Permit E
; ,CITY OF TIGAR® ELECTRICAL PERMIT
PERMIT #: ELC2004 -00577
*F
l DEVELOPMENT SERVICES DATE ISSUED: 9/14/2004
4.61:114.4 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25101 AC -01300
SITE ADDRESS: 07105 SW HAMPTON ST
SUBDIVISION: BEVELAND NO. 2 ZONING. MUE
BLOCK: LOT : 018 JURISDICTION: TIG
Project Description: Compressor change out.
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 HMI 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:
KAISER FOUNDATION HEALTH CHERRY CITY ELECTRIC
PLAN OF THE NORTHWEST #838 8100 NE ST JOHNS ROAD D -104
ATTN: PROPERTY ACCOUNTING VANCOUVER, WA 98665
PORTLAND, OR 97227
Phone: Phone: 360 - 571 - 4411
Reg #: ELE 37 -620C
LIC 91668
FEES SUP 3486S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/14/2004 $53.50
[TAX] 8% State Surcharge 9/14/2004 $4 Low Voltage Inspection
Elect'l Final
Total $57.78
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: k Permit Signature: SA
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
,; x'. J; ;� �' , • 1 , _:s Y k 5 , y S'i`t' C ,, ,, C3 3y
El 'trmit Appli 0� x ,fi )FF�CE .. �� f
City of Tigard ��v DateByd. �y _a,,,,7.
a/ �,�i /�- ~ Permit No. .L 1,04/ (7Q) 17 •
13125 SW Hall Blvd., Tigard, OR 97223 q 15 10 � Plan Review
Phone: 503.639.4171 Fax: 503.598.196 [¶ . J �� 11 Date/By: Other Permit:
Inspection Line: 503.639.4175 �GG" f`�' ! ' Date Re ady /By: Iuris: 0 See Page 2 for
rA �`I O ` \ `, S r.. Nottt d/ t ethod,
Internet: www.ci.tigard.or.us 1 Supplemental Information
: .,n,....a__ .., _, , -. .x f -,., . . W.. ,.- .. ,., -cam,.. r le • % may.
❑ New construction ❑ As • • i 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.,
..,7, •::*? ,t - 3 ' o wresidential
>r� r .,� -- . -_.- * t�r�•� = �r -and 2-family dwellings 4 or more new
wii. At..i_ 3, RY'4OF:aC01\STRUCTION 5 ..,. ° ,. i t ,, o. l ) o
,.;_:%�a;ic �:r•� :,.GAT -EGO � .
.4..- ��:_ .� � -.. __ � ,._._. _�,_ ..,.� „� .•�,_.,.r�`� :. : -_.
❑ 1 - and 2 family dwelling ,E /industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑ Building over three stories ❑ Feeders, 400 amps -or more
. ❑ Multi - family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons Manufactured structures or
fs:. o RV park
l ” :• - •> r - E gress /1i htin plan "`�t�t: �._.. . JOB�SI'• 1h�IlVF. OR9IZ: ATIOIV..- a '�p�IiO.CATIOl�,��t� �': >�' ❑ g � P
❑ Health -care facility ❑Other:
Job no 311,114,- p 1 Job �site address: 105 , 5W �/I
Submit 2 sets of plans with any of the above.
• City /State /ZIP L W The above are not applicable to temporary construction service.
� t4i l `~ , F E ;E =: AC ,,,, „. '
Suite/bldg. /apt. no.: Project name: i dfp 'V �/ De o ( . , 1 ' Description u.:,...._�. , t ..
p [ion t _ - . - _•” _ ._ � t I 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 I 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I 1
Limited energy, residential I . 75.00 J I 2
Tax map /parcel no.: • . Limited energy, non - residential I 75.00 1 I 2
-: ' ,., n2DESCRI'PTIOltt OF W072K= �., ' " ' x—
- :�> ` " "` r '""�' -�;�`� Each manufactured or modular
`�r.,��.,� .,; ;..f�>�s;:=��';f�:�::_���.,:,.. , ,., �, �3:. t�: z.. �..« ��,. � ..= �z= t�',�� >.�_ .u'��F> - sue:. - „
. Y ' C ^ dwelling, service and /or feeder 90.90 2
(l'�f1,/1 "/�" / V V v ' Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
,,_ .�_'.: - • .. „- .... >,.._;,><< ;: <' -' * "" _.,..,.:'- - rte : ,*...• t amps to 400 amps I
s•:t;vr sue: ° ;'
201 10 �
rod „:: , .c. 3=a c°i _ TEN =ANT: ,- ,, srR ,:- -;,
tr PROPFsRT1 _O«iVER. 1; _- 4 . __.
-_. _.....a,.K rw� �,x- w4,....v a' ' 1_- _x,� - , ...r kT� - 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 1 454.65 I 2
Reconnect only 66.85 . I 2 .
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less I 66.85 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps I •133.75 I 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
.,;;., ,._,.__.. ,_,. - .•s : - :: —t.-- z elf : ,:. ,;, - r .;,t - r =�; ,” 1 . A. Fee for branch circuits with
;:�;•�:'r - - g ��. s; �.,... =�, •`•.r <�.- .,,�,< A ..,; � ,CO'�' :P =RSO1�„>� =_,: a�.
x 12; °APPII;AIVT. <= ' •_..._,.,;r:::a...n , ._.4- ,,•F .....:._ ;:t.r°
-- .. - w - - - - service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, i
46.85 lam / � 2
each branch circuit "Lf� �.
Address: Each add'l branch circuit 1 6.65 �O �- 2
City /State /ZIP: Miscellaneous (service or feeder not included) 1
Pump or irrigation circle I I 53.40 . I 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
= ,.- ,;rnr.. = t :a >. - sf en ergy pan el, alteration, or
t a - „s :<`;'; =` ` r.� .. V"-"'�.,., g . a = z t wait energy P
: �'r �-:�= �:c-c::^�',.�*'�s�'`. -r� �. =e:-•ra:'`���:� ...< .. - .- ,.n... �'._.w`,��"�,:rk:w r' :.,��, , - ..,,.u�•:F -:�'� . 2
`" "�"" °� � extension. Describe: Page 2
Business name: eY ft f
- o l � /� // Each additional inspection over allowable in any of the above I
Address: g160 t �� Y I� l I Per inspection 62.50 I I
City /State/ZIP: Vain l ( ' l V V V 4 4s v (P5 Investigation per hour (1 hr nun) • 62.50 I
v / � / / Industrial plant per hour I I 73.75 I
� ant
Phone: ) L �U S7( � (14 V a n t
�(( Fax: ?=. _ 3,- . EMTI2TC T;; =PE121�7�IT REES ` .,
CCB Lie.: f / n�QQ Electii dal Lic.: r Suprv. Lic � S ubtotal 5-
Suprv. Electrician signature, re uired: Plan review (25% of permit fee)
f }f-= State surcharge (8% of permit fee) 7 s CA
Print name: �j t (�`i ; - t r•w Date: r '
e f l
TOTAL PERMIT FEE �7
Authorized signature: This permit application expires if a permit is not obtained within 1S
. days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
— Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PernitApp dot 12/03 440 4615T( /02 /COMIWEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Wne,�(,503) 639 -4175
MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 9 3 AM PM BUP
Location C ...e-diL_A6 Suite MEC
Contact Person .fe/1 Ph (tea) gl`� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC � ' d
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT /1.11
Post & Beam AWNS
Shear Anchors
Ext Sheath/Shear MEW
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall
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
F - farm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
A DA �°
Approach/Sidewalk Date 2 3 Inspector ✓ 1 � / i ' �� % Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•