Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00288
AJNI. R.� DEVELOPMENT SERVICES DATE ISSUED: 5/20/03
'-" 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 25103BC 08200
SITE ADDRESS: 12279 SW LANSDOWNE LN
SUBDIVISION: MLP1999 -00005 MOSES PP2000 -077 ZONING: R-4.5
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Installation of (1) branch circuit for NC unit.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION:
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 CRC: 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:
ED OSB URN GRF ELECTRIC
12279 SW LANSDOWNE LN. 15460 SE PARADISE LN
TIGARD, OR 97223 MULINO, OR 97042
Phone: 503 - 590 -7490 Phone: 503 - 829 -4146
Reg #: LIC 76751
SUP 1655S
FEES ELE 3 -484C -
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/20/03 $46.85
[TAX] 8% State Tax 5/20/03 $3.75 Rough -in
Elect'I Final
Total $50.60
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: i� �� Permit Signature: ,i , AAL-, c 5 - �pdosk /
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
. . i
, Electrical Permit Application
Date received:. )� Permit no ., '020D3 -a
'rot� { ) � c •
,..i t'
City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Ti iii 97223 Date issued: BSI Receipt no.:
Phone: (503) 639 - 4171 -
Fax: (503) 598 -l9 �e` Case file no.: - ent type:
Land use appro Qn3 7LC
i
TYPE OF PERMIT
• & 2 family dwelling or accessory o (& �. iy � l,ri d Cl Multi - family L Tenant improvement .
0 New construction ,ll't;'1 • ton/alteration/replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: 9. _) I • L. , H s o t f , : ,,,, y, Lin , Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: - Block: I Subdivision:
Project name: 0c, ItA ,. t . I Description and location of work on premises: i ,` `,h L •
Es .mated date of compli tiorvinspe =tion: _
"' CONTRACTOR A? f m'iiN" ' ' w '_ --- *: 1 - T ' SLED E_ `''
Job no: Fee Max
Business name: G 2F M eG+-Y. Description Qty. (ea) Total no. insp
1 New residential - single or multi- family per
Address: IS I'D e) S. I'Gt A dr's.e.. L et -, C?. dwelling unit. Includes attached garage. '
City: M tit J / ✓t D State: 02,1 ZIP: ei7 0 tf-Z Serneelncluded:
0 1000 sq. ft. or less 4
-05 Phone: �Z�t •i-(tf t I Fax: g251 ^ 4
Each additional 500 sq. ft. or portion thereof
CCB no.: .7 60-7 5 / J Elec. bus. he. no: 3 - i-{', 4. C
Limited energy, residential 2
City /metro lie. no.: 3 1. Limited energy, non- residential 2
I . #e •\ ' 175•L) ( j VC I19 '3 Each manufactured home or modular dwelling
Signature of su iervisingg elec[tician (required) bate ! Service and/or feeder 2
Sup, elect name (print): / �. 0.A License no: (o S S-S Services orfeeders— installation,
alteration or relocati
PROPERTY OWNER • ... 200 amps or less 2
Name not ' C_ : l . 201 amps to 400 amps 2
(� ) /� V S Y � 401 amps to 600 amps 2
Mailing address: 12 2 ? 'f L rr C Oi.t) 1---r 1---r ' 601 amps to 1000 amps 2
City: -r-,-- 4 _ L-- I � i%)- State: I Z IP: Z2 3 Over 1000 amps or volts 2
Phone: S'g - -- f-q 0 IFax: I E -mail: Reconnect only . 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 400
to
201 amps to 400 amps 2
Owners signature: Date: 401 to 600 amps 2
Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit u ` , 5 2 _
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) . misc. (Service or feeder not included):
0 Service over 225 amps- commercial ❑ Healthcare facility Each pump or irrigation circle 2
Cl Service over 320 amps -rating of t&c2 0 Hazardous location Each sign or outline lighting 2
family dwellings U Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
0 Systemover 600 volts nominal more residential units in one structure alteration, or extension' - 2 ,
0 Building over three stories 0 Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons U Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan 0 Other: Per inspection 1 I I
Submit _^ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. f Other ! - G
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ l o
C3 Visa 0 MasterCard expires if a permit is not obtained' Plan review (at _ %) $ 3 7 C
Credit card number. / / within 180 days after it has been State surcharge (8 %) .... $ "
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440.44515 (6/00/COM)
•
1 ' d Li7LS6Z9E09 0 Z - 3219 e00 :90 ED oZ Rew
CITY OF TIGARD 24 -Hour , .
BUILDING Inspection Line: (503) e69 -4175
INSPECTION DIVISION Business Line: (503) 6394171 MST
BUP
Received Date Requ sted "/ `� AM PM BU
. Location / - 9 9 ��� �� aid1 e_ " Suite
Contact Person Ph ( ) PLM
. Contractor Ph ( ) SWR c�
BUILDING Tenant/Owner ELC 3 r O6
Footing f( T% ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes ite_frie_e__. SIT
Post & Beam
Shear Anchors P, /4611 , (T / l /
Ext Sheath/Shear �"
Int Sheath /Shear
Framing
Insulation
• Drywall Nailing
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:
Final •
PASS PART FAIL
CHAN►L
` Post & Beam
Rough -In / ) t-
Gas Line
Smoke„ Dampers
. a
�'• ' - PART FAIL
CTRI . L
ervice
Rough -In sire J/
UG /Slab f •
Low Voltage
F' ' .alarm
�� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE Please call for reinspection RE: As Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date 9A-)A3
leespect Ext
Other:
Final DO NOT REMOVE this Inspection record f om the job site.
PASS PART FAIL