Permit , CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00043
it DEVELOPMENT SERVICES DATE ISSUED: 1/29/04
'�° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 113 B 0 - 00600
SITE ADDRESS: 16580 SW 85TH AVE
SUBDIVISION: SEWER TREATMENT PLANT ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install (1) branch circuit for UPS.
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 WIO 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 #: LIC 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 -in
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.
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 7:00pm for an inspection the next business day
Eileen ical Permit Ap tioE I VEp FOR OFFICE USE ONLY �/ �J
City Ylf'�'igard Date/B : - / 10 c / . Permit No.: _/_ _,0 7 '_ t/ D 3
13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev
JAN Phone: 503.639.4171 Fax: 503.598.1960 9 2004 /�, Other Permit: � �;� Date/B
Inspection Line: 503.639.4175 - ._ � �. '' Date Ready/By: [uric: la See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGAR Notified/Method: I) (\ Supplemental Information
PLAN REVIEW
❑ New construction [ Addition/alteration/replacement Please check all that apply.
ID Demolition ❑Other ['Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating DBuildng over 10,000 sq. ft.,
, f., g ti,F SONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling IS Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION :',S,'.,;-. ` DEgress/lighting plan RV park
Job Job site address: /6 ❑Health -care facility ❑Other:
�� 5�(� S Submit 2 sets of plans with any of the above.
City/State/ZIP: 5 . . The above are not applicable to temporary construction service
t. no.: Project name: S FEE* SCHEDULE
Suite/bldg./apt. I Project O f Description . I Qty. I Fee. I Total I **
Cross street/directions to job site: t� 14 „1 New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. R. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
Each manufactured or modular
dwelling, service and /or feeder 90.90 2
/ i ' � _ � t� �( . L��'' 01 9 Services or feeders installation, a and/or relocation
200 amps or less 80.30 2
� ,,k 1, '% ,i- - r 1 TENANT 201 amps to 400 amps 106.85 2
� ° r' ' 401 amps to 600 amps 160.60 2
( Name: « j )' 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
Phone: ( ) I F ax: ( ) relocation
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
" E" ". '' ° ' . Fee for branch circuits with
�, A
� - ' -4, i 4 . v .",
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, ( 46 85
Address: each branch circuit /
Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not Included)
Phone: ( ) I 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: .1-C C 6 c 7 c
Address: r I ( Ai€ di 5 r- _ _ iF /l Each additional inspection over allowable in any of the above
`� Per inspection 62.50
City/State/ZIP: y e C> 4c,rC7 Investigation per hour (1 hr min) 62.50
Phone: ( fit, ) q) t 0 5'o C( I Fax: ( 3 to YO —3g 3 Tc Industrial plant per hour 73.75
ELF�RICAL PER `FEES* .. ,,,,,,,„4
CCB CCB Lic.: A c 7 Electrical Lic.: to CC l Suprv. Lic.: 9$ Subtotal Z- �• l
7
Suprv. Electrician signature, required: 1 Plan review (25% of permit fee)
Print name: ,(� P . �� Date: S /D State surcharge (8% of permit fee) 3. 7 5
T / /7:t TOTAL PERMIT FEE l a
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 \Permits\ELC- PennitApp.doc 12/03 440- 4613T(l0/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
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
is\ Building \Pertnits\ELC- PermitApp.dot 04/03
CITY OF TIGARD 2 -Hour
BUILDING Inspection Lille: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
off/ A BUP
Received Y ;/2 Date Requested '''q/ 3 /Y AM PM BUP
Location / lO 5 t g - ,4J Suite MEC
Contact Person 44-i , Ph ( 5(3) 4'( 9-0 0 9< PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner � Clivt_ f�v G c ELC �.r)
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: /� SIT
Post & Beam
Shear Anchors 611;
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:
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
arm
PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SIT Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA - / 3' l
Approach/Sidewalk Date �j Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL