Permit -- iT 1 OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00241
:4:
DEVELOPMENT SERVICES DATE ISSUED: 4/29/03
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S104DA -23200
SITE ADDRESS: 13086 SW WORCHESTER PL
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R-4.5
BLOCK: LOT : 058 JURISDICTION: TIG
Project Description: Greenspace beside above address. Sprinkler pedestal and circuit.
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: 1 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:
BROWNSTONE HOMES, LLC DAVID JEROME ELECTRIC
12670 SW 68TH PARKWAY PO BOX 751
PORTLAND, OR 97223 HILLSBORO, OR 97123
Phone: 503 - 598 -7565 Phone: 648 -5144
Reg #: LIC 36051
SUP 2877S
FEES ELE 34 -1I9C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/29/03 $86.95
[TAX] 8% State Tax 4/29/03 $6.96 Rough -
Underground Cover
Total $93.91 Elect'l Service
Elect'I Final
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 0 -332 344.
• Issued By: ,t( y jt � G,v(X,v� Permit Signature: �, Ci.. ftC, c �
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
S,df
-, s Pe i' -P
. _.
Electrical Perms t pp c ion .
Datereceivedy{ l -0 3 Permit no. rL z (-
D
y 1
A.
ma y, l` ,.� �I City of Tigard I 2 9 rGsn Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, OR 7223 Date issued: BID Receipt no.
Phone: (503) 639 -4171 011 1( OF TIGARD
Fax: (503) 598 -1960 al LDING DIVISION Case file no. Payment type:
Land use approval: 1
•
TYPE OF PE .
U I 2 family dwelling or accessory U Commercial /industrial 13 Multi-family ❑ Tenant improvement
New construction ❑ Addition /alteration /replacement 0 Oth - Partial
JOB SITE INFORMATION ' ' ' . - '
Job address:
130I 4, S cAtt, eS'F'e -' Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: INIIII Block: S bdivision: C — `I �� • _ l
Project name: A 1,/J Description and location of work on premises: . z...--,-- _ ^— - /
ow; Estimated date of completion/in ction: ■ �l - - •
CONTRACTOR APPLICATION . FEE SCHEDULE .. - '
Job no: •— S Fee Max
Business name: 0 A J E R 0 M E ELECTRIC - Description Qty (ea.) Total no. insp
New residential -single or multi - family per
Address: PO BOX 751 dwellingunit Includes attached garage.
City: H I L L S B O R O State: O R ZIP: 9 712 3 Service included:
Phone: 648 -5144 Fax648 -9723 E -mail: Iwo sq. ft. orless 4
Each additional 500 sq ft or portion thereof
CCB no.: 36051 f Elec. bus. tic. no: 34-119C -----
United energy, residential 2
City /metro tic. no.: 1 tl • 3 1-k — 2--S — Limited energy, non-residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (re red) Date Service and/or feeder 2
Sup elect. name (pnnt)D A V I D A J E R O M E License no:2 8 7 7 S Services or feeders - installation,
alteration or relocation: ' 8 °0,30 2
. PROPERTY OWNER • 200 amps or less
201 amps to 400 amps 2
Name (print); (rcyZ.riwO vita - .p _
401 amps to 600 amps - 2
Mailing address: i ' G10 .. U3 7 A 2_0D 601 amps to 1000 amps _ 2
City:,P ' Stat . ZIP: Cr) 1:22 Over 1000 amps or volts 2
Phone: 8 IFax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - •
which is not intended for sale, lease, rent, or exchange according to installation, altecatlon, or relocation.
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: / DatC. 401 to 600 amps 2
• • ENGINEER Branch circuits - new, alteration,
or extension per panel: ------ Name: A Fee for branch circuits with purchase of t�t�
Address: service or feeder fee, each branch circuit I 2 -
City: I State: I ZIP:
13 Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail:
Each additional branch circuit.
PLAN REVIEW (Please check all that apply) :. . . .: Misc. (Service or feeder not Included):
0 Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps- rating of I &2 0 Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension 2
0 Building over three stones ❑ Feeders, 400 amps or more • Descripuon. r-
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
❑ Egress/lightingplan 0 Other. — Per inspection I I I I
Submit sets of plans with any of the above. Investigation fee ,
The above are not applicable to temporary construction service. Other -
.—
Permit fee $
Not all junsdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application $
0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _, %)
Credit card number: / / within 180 days after it has been State surcharge (8%) .... $ C • - {
! °
Expires accepted as complete. TOTAL $ q_ . .- . I i
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440 -4615 (6,00 /COM)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION•DIVISION Business Line: (503) 639 -4171 MST
BUP
Received / o � p� / Date Reqested S AM PM BUP
Location L 3 0 P w Suite MEC
Contact Person Ph ( ) 1 g — LC/ �� PLM
Contractor Ph ( ) SWR /
BUILDING Tenant/Owner ELC 3 `T /
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam ( .0 /3 6 6
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall •
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
ough -In
UN a.
Low Voltage
Fire Alarm
in -1- ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
�• PART FAI
SI Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
Approach /Sidewalk Date -C/a 7/03 Inspector ....e6CLOO
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL 1i