Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00287
j ll. DEVELOPMENT SERVICES DATE ISSUED: 5/26/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S135BC-00200
SITE ADDRESS: t000@ SW CASCADE AVE ZONING: C -
SUBDIVISION: /6 Deb LOT : JURISDICTION: TIG
Project Description: (4) feeders, (15) branch circuits, (1) limited energy.
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: 2 W /SERVICE OR FEEDER: 15 PER INSPECTION:
201 - 400 amp: 2 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:
VERIZON NORTHWEST E C COMPANY
1800 41ST STREET PO BOX 10286
EVERETT, WA 98206 PORTLAND, OR 97296
Phone: 425 - 261 -5408 Phone: 503 - 220 -5377
FEES Reg #: ELE 26 -45C
Description Date Amount LIP 49737
SUP 4040S 0405
[ELPRMT] ELC Permit 5/26/2005 $549.05
[TAX] 8% State Surcharge 5/26/2005 $43.92 REQUIRED ITEMS AND REPORTS
[ELPLCK] ELC Pin Rev 5/26/2005 $137.26
Total $730.23
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 th - se rules or dire .t questions to OUNC at
503 - 246 -6699 or 1 -800 -3 / 44. I
Issued By: ^ ��I� , Permittee Signature: ,b, P i 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: 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 Per 1 • •
'� . 1: ,, •
k I ORZ)1 1 1( L ONLY '`. ?3
City 9f lgard Received /_ //C� Permit
13125 S 0 W Hall Blvd., Tigard, OR 2 Date/By i �Y 6(� �.L p q t 7
r 0 ? 8 2005 Plan Review
Phone: 503.639.4171 Fax: 503.$98 96 8 /�+ � +i\ DDate/By: Other Permit:
f
Inspection Line: 503.639.4175 + r� ! {il' a' In Date Ready /By: Jun : m See Page 2 for
I nternet: www.Ci.tigard.or.us 1 TY OF TIGA D Notified/Method: / Er Supplemental Information
tai , Rte - 1 u s$ `. s 0 z e ..,-:01 ..„
CI New construction ',[ Addition/alteration/replacement Ple.se check all that apply:
❑ Demolition �❑ Other: /:a - rvice over 225 amps, comm'l ['Hazardous location
„q r Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
w . ° G1 ; A of 1 -and 2- family dwellings 4 or more new residential
0 1 - and 2 family dwelling '5'Commercial /industrial p Accessory building ['System over 600 volts nominal units in one structure
Building over three stories ['Feeders, 400 amps or more
0 Multi family D Master builder D Other: ❑Occupant load over 99 persons ['Manufactured structures or
it igli -xar., m '401 AC . e T U ► OCR' 0 > ❑ Egress/1ighting plan RV park
aa�' � • �§ � ` @�,h . ,n3� .,Wi>k�"., on9W'v°y� . -,. _ � � « � �'h_a.= '
Job no a Job site address: ❑Health -care facility ❑Other:
SW C t�S C l� z P� C Submit 2 sets of plans with any of the above.
d The abo ve are not applicable to temporary construction service.
City /State /ZIP: = t � ,_ c ), OR ��� pp p ry
Suite/bldg./apt. no.: I ��._ °:;:s a > * CSC EDtCtt''��E. °; 3,."LIW ,
_
Project name: v !? iT 1-1. _
{;,:e':..a.� i -Sn m ,.•%.yi,,. "y,`� - ': +,•''`^[.`'
Description 1 Qty. Fee. Total
Cross street/directions'to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: • Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
1 Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
;:x ' .x" " >.. ^k'' = I �., , ' > : ::ice "' ?
a. M;E�:=., bFSGwr ,:zIoi9: ' *0 s ra„- Each manufactured or .: >,��'s`,. ��,�.,,.,:� ,,., ..?3sw „�.er�, �u:,k,,.�: �a =s.�.. k ° :��;;�°�K�: ..,.;':- ,�.�,..,.'���,_ u turedo modular
dwelling, service and /or feeder 90.90 2 '
C3 ) LA `` A i^.' P A(), `\ t o - ‚- 'e• Services or feeders installation, alteration, and/or relocation
G � � � 200 amps or less a, 80.30 \ Co - [,p) 2
_' '` ;41.,.,�,,01L i �� , ; „,� � '.fe s to 400 a 1.... 106.85 2 2
amps mP s
� '`' * ' 44 . '1 E1 4 4` 401 amps to 600 amps 160.60 2
:k�. �,�. pr.§� '?�SSt +�31�1's< � ,'� _ .t&. =�'= d _, • ._ .;a,....,. ;�' ""4 s'"e ” 201 a ,
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 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 circuits— new, alteration, or extension, per panel
err y ' I'IsICOA ° �i 'F° j # ': =° v,,' ' t:`°/',£y!� "r;A[. mss` R .. A. Fee for branch circuits with
i::::' "5d= :`5'.l ....5..ebZ rii� ^., °.'.}- x "^'}":+:£ ?Y�'fr.'4i"%: + ®.; £ '. + '''Z
'�` service or feeder fee, each
Business name: branch circuit N5 6.65 0 , t -- 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
"�: '�"' ;� -: Cfl1V � . "CL'OR: � � , I' �7r,' „> ,�'�Z _ ° Y” energy panel, alteration, or
:' °b2:. »,:.�:t.i%]'��, r; '3;` , =o e,,.` "y� ��:'.N. -;<., 3r,•;.,.x��,' "s':`w_`-Y' "�::N?� may a..,
` " extension. Describe: '4 Page 2 , vild 2
Business name: cc L p
0 S 1 1,.._
Address: p Each additional inspection over allowable in any of the above
U S 0 '- Per inspection 62.50
City /State /ZIP: 9 \ \-j 0 g ' ))- C ') Investigation per hour (1 hr min) 62.50
Phone ( 1 �� � 1� Industrial plant per hour 73.75
1 S '� 1 Fax G• �
( ) U C, G1 ", ,. LECTRT ERMIRUE S*
w i.. .-ads' '". .:o,<..•s, x4 m,...,w, MAYA .,..a•. 51 n � '� %�;;F.;. •o
CCB Lie.: 'VA a 3 Electri 'I Lc. j• C.- S pf ic.� A 'reg Subtotal I 5.iq, OS
Suprv. Electrician signature, required: VIi / ,� Plan review (25% of permit fee) /'3 /, 2,
/ State surcharge (8% of permit fee) 4,3, 2,
Print name: - --5- (- 1 r Date: 7 ,,es
7 TOTAL PERMIT FEE 730 • 25 i
Authorized signature: This permit application expires if a permit is not o within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri -County Building Industry Service Board
*" Number of inspections per permit allowed.
i Building \Permits \ELC- PcrmitApp doe I2/03 .140 -461 5r(10 /O2/COM/WE
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:4 y _ 4f PROJECT:
9 i' 11 ` *.��1 el t 1f ' VERIZON - WASHINGTON SQUARE RSU D
L FNS 10000 SW CA SCADE m
WIRES; a ., C emiNrollswrNcEcauw. TIGARD, OREGON m
21 s.vv luakatin Wiley Hwy. sulk. 204 SHEET TIME:
e" °9006 ELECTRICAL ONE -LINE DIAGRAM
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