Permit „CITY OF TIGARD ELECTRICAL PERMIT
k;11 � y PERMIT #: ELC2004 -00251
"1111 DEVELOPMENT SERVICES DATE ISSUED: 5/11/2004
.,� �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S111 DD -04500
SITE ADDRESS: 15755 SW STRATFORD LP
SUBDIVISION: STRATFORD ZONING: R -4.5
BLOCK: LOT : 013 JURISDICTION: TIG
Project Description: (2) branch circuits.
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:
BETTENCOURT, ROSA HILLSBORO ELECTRIC
15755 SW STRATFORD 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97224 HILLSBORO, OR 97124
Phone: 503 - 598 -9385 Phone: 503 - 439 -9666
Reg #: ELE 34 -4399C
LIC 134481
FEES SUP 4941S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/11/2004 $53.50
[TAX] 8% State Surcharge 5/11/2004 $4 Rough -
Elect'I Final
Total $57.78
This Permit is issued subject to the regulations co ntained 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: 1 .A.. Permit Signature: F' _
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: ' W
Call 639 -4175 by 7:00pm for an inspection the next business day
From:HILLSBORO ELECTRIC LLC. 5036013680 05/11/2004 11:08 #763 P.001
R
•
E ecthcal Permit A lies t• FOR of uicr tiSr ONLY
sty' � � Received ) •
City of Tigard Date/13 , -/ d s • Permit Ne,Ar C420 — t90o1S�
13125 SW Hall Blvd, Tigard, OR 97213 . t t ., a . , Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 r r ' t F p 1� A :�t. Date/Bv: Other Permit: .
inspection Line: 503.639.4175 ' _,t; - `''__� Date Ready /By: /aria: El Sec Page z for
Y �'
Internet; www,ci,tigard.or.uS - �� Notified/Method: Supplemental Information
N ew construction
• .. _.:,.. - TY 1 y ) - § PLAN .REVIEW
P l e ase c heck all that n l
❑ .� Addition/a ter ation/replaccmcnt pp y'
[7] Demolition ❑ Colter, ['Service over 225 amps, comm 0I-lazardous location .
❑Service over 320 amps — rating ❑ Buildng over 10.000 sq. ft..
' '.CATiEGORY. OP:' CONSTRUCTION:; •, ,. ,;;:: " '' . .: of 1 and 2 family dwellings 4 or more new residential
,.t•1- and 2- family dwelling ['Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories [Weeders, 400 amps or more
❑ Multi family ❑ Master builder 0 Other: ark ['Occupant load over 99 persons ❑Manufactured structures or
:' ":: : .. JOB SITE 1N.FORMATION� IO .• " ;::, "::::.�'.; :'; • ❑B6�ress/I(ghting 1W p
r ❑Health - care facility ❑Other:
Job no.: S7Cl ■.f I Job site address: Si _ s c C � S � �� b � • Submit 2 sets of pla ns with any of the above. •
City/State/ZIP: \ x c, C t-, Pee _, J 0 • e f 1' ---1 ' ."� ) Total I Li The above are not applicable to temporary construction service. .
" ..FEE" SCNEDUL E
Suite /bldg. /apt, no P ro j ect e: \ ' � ,N c_0.4, � '}— 'Deft I Qtr. I Foe. P :` .' „'�
` .•
nam �� T'4 < 1.
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'/ 500 sq. R or portion . 33.40 I
• Limited energy, residential 75.00 2
Tax map/parcel no.:
.......;, . ;i.: ..::: :• ::. DESCRIPTION' OF WORfC';t_° In:•t ::''..::::5; ? :'i'.: .
e non-residential 75.00 2
„ Limited nerby, non rest enna
. , - .. Each manufactured or modular
. dwellin service and/or feeder 90.90 2
, Services or feeders installation. alteration, and/or relocation
• 200 amps or less 80.30 2
::, : ;.: - ., .... ;... :,.i. ;:,;..;,:.. r: s: -:.l: :i::a! . ;..,'. 201 amps so 400 am 106.85 2
❑:;PROPEeTY AWNER - ": e]: :;j: ;r . .•. ; .. .P4Ii lV1`::;r( ::
�:.,,.� +:: ., . 401 600 2
amps to amps 160.60
Name: . 0 S A u 4. vo c . i - t_. 2._ <) C Qtuf 601 amps to 1,000 amps • 240.60 2
Address: • Over 1.000 amps or volts 454.65 2
'" Reconnect only 66.85 2
City /State/ZIP: S "0 L t)' Temporary services or feeders installation. alteration, and /or
Phone: (' jt,�) 5
C — G 1 �j 5 I F ( ) ` elocstion
J 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps • — 133.75 2 -
Owner signature: - Date: Branch circuits — new, alteration, or extension, per panel
7.:- . • •• • P • " ";.:.:,`•::;:: . Fe for branch circuits will: ..,-. : . : ❑:�,APPL[CANT.:.' :::�:; . : . ”' � �:.:::�' •:. : ': ❑� �COFiTACT PERSONS •
„ A fed each 'service or feeder fee, sac 6.65 • 2
Business name: branch circuit
•
B. Fee for branch circuits
Contact name: • wllla,uI service or feeder fee, •
each branch circuit 1 46.85 U l k, 2
Address:
each add'/ branch circuit I 6 .65_ 6105 2
City / State/ZIP: • Miscellaneous (service or feeder not included)
•
Phone: ( ) I Fax:: ( ) Pump or irrigation circle 53.40 2
• Sign or outline lighting 53.40 , 2
E -mail: Signal circuit(s) or limited-
••••••••••:',-:.: ,;; :.:i•...a, :• •;:: :••• :'.'.• CONTRACTOR • _ ,, .... .. .., . . . "4: energy panel, alteration, or
B extension. Describe: Page 2 2
Business name:
Hillsboro Electric L.L.C. -
Address: 21185 NW Evergreen PKWY Ste #11 0 Each additional inspection over allowable in any of the above
Per inspection 62.50 .
City / State/ZIP: Hillsboro, OR. 97124 Investigation per hour (I hr min) 62.50 _
Phone, (5 0 3) 439-9666 . Fax: (5 0 3) 6 01- 3 6 8 0 Industrial plant per hour '7335
:. ^ ELECTRICAL `PERMIT FEES, •- `::: • •:'
CCB Lic.:1 34481 Electrical Lic.:3 4 4 9 9 C Suprv. Lie.: 4941 S • Subtotal S, IS 0
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) y, D/
Print name: Joey itacco Date: ,
TOTAL PERMIT FEF
Authorized signature: • This permit application expires Ira permit is not obtained within 150
days after It has been accepted as complete
Print name: . Date: • Fee mcthodoloEu set by Tri- County Building Industry Service Board
" Number of inspections par permit allowed.
i:\BuiidinyParmits\2LC -Penni .dec 12/03 44n- 4(13T(10/0 /COM/wae
CITY OF TIGARD 24 -Hour • ZD
BUILDING Inspection Llne: '( 0 3) 139 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
— 7
BUP
Q�
Received D at Requeste / — " AM PM BUP
/ S 5 '
Location :� �- - /��� S u it e — .� MEC
Contact Person Ph ( ) g / - $S PLM
Contractor Ph ( ) SWR rr��
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors i �
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL , L+ �
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 I V
Low Voltage
Fire Alarm
(Om ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
ITe ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA r�n n �f� Q 1 S
Approach/Sidewalk Date Inspector v A� ► 8 V., Ext
Other:
Final O NOT R MOVE this Inspection record from the job site.
PASS PART FAIL