Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00739
DEVELOPMENT SERVICES DATE ISSUED: 10/4/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY ZONING: MUE
SUBDIVISION: TRIANGLE CORPORATE PARK LOT : 002 JURISDICTION: TIG
Project Description: TI
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 HMI SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 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:
TIGARD TRIANGLE I LLC HILLSBORO ELECTRIC
4650 SW MACADAM AVE STE 220 21185 NW EVERGREEN PKWY #110
PORTLAND, OR 97201 HILLSBORO, OR 97124
Phone: Phone: 503 - 439 - 9666
FEES Reg #: ELE 34 -4399C
LIC 134481
Description Date Amount SUP 4941S
[ELPRMT] ELC Permit 10/3/2005 $46.85
[TAX] 8% State Surcharge 10/3/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
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 wo rk 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 -2344.
Issued By Permittee Signature: z'/ -}7°/' / 61-T/o
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.
Oct 03 05 09:59p Hillsboro Electric 503- 992 -2402 • p•1
l e c t r ical Permit Application VET FOR OFFICE USE ONLY
City of Tigard (` E, Plan Re -.win
Received %a y ,, +� Permit No.: EL ot OOS —D075
13125 SW Hall Blvd., Tigard, OR 97 9 v Gil / `
t' Plan Review '43/9S
Phone: 503.639.4171 Fax: 503.598. � It :} ,. j � jW� Date/Bv• Other Pcnnit6((.?/D5
Inspection Line: 503.639.4175 '( O N. J 3 ,_ s � _L Date Ready /By: huts: El See Page 2 for
Internet: www.ci.tigard.or.us • CO Notified/Method: Supplemental Information
TYPE O t�yR►F(� kt : PLAY REVIEW •
❑ New construction Addle /hl rrr ement Please check all that apply:
Demolition Oth6 V` 3 ❑Service over 225 amps. cummi ❑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 Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
• JOB SiTE INFORMATION AND LOCATION • : . • • . ' ❑Egress/lighting plan RV park
/fdj / 01 facility ❑Other:
Job no.: �D�I Job Site address: �. .5‘..$1• // / Submit 2 sets of plans with any of the above. •
City / State/ZIP: /, 1i/ i 4Z ! 7r - 3 The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: I 0 Pro ject name: j//J FEE', SCHEDULE
t�Lt � ^ • Deseripian i Qty. i pee. I Total I
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax Wrap /parcel no.:
Limited enerLry, non - residential 75.00 2
DESCRIPTION OF WORK '
Each manufactured or modular
` dwelling, service and/or feeder 90.90 2
�qa? rcr tip 4-u.Ll e3 Services or feeders installation, alteration, and/or relocation
200 amps or Tess 80.30 2
❑ PROPERTY OWNER ' • :I ••❑ TENANT • 201 amps to 400 amps 106.85 2
2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
• Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 . 1
Owner installation: This installation is being made on property that 1 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 bunch circuits with
I •• service or feeder fee, each
6.65 2
Business name:
branch circuit
B. Fee for branch circuits
Contact name: wi!lrna/ service or feeder fee,
fj
each branch circuit f 46.85 L CO 8 2
Address: Each addi branch circuit 6.65 _ 2
City / State/Z1P: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited- • CONTRACTOR . extension. r Page 2
-
1, alteration o
Pa e 2 2
Business name: Hillsboro Electric L.L.C.
Address: Each additional inspection over allowable in any or the above
21 1 85 NW Evergreen PKWY Ste # 1 1 0 Per inspection 62.50
I City / Swte/ZIP: Hillsboro, OR. 97124 Investigation per hour (1 hr nun) 62.50
Phone: (5 0 3) 439-9666 Fax: (5 0 3)601-3680 Industrial plant per hour 73.75
. . •ELECTRICAL PERMIT FEES* • . .
CCB Lic.:1 3 4 4 81 Electrical Lk. :3 4— 4 9 9 C I Suprv. Lic.: 4941 E Subtotal Ifo, 69
Suprv. Electrician signature, required: 4 Plan review (25g of permit fee) — "
State surcharge (8% of permit fee) 3, 75
Print name: Joey Vitacco Date: ici -3 -os TOTAL PERMIT FEE (
Authorized signature: • This permit application expires if n permit is not obtained within 180
days niter it has been accepted as complete
Print name: 1 Date: • Fee methodology set by Tn -County Building Industry Service Board
•• Number of inspections per permit allowed.
i : \Building\PernustELC•PamdAPPdm 12/03 .40.4(5 T(IUNLCOMIYEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200&00739
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/4/2005
Phone: (503) 639 -4171 !we�
Inspection Requests (24 Hrs.): (503) 639 -4175 -
INSPECTION WORKSHEET FOR DATE: 11/2/2005 TIME: 7:04AM PAGE: 99
SITE ADDRESS: 13221 SW 68TH PKWY' CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: HEALTH NET OF OREGON
DESCRIPTION: TI
OWNER: TIGARD TRIANGLE 1 LLC, PHONE #:
CONTRACTOR: HILLSBORO ELECTRIC PHONE #: 503 - 439.9666
Inspection Request Scheduled For: Date: 11/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 019768 -01 603.439 -9666 Y
Corrections /Comments/ Instructions:
•
�'� -S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 / "2-- c Phone #: (503) 718-
CITY OF TIGARD 1 ~ 'Y'
BUILDING DIVISION PERMIT #: ELC2005 -00739
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/4/2006
Phone: (503) 639 -4171 am
Inspection Requests (24 Hrs.): (503) 639 -4175 • ..-,44- :-'11..
INSPECTION WORKSHEET FOR DATE: 10/20/2005 TIME: 7:09AM PAGE: 82
SITE ADDRESS: 13221 SW 68TH ' ������f���r�= -= CLASS OF WORK:
SUBDIVISION: TRIANGLE CORP. *ARK LOT #: 002 TYPE OF USE:
PROJECT NAME: HEALTH NET OF OREGON
DESCRIPTION: TI
OWNER: TIGARD TRIANGLE I LLC, (�i�teCk Q
PHONE #:
CONTRACTOR: HILLSBORO ELECTRIC t>21'
2 ° C-( fee p i , _ PHONE #: 503 - 439-9666
Inspection Request Scheduled For: Date: 10/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 018808 -01 503- 4339666 N
Corrections/Comments/Instructions:
`,
( �� ' ASS ❑ PARTIAL APPROVAL El CANCEL El NO ACCESS
FAIL ❑ CALL FOR IN PECTI N ❑ ADDITIONAL FEES ASSESSED
Inspector:
42..-4
Date;/' �2 .>A ' Phone #: (503) 718 -