Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00691
��, r DEVELOPMENT SERVICES DATE ISSUED: 10/27/2004
4' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 101 AC -01900
SITE ADDRESS: 12615 SW 72ND AVE
SUBDIVISION: LOWE'S HIW, INC ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Extend existing circuits to X -mas tree display via cord drops & add circuit for fireplaces.
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: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 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:
WASHINGTON COUNTY SCHOOL GREENWAY ELECTRIC COMPANY
DISTRICT NO. 23 9460 SWTIGARD STE. 104
12615 SW 72ND AVE TIGARD, OR 97223
TIGARD, OR 97223
Phone: Phone: 503 - 620 -6020
Reg #: LIC 153421
ELE 34 -617C
FEES SUP 5025S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/27/200' $66.80
[TAX] 8% State Surcharge 10/27/200' $5.35 Rough -in
Elect'l Final
Total $72.15
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: i , 51��2 Permit Signature: .s.e pr p Q
OWNER INSTALLATION ONLY, l i
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 7:00pm for an inspection the next business day
.7: 7:-C:::::e.'r. ••,.,.:: , ':.:..-, ;, .... ::;, ,ACBEDITtIt ' ..: - . 1' . ' , - 3 f ;
Description I QI7 Yen TOM *
New redden/IA single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. it or leia
Cross streeddirections to job site: 217 and 72nd
145.15
Subdivision: 1 Lot no.:
Tax map/parcel no.:
Ea. addl 500 sq. 11. or portion
3140
."''''. .:Wi...... " ;!.:::..;;S:=
1
Limited energy. retatiential
City/State/ZIP:
75.00
Fax: ( )
2
Unused energy, non-residential
..":.: iTt041044'
75.00
Address: 9460 Tigard St Suite 104
City/Stater/1P: Tigard Or
Each manufactured or modular
dwelling, service and/or &erica.
Fax: : (503-620-6124)
90.90
''' ' . ...i
Business name: Greenway Electric
Services or feeders installation, alteradon, and/or relocation
200 amps or less
Phone: (503-620-6020)
I
80.30
CC13 Lic.: 153421
2
201 amps to 400 amps
Print name: 3. 1 / 10/26/2004
106.85
Print name: I Date:
2
401 amps to 600 amps
160.60
2
601 MVO to 1,000 amps
240.60
Ova 1,000 amps or volts
454.65
Reconnect only
66.85
2
Temporary services or feeders installation. alteration, and/or
relocation
200 amps or lees
66.85
201 amps to 400 amps
1
100.30
2
-
401 amps to 600 amps
13175
Brunch circuits — new, attention, or ellenshat. per panel
A. Fee for branch circuits with
service or feeder fee, each
branch circuit
665
2
B. Fee for branch circuits
without service ar feeder fen.
each branch circuit
46.85
1.4
2
Each addl brunch circuit
3
6.65
11.9S
2
Miscellaneous (service or feeder not Included)
Pump or irrigation circle
53.40
Sign or outline lighting
53.40
Signal circuit(s) or limited-
energy panel, alteration, or
extension. Describe:
Page 2
2
Each additional Inspection over
allowable
In any
62.50
Of above
Per *petition
Investigation per hour (1 hr min )
62.50
Industrial plant per hour
73.75
V n. - 7 ..: i' '.': ;ELECTRICAZETRER!::
7 • , : - ;:i . .' , :'. .:. ::!;',
Subtotal
Plan review (25% of permit tee)
6..<
State surehargc (8% of permit fee)
TOTAL PERMIT FEE
- 1 Z.
Job no.: 304132-4 j Job
......,. .. .. ............ ..........-•
site address: 12615 SW 72 ud eve
City/State/Eff': Tigard Or
Suite/bldg./apt. no.: I Project name: LOWES
Cross streeddirections to job site: 217 and 72nd
Subdivision: 1 Lot no.:
Tax map/parcel no.:
' •: -. .. :1 ;.! .. ..c'• '. .. : ;:: :; ; : A ; .•; 1 : ... ..••••L':.!•'..• , '"'":..;.;-:::"r• ! ;.". : ;./I)SCT4QLO W•04(0111‘ ';'.. • '..:::,;.... •.'...‘•:'!..,••••
Extend existing circuit to X Man tree display via cord drops and add circuit for fire
places
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Name:
Address:
City/State/ZIP:
Phone:( ) - I
Fax: ( )
Owner installadon: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Owner signature: Date:
• -....• "..- :. 2 ..i..J. ; •. :7 •:.1:341 1- 0,T4c,AMC .: -,...... ,:..
Business name: Greenway Electric
..":.: iTt041044'
Contact name: Byron Hayziett
Address: 9460 Tigard St Suite 104
City/Stater/1P: Tigard Or
Phone: (5034204020)
Fax: : (503-620-6124)
E-mail:
''' ' . ...i
Business name: Greenway Electric
Address: 9460 Tigard St Suite 104
City/State/ZIP: Tigard Or
Phone: (503-620-6020)
I
Fax: (503-6206124)
CC13 Lic.: 153421
I Electrical Lic.: 34-617C I Suprv. Lic.: 5025S
Suprv. Electrician signature, required: 11
Print name: 3. 1 / 10/26/2004
Authorized signature:
Print name: I Date:
giget-rteal Permit Application
City of Tigard
13125 SW Hall Blvd., Tigard, OR 9)RECE
Phone: 503.639.4171 Fax 503,598.1960
Imipection Line: 503.639.4175
Internet: www.citigard.or.us
::.!; • :-1?
ID New construction
LI Demolition
ID 1- and 2-family dwelling
Multi-family
CO 39
v4iir
41 '
181 Comm.ercial/mdustrial ID Accessory building
Master builder 1:1 Other
M�N AND • WCAmV
OD OR110313 AVMN33d9
Rer4 `7 1 /,2 7 01 PermitNe: LA.296 q
lie Review
Denday:
Dale keady/By:
Notified/mated:
Omar Ponnk:
I 0 See Peat 2 tar
I I U I Supplemental Informetion
Rivo6w--
Please check till that apply;
0 Service over 225 amps, comet 0 Hazardous location
IDSersice over 320 amps — rating Dlluildng over 10,000 sq. it,
of 1- and 2-ftunily &ceilings 4 or more new residential
['System over 600 volts nri ptimo unit in one taucture
Oftuilding over throe stories 0 nodal's. 400 amps or more
00ocupant load over 99 paeans ORdanufactured structures or
0Egress/lighting plan RV park
ElHeahlt-care facility 00th Submit 2 acts of plans with any of the above.
The above are not applicable to temporary construction service.
mit permit application squires Ifs permit isaut obtained withei180
days after it beebeen accepted as_____
* Fee methodology sat by Tri-Cotaay Building Industry Service Board
VZT90Z9E0S BE:ZT Vei0Z/97/8T
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171
MST
BUP
Received Date Requested "� Z3 AM PM BUP
Location ` e � (a / S 7 r\ -tV•2_ Suite MEC
Contact Person i3 ( Ph ( ) g [ (o — (' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner / , C) i ) E S ELC o2 b d y' D d 6 cl (
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
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Anal
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab /
Low Voltage i\ / 0.
Fire Alarm
1 ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
$ 0 Please call for rei. spection r • 0 Unable to inspect — no access
Fire Supply Line `
ADA D
Approach/Sidewalk Inspector. Ext
Other:
Final DO NOT REMOVE this Inspection record fr m the b site.
PASS PART FAIL