Permit • CITY OF AR
TIGD' `� ELECTRICAL PERMIT
TIGARD' K PERMIT #: ELC2005 -00601
DEVELOPMENT I Ig SERV R ICES 503 - 639 -4171 DATE ISSUED: 8/17/2005
13125 PARCEL: 2 S 101 AB -016 08
SITE ADDRESS: 07455 SW BEVELAND RD ZONING: MUE
SUBDIVISION: HERMOSO PARK LOT : 019 JURISDICTION: TIG
Project Description: 200amp service /4 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:
WESTERN TIGARD LLC PC ELECTRIC
PO BOX 2469 1147 SW JAMES CT
CLACKAMAS, OR 97015 DUNDEE, OR 97115
Phone: 503 - 628 -8508 Phone: 503 - 538 -6033
FEES Reg #: L1C 155180
ELE 36 -114C
Description Date Amount SUP 50125
[ELPRMT] ELC Permit 8/17/2005 $106.90
[TAX] 8% State Surcharge 8/17/2005 $8.55 REQUIRED ITEMS AND REPORTS
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 -8••-332 - • 4.
Issued By: � AP J Permittee Signature: :G4, i�
OWNER INSTALLATION ONLY T �
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applica Fox OI Fl(l.: I sh: ONI,1
City of Tiga 1 ri:* ` Room vod I'om,it Nn.,
I)ardtl I p r, , _C,_.. —r7t� , •
13125 SW Hall Blvd., Tigard, OR 97223 `\`` Ilan Revie
Phone; 503.639.4171 Fax: 503,598,1960 �v . "• ,n ;'' i I Date/By: other Permit:
Iavpection Line: 503.639.4175 C 1j�{ � • t �� IMO Kean / ly: 60 tint Paco 2 for
Internet: www.ci.tigard.or.ua 1,VG Notified/Method: ! tits
� � Dp4+nem[al Information
WORK • &
0* ,VIEW
O New construction Addition/alteration/replacement Please chock all that apply:
Demolition Other: OService over 225 amps, conutl'l ❑Haxatrdous location
. OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more now residential
0 1- and 2- family dwelling 1Commeroial /industrial 0 Accessory building ❑System over 600 volts nominal units in ono structure
❑Building over three stories ❑Feeders, 400 amps or more
El Multi- family 0 Mastcr builder ❑ Other:
JOB SITE INFORMATION AND LOCATION
DOccupant load over 99 persons ❑ u1 keturcd structures or
❑I;gross/lighting plan pm
❑Health -care facility ❑Other
Job no.: I Job site address: 7 St-6 - 5 8t ✓e1c TCrr5cc_
Submit 2 sets ofplans with any of the above.
City /Statc/ZIP: rsi,ea Ofe U ., 9 73 'rho above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: i Project name: FEE' SCIEIJ13AU •
AescripOo• , Qty. i Fete. I Total 1 ""
Cross street/directions to, job site: New realdendal tangle- or multi- family dwelling unit.
Includes •ttaehed garage.
_ 1,000 sq. It or less 145,15 4
Subdivision: l Lot no.: Ea. add'I 500 sq, fl. or portion 33,40
Limitod.oncrgy, residential 75.00 2
'I 'ax mup/purce no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular — '
dwelling, service and/or feeder 90,90 2
~ Addf �? Servieea or feeders installation, alteration, and/or relocation
200 amps or less I 80.30 84.30 _ 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 106.135 2
( � 40 I amps to 600 amps 160,60 2
Name: `_ .. _ • 1 �J - -. - ' , I e LA_s _. 601 amps to 1,000 amps 240.60 2
Addresses 00lq S� n B rv .1' 6 Over 1.000 amps or volts 454.65 2
Reconnect Only 66.85 2
City/Statc/%IP; �� /�
T U/�/f �� [ �1
O 0 7 Temporary services or feederx installation, alteration, Hod/or
Phone: �v� Q" -- .15'. f Fax: ( ) relocation
200 amps or less 66,85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 4(X1 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 600 amps 133.75 2
Owner signature: ___ Date: _.__.•,••••, Branch circuit' - new. alteration, or extertaion,perpanel
❑ APFz.,UCANT I ❑ CONTACT PERSON A. Poo for branch circuits with
Business name:
service circuit feeder ftle each
branch , 6,65 .2(;,( 2
rch ist
B. Pee for branch circuits
Contact name: - without service or feeder foe, 46.85 2
Address: each branch circuit
Each add'I branch circui 6.65 2
City /State/ZIP: Miscellaneous (nervier or feeder not Included)
Phone' Pump or irrigation circle 53,40 2
( ) Fax: ( )
Sign or outline lighting 53.40 2
E-mail:
Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension, Describe: Page 2 2
Business name: . PC Ekel _
Address: Po (lox 6, 7 Each additional inapeet:oo over allowable in _any of the above
Per inspection 62.50
City/State/ZIP: Mk-47 Or 9 Inv per hour (1 hr min) 62.50
Phone; (So ) 6' 3S -603? Fux: (503 ) L S 36-3965- Industrial plant per hour
— 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: /SS /8(J `i Electrical Lia: X 3 6 -I! Suprv. Lie.: 5o 12. Subtotal 06.40
el
Suprv. Electrician signature, required: Plan review (25% of permit fo
/ state surcharge (8% of permit foe) 8,55-
Print name: j (A P , 4kr Date: 8/f7 hr
TOTAL PERMIT FEE /115 .4$'
Authorized signature: This permit application or.ptrea Ira permit la not obtained within tae
Print name: Date: filer it has brae accepted o complete
))ate: • Fee methodology act by Tri-County Building Industry Service Board
•• Number of impactions per permit allowed,
. Vw sVU.C- IarnitApp.doc 12/0) 44O- 461s.rrioin eom/w1Ul
2 ' el S96C BES - EOS -la t awddadS dL4 : T 0 SO L I 2nH
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELC2005 -00601
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/17/2005
Phone: (503) 639 -4171 . ioyflivo3 l +
Inspection Requests (24 Hrs.): (503) 639 -4175 =,.
INSPECTION WORKSHEET FOR DATE: 9/15/2005 TIME: 7 :03AM PAGE: 51
SITE ADDRESS: 07455 SW BEVELAND RD CLASS OF WORK:
SUBDIVISION: HERMOSO PARK LOT #: 019 TYPE OF USE:
PROJECT NAME: WESTERN PSYCHOLOGICAL
DESCRIPTION: 200amp service/4 circuits.
OWNER: WESTERN TIGARD LLC, PHONE #: 503- 628 -B508
CONTRACTOR: PC ELECTRIC PHONE #: 503 - 538
Inspection Request Scheduled For: Date: 9/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 \ \/ Electrical final 015772 -01 971-246-7000 N
Corrections /Comments/ Instructions:
\ 00 k)\- C VIN\44-,
f V■ (\) o `r HLL
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / Date: -A Phone #: (503) 718 -