Permit CITY OF TICARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00675
16 DEVELOPMENT SERVICES DATE ISSUED: 10/21/2004
„�f l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136CD-00100
SITE ADDRESS: 11705 SW PACIFIC HWY Y
SUBDIVISION: • ZONING: C -
BLOCK: LOT : JURISDICTION: TIG
Project Description: Wire (4) circuits for outlets.
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: 3 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 E C COMPANY
BY WYSE INVESTMENT SERVICES CO PO BOX 10286
200 SW MARKET ST STE 345 PORTLAND, OR 97296
PORTLAND, OR 97201
Phone: Phone: 503 - 220 - 5377
Reg #: ELE 26 -45C
LIC 49737
FEES SUP 4040S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/21/200' $66.80
[TAX] 8% State Surcharge 10/21/200' $5.34 Rough -in
Elect'I Final
Total $72.14
•
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: L r 41r, 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
10/20/2004 02:02 5032205347 PAGE 02 ,
Electrical Permit Ap.plicahori ... 01. �U�
il� ,City of Tigard
]3125 $W Hall Blvd., Tiga OR 97223 a u Nil D a Y/ vZ 11- '��` Xturttie No,: L. (�, � •
Phone: 503.639.4171 Pax: 503.598.1960 I 4+
A Plan ltmaew
Inspection Line; 503.639,4175 "»' Ry 11 a OtherPeattit:
Internet: www.ci.tigard.or-us O 1 "" � ' Y-- Notfle eth
C` ` ' Ready/By: • N See Page 2 for
M ,;.; 3 .� ti s ( plemental Information
C N apt od U
rid .x•.; , w:t'.!(�.�;rr ..,,., . r .:: ,. , ,;..c.:: - sup
7",n:'. i d. + .. ...: .. Y:..:.... , ,,.,. » rv, ! ! ti I ... '
r „;lHfix7li..d(rd�we.r . ,. �,! .., . r.,, ... ........r�......... ,.
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,......... .,::71'. .c. . ..td.. °,',!7 ^,'Caa'. '�
a 11 r 1-. apply .::::..:'......,, ....,...::,..:.;Re;r ::. :.; i;,: .r...::.';.y.:::5a %.h�.'. ; ;t:•:'
New construction till, Addition/alteration/replacement 1
Please c eck all that apply:
❑ Detttolition Q Other: OService over 225 amps,
;, i ° ,:; ., .ei;Ir. „wt� ,ic : :::...:: . " . , A '' . 't- : _ :.: `..::.: .;:.... , ........
1- t; , - �h r,....�,..,.. ...t.,, ,: , '.r „ „ ' ;,. ...... ..,.;... ['Service rvice over 320 as contm' Hazardous location
�:, `: t1`'""' �;•'; 3t�� :hirt�.!::.,.u,r,,:�'z,;;,,, ,, ,
;;1 • : ; . TnP rating ❑ Buildng over v 10'
4. ' 000 s ft..
L ”' of 1 -and 2 fartiily dwellings 4 or more new residential
•:::.:.a,:..;; a1-.' : . ,;;;;�:,:::::i,'�:': , o
E] i - and 2- family dwelling EI Commercial /industrial ❑ Accessory building Qsystetn over 600 volts nominal units in one structure
❑ Multi - family 0 Master builder (:Building over three stories Feeder:}.
�( , ^, ^, r..... t bild � Other: uild ve 0 amps pr MOM
400
. �' 3 f ,;'.e: yp , ; rr / x e j tf > S, ,,+'! sf %t'2 < s',.`�y . . �' rt. � . a,; �;: �:. ,, .
,: ?:' ?;3= •s "e,.': , putt load over persons M.attufacture t
d� ,,yr „ 'Y � st n , � , , i,.. f 1 11 t ' ,,. f , Y ; , „ : {; Q cua
Occupant 99 P 0 d s ructures or
ttkl, } $4A- lk! hrt�t.r(iticaT..�'•.�.f.r,7.b .a %: �,• ,. i('.t.,R.r�,,i,:l'a >h , l t : :. ; ,1 t; ,',k
., M...1.,.,x ., ' ❑Egr'esshigJntiit let RV ., . _ . ,«, ..v:.., :�;•-, 8 park
Job no,: P
' (� .,_ Job Site address: `y ❑Health -care facility C Other:
3 �� �.. ("� (° t: ,�
Submit 2 sets of plans with any of the above.
City/State/ZIP: T
1 • ' +M p'Q • , The above are not applicable to graty construction service.
Suite/bldg./apt. no.: -' :.'w. .'r .w, qa,1. ^' ;,
�' Project .s:T'yckS' ;u' ;� l. : g i, .I!t;''rs.�fi w r. 'r': i
„
: : . • p;. : .p:i= kr:::- „_1-..,h n ii:;,..::z.,';, ; .., L' ,1- -.. r g 1-, 1 } 1
...:., s ., r rt • ....... ......1-.:;rz;:N::aar:xa'a'',(i' );., s,� ���1�����"•, ; 6,ip.
Q•5- C O 1-4 ►le G l C a Deaeripttoo Qty. Fee. Total
Cross sEneer/directions "to job site: New residential single- or Inuit-family dwelling unit. «•
Includes a ttached garage.
1,000 sq. tt._or less 145.15 4
Subdivision: Lot no Ea. add'] 500 3q. ft. or portion - 33.40 1
ax map/parcel Limite energy, alp parcel no.: o residential $Y 75. 'f
.
00
. '':' , i, y'}� ) •. 1t ,,.,,, ...,, }.. . ,:,t!�;,�,,.M . 1- : :: „.,,,.; Li mit ed ettert�r, non - residentia 75
� ,
d ... tBli� 4t.iffic4i4f .l"l\, n 4 U91 , ti a 1-.,,.,r.._. .QD
• ,w,. » - t••• • 'Y i O..4„ 4%; a ). 75 , ,. . !i . , i .1 t; l l r': : a 'f " : +rt , „ + 1 - ' i ach menu actured or moeular 2
\�< °C �
dwelling, service and /or feeder 2
LAY' �" � ` d �� \ cA Services or feeders installation, alteration, 9 90.90
relocation
or less 200 a
n Stl 1
1-r . .,....�:. 4•ru wm.,, =;
.. ;. . , .... + 5- +='4 em^mxxw.�c:a'^z"s.�:nsw
_ . r t.: .. n : aY' i, ": ;I A •,9 o. ta i 't. ,,_, 0 � . VI . . " , ,.VN: .. , 4t, . 1 •: , t2 4 r . ^.a :, : a ,. Y.'';••agi . ,.. , C .,. 11111111111 2
r 1 ,,, . 0 ''^1 : n . ,. .... d . t.: ;.'.:ir . .
,, 6;i c:y1''... . x..: ;4'1: l• , v h,!... ' 201 a � a to 4 0 � a 6
.. ,.,...,.a1- ..,..,....,,.., ,,.,.. »,5-•t
R `:.1 .:..' 1 85
.:.3
,, •,1' 1-n n ::... .'. ...... .. .. . ..n,. , .. • : • ,:.i.. , ...n :n,• ...' - ,.......,.. ;- � ::�, 401 amps to 600 amps 160.60 2
N 0 kr r s
etle r 641 amps to 1,000 amps
II 240.60 2
Address: , O6 Over 1,000 amps or volts 454.65 2
Reconnect only 66.55 2
• ' �� e- of Temporary services or ceders Installation, alteration, and/or
Phone: ( U ,_ ',) \ ` Fax: ( Q3) relocation
�� J , 200 amps or less 66,85 I
Owner Installation: is installation is being made on property t at I own which is not 201 amps to 400 amps 10030 2 -
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps t0 600 amps 133.75 2
Owner signature: Date: Branch circuits -. new, alteration, or extension, per panel
9 ,`r; r ' :11- x '''1- q 1-91;1/ Y1M 'diiWY d V' Y11.'4: . r ,, :'� o`\ ,�`"P aC "Cc,`:ril+.nmp l C' x'r nmH'C^:.n� yr:x.dx:.ixx C "1 " `W •` w•
;. '.1.V s f ,,.1 ` 4 h".`.4 1 'u 1- f ld 1;�'1<`� : `'? iii' t� ti ti lT, Si ikt sw (1!+•<<r1 A;;ltij h� fi�''"�yl A. Fee for branch Circuits with
Y it f,,. h. , t.:.. ._, ,.,,,w „ , ,.,,.1-r ..: .' d_, . =7,. "G,•.,...d.., >,,.M.,a„a
service Or feeder fee, each
Business name: branch Circuit 6.65 2
B. Fee for branch circuits !r
a
Contact name; TM witho service or feeder fee,
Address: each branch circuit 46,85 \3 �� 2
Each add'l branch circuit '1 6.65 t -- G \\ ,5r 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone:
( ) I Fax: : ( )
Sign or outline lighting 53.40 2 i
E -mail: Signal circuil(s) or iirruted-
) o:1-, :t "1- tt . n «r" i' ,.. r.. .- ; ...... ; . ; ., ; ..........,.,, r , ., ,,.
° - ":a'. , ., t 1.i .,i.1-. ,.,z:z'1'..xz,: ..1., 1-s• =x,t'r.'>s.r �
'(:�'1't`:; , '1-v w ' ., Yi:=• : � : •+ ::,':A °`.,:' �:` ?.:;:.�:'1:•'.i ",�+ ene Panel td ('" trr.,r:` •,,: ' +s,..:ir; t ' '';�; "., .,q a G`.i':,. 1.. r oration or
,, a .�zz`. r�.h : ",,�;� +t {� ^�:`w..., ..:.,:•. '�- r:. ":`�:csd.. ,�..... ,a .,..�:i gY P ,
'l',. �..: �;;.;:{; m�, a, 9F�) zn,«., 1.' Tl, d, xi�^ l�. x., i+ �l. ��. a.. r. a. n,- r'.. hs, v. J: �;::^,::.; uL' E:{' t ::`t,:1'!) ?2.1!'Yflr�,l<n,,;v.. �. ,•,.f },:, � yM ,, p.,.: `:'ioti:�.
F.u.,.L:.,v.;vna, . � , ": :;et.,s:: �, ins »:i� i�:;: n?' n„ a:': r::, it:: ��: ?:::y.eal:.'A ".::`_'.`:.,.,, .1.�
e Describe: Page 2 2
Business name: C CP*-....,er.,-1
Address: p S Each additional inspection over allowable in any of the above
, y is ` p Per inspection II 62.50
II
City /State/ZIP; \ '5'4` OR 0\ a 1 Investigation per hour (1 hr min) 62.50
Phone: (� ) \ _-` - 11 Fax ( ) Industrial plant per hour -
(, it: ..`,..t,1,. y ii;li�k •q.l :� 8 1-.NIEN
y ,
IrS1'a1-)k: 1-n, ,;,,, y.. t;;+:-: : ":''`>w.,w+.,.,::.r,:zat:a::a: y..::;..,.r2;.. �Y;?n�; %? �n, 1-r, r }frii ed5.,.i {1,. fi
ccs Lie.: a • � � subtotsl D
Suprv. Electrician signature, requ Alp Iii, Plan review (25% of permit fee)
Art. 4,` A I
r ' state surcharge (8% of permit fee) S, ,
—
Print nanse: , £ Date: / 0 ^ 7 P d TOTAL PERMIT FEE
Authorized signature: q / ai \ "
This permit application expires If a permit is not obtained within 1 ao
days after It has been accepted as complete
Print name: Date: - Fee methodology set by Tri -County auiidiog Industry service Board -
Number of inspections per permit allowed.
Bolding\Pennitskm- c- PermiWvvdoc 17io3
440-461 5-1-(10 +07rCOM /WE8
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: \504a39 -4175
INSPECTION DIVISION 4 Business Line: (503) 639 -4171 MST
BUP
Received Date Requested " AM PM BUP
Location 11 0 s P —c ' -U Suite 7 MEC
Contact Person .eCQ� Ph ( ) — 7 g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 6.1)4__M 1 ELC aDe `J Ov 675"
Footing ELC
Foundation 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
• T FAIL
E.1„ECTRIC:
Service
Rough -In
UG /Slab
Low Voltage
F Alarm
AS ART FAIL 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: • ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date / l7 25 Inspecto Ext
Other:
Final DO NOT REMOVE this inspection record rom the I. ' site.
PASS PART FAIL
•