Permit ELECTRICAL PERMIT
•
� � �� OF TIGARD
DATE ISSUED: 05/16/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223011199 (503 mun'«�r�
' PARCEL: 23103CD-04700
SITE ADDRESS...: 11645 SW TERRACE TRAILS DR
SUBDIVISION ^ TERRACE TRAILS ZONING:R-4.5
BLOCK ^ LOT ^15
Project Description: Installing one branch circuit.
_____
---RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- MISCELLANEOUS
1000 SF OR LESS ~ 0 0 — 200 amp ~ 0 PUMP/IRRIGATION ~ 0
EACH ADD'L 500SF...: 0 201 — 400 amp ^ 0 SIGN/OUT LINE LTG..: 0
LIMITED ENERGY : 0 401 — 600 amp ^ 0 SIGNAL/PANEL ^ 0
MANF. HM/ SVC/FDR..: 0 601+amps-1000 volts.: 0 MINOR LABEL (10)...: 0
----SERVICE/FEEDER---- ----BRANCH CIRCUITS ---ADD'L INSPECTIONS---
0 — 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION • 0
201 — 400 amp ^ 0 1st W/O SRVC OR FDR. : 1 PER HOUR...........: 0
401 — 600 amp ^ 0 EA ADD'L BRNCH CIRC: 0 IN PLANT ^ 0
601 — 1000 amp ^ 0 — PLAN REVIEW SECTION —
1000+ amp/volt : 0 >=4 RES UNITS ^ > 600 VOLT NOMINAL..:
Reconnect only ^ 0 SVC/FDR >= 225 AMPS..: CLASS AREA/SPEC OCC.:
Owner: — FEES ----- ------
WAYNE SEDGWICK type amount by date recpt
11645 SW TERRACE TRIALS DR PRMT $ 35.00 CJS 05/16/96 96-279493
5PCT $ 1.75 CJS 05/16/96 96-279493
TIGARD OR 97223
Phone #: 503-620-9694
Contractor: —
SERVICE NOW OF OREGON $ 36.75 TOTAL
615 RAILROAD AVE
REQUIRED INSPECTIONS
OREGON CITY OR 97045 Wall Cover Elect'l Final
Phone #: 503-655-7558 Elect'l Service
Reg #..: 87788 •
This permit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Permittee Signature
applicable' laws. All work will be done in accordance with
approved plaos. This peroit will expire if work is not started
within 180 days of issuance, or if work is suspended for more
than 180 days. Issued By �.
------ 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: n� ` » DATE: �5- �c-q6
//
LICENSE NO:
Call for inspection — 639-4175
•
'.
Community Development ELECTRICAL PERMIT APPL1CAT!!"
z
SW Hall Blvd.
Tigard OR 97223 Permit # gc - rl 4 13125
� Date Issued ,6 sc �. --• -_- --
• II Phone (503) 6394171
'-'"° FAX (503) 684 -7297 •
CITY OF TIGARD TDD No. (503) 684. 2
Inspection (503) 639 -4175 •
1. Job Address: 4. Complete Fee Schedule Palevtr: u..
Name of Development _ Number of Inspections por forma GL'v.w'.:! r
Address ) 1 Cr) yS . 5tA.) T -evvcs c - Try.: IS J,)r Service included: Items Cost(ea) Si:
CitylStatelZipS 1 rr' ? 0 IZ `1 22 3 _� 4a. Residential -par unit
�� �" q 1000 sq. ft. or less 5110.00 _
here .
Name (or name of business) S e( Cl_' c e. , Vt)G JA-e.- Each addition/3i 500 eq. ft. or (J �( portion thereof $25,00
Commercial Q Residential 7"C Limited Energy 525.00 - t
Each Manure Home or Modular
2a. Contractor installation only: c.vest, d tee, r,ce iii FtltlYPY
4b. Services or Feeders
Inatallailon, alteration, or relocation
Electrical Contractor U`sc. e_ 4)nt.) ,Z H o 200 amps or toss $50.00 2
Address c y-.0 c oC Pro-e- 201 amps to aoo amps g$5 " !
City (7 c e ,n , C ; -J- State Zip 9 7 ,4 401 amps lo 600 amps .....
Phone No. 5 lj p 3 r s p U 601 amps to 1000 amps $t.'0,r� _�„__,____
:•r:.
S 2 �� ovor 1000 Sro ?s a Vo lta $ • __._._ ___._.._
Job NO, Reconnactonly W � wan _•,� -.___ -
contractor's license N0, ac. Temporary Services cr Fc ^:'ors
Contractor's Board Reg. No_ C- 11. 0 19 installation, alteration, or relocnuon
Signature of Supr. Elec'n ��. 14) I,ti. (, -c r S se _ 200 amps or less
- ------- _
License No. r` SL tia_ Phone No./2.1c2-2__ 201 arnps 10 400 omp. 8541.07
401 amps to 600 amps _ _ _ _ 575.4.1
Over 600 amps to 1000 volt: 3100.00 ----- -
2b. For owner installations: see "b" above.
Print Owner's Name 40 Branch Circuits
. Naw, a or extens per pane
Address . a) The tee for branch circuits with
purchase or service or louder fee. `
City State Zip Each brantn Circuit 56,00
Phone No. _ _ b) The tee for branch clrcuhs _ _ without ?
The installation is being made on property I own which is purchase of Service or feeder rue. _
Firs branch circuit I $55.00 3 S . O Q
not intended for sale, lease or rent. Each eddittonai branch circuit 55.00
Owner's Signature 4e. Miscellaneous
(Service or feeder not included) , 2
3. Plan Review section (if required): _ :v; >; :.Ir= „t:0.:
Each sign or outline lighting 540.00 _ _`
5rgnal clrcuh(e) or a limited energy 2
Please check appropriate item and enter fee in section 513. panel. alteration or extension $40.00
4 or more residential units in one Structure Sklar Labels (10) 5100.00
Service and feeder 225 amps or more
System over 600 volt nominal 4f. Each additional inspection over
•
Classified area or structure containing special occupancy the e110wahla in any of the zy�vs •
- as described In N.E.C. Chapter 5 Per Ins - l'.35.(.10 _ --
Per hour _.- ; , - ---- -- .......
In Plant :
Submit 2 sets of plans with application where any Of the above - __ _
apply. Not required for temporary construction services. 5. Fees:
53. Enter total of above fees 1; 3 S• UQ
,_:1 _ •
NOTICE 5% Surcharge (.05 X total fees) g
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Sue 3--(e..,..2
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter r 2 5%
of Ilse A fer
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Revvi ew if required (Soc_3)
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS S __- __. -__ -_
COMMENCED. ward■tornar a.c• LI Trust Account 9b
prm.mo .
Balance Due 5 3c. 25-
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 9/i AM PM BLD
Location / 7F trace ( / Suite MEC
Contact Person Way n e Sete uJ Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC / t " O3 J
Retaining Wall ELR
Footing Access:
Foundation ` FPS
Ftg Drain (
Crawl Drain Inspection Notes:
SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING -
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
CCM
PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL D NOT REMOVE this inspection record from the job site.