Permit / CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00071
c l � DEVELOPMENT SERVICES DATE ISSUED: 2/9/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S125DB-01600
SITE ADDRESS: 07120 SW TAYLORS FERRY RD
SUBDIVISION: SHADY DELL ZONING: R
BLOCK: LOT : 016 JURISDICTION: TIG
Project Description: 200 serv. replacement.
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: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
TEHRAN!, KAZEM + DIA NE WEST SIDE ELECTRIC CO INC
7120 SWTAYLORS FERRY RD 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 892 -9329 Phone: 503 - 231 -1548
Reg #: LIC 13306
SUP 4654S
FEES ELE 26 -135c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/9/2005 $75.00
[TAX] S% State Surcharge 2/9/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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: � ��.. Permit Signature: OYL
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
,, ivy,®
ll.lrical�L °d'> App lication
P ><]na
, 1FOR OFFICE. USKONI.A' 11
Cify of Tigard FEB 9 2005 xaceived
Date/13 :1 -
13125 SW Hall Blvd., Tigard, OR 97223 — tom S Permit No. C. 4 , . —0,9 OW
Phone: 503.639 -4171 pxv L:IT,3i18.0.1(RD b t p Plan Review
(`a t t { a l } lly rt11 nfe/B Permit: Inspection Line: 503,6'39.417 �+ ,.' I� R, Y Other If tem W WW- Ci.ti> fd or- l G DIVISION - Dale Rcady/By: Suni,: l3 Sec Page 2 for
_ NotiFied/Menrod 77/ r t Supplomunlnl Informat:pn
TYPE OF WO JIC • PLAN 1U V1EW
- New construction Addition/alteration/replacement Please check all that apply:
❑Service over 225 amps, comml ❑Flazurdous location
❑ Demolition ❑ Other:
❑Service over 320 amps — rating ['Bulldog over 10,000 sq. fl.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
1- and 2- family dwelling ❑Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal unir: in one structure
Multi- £atoll ❑Building over three stories ❑'ceders
y _ ❑ Master builder ❑ Other:
1011 SITE INFORMATION ANA • LOCATION ❑Occupant load over 99 persons ❑Manufactured , 400 amps or more
sn•ucwre-s or
❑ Egress/lighting plan RV park
Job n0.: ���' t1 Health -care facility ❑Prher:
J J.,_ �� Job site address: ❑ y
S Z sets of plans
City /State /ZIP: 11 (i 7 — with any of the above.
i _^
The above are not applicable to temporal construction service,
Suite/bldg. /apt. no.; {Project name: ( � ' r 1 FEE* SCHEDULE V^
V" s' I ( Li j, i nea<r[nlon Qty. I , Totnt
Cross street/directions to job site: New resid single- Or multi- family dwelling unit,
_ -- "" -- Includes Attn garage,
- -.._. _ __ l ,000 sq. t1, or less � 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map/parcel no.:
Limited energy, residential _ 75,00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular -
, �/`�n ( / dwelling, service and /or feeder 90.90 2
(4 �, �� J ��� ,-,x-\ U' 4� , r` -G "' Services or feeders installation, alteration, and relocation
200 amps or less 80.30 2 i ll
❑ PROPERTY OWNER J 0 TENANT 201 amps to 400 amps 106,85 2
Name: 401 amps to 600 amps — 160.60 2
c t \' !, � -. \. l r' , t v. l • 601 a to 1,000 amps 240.60 2
Address: y 1 l, .1., L Over 1,000 amps or volts 454' 2
. V _ - . P -^ _
City/State/ZIP: ` I r
Reconnect only - 66,85 2
t•ti CA. Temporary services or feeders instnilatlon, alteration, and/or
Phone: (f - ) , e f 2 _ C 1 T < C% Fa ( )
relocation Y
200 amps or leis 66.85 I
Ovvner ins lation: 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
0 APPLICANT • Q 'COr [ACT PERSON. ' A. Fee for branch circuits with
service Or feeder fcc, each
Business name: branch circuit 6:65 2
Contact name: B. Fee for branch circuits
R wit/wa[ service or feeder fee, 46,$5 2
Address: each brunch circuit
Each add'1 branch circuit Ili 6,65 2
Clty /Stnze/ZIP: Miscellaneous (Service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle L 53 ;40 2
-� Sign or outline lighting 53.40 2
Iv -mall. Signal circuit(s) or limited•
CONTRACTOR . energy panel, alteration, or
Business name; WEST SIDE ELECTRIC CO. extension Describe: Page 2 2
Address: 1534 SE 8 AVE. Each additional inspection over allowable in any of the above
- I'er inspection 62:50
City /State/ZIP: PORTLAND, OR 97214 N 6wtstigntion per hour (I la min) , 62:50 — T.. -
Phone: (503) 231 -1548 Fax: (503) 736 -0677 Industrial plant per hour 73.75 '
__.._ ELECTRICAL PERMIT FEES* CCB Lie.: /3306 Electrical Li - 26 -135C Suprv. Lic,:Zf q4 't) s Subtotal 9/19 2.i Suprv, Electrician signature, required: � /. � (L�� Plan review (25% of permit fee) (C2 , L Z
Print name: V._ r� Date:
State s (8% of permit fee);
l L Q � ,/' S TOTAL PER1Krr FEE �J
Authorized signature: ��� ??
This permit application explrea Ir permit is not obtained within ta0
g'i'ft name: days after It has hecn accepted ae complete
Dote: • Fee methodology set by 7 `ri - Cully building Industry Sorvite Board
' °Y Number Of inspectionx par permit allowed.
i:BBuilding rrmh4ALC.PermIt.App.dne 12/03 4a0 4615r( t0 /OJCOM/Warl
2' LL90 -9EL CEOS) •00 o>;..11oai3 ants Zsapl dLO:2T SO GO qa3
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) •> 9 -4175
INSPECTION DIVISION Business Line: (503 ,•39 -4171 MST
BUP
Received Date Requested / I . PM BUP
Location D- Suite MEC
Contact Person 46, Ph PLM
Contractor -1-) f Ph ( ) 2-- 9- -V SWR
BUILDING Tenant/Owner ELC 07005 -"ODO 7
Footing
,., ELC
Foundation
Ftg Drain Access: ~� °�°-/ I 7-0 ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear /
Framing A t 4��L . 1 7,Q, l_I At 6i'4 .( S :LW 4�
Insulation n ,�
Drywall Nailing v r L k//
Fi rewall
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
El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
AS PART FAIL
E . 0 Please call for reinspection RE: E] Unable to inspect — no access
Fire Supply Line �---
ADA 7 - /f
Approach/Sidewalk Date / Inspector ` Ext
Other:
Final DO NOT REMOVE this inspection record - one the Job site.
PASS PART FAIL