Permit CITY O F TIGARD GARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00094
1 0 DEVELOPMENT SERVICES DATE ISSUED: 2/16/2005
> 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 25101 DB -01000
SITE ADDRESS: 07080 SW FIR LP aka
SUBDIVISION: 72ND BUSINESS CTR -VARNS PARK ZONING: C -P
BLOCK: LOT : 012 JURISDICTION: TIG
Project Description: 2 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: 1 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:
SHROYER RANCHES INC SAFE ELECTRIC
BY REX SHROYER PO BOX 1677
PO BOX 1538 GRESHAM, OR 97030
PHILOMATH, OR 97370
Phone: 541 - 929 -2694 Phone: 503 - 998 -8832
FEES Reg #: ELE 26 -984C
Description Date Amount SUP 127541
SUP 4384S
•
[ELPRMT] ELC Permit 2/16/2005 $53.50
[TAX] 8% State Surcharge 2/16/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Speaalty 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- 344.
Issued By: i�2 Permit Signature
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
Electric �l Permit Apps � , 4
a �: T kr � FOR OFFICE USE ONLY t '
City of Tigard Received _ //
Date/By- off-' ib /6 r Y Permit No ��1°� �QG
13'125 SW Hall Blvd., Tigard, OR 97223 FEB 16 20 4fiy / Plan Review
Phone. 503 639.4171 Fax: 503 598 1960 4 4i , Date • Other Permit
Inspection Line. 503.639.4175 ( JAVA ' I!,' B Date Ready/By- H See Page 2 for
Internet www.ci tigard or.us CITY OF TI(iA Notified/Method- Supplemental Information
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a i. •c' a 65 ? > i , ; -, rs' :".i tc : : i° l` P A , B ' n � - ` W - = .
.fir � �5� �' ^`- `'��+:za�"'�'%t:a��a ;,��'�,} f *<_: - 3 ®,� 1 13� �� � � ry� �...,.< #..y ,. r .. .... .. .. . _ W.. ^ ..ate. ��.�Z�'., . .. ,
❑ New construction ❑ Addition/alteration/replacement Please check all that apply
CI Service over 225 amps, comm'l ❑ Hazardous location
❑ Demolition ❑ Other.
y ;5t - j;t^A „ yG , ,t irr .” - „ 4;r T wyO ,g y; x µ ffi; of 1 -and 2-family over 320 amps — rating ❑ Building over 10,000 sq ft ,
e f C'ATiE G RSr ° CO1Tl 1tUGTI iii 4 2-family dwellings 4 or more new residential
< : � ai S. �f; d�3ii���' a'. ��i'' �>.. s� "- ++,+���i&9. » ^,. * aLS` 3mP�k°'..«� t2 ;` ^fr`,n �..3Fhs'''t; y titi': �` '.' S 'i§k +- w 'w'�.'�^�#.
❑ 1- and 2- family dwelling Commercial/�strial ❑ Accessory building ElSystem over 600 volts nominal units in one structure
El Multi-family aster builder 111 Other: ❑Building over three stories ['Feeders, 400 amps or more
y L l f a z s f K e b � l , y ^ O , e. `� z ,- ❑ Occupant load over 99 persons ['Manufactured structures or
��� 1 �, aii IT TNk'O TI I� irle kl 4 ❑Egress /lighting plan RV park
Job no.: Job site address: - 3- c7 0 5 L m(4_ _ cP, ❑Health -care facility El Other
Submit 2 sets of plans with any of the above.
City /State /ZIP: /� The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: Project name: G� X CHEp° Y E "'
�' , ` C Description 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
Limited energy, residential 75 00 2
Tax map /parcel no.: Limited energy, non - residential 75 00 2
: e r ,=` t ;/ :�x .a �.; n 's max ,.�rr< •- �s •,a_.,. -, �. » Lti =,r :.s x
t o t2 M 2 „ %`,n, ,, , ,':' : t., IlF, 4 DI2 ” ,,,, " a£., r*c l Ea ch
r�� ^i; �- --��;�: ^;�;���.� ^�= . �'-�i�`,� - �:. � � _ .. _ 2 �,v„_�� ��� ��.?.,. - �;^s�.�.���.�� . ,� manufactured or modular
dwelling, service and /or feeder 90 90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
r. ,, -„ ,.,... , „n x, ., 201
amps to 40 s 106.85 2
21; f '�( = " u p s „ „f ;: O OV N ' 4 &:, s ;' e ' _ ,; � € .,
t &I, ; ,. T : ,
>3C��.^ ,,Nn,f.y, ^ -,<. a�;�•�_....,tix- ,r.A�,= �.,a 401 amps to 600 amps 16060 2
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
;ti ``'r'ty`,R ',” ?'2,ib i.t•�;.M = , nTa71 tytir °. »r » ._'�^ - ra:„$.`aa; . . -.
t • � i `° �,r ^ „ -, �` r�.� 1 'ice; A. Fee for branch circuits with
f`t2 'k A, : ®: PLIGA T: t , . i h l� Oi�'`it'ACT *P RSOnilll' .. , ik
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: .
Each add'l branch circuit 1 6 65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone. ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
J E -mail: Signal circuit(s) or limited -
as° i ,e, • •,,, _ , tt ° �` ; V , : ,t:i�, ; ia i� r .. energy Panel, alteration, or
'. e' r:�' > -3 >�tt 1T '� COI;I, RACTO ^ —r-'-- ,< : f ' .,. .
extension. Describe• Page 2 2
Business name: C L f--(...,EC.../ jL/ (.
Address: fa v., 40 r /67-7- Each additional inspection over allowable in any of the above
1 Per inspection 62 50
C City /State /ZIP: 6, C)IZ - C U 3 0) • Investigation per hour (I hr min) 62.50
Phone: (5 ) 1j g 3 Z I Fax 7 Industrial plant per hour 73 75
,y° „ ��Y •��_�'"�` � "�' =; - '�”
L. L 5l_f
CCB Lic.: (2 Electrical Lie.: 24-'V�� Suprv. Lie • 1 ¢s Subtotal t� 5�
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: it ' /3 u % J (Le). Date: L-16 — C7 S State surcharge (8% of permit fee) ��
TOTAL PERMIT FEE 3-7, 7 g
Authorized signature: 6, This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
)/ Print name: 4 4 U f fu/to 2....- Date. i‘ - C)5 _ . * Fee methodology set by Tn- County Building Industry Service Board
** Number of inspections per permit allowed
1 \Buildmg'Pemuts\ELC -Peru sApp doc 12/03 440-46 I 5T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information . .
LIMITED ENERGY PERMIT FEES:
Wailt:NWROWORVIERRETINEVINI
Fee for all residential systems combined... $75.00
Check Type of Work Involved:
111 Audio and Stereo Systems*
El B urglar Alarm
Garage Door Opener*
H Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
fl Other:
,t70-70WaTTMWTORWRICAMINERE1
Fee for each commercial system $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
A udio and Stereo Systems
El B oiler Controls
0 Clock Systems
• Data Telecommunication Installation
El F ire Alarm Installation
LI HVAC
111 Instrumentation
• Intercom and Paging Systems
111 Landscape Irrigation Control*
O Medical
H Nurse Calls
fl Outdoor Landscape Lighting*
fl Protective Signaling
fl Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\BuIldingTerrruts\ELC-PerrrutApp doc 04/03
-f
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006 -00094
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/16/2005
Phone: (503) 639 -4171 i0�iirdli��p,Ili�f+l
Inspection Requests (24 Hrs.): (503) 639 -4175 ' W- `:_.. .
INSPECTION WORKSHEET FOR DATE: 3/21/2005 TIME: 7:10A/s4 PAGE: 16
SITE ADDRESS: 07080 SW FIR LP Z°v CLASS OF WORK:
SUBDIVISION: 72ND BUSINESS CTR -YARNS PARK LOT #: 012 \ TYPE OF USE:
PROJECT NAME: KCM INC
DESCRIPTION: 2 branch circuits.
OWNER: SHROYER RANCHES INC, PHONE #: 541 - 929-2694
CONTRACTOR: SAFE ELECTRIC 7___ PHONE #: 503-998-13832
Inspection Request Scheduled For: Date: 3/2112006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 002322 -02 503.515.6478 N
•
Corrections /Comments /Instructions:
C
. /1;7
`PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i ih i c - ------ Date* l / — QS Phone #: (503) 718 -