Permit „ CITY OF TIGARD ELECTRICAL PERMIT
TIGARD #: ELC2004 -00309
' n DEVELOPMENT SERVICES DATE ISSUED: 6/4/2004
f I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S136CD -01600
SITE ADDRESS: 11674 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install 2oo amp service and (3) branch circuits
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: 1 W /SERVICE OR FEEDER: 3 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 0 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:
DOUGHTY, J PAUL LILLI GEORGE + SONS ELECTRIC CORP
10150 SW CANYON RD PO BOX 339
BEAVERTON, OR 97005 CLACKAMAS, OR 97015
Phone: Phone: 503 - 654 - 8634
Reg #: LIC 35600
ELE 3 -1I7C
FEES SUP 3185S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 6/4/2004 $100.25
[TAX] 8% State Surcharge 6/4/2004 $8.02 Elect'l Service
Rough -in
Total $108.27 Elect'I Final
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 N otification 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 -000- 332 -2344.
Issued By: 6 , l i Permit Signature: al 4/1 CG 4
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
06/01/2004 9:48 503-653-6886 GEORGE & SONS ELECTR , PAGE 01
. 'lir .
RECEIVED
• (
Electrical Permit Application
City of Tigard JUN 1 200A
13125 SW Han Blvd., Tigant, OR 97223
in I ,'; ,elM
Phone: 503.639.4171 Fax 503.598.1960 ciTy oF Tn.., • -'.,..... ...0„. i Other Pam r
Inspection Line: S03.639.4175 DI .4.:•••,i• ',1" J:. 1 liati seady/K • — • - • - - - • - ••- --- ---t•-jggr - 6117. ---"
hitenict www.citigard.or. •• BUILDING I Notified/Method: suaabannioniesamilass
);
litilikW;'''.40'li'ilisfirirll'''''''''':i'''''')'•"‘v-r' ,i
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I "-i41 , 1 .t ‘ i' a : '•' ' '7113.107.: , • :!:.iil!:'AF,H. 1 .••tii,4;,;.1:■1;::-.i-- ; -4,;iii . ? t : 'e.f4s.'el 1
, .. mod /,!..!=•!... i ,(Y. 1 .; i',) ) M'1)(:.: :.:11A: . 1;1 .. , et.thu: i. '.... ■ ' ' all
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• Please check ll that
i IN NM CODSITUCtiOn '-I Addon/alteratIonheplacentent .0,1
i I 0i a apply:
i ce over 225 amps, cornml ntiazardous location
0 Demoliton Sery
El Other:
a ii ,- 4 ,- ,.. , 0.4 , ..• , fe , ' /414 ,i, ; eoi „.., : • OSerViCe over 320 amp: - rating DEnigdn over 10,000 oi. ft I.
'''. t ..,, '‘44,■:17-tl..;,;i1::i!'!t:,.h. 4 . 4 „:i/.! . of i - and 2-family dWell jogs 4 or more new residenial •
I • 1 - and 2-fiunily dwell'...: 7, Commercial/Industrial II Accessory building i OSystem over 600 volts nominal units is one structure • '.
0 Multi-fami ■ 0 Master builder 0 Other I 1 0Building over three stories Feeders, 400 amps or more
hr.1.c,.Jtimigyo ',I.1.:,.4,,,...t,pj).1;:‘,,,•,,,‘:iic.,..;;!■4.1731'.,,,tc,I,..1v,?,.;.'4.741p,./.11:, WI...Milt -- 00ccupant load ov 99 persons : manuacred sc or
tunues
114C - ,..a..: - .M4i441 0 ' , .;04A, ' ''..„ -..!;,.!;111,;;;;;;I:2:ii,...4;.'li.10.',Ii? DE RV pork
- " I ' • 1 ltressAighting pen
I Job no.: fite
rlei RIC /fi 1 • I 0 -
L ___ _. .— c) --1 -
; City/State/ZIP: ""r
4 ! ; Submit _2_ sets of plans with any arm above
. .•
_____. . ....,... ... . I . ,
1.-H - ,. 1 it / - ... . . _. ..: ..„ The . above arenot applicable to terrqsormy eoristniction service.
I .
..•
. .• ,,,.. ' 0-1...IL: t.:- . ' '
— - 1131Cibid — gj •-- aPL — n° •- •: • • - - • i Pr° -.... j . c _ c / nani ......_ e: _ 54 r4..._. ._. . v 4 A 1)0 ... ra . ., 1'"7"--"- .` ‘ . . L.. .• ! .! : .: ' ;:'1'..V . WrillEt440 7 7:.? "'...
I T
! Cross street/directions to '. . site: Deirdndon
- !UPI iiiiiieiiiiii or . m - iiil-la - iihy - dwellhmt unit
, ' Inekdes attached ggrtge...___ . .. . _ . __ . ...... ._ _ ...,
------ •-- • • - • ' " - '" " 'i l__!.,°°° 59 '. ft- T. t!'s$_.__.. ______...,..._ i . .. ... ....1... i i
Subdivision: ' Lot no.: i Ea. add't 500 sq. ft. or portion 1 33.40 ' I '
Tax map/parcel no.: : • Limited energy. residential ' 75.00 . 2
F 1 571 7 . 271 .:4'..'1 4 lF.,'::... 1 i' I IF 'Y ;' ! 7' i '' -- MI:'.,) , , , , 7 ::" , 777 - 7 , ... 7 777,',..;i7,r... 7 7 .77 i Limited energy, non-rcsiciential 75.00 . • 2
. ,.:.t...,.., 1) L.., 4 ... :..; it gl.f. - 3" W :;.: r ...hk ' ......;;. ......3. ,... ±9,.,.,....',. .:.J.1 - Eh Triii,ciriituria or i i - • 1 • • '
I
k \ ...skg.. i. 2o6 4 p ' ; --- d . r .Ciling• se.r.Y.IEF an0/91._fe.eder „._.1_.... . .. 9 . _ t.2..,
. - --"" .1 . Services or feeders Installation, Alteration, atid/or relocatIoe .
'i 3 v ac- 1.),‘,1 ! , 200 amps or less ' 7 • 80.30 1_ 2
.. ' ; 4 _ ,'' ■ 1, ' ,11111,14 .L H T ,; : .; ....'.. 7 ' ,1 , 11.. 1.! c , 'I f.? " , : :(T.: ‘' . ,' ::1 1 %. i ' ...2.A. , 50 1* i ."f i ' '' '.'1 1 +: ! :1 1 ,11 1 1 li ' i t'll e ll i.: 1711144- : '''.. '' '' ''' 3"..5: • ".111 ''' ' ..:' 291.117. ;13 to - - • .--- r - 1915, . 85 -• • -• • .i. - 2 .-
--1 . 401 amps to 600 amps • 160.65 1 2
Name:
6 tones to1,000 .. 4_ 24060 : 2
Address: 1 ! ov,:tr 1.000 amps or voltS ' 454.65
, —
•— — “ --- - " ' • ---- Reconnect only .. . 66.85. ! 2
City/Statc/Z1P:
1 Temporary sevIcei oi iiii Hatiiiii,ilieraHon. atutie . 1
...-- .— . .. --- ---. ----.--- - ----- -..-.. -...-.. .-....... ocon
Fax: ( ) ... . 200 amps or less I . 66.85 : T I
Owner Installation: This installation is being made on property that I own which is not : ', to -amps • 100.30 ! 2 1
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. '74 I
...,_... o 600 am ps.... __, .:. ...i 133 .. . Li
Owner . : . , , , , , , . . ,., Date: • 11 circuits - new, alterailon, • extension, per panel
.... • , ... . .. IT , .... N. d.1 - v . 0, ' , , , 1 6111, • ■ IP ..."
-. ). • l'.. ...!• • A r .
. ; r-,'„,, 'ILIkkb isititios.!,! A . Fee for branch circuits-W/7h 1
service or feeder fee each
--I ,
.
• :
! Business nafne: 6 65
i branch circuit ' 3 • O. fil 2 1
' • • — ' . B. Fee for branch Cirotilts ..-- !- — ' ---- - . - i .--
Contact name:
1 without service or feeder fee,
• Address: — ._ ach • Each add'i branch circuit ! 6.65 , 2
City/State/ZIP: ' Miscellaneous (service or feeder 1101 Included)
....._. .. . ..__ _ _. . .. ....
• — • •-• ----- •-•---• --•-•--••• • . .---•-.--- -,• .-. --.- •-• • • • - - - • Pump OT irrig 2
ation circle I 53,40 2
. Phone: ( ) , Fax: : ( ) • Sign or outline lighting , 53,44i 2
....
E -mail:
; Signal circutt(s) or limited
I enery panelalteratio
'
p T
in Ir i
im q..: . .- . : ; g, n, or •
" .:Buir.)... ■•••■:: .. ::,.•.'"••''' ' .a. ,
i..:.■:,liCl.i.:,',.. ..1„:.:.1'..1.1.!...,orli:11■',11?-.TRI: ''ii ;;,. extension, Describe: ! , Page 2 ; , 2
Business name: G. of tor I lk_S 4 %•;.% Z. 4 ( °Cc) .
. ...__ ..._... . . ._ ___. ___... . _... .._.......,„ . -... -- ... . - • ..... _ • '• Each Additional inspection over alto vahli lis Any of the alicis4
Address: it .., olc 27 - 2 1_
: • Per irtspeetion 62.50 '
— 3
,
• I. . .
, .
City/StatelZ I P: c co1/4.-4,104 0 R ' 7 0 er" ! investigation ter hour (1 kr min) i • 62 .16 .
P L.. •.".'• . 7- alli . ...... ; • ••.' *.' '',•: -.'....1.i .ii
CCB I .ic.: 55600 i Electrical Lie.: 5/- ' Suprv. Lic.: a i E35"--S . >ubtotel • /op. 5"
_. .. _......_
Plan review (25% of pit fee) i
Suprv. Electrician signature, required: ._...._. . .._.. . .._. _ ___. ... . - .
foe)
•
• --- • • • . - • •• .• State surcharge (8% of parmit !
......... .
Print name: C "-a ‘, i s it , „. i Dale: ‘,, — / - co
TOTAL PERMIT FEE /CIS 2.7
___... ......_.._..___ ..
. ---- . •---.. y - -- frii pertniiiiiiotesic■n•pi. iii'i;rrde fe iii;tobiallieilioldilniii
Authorized signature:
dmys lifter 11 bet been acme sd as compkte
.. _ ..._.. . .. ..
Print
• Fee ntothodology vs by - County Budd libidinal) service Board
name: ' Date: Tri
•• Number of inspection; Pri Mull allowa4
:,.
i:\BuiltbsPermiis\ELC-PerroitApp.doc
12.4 440-44 i sn 1 tvraicomnvEs
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ' —' <' AM PM BUP
�-
Location I) £v - 7 Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) 57? EY& 7' SWR
BUILDING Tenant/Owner ELC g d 6 Y - 6 6 30 7
Footing
"
Foundation `��� �� �_J`r ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
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 = Alarm
•ART FAIL
__ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
\
S 0 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line ' /‘ A.., ADA �Approach/Sidewalk Date Inspector .(.77 Ext
Other:
Final DO NOT REMOVE this inspection record fr m the j site.
PASS PART FAIL