Permit (45) 51a9,167 eLecnc
CIT OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00262
COMMUNITY DEVELOPMENT DATE ISSUED: 5/1/2007
T:IGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S136DD 04100
SITE ADDRESS: 11850 SW 67TH AVE 200 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT : 007 JURISDICTION: TIG
PROJECT: AMERICAN FAMILY INSURANCE
Project Description: Electrical TI, 2nd floor. Job No. 270610
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: 69 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: 1 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:
LEISER, ANNE TRUSTEE CAPITOL ELECTRIC CO INC
6009 SW PENDLETON CT 11401 NE MARX ST
PORTLAND, OR 97221 PORTLAND, OR 97220 -1041
Phone: Contact #: PRI 503 - 255 -9488
FAX 503 - 257 -7121
FEES
Description Date Amount Reg #: ELE 26 -496C
[ELPRMT] ELC Permit 5/1/2007 $619.45 LIC 48748
[TAX] 8% State Surcharge 5/1/2007 $49.56 SUP 3132S
Total $669.01 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those rules ar set orth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.246.66 or 1.80e. 3 44.
Issued B • ` / � _ , , Permittee Signatur
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7 :00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
_ FOR OFFICE USE ONLY
Elec teat Permit Applietion - Received
Permit no
City of Tigard t y. ' - _ Date/By:/4J,7 0 p�— DO
Plan Review
1 r� A� Other Permit:
13125 SW HALL BLVD., TIGARD, OR 97223 i� L f II Date /By: / G
Phone: (503) 639-4171 Fax (503) 598 -1960 APR 3 rr'. CI ' II: TIGARD Date Ready /�y: '4' Juris: 7 U See Page 2 for
Inspection Line: 503 - 639 -4175 Not' l irM• had: Supplemental Information
Internet: www.ci.tigard.or.us �j ,� � ` ti d jt ^ \ }� 0 ∎ lik . A -
TYPE QE_19$K:- ! °r - ro - 4:17 /
AN REVIEW
lefi New construction k] Additidn`lalteratio rrtjilaBement Please eck all that apply:
❑ Demolition ❑ Other: ❑ Service over 225 amps, comm'I ❑ Hazardous location
CATEGORY OF CONSTRUCTION ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
U 1- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building of 1- and 2- family dwellings 4 or more new residential
❑ Multi- family ❑ Master Builder ❑ Other ❑ System over 600 volts nominal units in one structure
JOB SITE INFORMATION AND LOCATION ❑ Building over three stories ❑ Feeders, 400 amps or more
Job no.: 270610 Job site address: 11850 SW 67th ❑ Occupant load over 99 persons ❑ Manufactured structures or
❑ Egress /lighting plan RV park
City /State /ZIP: Tigard, Or. ❑ Health -care facility ❑ Other:
Submit 2 sets of plans with any of the above.
Suite hld nn.: 200 Project name: American Family The above are not applicable to temporary construction service.
FEE SCHEDULE
Cross Street /Directions to job site: Description I Qty. I Fee. I Total I "
New residential - single or multi - family dwelling unit.
Subdivision: Lot no.:
Includes attached garage.
1000 sq. ft. or less $ 145.15 4
Tax map /parcel no.: Ea. Add! 500 sq. ft or portion $ 33.40 1
DESCRIPTION OF WORK Limited energy residential $ 75.00 2
New switches, outlets and lighting for Tenant improvement. Limited energy, non - residential $ 75.00 2
Each manufactured home or modular
11 PROPERTY OWNER 1 11 TENANT dwelling, Service and/or feeder $ 90.90 2
Name: Service or feeders installation, alteration, and /or relocation
200 amps or less $ 80.30 2
Address: 201 amps to 400 amps $ 106.85 2
401 amps to 600 amps 1 5 160.60 160.60 2
City /State /ZIP: 601 amps to 1000 amps $ 240.60 2
Over 1000 amps or volts $ 454.65 2
Phone: Fax: Reconnect only $ 66.85 2
Temporary services or feeders installation, alteration, and /or
Owner installation: This installation is being made on property that I own which is not relocation
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or less $ 66.85 1
Owner signature: Date: 201 amps to 400 amps $ 100.30 2
401 amps to 600 amps $ 133.75 2
U APPLICANT I U CONTACT PERSON Branch circuits - new, alteration, or extension, per panel
Business Name: CAPITOL ELECTRIC CO., INC. A. Fee for branch circuits with
service or feeder fee, each
Contact name: John Uhl / branch circuit 69 $ 6.65 458.85 2
X "1 B. Fee for branch circuits
Address: without service or feeder fee,
each branch circuit 5 46.85 2
City /State /ZIP: Each additional branch circuit: $ 6.65 2
Miscellaneous (service or feeder not included)
Phone: 503 - 255 -9488 Fax: 503 - 257 -7121 Pump or irrigation circle $ 53.40 2
Sign or outline lighting $ 53.40 2
E -mail: Signal circuits(s) or limited -
CONTRACTOR energy panel, alteration, or
Business Name: CAPITOL ELECTRIC CO., INC. extension. Describe: Page 2 2
Contact name: John Uhl Each additional inspection over allowable in any of the above
Per inspection $ 62.50
Address: 11401 NE MARX ST. Investigation per hour (1 hr min) $ 62.50
Industrial plant per hour $ 73.75
City /State /ZIP: PORTLAND, OR 97220 -1041 ELECTRICAL PERMIT FEES"
Subtotal 619.45
Phone: 503 - 255 -9488 Fax: 503- 257 -7121 Plan review (25% of permit fee)
State surcharge ( 8% of permit fee) 49.56
CCB Lic.: 48748 'Electrical Lic.: 26 -496C ISuprv. Lic.: 3132 -S TOTAL PERMIT FEE "8T
This permit application expires if a permit is not obtained within 180
Suprv. Electrician signature, required: /� . _ . �J 1 l , b �6p Q .
�A (/ (J�� days after it has been accepted as complete
Print Name: DARRELL MCNEEL Date: 04/18/07 * Fee methodology set by Tri- County Building Industry Service Board
Authorized signature: * *Number of inspections per permit allowed.
Print Name: DARRELL MCNEE
t;�� - �� ! tip C
CITY OF TIGARD . • Ai 110
BUILDING DIVISION PERMIT #: ELC2007 -00262
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2007
Phone: (503) 639-4171 4�
Inspection Requests (24 Hrs.): (503) 639 -417 �p�0� °:_ 1/7C
INSP C1 NWORKSHEE'" cY DA T E E: 7 /1 J2Oa 7 v fO� T M E: 3 7:OOAM PAGE: 30
SITE ADDRESS: 11850 SW 67TH AVE 200. CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Electrical TI, 2nd floor. Job No. 270610
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503. 255 -9488
Inspection Request Scheduled .For: Date: 7/13/2007 Pour Time:
Code # Inspection Description / Confirm # Contact # Message
125 Wall cover 051955 -02 971- 505.3396 N
Corrections /Comments/ Instructions:
a) LO wiX WA u e9/ /C f J -,
al I I.W_ . ■ e
0
1 PASS W; PARTIAL APPROVAL fl CANCEL n NO ACCESS
r
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 6 -2L/1 • • Date: 7 f 7 Phone #: (503) 718,-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007- 00262
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2007
Phone: (503) 639 - 4171 •
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/13/2007 TIME: 7:OOAM PAGE: 29
SITE ADDRESS: 11850 SW 67TH AVE 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Electrical TI, 2nd floor. Job No. 270610
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503 - 255.9488
Inspection Request Scheduled For: Date: 7/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 1 051955 -03 971- 506 -3396 N
Corrections /Comments /Instructions:
/- LI i/ 6 G �� � - ,12 � -- � 2 ) tW
X.PASS /j PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:
- iL' %A-7,6 Date: t 3 / Phone #: (503) 718 -
CITY OF TIGARD . 4
• BUILDING DIVISION _ PERMIT #: ELC2007 -00262
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2007
Phone: (503) 639 -4171 t�,' „�,,�� I
Inspection Requests (24 Hrs.): (503) 639 - 4175±+1 6 : .
INSPECTION WORKSHEET FOR DATE: 7/10/2007 TIME: 7:00AM PAGE: 42
SITE ADDRESS: 11850 SW 67TH AVE 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Electrical TI, 2nd floor. Job No. 270610
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503-255-N188
488
Inspection Request Scheduled For: Date: 7/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover -
051709 -01 , , 971- 506 -3495 Y
Corrections /Comments /Instructions:
CO'\l 1..* W ALLY w VA, ON 1. ) ?
n PASS 7,4 PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL II - _ : = ISPECTION 1 ADDITIONAL FEES ASSESSED
Inspector: r V4 o8 LE' Date: I t b 61 Phone #: (503) 718-1)4.
CITY OF TIGARD
• BUILDING DIVISION PERMIT #: ELC2007 -00262
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/20/2007 TIME: 7:04AM PAGE: 50
SITE ADDRESS: 11850 SW 67TH AVE 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Electrical TI, 2nd floor. Job No. 270610
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503 - 255 -9468
Inspection Request Scheduled For: Date: 6/20/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 05055301 971 - 506 -3495 N
Corrections /Comments/ Instructions:
TAIL Wfakial 0 K
•
n PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ( ` ' Date: 6' 2) Phone #: (503) 718 - 2 -`t 1t
CITY OF TIGARD
BUILDING DIVISION G PERMIT #: ELC2007 -002G2
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2007
Phone: (503) 639 -4171 11\ k
Inspection Requests (24 Hrs.): (503) 639 -4175 '4_�I
INSPECTION WORKSHEET FOR DATE: 5/21 /2007 TIME: 7:02AM PAGE: 30
SITE ADDRESS: 11850 SW 67TH AVE 200 CLASS OF WORK:
SUBDIVISION: TIGARD '"1RIANGLE O MVMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Electrical TI, 2nd floor. Job No. 270610
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 5/21 /2007 Pour Time:
Code # Inspection Description # Contact # Message
125 Wall cover 048712 -01 971 - 506 -3495 Y
Corrections /Comments/ Instructions:
�_ --' AIM
�cl Aep i0 F cAUE K,
❑ PASS 121 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C Iv O Date: 1 .2- 09 1 Phone #: (503) 718- 2 4 1 4 V
CITY OF TIGARD
• BUILDING DIVISION ' PERMIT #: ELC2007 -00262
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2007
Phone: (503) 639 -4171 400' +,,.
Inspection Requests (24 Hrs.): (503) 639 -4175 :' IL
INSPECTION WORKSHEET FOR DATE: 8/24 /2T: =' TIME: 7:0OAM PAGE: 62
SITE ADDRESS: 11850 SW 67TH AVE 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Electrical TI, 2nd floor. Joky No. 270610
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503 - 255.9488
Inspection Request Scheduled For: Date: 8/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 05458603 971- 506.3495 N
Corrections /Comments/ Instructions:
IX PASS PARTIAL APPROVAL n CANCEL Ti NO ACCESS
n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: 8' 2 '`4 Phone #: (503) 718- 2- 41/4?
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00262
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2007
Phone: (503) 639 -4171 r \ ��
Inspection Requests (24 Hrs.): (503) 639 -4175.
INSPECTION WORKSHEET FOR DATE: 7/25/2007 TIME: 7:02AM PAGE: 5E3
SITE ADDRESS: 11850 SW 67TH AVE 200 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: Electrical TI, 2nd floor. Job No. 270610
OWNER: LEISER, ANNE TRUSTEE, PHONE #:
CONTRACTOR: CAPITOL ELECTRIC CO INC PHONE #: 503. 255 -9468
Inspection Request Scheduled For: Date: 7/25/2007 Pour Time:
Code # Inspection Description • • °" -- . Contact # Message
130 Ceiling cover 052685 -01 971- 506.3495 Y P
Corrections /Comments /Instructions:
11Y
A PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
n FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: N OG LL' Date: 11 i Phone #: (503) 718- 1/101(0