Permit CITY OF TI G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00333
`.� , DEVELOPMENT SERVICES DATE ISSUED: 6/26/01
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S114BB -01100
SITE ADDRESS: 10185 SW SERENA WAY
SUBDIVISION: PICKS LANDING NO.1 ZONING: R -4.5
BLOCK: LOT : 010 JURISDICTION: TIG
Project Description: Installation of one branch circuit.
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: 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:
CHINN, FRANK L TR + WESTMORELAND ELECTRIC
REBECCA A TR 13150 S CLACKAMAS RIVER DR
10185 SW SERENA WAY OREGON CITY, OR 97045
TIGARD, - OR 97224
Phone: Phone: 557 -2220
Reg #: ELE 26 -1050C
LIC 140551
SUP 4638S
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 6/26/01 $46.85 2720010000( Elect'I Final
5PCT CTR 6/26/01 $3.75 2720010000(
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 -00 0 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:
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
Call 639 -4175 by 7:00pm for an inspection the next business day
1- Electrical Permit Applicati
Date received:6 /2,6 c j Permit no.: -� z
( ri nC.�� yl 1 liq •
_, ,.� I City of Tigard 776" Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT
„9'1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
JOB SITE INFORMATION
Job address: 1 0 \ B . Sr-✓ sazerii L','l y Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name: I Description and 1 cation of work on premises:
Estimated date of completion/inspection: 6 2 7
CONTRACTOR APPLICATION FEE SCHEDULE
E
Job no: j Fee Max
Business name: (�J eSTfnO e S14Aj p F 1 e L l t L Description Qty. (ea) Total no. insp
New residential - single or multi -family per
Address:
0. goy- S 3 S (cS dwelling unit. Includes attached garage.
City; ( f TLi .J O I State: pY I ZIP: 9 7 a o Serviceincluded: •
Phone:d3 Q S3 c, D I Fax:, 3, 7e a (01 E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: MD 55 ( 'Elec. bus. lic. no:,U /DSO (.... Limited energy, residential 2
City /metro lic. no.: Limited energy, non- residential 2
7
Each manufactured home or modular dwelling
Signature of s perv�isi electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): RA., Es License no: 3E55 Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 5 f a.. (L C_1, 1 n... 201 amps to 400 amps 2
401 amps to 600 amps ' 2
Mailing address: 1015? S S'-J J e_r a - " o L/G y 601 amps to 1000 amps . 2
City: 1 State: O,tI ZIP: 9 7 2-2-V Over 1000 amps or volts 2
Phone: (S o3 68y- 2810(Fax: I E -mail: Reconnect only I
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration,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,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 'State: I ZIP: B. Fee for branch circuits without purchase /
of service or feeder fee, first branch circuit: / / 2
Phone: Fax: E -mail: /
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service orfeedernot included):
0 Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings 0 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
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
0 Egress/lightingplan ❑ Other. Per inspection 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 $ g4 . i
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ 3.75
Expires accepted as complete. TOTAL $ SO . 4
Name of cardholder as shown on credit card ` �r 3D
$
Cardholder signature Amount 440-4615 (6/00/COM)
/2er, 9D
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24'Hour Inspection Line: 639 -4175 Business Line: 639 - 4171
BUP
Date Requested Z AM PM BLD
Location / 8 5 Sw Sore me---' Suite MEC
Contact Person Ph 55 7-s2 ?A) PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC Zczm /— Od 3 3
Retaining Wall ELR •Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
. Ext Sheath /Shear
Int Sheath /Shear
. Framing
Insulation
Drywall Nailing 3 15/10 •
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling. .
Roof
Misc:
Final
PASS PART FAIL
PLUMBING 41c:7
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
R Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
-
Gas In
Line
Line
Smoke Dampers OC
Final
PASS PART FAIL
c-€L�CTRI
?? Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
J PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ I 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 Inspect. E� 9- Q 1 I ect• r `% /TA Ext
Other
Final
PASS PART FAIL DO NOT. REMOVE this inspection record from the job site.