Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00599
ili tl�
DEVELOPMENT SERVICES DATE ISSUED: 9/25/03
{ � II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25111 BD -00315
SITE ADDRESS: 09850 SW PEMBROOK ST
SUBDIVISION: PEMBROOK HEIGHTS ZONING: R-3.5
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: Replace meter base and wire for hot tub.
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: 1 W /SERVICE OR FEEDER: 1 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 0 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 0 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:
DAVIS, JAMES A/SUSAN L WEST SIDE ELECTRIC CO INC
9850 SW PEMBROOK ST 1834 SE 8TH AVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: Phone: 231 - 1548
Reg #: LIC 13306
SUP 2663S
FEES ELE 26 -135c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/25/03 $86.95
[TAX] 8% State Tax 9/25/03 $6.96 Rough -in
Elect'I Service
Total $93.91 Elect'I Final
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 -2 . /
Issue By: ,.� - Permit Signature•—‘""4 (1.QQ
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: �^� d`�'« DATE:
LICENSE NO: A66c5
Call 639 -4175 by 7:00pm for an inspection the next business day
•
• Ruh 11 Q 3 1': Duf l'y Mercep SU;i G35 E1b17 , P. 2
Electrical Permit Application FOR OFFICE USE ONLY
Dag en n : all aee NO.: E a -466 9 d.4 e3 pe,lr,;l ,
City of TignE Plamang Approval ss>�
►lrtr/Ii Permit No..
13125 SW Hall i'1an ii..~. Other
Tigard, Oregon 91223 Date ll : Permit No.. — .._
Phone: 503 -639.4 Ep Ii�t451 -1960 Post - Review rand Use y rase
Internet: www.ci.t onus ''' I C,, .1 ,: See Pace 2 for
24 -hour Inspection Request: 503.63%4175 Namc/Mclbod: _•, • . __ I 1 G :.. Snpplemeatal Informality. -
CITY OF TIGARu
BUILDING DIVISION
TYPE YPE nF WORK PLAN R KV I E:W (Please cheek all that ant" ' —_
.
_ l Ntwp construction i J Demolition $ctvtCC over 225 amps- 1-1 Menith-care facil
commercial ❑ I lasanlmet location
_ ddition/aiteration/i lacemcnt _ I:I Other. _ p service over no amps•ratng of CI Building over 10,000 slurs keg.
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings tburur muse residential units in
•
- 0 - 1 & 2- Family dwelling 0 Commerclal/industrial _ D System over 600 volts nominal one suuctwc
- - - - I] Building over throe crones ❑ Feeders. 400 limps or more
Accessory Buildin L j Multi-Family Oeeut,ant had over 99 poisons ❑ Manufactured structures or RV park
ID Master Builder 0 (hoer: 0 Egrosalignini•: pk+n 0 Other: _ .....
' • JOR SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
� s , J e .. ` r The above are not appficahle to temporary eonstnactioo service-
address: 9
Job site add ctIm .f , S t_ • F4 SCHEDULE
Suite II: I Bld . /Awl. #: - - - -- -� Number of inspections per `lermii allowed
Pmjcct . .� ./ 1 . S : � _ Description Qty Fee (ea.) Pout !
■
Nero reridrntlai- slosh er muh�famity per
Cross street/Directions to job site: d.x+tllieg Includes attatbed game.
Service lechnted:
1000 so ft. or less _ - 145.15 - 4 _
•
Each addil,o 21 50 sit 4 pnrtron Itieroor 33.40 . 1
- _ • • • __ . • •••• - •-- Lenaed energy, residential 75.00 2
Subdivision: Lot if: — • -- —
. . _- _ . -... ... .. -- „, tanned enemy, non resuknool /5.00 2
lax map/parcel #: Loch xnanuractuzrd h ome an m dwelling - -
DSSCRlPTION OF WORK service ant se fader 90.90 2
( (� Services or feeders - Installation.
1ai. "(2 r ab+ c' 1/d. L.s' anaation or relocation: -
!l amps or Ina 1, _ 8030 30- ko 2
7 1L 200 a 201 amps to 400 ttmrs 106!15 Z
•
_ snips - - ,- 240.60 2_
Over 1000 amts oe volts 400.1) 2
A An O CSS: I ne: ,, e Q G Q � / e } �r) c,-t.) Pe � T� �' . Per- , / /5 /'-
Reconnect any 6,.x> 2
Ad J jr - Temporary &eroues or feeders - installation,
aft/MP" or relocation:
City/State llip►�f� A-Q D / 02 ... 9 7 3 . —. 200 amps r. > 6(1.K5 ]
201 an r a 00 ^ mps _.. _..._10030 _ —. z
Fax: Phone: •• -• • ...__
— 113.75 2
OPPLICANT - V i CONTACT PERSON _ . .. 401l0600amps
- Qraoeb tweaks - ten, alteration, or
Name: \A/d S \ . (J ac..... - co ...... _ .__ eateodon per panel:
A. Pee far circuits with purchase of
L S i blanch
or feeder fie, rash Minch unveil
Gityistait;/zip: � }C 1 q 2 t 6.65 G . 2
B. Fee fo br altch c6coits without purchase or
service v' feeder fee Ra tM}n
t rh circuit 46.85 2
Phone: 2. - 7 F ax: -- /S b ~D tl, 7 . E a _ ch,dd:l:on branch client n 65 2
. r !wise (Service ow (aster not included):
-
- = � Q �CLa"""`�C� C � Fx hpumpairrip}�rmmcirck 53.40 7�
. CONT,aACa . i nch son Of Outline Nitta_ 5:e.40
Job No: • 1 to ) $ I Si mane(%) nr a lirad energy panel. 2
BusinessNameL�EST
D d. C ZLfe- rib' - �, - at > q n exrrnsia, Page2 _.
Address:
•- • ° "' •- Fads additional inspection Over the allowable in any or the above:
City/State/Zip: - Per inapretinn per hoar (min, i horn _ 67 -50 -...
Phone: Fax: In ' :un, fee: - -
li: tic. it: - ` °d" rt - - -� - -
CCF3 Lie.
L`' D �-(D_ 3 r7 C.. ...
Electrical Permit Fees'
Supervising r)ectricia _ Subtotal S �o , �f
signature rcquu ed: , • ■.G�wwt -4. Plan Review . 25% 5% of Pcamil Fee) S
Print Name:, �.a (Ar. ,., a ii • 15 - State Surcharge (x% of Permit Fee) S e e
TOTAL PERMIT FIFE S
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: _ __ ____ .._ .._._. _. Date: IR0 days after it btu been accented ascomplete.
' Yee methodology set.by Tri -County Building Industry Service Board.
• (ulnae print name) -
i•t ,Pramit Pornaill3tcPcrinitAppAlac 01/03
2'd LL90- 9EL(COS) •03 ot.t2Oai3 api2 2sam eC4 LO CO b2 daS
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (403) 639 -4171 MST
BUP
Received Date Rueste — 3 AM PM BUP
Location qg so Suite MEC
Contact Person le Cr 5- Ph (_,Sa) Z f — 9 C cf 7 PLM
Contractor Ph ( ) 7 1 "? SWR
BUILDING Tenant/Owner C100 �C
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Drywall on
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 S P I\ A k lj � C�
Rain Drains " �
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Anal
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
� P A FAIL
R P r AL �
UG/Slab
Low Voltage
•
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• ART FAIL
SITE ❑ Please call for reinspe on RE: Unable to inspect — no access
Fire Supply Line
ADA �j
Approach/Sidewalk Date d — Inspect r 0u-- xt
Other:
Final DO NOT REMOVE this inspection record fr m the job te.
PASS PART FAIL