'sc E- .
Suite #: 1\1\-...A1 � Bldg /Apt. #: Num of ins ec tions per permit allowed ..
• Pro Name: ` A y r
9 c 4/ Description Qty Fee (ea) Total
New residential- single or multi -family per •
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included: ,
1000 sq. ft. or less _ 145.15 4
Each additional 500 sq. R or portion thereof _ I 33.40 1 _
Subdivision: Lot #: Limited energy, residential I 75,00 2
Limited energy, non residential 75.00 2
• Tax man /parcel #: Each manufactured home or modular dwelling �T
D BSCRIPTIOI OFVWO K service and/or feeder 90.90 2
Services or feeders - Installation,
• ' alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2_
401 amps to 600 amps 160.60 2
]i PR0klERTY:OWNER I TE 601 amps to 1000 amps 240.60 2
( Over 1000 amps or volts 454.65 2
M Name: e�l/11ct, ` Reconnect only 66.85 2
Address: 1211 46 S,u ) La IA ,v tar' tl J T / es k Temporary services or feeders - installation,
atteration;•or relocation:
/
Ci /State /Zi.: : _ j / 200 amps or less 66.85 1
Phone "; Fax: 201 amps to 400 amps 100.30 2
I `A'PPLIC;ANT 'i -I� "CONTACTPE11$01+I 401 m 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
Ci /State /Zi .: B. Fee for branch circuits without purchase of r ,, �
service or feeder fee, first branch circuit 46.85 qtr 2
Phone: Fax: Each additional branch circuit 1 6.65 --rot.
2
E -mail: Misc.(Service or feeder not included):
CO�Vr1 Rdi71L
r Each pump or irrigation circle 53.40 2
Pesch signor outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: ROSE CITY ELECTRIC CO INCflescrip or extension Pate 2
scription,
Address: 4012 NE CULLY BLVD .
Ci /State /Zi P OR TLAND OR 97213 7 213 Each additional inspection over the allowable in an of the above: .
• City/State/Zip: p Pcr inspection per hour (min. 1 hour 62.50
Phone: 503 2 8 7 6164 Fax: 50'1 2 R 2 1060 Investigation fee: I
CCB Lic. #: 3 567 Lic. #: 26 1 13 C Other. i _ �I�
i: i .�1cl;�elvli>,it!��!e�s�`
Supervising electrici.i /j_ Subtotal $ 3�8
Si: ature re • uire • : 0 Plan Review (25% of Permit Fce) $
Print Name: R L Gotham Lic. #: 2127s State Surchargcf % of Permit Fee) $
TOTAL PERMIT FEE $ �
• Authorized Notice: This permit application expires if a permit is nut o6f6in within
Signature: Date: 180 days after it has been accepted as complete. -
*Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
i:'Dsts\Permit Forms\ElcPermitApp.doc' 01/03
•
'T -
CITY OF TIGARD • 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 •
INSPECTION DIVISION Business Line: .'5'03) 639 -4171 MST
BUP
•
Received Date Requested — (3 AM PM BUP
i
Location a buite MEC
Contact Person Ph ( ) PLM
Contractor C e C/ ( Fbeir C Ph ( ) ,3-g 7 -Ca/ 6 9 SWR
BUILDING Tenant/00 ELC 3 _ D d 3/
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing i
Firewall ' ,.
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: �--! 151--
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
Fir /Alarm
ai Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
I' PART FAIL
Li Please call for reinspection RE: 0 Unable to inspect — no access
" Fire Supply Line /
Inspector .,
ADA Date //3 Ins Ext
Approach /Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL