Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00374
1P DEVELOPMENT SERVICES DATE ISSUED: 6/24/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S103AA -00101
SITE ADDRESS: 10865 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: • LOT : JURISDICTION: TIG
Project Description: HVAC upgrade, (2) 200 amp services and (17) 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: 2 W /SERVICE OR FEEDER: 17 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FOR: 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:
SCHOOL DISTRICT NO 23 J 3D ELECTRICAL SERVICES INC
13137 SW PACIFIC HWY PO BOX 173
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: 503 - 620 -1620 Phone: 503 -657 -9173
Reg #: ELE 3 -460C
LIC 135234
FEES SUP 4478S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/23/2004 $273.65
[TAX] 8% State Surcharge 6/23/2004 $21.89 Elect'l Service
Rough -in
Total $295.54 Elect'l Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2 44
Issued By: ._/7.‘„( Permit Signature: Crl 6:7 p
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
', :WED 10:49 AM P. 002/002
I ,,
' 4 Electrical Permit . :j I . rl : Lion
' : ' , Datereoelved: 6/MITA Permit no.: r 3 it
Li` a ► i City of Tig , t �� O � ProJect/appl.no.:
City ofTlgerrl Address: 1312.5 SW '•`Vd, Tigard; ) Date issued: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 � �� O� ' ` v. .. , O- Case file no.: Payment type:
�f p
C,�� � �1 1 -- 2� ! - • i (Z l f % Land use approval: •
,
'l vi'h: ( PERT ll l'
❑ 1 & 2 family dwelling or accessory tCommercial/industrial O Multi - family ❑ Tenant improvement
❑ New construction ❑ Ad dition/alteration/replacement ❑ O ❑ Partial
Job address: Pa (DI ‹,10,0 Y.,ij kf'd L$T C, r, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: ?e W LE R MI D1) kE SC- 1.160 L.
Project name: Description and location of work on premises: VA C.- 0 GRA) tr
Estimated date of core letion/inspection: "O l i •
Job not • Fee Max
Business name: W
v Ez- - r g c..4 . Sew vic 4S 1 Zf`t C- DesCriptlon Qty. (ea.) Total no. lnrp
Addre J 4 X 1 Z 3 Nonresidential - single ormolu- family per
dNemng wdt. Includes attached garage.
City:O REIp1J G I State:p 1Z I ZIPS ce70/1�' Servlcelnduded;
Phone: 667 "C( ! 1 1Pax:055 - 7ryOI lrmail: 1000 sq. ft.orlees _ . 4
Bach additional 500 sq. ft or pinion thereof
CCB no.: •1 3 5 2 3 glee. bus. lie. no: 3 Cr Limited energy, residential 2
City /metro Ile. no.: 5c! _ Limited energy, non- residential 2
f u �� t - Z 3 O 44 Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (pant): 15) 1 t ks` tin to License no: Prilb $ Services or feeders- installation,
alteration or relocation: 2 2 ��e ' � 2
200 amps or less
Narne (prit n Q T A T r 0 d pij ST. II a33 201 amps to 400 amps 2
ai address: 401 amps to 600 amps 2
M
�09 (n `d t� l ' . 6 amps to 1000 amps 2
City: fir OZT) I State: ZIP: Over 1000 amps or voila - 2
Phone: f — /(pap IFax: 1 13,-mail: • Reconnect only 1
Owner installation: The installation is being made on property I own T mporaryservices .
which is not intended for sale, lease, rent, or exchange according to instailadonolteration,or reiotatlon:
ORS 447, 455, 479, 6.70, 701. 200 amps or lees 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am 2
Branch circuits - new, alteration,
or extension per panel: S 1 e5
n
Name: k Fee for branch circuits with purchase of 1!4 13
Address: service or feeder fee, each Branch circuit 1 1 Y 2
City: I State; • I ZIP: B. Pee for branch circuits without purchase
Phone: Fax: E-mail: of service or feeder less, first brooch circuit: 2
Each additional branch circuit
Mee. (Service erica erect eluded);
O Service over 225 amps-commercial ' C1 Health - cam facility Each pump or irrigation circle 2
0 Service over 320 smps.rating of 1&2 O Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 square feet four or Signal circult(s) or a limited energy panel,
Cl System over 600valtsnominal more regldential units in ono etmctute alteration, oreaten:dons - 2 _
U Building over throe stories 0 Feeders. 400 amps or more ' •Deacription:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional Inspection over the allowable to any of the above:
0 Bgtcsahightingplan 0 Other. Perinspection l I 1 I
• submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary 'construction service. Other
Not all Jurisdictions accept credit cards, please call Jurisdiction for mem lnfeatlon. Notice: This permit application Permit fee $
2 ' 7 3. Gs
rm
0 Visa O MasterCard expires if a permit is not obtained Plan review (at — %) $
Credit cold number. ( wi thin 180 days after it has be en State su rcharge (8%) .... $ •
Name of aa:dgolder as Mown ns credit card
respires TOTAL as complete. TOTAL $ �' •
,
g
- Cardholder it .. , we Amount 4403615 (6100/COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lino: (503) 639 -4175
MST
INSPECTION DIVISION Business Line: (503) 639 -4171
Q' BUP
Received Date Requested ( (/ AM PM BUP
Location ! d gle• c l OOL&Yte Suite MEC
• Contact Person 1L44- Ph (_/21_* 0 "g S6o ?' PLM
Contractor Ph ( ) SWR
•
BUILDING Tenant/Owner ELC ? e ( -00 - 3 7g
37`
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam MraM
Sr Anchors
Ext Sheath/Shear
ear
Int Sheath/Shear MIW
Framing
Insulation A ► ° 1i.0 rf � F �t-- -P
Drywall Nailing / ��
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
C--"
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
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
AS0 PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line I '
ADA Approach/Sidewalk Date o Inspector 1 i Arai .•
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL