Permit ' CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00691
DEVELOPMENT M T DATE ISSUED: 11/25/03
13125 (503) 639 -4171
PARCEL: 2S110DC -02400
SITE ADDRESS: 11565 SW DURHAM RD
SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: JOB NO 10180 Temporary service for new shell building
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 2 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FOR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: . � f 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:
DOUG FRY COHO ELECTRIC INC
2423 REMINGTON CT PO BOX 40
WEST LINN, OR 97068 WILSONVILLE, OR 97070
Phone: 503 - 348 -2237 Phone: 503 - 582 -9774
Reg #: LIC 157169
ELE 3 -575C
FEES SUP 3483S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/25/03 $267.35
[TAX] 8% State Surcharge 11/25/03 $21.39 Elect'I Service
Elect'l Final
Total $288.74
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- 800 - 332 -2344.
Issued By: Permit Signature: I _
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 639 -4175 by 7:00pm for an inspection the next business day
•
Nov 24 03 12:25p p -1
• FOR OFFICE USE ONLY
-Electrical Perm �' � a>!" C tion Received Electrical
r Date /By: arlh-- Permit No.:E OV 3-e7 (, 9/
Planning App Si
City of Tigard 203 Date /By: Permit No.:
13125 SW Hall Blvd. 0 41 Plan Review Other
Tigard, Oregon 97223 `GPpI Date/By: Permit No.:
Phone: 503- 639 -4171 F liZe -r G /� 4di,i 4. � ;A e
Date1B Post- Review Land La No
e
Use
www.ei,tigard :or j�®1N F e lE Contact Juris.: ®Sec Page 2 for
24 -hour Inspection Request: 503 639 - 4175 — W Name /Method: Supplemental Information.
TYPE.OF.WORIC. PLAN REVIEW (Please check all that apply)
•
' X New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -cart facility
commercial ❑ Hazardous location
El Addition/alteration/replacement n Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
.CATEGORY OF c9FISTRUCTION 1 & 2 family dwellings four or more residential units in
❑ I. & 2- Family dwelling al, Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building n Multi- Family CI Occupant load over 99 persons ❑ Manufactured structures or RV park
— 1 Master Builder n Other: ❑ Egress/lighting plan ❑ Other:
Submit i sets of plans with any of the above.
§JOB'SITE INFORMATION and LOCATION The above are not applicable to temporary construction service.
\ \565 S\tJ 0� h '. :'.�, :.. ,
_ Job site address: 4r 1 FEE * %S+L$EDUI E
Suite #: Bldg. /Apt. #: F. Number of inspections per permit allowed
Q l Description ' Qty Fee (ea.) Total J
Project Name:,��� = y am - Cy c ' t� New residential - single or multi- family per
Cross street/Directions to job site: .
dwelling unit. Includes attached garage.
Service included: 145.15 __ h 1000 sq. ft. or less
�� " fir �� Each additional 500 sq. ft. or portion thereof 33.40
' Limited energy, residential 75.00 •
Subdivision: Lot #: Limited energy, non residential 75.00
Tax map /parcel #: Each manufactured horse or modular dwelling
service and/or feeder 90.90
DESCRIPTION OF WORK. Services or feeders - installation,
.. -4‘-- � ...) ( .�h�...1• \ alteration or relocation:
_ \ C= =—t � :. O� 80.30 1ko('), nO
200 amps or l ess
%1/4 t i (� �r11 201 amps to 400 amps _ 106.85
�� 401 amps to 600 amps 160.60
601 amps to 1000 amps 240.60
( EROS' RIY :OWNER,r "u}is` ®':TENAI�IT `;5 >• i s _.: . ,. . 454.65
Over ]000 amps or volts
Name: O(^jy \ Reconnect only 66.85
Address: •DLi i-�t J • l O'er Temporary services or feeders - installation,
alteration, or relocation: `
City /State /Zip: �c - ' i.�,r
- mr - N c \ — 10 L ; 200 amps or less ` 66.85 �•- .i
201 amps to 400 amps 100.30
Phone: Fax: 401 to 600 amps 133.75
❑ IAPPLYCAN - -' : ° "::r :. - [] AC
CONTr'ERSOIN ` ":.,:. 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 FiQ .c\c:!,
. City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85
Phone: Fax: Each additional branch circuit 6.65
E -mail: Misc.(Service or feeder not included):
r_r c- um irriga ion circa 53.40
,:.:... -. ......:r ............ .. Each or 53.40
p p t e
r.:. a5 =: ,:a:.a::: :"..t : ; ;Ci'; , , .: iCON 2A.CIO..I':_, .,.. • .. Each sign or o utline lighting
Job No: _ k.0 Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2
Business Name: C t" �'ke__., t Description: •
Address: c)u ftgri,1 � Each additional inspection over the allowable in any of the above:
City /State /Zip: L,....) n tsc, - '.) \ \L i (& C — / - \ < Per inspection per hour (min. 1 hour) 62.50
Phone: ;5 \ ' ,a - �''1 y Fax: ;` -') 4. i , Investigation fee:
CCB L1c ; ; Lic. #: Other:
,. . ,.,,: ii :'' ?; Iectirieala'Permiiire *> 'r:. Ii4.11: •; : :-
Supervising electrician/2 z;- Subtotal S 4_, . •=,
• signature required: ' // f z t> /imp- Plan Review (25% of Permit Fee) $
Print Name:■'1,4<;✓ L .
� � #: ' -1 State Surcharge (8% of Permit Fee) $ e. \ ,, TOTAL PERMIT FEE S a
Authorized Y , Notice: This permit application expires if a permit is not obtained within
Signature:
v Date: 1k- c�4 180 days after it has been accepted as complete.
V‘' V‘ AA R
•Fee methodology set by Tri- County Building Industry Service Board.
-- (Please print name) . 2 gg, Ti
is \Dsts\Permit Fortns\ElcPerrnitApp.doc 01/03
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Liner +(503) 639 -4175
INSPECTION DIVISION Business Line: 1503) 639 -4171 MST
. BUP
Received Date Requested 7 - _ AM PM BUP
Location / / g( GULL21L) Suite MEC
Contact Person h-�- -e Ph ( ) s q ra - / 7 7 it PLM
Contractor Ph ( ) x -&-- SWR
BUILDING Tenant/Owner ELC fe2.d3 " L 11 / f
Footing
Foundation Access: ELC
Ftg Drain ELR 4
Crawl Drain
Ar Slab Inspection Notes: SIT
Post & Beam m
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation y
Drywall Nailing p dill; _ j
Firewall , A P v /V1,�,//✓
Fire Sprinkler
�Jt1
Fire Alarm 'Oat
Susp'd Ceiling r/f
Roof ''el '
Other: A \ q
Final � `
PASS PART FAIL ei 11 - 4 '1° 11 - 4 '1° �7
PLUMBING /Va ¢, f%1 f
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain G, 7 )
Shower Pan
r_
Other:
Final s ‘,• 01-4/)‘-%
PASS PART FAIL j v, ��
MECHANICAL
Post & Beam
Rough -In
Gas Line t U V)
Smoke Dampers
Final '
PASS PART FAIL ,
ELECTRICAL 7j r' 00, wo E 'p 0 -- 44 8 - 4' -
Service
Rough -In �4 t,r./d - P 5,, , 71 iti
UG /Slab i v ✓y /' Av /.v/C Ali d 4'S5Gv7i-d�
Low Voltage
7/ / � /�� �l
Fire Alarm
PAS PART FAIL ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE El Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Approach /Sidewalk Dat 7 of Inspector - / Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL