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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00003 4 DEVELOPMENT SERVICES DATE ISSUED: 1/4/2005 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112DC -00500 SITE ADDRESS: 15895 SW 72ND AVE BLDG B 250 SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING. I -P BLOCK: LOT : 040 JURISDICTION: TIG Project Description: (7) branch circuits. 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: 6 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 R EALTY ASSOCIATES HILLSBORO ELECTRIC 15350 SW SEQUOIA PKWY #300 -WMI 21185 NW EVERGREEN PARKWAY PORTLAND, OR 97224 HILLSBORO, OR 97124 Phone: Phone: 503 - 439 -9666 Reg #: ELE 34 -4399C LIC 134481 FEES SUP 49415 Description Date Amount Required Inspections [ELPRMT] ELC Permit 1/4/2005 $86.75 [TAX] 8% State Surcharge 1/4/2005 $6.94 Rough - Elect'I Final Total $93.69 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 -800-33 344. Issued By: Permit Signature: 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 639 -4175 by 7:OOpm for an inspection the next business day F r om: H I LLSBORO ELECTR I C LLC . 5036013680 01/03/2005 17:21 #619 P.002 Electrical PerJ.01$10guk-'e.gi'L'inr,,' l'Olz OFTIC:E LSE OM .Y City of Tigard . - - Received , Date/Elv 1 0 13 i.25 SW Hall Blvd., Tigard, OR 972tkl 03 2005 il Plan Review Phone; 503.639.4171 Fax: 503.598, ' l''''rliciili'''` Date/13 . Other Permit: Inspection Line: 503.63i4-..., ..,:,!,;N.P ''':f. 1 .. Date Reedy/ay: IM El See Peg*? for Internet: www.ci,tigard.ocus MY OF TIGARD Notified/Meihod: Soppicoromat Information • •••• . . • .• • 1:5 1 141 1 rartV4DTK c-s • : :•• • : : • • • • • • '• . s ' . • . • • • • • . - • ' .. •••• PLAN REVIEW " • • • . • ' : ..% • ' 0 Now construction ddition/alteration/replacement . Please check all that apply; ['Service over 225 amps, comml PHazartious location 0 Den1OlitiOn , .. Other OService over 320 amps - rating Ej Buil dn g over 10,000 sq. ft., •*'• • ... .. • • CATEGORY .OF CONSTRUCTION.•• " • ' •::' .. •:. • :. . of 1- and 2 dwellings 4 or more new residential 0 1 - and 2 dwelling ommercial/industrial 0 Accessory building ElSystom over 600 volts nominal units in one structure 0Building over three stories inFecdcrs, 400 amps or more 0 Multi Master builder ID Other: .. . . .,. , . 00ccupant load over 99 persons El Manufactured structums or •:. • . y:::: s• . • JOB SITE INFORMATION AND. )1.0CAT1014 : :"•:: .: •:- ';. . .: c .'•*". • ElEgress/lighting plan RV park srNd ' . El Health-care facility pOthcr: _ . Job no.: 1 Job site address: \SSCSS ¶ ' 7z, 7 Submit 2 sets of plans with any of the above. • City/State/Z1P: \ ,',C. C:i-Z...., R122,5 " The above are not applicable to temporary construction SeNiCe. 1 i ... . .-----—'" c4.0.4014.. • . . • ..: .::- . .. :FEE"... SCH oly EDULE.. . .. ow .' .... • . . ' . . • :. . Suitc/bldg./apt. no.: - 219,D I Project name: ,..y.60 I" \ Q\ Cross street/directions to job site: • • New residential single- or Multi-family dwelling unit. - Includes attached itaragt • . 1,000 sq. ft or less 145.15 4 Subdivision: __ . • [ Lot nO.• Ea. add 500 sq. ft or portion 33.40 1 • • Limited energy. residential 75.00 1 _ - Tax map/parcel no.: ' . . Limited energy, non-residential 75.00 2 :.:. : .:.:::::.:••....;•;:: ■:: • :,, • :...: c,:;•. ,, .:.',. DESCRIPTION OF vvOlitk ::::.: Each manufactured or modular dwelling., service and/or feeder 90.90 2 — :' - .. CNJ e.- .4/1 ir•fNe. ... .- _ Services or feeders installation, alteration, and/or relocation AiiilklatallL l r: e•-• \L.% % ..■...)%. %t 200 amps or less 80.30 2 :.: ' •:*:, :',.: Owriril ':•:::.: - '01 amps to 400 amps 10685 2 • 401 amps to 600 amps 160.60 2 Name: 601 amps 50 1,000 amps 240.60 2 Address: . Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/Z I P: Temporary services or feeders installation. alteration, and/or Phone: ( ) • I Fax: ( ) relocadon 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 10030 2 intended for sale, lease, rent. or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 600 amps : I _ 2 Owner signature: Date: Branch circuits - new. alteradou, or extensioll, per panel •!......: ;:•:: '...,:,;ki,,..,.:.: 1:1..APpfICANT :•. .PERSON ..!i . A.. Fee for branch circuits with . some* or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: withour service or feeder fee. I 46.85 46. pc 2 each branch circuit Address: Bach add') branch circuit ( 6.65 1 52,,40 - 2 City/State/ZIP: , Wliscalianeous (service or feeder not included) _ Pump or irription circle 53.40 I 2 Phone: ( ) . Fax: : ( ) . - - Sign or outline liOning 53.40 2 E-mail: ' . Signal circuit(s) or limited : :,, .., :, :........: :... • • ..:: ,..e .. • coNTRAcToR ...1.!...4':!.":::;:: ,.. :...;:, :: : ::::' enema panel alteration, or extension. Describe: Page 2 2 susinessnarne:Hillsboro Electric L .10 .C. ' Each additional inspection over allowable in any of the above Addrcss: 21185 NW Evergreen PKWY J ae #110 Per inspection 62.50 , . City/State/ZIP: Hillsboro, OR. 97124 Investigation per hour (1 hrmin) 62.50 Phone: (503) 439-9666 j Fax: 03 )601-3680 Industrial plant per hour 73.75 _ - • • ••• . ::•ELEtTRICAL PERMIT FEES* • • - • ..- ' ..........:. . CCB Lic.:1 34481 Electrical Lic.:3 4 - 4 9 9C Suprv. Lic.: 4 941S Subtotal - i., fi Suprv. Electrician signature required: Plan review (25% of permit fee) MITI State surcharge (8% of permit fee) Elm Print name: Joey Vitacco Dam: \ ...-5 ....05 TOTAL PERMIT FEE Authorized signature: . This pct empires Jim permit is slot obta n , within 180 days after It has been accepted as complete Print name: • Date: • Fee methodoMay sot by Tri Building lodusuyService Board " Number of inspections per omit allowct Lasilding1PcnnitELC-PermitApp.doe 12/tr: 440461:1T(10/02/COMAVEB . / g • 511 CITY OF TIGARD 24 -Hour BUILDING Inspection LIne:>(503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested 7 AM 1--- BUP Location ! S� � Suite 8 a 3 MEC Contact Person Ph ( ) c? - PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC 2(2-S e O� Footing ELC Foundation Ftg Drain Access: ELR Crawl Drain Stab 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 ' ffrp 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 Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. — *LAW PART FAIL SITE 0 Please call for reinspection RE: D Unable to inspect— no access Fire Supply Line r� ADA Approach/Sidewalk Date a 1 " ©5 Inspector 14 ki1 14CL Q V, �� Ext Other: Final DO NOT REMOVE this Inspection record f rom the Job site. PASS PART FAIL