Permit CITY OF TIGARD . ELECTRICAL PERMIT
PERMIT #: ELC2004 -00710
x1111 DEVELOPMENT SERVICES DATE ISSUED: 11/4/2004
�� II 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 103CC -02000
SITE ADDRESS: 12040 SW ROSE VISTA DR
SUBDIVISION: COLONIAL VIEW ZONING: R-4.5
BLOCK: LOT : 015 JURISDICTION: TIG
Project Description: (3) branch circuits for furnace & NC.
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: 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: 2 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:
HAZARD, JOHN GERALD + ELECTRIC TECH INC
DARLINE GROGAN CO -TRS 2870 SW 221ST # 204
12040 SW ROSE VISTA DR HILLSBORO, OR 97123
TIGARD, OR 97223
Phone: 503 -639 -6561 Phone: 503 - 640 -4333
Reg #: ELE 34 -638C
SUP 4912S
FEES LIC 155230
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 11/4/2004 $4.82
[ELPRMT] ELC Permit 11/4/2004 $60.15 Rough -
Elect'I Final
Total $64.97
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: ,v Permit Signature: 5.4_,-C Q, \e ,p
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
Nov 03 04 10: 17a James Currts 5036429699 p. 1
4. "" �(', EU
Electrical Permit A�p1 lPtit+B'p wiz 01.1. NI; ()NIA
C ity wf T i W> d Ttgard. OR 97223 140\1 0 3 2004 ;; y: / / �y 6 v Ne.vLe_ , 0e� 60 7/ 6
Phone: SU3.639.ai71 Fax: Ma-59111960 OF T IG ' ^' � : ; '.• r w Other Permit:
Inspection Line: 503.639.4175 v1 1 G► DI ..r : tJ�. '±J. . Data Ree y/By / I ® See Pq�2 Tor
Internet: w.�vw.ei.tigard.or.ua BUILDI moifeedlMetbud: = L I matioa
er
TYPE OF WORK ]PLAN REVIEW
- ❑ Ncw conctniction ® 'Addition/altcration/replacctrlcnt Please chock all that apply.
❑Service over 225 amps. comm'I 0 Hazardous location
❑ I)e inolition ❑ Other: - ❑Service over 32(1 amps - rating ❑Buildng over 10.000 sq. R
.,. CATF..GORY OF CONS R CrION oft- and 2-fan ily dwellings 4 or more Mal residential
and 2- family dwelling C] Commercial/industrial ❑ Accemory building O Sydcm over 600 volts nominal emits in one structure
QBuilding over throe stories °Feeders, 400 amps or more
❑ Multi - family ❑ Ma.ea- builder ❑ Othrx: - ❑Occupant load over 99 persons DMaautaetmed atruanres et
JOB SITE INFORMATION AND LOCATION ❑ Egress/lighting plan RV park
Job no.: • Job site address: 0Healdraaao facility
s . 0 1 •. - : • Submit 2 sets of plans with any of the above.
City/Statc/Z11' rr C 1 (� e► n me _ The above are not applicable to temporary construction savvier). .
Suite/bld / art. no.: 1. - Project Gname: FEE* SCHEDULE Qty. T�
g. Pr°�
Crops Stroct/diroctions to job sire: New residential mmgb- or multi family dwelling min.
lnclods attsched garage. -
Lot sq. It or lets 145.1 5 - 4
+ Subdivision: I Lo no.: F.a. adds) 500 s41. 1t. or portion 33.40 _ 1
. L-- limited energy. residential 75.00 %
Tax map/parcel no.: '
Limited energy, non- rcaidcrdial 75.00 :
DE.!K.R11tT /ON OF WORK Each manufacxurod or modular
` - � dwellin�.cr.ree antler feeder 90.90 � %
—3_011.0-4122.) i e . / I/ • • Services or feeders lnstallwtiun, alteration. and/or relocation
200 amps or loss 80.30 �
I 0 TENANT 201 amps to 400 amps 106.55
oa PROPERTY OWNER
401 amps In 600 amps 160.60 .
—
Name: (� Q ry e 601 arts to 1.000 amps 240.60 I •
Address' / • • _ z C .s,, t a , Over 1 mops a voile 454.65
Reno men only 66.85
City/State/7,1P: 0 fP Ur. emmperery srrvkes or feeders mstallatbn. alteration, and/or relocation
� 3 ) X 39 -4
Phone: ( ax ( ) 200 amps or leas 66.85 1
Owner installation: - lats installation is being abrade en proptzty that I own which is not 201 amps to 400 amps 100.30
intended for sale, lame. rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 . •
Owner signature: Date: Branch circuits - new. alteration. or exte nlon, e.r panel
❑ ,tPPLiCANT L 0 c NTACT rp.nsoly A. Yoe tar !MK* cietivita with
service or feeder foe, each 6.65 .
Business name: branch circuit
._. B. Fee for branch circuits
Contact name: rrithoret service or feeder fee. j 46.
^ 5 ,��.
each branch circuit Address. Each us ch add'1 branch circuit .".1 6.65 . .
city /Slatel/.IP: Mbeellaneous(service or feeder not Included)
- Pump or irrigation circle 53.40
Phonc: ( ) I Fax: : ( ) Sign or outline lighting 53.40 .
E-mail: Signal evcuit(s) or limited-
..... - - CONTRACTOR energy panel, alteration, or
exten i.n . Dctcribe: Page 2 .
I3usint'v� name: Electric-Tech Inc. ' . ^� _J _
AddreN:: 0( 1 W L . + .1n ac E inspection tional ins over allowable 2 any of the above
ve
Pw City/State/ZIP: Hillsboro, OR 97123 Investigation per hour (1 hr min) 62.50
Industrial plant per hour 1 79.75
Phone: rj 0.3+ 4/0-/ .2.3 ------
Fax: ( 50 - L'S� -��i 94
I�c-rwcu, rltRl►Irr ttlatt�y
(:CB Lie.: 155230 Tilectrica1 Lie.; 34-638C Suinv. I.ic.: 49125 Subtotal T -
Suprv. Electrician signature, required: �I. Plan review (25% of pelrm fee) �� ,
State surcharge (8% of permit fee)
Print name:'. Date: - -
. fines C 1 ,i • TOTAL PERMIT FEE I -
Authorized aignnture: d This permit e� artrr It pM redl b within loo
Print tun= ter: 1 r • • Fm methodology set by Th -t" ounty Molding Industry service !hare!
�.-. ��. --•• [` � '� •• Number of uaeuCtiont er h pemni annwed. Z70 . /
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business•Line (503) 639 - 4171 MST
BUP
Received Date Requested ! l J / A PM BUP
D 7(,
Location / O 8A__.,1,2_ Suite 40 c� _ o (/A 7e -1
Contact Person 1� P ( ) 5- 9 / ` / ? PLM
Contractor :LC BUILDING Tenant/Owner Zvi 009/v
Footing
ELC
Foundation Access: L dt ARI E /, 21
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: E 24Q ( G -�
� o ' a SIT
Post & Beam t'V �{
Shear Anchors 1 ( . (---. ) Q6.- e- . — / Al C.--
Ext Sheath/Shear
Int Sheath/Shear A / ( , p a // p 7 t
Framing ' f� /V fl _
Insulation
Drywall Nailing A ► I '° "'`
Firewall f/ /
UN / U / � '" 1 / Fuse �KO_ `'S'- �R,t�
Fire Sprinkler `t *vac._ f
Fire Alarm Y" L 5 � 2 so ��///�
Susp'd Ceiling I j ` J k ! ` v
Roof
Other: _ - -
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In S F a/
Water Service
Sanitary Sewer + '
Rain Drains
y�
Catch Basin / Manhole e ,,,,� . ;
Storm Drain
Shower Pan
Other:
Final
PASS , FAIL
S AL c)
.s
In Beam
Ro , 10 "„ �"
uIn v � -r
Gas Line
Smoke pampers
Illir- ^_' ,- T FAIL
411
CTRIC
Service
Rough -In
UG/Slab
Low Voltage
F'..- rm
4 El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
0 Please call for reinspection RE. 0 Unable to inspect - no access
Fire Supply Line t
ADA / lo 0
,
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record m the job site.
PASS PART FAIL