Permit CITY OF TIGARD ELECTRICAL PERMIT
DEVELOPMENT SERVICES
PERMIT #: E 10/24/2006
I I I I DATE ISSUED: 10/24/2006
A,14- '' 13125 SW Hall Blvd., T OR 97223 503 - 639 -4171
PARCEL: 2S101AA- 09100C
SITE ADDRESS: 12447 SW 69TH AVE ZONING: MUE
SUBDIVISION: TIGARD CORPORATE CENTER LOT : OOC JURISDICTION: TIG
Project Description: HSBC. (1) branch circuit for light & switch, LV for voice /data. Job # 600706.30662.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION:
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: 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:
HOUSEHOLD CREDIT SERVICES BROADWAY ELECTRIC - COCHRAN INC
12447 SW 69TH AVENUE 626 SE MAIN
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 686 -2083 Contact #: FAX 503 - 238 -2098
PRI 503 - 234 -6564
FEES
Description Date Amount Reg #: ELE 37 - 546C
[ELPRMT] ELC Permit 10/24/200( $121.85 LIC 72942
[TAX] 8% State Surcharge 10/24/200( $9.75 SUP 3447S
Total $131.60 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 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 -800- 332 -2344.
Issued By: Permittee Signature: ` Q p
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.
Electrical Permit Application FOR OFFICE USE ONLY
e
Plan City of Tigard Received / � . -66 6 DateB : /, —.--- Permit No.: / 6
13125 SW HAll Blvd., Tigard, OR 97223
P t Rview
Phone: (3'3.639.4171 Fax: 503.598.1960 OCT 21 G � � ''r %"t4,t i � f Plan Date/13y: Other Permit:
Inspection Line: 503.639.4175 ° 0 ' � Date Ready/By: Juris: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
. s . ,.. 'OF -WQRK , , .. - .. ,.. RLAN REVIEW
❑ New construction Addition /alteration/replacement • 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.,
•CATECO OF 'CONSTRUCTION: of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling Co rrunercial/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
' ' ''y '3OB - SITE INFORMATION AND LOCATION - ❑Egress/lightingplan RV park
Job no.: / - _. ,� J s ite add ress: t � � W UR t ,Health-care facility ['Other:
D(Q Submit 2 sets of plans with any of the above.
City /State /ZIP: ) CO_ 1 !� The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: `) Project name: FEE *. SCHEDULE , • „ _
Description I Qty. I Fee. 1 Total
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: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
. Limited energy, non - residential 75.00 2
DESCRIPTION. OF WORK Each manufactured or modular
Will \ L L1 �- 1 �(\
rl ! a t 1 C ,, 1` 1 , I " l dwelling, service and/or feeder _ 90.90 2
J tl t� JkJ T�/ Services or feeders installation, alteration, and/or relocation
't/1Ck la (t \ \ b ci till pi-- " O � j- 200 amps or less 80.30 2
❑PROPERTY OWNER \+^'` `/w" ❑TENANT. 201 amps to 400 amps 106.85 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: ( ) Fax: ( )
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 .. I , CONTACT. PERSONY • A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
, 1 \,� f kt �� B. Fee branch circuits
Contact name: 1I t� 1 without feeder t service or feeder fee,
each branch circuit 46.85 4 K2
Address: Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: (5D3 (... lblo Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: • riP(ljP - 1-ia O 112L Signal circuit(s) or limited-
CONTRACTOR - energy panel, alteration, or C
` ,. extension. Describe: I Page 2 i I J 2
Business name: ��o (dw 4`' , �e �� J,"
�� Each additional inspection over allowable in any of the above
Address: C Z 5 M �
Per inspection 62.50
City/State /ZIP: 'I \ -- 6 OcZ- Ck1 2 L4 - Investigation per hour (1 hr min) 62.50
3
Phone: (b ) 2,3(..k —C.5 t (9.3) Fax: ( . 1 % - `1$ Industrial plant per hour 73.75
, •ELECTRICAL• PERMIT 'FEES* * 1 ': : ' `-
CCB Lic.: - 7 2 q q Z, Electrical Lic.: 31 -5 6,c_ t Suprv. Lic.: 3,44-1-5 Subtotal ') • t
Suprv. Electrician signature, required: Plan review (25% of permit fee)
�� State surcharge (8% of permit fee) 9 .1 4,
�v
Print name: `G e‘e c. X-C. Date: TOTAL PERMIT FEE 131 • Lip
Authorized signature: This permit application expires if a permit is not obtained within 190
days after It has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board
** Number of inspections per permit allowed.
i:\ Building\Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COM/WEB
CITY OF TIGARD • -
BUILDING DIVISION PERMIT #: ELC2006 -00606
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/24/2006
Phone: (503) 639 -4171 /*NAi
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/27/2006 TIME: 7:01AM PAGE: 44
' SITE ADDRESS: 12447 SW 69TH AVE C T � av .\ At") CLASS OF WORK:
SUBDIVISION: TIGARD CORPORATE TER LOT #: OOC TYPE OF USE:
PROJECT NAME: HOUSEHOLD CREDIT SERVICES
DESCRIPTION: HSBC. (1) branch circuit for light 8, switch, LV. for voice/data. Job # 600706.30662.
OWNER: HOUSEHOLD CREDIT SERVICES, PHONE #: 503. 688.2083
CONTRACTOR: BROADWAY ELECTRIC - COCHRAN INC PHONE #: 503. 2346564
Inspection Request Scheduled For: Date: 10/27/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 038915 -01 503- 522 -7381 N
Co � A
rrr /Coomr enls /Instructions:
A PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: &-• N 6 ES Date: i O i 2•1 Phone #: (503) 718- *IV
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