Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00680
DEVELOPMENT SERVICES DATE ISSUED: 10/26/2004
"61
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136AD-04000
SITE ADDRESS: 11507 SW PACIFIC HWY A
SUBDIVISION: VILLA RIDGE ZONING. C -G
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: JOB NO. 04 -493 Tenant Improvement
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: 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:
SMITH, EDITA M LEAR ELECTRIC
833 NW 170TH DR PO BOX 573
BEAVERTON, OR 97006 GRESHAM, OR 97030
Phone: Phone: 503 - 665 -9840
Reg #: LIC 00052278
SUP 3786S
FEES ELE 26 -411C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/26/200' $53.50
[TAX] 8% State Surcharge 10/26/200' $4.28 Rough -in
Elect'I 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: 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
10/25/2004 13:51 5036616389 LEAR ELECTRIC CO INC PAGE 02
Electrical Permit Application FOR OFFICE USE ONLY
f Tigard DateBy: eee 60 tW
C i}�'.� Date/By:
`.1 g Permit No.:
13125 SW Hall Blvd., Tigard, OR 972REC E I VE I/ Plan Review
Phone: 503.639.4171 Fax: 503.598. " '" 't-lim: 1 ` Date/By: Other Permit: arJay -00 itci�
Inspection Line: 503.639.4175 aA; ;'' 1 Date Ready/By: lusts: ® See ge 2 for
Internet www.ci.tigard.or.tts y 2004 Notified/Method: Supplemental Information
OCT TYPE .OFF , _ WORK . PLAN REVIEW
El New construction 1 d a712#aii„ . f. men[ Please check all that apply:
El Demolition El • DIVI ION ❑Service over 225 amps, comm'l ['Hazardous location
CATEGORY OF CONSTRUCTION
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
of 1- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ( Cotnmercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family 0 Master builder ❑ Other.
JOB SITE INFORMATION AND LOCATION. ❑Occupant load over 99 persons 0 R MVnu rk l structures or
❑Egress/lighting plan P
Job no.: Job site addres ?mar n „ ❑Health -care facility ❑Other:
Q�' y� 3 �l�d`f �tA7 . � Wt.( 'S� Submit 2 sets of plans with any of the above.
City/State/ZIP: - ;Qara e J The above are not applicable to temporary construction service.
J FEE" SCHEDULE
Suite/bldgiapt. no.: I Project name: -- n
• ' "" G V RA LS Description I Qty. I Fee. l Torsi I "
Cross street/directions to job site: J 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. R. or portion 33.40 t
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK Limited energy, non - residential 75.00 2
Each manufactured or modular
C_ / 1 dwelling, service and/or feeder 90.90 2
1(�
` `e..1.D C(i 1 milk) Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 ' 2
0 PROPERTY OWNER I ❑ 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 _ 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
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
Address: each branch circuit 46.85 t��,� 2
Each add branch circuit j,.., 6.65 (p .(y5 2
City/State /ZIP: Miscellaneous (service or feeder not Included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR • energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Le 5t�.�L. ie, CO. T.,.,_ .
Address: .� tg d K tom �� � 3 `ri Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: c .`I,.n w O-. co D Investigation per hour (I hr min) 62.50
Phone: (M7) Ll;( 5.. � 4D Fax: ( l � )) L r�. (1029 _ industrial plant per hour 73.75
ELECTRICAL. PERMIT FEES*
CCB Lic_: 5 Electrical Lic.: - 4ll C Suprv. Lic.: , 1%7e5 Subtotal 15 3.E
Suprv. Electrician signature, red: , --- //,,y, w Plan review (25% of permit fee)
n State surcharge (8% of permit fee) � . gi
i
Print name: .Vift C. mtIN,A � p v .A. ate: l0 • 5•Od �J ��$
� TOTAL PERMIT FEE
Authorized signature: This permit application expires We permit is not obtained within 180
days after It has been accepted as complete
Print name: I Date: • Fee methodology set by Tri -County Building industry Service Board
•• Number of inspections per permit allowed.
i:\ BuildinglPermiu \ELC- PemtitApp.doo t2/03 4404615T(10IO2/COM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspectidn Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
/ � BUP
Received Date Requested 1/ ° Q AM AM BUP
Location 1/ 5 7 Pa-e--4,
Suite MEC
Contact Person Ph ( S 3 ) 8 A- \V PLM
Contractor Ph ( ) 9F % e) SWR
BUILDING Tenant/Owner r ELC o � 66 4 1 – OD
Footing
ELC
Foundation
Ftg Drain Access: 171 pJ ELR
Crawl Drain L - X / �
Slab Inspection Notes: 0 , V r1 SIT
Post & Beam L'S1
Shear Anchors C \� \ J J P b
Ext Sheath/Shear �'" 1 (� \� ,�,
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof � .�: g..SZAlk
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 No_ E r
Fire Alarm
PAR ea Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Li Please call for ection RE: El Unable to inspect — no access
Fire Supply Line
ADA / G�
Approach/Sidewalk Date �: Inspector Ext
Other:
Final ' O NOT REMOVE this Inspection record from t ob site.
PASS PART FAIL