Permit CI TY OF TIGARD ELECTRICAL PERMIT
40140 PERMIT #: ELC2003 - 00727
��I
DEVELOPMENT SERVICES DATE ISSUED: 12/18/03
. -
+L - 1 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S113B0 -00600
SITE ADDRESS: 16580 SW 85TH AVE
SUBDIVISION: SEWER TREATMENT PLANT ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Administration Building - Reconnect 40ton ground HVAC unit. Job No. 3056
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:
UNIFIED SEWERAGE AGENCY ELECTRICAL SOLUTIONS, INC.
150 N 1ST AVE 491 SW 4TH
HILLSBORO, OR 97123 GRESHAM, OR 97080
Phone: Phone: 503 - 492 - 0773
Reg #: LIC 99940
ELE 26 -872C
FEES SUP 2806S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/18/03 $46.85
[TAX] 8% State Surcharge 12/18/03 $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 952 -0 h0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -800 32 -2344.
1
Iss ed By: X I i ;i 0 ■ Permit Signature: ,l f / I 4 _
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: , 7 ? S
Call 639 -4175 by 7:00pm for an inspection the next business day
•
Electric Permit Application FOR OFFICE USE ONLY
lees Received lg. Electrical
Date/By: 7 0 3 Permit No.: ELC.a1G1d' - ev7 7
City of Tigard Planning Approval Sign
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other MC Lr�DD� �59g
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
Internet: www.ci.tigard.or.us �,�� o'1 Date/By: Case No.:
�I Contact Ju ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name /Method: / (j�, Supplemental Information.
TYPE OF WORK PLAN REVIEW (Plea se check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
IT: Addition /alteration replacement ❑Other: commercial ❑ Hazardous location
❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling f.Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Accessory Building ❑ Multi- Family ❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
/ / O �� A The above are not applicable to temporary construction service.
Job site address: ! b O S-7-4 FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: C tE44 w4,--. 5 fJz -1hcF S Description Qty Fee(ea.) Total
New residential - single or multi- family per j
Cross street/Directions to job site: dwelling unit. Includes attached garage.
12$CO I 40 K v ' Service included:
MO f,N1.'EQ 1 4 . . y A L t,, p,, t T 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
/�
14.v fit-c. (_. -e O / VWY &G7 a e or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City/ State/Zip: alteration, or relocation:
Y P 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
❑ APPLICANT ❑ CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits • new, alteration, or
Name: extension per panel:
Address: , A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of 46
service or feeder fee, first branch circuit I 46.85 6 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR , Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: 3 IDS Signal circuit(s) or a limited energy panel,
Business Name: e LE-el rate4.L saw aN1Z•ive Description:
or extension Paget 2
4 S 4T*
Description:
Address:
Each additional inspection over the allowable in any of the above:
City /State /Zip: GAS a a SZ . 4 708 0 Per inspection per hour (min. I hour) 62.50
Phone: 5o3- $$a - 3S6 9 Fax;,so 3 4 g 2- 07 7 3 Investigation fee:
CCB Lic. #: '[44 4a L ic. #: z- -- -4R "7- C., Other:
Electrical Permit Fees*
Supervising electricia Subtotal $ 4 N'
P lan Review (25% of Per
signature required: Permit Fee) $
Print Name: B Arizy g + _ Lic. #: 2 S State Surcharge (8% of Permit Fee) $ 3 6 e
TOTAL PERMIT FEE S S0 - - _
Authorized / l Notice: This permit application expires if a permit is not obtained within
Signature: Date: L - ( / /73 180 days after it has been accepted as complete.
CCCC ((( •Fee methodology set by Tri- County Building Industry Service Board.
a ( A
(Please pnnt name)
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (R03) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / 2 2 AM PM BUP
Location ( .S Suite MEC
Contact Person Ph ( ) 3 K d 35 (p 7 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3- De 7a 7
Footing
Foundation ELC
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 V N ti- 15 i (,J p
/ // 7:
Fire Sprinkler YV
Fire Alarm
Susp'd Ceiling (( mi�ll
Roof f I l>L, % V
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
Fire Alarm
� � � Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
l' PART FAIL
SIT Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA 2 Z,� n Approach/Sidewalk Date �� I nspector � `�. N166 Ext
Other:
Final DO NOT REMOVE this inspection re d from the job site.
PASS PART FAIL