Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00024
i . DEVELOPMENT SERVICES DATE ISSUED: 1/21/04
„� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 250
SUBDIVISION: TIGARD OFFICE BUILDING ZONING: MUE
BLOCK: LOT : JURISDICTION: TIG
Project Description: Relocate (1) 100 amp panel and (29) branch circuits to new wall on 3rd floor.
Job No. 01 -24
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:
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: 29 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:
PACIFIC REALTY ASSOCIATES ELECTRICAL CONSTRUCTION CO
15350 SW SEQUOIA PKWY #300 -WMI PO BOX 10286
PORTLAND, OR 97224 PORTLAND, OR 97296
Phone: Phone: F - 295 - 301
Reg #: 20-3511 049737
SUP 3286S
FEES ELE 26 -45C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/21/04 $273.15
[TAX] 8% State Surcharge 1/21/04 $21.85 Elect'I Service
Rough -in
Total $295.00 Elect'I 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 Mu days:. TTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth i AR 952-001-001e rough OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or
1 -8 - 332 -2344.
.V / / / .
Iss ed By: � ! /'.� 1 IG� /� Permit Signature: .� // .,j�_I�
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: '! O i i DATE:
LICENSE NO: !`
Call 639 -4175 by 7:OOpm for an inspection the next business day
J 01/19/2004 20:50 5032205347 PAGE 02
Electrical Permit Application FOR OFFICE USE ONL 1'
City of Tigard 0 Planning A.•,• , val Sign
13125 SW Hall Blvd. CO Dam'' Permit No.:
Plan Review Other
Tigard, Oregon 97223 0 Date/By: Permit No.:
Phone: 503 - 639 -4171 503 -4 Q , Post Lend Use
��11 : A Date/B Internet: ww .or.us w.ci.ti ard .. Case No.: • g �•s�� '\� � ' Contact 4J ■1 , � See Page 2 for
24-hour Inspection Request; 503G\1` Nt3, .... Name/Method: -i /tc Supplemental Information.
..
Q�
'. / co o 1
TYPE O > ORK .. PLAN REVIEW ' lease checkill thatj.
New construction 1emolltion ❑ Service over 225 amps- • Health-care facility
❑ Addition/alteration/replacement ( Other: — NI- ❑ commercial Ca Hazardous location
Service over 320 amps- rating of ❑ Building over 10,000 square feat,
• • CATEGORY OF CONSTRUCTION • • 1 & 2 family dwellings four or more residential units in
■ 1 & 2- Family dwelling I ' Commercial/Industrial ❑ System over 600 volts nominal one structure
• Accessory Building ■ Multi -Farnil
0 Building over three stories ❑ Feeders, 400 amps or more
}� ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
• Master Builder [ Other: 0 Egress/lighting plan ❑ Other:
• JOB SITE INFORMATION and LOCATION Subetlt _ sets of plans with any of the above.
Job site address: \ a eto'N S W G g+` OkN The above are not a to temporary construction servile*.
FEE* SCHEDULE •
Suite #: Q° Bldg./Apt.#: • •
5DI Bld g. Number of inspections per permit allowed
Project Name: Le - -n -t ,,e .c1._ 1 t. #: felt) Description Qty Fe (a.) Total
Cross street/Directions to job site: Al-HI/4 e0,5 / • New residential - single or multi -family per j
dwelling unit. Includes attached garage.
Service Invaded;
1000 sq. ft• or less 145.15 4
Each additional 500 sq. R. or portion thereof _ 1
' Limited energy, residential 75.00 2
Subdivision: Lot #: Limited enerlty. non residential 75.00 2
Tax map /parcel 4: Each manufactured home or modular dwelling
• .. • • DESCRIPTION •OF WORK •, , — service and/or feeder 90.90 2
Rey o,cn,•k a t-A 0ii Ar ld
. a /a`lu Serv icaorf eed en-Ipsalbtlon,
IN .t\ . Al QrA�t` alteration or rel oc ation:
(. r c v.O k t t _t *tom nr era\\ P 'A g l ` Q \ e , ' zoo amps or less
80.30 k u' 3 0 2
201 amps to 400 amps 106.85 - 2
401 amps to 600 amps 160.60 2
r [ TENANT 601 amps to t 000 amps 240.60 2
/�� 1 Over 1000 amps or volts 454,65 2
fPROPEROWNER
tue: r7 1� I ��`p Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps • 100.30 2
0 0 A • ❑ CONTACT PERSON • r n 600 amps 133.75 2
Branch circuits - new, alteration, or •
N ame: extension per panel,
A. Fee for brunch circuits with purchase of o11
Address: service or feeder Fee. each bnmeh circuit 7� 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, fast branch circuit 46.85 2
Phone: 1 Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
: N i NTRAC:I OR . :: ::r . Each pump or irriastioo circle 53.40 2
''s' ' Each shirt or outline lighting 53.40 2 •
Job No: O \ '•{ Signal circuit(s) ore limited energy panel,
alteration, or extension Palle 2 2
Business Name: G C C 6_x- r"-, Description:
Address: W b Et) lu 1 F C
` 1 Each additional In , ectlo4 over the allowable is an of the above:
City /State /Zip: f \ ' Yr' D r °\1 .1°1 ( _ Per i . lion . hour min. 1 hour 62.50
Phone: a a 0 . S 11 Fax: '4)) S • 3 b.% Z Investi: lino fee:
CCB Lic. #: '-1 0n) '1 Lic. # ' y S C Other:
3 ,' ;e'' Electirlcal It Eedl : .. ' .
Supervising electrician �� subtotal $ a'1 1
signature required: 1 �' X 14 • Plan Review 25% of Permit Fee $
Print Name: 12.. In Clef t�A 4.-ev, i t #: L 3 L f c State Surcharge (8% of Permit Fee) $ a 1 S
TOTAL PERMIT FEE $ • S. 0
Authorized Notice: This permit application expires if a permit Is not obtained within
Signature: Date: _ 180 days after lakes been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
• (Please print name)
is \Dsts\Permit Fon= \ElcPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
1.2 p BUP
Rece ' 'Z' v Date Requested �v /0c( AM BUP
Location / 2- ! % Co f ' ,Au� Suite MEC
Contact Person /.[ Ph ( ) 22-0 ' 5 19 PLM
Contractor CC 2 Ph ( ) SWR '1
BUILDING Tenant/Owner V
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
e •
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 • 6
Smoke Dampers Mk
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage >�
Fire Alarm
a hero ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
C5 PART FAIL
❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA L/
Approach/Sidewalk — /O 7 / Inspector / try � � Ext
Other: �f
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL