Permit A CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00816
- •�l�l DEVELOPMENT SERVICES DATE ISSUED: 10/17/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 1S136CD - 00100
SITE ADDRESS: 11705 SW PACIFIC HWY K ZONING: C - G
SUBDIVISION: PACIFIC CROSSROADS LOT : JURISDICTION: TIG
Project Description: (2) 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: 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:
PACIFIC CROSSROADS PROPERTIES, I GUILD ELECTRIC INC
BY WYSE INVESTMENT SERVICES CO PO BOX 674
200 SW MARKET ST STE 345 BEAVERTON, OR 97075
PORTLAND, OR 97201
Phone: Phone: 503 - 957 - 1173
FEES Reg #: LIC 109116
SUP 3868S
Description Date Amount ELE C21
[ELPRMT] ELC Permit 10/17/200' $53.50
[TAX] 8% State Surcharge 10/17/200' $4.28 REQUIRED ITEMS AND REPORTS
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 rul s or direct questions to OUNC at
503 - 246 -6699 or 1 -80 z' 332 -
Issued By: 4. , i� 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.
1 estlrical Permit Ap 1,11,;_. CEIVED FOR OFFICE ESL.ONL.1
City of Tigard Received o vs 66 Permit No C j _ D ( ) 1 6
13125 SW Hall Blvd., Tigard, OR 97223 1 7 2005 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 OCT lJ 1 7 J ii ' i • � e/g .
Inspection Other Permit:
ection Line: 503.639.4175 .,t
p „ ,�.' : �-, Date Ready/By:
Ma VI See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method Supplemental Information
. L 12 ,6a15IUN PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ 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 I- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION RV
❑Egress/lighting plan park •
Job no.: Job site address: I 1705 �o5 s t„/ 3464- }{.will 5 ❑Health care facility ❑meter.
Submit 2 sets of plans with any of the above.
City/ State/ZIP: I 1 r� 1 4 4 -9 Br— �7-LZ?) The above are not applicable to temporary construction service.
f 4 ,p _ _ _ FEE* SCHEDULE
Suitt:/bldg. /apt no.: Project name: 14- M •n me - j��. pperiptioa I Q I Fa I Tdd l "
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'l 500 sq. ft or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
4 �- dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ 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
Phone: ( ) Fax: ( ) relocation
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
lI(PPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or Business name: / 11 bran h circuit
fee, each 6.65 2
B. Fee for branch circuits
Contact name:
....AG, C_ 4 7 E942 without service or feeder fee,
each branch circuit 46.85 2
Address: e0 ' ie- 6 b 14 Each add'I branch circuit 1 6.65 2
City/ State/ZIP: I loiditi1 CIZ— 9'7074," Miscellaneous (service or feeder not included)
� Pump or irrigation circle 53.40 2
Phone: ( 95 3) GI v Q
7,39g 7 Fax:: ( 03) I 145' Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: /A extension. Describe: Page 2 2
(_%( r L O 1: L- -
Address: �� ,�hor�� Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZlP: Investigation per hour (1 hr min) 62.50
Phone: ( ) 1 , a A VAP Fax: ( ) /) 1 10k49 / \C Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: (09 I (0 Electrical Lic.: (� - Z( Suprv. Lic.: 3 O 4 $ S Subtotal 6- 3 50
Suprv. Electrician signature, required: ht-' . Plan review (25% of permit fee)
Print name: j f "JN 0...c ( K ! v t cr V h Date: 1 D / I -1 /05--- State surcharge (8% of permit fee) 4 a g
TOTAL PERMIT FEE 57,-71
Authorized signature: This permit application expires if a permit is not obtained within 180
days atter it has been accepted as complete
Print name: I Date: • Fee methodology set by Tri -County Building Industry Service Board
• • Number of inspections per pemtit allowed.
i:\ Building \cnuits\ELC- PmnitApp.doc 12/03 410-4615T(10/O2ICOM/WFB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: 7
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
,
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: -
Fee for each commercial system $75.00
(SEE OAR 918 260 - 260)
Check Type of Work Involved:,
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
N.
❑ Fire Alarm Installation
❑ HVAC •
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting* •
❑ Protective Signaling
❑ Other
Total number of commercial systems: •
*No licenses are required. Licenses are required
for all other installations
iABuildingTennits \PLC- PamitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005.00816
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/17/2005
Phone: (503) 639 -4171 �aeehl t�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/26/2005 TIME: 7:07AM • PAGE: 35
SITE ADDRESS: 11705 SW PACIFIC HWY K CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE:
PROJECT NAME: H & R BLOCK
DESCRIPTION: (2) branch circuits.
OWNER: PACIFIC CROSSROADS PROPERTIES, I, PHONE #:
CONTRACTOR: GUILD ELECTRIC INC PHONE #: 503 -957 -1173
Inspection Request Scheduled For: Date: 10/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 019392 -01 503 -957 -3887 N
Corrections /Comments /Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /o ' L ` Or Phone #: (503) 718-
OF TIGARD
B NG DIVISION PERMIT #: ELC2005 -00816
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/17/2005
Phone: (503) 639 -4171 eu l 1'i�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/19/2005 TIME: 7:03AM PAGE: 43
SITE ADDRESS: 11705 SW PACIFIC HWY K CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE:
PROJECT NAME: H & R BLOCK
DESCRIPTION: (2) branch circuits.
OWNER: PACIFIC CROSSROADS PROPERTIES, I, PHONE #:
CONTRACTOR: GUILD ELECTRIC INC PHONE #: 503-957-1173
Inspection Request Scheduled For: Date: 10/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 018717 -01 503957 -3887 Y
Corrections/Comments/Instructions:
CAL
N b f'1 C Mot 6 A) CV—
■ 1- t.1 •Z Ul 1 1--E -
C KCY.) ‘‘ Cse \(- " i . -- ef■ L , m 7 IR
- ?‘&61b. -- 16 f
fifeezki - a,via.r P1C -ieL
\ (]•PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ 'ALL FOR INSP CTION ❑ ADDITIONAL FEES ASSESSED
// /
Inspector: / / Date: 1 6 i R / Phone #: (503) 718 - 24K