Permit rr , P ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00046
DEVELOPMENT SERVICES DATE ISSUED: 1/31/2005
-- 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S109AC -02100
SITE ADDRESS: 14850 SW 132ND TERR
SUBDIVISION: ALBERTA RIDER ELEM. SCHOOL ZONING: R -7
BLOCK: LOT : JURISDICTION: URB
Project Description: Installation of (3) 200 amp or less temporary services and (2) 201 - 400 amp temporary services.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 3 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: 2 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: 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:
TIGARD - TUALATIN SCHOOL DISTRICT A C + E ELECTRIC CO
6960 SW SANDBURG RD 3535 DEL WEBBAVE NE #100
TIGARD, OR 97223 SALEM, OR 97303
Phone: 503 - 431 -4003 Phone: 503 - 363 -2301
Reg #: SUP 5021S
LIC 591
FEES ELE 24 -IC
Description Date Amount
Required Inspections
[UELPMT] ELC Permit 1/31/2005 $401.15
[UTAX] 8% State 1/31/2005 $32.09 Electrical rough -in
Electrical final
Total $433.24
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 fort 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 1 -800- 332 - 44
Issue y: _ / � � ! Permit Signature: 1;,';.(gallIf 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: C :r��'""` DATE:
LICENSE NO: 569-1 S
Call 639 -4175 by 7:00pm for an inspection the next business day
1 01/28/2005 12:04 503363230 AC AND E ELECTRIC PAGE 02/02
UU /uz /Luv4 wd:LI t.a... ou„i :JR CEl V ED ltl.=11KJ 1 4.1 0 02
Eliqtical Permit Appiicati 2 8 200 FOR OFFICE USE ONLY .
City' o Tigard Received / OS
13 (25 SW iatl Blvd., Tigard, OR 97223 DacelB ' �g ' / Permit 5 � �
Phone: 503,639.41 71 Fax: 503.595.1963 CITY OF TI , ^ �' Pianl�View
od, Pen ✓ /�
7
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Inspection Lint: 503.6394175 !aj
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BUILDING rtr '° ' Y y` ;
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tiv,ci.tigerd.or.us � � ( o
Nvtit7c
r: t - mental Information
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'":�E� �J��`FF'tt���lC�l�f�%?IY� }'I f a!�i �;.'f ° 'I
; 7i 1 F.� - . ��a' 'rro::�.ry: ",i�;�1�: -::,:� -�iFr.. ..A t.
l.•eF .I ['Yi . * N • y , ! r,,-i•'� �� 1. iii '(. g 7 :1•� :• Ai {�iiu:I +: a ? .,i �'ul!^, ',.'� �• is �F • ; i. : ��.. Supplemental
�v,.' L•.�N,.d.�:.(� SNl . r�: K}:,:iy,I� i� I.�I�SCi�w2SYr .•i'fS�. Ir- ..I..dI`.i °�fC�PN''ri��l �� :,:. �. ��.`;.I��' �� •i.� •..i.I, nL�adf.G;.�. '.i ar: Y ,,.
. 3r, 1,,:• A.:., lu.,. ':,r .;: a y ti,A!:hl- i'�,,;, �PFLP�i}1�•,, -r ';
i cw constrUCt1cn [] Addition /aiteration/replacetrlent Please Cheek all that apply; • -
,�� Demolition {{ Q pthrcr; I ❑ 1 Ser rice over 22,5 amps, camrz'1 ['Hazardous location
Ss�vtl �.F, } E 's 'iul f S�,. i¢ m N 4'. - 1; � l i {• n _ ;y. . , 0 Service over 320 amps - rating ❑Bullring over 10,000 so ft„
, . t v,•�,,I l � � t �'yi�' or i.. a nd a- idrnfl dwelhrt C
t • � � . �• , u cl ,,A,',, ,>E � ak ��h. �ltr:,t _ Y gs 4 or more new residential
❑ 1- and 2-family dwelling ❑ Commercial /industrial ❑ Accessory bulldog ❑System over 600 volts nominal units in one structure
El l'vltllti-family Q Master builder /4 Other: y.1, by / ❑Building over three statics �Peede�, d00 amps or more
' h ' j n:wi(' a i "' a �^1 one ^7: S';r'- .ru lj a.yt, br! EOccupant load over 99 persons EMenureecured
.ai'; Z31 11 utiQt?K•t• p CA! ;1 ! O',0.a;it io.t�c d.'ii Vi;iii,- "' � sill hti plan V
srs?a mt � F..• t ��jrs'lr7!i�i.�" C Eras B Txgp a R park ¢tructureS or
lob no -' lob site address J j ' 01- Iealth -care facility ❑Other
OHO '�'"' y �` ` r Submit Z ses of p1sn with any of the abye.
City /State/ZIP: J Q The above arena( applicable to temporary eOnsr u cti -n service.
Suitclbid
./apt. no.; /�` ' - ''i!'t u vl;l - 4'rl'I ' i; ' a ,iti ..t,.': :
Proj yet n �� - ,11, ',i es i gm , .m, ' - . , ; , , .. 1 ,.., , ,.. [y
single-or g - P �0: p _ � Nld . _�','�- , �W ° "Ghr� - : . ':.. .
�• � 4-- �+� - � Mil �. f j� t AeaarlpUOe Qty, Fea, Total Nil
Cross street/directions to job site: New residential multi - family dweiling unit.
Includes attached wage.
1,000 sq. ft. or less 145,15 4
Subdivision: Lot no,: 5. add'1 500 sq. O. or portion 33.40 — l
Tax I-nap /parcel no_: Limited energy, residential 71.00 MN
1 hi �" um• , Limited energy, non-residential 75 -00
'" T : '�-r _ AI o' r; tt a o „ A , iii t
' :ir. �A:3r. t. _ .,� �i 'ikh�';� �� ".' Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Sarvices or feerders lnStalisltion, alteration, and/or relocation
200 amps or less f 80,30 2
p i
{J g., . ;tt�� Ia.. _ .�'��,, - n , . ;�1f • �� l � G r�f ,5"� 41 a. a t � a � aznp5 106.85
�'--r �� 401 amps e [0 500 amps � 160.60 KM
Name: 601 snipe to 1,000 amps 240,63
Address: Over 2,400 amps or vets 454,65
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, an d/o r
Phone: ( ) Fax; ( ) relocation
200 a or less MI 66.85 20, 70
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps Mil 10030 O0 p Ell
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 : IMIIIIMMIMMEI
Owner sig ature: Date:
8 „hy:,:w "A: i "t�3';�l o '"•' ... , r, . .,.,.• ,••;� .�:_ -.—. -. - panel
•S •S
_ Branch circuits new, alti =rni ion, or extension, per
"' +rt i (.tih:�, ":6;15p ii z i Iii ,1ailZj '7',�'! l irl'1t�ty t^t;t)17a,. o l''y' py'^ e A. for b ctrauit W
'l:e:i(,�Lui r�l, l” 2iAJ It � ,. 9 �4 %• �� ;,�lill " r4�t �CS�FC�C�ii� 4�f'W's��,1"�1,� Fee A if�1
ser or f ratach e f e ac h IIIII
Business name: fi.65
• . Jt 1 � brnnch eirou {t
B. Fee for branch circuits
Contact Warne:
1 _ ti Q l "- h without service or feeder rocs 46.85
Address: -3s 3S- �1 tlje�� a each branch circuit
Each add'! branch circuit ME 6.65. IIIIIIIIIN
City /5taxe/ZIP; 0 e 6 ,, 6 p . 3) Mi9cellanetnis (service or feeder not Included)
PJlone (503) p Pump or irrigation circle 53.40 EN
( �) 3c,-- - 23c -2.... or outline lighting MI 53.40
E -mail:
4 „ ,, p P ,: Signal circuit
(s) s) or limited -
w'i?F, >':!f" - e..
F,q )jp, ^ .c ,:: ` ' D,�. f 0 ,r1. iFh.,! .
i : !.,,:Yti .F , w1 ;!
4 ., �al�,t a � k:.tyr d °' P % energy Panel, alteration. or
Bu einess name: �. _ . ��
Mosion. Dcacn'be: Page 2
Address: Each additional inspection over allowable In any of the above
Perinapacdon 62.50
City /State/ZIP: investigaoon per hour (1 Iv tniu) [ 62,90
Phone; ( ) pt( Fax: ( ) Industrial plant .er hour Imis 73.75 Ell
_ p ur r .oM.r
CCZ3 Lit.; 9 Electrical Lic - 50� S .! a k' !. _ - s, c .. ..,. ..� "':4` �i1 «' ''l .... .
Supt I.ie -: t Subtotal
Suprv. Electrician Signature, required: -f ( ) P lan r eview (25' /a of permit fee)
r A—
print name: 1 1,- u �) Date: i , z a 6 State sUrthmrge (5% of permie fee) � , p
TOTAL PERtvi,T)' FEE "1 5 ? 2-11
Authori2ed signature:
This permit apyltcatiftaaIt :aplres hb een If permit is not Obtained within 150
Print name: da y, ,cr e, acc es aoesp
D ate: - Fee tnR lY] dat O gy amt ), y Zri•County puiid tat Industry Service Board
^^' 1 •' Number of inspection: per permit allowed_
...Il Urrdiege.mafnVeLC•Pennte..00104 'alas 4.0- t6trniu a'JCOMJWae
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Linz:' ( 3) 639 -4171 MST
3
BUP
Received Date Requested ° AM PM BUP
Location /-' ? s� /,_3-), /7 ., Suite MEC
Contact Person R -- Ph ( ) 9 3 -- 2-3 -- 2) / PLM
Contractor Ph ( ) - SWR
BUILDING Tenant/Owner ,ems h../ ELC 6 °5- bao 44
Footing
Foundation ELC
Ft Drain Access: n
Crawl Drain 6 ` ELR
Slab Inspe i tes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Pr
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
Ee e - • " ' AL
Rough-In
UG /Slab
Low Voltage
larm
min ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 4 `� S Inspector 14 \A c ) \J 0 k./\ N Ext
Other:
Final DO NOT REMOVE this inspection record fro the job site.
PASS PART FAIL
•