Permit A .. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00683
I n DEVELOPMENT SERVICES DATE ISSUED: 10/26/2004
1II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S125DB-04700
SITE ADDRESS: 07175 SW SHADY CT
SUBDIVISION: SHADY DELL NO.2 ZONING: R-4.5
BLOCK: LOT : 021 JURISDICTION: TIG
Project Description: (2) branch circuits, wire A/C & exterior outlet.
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: 1 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:
HAMILTON, RICHARD F+ JUDY E WEST SIDE ELECTRIC CO INC
7175 SW SHADY CT 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Phone: 503 - 231 - 1548
Reg #: LIC 13306
SUP 4654S
FEES ELE 26 -I35c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/26/200' $53.50
[TAX] 8% State Surcharge 10/26/200 $4.28 Rough -in
Elect'I Final
Total $57.78
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: // L�Z�� Permit Signature: _542;--c, p�`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
J \ iY
`E1_ect;;lical Permit A pplicati on FOR OFFICE USE ONLY
City of Tigard fcmeived _
13125 SW Hall Blvd., Tigard. OR 2 2r C E IV E D PDate/fl
Iwv /� �" ,d PerntirNi�,: ... i.,.., v.-- Phone: 501639.4171 Fax_ 503.5.8.1960' a" a n,>'yl, pa y _ Other Form&
Inspection Line: 503-639.4175 FAY 2 ' i . . la See Ready /By: !u See Page z ay Internet: wWw,ci'.tigard.or.us of I / 5 2004 Nnti£td/Mothod: • y ,O Supptampns,l ln(Ormutiun
;farm, OXrW01EICRD PLAN REVIEW
❑ Ncw construction b'' Addition�/ tern oiJxc'h Pleasechetk all that apply:
7UILIJ i✓ vr'-'‘"'n ment ['Service over 225 amps, cnmm'l ['Hazardous location
❑ Demolition ❑ Other:.
. _ ['Service over 320 amps rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION • of 1 - and 2- family dwellings 4 or niorc new r '
1 and 2 family dwelling I: ComrtterciaVindustrial ❑ Accessory building ['System over 600 volts nominal •units in one structure
°Building over three stories ❑Feeders, 400 amps or more •
] Multi family iii Master builder ❑Other:
❑Occupant load over 99 persons 0 Manufactured structures or •
• JOB SITE 7NFORNIATION AND LOCATION _ _ ❑egress /light plan RV park
Job no.: ^ Z (tp Job site address: C]1'lealth - care facility 0006:
SUbmit 2 sets of plans with any of the above,
City /State /ZIP:. ` t . C .. 0 C 72 Z. 3 The above are not applicable to temporary construction service.
SuiteJbld /a t . no.: Project name: c / 1 ^ ~✓ FEE• SCHEDULE •
ffi P l / `f u t( f . �-
� V� n" �r ` C l7 S nrACri Qty. � Ri:r. Tufal
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
-' Includes attached garage,
_ 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.; Ea. add'l 500 sq. ft or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75,00 _ 2
Limited energy, non-residential 75.00 2
• DESCRIPTION OB WOXUC • . Each manufactured or modular
� dwelling, service and /or feeder 90.90 2
41
/ / ` C p •r
r ` " •- s c 0 w_.._ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
•
PROPERTY OWNER [—r__,... TENANT • • -- 201 amps to 400 amps 106.85 2
• ! -� --- 401 amps to 600 amps 160.60 2
Name: Jc` CA w..1. t ( SQ VI iS - 601 amps lo-1.000 amps ' • 240.60 2
Address: C Over 1.000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: •T - Temporary services or feeders installation, _ alteration, and/or
Phone: relocation
z, ) 2AIS.. �.2(.!L( • Fax :( )
T 200 amps or less _ 66.85
Owner installation: This installation is being made on property that I own which is not Y01 amps to 400 amps 100.30 2 Z
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.. 401 am s to 600 a _
m
p ps 133.75
Owner signature: _ _ Date: Branch circuits- new, alteration, or extension, per panel
•
❑ APPLICANT J • Cr'CONTtcT PEksON .' A. Fee for branch circuits with
service or feeder fee, each
Business name: , branch circuit 6.65 2
- 13. Foe for branch circuits
m Contact name: _ without service or feeder fee.
Address: each branch circuit 46.85 { lj, ` 2
... Each add'l branch circuit I 6.65. 4t. 2
City /State/ZIP: J Miscellaneous (service nr feeder not included)
Phone: T -- I'unip or irrigation circle 53:40 • . 2
( - - T ; ( )
S� ign or outline lighting 53.40 2'
E -mail: • _ - _ Signal cireuil(s) or limited-
CONTRAC'T'OR . . energy panel, alteration, or
Business name: WEST SIDE ELECTRIC CO. extension, • Describe: P 2 • 2
Address: 1834 SE 8' ' AVE. . Each additional inspection over allowable in a ny of the above
- Per inspection - . 62.50'
City/State/ZIP: PORTLAND, OR 97214 lnvrstigstion per hour (I la thin) 62.50
•
Phone: (503) 231 -1548 I Pox: (503) 736 -0677 Industrial plant per hour 73.75 T^
- ELECTRICAL PER1VIIT PEES*
C C B Lic.: 13306 E lectrical L' - 26 -135C . Suprv. Lic_:1- ' 9. i S Subtotal . L' S
Suprv. Electrician signature, required: W,/ )12.,e:7---- -
Plan review (25% of permit fee).
Print fence: / �� • ? Dat V L Slaw surcharge (8% o permit fee).' L f c Z
TOTAL PERMIT FEE 5 7
Authorized signature:, . This permit npPl[tptloo expires It a permit to not Obtained within 180
Print name: • days after It has been accepted as complete
_ Date: ' Pee methodology set by Tri County Building Industry Service Hoard '
•. Number of inspections per permit allowed.
is Utulld.ng\Pcronlft5LC.Pem,kMD I2/03 4404615r(I0t02/CQM/WEIt
' 2' LL9O- 9ELICOS) •00'oT..11oaI3 apTsZSaO • e92t9O 4.0 SZ 100
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Re uested 3 AM PM BUP
Location 7/ 7_ Suite MEC
Contact Person � , /.t J Ph ( ) c •.))' -733/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELCO- (/ — 60 6 5 3
Footing
Foundation ELC
Ftg Drain
Access: ELR ZAMIk
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam MIN
Shear Anchors
Ext Sheath/Shear MEW
Int Sheath /Shear
Framing
Drywall
Dryll 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
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
LASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line A ' <� (� ADA Date e t ) Inspe 7 ( j ��= k "-"
PP
Other: _
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL