Permit ;r° `? CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2001 -00307
-7Ail DEVELOPMENT H PMENq Tigard. SERVICES 639 -4171 DATE ISSUED: 6/12/01
PARCEL: 1S126DC-04500
SITE ADDRESS: 09575 SW LOCUST ST
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Installation of (2) branch circuits.
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:
VIP'S MOTOR INNS INC CITY ELECTRIC + SUPPLY CO
29757 SW BOONES FERRY RD 8900 SW BURNHAM F -27
WILSONVILLE, OR 97070 TIGARD, OR 97223 •
Phone: Phone: 641 -8012
Reg #: SUP 3592S
LIC 42422
ELE 26 -289C
FEES Required Inspections
Type By Date Amount Receipt Elect'l Final
PRMT CTR 6/12/01 $53.50 2720010000(
5PCT CTR 6/12/01 $4.28 2720010000(
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 - 0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1-800- 332 -2344.
Permit Signature: Issued By: A / / A //
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:
TRACTOR INSTALLATION ONLY
/ 9P14
SIGNATURE OF SUPR. ELEC'N: > DATE: 6 " 12- 0)
LICENSE NO. . 3 552 5
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Datereceived: Permit no.:�� 200 / - 00 307
�ssi N3 i ; p
._j City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory U Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: c l 675 S t,..1 1.0 cut+ 4, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: 'Block: !Subdivision:
Project name: ph 1 'Description and location of work on premises: Bir,,,K{n4.1. lbr,,,t - 0,t; 12o,,.1
Estimated date of completion/inspection: ,- 1+( -0l
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Description Qty. (ea.) Total no. insp
Business name: CITY Fl FCTRIC ANTI Sl IPPI Y
New resitkittial - single or multi per
Address: 8900 SW BURNHAM ST F27 dwelling unit. Includes attached garage.
City: TIGARD I State: OR I ZIP: 97223 Serviceincluded:
Phone: 503 - 443 -1092 I Fax503- 625 -3052 E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: 42422 1 Elec. bus. lic. no: 26 - 289C
Limited energy, residential 2
City /me ic. • 0002604 Limited energy, non- residential 2
6-i2-o/ Each manufactured home or modular dwelling
Sign f supervising electrician (required) Date Service and/or feeder - 2
Sup. elect. name (print): CHARLES FRIESEN License no: 3592S Services or feeders — installation,
alteration or relocation: ] I
Maws orkss 1 1 1 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: • 'State: I ZIP: Over 1000 amps or volts 2
Phone: 'Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporar3' services or feeders -
which is not intended for sale, lease, rent, or exchange according to • lust allation,alteratioa,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
Name:
or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: 1 ZIP: B. Fee for branch circuits without purchase [ p
Phone: Fax: E
of service or feeder fee, first branch circuit: i `f O
2
Each additional branch circuit: I (o. b') •
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not Included):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1 &2 0 Hazardous location Each signor outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, •
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
0 Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lighting plan O Other: Per inspection I I I
Submit sets of plans with any of the above. Investigation fee
_ The above are not applicable to temporary construction service. Other
■
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ 50
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: I / within 180 days after it has been State surcharge (8%) .... $ ^I r atCJ
• Esp1ca accepted as complete. TOTAL $ 5'7 i 7 8
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4615 (6/00 /COM)
CITY.,OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 B Lsiness Line: 639 -4171
BUP
v.v Date Requested �� AM PM BLD
Location g5'7S •e cz,60,6 Suite MEC
Contact Person Ph 3 0. 7Z , PLM
Contractor C Y` / y /= /e c /r/ C Ph SWR
BUILDINGY ' , ,. ; Tenant/Owner o ell/ X /4 Y! ELC 249 ( -O
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT -
Post & Beam
Ext Sheath /Shear r4" C-Li ' C rC'v t
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall _
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Final -
PASS PART FAIL
P LU',MBINGu `,,
Post & Beam
Under Slab
Top Out •
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL •
MECHANICAL' as
•
• Post & Beam
Rough In
Gas Line - • •
Smoke Dampers
Final
A T FAIL
Service
Rough In
. UG /Slab .
Low Voltage
Fir- alarm
PART FAIL
• Backfill /Grading'
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before. next inspection...Pay.at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date r7 "- 6 / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •