Permit $ -r CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00170
DEVELOPMENT SERVICES DATE ISSUED: 4/6/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S133DC-17400
SITE ADDRESS: 13258 SW LAURMONT DR
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK ZONING: R-12
BLOCK: LOT : 029 JURISDICTION: TIG
Project Description: KITCHEN REMODEL
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: 3 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:
PEMENT, JOHN MICHAEL + BERIT LOCAL ELECTRIC CO INC
13258 SW LAURMONT DR PO BOX 508
TIGARD, OR 97223 FAIRVIEW, OR 97024
Phone: 503 - 579 -7589 Phone: 503 - 296 -0060
Reg #: ELE 37 -932C
LIC 153034
FEES SUP 4271S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/6/04 $66.80
[TAX] 8% State Surcharge 4/6/04 $5.34
Total $72.14
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: t (-CM Permit Signature: _1I4
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
FROM :LECAL ELECT IC CO. FAX NO. : 18004459104 Apr. 04 2004 07:55PM P2
S, •
F'lectrical Per A 1 11( l: l •► i►N1.l
City of Tigard
E "' � Received
Date /By: Permit Nc. dTJ 7 P 13:125 - Hall Blvd., Tigard, 4 ' ' Plan Review
Phone: 503.639.4171 Fax :: 03.598.1960 ry 4.,h "� .tii; I, ' Date/By: Other Permit
Inspection Line: 503.639.4175 0 L00 � ,- .1J!. Date Ready/By: dens: ' H See Page '2 for
Internet: www.cr.trgard.ot.us oat � /Method: Supplemental Inform
N 'fed SnppFtsm scion
J. 1. N 'Y. l f
.... .... ..... ,.. /. ...,, ,, ..., ..: .. r Y . .... .. ...... ... .... , .. .,.. Y ..... ' 't ^':�r Y. , "�'ff�..
® New construction bili 1LcW1iii . " '..lion /replacement PIease chock all that apply:
[] Demolition LJ Other: over amps, comm ['Hazardous on
['Service t er 225 um m I ❑Hai ua location
: < >.a' .c .w :;, , , ,. , y, , , ., , , — rating ❑B dng o sq. R
, . ❑Serv over 320 amps tali ail over 10,000
�,:: . �(�) 4,..... w.,r6 �.R:.:Q ti +., (q . i ! . _ , ,,a,_ f „ r ,. _ 9 �. ,� ..
, , , •„4 . V , ) ,, 'r -M' , ,,., 7, ,: .,,, � „,, : ;; ,7 ,;, ; , ?•7. t :,e`∎ of I- and 2-family dwellings 4 or
;.r:.,1 <:. r „ fa'h ' i�k:.� , . a. b �f; t zi :;C.y� <, e<..,..a,::.."'�'.S•' , ���:iu:� %:�, � , '. � }{ � more new residential
121 1 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building [(System over 600 volts nominal units in <ne structure
❑ Multi - family ❑Master builder ❑ Other:
['Building over three stories °Feeders, 400 amps or more
persons d structures or
,.: ❑Oc i load over 99 pe Manufact»te •
„,1., �, k.,,, , $ , : N. •$ � m S i , y � ” { i(' i :"f: • . & " , : S. !y .x: r. , ' ;,q';NU , F';�i ' =
•hay. . ' ,a �'' ' ' rk;lr ;<w �^;+F??.: , :: ." 6!�. +k. :a„�•. s'rn:,: . .�:.. •^ E eS RV park
•
1
' �. a.,,.., �r..; K�q��. �) 1... s..._��....,�.�,...:,;::.<. .. ,n..,::.i:.... �.:, �� >. ❑ � s/lighting
Job no.: lob site address: 13258 SW Laurmont DR. ❑Health -care facility °Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: Tigard OR 97233 The above are not applicable to temporary construction service.
fi'_'.;:':ri1S; 'r' '%i 1 ' j^ �;'. "�. Ck.5 "4. ,. il'2�r5R1
Suite/bldg. /apt. no.: Project name:
: a �� o I ace, I Total
Cross street/directions to job site; New residential single -or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less t45.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: ,
�} Limited energy, non - residential 75.00 2
' r^ � , �o.,„xr';: +;;,...�,:n•,F'�ive, :a.a�:,.4;a ".``.��:, � s` r„". 6 '',,. ��q a`, 4 %aiCa:, a:: y .:•Q' :q ",,,.:4,:.Y Each manufactured OrrrlOdlrlaf
Kitchen Remodel Install 1 new branch circuit extend 3 dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
W z y;'; <
" . „ :.°�« . , r•. 201 amps to 400 amps
�r, ~r �' 106.85 2
;�,. , �iR; 4'i 'fix✓: 1:� :�rial.i'Y1 ".'l�4��' ,;:' :�(, .a4::'.1f�4t. < ;, ?,�,�,
•:: ,, :c „ :,.ns•'� „ -. ,. °1 �3d :Y.T....� "a. (: ;; ir`�. "!.i §�i e`i:� , ...,.,. ,,: • , �Y�,�, �.`];v�: /,.iS.r i �, "�
: _ �" :a. :...,'�e: 401 amps to 600 amp°
jJ 160.60 2
Name: 601 amps to I ,000 amps 240 .60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Reconnect only 66.85 2
_ Temporary services or feeders installation, alteration, and/or
Phone: (53) 5 71 7Sp p 9 - Fax: ( ) relocation
t 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 an to 400 amps 100 :30 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
0, ' „4 , "il 1-. :M V',� A Fcc for branch circuits with
service or feeder fcc, each R
Business name: branch circuit 6.65 / !, q
B. Fee for branch circuits
Contact name: ` f without service or feeder fee j
Address: each branch circuit l 46.85 („ f / I 2
_ Each add'1 branch circuit 6.65 J l � 2
City /Stale /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 1 53.40 1_2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
�; at.� ',�., '.'�'•' ;;. ;',;<-. � • -' : ' .:. ene Panel, adenron pr
,.3,. .'n k� �3 +ti �A "' .'•,.N'S ' �r.> : YG',t ','�.. i �,r ... ., t ' i.n�: �:�, }� ::'rif';�: f >�. �'tti,
extension. Describe: Page 2 2
Business name: Local Electric Co. Inc.
Address; PO Box 508 Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Fairview OR 97024 investigation per hour (1 hr min) 62.50
Phone: (503) 296-0060 Fax: (503) 675-1665 Industrial plant per hour 73:75
_. ;.,...
C:Ct3 Lic.: 153034 Electrical Lie.: 37 -932 -C Suprv. Lic.. 4271 -5 (p 6 g o `°
„ ^:``"' ' '�' ,t° n ;; c
y;t.. Y < <r?:+ "fit
J
Subtotal
Suprv. Electrician signature, required: „14/ k _ ,f / Plan review (25% of permit fcc)
State surcharge (8% of permit fee)
Print name :_ ___ e :_ _ _ _ �L _ _ _Date :__4°4-04_ -- 5 3
•I'o'l'AL 1'ER1V11T J?JSE -7,2 . 1 y • Authorized sign.= .. • This permit applitatioa expires if a permit is not obudded within 100
]
�' a ' days after It hat been accepted as complete
Print name: }'-"" �,— f 4) h ate: 4-4-04 • Foe methodology act by Tri -County Building rndusuy Service Board
CITY OF TIGARD 24 -Hour —.-
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Res ested AM PM BU c_
Location / 3 Suite b0 -00
Contact Person Ph ( ) 670-8'3(13 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 011 170
Footing C ..
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ,; _ -� s6._` - a - SIT
Post & Beam
Shear Anchors 1443 ( - 1'D Vs C2,• v
Ext Sheath /Shear
Int Sheath/Shear 0111 I `ga
vir
v�
Framing ` "�
Insulation • C> (y 6
Drywall Nailing 7
Firewall ����/ _ �fi , C O f 70
Fire Sprinkler l/ li 11
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING, �/{rr�� �` Post & Under Slabm / Perk J L� �f � �1
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: `a 1
Final PART FAIL F 1,0 0 L1 ~ O )11 v
MECHANICAL
Post & Beam k L Lt ,6 PX� 7 4
Rough -In F�
Gas Line
Smoke Dampers
PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
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: 0 Unable to inspect — no access
Fire Supply Line '__ j�
Approach /Sidewalk Date r� ' ' I Inspector (ii/v y Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL