Permit k I CITY OF TIGARD ELECTRICAL PERMIT
t: PERMIT #: ELC2004 =00044
:4611, el i 1 DEVELOPMENT SERVICES. DATE ISSUED: 1/29/04
` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S113B0 -00600
SITE ADDRESS: 16060 SW 85TH AVE
SUBDIVISION: SEWER TREATMENT PLANT ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 1 branch circuit to UPS facility. •
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: . 201 - 400 amp: - • SIGN /OUTLINE 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: WISERVICE 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: '
UNIFIED SEWERAGE AGENCY KEC ELECTRIC INC
150 N 1ST AVE ' 1281 NE 25TH AVE UNIT K
HILLSBORO, OR 97123 HILLSBORO, OR 97124 '
Phone: Phone: ' 503 - 439 - 0904
Reg #: L1C 99267
SUP ' 4489S
- FEES ELE 34 -426c
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 1/29/04 $46.85
[TAX] 8% State Surcharge 1/29/04 $3.75 Rough - •
Elect'I Final .
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 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. i
Issued By: Permit Signature: PC`y�,„, , - d____, L /
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 7:00pm for an inspection the next business day
•
• w
Electrical Permit Applic'g E I VE D FOR OFFICE USE ONLY
1.9 ? ' JAN `�
City of Ti gard 9 ZOO� D e t ' - 7- 63 Pemu D y _tea
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503 . 598 . 1960 CITY . OF TIGA�''''° ° 't ° !�I' Dam Other Permit
Inspection Line: 503.639.4175 6. Date Ready/By: Soria: ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVI' `= — Notified/Method: Supplemental Information
}
❑ New construction Addition/alteration/replacement T .E .OF WORK =. ;, .. PLAN REVIEW ' 4
Please check all that apply:
I=1 Demolition Other: ['Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
: ' CATECOR CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential
❑ 1 -and 2-family dwelling ommercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
Multi-family Master builder Other: ['Building over three stones ['Feeders, 400 amps or more
ID y ❑ ❑
Occu ant load over 99 persons OManufactured structures or
JOB SITE `INFORMATION AND LOCATION ''' RV park
" J _ �� ❑Egress /lightin plan P
['Health-care facility ['Other:
Job no.: . Job site address: j �, CC c � 8 Submit 2 sets of plans with any of the above.
City /State /ZIP: a, The above are not applicable to temporary construction service
O > . i .FEE * -SCHEDULE, -'-
Suite/bldg./apt. no.: Project name: �� O 5' Description I Qty. I Fee I Total
Cross street/directions to job site: AUY 4 3 � 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'I 500 sq. ft. or portion 33.40• I
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK `x Each manufactured or modular
% a � ,-of C dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
•
200 amps or less 80.30 2
amps to 106.85 2
❑ :PROPERTICOWNER ;. - ❑ ,TENANT
.• 201 mps t amps
401 amps to 600 amps 160:60 2
Name: (_ U) S 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
- ::...-"s: A. Fee for branch circuits with
.Q�APPLIC,ANT �`� �:® ,CONTA PERSON
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, t 46.85 i
each branch circuit
Address:
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
`: CONTRACTOR_;'. _ . energy panel, alteration, or
extension. Describe: Page 2 2
Business name: e C ELECt. /V G
Address: + O 1 N E c Ali, ) 1 . , L /V i - - le— Each additional inspection over allowable in any of the above
5 � f I1/ l/ Q Per inspection 62.50
City/State/ZIP: I� I L L.5 Q d R o OR f - 7 I _L I Investigation per hour (1 hr min) 62.50
Phone: ( 50 9 4 3e3 —041 014 Fax: (,5)3 10240-383 ? industrial plant per hour 73.75 • v .. ELECTRICAL :PERMIT :FEES* . , '
CCB Lic.: gga(o -7 Electrical Lic.: yaeoc Suprv. Lic.: q 48 g Subtotal /6.85
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) • G
Print name: / D\ , � /u Date: --Al _ II
TOTAL PERMIT FEE 5-t, t w
•
Authorized signature: This permit application expires if a permit is not obtained within 180
• . 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.
is\ Building \Perrniu\ELC- PermitApp.doc 12/03 440- 4615T(10 /07/COM/WEB
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i: \Building\Pamits\ELC -Pe mitApp.doc 04/03
CITY OF TIGARD 24-Hour
BUILDING • Inspection Line: (503)139-4175
MST
INSPECTION DIVISION • Business Line: (503)630-4171
BUP
///
Received 2 -- S Date Requested .=',//yy YAM PM BUP
Location /60 er
Suite MEC
Contact Person i<e-
«3 ()/ P LM
Contractor . Ph( SWR
BUILDING Tenant/Owner gai44 c—Cre4,6 < VC/
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
o
Fire Alarm iTh •
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:
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
m Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ART FAIL
'SITE 111 Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA #
Approach/Sidewalk Date - 5-- d Insp. - smaise"' Ext
Other:
Final DO NOT REMOVE this inspection record from the Jo site. .
PASS PART FAIL