Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00723
Ii DEVELOPMENT SERVICES DATE ISSUED: 12/16/03
``'` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 102AD -02400
SITE ADDRESS: 08950 SW BURNHAM ST 100
SUBDIVISION: BURNHAM TRACTS ZONING. CBD
BLOCK: LOT : 005 JURISDICTION: TIG
Project Description: Electrical TI, (1) 200 amp or less service, (10) branch circuits & (1) limited energy panel for data
telecommunications. Job No. 71017
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: 1
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: 10 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:
NW PREFERRED FEDERAL CREDIT UNION E C COMPANY
13333 SW 68TH PARKWAY PO BOX 10286
TIGARD, OR 97223 PORTLAND, OR 97296
Phone: 503 - 403 -6210 Phone: 503 - 552 -5503
Reg #: ELE 26 -45C
LIC 49737
FEES SUP 4040S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/16/03 $221.80
[TAX] 8% State Surcharge 12/16/03 $17.75 Low Voltage Inspection
Elect'I Service
Total $239.55 Rough - in
Elect'I Final
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 t - . ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth i 0AR 001 -01 ' through OAR 9 .:1 -0100 You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -814- 332 -2344.
Is ed By: r �f � J� 1 Permit 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: ;.� %� � i�rY -- DATE:
LICENSE NO: a3 ` -
Call 639 -4175 by 7:00pm for an inspection the next business day
12/15/2003 02:56 5032205347 PAGE 02
• ' E lectrical Permit Application, FOR OFFICE USE ONLY.
P Received 2 Cab (y� Electrical
rL� E � h nli t ® Date/B ; / fl d Permit No.: ePCr�3 ,3 `.' 6
Cl of Tigard Planning Approval Sign
g Date/By: Permit No.:
i 13125 SW Dap Blvd. EC 1 5 rik Plan Review Other
Tigard, Oregon 97223 Dates : Permit No.:
Land Phone: 503- 639 -4171 Fax: 503- 598 -1.960 .,qt^ Post- Review
G Y OF T ii.; ,,• , lir Case N Date/By: Case No.: .:
Internet: www.ci.tigard.or.us g1 III DING_.. . l � I Contact ! El See Page 2 for
24 -hour Inspection Request: 503 639 - 4175 ' J Name/Method: - / f a Su lemental Information,
TYPE OF WORK PLAN REVIEW (Please check all that apply) .
• New construction U Demolition ❑ Service over 225 amps- ❑ Health-care facility
commercial ❑ Hazardous location
i' Addition/alteration/replacement O t h er: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
' ' .CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling Commercial /Industrial ❑ System over 600 volts nominal one structure
. ❑ Building over three stories ❑ Feeders, 400 amps or More
MI Access° Buildin • • Multi-Famil ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
• Master Builder • Other: 0 Egress/lighting plant ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: ic°So St. Q4.c.y \P+'^ FEE* SCI.IEAULE
Suite #: \ 00 Bldg ,Apt. #: Number of inspections pexperrnit allowed
Pro 'cot Name: Pr r4. kk Description Qty Fee (e2.) Tatar i
Cross street/Directions to job site: New residential- single or multi - fancily per
' x - 110 11 dwelling unit. includes attached garage.
Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq, ft, or portion thereof 33.40 1
Limited enery , residential OM 75.00 NIIINIIIIIII .2
Subdivision: Lot #: , - . Limited energy, non residential 75.00
2
Tax m$2 i2 Cel #: Each manufactured home Or modular dwelling
. .. DESCRIPTION OF WORK . serriee and/or feeder 9030 2
Services or feeders - Installation,
. S 1 SNo kf3t 10) c � alteration or relocation:
200 amps or less 80 -30 `5 i °3 2
`', �* 201 amps to 400 amps 106.85 _ 2
401 amps to 600 amps 160.60 2
• DI PROPERTX °OWNER • I'D TENANT 601 amps to 1000 amps 240-60 2
Over 1000 amps or volts 454.65 2
Name: Reconnect on& 66.85 2
Address: Temporary services or feeders - Installation,
alteration, or relocation:
City /State /Zip: zoo amps or less 66,85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
• APPLICANT nn CONTACT PERSON • Branch n circuits h amps 133,75 2
al $rn „ch - new, alters ;fort, or
Name: extension per. panel:
A. Fee for branch circuits with purchase of
Address: 2
service o r feeder fee, each branch circuit 6.65 [. (, S U
Cl /Slate /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Mist Sere ce or feeder not included):
Each pump or irrigation circl 53,40
.: :C.t91‘1TRACTOR :, ...:
Each sig Outline lehtiny, 2 53.40 2
Job No: `110 \- Signal circuit(s)or a limited energy panel, / • alteration, or extension Page 2 -7 . `�' r 2
Business Name: r C Co tr: f vs, - Description: -
Address: P l3 0}c L 0 •,i C rl
Cie /State /ZI e : Each additional inspection over the allowable in any of the above:
F” 1 o r' a1 - 61 t Per inspection per hour (min. I how) 62.50
Phone: . t 7 , s A - 1 'mil Fax: 1 1'NS -- 1 o 1 .Z Investigation fee:
CCB Lic. #: ' 6, W S
Other:
`,1a�1 ∎�1� ic. ( ` Ele P.elr ; ,,ill; -
Supervising electrici Subtotal $
signature req . ed: --- Plan Review (25% of Permit Fee) $
Print Name: . ,r1.,.+, I Lic. #: a3 State Surchar• c 8% of Permit Fee $ w , . .
TOTAL PERMIT FEE $ R39•
Authorized Notice: This permit application expires If a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
• (Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
•BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received (z /3 / A ! 3 D ate Requested / - Z Am_ /r PM BUP
Location 7 9 / 5 0 U 7 .CA-4% &OAW] Suite 0 MEC
Contact Person o .2 5D T / q6 � PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner • (.der • 4•42r3 ---0d 72 3
Footing ��
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: c , SIT
Post & Beam �� C
Shear Anchors b
Ext Sheath/Shear Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Ot <om
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
453 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
SITE 111 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA L- � � `
\ Z • 0 l �TQ \ y L E Ext
Approach/Sidewalk D Inspector
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL