Permit •
J ITY OF TIGARD ELECTRICAL PERMIT
ii: PERMIT #: ELC2004 -00210
rl DEVELOPMENT SERVICES DATE ISSUED: 4/23/2004
..,1,1- I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S125DD-02200
SITE ADDRESS: 06965 SW VENTURA DR
SUBDIVISION: WASHINGTON SQUARE ESTATES ZONING: R -4.5
BLOCK: LOT : 013 JURISDICTION: TIG
Project Description: (2) branch circuits for a/c & plug.
Job No. 2612
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:
BAIRD, TOM HILLSBORO ELECTRIC
6965 SW VENTURA DR 21185 NW EVERGREEN PARKWAY
TIGARD, OR 97223 HILLSBORO, OR 97124
Phone: Phone: 503 - 439 - 9666
Reg #: ELE 34 -4399C
LIC 134481
FEES SUP 4941S
Description Date Amount
Required Inspections .
[ELPRMT] ELC Permit 4/23/2004 $53.50
[TAX] 8% State Surcharge 4/23/2004 $4 Rough -
Elect'l 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 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 -0699
C
2 -2344. -
Issued P ermit Signature /
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
4
SIGNATURE OF SUPR. ELEC'N: /1 - .l, AM 'erJ--c—_ DATE:
LICENSE NO: d l i l F T s
Call 639 -4175 by 7:00pm for an inspection the next business day
r :HILLSBORO ELECTRIC LLC. 5036013680 04/21/2004 16:22 4595 P.002
- - ir -\•---, . . .
Electrical Permit Applieaticie ' FOR OFFIU.E 1S.,1 ONI.1'
\\_-;? ',c - \:...---,1 •
\\ \---
City of Tigard . 1qPi Rc=iv.cs 4. pe oef L31111111 Permit o.: -
N6 Pie
Date/I3v:
13125 SW Hall Blvd., Tigard, OR 97223 . . -, , , '.. Plan Review
Phone; 501639.4171 Fax: 503.598.1960 - .• ' ..., N:7\:‘, 't Dete/Bv: Other Permit: .
Inspection Line: 503.6394175 --7'. - r, ,:... - ,4241 - 1 i ' Date Ready/Sy: 1P;1011 El See Page 2 for
Internet: www.ci.tigtrd.or:us c'c':: \ I .- ,-\\\: \''S Notified/Method: Supplement: Information
..-:.:' '', ;: :;!.';::. .':'....,...•! ..': . ::' -... ... ':.::::.;: fSCieeti
WORK •:::::•: :'..j.: ••••••.::....:....,,:......•..: -:i.. .: REVIEW . ::: .i, .......,1; ..,'.,....,.: ...
0 New construction Addition/alteration/replacement . Please check all that apply:
• ['Service over 225 amps, comml °Hazardous location
0 Demolition Other:
. ,-- IDService over 320 amps - rating OBuildng over 10,000 sq. ft.,
• • - .,::.• .:-.. : : ,. ,:.• • ..•:.' '..- ..:.• .•':. :. • tATEGORY. OF CONSTRUCTION E•':',:.:1,:.; oft- and 2 dwellings 4 or more new residential
. 1 - and 2-family dwelling 0 Commercial/industrial 0 Accessory building
t
Multi-family 0 Master builder 0 Other ['System over 600 volts nominal units in one structure
DBuilding over three stories ['Feeders, 400 amps or more
['Occupant on over 99 persons 0Manufactured structures or
. . . - .. . . . .
..... - . .:;•.:._:..:::.... 4 ... :-''' ,..'..,;?:.
JOB SITE. iN.FOIIMATioN ['Egress/light ng plan RV park
Job no.:7 L q Job site address: ( oCy".5" 1 \ tinlAr2k OHealth-cere faCiliry • 00ther
Submit. 2 sets of plans with any of the above. '
City/StateJZIP: 11A,.--14 (1) 6117/7-• The above are not applicable to temporary construction service.
% .. . ,...',.,.:.c.::.:•!;;':.,..,:•,,:,:').,!,;;;,:•:-.:i".....EE,';:,::::'.;:':'-','!•:`•-i:.':::•-
Suite/bldg./apt. no.: Project naMenVyi I y
F ..SCHEDITLE ,,:; .
Description ' Qty. I Pee. I Tout ••
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. addl 500 sq. it or portion 33.40 I
Limited energy, residential 75.00 2
Tax map/parcel no.: '
Limited energy, non-residential 75.00 2
.• OP W.OkS: ::::- Each manufactured or modular
dwelling, service and/or feeder 90.90 2
i i 7 ., - : ' AI • .4 A. i - a .1 I / A.1- Services or feeders installation, alteradon, nd/or relocatio
200 amps or less 80.30 2
:.' :'•,:' , ''::•"•::,.':;';.•:i;:, 201 amps to 400 amps 106,85 . 2
'.)&- I : • • 601 amps to 1,000 amps . 401 amps to 600 amps
160.60
• 240.60 2
Name: N1a 4 i 1 1.
2
Address: • Over 1,000 amps or volts 454.65 2
- • Reconnect only 66.85 2
City/State/ZIP: • Temporary services or feeders installation, alteration, and/o
relocation
Phone: ( ) Fax;( ) ,
200 amps or less 66.85 . 1 •
Owner Installation: This installation is being made on property that 1 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
_1
Owner signature: Date: Branch circuits- new, alterntiOn, or extension, per panel
A.
.:'::•••:'::'•::.=•;•:-.:•:;',:•:;').. El .:APPLI .. 0j4iTAL‘T . :) ) iii,SC)1•1 : :!i:.;::;;;!:;:: Fee for branch circuits with .
service or feeder fee, each
. 6.65 • 2
Business name:
4-. •
- branch circuit
/
B. Fee for branch circuits
Contact name: • without service or feeder fee. k 4685 41 '35". 2
,
each branch circuit 0' _.,,
• Address: • • Each add'l branch circuit l 6.65 L( 2
City/State/ZIP: - Miscellaneous (service or feeder not included)
- Pump or in-igation circle 53.40 2
.
Phone: ( ) I Fax: : ( )
Sign or outline lighting 53,40 2
E-mail: • . Signal circuit(9) or limited-
_,ii, -,..:..r.i1::.%. ,,..:.,:. coNTRAcrclit,i ' :: '' ' '?:,•;:',::.:!,.!:•.•:;:::.•:••: energy panel, alteration. or
extension. Descbe : Page 2 2
5 usineas name: Hi 1 1 SbOr0 Electric L.L.C.
Each additional inspection over allowable in any of the above
Ad dress: 21185 NW Evercrreen PKWY Ste #110 Per inspection 62.50
City/State/ZIP: Hi 1 1 sboro , OR. 97124 Investigation per hour (i hr min) 62.50 _
Phone: (503) 439-9666 I Fox: (503 )601-3680 Industrial plant per hour '73.75 , •
... ' '•".':.• ''. '":.. !:•:41LECTRICAL 'PERMIT FEESO... : • •.:• • • ••• '.,:.:.:•:'
CCB Lic.:134481 Electri .; I ie.:3 4-4 Suprv. Lie.: 49 4 1 S _ Subtotal •_ "
-
Suprv. Electrician signature, required: / Plan review (25% of permit fee)
,
. State surcharge (r/o of permit fee) ,/..1-- 7
Print narne: Joey V i t ace'. / Date: 4,12 *
, TOTAL PERMIT FRE • qg .
Authorized signature: Tbh permit application expires if a permit is not obtsiV IN
days after it has been accepted as complete
Print name: • Date: ' Fee methodology set by Tri-County Building Industry Service Board
** Numbet- of inspections per permit allowed.
IABeikiing\PermiuNst..c.Pacmitapp.doc I MO 440.4015T( i11/u2/OM/WEB
. . •
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/� �n J� BUP
Received l: Date Requeste• AM PM BUP
Location ! • s ... 1 uite — E r
_ Contact Person Ph ( ) PLM
Contractor c+2.0 ., /t Ph ( ) SWR
BUILDING Tenant/Owner" 42r0 add-JO
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall n �� �ti ( J � Pink-04
Sp
Fire Sprinkler
J ))
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 IL
MECHANICAL �c
Post& Beam
Rough -In V
Gas Line
Smo ; Dampers
Ak RT FAIL
— 4 - 717.Tr AL
Service
Rough -In
UG /Slab
Low Voltage
Fir- - rm
Ir ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
.ART FAIL
SIT fl Please call for einspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk . Date Inspect LI . , Ext
Other:
Final DO NOT EMOVE this Inspection record f m the Jo site.
PASS PART FAIL