Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00288
i DEVELOPMENT SERVICES DATE ISSUED: 5/24/2004
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 111 AC -00100
SITE ADDRESS: 09075 SW PINEBROOK ST
SUBDIVISION: PINEBROOK TERRACE ZONING: R -4.5
BLOCK: LOT : 042 JURISDICTION: TIG
Project Description: 1 panel 200amp /less and 4 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: 1 W /SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
KITTELSON, WAYNE K AND AM ELECTRIC INC
JANICE R 2809 NE 58TH AVE.
9075 SW PINEBROOK PORTLAND, OR 97213
TIGARD, OR 97224
Phone: Phone: 225 - 0720
Reg #: LIC 00083526
SUP 1578S
FEES ELE 26 -795C
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 5/24/2004 $8.56
[ELPRMT] ELC Permit 5/24/2004 $106.90 Rough -in
Elect'I Service
Total $115.46 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- 23 •
Issued By: ��7/� �` / 4 4 4 , , A Permit Signature: d>
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: 15)e-)
Call 639 -4175 by 7:00pm for an inspection the next business day
VI/ u.r/ cuuJ 14: ac r:t,a au.io ro iyou L.1 Ur i i kiztrur tYJ VUL
FOR OFFICE USE ONLY
Electrical Permit Application •
Received , < as C10-='• ED Date/: B ! �� I
CEIV PlamtingA•prim: S
City of Tigard RE Date/Br
Permit No.:
•
13125 SW Hall Blvd. Plan Review Other
0 04 Date/By: Permit No.:
Tigard, Oregon 9 7223 MAY ppgt_Qvies✓ Lead Use
Phone: 503 -639 -4171 Fax: 503-598-1960 kn ' 4!L „,i'I i I . D Date/Br t -Ke Case No.:
Internet: www.ci.tigard.or.us a .- I 41 i tact kris.: ® Sec Page 2. for
24-hour Inspection Request 503-639-4 RIN c/]vlethod:
Supplemental Information.
: ::..'.'.:::::::
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. :��s� .�, :� I.� . : •'!. ;�I;� :f ;�'�i'. .II .I:.' .. : '�Il :, :y :..�. �'� :.. .• ,, .. �,.�;`_',.. ..�, ,. , '
,
❑ Service over 225 amps- 0 Health -care facility .
111 N� construction • Demolition commercial ❑ Hazardous location .
E Addition/alteration/ - • lacement • Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 squats feet,
I• •::! q:: i... . :: ''' four or more residential units in
.::. : , ; :'', °. i' .' �.” ' Cpii I• ' c!GIF'3i�O1!iS.' ' ' CTION; •- li:, • � •' .. _ �Ir . 1 & 2 family dwellings
� y I : . El System over 600 volts nominal one structure
■Siege 2- Family dwellin: ■ • .. ., + • - 14 • 0 Building over three stories ❑ Feeders, 400 amps or more
• Access. Buildii • ' ■ Multi- Falnil ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Builder ❑ Other: 0 Egress/lighting plat ❑ Other.
El Master , „. e
I � y � ( r !ter s }} ��TT '�: �.i.. C'
:in, B' � ;!end�'I 10 fll��. ��i'��'�' I t Submit sets of plans with any of the above.
site J • address: • The above are not a • Betide to tern orary construction service.
•
Job site address: ` S S c • t• :i '.,_:. g : r, t, �.,... ::° : • :!:.;;;. : :;.. :.ii ..?. .. :.,; ∎Iii.- .
Suite #: 9 015 Bldv./ • 'tit. Number of inspections per permit allowed
Deseriptisn Qty Fee (ea) Total — I
Project Name: New resldentbd -single or multi- family per
Cross street/Directions to job site: dwellings unit. Includes attached garage.
Service Included:
1000 sq. ft or less 145.15 4 .
Each additional 500 sq. ft. orportion thereof 33.40 , 1
Limited encrl.7, residential 75.00 2
Subdivision: Lot #: Limited energy. non residential 75.00 2
Tax mac/ areel #: Each manufactured home or modular dwelling 90.90 2
P wl,,, rewire and1or feeder
iP'I 'llii I° { $wi i�l o' • �l 1� )v` ® "W4RI$;'z.'I Services or feeders - installation,
■ l , a . `WA n , alteration or relocation: (,
1 200 araiz or less I 50.30 b D .3..D 2
201 arnps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
.: .. ;, amps amps 240.60 2
GO l ]000
�a ,I: I'M ' :Q i; . . . mu.. :.T:c Over amg:s or 454.65 , 2
Name: a I — Reconncet only 6 6.85 2 _
Address: Temporary services or feeders - installation,
alteration, or relocation:
Ci /State /Zi r : 200 amps or less 66.85 i
,Q I 201 amos to 400 amps 100.30 2
Phone :�3 - (`a O Fax: 401 to 600 amps 133.75 2
:.'. "74 WT. !r - ... : ':!:' ®p iro CT IPERS0.Nbilr' • Branch circuits - new, alteration, or
•
Name: extension per panel: •
A. Fee for branch circuits with purchase of •
Address: service or feeder ice. each branch circuit 6.65 2
City/State/Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit
Phone: Fax: Each additional branch circuit 6.65 2
A1isc.(Service or feeds not included): I'
E-mail: Each pumporin rircle _ ,
.....
53 40
' a . :.i +5.: CO D? a�'O1lt a'i r :I� • , !: � !� ". ' ' `. .. 5 3.40 2
., :'. ;•',lira :. ; a :. -_ .it �'. Each sitar or outline lightinfi
Job No: li t i r WA= ' Signal circuit(s) era limited energy panel,
Descri n extcosioo rage 2
2
Business Name: a esgiption
Address: 1
7 1+
Each additional inspection o�r the allowable in any of the shave:
City/State/Zip: � O 7� Per inspection per hour (min. 1 hour) 62.50
Phone:�,481 -90 - 3 Fax: erg - 009 y investigation fee:
{ / 1 CCB Sug Lie. ising :liectri cian 'S omen .. I'. "I31 i :Per®t: F :`? : :'.. "I I�!n!;: .!,' I_.
10 '
•� Subtotal $ �- ► 1 0 b tqp
_
s ature re. aired: '. Plan Review (25% of Permit Fee) $ r)66 D ,��,7, - State Surcharge (8% of Permit Fee) S —�"--
Print Name: L7 �� ...—.► � JJ�� – TOTAL PERMIT FEE R 2.
it
Authorized V '' _O 1
Notice: T permit expires if a permit Is not obtained within
Signature: Date: 180 days otter It has been accepted as complete. i
•Fcc methodology set by Tai- County Buildi Service l Board.
(Please print name) / ' (� r
i:\ Dsts�Fem rtu
tit pors `E1cPeRnitApp.doc 01/03 _
all6.1'
CITY OF TIGARD 24 -Hour
BUILDING InspectietLin : (503) 639 -4175
INSPECTION Business Line: (503) 639 -4171 MST
N DIVISION
BUP
Received 7' 4 Date Requested 5 « AM PM BUP
. Location f (' ` 7- S / d iJr' I7 Suite MEC
Contact Person Tli-t/01.(A Ph (5 3) 9 9 9 'V? PLM
Contractor Ph ( ) SWR
BUILDING Tenan owner . ! 4 - '.' 4 i_' Vii, c 2 t1)6 Z 8,
Footing /
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: � /�� � J SIT
Post & Beam c 6(1_0 J�%�/Wt_ �
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing _
Firewall �— - N�� E1 t -4 SQ Y cwv fl�L
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
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
11 M PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line I ,�
ADA � � 24 ,v(3
Approach/Sidewalk Date � Inspector �''��� C 13 LE Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL