Permit A.,. CITY O GARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00178
DEVELOPMENT SERVICES DATE ISSUED: 4/8/04
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 - 4171
PARCEL: 1S136CD-01001
SITE ADDRESS: 11747 SW PACIFIC HWY
SUBDIVISION: ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install (1) branch circuit.
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: 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:
CHEVRON U S A INC NORTHWEST PUMP + EQUIPMENT
PO BOX 285 2800 NW 31ST
HOUSTON, 1X 77001 PORTLAND, OR 97210
Phone: Phone: 227 - 7867
Reg #: ELE 26 -852C
LIC 64567
FEES SUP 4884S
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 4/8/04 $3.75
[ELPRMT] ELC Permit 4/8/04 $46.85 Rough -in
Elect'l Final
Total $50.60
This Permit is issued subjed 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.
4
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: ,2/(J /9/' )"LI C�-� �of DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical .Etrni afi / FOR OFFICE USE ONLY
City of'Tigard Received _ _
2UU4 Date /B 0 1� r Permit No �/ �% / / /, i -
13125 SW Hall Blvd., Tigard, OR 972'pv -
Plan Revie ,
{ � Other Permit:
Phone: 503.639.4171 Fax: 503.598'1960 mi Date/By:
Inspection Line: 503.639.4175 CITY OF TIGARD 11- Date Ready /By: Jura: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
RI In niNG nlvlsloN
TYPE OF WORK i PLAN REVIEW
❑ New construction K Addition /alteration/replacement Please check all that apply:
CI 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 l- and 2- family dwellings 4 or more new residential
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System 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 ❑Egress /lighting plan RV park
+r1 �$ �7 / ❑Health -care facility ❑Other:
Iv
lob no.: 6 Job site address: , '7 L f '� s paCI �� /`t Submit 2 sets of plans with any of the above.
City /State /ZIP: 1- 1/7 Pr /� O fl / q 'l Z23 The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: C� ejr-� t1/4) Description SCHEDULE
Description I Qty. I Fee. I Total I **
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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
�,� �j• dwelling, service and /or feeder 90.90 2
�+^� ''�
i t 5 T. Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
lil
201 amps to 400 a s 106.85 2
PROPERTY OWNER I ❑ TENANT 401 amps to 600 amps 160.60 2
Name: (Is U yQ\v (L A 601 amps to 1,000 amps 240.60 2
Address: 6k- S ^
1..(�vCw Over 1,000 amps or volts 454.65 2
' p L _ Reconnect only 66.85 2
City /State /ZIP: (/ 1 q , 2 Temporary services or feeders installation, alteration, and /or
�c� �
I I J
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 A. Fee for branch circuits with
'� CONTACT PERSON
1 service or feeder fee, each 6.65 2
Business name: f jL v i r ,,,, - .,, , \ branch circuit
V �` 'L B. Fee for branch circuits
Contact name: 17.7.-Rc I ^ / P ki without service or feeder fee, ) 46.85 2
Y' each branch circuit /
Address: /15 �w 3 S S 0
\ Each add'I branch circuit 6.65 2
City /State /ZIP: ], T ( ti� ( 'yy 7 C' a( 0
Miscellaneous (service or feeder not included)
`i ( q06 q • ` I Fax: ( ) Pump or irrigation circle 53.40 2
(v 3) ttJJ
Phone: 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: (Oa l� yT LJe.)T i -+- r
Address: do bvl l I" / 5=1: Each additional inspection over allowable in any of the above
SSS 1 Per inspection 62.50
City /State /ZIP: •�d I -G� ,y o q 1 P.( 6 Investigation per hour (I hr min) 62.50
Phone: (1 ) �'] 4-- 7 ( 6 (, / I Fax ( ) Industrial plant per hour 73.75
` • ELECTRICAL PERMIT FEES*
CCB Lie.: (4c.J(O Electrical Lic.: . o. . 1� 4 v. Lie.: Lf Subtotal et( $ S'
Suprv. Electrician sigrYr I�rired: %, C, /. % Plan review (25% of permit fee)
‘, State surcharge (8% of permit fee) 3, 7s
Print name: e'..-Pi-ti -1k1A.-.0 . J Date: 7� 04
� - G O
TOTAL PERMIT FEE
Authorized signatures �� This permit application expires if a permit is not obtained within 180
..--r _ — days after it has been accepted as complete
Print name: - `, ili-e" Date: el 56 U C r • Fee methodology set by Tri -County Building Industry Service Board
T •" Number of inspections per permit allowed.
i Mnuilding \Permits \ELC- PermitApp.doc 12/03 440-461 5T( l 0 /02 /COM /WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503j 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Re uested � 4-f AM PM BUP
Location I / 79-7 _ Suite MEC
Contact Person Ph ( ) s q —� PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner L%+'t -Y ELC — 6 O / 7 8
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
PASS PART FAIL
ELECTRICAL •
Service
/dough -In
UG/Slab
Low Voltage
J Fire Alarm
❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
4E0 PART FAIL
SI Please II for reinspection RE: Unable to inspect - no access
Fire Supply Line Q Inspector NOB \I Ext
ADA 1
Approach/Sidewalk Date 4
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL