Permit • CITY OF TIGARD . -,, a ELECTRICAL PERMIT
PERMIT #: ELC2003 -00579
I
DEVELOPMENT SERVICES DATE ISSUED: 9/17/03
° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 114A0 -01500
SITE ADDRESS: 17005 SW 92ND AVENUE
SUBDIVISION: ZONING: R 12
BLOCK: LOT : JURISDICTION: TIG
Project Description: Concession stand - Alteration of (8) 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: 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: 7 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, CITY OF WILLAMETTE ELECTRIC INC
13125 SW HALL PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 503 - 624 - 3631
Reg #: L1C 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/17/03 $93.40
[TAX] 8% State Tax 9/17/03 $7 Rough -in
Elect'I Final
Total $100.87
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 mor an 180 ay .. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth ' OAR 952 - 001 -00.0 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -8 - 332 -2344.
/6V Iss ed By: 1K �� ! _ Permit Signature: 1 / / _d' !:!%/ �� ; ... 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• ` .d .Co , Co eU - - DATE:
LICENSE NO: /965-5
Call 639 -4175 by 7:00pm for an inspection the next business day
SEP.1- 2003 11:04AM HP LASERJET 3200 p.2
Electrical Permit A p p l i c a t i o n F o l t z OFF«:F US QNLY
Received �P't Electrical ��.. nn
Date/Bv / /o &. A.0 _ - /0 , e
City of Tigard Planning Approval Sign
Date/Bv. Permit No..
13125 SW Flat] Blvd. Plan Review Other
Tigard, Oregon 97223 DatJBv. Permit No.:
Phone: 503 - 639 -417L Fax: 503-598-1960 Post - Review Land Use
Internet: a w w.ci.tigard.or.us .' C� ct A ' ►1 See Page 2 for
24 -hour Inspection Request: 503-639-417 r ' IW
Name/Method �i .lementalInformation.
-" , 71 , :. ]1�' 1.. arq+^ �< 'T , ... � 11 • C 11,fc„ � ' , u q• � • t°i'1 °w t � MOW
:,K - - „�'s
i 1 i .S E 1' n� k` `� .' . {i L �b"P� Z 11 i „ r , T a .- AT , J ro
�. 7 � aee�:�1� , $:iv._m'.t„�w� .a r � • I�i'L,. . r�,rl�.rn�rYs i J n, eY. b- n.A:��.... . ,.�t�>r::l� :'' ; .s
Ii New construction • Demolition • Service over 225 amps- • Health -care l cilit
commercial ❑ Hazardous location
on Oth
❑ Addition/alteration/Teo � /reolacement Other: ❑ Service over 320 amps-raring of ❑Building over 10,000 square feet.
,' , ' ,I •. :iti�' .:b` i . Art „ ' t l ; i ' " f t ( + ', ' I & ' farmlY dwellings tour or more residential units in
❑ 1 & 2- Family dwelling In Commercial/Industrial ❑ System over 600 volts nominal one structure
['Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building • Multi-Family ❑ Occupant load over 99 persons ❑ Manufactured structures or R \' park
n Master Builder ❑ Other: ❑ E plan ❑ Other:
l i o f ; w,°, q• / t ' 9^ d 1 s ^_°:. Submit sets of plans with any of the above.
``t r 41 k�'r �1 t s t ai e t:.i L 9 + �#
Fh ul,alti.t: oa. d ess ? - °_ sS 'gt The a are not a , hcable to tem Drat construction service.
-r
Job site address: �;a /'7 W te :G� . ;, v� A t � k �,
� 1..4.$�dl ". � .�, +. a9. ..,;':o. ��t4]'I. _ .. . .. � � � ' � LL N 4 .ie �l�
Suite #: I Bldg./Apt. #: Number of inspections per permit allowed
Proje Name: r^ <s. ST,4,,, ,,1 Description Qty Fee (ea.) Total 1
J L e t IC l r t�rF' c 4.
Cross street/Directions to job site: dwelling ark. [ single or ta ched a ra per
� dweuing unit Includes attached garage.
Service Included:
C f,l._C pe r , c is, - , C 1`ct. rnr ..: I000 sq. ft or less 145.15 4
Each additional 500 sq. ft or portion thereof 33.40 1
Limited-energy, residential 75.00 2
Subdivision: I Lot #: Limited energy, non residential 75.00 2
Tax ma a / s arcel # } q Each manufactured home or modular dwelling
" i �.. ct ,. a lli' . ' [x..� ' Ws' se Services e feeder
Serviees or or feeders - installation,
L ,. a�.3 , \ (3, T 'k.S alteration or relocation:
200 amps or less SO 30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
y ,p* i , a, ^ • 601 amps to 1000 amps 240.60 2
1t i1 1 . , :.' k ._..,. t ti Nat
Over 1000 amps or volts 454.6:F 2
Name. L.( �' U j 4 , - y y 1 Reconnect only 1 66.85 2
Address: Temporary or feeders - installation,
alteration, or relocation:
City/State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
}may ,,; a . ,,,, 401 to 600 amps 1 133.75 2
pp @tu+d' E� �;,,•`� L' u * ai . . ' Plat lfiri ,trsi Y, ? Branch circuits - new alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee. each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits w purchase of p y/ _FS
service or feeder fee first branch circuit ( 46.55 Y ` 2
Phone: i Fax: Each additional branch circuit -I 6.65 di f % , 2
E-mail: Misc.(Service or feeder not included):
p 7 - ...r Each pump or irrigation circle 53.40 2
�(++ •e t 1 '9 1i" C4 � 9 ar 3, f * .,'xizt 8 , t y .
lis.a � e',.1. u+. .,E S'��lt,:t t. - �,;. r r Each sign or outline lighting 53.4E
Job No: 3 el 1 } Signal circuit(s) ur a Limited energy panel,
n ) alteration, ar extension Page 2 2
Business Name: („j, I I a,_...,. 11 t trepur ii,,. ` Description:
Address: f 0 ;, 23 o.�r■ 7
9 Each additional inspection over the allowable in any of the above:
City /State /Zip: I , - Vi/ � 2 Zk- / Per inspection per hour (min. 1 hour) I 62.50 ,
Phone:01. ) i, 2.y • 3 3 t Fax:( o 3) 6 -e .- -2-i Investigation fee:
Other.
CCB Lic. #: mac. 5 `=1 Lic. #: 3y - z •-? (-. : =rf s i r ; a a , 1 �, "Al "" ` ` `+ -'' "' °''"
'Ai2:n -. ,�; 8 4, �3,:r�,`�fi� ,'�a`.z - la.., m .9 J,r x„t. .� �!S�u.Lna.5
Supervising electrician Subtotal I $ 3, t-�U
signature required: / ---- f 'rf 2'6 Plan Review (25% of Permit Fee) $ r
r. L" rj . -S S tate S urcharge ( 8% o P ermit Fee) $ J, V - T
�tk�, �.
Print Name: 1e. #: _1
TOTAL PERMIT FEE 1 $ / v , g - ' }
Authorized Nonce: This permit application expires if a permit is not obtained within
Signature: Dale. 180 days after it has been accepted as complete.
"Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts \Permit Forrrts \ElcPerrnrtApp.doc 01 /03
lb0 _/‘2o G 6 /'a
CITY OF TIGARD 24 -Hour .�
BUILDING • Inspection Line :504639 -4175
INSPECTION DIVISION . Business Line: (563) 639 - 4171,- MST
Q BUP
Received Date Requested "— r p A4a _ . PM BUP
Location / 7 06) 1 I ( 2 Suite MEC
Contact Person (. �v ' r ` -allfr Ph ( .Z) - 7/ r- 2 S vPLM
Contractor Ph ( ) SWR cc
BUILDING Tenant/Owner ELC , 22 ) 006 77
I Footing ELC
Foundation Access:
Ftg Drain - ELR
Crawl Drain
Slab Inspection Notes: UM- CpA4 -(/(/1/1 SIT
Post & Beam /vi a L
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Drywall ywal
Dywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof Zi*
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
FAIL
ELECTRICAL
er�ice -�
Low olt Voltage 1 v O
Low
Fire farm
I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
1 FAIL
Please call for reipspection RE: Ei Unable to inspect — no access
Fire Supply Line
ADA d ! - / Ext
Date Inspe r
Other:
Final DO NO REMOVE this inspection record rom the Jo ' ite.
PASS PART FAIL