Permit C "s CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00652
1hi DEVELOPMENT SERVICES DATE ISSUED: 9/7/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S101 AD - 00400
SITE ADDRESS: 06655 SW HAMPTON ST 120 ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS • LOT : 034 JURISDICTION: TIG
Project Description: (8) branch circuits. Job # 958.
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: 7 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:
NORRIS BEGGS & SIMPSON WILLAMETTE ELECTRIC INC
121 SW MORRISON SUITE 200 PO BOX 230547
PORTLAND, OR 97204 TIGARD, OR 97281
Phone: 503 - 273 -0320 Phone: 503 - 624 -3631
FEES Reg #: LIC 75059
Description Date Amount SUP 1965S
ELE 34 -283C
[ELPRMT] ELC Permit 9/7/2005 $93.40
[TAX] 8% State Surcharge 9/7/2005 $7.47 REQUIRED ITEMS AND REPORTS
Total $100.87
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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: I z 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.
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SEP 07 2005 8:O1RM HP LASERJET 3200 p.2
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Electrical Permit Appii (,{� �(/J� ue _ 1 FOR OFFICE USE: olvl ONLY /�
U US�v �°� NY Date/By. _ _ `l / Pe =mitLI S �/
City of Tigard Date 0
13125 SW Hall Bivd., Tigard, OR 97223 _ Plan Review Other Permit
Phone: 503.639.4171 Fax: 503.598.1960 si r 0 �� %1 ' /" ,,,,,, '' ei 1' Date/B
I Ready /By RI See Page 2 far
Inspection Line: 503.639.4175 'r"' ' Notifed/MeBod: Supplemental information
Internet: r.us
r ry r,c - rlr~nlan � . r1;� ,: �..,
7 7`1;';,:!,' rr Y 'r1y1 II� - , M ..: 'F ;"At 44)' i!4''t � 'j;e i' ,„,,1**,,,.:. .
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,� , � i� ..k, c�f,�rlt as rrr�:��',�' �:. �� r Please check all that apply:
❑ New construction Addition/alteration/replacement ❑asevihe ovar 225 amps, eomm'I ❑Hazardous location
❑ Demolition ❑ Other []Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft:;
t # , i �t, ilW:;:T ", t A :Ttg-M r J?t; a' ° y °^`', p_ of 1- and 2- family dwellings 4 or more new residential
k� ii k a K9 5. f1. l.. tt iT �n , I r dt t ' . 146 M ' . t ' -. % units in ore structure
❑ l - and 2 dwelling ®CommerciaU ❑ System over 600 volts nominal industrial 0 building Building over three stories ❑Feeders, 400 amps or more
❑ Multi faintly 0 Master builder ❑ Other ❑Occupant load over 99 persons ❑Manufactured structures or
^ a i 7i1 P� �m i 7 f °5'E.dl._,! fa ° 5 �; ,tp xn a ��,F I fk5 -.- .1 e r • ` r
< i 1 }Ain an RV purl(
?.a -N; 4.1 t? 11.4.1ii l F"`alitr C " e t a b urn;,. .
` l a .'.1 1 .
A " ;' 5 ,
, ❑B6`t � a gP
�-- ❑Flealth -care facility ❑Other:
Job no.: 9 Job site address: G, 45.1 sG✓ 4„_, 51 Submit 2 sets of plans with any of the above.
The above are not applicable to temporary construction service.
City/State/ZIP: j /, .4-4 0 RILI .,.f r * 1 r � ` � t ��t L ' � c1]]r
3 x.tt_,.Hl".i ,,..1 "Ei. .LYaY � -c,m",
Suite/bldg. /apt. no.: r1 l Project name: �R. ( Description Qa• i=•e• Tetnt "
Cross street/directions to job site: VN,S?).(3\r..C>N\-- f\\,..\\ ( New residential single -or multi- family dwelling unit.
t Includes attached garage.
1,000 sq. ft. or less 145.15 4
Lot no.: Pa. add'1500 sq. ft. or portion 33.40 1
Subdivision: Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non-residential 75.00 • 2
_ ^�l:x TiV 1q i+ a zgli . R r6fii ' � g°. 403' P-,t� '"' q icy 'a' x.si Each manufactured or modular
;�` `! , � ray ,, -��: ,�,;,
'c if�'s 0.i ig 1 IA'..i e � .-r.v. a. r " . -aa.a.a"m':' 13 -' - dwelling, service and/or feeder 90.90 2
- - p �, - L ,,, _ Services or feeders installation, alterat and /or relocation
' 200 amps or less 80.30 2
r , °te nkr �,. tp1 ", i i a r ^ r ° t �4 r n2 0 , 201 amps to 400 amps lOb.85 2
� a g, .3 ) 4 , : :: K i e #w � .. t _�-4-c = i to ' .z ` ~ t ; ` 401 amps to 600 amps 160.60 2
Name:
601 am to 1,000 amps 240.60 2 Over 1,000 amps or volts 454.65 z
Address: 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, p er p anel
Y. l , , r t ,.� g r i , s O, Is 'R C�ll VER I * } �. - RT 'ht ` f A. Fee for branch circuits with
;;� �, �� �" r W . r � Y , � � ;, _. ^s ,,� �, r,3 - , t�,tr t �' a � service or feeder fee, each 6.65 2
branch circuit .
Business name:
B. Fee for branch circuits
Contact name: without service or feeder fee, / rs V
46.85 o 2
each branch circuit
Address: Each add'l branch circuit . 6.65 r/ (, 2
City/State /ZIP:
Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) 1 Fax: : ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited -
tl� {� �1 it + l �'� ; n 7, 4 a rC ItLt_ energy panel, alteration, or
x # f"f�i r Nis a i , c F„ A tI" ,; I' . TSS d ' t �lt I 1 5.. , l Page Z
utc , lrr w Cdr extension. Describe: g
Business name: u ( v + , 1 ►e_ ( <- Each additional inspection over allowable its any of the above
Address: P 6 f.e.,,. z,1 () ?j 4 I- - Per inspection 62.50
City /State/ZIP: rtslA . I c) t,.-- 91 TA -- $ Investigation per hour (I hr min) 62.50 ��
Industrial plant per hour Ill 73.75
Phone: ( 1 . O3 ) 42t1 - 16 ( I fax: (.6ze3 ) 102At - - 1-`i .3' g- gl g - l �%! ,i„ .a MSYME 1 `" r
CCB Lic.: '7-s s-A, Electrical Lic.: 3.9 Z6-3 CI Suprv. Lic.: (9 6 5' c Subtotal q t 4..0
Plan review (25% of permit fee)
Suprv. Electrician signature, required: v
State surcharge (8% of permit fee) T y
Print name: . - I Date: -p 1� L t - �, - TOTAL PERMIT FEE i 60 ff -
Authorized signature: Tide permit application expires if a permit is not obtained within 180
days after it has been accepted as compiete
I Date: • Fee methodology set byTrt- County Building industry Service Board
Print name: .# Number of inspections per permit allowed.
emritstBLC-PemdtA doc 12/03 440.4615T(1W0]SCOM/WEB
i:�Building�P PP�
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00652
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/712005
Phone: (503) 639 -4171 h d�j�� ��
Inspection Requests (24 Hrs.): (503) 639 -4175 '!+�
INSPECTION WORKSHEET FOR DATE: 9/29,2005 TIME: 7:OBAM PAGE: 74
SITE ADDRESS: 06655 SW HAMPTON ST 120 CLASS OF WORK:
SUBDIVISION: WEST PORTLAND HEIGHTS LOT #: 034
TYPE OF USE:
PROJECT NAME: MARSHALL FAMILY CHIROPRATIC
DESCRIPTION: ( branch circuits. Job # 958.
OWNER: PHONE #: 503-273-0320
CONTRACTOR: NORRIS BEGGS & SIMPSON PHONE #:
WLLAMETTE ELECTRIC INC 503-624-3631
Inspection Request Scheduled For: Date: 912912005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199N Electrical final 016981 -01 503- 624 -3631 N
Corrections /Comments /Instructions:
C._ _ _ _ _ _ '---- ,
'7 1'
❑ PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL I f CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED - ; - / Inspector ..✓ y c ' Date: • 2 T 0 Phone #: (503) 718-
6
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