Permit CITY TIGARD ELECTRICAL PERMIT
} PERMIT #: ELC2004 -00804
DEVELOPMENT SERVICES DATE ISSUED: 12/15/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135AA
SITE ADDRESS: 10215 SW HALL BLVD
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -
BLOCK: LOT : 037 JURISDICTION: TIG
Project Description: (3) 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: 2 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:
INTEGUMEND BOONES FERRY ELECTRIC INC
10215 SW HALL BLVD PO BOX 628
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: 503 - 245 -2415 Phone: 503 - 682 -4936
Reg #: SUP 4918S
LTC 88482
FEES ELE 3 -223C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/15/200' $60.15
[TAX] 8% State Surcharge 12/15/200' $4.81 Rough -in
Elect'I Final
Total $64.96
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:"
—o s�� 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
EIIDe 15._ 2004 2.3 - B Vt!)Y ELECTRIC No. 3218 P. 1
FOR OFFICE , :ONLY
City of Tigard Received / � (
13125%3W Hall Blvd., Tigard, OR 97223. °100 I�ate/I3 : , . ��P� ) Permit No.: 6� Y . 4./ S/d C/
l; 'hone: 503.6394171 Fax: 503.598.19 `� O
'f " " "'� +r4' plan Review
D • Other Permit:
Inspection Line: 501639.4175 CIT OF TIGAR ® �
r _ i I Date Itesd y/By: m an
nternet www ci tigatd or ua
Noni'+ gee Yage a for
ION ed/Ivleihod �
n r . SupplementalInforrretiori
v.rSL�t�; ?> �.'_.r •r. N r,� to ^spa, tyn.�''�jr�a 6
z�5 i t } D� °� 0 nr r N ,�;r'�7wlr :ice 5� a�. !'hrF a c :r
:ZZ r . __ .w.1_..a u � :N i iTi •,,1 57 R ? :f 'C +3f41:ffiS lh ` til t �"''F 3 M, 1 I + s � 1' � , � ` S� E �F I � tit' .� . 5`7 ( 4c_
t _rr? .._ ,.:.,- a- 5 all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, eomm'1 ❑
.,e Eazardous location
. �y Demolition i a � 'e,�i+t a tai it�r �`r y�� r�r'` 2 r �") t`��" i t, y l l ^'""g4Fi .. , ., . 0 Service over 320 amps - rating ❑ Buildng over 10,0!;3 sq. ft.,
ii` ,..,., ', 1 M1i7 i ` J ilt '' J, `S l, , r , i ag.: E ir . !. f V11rtw ! iii (a ,� F y 7 5��`tt , llx ! ;�i!�it ,1 G�, of l- and 2-family dwellings �• -.-� t , t�.._,.__,.... ,,.tt.. Y !!lags 4 or more new resi Icntial
❑ 1 - and 2 family dwelling 2 Commercial/industrial ❑ Accessory building Ill System over 600 volts nominal units in one strum. , e
El Multi family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps �r more
7y j k iIyR .,, 1Y. g+. b5-
ra+. ' - 'Z,..r ! tl �" I r � 7 r N r ❑Qcc ant load
fir. - i� t ^lr.:?ldli-,rl , lit ,+�f�ad�4i f Jh ' �I li r,) ivvii �'� e3w 7 F P over 99 persons ❑Manufactured structures or
t ...:. a .._ : . _ » _ 5,�..t.! .nr1 w,. J �v 1 L+.. J 4 r,. ❑ Egress /l ght ng plan 1W park
lob no,: `7 it 1. Job site address: /0 2. 15' 5 , -/ n Pv ❑Health -care ses facility ❑Other:
/ S ubnnit 2 t of plans with any of the above.
City /State/ZIP: , • • , - : / I; „ ar d 0 - j The above are not applicable to temporary construction service.
Suite/bldg./apt no.: , i r ',
Project name: 2n } (Am v nt� ' �'� �x `�c " . ` l ' 4K_ :�.,!' a �` z s sip ul x, r < =:."
Description Qty. Fee. Tat
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
Tax reap /parcel no.: Limited energy, residential 75.00 2
i ' . f r J. , lk r� 'r rr r r r 7 ¢i' T T " n . . Limit energy, non - residential 75.00 2
,i .r'rd....l:l, (112, o 's :k 7-7. ,6. 7.71 l i r . fi i hff 1 ' y � l . rl ,je . y �o - 1 rr ' fi r , 1 , il y s t T ry F, ,.;
•
k r a . J 4i r..__ .... , .� 11? :t . c r :ra'.,_ n'. Each tnanufacwred or modular
e r^ip• r - 7 dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or reloc tion
200 amps or less 80.30 2
401 a
'r 2
o 1 h ". rri SW 3 1Zf v 7lt i�' js °3\ m� r{Ayg T : 1 i1 t w "1 tn t t rf, . 1 a� i a i ^r `PrN �1 'ti. 201 amps
Name: - ..k i.w.....: Ash' :; ,t6l1A A '.,gr`+t11.` li:iii � . JS,y :;.:li1 "`,�/., ' �f skank,; iier s to 600 amps 160.60 2
L \IY- f�M'�'� 6 _ 601 amps to 1,000 amps 240.60 2
address: �� \ .) S \ \ \� Over 1,000 amps or volts 454.65 2
City/State/ZIP: r _ 6 1_, J `7 Reconnect only 66.85 2
T ��� Temporary services or feeders installation, alteration, and /or
Phone: (s3) 6 ,�.y.�2y /, Fax: ( ) relocation
Owner Installation: This installation is being made on property that I own which is not 200 amps or less 66.85 I
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 400 amps .
2
401 amps to 600 amps 133.75 2
Owner signature; Date:
B ranch circuits - a new, alteration or extension, per pan I
k+
� , +' r i r � ,4; i r p t e� ,n i re r r z , r ,
'.,w ".4!4. f! : 3 i r i 1 .,,. 6 4 Y - 1:7 J v �Z 4 l a . t ` u .� 9 " r r ;: �i ,5 . � t t,", �' 1� y ikt � l2, . '_ A. Fee for branch circuits with
Business name: service or feeder fee, each
branch circuit 6.65 2
Contact name: B. Fee for branch circuits
without service or feeder fee, ( 46.85 2
Address: each branch circuit
Each add'I branch circuit Z 6.65 _ 2
City /State /ZIP: . Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
E Sign or outline lighting 53.40 2
'w Signal circuit(s) or limited -
,,�� d �l�Z. �i Yr t� �f }i�My I r 4�Caf� nit �i7 -. E r r' t F � /.�3Y? , �L�
I'-:, {4,7g._. ..�C._��s R, i.-7 L�1o_:eiit$� a:,G7i {s i , :�t 4 energy panel, alteration, or
Busine68 name: Boon e 5 Ferry E l e c f; r i c ex D escribe: page 2 2
Address: P.O. o 628 2 8 Each additional inspection over allowable in any of the bove
City/State/ZIP: W115onyiL@ OR 97070 Per inspection 62.50
Investigation per hour (l in min) 62.50 - Phone: (5.03) 682 -4936 I Fax: (.503) 682 -7946 Industrial plant per hour INE 7375
CCB Lic. : 88482 :�x�m t�t �l,ytxa h "yrJtf7C�14�4, +P ,..
I Electrical Lic.: 2 2 C S uprv. Li c.: ! t - -�
Subtotal 6 b /$
Suprv. Electrician signature, required: Plan review (25% of
( pit fee)
Print name: Date! State surcharge (8% of permit fee) $ /
HOItt.on
Authorized signature: TOTAL PERMIT FEE 4 Lt , 7 6
This permit application expires if a permit is not obtained wit In mso
Print name: ,Date: days after it has been accepted as complete
' Fee methodology set by Tri- County Building Industry Service hard
""
i:V3aildm �Permits�BLC_ Number of inspections per permit allowed.
B PetrnitApp.do 12107 440.451STt10/o2 /COM/NEa
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
r� BUP
Received ` Date Requested AM PM BUP
Location / a - f � AIZILLQ / Suite MEC
Contact Person Ph ( ) PLM
Contractor � Ph ( ) (2 g -(-3' SWR d
BUILDING Tenant/Owner ELC alJ� 6 1'06 b c5l
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: cCQ� —.0°Y/ ,a�a�_ SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing (1 ( i I
Insulation i
Drywall Nailing L 1 \--A � f\f C p v , j (U
\1�
Firewall
v
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
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
Fir larm
ma� Reinspection fee of $ required before next inspection. Pay at City 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Dated' 2 — O Inspector \A) 3 yo IA w Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour ''
BUILDING Inspection Line: (503)•639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested AM PM BUP
Location / 0 a / 5-- ) 42 Suite MEC
Contact Person .&- Ph ( 5/ Vg75 PLM
Contractor Ph ( ) 6 p` SWR
BUILDING Tenant/Owner !�.4 = . . Jll warif _, ELC oa0 -Od XO
Footing
Foundation Access:
Ftg Drain ELR
Crawl Drain
I Slab Inspection Notes= SIT
Post & Beam
Shear Anchors r- )
Ext Sheath/Shear f / '/ `
Int Sheath/Shear / �`-
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler /� /� �(�
Fire Alarm J 1 r Y 01 �. 6 -, �i Lo c J 1 (y ) r`"C/ orr'
Susp'd Ceiling J 0.0.
Roof 1 � .� E C. c JJ�
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam N4L 61s0 ).,v P 5 U P v 0 5 €I o1/l� �. � , , (1 1 5 as Y'l" \ W 1�' U
Under Slab �( ,�/ . �
( I1
Rough -In V t\ w J i l \\ f H I` Ea A 1. L ' rn i) )U L W
Water Service 1
Sanitary Sewer 1 \ n
Rain Drains �� i `� I 1
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
'ECTRICAV
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PAR FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date 05 Inspector %; r/1 a Ext
Final DO NOT REMOVE this inspection record rom the ob site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Line: (50$) 639 -4175
INSPECTION DIVISION Business Line (503) 639-4171 MST
BUP
Received Date Requested / AM PM BUP
Location /6 S Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) -( 3 SWR / j `
BUILDING Tenant/Owner -L T6 - 6 L[ e✓ ' I' /�L o ELC �0e)`� J - Foci
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear �/
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling , I y�,� 1� I> I v m
Roof D M ` W \ 11 �3 Y l l i l J., Ik
Other:
Final
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
UG/Slab
Low Voltage v - Gv 3 ji/
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
A S PART FAIL
SITE E Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA / ,
Approach /Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Jo site.
PASS PART FAIL
I I TV II ■■aI Iav —•.._
BUILDING Inspection Line: (503) 639 - 4175
MST
iPECTION DIVISION Business Line: (503) 639=4171;:
BUP
lived Date Requested - - O 3 AM PM BUP
tion l 5 t D Suite MEC
act Person ? Ph (',jO� ) � 9 r i PLM _
ractor � b b W �� 1 1.. ' {>\ Ph (— ) SWR � 351 - ° g ZY
ILDING Tenant/Owne 111 ELC /
Ming ELC -ab o H ts
indation Access:
Drain ELR
wl Drain
b Inspection Notes: SIT
.t & Beam
)ar Anchors
Sheath /Shear
Sheath /Shear
ming
elation
wall Nailing
wall
Sprinkler
Alarm
;p'd Ceiling
)f
ier:
al
\SS PART FAIL A
UMBING
.t & Beam
Jer Slab
ugh -In
ter Service
utary Sewer
n Drains
:ch Basin / Manhole
rm Drain
)wer Pan
ier:
al
ASS PART FAIL
:CHANICAL
& Beam
ugh -In
s Line
oke Dampers
al
ASS-___EART FAIL
ECIBICAL'
vice
ugh -In
JSlab
v Voltage
Alarm
AS�' PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
fE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Supply Line 4
r oach /Sidewalk Date � 5 Inspector " Ext
ler:
al -.. DO NOT REMOVE this inspection record from the job site.
ASS PART FAIL
•