Permit ,CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00207
DEVELOPMENT SERVICtS DATE ISSUED: 10/26/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 25101 AB -01606
SITE ADDRESS: 07357 SW BEVELAND RD
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT : 017 JURISDICTION: TIG
Project Description: Electrical work for new office building.
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: SIGNAUPANEL: 1
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: 10 PER INSPECTION:
201 - 400 amp: 1 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:
TOM CLARKE JARMER ELECTRIC INC
12448 SW ORCHARD HILL RD 5105 SW 45TH AVE
LAKE OSWEGO, OR 97035 PORTLAND, OR 97221
Phone: 503 - 293 -1226 Phone: 246 -5381
Reg #: LIC 6924
SUP 4044S
FEES ELE 26 -144C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/26/200 $248.35
[TAX] 8% State Surcharge 10/26/200 $19.87 Underground Cover
Low Voltage Inspection
Total $268.22 Rough -in
Elect! 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 18 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the ego tility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies f these? le or dir ct q stions to OUNC at (503)
246 -6699 or 1-800-332-2344.
Issued By: - 2 Permit 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
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
- `3:)P--9Op ao010
, Electrical Permit Application FOR OFFICE USE ONLY
' Received P No.: l �PVO
City Of Tigard Date /6y: er ' 0D C96 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
• Phone: 503.639.4171 Fax: 503.598.1960 'l Date/By: Other Permit:
Inspection Line: 503.639.4175 � Itl Date Ready /By: Jur ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: � • Supplemental Information
TYPE OF WORK • ' PLAN REVIEW
New construction ❑ Addition /alter>Itian /t`e Please check all that apply:
Demolition ❑Other: ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling R Commercial /industrial ❑ Accessory building System over 600 volts nominal units in one structure
0 builder ❑Building over three stories ❑ Feeders, 400 amps or more
❑ Multi - famil
Multi ❑ Other: ['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑ Egress /lighting plan RV park
1=f Health-care facility ['Other:
Job no.: Job site address: - 7 3 i 75 0 '1.4; }JO Submit 2 sets of plans with any of the above.
City /State /ZIP: M IA' t Ora. G -7 VA 8(Y909 The above are not applicable to temporary construction service.
Suite/bld /a /� /n�/ x /_ FEE* SCHEDULE Description Qty. Fee. I Total
g• P t. no.: Project name: J C [-- R 1/ `
ore �CJ V��Ll
Cross street/directions to job site: T New residential single- or multi - family dwelling unit.
Includes attached garage.
1'2- + %F. Ve-LA=0.m 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add') 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90.90 2
11 04 1 _ . i• P )t )\L b 1 L Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps I 106.85 /A .�/
401 amps to 600 amps 160.60 2
Name: — rum /` t n.((f 601 amps to 1,000 amps 240.60 2
Address: I-�44 , s‘,3 0ex_vtAt2> *ILL. 2_ &, Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Lip. e_ OSWG-(1•o f D P- 91t>3.5" Temporary services or feeders installation, alteration, and /or
relocation
Phone: (5D3) i 95 _2, 6 z t Fax: ( 5b) 2-6 - / 53 G 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
® APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 1 6.65 *1 2
Business name: 'p 1ve.ec. t F I el, coosTe 0 LT) D►. co . O: 042.. branch circuit
B. Fee for branch circuits
Contact name: M LLQ-K-� without service or feeder fee, 46.85 2
each branch circuit
Address: 12_44- 8 S O Q,t_,t,.t- 14I L-` Z-4 . Each add'I branch circuit 6.65 2
City/State /ZIP: L.A. yL„G- (A , A) 1) R- q-- per— Miscellaneous (service or feeder not included)
• Pump or irrigation circle 53.40 2
Phone: (5 743 - -7„.(..2_ Fax: : ( 7"D3) 2.. S 3 — 1 _5 3 L Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or n
extension. Describe: 1 Page 2 - 7 ,5 ---42.--- 2
Business name: J ixQ - tNIP e_ F 1...6 a.% ' T IJ f
Each additional inspection over allowable in any of the above
Address: S/05- S W 4_5 AVE. Per inspection 62.50
City/State /ZIP: ?al- Lix x..) s pp_ 9 7....2.j — 3 f.2.e5 Investigation per hour (I hr min) 62.50
Fax: Industrial plant per hour 73.75
Phone:
(593) Z� tp' 838 I ( ) ELECTRICAL PERMIT FEES*
CCB Lic.: I Electrical Lic.: ( Z4 Suprv. Lic.: Subtotal ) 5/ „ 35
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) /'
Print name: Date: q �
TOTAL PERMIT FEE 21K. ' ji_
Authorized signature: L) . � lr This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Rot S / (J,A.i. Date: •=1/ /Dc. ` Fee methodology set by Tri- County Building Industry Service Board
` •• Number of inspections per permit allowed.
is \ Building \ Permits \ELC- PermitApp.doc 12/03 440.461ST(10/02/COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK-'ONLY,.. ,..._ ,
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORE ONLY
Fee for each commercial system $75.00 •
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems 0
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation ,
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\ Building \Permits\ELC- PennitApp.doc 04/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223 RECEIVED OCT 2 7 2004
IMPORTANT PERMIT NOTICE
JARMER ELECTRIC INC
5105 SW 45TH AVE
PORTLAND, OR 97221
Electrical Signature Form
Permit #: ELC2004 -00207
Date Issued:
Parcel: 2S101 AB -01606
Site Address: 07357 SW BEVELAND RD
- - - Subdivision : - HERMOSO -PARK - - -- - -_.. _ - — - - -- - -
_ Block: Lot: 017
Jurisdiction: TIG
Zoning: MUE
Remarks: Electrical work for new office building.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
TOM CLARKE JARMER ELECTRIC INC
12448 SW ORCHARD HILL RD 5105 SW 45TH AVE
LAKE OSWEGO, OR 97035 PORTLAND, OR 97221
Phone #: 503 - 293 -1226 Phone #: 246 -5381
Reg #: MET 00001312
LIC 6924
SUP 4044S
ELE 26 -144C
AN INK SIGNATURE IS REQUIRED ON THIS FOR
X
Signature of S p ising Electrician
If you have any questions, please call 503.718.2433.
E I c. 2c 4-(- 002c:l-
Building Division
II Applicant Request for Permit Action
al
City of Tigard
TO: CITY OF TIGARD, BUILDING OFFICIAL
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960
FROM: Applicant Name: Diversified Construction Co
Mailing Address: 12448 SW Orchard Hill Rd
City /State /Zip: Lake Oswego OR 97035
Phone No.: 503- 793 -2621
``� a Fax No.: 503- 293 -1536
Cor
PLEASE TAKE ACTION CHECKED ( ✓) FOR THE FOLLOWING PERMIT:
CANCEL PERMIT APPLICATION.
V, REFUND PERMIT FEES.
Permit No.: ELC2004- 00207 €c Ez-Co2ooS- D0199(6.
Type of Permit: Electrical, new construction
Site Address: 7357 SW Beveland Rd
Subdivision: Hermoso Park
Lot No.: 17
EXPLANATION: Electrical permit originally submitted by general contractor, did not
require plan review. Site design plans by electrical contractor were significantly different X polo
and did require plan review. It was decided by Hap & Brian to create new permit. - -�
E�Gtnr/,
( Fem . , O7 / /Y/7 — / / / . /9 H P
Signature: / ,/ Dates 4 S�
Print Name: fla {BSI`. 1
9 r» '" '� I(<i ?X 'ift �' rw ?� � 'i� "P' �F�d�h� �4� �, r
fifIM IFP. t�� a5 Nii'oi OFFICE US E, ONIY4 P41 -.;l , , i:K�� .�. u`" `�, G�i; `
Route to Admin.: Date: r$" OS By. !
Permit Canceled: Date: ,y,RdyaS By: i '
Refund Processed: Date: �� /a_5 By: :�
Cashier Receipt: Date: /oz6 jo,/ #: ,z j _ y6 Amnt: $ OS3� 7
Payment Type: CZe c`L Per:
is \[3uilding \Forms \RegPcrmitAction 09- 27- 04.doc