Permit CITY OF T ELECTRICAL PERMIT
PERMIT #: ELC2001 -00250
A i4+1 DEVELOPMENT SERVICES DATE ISSUED: 05/16/2001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112AC -01800
SITE ADDRESS: 15055 SW 72ND AVE
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT : 046 JURISDICTION: TIG
Project Description: Installation of branch circuit to coke machine located on fuel island.
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: 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:
TRUAX HARRIS ENERGY COMPANY STW, INC
PO BOX 607 P O BOX 1629
WILSONVILLE, OR 97070 SANDY, OR 97055
Phone: Phone: 503 - 668 -7757
Reg #: ELE 3 -502C
LIC 145981
SUP 3155S
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRMT CTR 05/16/2001 $46.85 2720010000(
PLCK CTR 05/16/2001 $11.71 2720010000(
5PCT CTR 05/16/2001 $3.75 2720010000(
Total $62.31
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246-6699 or 1 -800- 332 -2344.
Permit Signature: , - Issued By: /
off ei,f epli_ ]? /414r4.r i t/./ :'
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: CT)? G% O. � in / /2/i4 DATE:
LICENSE NO: ` 5-5- 5
Call 639 -4175 by 7:OOpm for an inspection the next business day
05/11/2001 09:44 FAX 5036847297 City of Tigard (1002
i '"'"
• Electrical PermitApplication
0 ` )1 Date Ind. h (v of Permit no.: C.. - l 1 •
"':II City of Tigard ci h Projecl/appl.no. Expire date:
City of7gard Address: 13125 SW Hall Blvd Tigafd 97223 r j Date issued: By: Receipt no.:
Phone: (503) 639
Fax: (503) 598-1960 0 ' v� t file no.: payment type:
0;
Land use approval: V
TYPL OP PERMIT _.
O 1 & 2 family dwelling or accessory t. Commercial /industrial ❑ Multi- family 0 Tenant improvement
O New construction 0 Addition/alteration/replacement 0 Other L Partial
J01.1 SITE INFORMATION
Job address: t_ _ i , 0 1 ; ' 1 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: r lock: Subdivision: _
Project name: If ;�/1Tig izi " Description and location of work on prcmises: 0 if ' •IPI(/'
Estimated date of co . .Ietion/inspcction: IN 4 i A 1
CONTRACTOR APPLICATION •• FEE Sf :IIEDULE
Job no: Fee Max
Business name: ) .ZNG Description Qty. (ea.) Total no. imp
New residential -fi mub
e or6- fana77per
Address: ° 0 L , 9 q dwe�®it.iododesattaebedclrage.
City: i - P%) State: / , ZIP: 9 705 Ser.icr'mduderk
Phone: 4 • Z / i E -mail: 1000 sq. n. or less 4
Each additianal 500 sq. IL or portion thereof
CCB no.: A_ 9 6 U ( Elec. bus. lie. no: – fa , - G limited energy, residential 2
City /me ,;• lac. no ix . 3 —50- C/ Limited energy, non-residential —_ 2
- W I _ Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date – gra Service and/or feeder _ • 2
'Q ) 1 ..0 license me iv_ Services orfeedera Installation,
alteration or relocation:
PROPERTY Y O1i' N F R' 200 amps or i csa 2
Name : 201 amps to 400 amps 2
(P runt ) - 401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: State: ZIP: Over 1000 amps or volts 2
Phone: Fax: E-mail: Reoonnect only 1
Owner installation The installation is being made on property I own Temporary manias or feeders - .
which is not intended for sale, lease, rent, or exchange according to. Installation, T�OceaOm
ORS 447, 455, 479, 670, 701. 200 amps or l less ess — 2
201 amps to 400 amps 2
2
Date: 401 to 6 00 amps
Owner's signature: _ •
• L\G1\'EER Brandi circuits- alteration,
or extension per pan&
1•Iarrte: A Fee for brunch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
State: • ZIP: B. Fee for breach circuits without pntc p �
�maif of service or feeder fee, first branch Circuit: 1 4 ib &� r f dS 2
Phone: Each additional branch circuit
. < - PLAN RL11''% (Please ellcck: all that :Ippll) Mlec .(Serviceorfeedernottodndcd):
O Service ever 225 amps-commettial 0 ..t 1h.carefacility Each pump or irrigalioo circle 2
O Service over 320 amps -rating of l &2 - Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 squint feet four or Signal circuits) or a limited energy panel,
❑ System over 600 volts nominal more mesidentinl units in one structure alteration, or extensions - - 2
CI Building ovcr stories 3 Feeders, 400 amps or more *Description:
O Occupant Iwd ovef 99 persons 0 Manufactured structures or RV parks Eillth additional Inspection over the allowable in any of the above;
O Fgressllightingplan 0 Other. Per inspection L 1 1 1
Submit sets of plans with any of the above. Investiearion fee
The above are not applicable to temporary construction service. Other
2 16 I • t fk •�5
'Net all . ' & card mail • .. accept • - mil •• • - • tiro for , ornm�ad® Permit fee Notice: This permit application ( $ %) $ 3
ay.. u :, ,. and expires if a permit is not obtained Plan review az
Cie um surcharge 1 / within 180 days after it has been State (8%) $
Espial accepted as comp TOTA $ .50 .1 1 4)
N®te of eanlbol , • 88 • , , on Melt pod $ 6 �
,,,.,,,. ,,,��., . L e �� - 440.4615(6000C•OM)
"cam // • 7:
3
74 y
'CITY OF TIGARD BUILDING INSPECTION DIVIS
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested -‘ 14 PM BLD
Location j5 S - / Z "d I -' Suite
MEC
Contact Person c1/e47 Ph W7 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC / -0 D Z.1
Retaining Wall i . . — ELR
Footing Acces - / /�/ / 'T� /_ " /
Foundation w LQ FPS
Ftg Drain Ire 1. 2-W .. • ) e erNe " FK.eX Z Ia SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final / /f��ry
PASS PART FAIL l h q
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECT
Service nA
Rough In
UG /Slab. Cv h1 u c4 �...
Low Voltage
arm
S PART FAIL
SITE
BackfillGrading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin 1 Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA //
Other oach/Sidewalk Date ch --/Z-3 / Inspector 7, GZ ,!/ /h c,Qi Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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CITY OF TIGARD \\17 EXPENDITURE REQUEST D
This form is a multi -use form. Appropriate receipts and documentation must be attached to this
form. Approved request due Monday 5:00 PM to AJP for checks by Friday (week opposite
payroll only).
VENDOR NO.: DATE: May 16, 2001
PAYABLE TO : STW, INC. REQUESTED BY: Barbara Butler
P.O. Box1629
Sandy, Or 97055
MISCELLANEOUS EXPENDITURES:
Date Description, Invoice No., etc. Account No. Amount
5/16/01 Refund of plan review fees that
were not required for 15055 SW
72nd Ave., Tigard, Or. ELC2001-
00250
ELC Plan Check fee 220 - 0000 - 433040 $11.71
TOTAL $11.71
Mileage 34.5tt
APPROPRIATION BALANCE: AS OF: PURCHASING:
APPROVALS:
(IF UNDER $50) Section Manager/Professional Staff
(IF UNDER $2500) Division Manager
(IF UNDER $7500) Department Manager
(IF UNDER $25000) City Manager
(IF OVER $25000) Local Contract Review Board