Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00610
DEVELOPMENT SERVICES DATE ISSUED: 8/22/2005
---� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102DA -00401
SITE ADDRESS: 13125 SW HALL BLVD PD ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Install circuit for printer in police records dept.
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: 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: •
TIGARD, CITY OF OREGON ELECTRIC CONST /GROUP
13125 SW HALL 1010 SE 11TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 639 -4171 Phone: 503 - 234 -9900
FEES Reg #: LIC 203
SUP 4460S
Description Date. Amount ELE 26 -95C
[ELPRMT] ELC Permit 8/22/2005 $46.85
[TAX] 8% State Surcharge 8/22/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
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: -t5 ^ `, y i _ Permittee 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 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 Permit Applicat ; t�i 1',oR c )Fri`r i t1 :UNl y
C of Tigard �r 0 , Deceiv D� ��� Perm t No..� •
13125 SW Hall Blvd., Tigard, OR x972 t Plan Review
Phone: 503.639.4171 Fax: 503.598.1 4Q f� (4 2, 2 J Mfr 17fi3jli "�'` Date/By: Other Permit:
In Inspection Line: 503.639.4175 0 _.. Date Ready/By: Jam. H See Page 2 for
Pi Internet: www.ci.tigard.or.us S A G Notified/Method ! Supplemental Information
-[1G • . .f4 � •. , - PLAN. REVIEW . ' •
•
❑ New construction g i on/alteration/replacement Please check all that apply:
® ['Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition ❑ Other:
® ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
C ATEG O RY' OF • CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
{.lam ❑ 1- and 2- family dwelling jg Commercial/industrial ❑ Accessory building ❑ S over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ID Other: ❑Building over three stories 0 Feeders, 400 amps or more
ill ❑Occupant load over 99 persons ❑Manufactured structures or
• JOB S I TE 'INFORMATION AND LOCATION '' ❑Egress/lighting RV park
Job no.: Job site address: Ty ['Health-care facility ['Other: I{A I � 1 tPo Ci cc RECni:O5 Submit 2 sets of plans with any of the above.
City /State/ZIP: tl 3 /ZS . $ W N d(L L co/ 0_ The above are not applicable to temporary construction service.
• Suite/bldg. /apt. no.: Project name: FE S C H ED ULE `
• Description I Qty. 1 Fee. I Total I `*
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.:
energy, Limited rest 75.00 2
:.- DESCRIPTIONi .OF•,;WORK e
• .. .Y.: � Each manufactured or modular
0 Z bA C r r �K F'Rtn/TEI; dwelling, service and/or feeder 90.90 2
INCTAC
PE o I CA ` E < Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
to ° .. 201 amps t 400 amps • 106.85 2
. -
PROPERTY OWNER ;❑ TENANT'' • ,; .
401 amps to 600 amps 160.60 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
❑; :-
... ;•`_`''.. A Fee for branch circuits with
,... } ^' :L OON,TA C T.; :EERSON:-' . " : : <' : "
service or feeder fee, each IZ
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee, I
each branch circuit 46.85 2
Address: 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: : ( )
1 Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
?,: energy panel, alteration, or
' extension. Describe: Page 2 2
Business name: OREGON ELECTRIC CONSTRUCTION
Address: 1010 SE 11 AVE. Each additional inspection over allowable in any.of the above
Per inspection 62.50
City / State/ZIP: PORTLAND, OR 97214 Investigation per hour (1 hr min) 62.50
Phone: (503) 234 -9900 Fax: (503) 535 - 2763 Industrial plant per hour 73.75
' ELECTRICAL.: PERMIT FEES*:. • : ' .
CCB Lic.: 203 Electrical Lic.: 26 -95C Suprv. Lic.: 4460S Subtotal c �� •
Suprv. Electrician signature, required: ,. . �_ J.,_ Plan review (25% of permit fee)
' Print name: MARK J J. KENNEY Date: 8 JZ2_ (os State surcharge (8% of permit fee) 5 75
TOTAL PERMIT FEE 5Z. (v
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name MARK J . KENNEY Date: S ( L / 5 • Fee methodology set by Tri - County Building Industry Service Board
•• Number of inspections Der permit allowed
•
AUG- 22-2005 08:48AM FROM -OR ELECTRIC SERVICE 5035352763 T-801 P.001 /002 F -889
lea:LIi -at i eaaaaae 1 „ ,...,......--
y Received Permit No -:
A . City of Tigard D
13125 SW Hall Blvd., Tigard, OR 97223 www.ci.tignrd a f t Y# I ' ` Date/BPlan Review
503. 598.1960 pt►ur permit:
Phone: 503.639.4171 Fax: ' Othe El sec Page 2 for
A I l3 ateReady/13y: El 5cc F eg o 2lIntormetlon
Inspection Line: 503.639.4175 Notified/Method; Notified/Method; Notified/Method nus
—
TYPE OF WORK - PLAN REVIEW
el Addition /alteration/replacement Please check all that apply:
❑ New construction ❑Service over 225 amps, comm'1 ❑Ilvardotis location
0 Demolition 0 Other: _ ❑Servi over 320 amps - rating El Buildng over 10,000 sq. ft,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
^!� 0 System over 600 volts nominal units in one structure El 1 - and 2 family dwelling ®COtttmercia] /itcdnsttial 0 Accessory building OBuilding over three stories ❑Feeders, 400 amps or more
❑ Multi family 0 Master builder 0 der: ❑Occupant load over 99 persona QManufaotured structures or
E li
JOB SITE FORMATION AND LOCATION ❑ � - e4 N ghtin g plan RV park
❑Odier:
0Health -care facility
Job no.: 84046 - 123 Job site address: 13125 SW HALL BLVD. Submit 2 acts of plans with any ofthe above.
The above are not applicable to temporary construction service.
City/State/ZIP: TIGAIZD, OR 97223 IrEE* SCHEDULE
Suitc/bldg- /apt. no.: Project name: CITY HALL, POLICE RECORDS uarviDtks _ r Qty. po Iotat 1 •'
New residential single- or multi- fancily dwelling unit.
Cross street/directions to job site: Includes attached garage
1,000 sq. R. or less 145.15 4
Lot no ka. add'l 500 sq• 8. or portion I 33.40 1
Subdivision: Limited energy, residential 75.00 2
Limited energy, non-residemittl 75.00 2
DESCRIPTION OF a Each manufactured or modular • dwelling, service and/or feed 90.90 2
INSTALL I 1 CIRCUIT FOR PRINTER RECORDS.
Services or feeders installation, altcrsdion, and /or irelocation
200 amps or leas 80.30 2
201 amps to 400 amps 106.85 - 2
E PROPERTY OWNER in TENANT
401 amps to 600 amps 160.60 2
Name: OF TIGARD 601 amps to 1,000 amps 240.60 2'
Over 1,0001111p or volts 454.65 2
• OULEVARD Reconnect on 66.85 2
• . 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (5I 200 amps or less 66,85 1
being Owner installution: This intstallation is made on property 201 amps to 400 amps 100.30 2
intended for sale, laise, rent, or exchange, .. , . to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 . 2
Owner signature:
Date: Itranch circuits - new, alteration, or extension, per panel
A Fee for. branch circuits with
■ ■ CONTACT PERSON service or feeder fee, each 6.65 2
Business name: brunch circuit
B. Fee for branch circuits
Contact name: without service or feeder foe, ' 46.85 Y ` • O S 2
each brunch circuit
Address; Each add'I brunch circuit 6.65 2
City/Sta
Miscellaneous (service or feeder not included)
/tl'
Pump or irrigation circle 2
• , . ' _Sign or outline lighting 53.40 2
S ignal circuits) or limited-
CONTRACTOR energy patrol, altenttton, or
extension. Describe: Page 2 2
I3usiness name: Oregon Electric Group
Each additional inpection over afownble in any of the above.
• , . I I Per inspection 62.50
City/State/Z1F: Portland, OR 97214 love-stigatior per hour (t iv min) 62.50
Industrial plant per hour 73.75
i t t i ELECTRICAL PERMIT FEES'
CCB Lie.; 203 ' I Subtotal ` ! (, . $ S
Plan review (25% of permit fee)
Suprv. Electrician signature, n-quired: � -
State surcharge (8% of permit f 3. S
Print name; t'1 n Rk., ` / •. M� TOTAL PERMIT FEE So, 0
r
Authorized signature; i'/=, , . This permit application expires Ifs permit Is net obtained within LAO
days Own has been accepted ae complete
Print name: M • • `/ S J,' N E y ' • : W22/05 • Fee methodology set by Ili- County Building Industry service aoaid
" Number of insaeetions net permit allowed-
TY OF TIGARD
tr ' -SING DIVISION PERMIT #: ELC.2005 -00610
13125 SW Hall Blvd., Tigard, OR 97223' DATE ISSUED: 8/22/2005
Phone: (503) 639 -4171 : �u �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 23/2005 TIME: 7:05AM PAGE: 64
SITE ADDRESS: 13125 SW HALL BLVD PD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: POLICE DEPT
DESCRIPTION: Install circuit for printer in police recur +,, dept.
OWNER: TIGARD, CITY OF, PHONE #: 503 - 639 -4171
CONTRACTOR: OREGON ELECTRIC CONST /GROUP • PHONE #: 503 - 234 -99g0
Inspection Request Scheduled For: Date: 8/2 A:20055 Pour Time:
Code # Inspection Description . ' - . Contact # Message
199 Electrical final 0144 . 01 603 849 N
Corrections/Comments/Instructions:
•
1 14 PASS PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: G ' o Ly Date: 5 8 (23(Q5 Phone #: (503) 718- Z441-
•