Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00351
l v DEVELOPMENT SERVICES DATE ISSUED: 6/15/2004
A II 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 11380 -00600
SITE ADDRESS: 16580 SW 85TH AVE
SUBDIVISION: SEWER TREATMENT PLANT ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: 1 branch circuit to gas flow meter.
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 FARNHAM ELECTRICAL CO.
150 N 1ST AVE 1050 LAFAYETTE AVE
HILLSBORO, OR 97123 MCMINNVILLE, OR 97223
Phone: Phone: 503 - 472 -2186
Reg #: ELE 36 - 3C
LIC 1217
FEES SUP 1597S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/15/2004 $46.85
[TAX] 8% State Surcharge 6/15/2004 $3.75 Rough -
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Ore on Utility Notification Center. Those
rules a r -- orth in • = - 952 - 001 -0010 thr•u• h • A - 952 - 001 -0100. You may obtain copies of these rules ' ect questions • OUNC at (503)
246 .699 or 1-800-332-23
1, . iii ' i __
I ued By: ■ !11�,� T& v _. /4, : Pe rmit Signature: 1:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: �'_' _.G . ..ii i/ ' . — DATE:
LICENSE NO: /SY 75
Call 639 -4175 by 7:00pm for an inspection the next business day
Jun.15. 2004 10:45AM farnham electric co No.4791 P. 2/2
Electrical Permit Application : - OFFICE [.ISE.fll�.y
Received RQ g Electrical /,,, y- O(� �rJ
Ds , i 4 4) Permit No.. , �O I
C1 Of Tigard `` plui mng / • •rev R S i
n
/ v lan : etlpltNo.:
13125 SW Hall Blvd. Plot Review , Other
Tigard, Oregon 97223 �' �� De rJ . Permit No.: •
Phone: 503 -639 -4171 Fax: 503 -598 -1960 •
+� d'?r Post Review Land List
• • ;';: tt `
Internet www_eitigard.or.ttS -e ei � rrj '.!!I ! DatdB a No.:
Contact � � Set Page 2 for
s+.vn w
24 -hour Inspection Request 503- 639 -•4175 J' Name/Method: liiV Su. temente! Information.
_� ;'iyr i : b + i,`:� ..: ' � i I . 1 .el
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�.� �+ i - y'�tW �:`:': �. +��,•,r,, yy�� i11;'�" � m S' .; �'2}i��' J• w y '. �� : �� , A ' j1�E .. (j° fR$S.#3 rU�l`,►� k } ._ "�.:'� �•
.d ,,..���j1+7 ? _ :::1 ii �'.._. .:iL?= k�.4+iil :�'�Tlp _..•: �P,rr
Scr I T Ic over 225 carps- El HeaIth -taro facility
Net COI1StrliCt70)2 _ ■Demolition _
commercial El Hazardous location
Addition/alteration/replacement • Other: z — 0 Service over 320 amps- rating of . 0 Building over 10,000 square feet,
�� A k"?�'.p.1�t115 ?� aTl' ` A: ; client 1% t11.4,.:��-;'i'�;j:� I &2 &2 family dwellings four or more residential units in
ri 1 842-Family dwelling ) .14 Com.mercial/Industrial _ 0 SYstetn over 600 volts nominal one structure
❑ Building over three static' ❑ Feeders, 400 amps or more
• Accesso Buitdin , Multi- Family 0 Occupant load over 99 persons [] Manu1 oiured struauios or RV pork
• Master Builder • Other: ❑ Egress/lighting plan p r.
Othe
} :r.'�� s � Submit sets of plans with any of the ahem
_.. �..�, I F J ' � ' � MXtt i ' ON: - The above are not applicable to temporzary construction service
/4
Job site address; . • 5, i _ { E 7—'.f .. • 4 •'Wailkl "iCItiirWit'SdaZ 5 : r" 1.
Suite #: Bldg. /A it. #: Number of ,a ;peetfous per permit allowed
Frde Name: I • , + ; Description Qty I Fee (ell) _ 'total 1
. /.. , I!� 1f __ . .. New residential-single or malts - family per
Cross street/Directions to job s - • dwelling unit_ Includes attached garage. .
5e c3 . 7).akiiitir Rd, 1000 sq. Included: l
145.15 4
- Each additional 500 sq. R orportion thereof 33,40 ]
Limited oicrgy, reaiderttial 75.00 2
Subdivision: _ I Lot #: Limited energy, non resicential _ 75.00 2
Each manufactured home or modular dwaliing
Tax map/parcel parC61 r : tryy ,�,,�.���, 7Pyrr.�r��e�, ���7e}}���tly��±J��fj.. r ��� r terrine oodler feeder 90.90 2
1 1,• irr+ r ` AtiAAR�+��sW�LItiYL'V1✓. tN .M {�� A ... r J,�,';,i'
7&wit r.x.r •d.,a ..r
�;wr.'�6i:��' Serried or feeders - ;astaltatioo,
'170 1 If £ 4 5 �Pi r i c M C# .t , attention or relocation!
200 woos or less 80.30 2
. 201 amps to 400 drops 106.85 2
401 woos to 600 amps _ - _ 160 -60 • 2
t pN 1! 2111 r5 ' Vw p;, � � :NIA �5• ; 5 - 601 ampe to 1000 at pe , 2240.60 2
,•; = " + w S,L7 a ,. Over 1000 arms or relic 454.65 2
`
Name: O. /E4,v 4.1 . : - Reeotmcet only i 66.85 2
/j ` Temporary servieee or feeders - instail&tlon,
Address: 25515 v�7 / �✓ L 1 ►L •. l�( 1 alteration, or relocation: ]
City/State � /4 i� &m7 GHQ 9 7 zoo amps or less
Fax: .613 201 an to 400 am • 100 -30
Phone' • 6$ - . • Q 4oi m 60o amps 133.75 2
i•`. �irilrrt•IV,. i1n;:,;.te;txrIl ., MMO • dPliageirt - Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee far branch circuits with purchase of
Address: service nr keder fee, earls branch Circuit 645 2
-
' Ci /State/Zi : e. Pee for branch circuits without prat tease $,,,, p / 85 ,i 2
service or feder fee first branch circuit. Tf�
Phone Fax: Eaeh additional branch circuit - I 6.65 2
Mirc(Seivice or feeder not Included);
E -mail: Each pump or irri lion circle 53 -40 2
sa i'k `if �r ., 7, .- 1;:.r,....aa : idita ,0 � ; :r. - :,:,, l c._, E.h ai orodoihe liRhtink 53.40
Job No: Z _ signal circuits) or a limhod energy panel,
/� alteration, arextension r rage 2 , 2
1-i
Business Nar e: 2RA /c (O. - Dcstrription: .
Address: a S4 4(E' _ & i 4 ' .
�- Each additional inspection over the In any of the above
CI /StAttZl ; �„( /4/��J(� - _ Pcr instzction per hour (min- I hour) 6250 '
Phone:56 . Fax: 46 ...e. - A.,Ir Investigation fee; _ .
/vT] T iC. '.J /2/ Lie. #: ` .� Sts Th_+41 ' '' :��•.•. ,y s j;P l " e� 3..; "� r;•".0 '�`
Supervising electrician '. , ( h . $ • ice
Si_ a afore re•Lilted: _ Plan Review (25% of Permit Fee) S .
J ,---. SzRte Stucb } t 8% of Permit Fee S
Print Name .�_ A/ ti ��Q�GhI Lic. • rr . %�97� TOTAL PERMIT C $ SlZ 6a - --
Authorized Notices Tills permit application expires if a permit is not obtained within
D 180 days after it has been accepted as complete.
Si � hANCC *Fee methodology set.by Trl -County Building Industry Service Board.
(Please print name) •
CITY OF TIGARD 24 -Hour
BUILDING Inspection...e:.(503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 6-142 AM PM BUP
Location / r!o 5 8Z 316
T v Suite MEC
Contact Person Ph ( ) SS " D 8 q3 PLM
Contractor Ph ( ) 11 SWR
BUILDING Tenant/Owner r�tJa- ELC V—d 6351
Footing
Foundation ELC
Ftg Drain Access:
ELR
Crawl Drain ri SIT
Slab Inspection Notes: Y� �7 .
Post & Beam 0-"r ( %�
Shear Anchors
Ext Sheath/Shear /4 i eL6e—F--4.
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
Fire Alarm
Y Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line I� y
Approach/Sidewalk D ate - - 6 ✓ Inspector riM. 4 fT Y Ext
p 6 1
Other:
Final DO NOT REMOVE this inspect on record from the Job site.
PASS PART FAIL