Permit + CITY OF TIGARD ELECTRICAL PERMIT
+ PERMIT #: ELC2005 -00114
iti I ! DEVELOPMENT SERVICES DATE ISSUED: 4/20/2005
ref � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S 102AA -04100
SITE ADDRESS: 12230 SW MAIN ST ZONING: CBD
SUBDIVISION: MORINS ADDITION LOT : JURISDICTION: TIG
Project Description: Elec for bldg. (Misc = one sign ckt and one smoke detector ckt)
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: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: 2
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 5 W /SERVICE OR FEEDER: 60 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: 1 > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
INTEGRITY INVESTMENTS INC ATLAS ELECTRICAL CONTRACTORS
2229 NE BURNSIDE SUITE 86 4403 SE ROETHE RD
GRESHAM, OR 97030 MILWAUKIE, OR 97267
Phone: Phone: 659 -2212
FEES Reg #: SUP 2581S
LIC 1532
Description Date Amount ELE 3 - 2C
[ELPRMT] ELC Permit 4/20/2005 $1,458.55
[ELPLCK] ELC Pin Rev 4/20/2005 $364.64 REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcharge 4/20/2005 $116.68
Total $1,939.87
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-:!•-332-
Issued By: ! , ' /r Permittee Signature: /4 r 2, 0a . s J e ,
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 Application P6I'cl FOR OFFICE USE ONLY
City of Tigard /C�( .ce Pe No.: C �f/
13125 SW Hall Blvd., Tigard, OR 97223 ` Ian Review
Phone: 503.639.4171 Fax: 503.598.1960 /jy U- I
C A''';'. t ' '� Date/By: Other Permit:
e
Inspection Line: 503.639.4175 �/ / O _ �• Date Ready/By: Jens: SJ See Page 2 for
Internet: www.ci.tigard.or.us //I � Notified/Method: 1 C. Supplemental Information '4
TYPE OF WORK O /L 49 / O M PLAN REVIEW )
Ell New construction ❑ Addition/alteration/replacement Please check all that apply: 1
El Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., ''
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure r n
El Multi-family ❑Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more V'
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
❑Health -care facility ❑Other:
Job no.: 12400 Job site address: 12230 SW Main Street
Submit 2 sets of plans with any of the above.
City/State /ZIP: Tigard, Oregon 97223 The above are not ,plicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: Crown Carpet Description I Qty. I Fee. I 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'I 500 sq. ft. or portion 33.40 I�
Limited energy, residential 75.00 2�
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular �}
dwelling, service and/or feeder 90.90 2
Electrical for Crown Carpet. Services or feeders installation, alteration, and/or relocation
200 amps or less 5 80.30 401.5C 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
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 1 454.65 454 65
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
EI APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: Atlas Electrical Contractors, inc, branch circuit 50 6.65 399.0C 2
B. Fee for branch circuits
without Contact name: Ronald J Gauger u ut service or feeder fee, 46.85 2
each d'I branch
branch ch c i n
Address: 4403 SE Roethe Road
Each add'I branch circuit 6.65 2
City/State /ZIP: Milwaukie, Oregon 97267 Miscellaneous (service or feeder not included)
Phone: ( 503 ) 659 -2212 Fax: (50359 -4944 Pump or irrigation circle 53.40 2
Sign or outline lighting I 53.40 53.40 2
E -mail: Signal circuit(s) or limited- ��pp
CONTRACTOR energy panel, alteration, or 75 ¢�.� % ��
extension . D crl e: 1113X{ Page 2 y 2
Business name: Atlas Electrical Contractors, Inc. 17A ,DOCT012,5
Address: 4403 SE Roethe Road Each additional inspection over allowable in any of the above
•46` Per inspection 62.50
City /State /ZIP: Milwaukie, Oregon 97267 1> Investigation per hour (I hr min) 62.50
Phone: ( 503 ) 659 -2212 Fax: ( 503 ) 659 -4944 ID -1 -01 Industrial plan per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 1532 Electrical Lie 3 -2C Suprv. Lie.: 1009S Subtotal /t/6g g
Suprv. Electrician signature, required: e.t. Plan review (25% of permit fee) y r (rp�
Print name: State surcharge (8% of permit fee) / t l l D
Ronald Gauger Date 2/22/05
TOTAL PERMIT FEE / 939.87
Authorized signature: This permit application expires if a permit is not obtains„ ....inn ISO
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
SO Number of inspections per permit allowed.
is\ Building \Permits\ELC- PermitApp.doc 12J03 440.4615T(10 /02/COM/WEB
ITY OF TIGARD -
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ELC2005 - 00114
Phone: (503) 639 -4171 �� d 4/2012005
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
6/1/2005 7 :15AM 22
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 12230 SW MAIN ST LOT #: TYPE OF USE:
PROJECT NAME: MORINS ADDITION
DESCRIPTION: CROWN CARPET
Elec for bldg. (Misc = one sign ckt and one smoke detector ckt)
OWNER: PHONE #:
CONTRACTOR: INTEGRITY INVESTMENTS INC, PHONE #:
ATLAS ELECTRICAL CONTRACTORS 659 -2212
Inspection Request Scheduled For: Date: Pour Time:
6/1/2005
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 008092 -01 503 - 901 -9336 N
Corrections/Comments/Instructions:
❑"PASS � 'ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: , /j r 1 /\t, Date: Phone #: (503) 718-
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELG2005 00114
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/20/2005
Phone: (503) 639 -4171 n rtl'�r' 4h , I �
Inspection Requests (24 Hrs.): (503) 639 -4175 `'� I ..
INSPECTION WORKSHEET FOR DATE: 5/31/2005 TIME: 7 :11AM PAGE: 30
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Elec for bldg. (Mist = one sign ckt and one smoke detector ckt)
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: ATLAS ELECTRICAL CONTRACTORS PHONE #: 659-2212
Inspection Request Scheduled For: Date: 5/31/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 008013-01 503-901 -9336 N
Corrections /Comments/ Instructions:
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7 ,id . ,i Ari /1 0f / './� I ,L"
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / Ii . Date: • ./ / Phone #: (503) 718-
CITY OF TIGARD - .. -
BUILDING DIVISION - PERMIT #: ELC2005 -00114
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2005 i�„,,
Phone: (503) 639 -4171 ,, � i
Inspection Requests (24 Hrs.): (503) 639 -4175 -' °1_ I
INSPECTION WORKSHEET FOR DATE: 5/20/2005 TIME: 7:11AM PAGE: 54
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Dec for bldg. (Misc = one sign ckt and one smoke detector ckt)
( 9 )
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: ATLAS ELECTRICAL CONTRACTORS PHONE #: 659-2212
Inspection Request Scheduled For: Date: 5/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service/reconnect 007388-01 503 - 659-2212 N
Corrections /Comments / Instructions:
)---1 .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Y A .-.LLB / Date':--- ' 1 - 6 Phone #: (503) 71 8-
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELC2005.00114
. 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2005
Phone: (503) 639 -4171 �n ,�nd4gp
�llih;
Inspection Requests (24 Hrs.): (503) 639 -4175 „,_191- `__1.
INSPECTION WORKSHEET FOR DATE: 5/16/2005 TIME: 7 : 09A1v1 PAGE: 72
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
• PROJECT NAME: CROWN CARPET
DESCRIPTION: Dec for bldg. (Misc = one sign ckt and one smoke detector ckt)
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: ATLAS ELECTRICAL CONTRACTORS PHONE #: 659 -2212
Inspection Request Scheduled For: Date: 5/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service/reconnect 006862 -01 503 -901 -9336 N
Corrections /Comments/ Instructions:
?\ acE \gg cud c 1.NIL., w N i S WI ); .
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❑ PASS )4 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
c-�
Inspector: G Date:4 1 Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION i ,--. PERMIT #: ELC2005 -00114
•
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 :Nom i l 4/20/2005
Inspection Requests (24 Hrs.): (503) 639 -4175 `__..
INSPECTION WORKSHEET FOR DATE: PAGE:
5110!2005 TIME: 7:16AM 62
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 12230 MAIN ST LOT #: TYPE OF USE:
PROJECT NAME: MORINS ADDITION
DESCRIPTION: CROWN CARPET
Elec for bldg. (Misc = one sign ckt and one smoke detector cld)
OWNER: PHONE #:
CONTRACTOR: INTEGRITY INVESTMENTS INC PHONE #:
ATLAS ELECTRICAL CONTRACTORS 659 -2212
Inspection Request Scheduled For: Date: 5/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 006492 -01 503- 901 -9336 N
Corrections /Comments/ Instructions:
4'✓ / "
L __________ _
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6., j)4 / \J Date: , 0 B7 Phone #: (503) 718-
CITY OF TIGARD • j='
BUILDING DIVISION PERMIT #: ELC200S -00114
. 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2005
Phone: (503) 639- 4171Am� �I(i
Inspection Requests (24 Hrs.): (503) 639 -4175 _. ___ '__-
INSPECTION WORKSHEET FOR DATE: 5/9/2005 TIME: 7 :10AM PAGE: 49
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Elec for bldg. (Misc = one sign ckt and one smoke detector ckt)
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: ATLAS ELECTRICAL CONTRACTORS PHONE #: 6532212
Inspection Request Scheduled For: Date: 5/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 006381 -01 503 - 901 -9336 N
Corrections /Comments/ Instructions:
fi- P� 60vfg itepfSD'2 D, 'r
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WGJJ L-&-. (- V,'7 r •a--c i< ) J-iot;
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❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ay / Date: Phone #: (503) 718 -
•
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELC2005.00114
. 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2005
Phone: (503) 639- 4171�u.nr •
Inspection Requests (24 Hrs.): (503) 639 -4175 -
INSPECTION WORKSHEET FOR DATE: 4/21/2005 TIME: 7:08AM PAGE: 56
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Elec for bldg. (Misc = one sign ckt and one smoke detector ckt)
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: ATLAS ELECTRICAL CONTRACTORS PHONE #: 659 -2212
Inspection Request Scheduled For: Date: 4/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 005051 -01 503 -901 -9336 N
Corrections /Comments /Instructions:
/k7.-
•
❑ PASS . P ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / ct Phone #: (503) 718 -
•
CITY OF TIGARD ..
BUILDING DIVISION PERMIT #: ELC2005 -00114
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2005
• Phone: (503) 639 -4171 411,, ��ii �
Inspection Requests (24 Hrs.): (503) 639 -4175 _ -_ 4— `' I..
INSPECTION WORKSHEET FOR DATE: 6/2/2005 TIME: 7:12AM PAGE: 42
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Elec for bldg. (Misc = one sign ckt and one smoke detector ckt)
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: ATLAS ELECTRICAL CONTRACTORS PHONE #: 659-2212
Inspection Request Scheduled For: Date: 6/2/2005 Pour Time:
Inspection Description Confirm # Contact # Message
r
199 Electrical final 008200 -01 503 -96 -9336 Y -,, 4 `' i 4,% ' ti
Corrections /Comments /Instructions: e
1/0,44 140 4— it:49-4°
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a ,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
7A FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C? r / /
p � Date: V Dj Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 6 LL a A6= 6 � T a ��1
' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
At l� yii ,� 1 1 I
Inspection Requests (24 Hrs.): (503) 639 -4175 `:_
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 1 ).,a,b0 h'11 )y� CLASS OF WORK:
SUBDIVISION: p 0 \ry S Q DU) 1/N-1 LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE NS-0i
CONTRACTOR: q L
S ��Gt�j L� I�-' PHONE � � 1
Inspection Request Scheduled For: Date: -6 .3 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
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•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �,, _� /4r Date: Phone #: (503) 718 -
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