Permit , rV CITY OF TIGARD ELECTRICAL PERMIT
A PERMIT #: ELC2004 -00291
DEVELOPMENT SERVICES DATE ISSUED: 5/25/2004
'I'll 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S135BD-00400
SITE ADDRESS: 10895 SW 95TH AVE
SUBDIVISION: ZONING: R 12
BLOCK: LOT : RISDICTION: TIG
Project Description: Panel change and 4 branch circui . 7/8/04 added 5 circuits to this permi
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: 1 W /SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 5 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:
GILLIGAN, NEAL WEST SIDE ELECTRIC CO INC
10945 SW TUN ICA 1834 SE 8TH AVE
TUALATIN, OR 97223 PORTLAND, OR 97214
Phone: 503 - 463 -7731 Phone: 231 -1548
Reg #: LIC 13306
SUP 2663S
FEES ELE 26 -135c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/25/2004 $106.90
[TAX] 8% State Surcharge 5/25/2004 $8.55 Rough -in
[ELPRMT] ELC Permit 7/8/2004 $33.25 Elect'l Final
(additional fees not listed here)
Total $151.36
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: A _ ( 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
Electrical Permit Application
City of Tigard REcEyEA D `y: P No.: .� g
13125 SW Hal] Blvd., Tigard, OR 97223 any a
t Review
Phone: 503.639.4171 Fax: 503.59L1960 ny `1t Date pple/rty; Other Permit; .fr
Inspection Line: 503.639.4175 JUL 8 .. . .�l I I Dat9 rOady /Hy: Juror: 10 See Paget ant .. —....
Internet: www.ei.tigard.or.us Notified/Metbod: Sipplementai la(Orunation
TYPE GSM TIGARD PLAN REVIEW
^' 'r "r i t Please check all that apply:
[3 New construction ddilignL)tg[`3itibn/replacemcn PP Y
i=1 Demolition Other: ['Service over 225 amps, conlrn'l 01- lazurdous locution
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. R..
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
Ivlulti F &rllily ❑ 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 0Egress /lighting plan kV park
1 4/7 / !� J v !) Ci j 5 ( j q S - ❑ilcaith -care facilit ❑other. .
Job no.: J CJ Job site oddness: " - --
Submit 2 sets of plans with any of the above.
7 ?
C 2. Z
City /Statc/ZIP: -----• The above are not applicable to temporary construction service.
tz ��_: 1
Suite/bldg. /apt. nQ_: Prujccl oiamc: 1 r,]t. � l (' r
— ` { +l� � " � DacrlPttw FEE' S' SCHEDULE
r 1 Qty.' Pte. I Totn ""
Cross street/directions to job site: ((( � •
New residential single- or multi- family dwelling unit.
Includes attached garage.
_ 1,000 sq. il. or le 145.15 4
.r.r
Subdivision: Lot no.: Ea. add'l 500 sq. R. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel n0.= Limited energy, non - residential 75.00 2
A-64 DESCRIPTION OF WORK Each manufactured or modular 7 rr t / dwelling, service and /or feeder 90.90 2
C ? 4 r-4 70 � L a) ci ( Services or feeders installation, alteration, and/or relocation
r_ ,. � 0 t , 200 amps or less 80.30 2
ii. I-(, 201 amps to 400 amps II 106.85 2
0 P1tOP a OWNER 0 TENANT
401 amps to 600 amps 160.60 2
Name: \Ii . r' t 601 amps to 1,000 amps 240.60 2
Address: - Over 1,000 amps or volts 454.65 2
Cis S IrJ !' (. i s. !.. Reconnect only 66.85 2
City /State/ZIP: q ? 4
l�ta t'i't b 1 , Z. Temporary services Or feeders installation, alteration, and/or
relocation
Phone: (57)>) 4( _3 _772 ! Fax: ( ) 200amj)s 66.t {5 1
Owner installation: This installation is being made on property that I own which is not _ 201 amps to 400 amps_ ____ 133 -75 2
Owner signature: bate: Branch circuits - new, alteration, or extension, per panel
0 APPLICANT 1 "CON?ACT PE RSON ' A. Fcc for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.45 2
• B. Fee for branch circuits
Contact name: wirhuur s ervice o feeder fee,
46.85 2
each branch circuit
Address: .,
Each add'l branch circuit 5 6:65 < J < 4 2 M
City /State/ZIP: Miscellaneous (service or feeder not included) '"
Pump or irrigation circle 53:40 2
Phone: ( ) : ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, aiteration, or
extension. Describe: Page 2 2
Business name: WEST SIDE ELECTRIC CO. _
Address: 1834 SE 8 AVE. Each additional inspection over allowable in any _of the above
.. Per inspection 62.50
City /State/ZIP: PORTLAND, OR 97214 Investigation per hour (I Iu_u,i ■t) 62.50
Phone: (503) 231 -1548 Fax: (503) 736 -0677 Industlial plant per hour 73 —
-. - ELECTRICAL PERMIT FEES*
CCB Lic.: 13306 Electrical Li ' 26 -135C Suprv. Lie.: 2663S Subtotal 3 1, 2 S
Suprv. Electrician signature, required: 1 „ / Plan review (25% of permit fee) r
Print name: �� a � Date: --7/...-3/ State surcharge (8% of permit fee) , ' h
v.�tw._'� TOTAL PERMIT FEE I ,�_
Authorized Tilts permit signature: _ ........-- uzplrea it a permit it not obtained within 380
days alter it has been accepted as complete
Print name: Date: - Fee methodology sot by Tri -County Duilding 111duatry SuaVic• Dour)
•* Number of inspections per permit allowed.
iAlhaildinglParmitatELC •PcrwltApp.doc 12/03 440- 4615i(10t02/COM/WFM
Z LL90- 9EL(E09) '00 0i-l' T3 aP'S asap[ ez + '0 BO inC
C ITY OF TIGARD ELECTRICAL PERMIT
.A • PERMIT #: ELC2004 -00291
S DEVELOPMENT SERVICES DATE ISSUED: 5/25/2004
J.- 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S135BD-00400
SITE ADDRESS: 10895 SW 95TH AVE
SUBDIVISION: ZONING: R 12
BLOCK: LOT : JURISDICTION: TIG
Project Description: Panel change and 4 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: 1 W /SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
GILLIGAN, NEAL WEST SIDE ELECTRIC CO INC
10945 SWTUNICA 1834 SE 8TH AVE
TUALATIN, OR 97223 PORTLAND, OR 97214
Phone: 503 - 463 -7731 Phone: 231 -1548
Reg #: LIC 13306
SUP 2663S
FEES ELE 26 -135c
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 5/25/2004 $106.90
•
[TAX] 8% State Surcharge 5/25/2004 $8.55 Rough in ELGG • 5OR1/ CE
Elect'I Final
Total $115.45
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: IL)G,t 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: )J S
Call 639 -4175 by 7:00pm for an inspection the next business day
.4 . 1
.
',... / , •
. .... ?
111,'iciStrical Permit A ) )licatimi. \fiEl . FOR OFFICE USE °XVI'
City of Tigard
R . 7 i _ 7 ____
It cc./ 1 vehl . 4 v 66
.. fletteilly: ' Permit Nii,d0_601 ...--ed,A 4 77
I 1 I ?...) NW I lull I tivd., ligard. OR 9722:1
ipacIli 1.1:1 itevic _____ ._.
Other beeniiI
Inx ,
1'1mile: ' 171 Fax: 503.598.190V 2 4 ..._ ,„,.* DaivIlly:
peC tion 1 .ilu... 503.039,4 1' 0 A ...I late Iteady/0y: J..•.- C s (4 See Pow: z tor
n
Iternet: www.ci.tia
grd.or.iis .. kGp,BU Notitki.vmotiu.i. .. iiituntimion
e ..., {f of •.. _,..,...,No 7 ... ... . . .. .. .....
TY itir... )khwAlliklOt PLAN IIEVIFAV
I I New construction C/Ct4tlitlii.;11eration/replaccincnt I'leoso check all that apply:
EISt.o over 225 amps, comull 0 1 lazanious location
( Demolition 11 Other:
DServiee iwur 320 ;wile; riling ott,,ikin I ()moo :;.i. It .
C.ATECORY ()E CONSTRUCTION 01 I • ;Ind 2 l'arnily dwellings 4 or more new residential
'''-'-- and 2-11uniIYdwel I in); E1 Contnicreial/industrial (1) Accessory building 0Systero over 000 volts tun nitial units in One. Ste1.1.AU IV
0 I 11 li ;Cline, I/ 40.1 thrtNi ,ittliiit:t 0 1 Its.r,i, 400 :Jill's: im h tort:
L j tvInlii-1;imily fl rviti:;tei. buiido, 0 ()there
['Occupant load over 99 persons DM ataillicwied structures or
' . .....
..101t SITE INVOlt MATION AND LOCATION 01 plan RV park
nlleolth-core facility ID uhei.•
Job no. 75 -76 _ , f' I Job sim addross: 10 E 4. 5 5, (K : C.._
....__. SUIlli li I 2 sets of planS With :kny of the above.
-----
( !ity/Statc/Z1I': _...1 ( c ,- ! e l, 7 1- 3 The Dhovo :1,.. ,),.1 mmiit t 1,..,111701; eolisirilei1011 soviet.%
----
....
Suite/bldr./..tpl. no.. Prop, .(.1 nonx., yL t _............. " i,, .. 147.sdi t E _____ ..._ ..____. . .. . .... - -- - ---• -- - f
. 4, 1 &,,,_f ,-,-.._1.,, „,•,..,, 1 " i 1- 1_ . .? 1 •.".
Cross streel/d irectil MS to job !Me: Nov ees ii/enlial XI 11gIe or multi-Ctunity dwelling unit.
• Includes attached garage.
1,00n sq. ft. or less 145.15. 4
--......___ .. - .
Sub& Visi110: t Lot no Ea. add% 500 sq. el. or portion 3.3
1.,iiiiileclencrgy, residential 7.S.00 2
Tax map/parcel no.: .... ...
limited energy, non ia I 75.00 2
DESCRIPTION OP WORI: 1itelt manufactured or modular
.. d r
dwellinc, service and/or feeder 94).00 2
v..rs,,e,. 4" 1 ." 4, 4 S ke. ....- ,. Cr / a
=.1._ 1*. -- ( k. tij(3 1 \ 4 ?. % '.',6 . ServIreN feeders installatim;, alter,' ion, :truth) - retilco hot
/ 200 !MTN or Itt.
6.■ r t w).30 947. 3.v ?
201 al rips to 400 amps I 00.X5 2
It: PROPERTY OWNER
I 0 TENANT
401 antes to (4)0 snips Is 00.60 ',
Name: r
' 0 C.C.A.... ..... _........i.g_l_g_ t"A 001 amps to 1,000 amps 240.60 2
Addres e L ._ s: ) c t c C
_2 G.-) ---- i
I .(4. vk L G.61 Over 1,000 alips or volts 454.05
Tietit)1111e(il tlilly
.,
2
Cily/Slate/ZII -- k.. -- c,: , . •-t- i: vt _ 9 -7 6 1.. 2 Temporar services or feeders installation, a Ilei-a tion, :111(1/01:- -- ri.ltira ('III
Ph011e: (...)',... c 3__ 7 73 1 I I ( )
200 all IrNi or less 06.1-5
Owner installation: ThiN installation is being made on property that 1 own which is not 201 alopx In 400 amp 100.30
intended l'Or snlo, le.ilse., rent, or eXCIIL10).4C., according 1.0 ( )RS 447, 449, (i70, 011(1 701.
401 ainns In 0411) ;imps 1.1.1.75 2
..
Owner signatu . re: Dare; Branch circuits- new, alter:Win I, or• e.'10.1ision, Inv panol
, . ..... .... ..
__. . . . . ,
0 APPLICANT
1 0 coNTAct 1.
A. Fee lhr branch circuits w /ph
_..... .. ..
service or feeder fee, each
44 05
Busi 0055 norne: branch circuit .. .. _ ___..... _ 0.
. ......._ ...__.._.._...
.. . _ _________._..
13.. Fec for branch circuits
Contact nanw:
whhemt service or feeder Ice,
____.......
40.S5
_ 2
cacti branch circuit
Address:
____ ..... . 1:ach aild'I branch circuit 6.05 2
Cily/Slaie/ZIP: Miscellaneous (service ni I not i nelti tied)
-....._._ .
• - --- '''''' --- l'unip or irrigation circle 51.40 2
Phone; ( ) I Fax: : ( )
Sign or Outline liglitiur, 5.1.40 2
E -mail:
. ___
Sival eireuit(s) or limited-
______....... .. ......___
CONTRA(7ro ___ R energy panel. :ilteration, or
...__._ .
---- --- extension. Describe: Pot,e 2. 2
litiincss name: WEST SIDE ELECTRIC CO.
. . . ..._
Address: 11i4 SE ti AVE. _ _ Each additional inxpectioil Over ulluw; tile III any or (lie above
.. ----••• - • - . Per inspection 0.50
Cif y/Sime/7.1P; PORTLAND, OR 97214 Investigation per hour (I lit Juno 62..50
....._____ . .
...___
Phone: (503) 231-154x Li,,,„„(503)"(,_0677 Industrial plain per hom. 73,T.
— __........ . .. . ...._ ict,i;:clIZICAI, RMIT TEES*
C.C.11 Lic.: 1330G i Electrical 1 f Suprv. Lie.: 2663S
Subtotal 106,
Suprv. Electrician signature, required:
. is )/ -2_A...i...4.-.............-,_.-
( Pla
n review (2: or permit lee)
State surcharge (8 .4 01 po Mil li.i.)
1 FD c c",...
.....- .
- (.:-._____ TOTAL PERMIT FEE a q
Aui horized si gnatur e:
- •riti■ expires ir Cl permit ix 11 ;1111;(11iNn —
.. _ ._.._ . ...
(lay. tiller it Max been accepted Ilk complete
Print narrie: Date: ' ICs: ox.'111k1dotne,y set by •Iii County Building Mike:11'y Neryii•i: lioxill
• ---- ....-
"•-•---•-- ''"' Number olinspeeliimS per p1 11111 allowed.
i 00(1) 440-461 51 1 110 02/COM/Willt
•
2 ' d LL90-9EL(EOS) ' 0 T- 1 2.0.9'13 sets asaM dS2:E0 i7o 1,2 Rew
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received / Date Requested AM PM BUP
/
Location 0 8Q - cT5-- Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 2 -' 9 4 64 / — aD 21/
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 i`7 I P n _�� Fag— F/ Al
Drywall Nailing W
Fi rewall
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
- Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
'AS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA 4 l/ ' 1 " y
Approach/Sidewalk Date - ` o Y Inspector 4M PL�r ( Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL