Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00182
a .4 DEVELOPMENT SERVICES DATE ISSUED: 4/12/2004
c - 1 13125 SW Hall Blvd.. Tistard. OR 97223 (503) 639 -4171
PARCEL: 2S103CB-08200
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SITE ADDRESS: 12345 SW QUAIL CREEK LN
SUBDIVISION: QUAIL HOLLOW - EAST ZONING: R-4.5
BLOCK: LOT : 031 JURISDICTION: TIG
Project Description: (1) branch circuit to AC.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS 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: SIGNAUPANEL:
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: 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:
SUMMERS, DAVE & NADIA WEST SIDE ELECTRIC CO INC
12345 SW QUAIL CREEK LN. 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503- 590 -4492 Phone: 231 -1548
Reg #: L1C 13306
SUP 2663S
FEES ELE 26 -135c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/12/2004 $46.85
[TAX] 8% State Surcharge 4/12/2004 $3.75 Rough -
Elect'l 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 -33 -2344.
Issued By: Permit Signature: 0 l �,�
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
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SIGNATURE OF1SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard
Permit Na.: / 01.01)V..." -' - /g ' 2 -
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131.S SW 1Iall It lvd., Tigard, OR 9722.1 REC .D i
. HCV. C , 0
.,_ _ - . „
P.all • • • _ .. _ _. . .. .
1110110.: 503.639.41 71 Fax: 503.59S.1960 ' • ' iblenlY Other Penn&
Inspection I ,ii le: 50:1.639.4175 P
.l 12. . ple It
ac2dy/Ily: Juri: Id See M Z for
internet: www.ci.tigard.or.us APR tva • Nutinctl/Mcihod:
• • ' 11 6
quppleoscutul Ifiroemblion
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..--- ..... ..-.. . ........-- .. . ...... . . .. ... .. . . ....... . . . .. ... . .
TYPE OF woit
PLAN REVIEW
0 New construction Addition/altcrgui Please check all that apply:
O 25 Service over 2 amps, comml Ell luxurious location
n Demoliiion n Other: gffallUNISION
I:1St:lynx over 320 amps rating 011uildttg over 10,000 sq. 11..
CATEGORY OF CONS1M(JM10N of 1 - and 2-family dwellings 4 or more new residential
0Systian over 61)0 MIS nominal units In one structure
K
I - and 2 dwelling D Commercial/industrial El Accessory building
Dinilding over three stories Ell'octicrs. 4(X) amps or more
r.1 Multi-family n Master builder 0 Other
I:Occupant load over 99 persons OManufactured structures or
JOB SITE INFORMATION AND LOCATION 01gres.s/lighting plan 1W park
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Job no.:Irti et q Job site address:f z q 5 cf.,.) a.A....f f 6.c.a.tely.L. Ell lealth-care facility r:
Submit 2 sets of plans with any of the above.
City/State/ZIP: \ k 0.... ... e/ Gi - 2 2 3 The above are not applicable to temTsmuy construction service.
7..› -_..__. ._.,... , ..--...... .......... -._. ,- ......... ........ -.
FEE* SCIIEDIULE
Suite/bldg./apt. no.: Project name:
_ nesrdpuss [ Qty. IT . Per. [ Total ".
CMS:: NEI CelklifeellOTIN to job site: New residential single- or multi-family dwelling unit.
Includes attacked garage.
1.000 sq, 0. lie less 145.15 4
Subdivision: I Lot no.: lia. add'1500 Sq. IL or portion 33.40 I
I.imited clici•gy, residential 7.5.00 2
'I'a x n imilnurce1 no.;
.-----......1.-. - . .., . - - ,- Limited energy. non-residential 75.00 2
DFSCRIPTION OF WORK Each manufachired or imultilar
dwelling. serviReand/or feeder 90.90 J 2
t'_...._..1.--c.... A
.. • " '"" "
.... Services or feeders installation. alteration. and/or reloratini
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200 amps or less 0.30 1
- ..,
23. PROPERTY OWNER 0 NANT
201 amps to 400 amps 106.H3 2
TE
401 amps to 600 amps 160.60 2
Name: f . S GOTs...e 601 amps to 1,000 alms 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Recnimeclouly 66.85 2
eity/State/Z11': Tentporary services or feeders installitint;, plierolio
relocation_ .
P11000: (cd 7,) . , 0 - t - •(±1 q 7 I ; ( F " x )
, r 20(lamps o less 66.85 1
Owner installation: This installation is being made on properly that 1 own which is not 201 amps km 400 amps 100.30 . 2 -
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, :ma 701.
401 amps to 600 amps 4 133.75 I 2
Owner signature: ._... Date: Branch circuits- new, alteration, or extension, per panel
. - • •
0 APPLICANT - 0 conTAcr PERSON A. lice for branch circuits will,
service or feeder fee, each
DusitleSS name: brunch circuit 6.65 2
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' "---- It. Fee For branch circuits
Contact name: "Willow sort ies or feeder fee, 1
,.
6 2
46.85 .
Address: -- . .. . . - . -..--- .-
each branch circuit
f../
_. .. --.•-------- •• --. • Bach adcl'l branch circuit 6.65 2
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City/State/ZIP: Miscellaneous (service or feeder not in cluded)
Pump or irrigation circle 53.40 2
Phone; ( ) Fax: : ( ) • -.- • -- --
Sign or outline lighting 53.40 2
E -- Signal circuit(s) or li inked-
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CONTRACTOR enexy panel, alteration, or
• -• extension. Daseribc: Page 2 2
Business name: WEST SIDE ELECTRIC CO.
.. .. ..._____
Address: 11134 S -- E E AVE. Each additional inspection over allowable in a ny of the above
- ....___ . Per inspection 62.50
City/State/ZIP: PORTLAND, OR 97214 InvcSliff,ation per hour (1 Iii min) 62.50
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Phone: (503) 231 I Fax: (503) 736 Industrial plant per hour 1335
. - - ELECTRICAL PERmir VEES
((13 111.. 13306
- Fileclricid 1,i ' 26-I35C Suprv. Lie.: 2663S Subtotal
_....___._ __..
Sultry. Electrician siLvitiltire, required : 1 Plan review (25'V of permit fee)
....1.4.".."-^."....."-----
7 5
signature. Sint(' surehar c ft' s of xtroli fee
e. ( Y I 1 ) -3.
Print name e - tA ce - C.." .. Date: q Ic( /
Tow. rErtm IT FEE ofollh (
Authorized .,..-..
This permit application expires it a permit is not obtained wilhin IMO
• days idler Ii has ho er seeeplcd as complele
Print nanie: I Date: • Pee methodology set by Tri-eounty Building industry Service maid
• • • • - ' "" " •• Number or inspeelines per permit allowed,
. \ nue k loneVel tna AM .c•Per.mArip doe i vox 440.4415TO 0/(7.41)MAY1111
a • d LLSO - 9EL(E0g) '00 0T-120a13 aPTS 2saM d:20 .1 GO Jelld
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
_ BUP
Received 2 - n � �` Date Requested 6 -2 M�� PM BUP
Location z �� c.[� ae-e- �� .Suite MEC .
Contact Person Ph ( ) 453 t 2 Z PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 2./10/ — OO /(ra
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
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
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
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Service
Rough -In _
UG /Slab
Low Voltage
Fin - ❑
1411 •ART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SI 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA /� ( I Ext
Date _ Inspector V
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL