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CITY OF
T I G A tR�tD ELECTRICAL PERMIT
CITY 1J PERMIT#: ELC2004-00117
DEVELOPMENT SERVICES DATE ISSUED: 3/16/04
13125 SW Hall Blvd., Ticiard, OR 97223 (503) 639-4171 PARCEL: 1S135DB-05900
SITE ADDRESS: 11550 SW GREENBURG RD
SUBDIVISION: MILLER ZONING: R-4.5
BLOCK: LOT . 005 JURISDICTION: TIG
Project Description: Servico change,Job No.900-0234
_ RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS MISCELLANEOUS
_
1000 SF OR LESS: 0 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGNIOU f LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER `BRANCH CIRCUrrs A ADD'L INSPECTIONS
0 200 amp: 1 W/SEPVICE OR FEEDER: 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:
_T Reconnect only: SVC/FDR>=22.5 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
CHRIS WILLIAMS T&T ELECTRIC
11550 SW GRE ENBURG RD 4120 SC INTERNATIONAL WAY
TIGARD,OR 97223 A105
MILWAUKIE,OR 97222
Phone: Phone: 503-969-8487
Reg#: I-W 15rnr1
FEES I 1 1 20 1105C
I I' 'I1I"
DtesarlptIon Date Amount Required Inspec0ons
(ELPKMT]ELCPermit In fit $80.30 ---
jTAxj R";,SwIc Surchanv, I(, n.l $6.42 Elect'I Service
�. Elect'I Final
Total $86.72
This Permit is Issued subject to the regulations contained'i 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. ATi ENTION: Oregon law re4 wires 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
1-87ued
Is y: -�. Permit Signature: 'QA t
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: __ QE
LICENSE NO:
Call 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Appolicatlo,�"��
Cit of Tigard Itecelved 7
�' Va" l y 4 Petmk No.: - �I
13115 SW Hall Blva.,I igard,OR 97223 Plan Review
phone: 503.639.4171 Fax: 503.598.1960 Date(li , otMrtbmac
Inspection Line: 503.639.4175 Ali trate Resdy/riy. tura ® Ser I'Vie 2 fur
Internee www.cl.ligard.or.ua NoNtledM1letlnd: _ Sappletnenutlsr,resatw i I
❑ New com.trnction ❑ Addition/alteraiton;replacerrtent Please check all that apply:
❑Service over 225 amps,comm') ❑Hazardous kxation
❑ Demulit un [� Clther [3service over 310 amps- rating ❑Buihing over 10,000 sq R.,
^L�d li of 1-and 2-fancily dwelling,, 4 or n"v new residential
..�;u_ 'utw.ua■uui.uYl'1'Yb'a ,,u
I wid 7-family dwellinK [j l'orttntercial/industrial []Accessory h.tikling ❑System over 60x1 volts nominal units in one moisture
C] M,Ilti-fnmi'y E]Master huileler El(�thcr. ❑Dultding over three stories []Foeders,400 amps or rtxRc
❑Occupant load over 99 persons [].Manufactured structures or
+ a'',,..•,', 013gress/lighting nlan RV park
Job no.:qj> ,02_S+ Job site(address: )l 5� $14 /„ren � ❑l-lealth-care facility Odther
sd Submit;sets of plans with any of the abnv e.
City/Stale/ZIP: CO- 9-17-20 The ab,.rve are not upplicahlc to temporary construction service
1
Suite/bldg./apt.no.: P%ect name:
Cross,treat/directiDns to job site: New resldentlat slekle-or multi-famlly dwelling unit.
- -- - Includes attached garage.
1,000 sq.ft.or less 145.15 4
Subdivision: L t no.: Ea.add'l 500 sq,il,or portion 33.40 1
—-' - -- - Limited energy,residential 73.00 2
Tax map parcel nu Limited
energy,non-residential 73.00 2
ar r.�a 4..
s i I' _ * ', Bach manufactured or modular
�. dwelling,service end/or feeder 90.90 _ 2
--- � � > Q L Servlees or feeders lastallollon,alteration,and/or relocation
200 amps or less 80.30 2
1 „I 201 amps to 400 amps 10695 2
a' 401 amps to 600 amps 160.60 2
Name h r L� /a srin �--- 601 amps to 1.(M amps 240.60 �V 2
Address O 5'_ f at.ej �� QA - Over 1,000 amps or volts 454.65 2
Vv
Recionnect on ly 66.85 1 2
CitylStetdZlP Q 722- Temporary%erviw or feelers hatallaflon,alteration,Had/it
Phnne - - - - relocation
( ) Fax: ( 200 onp or'ess 6' 8t --- 1
Owner Installation:This installation is being made on property that 1 oven which is not 201 amps to 400 amps IG.•+u ___
Intended for sale. lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps 133.75 � 2
_p --
Owner ai Ilturc tc !!ranch rlrrulta-nes,alterrfloa,or eztcudor panel
----- ----- --
-- P`! ;,i �' 1 A.Poe fir branch circuits wtrA
service or feeder fee,each
Hubincss name: branch circuit 6.65 2
----- "- D.Fee for branch circuits
Contact name: without service or fbeder fee,
each branch circuit 2
Address:
Each add'1 branch circuit 6.6J 2
City/State/ZIP: Mleeellaneoas(service or Awder not Ineladed)
Pu irrigation - -
Phone: mP or piton circle 33.d0 2
— - -- Stgn or oullire lighting i 53.40 2
E nail: Signal circuit(s)or limited- _ -
4w; ! Ill ,d I I energy panel,alteration,or l
Hueineae name:
extension.Dexribe: Page 2 2
-j-'a T��lt��r�li
Address: ���Y (d Each addltloaal los ectlan over allow bit In any of the ahnve
City/State/ZIP: y Per lnspecU(m62.50
j i industrial limt er hour ) 62.SD
InvWi anon l_hoot o fir rmo
Phohe:5a3)(05—�- -1 co I O Far: cc�3) lo'� 7�1'Z.
t'rl3 Lfc G
(�, '�'�j Bleclrical Lic.:�� ��jy Suprv.-Lit: J subtaal
. 30
Suprv.Electrician signature,requir �� _ Plan review(25%of permit fee)
Print narne: L1 Date: �-0 state surcharge(6%of permil reel
Authorized signature: c7 TOTAL FERMfT PEE
__ Thh pasta!(spplk,Hon eftplrn If a pesos!(b not ahtalaall rvlda-!a0
days oft"It has hese aeeeptrd as eeetphee
Print Herne Y Date: Fee rmthodulogy set by Tri-Comity Hsild,nF Indtutry Service Hoard
"Nurd"t of trapections pet pemit ellnwed
�u�Idi,eV'rrrtdl,al.C-PMxadiApp.Mr i7n,� NO-161�T(IO,EQfCQMlWa9
T 'd ?i 9LaS9t3nS 0 IH3I813913 1'tel b I :t� i bona at JRW
' CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST -
INSPECTION DIVISION Business Line: (503)639-4171
BUP
Receiv �l9_-3. 3 Date Requeste _3^ AM_ PM BUP _
Location _ • Suite . MEC
Contact Person _ ,ed f C _ ( 3D ) — ;?L<7 PLM -
Contractor ___� --__.__�t Ph(�3) S 6'g— V755SWR v-- -
BUILDING Tenant/OwnerIOD —
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain SIT
Slab Inspection Notes: C
Post&Beam
Shear Anchors --
Ext Sheath/Shear —
Int Sheath/Shear
Framing ---- — —
Insulation
Drywall Nailing - C —
Firewall ��,� �� > ;�� ,J l I
Fire Sprinkler e, -}
Fire Alarm �� (r ( �� ��► c) �-� �t l I
Susp'd Ceiling
Roof
Other:
Final _
PASS PART FAIL
PLUMBING
Post&Beam
Under Slab ---- ---— - —
Rough-In
Water Service — —
Sani'.ary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain '—
Shower Pan
Other: —-
Final - - _ —_--
PASS_ PART FAIL
HA —^
MECNIC_A_L _ _ ---
Post& Beam
Rough-In
Gas Line
Smoke Dampers --- -
Final
PASS PART FAIL
ELECTRICAL _
Service
Rough-In
UG/Slab
Low Voltage — -
arm
Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
P PART FAIL
ITE Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA gats _Z11 - in / ut
Approach/Sidewalk
Other: /
Final DO NOT REMOVE this Inspection record f en the Job ib.
PASS PART FAIL