Permit i
CITY OF. TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00358
,A.in. DEVELOPMENT SERVICES DATE ISSUED: 6/18/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135BD -00300
SITE ADDRESS: 09735 SW SHADY LN 200
SUBDIVISION:
ZONING: C G
' BLOCK: • LOT : JURISDICTION: TIG
Project Des Install (1) branch circuit for outlet and Low Voltage for voice /date cabling.
Job #JI5562
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: '
HAZEL INTERNATIONAL, INC AND WEST SIDE ELECTRIC CO INC
HIGASHIYAMA.HIGHLANDS CO, LTD • . 1834 SE 8TH AVE
BY NORRIS + STEVENS REALTORS PORTLAND, OR 97214
PORTLAND, OR 97204 -
Phone: - . ' Phone: 231 - 1548
• Reg #: LIC 13306
SUP 2663S
FEES. ELE 26 -135c •
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/18/03 $121.85
[TAX] 8% State Tax '6/18/03 $9.75 Low Voltage Inspection
Rough -in •
Total • $131.60 Elect'I Final •
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 throug OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- j "'3 . . •
Issued By: 41110", ,a,f,t— .„it Permit Signature: 01 CW C
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: ((0103 •
Call 639 -4175 by 7:00pm for an inspection the next business day
•
r ,
Electrical PermitA,pplication OFFICE USE ONLY
City Tigard REC EIVED
Date pecoivcd� __ Permit no.03 (� � '• k
, Cllr of Ti so rt Project /oppl, no.: Rxpire date:
'" Add 13125 SW H Bl Ti OR 97223 • --• --' •" ' _. _...
ir3/oj7%i;ur Date issued: Ry:3 Receipt no.:
Phone: (503) 639 -4171 _.. -.__ ....- ,................. - _ - • • . _..__ - .. - __ -.- .._
Fax: (503) 598 -1960 JUN / ,y 2003 Case file rte,: Payment type:
Land use approval: CITY OF TIGARD
Pi ii ■ I.. •
TYPE OF PERMIT
U 1 & 2 family dwelling or accessory ommercial /industrial U Multi-family U Tenant improvement
0 New construction Addition /alteration /replacement 0 Other: ❑ Partial
JOB SITE INFORMA'T'ION
Job address: q c.-L.....) 6'F l L - y � ' w� Bldg. no.: Suite no.:70 Tax map /tuts lot/account nu -:
Lot: Block: SubdiJision:
Project name: • v� location - .. , - .• A Description and ation of work on premises: t l.,,,, 0 ,, t . t .,., ( � r I N c? .. 1 eve..
F..r:tirnated of completion/inspection: � ...,m.� — 1' N - ,, r ,., t •i ( .*
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: 3 x<c ) 7- Fee Max
Business name: WEST SIDE ELECTRIC CO, Uesc"°I"'n Qty. (lq) Total- no.In p
New residential - single or tomiti family per
Addres:;: SE 8TH AVE. dweoingmtit ,>Incalaesatraehedsarese,
City: PORTLAND S tate :OR ZIP : 97214 Servleelndnde,t:
- lihone: 2- 1548�i�ax: 736 -0877 it -mail: 1000 a (L or Ices _ — - -- .,, 4 _
—• -
(X33 no.: 13 06 — 1 Tilcc. boas Isis. no: 26-135C J 1?och Addilitmal 3011 ;¢1, f. or portion llwrcof
_... .... •
-- •--- -...--•---• -' • -.•.
Limited cull +caduthal 2
City/ try lie, no.: _ _ Limited enemy, non - residential -. '2
_ - - 7rZ / roach manulucttnrd home or modular dwelling - --
�/ St .rviu:: and/or feeder 2 d
Sigma are of s(pe 'sing electrician (rcr _
Date • •,•_ _ - -_
Sup. elect. name (print)' BRUCE ZIMMERMAN License no: 2663S Serviceaorteedars- installation,
PROPERTY OWNER alteration urrelocation:
21111 amps or lecx 2
Name (print) : .1 ,J.r /JW. wv _�, , sir, / : - A 201 amps to 400 amps 2
Mailing address: i
401 amps to 600 maps 2
y • , 601 amps to 1000 amps 2
C
City: State: ZIP: t./ / ?. Z j Over 1000 amps or volts -- 2
PhonC :Cf ( ‘, - N 7 f �1rax : .1- E -mail: Reconnect only r _ - ~- r t
•
Owner installation: The installation is being made on property I own Temporaryrrervitm or fcedcnr -
which is not intcndcd for sale, lease, rent, or exchange according to t°olatlanon,alteratioto , orrelocation:
ORS 447, 455, 479, 670, 701- 200 amps or lea _ . _ 2 —
201 amps to 400 amps 2
Owner's signature: _ Date: 401 to 600) amps -- 2
ENGINEER Branch circuits -new, aheration,
N. or eat olden per panel:
- -. A. rcc for branch circuits with purchase of
_ Address: service or feeder (cc, cacti branch circuit _ _ 2
City: State: ZIP: - It. Tee for branch circuits without purchase
of service to fccdtz Ice, fiat btancll circuit: I - � &, J 2
Phone: - -- Fa E-mail: . - --
' additional branch tirenrt:
PLAN REVIEW (Please check all that apply) N1 lsc . (Service or feeder not Included): -
U ierviec over 221 amps.cunnnercial 0 Ilealth -trc Otcility Hach pump or irrigation circle 2
O Nervits over 320 arnps•ratinp of i &2 U Hazardous location Inch sign err r outine lighling,
family dwelling, ❑ Ruilding twcr 10,000 square feet foie or Signal circuits) or a limited energy panel,
U System over busy volts nominal mere nnulunti¢I units ill one structure alteration, or extension' 1 . ... r
? _
U ltviklin over three aerie. ❑healers, 400 amps or more � - -- '
- 1 :_ V %! - / L •G +t E'G C C 1� 1 •V.. 4 •
_.. _.
cu
U Occupant load over 99 persons ❑ Manuf¢utured structures or RV pork Each additional Inspection over the allowable in any o f the above:
U 1%m-sr/lighting plan 0 Other: ._... _ I i I I
•• Pa inspection
Submit _sets of plans with any of the above. investigation fee
The above are not applicable to temporary construction service. Oil= 7 /
�.�.......,T Permit fee $ .12 Li'. ...
Nut all jurisdictions accept credit cards, please call jurisdiction far more ingot-mahout.' Notice: This permit application
❑ Visa 0 tvtaelerc'ard expires if a permit is not obtained Plan review (at _ %) $
Credit card numher: / / within 180 days after it has been State surcharge (8 %) $ ..... 1-.. 7_5__ —
LxD ""d accepted as complete. TOTAL $ -L 1 .) U -_
Name of cardholder as shown un credit Card
S _
- -- -- - Cardholder signahtre .• • • Amount ., 440-4615 (O/DO /COM)
2 ' el 1.L90- 9£L i£OS) - 03 Ot-.I20aT3 apes aisa0 eBZtOT CO LI unC
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 6 ;- AM PM BUP
Location 9135' O"'�' 1 Suite MEC
Contact Person - 1vYLe_Y-4 Ph ( ) 3) -t S 4g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC 3 -0 v 3.
Foundation 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
E Et CTRICrAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Fi ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS ART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line ,
Date /
Approach/Sidewalk _ Z — 0 3 I ns pector �1 �
ADA Dt Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL