Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00499
DEVELOPMENT SERVICES DATE ISSUED: 8/12/03
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 1S125DC
SITE ADDRESS: 07160 SW VENTURA DR
SUBDIVISION: WASHINGTON SQUARE ESTATES ZONING: R-4.5
BLOCK: LOT : 022 JURISDICTION: TIG
Project Description: Installation of (2) branch circuits for bath remodel.
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:
JOHNSTON, MICHAEL R + MARY ELLEN KELSO ELECTRIC INC
7160 SW VENTURA DR 545 SE 3RD
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503 - 785 -8939 Phone: 503 - 648 -6360
Reg #: LAC 116254
SUP 4270s
FEES ELE 34 -433c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/12/03 $53.50
[TAX] 8% State Tax 8/12/03 $4 Rough -in
Elect'I Final
Total $57.78
This Permit is issued subject to the regulations contained 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 i . ' • -8 i 1010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or
1 -:%• 332 -2344.
l- sued By: ? i v. ■ � 1 i /L_. Permit Signature: � ( .5 0
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: `eL DATE:
LICENSE NO: 7 7() S
Call 639 -4175 by 7:00pm for an inspection the next business day
, -- , ei , I
Electrical Permit Application
Rece pati/B iverl Y: /c t;e P -oa Y5
City of Tigard -1-
i est Form Pluming Approve)
Date/By: Sign
permit No..
1 3125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Data/By: Permit No.:
Phone: 503.63 9-41 71 Fax 503-598.1960 ,;4W11... Poil•Rreiew Land Use
• .r, / :, Date/By: case No.:
itit0113et; www.ci.tigard.or.us 6 14..' , A 1 contact
24-hour Inspection Request: 503-639-4175 Nurne/Method: - - - '715 E P
nplemi fia 1n f rine tio n.
' ::,:...::1(PE. OF 1...
ew construction • Demolition
ddinon/alteration/replacement • Other:
iii‘l 0 SCMCG over 225 amps-
commercial
0 Service ova 320 amps-rating of 0 Health facili:y
100 Hazardoks location
A
0 Building over 10,000 squire fat,
. • . .. '''..,; - 4 .- ' - . eks'Iik sraiNS ' 9 ‘ . . t :."./. er' 1 5c2 tbmily dwellings four or rnore residential units in
7.1 1 & 2-Family dwelling - Commercial/Industrial 0 Sysem over GOO volts nominal one amain
IQ Building over three s mp or
tones Ei Feeders, 400 a more
• Accessory Building E Multi-Family El Occupant load over 99 persons Manufactured structuns or RV puck
0 Master Builder E Other: 0 Egress/lighting plan 0 Other
.'.10B SITE INFORMATION 'atid 'COCATION.1'. '.! l..1., Submit acts of plans with any of the above.
The above are not applicable to temporary construction iorilce.
Job site address: 1444G Su ) U lArctEr A_‘)._, , ','=1' '',.:'... 0 :::' "..PEEtleMEEDULE'.:;. . ',:;f:V.''
Suite #. r !La 0 Bldg./Apt.#: Number of inspections per permit allowed .
Project Name: _INA, iykszt--e3rN Description Qty 14e (as.) I Total
New raltiontlakingle or multi-family por
Cross street/Directions to job site: dwelling unit. laiktdes attacked garage-
Service included:
1000 Sq. it or IC59 145.15 4
Rath additional 30 sa.fi, or roman thpoot 33.40 1
Limited energy, residential . 75.00 I 2
subdrvision: I Lot #: Limited energy. non residential 75.00 .. 2
Tax map/parcel #: • Each mundactured borne or modular dwelling
ce rftuir 90.90 2
4- ' Servica or feeders - inetullation,
„ay ..asit......1 - • Li __• _ alteration or relocation:
200 amen or less 80.30 ' 2
201 smvs to 403 ernes :06.85 2
PROP 401 un — te k°111 0 2
• ;ERTr ils./Pi t .1:1 .i., t -r. # 1.P. I .. 1 :- :; ; I ' ' FTI..!'" - 601 "2810 1000 1 I M g 240 2
#
me Infil ei. ,a, .0 2_4 ma ILLI Flle.f. over 1000 &rim or volts
Reconnect oniv 66.85 414,65
2
2
Address: q n ja- Temporary servlas or feeders • Installation,
alteration, or relocation:
City/State/Zip: 200 amps or less 66.85 I
Phone: Fax: 201 ems to 400 antes 100.30 2
133.75 2
.iD APP.LICA1Yr ;V .,:i;:-,; i-:...4:....i....DiCONTACTIPERSON.?40-t..:.:4 41 WS MPS
Branch circuits - new, alteration, or
Name: extension per panel:
A. Fce for brim% *culla wth purchme of
Address: service or feeder fbe,sach trench circuit 6.65 1
City/State/Zip: a. Fos Air branch circuits without purcluiso of 4
service DI foldtr (ee. Ent brinch cirCuit 1 46.85 110 - 2
Phone: _ Fax: Each additional branch cirouit _j 6,65 (n- (t9S i 2
E-mail: Misc.(Servior err feeder not included):
-.; . : •--. .- ; 1; " :L. , :t . it: ; ;" 4 ;;'::;,.;:' .! ; ; ::;):! Li;*:;''I'.!'.' ' T:'! Pack Puma or imgarlon circle 53 40 2
_ Each sir or outline lishti5e 53.40 _ 2
Job N ■ ....--_ . Signal oircelr(s) or a limited energy panel,
4spawanglsgi.____ • 2
Business Name: afroMFalIM k I _._...____.... 75.
Address: 5 5 j_ 5. 12... gz-- .
cit 16414,0 9 7 ,25 Each additional Inspection over the allowable in any of the above:
-
Per i ver,.dcm (Der hour • min I howl i ' stso
Phone: to eig — Do-ipz) Fax: kricadeadon tcc:
CCB Lic. #: Lic. #: other: 1,
1 !:■ 1 ...-. ":' i ::7 Hi - .7 - ;'17.1 . eititeM i iiiiiiirr ' ••■■.' :) '''''',
i
Supervising electncian iso..
Subtotal i $
si.l..tureresuir• .: riv•---.4",..—(6-- "— I . Plan Tteview (25% of Permit Fee) $
Print Name: imarammirimi . ste, Sursihance (8% of Perrnit Fee) 5 4. o
TOTAL PERMIT FEE S 6 72
A.uthbrizied Notice This permit application expires If. permit is not obtained within
Signature: Date: 30 der attar It has been accepted as ansiplete.
*Foe methodology tot by Tri Building Industry Service Board.
(Please print name)
T00 Z MOIL AO ALIO 098198CC0 S ),VA fT:tT 2002/92'90
CITY OF TIGARD . 24 -Hour- -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION • , Business Line: (503) 639 -4171 MST
BUP
Received Date Request,d 9 1 AM ' ' PM BUP
Location 7/ (D 5t ) V Suite MEC
c
Contact Person P, (_.d,(. • - :.r .. ,..( ) PLM
Contractor - VfiJ4{) - Ph ( 5 ) /D _ �0_1b SWR //ll L�
BUILDING Tena �,1 ! 11 14.-- ELC 3 - w �"
�� ,- .�
Foating ,.
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: / 7. �� SIT
Post & Bea y� �1�2C. (/ K
M. wt0
Sh ar Anc ors
E heat Shear
Int heat Shear
Fra ing
Insu do
D II ailing -
Firew Il
Fire S i•inkler
Fire Al m
Suspd iling
Roof '1
• •i
.1, 1-- • AR FAIL
PLUMBING
I
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains .'
Catch Basin / Manhole \\\\J
Storm Drain -
Shower Pan
Other:
Final
\,
PASS PART FAIL •
MECHANICAL
Post & Beam
Rough -In
Gas Line .
Smoke Dampers -
Final
FAIL
Service
Rough -In
UG /Slab
Low Voltage
Fi rm
4,00,' PART FAIL El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA �?�
Approach /Sidewalk Date q I I V ( () 3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL