Permit CJTY OF TIGA13.6. ELECTRICAL PERMIT
PERMIT #: ELC2003 -00113
� I� DEVELOPMENT SERVICES DATE ISSUED: 3/7/03
13125 SW Hall Blvd., Tistard. OR 97223 (503) 639 -4171 PARCEL: 1S135BD -01100
SITE ADDRESS: 09780 SW SHADY LN 200 ZONING: C -G
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Job #2000 -58: Install 1 branch circuit in second floor room.
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:
LEWIS, GLORIA M + BRIGHT SIDE ELECTRIC
LEWIS, GLORIA M TRUSTEE + PO BOX 930
LEWIS, ANDREW M ET AL CARLTON, OR 97111
PORTLAND, OR 97225
Phone: Phone: 503 - 852 -7900
Reg #: LIC 153860
ELE 36 -110C
FEES SUP 3863S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 3/7/03 $46.85
[TAX] 8% State Tax 3/7/03 $3.75 Rough -
Elect'l Final
Total $50.60
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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246-6699 or 1 800-3 -2344.
Issued By: /� ` 1
� / •`J LevrAJ( Gc,� V Pe rmit Signature: I
Y aA 9 /1" /. f _ ! _ . . _. . i.
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: R63S
Call 639 -4175 by 7:00pm for an.inspection the next business day
•
•
• 3!3/2002 19:15 5038529573 BRIGHTSIDE PAGE 01
Electrical PermitApplication
Fi . EC GI V E D ator ecee;ved :3 — 7-03 Petmitno.:4c- 03 -0 //
_;j;l ai City of Tigard • Pfoject/appl.no.: Expire ate:
City of Tigard Address: 13125 SW Hall Blvd, Ti O 7 • Datcissued: B I Recciptno.:
Phone: (503) 639.4171 MAK • 3 �3 Pa
Fax: (503) 598 -1960 Case file no.: ARD Payment
• CITY OF TIG
Land use approval: RI III DING DIVISION •
TYPE OF PERMIT
Cl 1 & 2 family dwelling or accessory r' Commcrcial/industrial 0 Multi- family 0 Tenant improvement
0 New construction O Addition /alteration/replacement • 0 Other. ❑ Partial •
JOB SITE INFORMATION
Job address: 9 T) u) Sfz .D IC Bldg. no.: Suite no.: Tax map/tax lot/account no.:
Lot: I Block: ISubdtvisi n:
Project name: • J Descriiptidn and location of work on ONE ae,Mxe V C/CT- A'S F vQ.
. Estimated date of co . • letion/ n . don: • • . • R
CONTRACTOR APPLICATION FEE SCHEDULE • Fee . Max no: 1910120 – S I • • - .an Qty. Fee . Total no. ansp
Business name: zRfC,1lS E�e x/�'-- • N ewnaideatlal- leo,r pa
' Address: po, goye 930 dweIrmgtmit.indadcsr edgaage.
City: < . % 0/3 State: / 4 ZIP: 97// / ser.iceindndeIb 4
Phone: -033 isa, n0 j Fax:' 03 - 5 -- E-mail: 1000 sq. ft or less •
Each additional 500 sq. ft. or portion thereof
CCB•no.: L 860 i l=ire. bus. lie. no: / —ieO C - timited 2
Ci /metro , c. n .: _ ' /O O/- O Limited energy. non- tsrdential 2
' , /WPM , WT,Mf • • . • 3-03 -� ' Each mangy home or modular dwelling " -
2
`nd/pv
Signature of supetvisin • electrician (required • Dater ;� - Service a ntVor feeder d eta— ierstallatlon,
Sup elect me na (print): c .4., r` u+ License no-3 K alteration vrreloeation: • • • •
PROPERTY OWNER 200 amps or less 2
•
201 amps to 400 amps 2
Name (print): 401 amps to 600 amps ' 2
Mailing address: _ 601 amps to 1000 amps • 2
City: I State:' . j ZIP: Over 1000 amps or volts _ 2
Phone: • IFax: I &mail: Reconnect only _ i T
Owner installation: The installation is being made on property I own Temporary services or feeders -
installation, alteration, or reloeatiotu
which is not intended for sale, lease, rent, or exchange according to 200 amps orless 2
ORS 447, 455, 479.670, 701. - tot amps to 400 amps 2
Owner's signature: Date: 401 to 600 am El , 2
Bt neh el malts - new, alteration, .
or extension per panel:
Narne: A. Fee for branch circuits with purchase of
Address: service or feeder icc. each blanch circuit 2
City: J State: I ZIP: B. Fee for branch circuits without purchase ` � - 2
E -mail: of service or feeder fee, first branch circuit
Phone: Each additional branch citeuit:
Misc. (Service ar feeder not included):
Each pumper rriga circle 2
O Service ove amps-commercial . O Health••care or outline lighting 2
0 Service over 320 amps- rating of 1 &2 0 Hazardous location Signal the �hRip o ut a limited energy panel,
family dwellings 0 Building over 10,000 equate feet four or gna 2
0 System over 600 volts nominal more residential units in one structure alterat or extension*
0 Building over three stories . 0 Feeders. 400 amps or more •Deserlption
0 Occupant load over 99 pawns 0 Manufactured structures or RV park " Each additional inspection over the allowable In any atilt above:
0 Egress/lightingplan ❑ Other: . Per ins •om
•• •• • • . • - -- Submit ! sets of plans with stay of the above. ... :, • Invesdgatioefee
• The above are not applicable to temporary construction service. • Other • . • • - _ .. . _ - ... _ . _ . . — P f ee ��� ��
Not all Jurisdiction accept aedit cards, please call J iro for mate infonnadoo. Notice: This permit application ltcation • .. Plan review (at ^ %) $
a Visa --• • e MaatnrCard expires if a permit is not obtained
Credit ems number: --1.--/---_ — days a
w ithin 180 dfter it has been State surcharge (8%) ....S
L'' _� /� 0s accepted as complete. TOTAL $
Nwne er cardholder as shown on reedit cord $
Cardholder signature Amount 440.1615 (6103/03M)
•
CITY OF TIQ.ARQ 24-Hour
BUILDING 1 Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Eine: (503) 639 -4171
0-- 3 BUP
Received o Date Requested 3 l C AM PM BUP
Location C1 b Suite 20 6 MEC
Contact Person Ph( ) g5;7-. "79ea PLM
Contractor Ph (( ) SWR
BUILDING Tena Owner ELC 3 -060 l /3
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: - SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear L� E J — S
Framing T" �S. ' Q
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL ( v im
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
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS PART FAIL
SITE ' Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line /
ADA
Approach/Sidewalk Date ! o `� 013 Inspecto /� . • - I. -..� / �i�Ext
Other:
Final DO NOT REMOVE this inspection record from the job = te.
PASS PART FAIL