Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00489
111, h I�
DEVELOPMENT SERVICES
`� 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 DATE ISSUED: 8/5/2004
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 4 )
SUBDIVISION: HOFFARBER TRACTS N ZONING. C -G
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Relocate 100 amp panel,
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: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 4 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:
•
TIGARD PROPERTIES INC MILESTONE ELECTRIC
2106 SE OCHOCO ST 2056 NW ALOCLEK # 411
MILWAUKIE, OR 97222 HILLSBORO, OR 97124
Phone: Phone: 503 - 645 - 5323
Reg #: ELE 34 -618C
LIC 153480
FEES SUP 2113S
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 8/5/2004 $8.55
[ELPRMT] ELC Permit 8/5/2004 $106.90 Rough -in
Elect'I Final
Total $115.45
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: - F _ . Permit Signature: ��w�—
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
Electrical PermA n _ ed(, FOR OFFICE USE ONLY
fl Receiv _ Electrical _ t/
Date/By: Jf ,/ D Perm No.:�L/ c / GG 7 79
11 Planning Approval Sign
City of Tigard AUG O 2U04- Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 O p TIGARD Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: r
v f , yglAVI$1 r,t� Post - Review Land Use
T1NU �u��ad , ' I Date/By: Case No.:
Internet: www.ci.tigard.or.us _g_11 ,1„ ee I Ju ' . ® See Page 2 for
24 -hour Inspection Request: 503 - 639 -4175 - Name /Method: _' '7G Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction I El Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
® Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION l & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling EiCommercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi-Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
` (► The above are not a to temporary construction service.
Job site address: J114S SU, PaCt`F�c_ i ,. FEE* SCHEDULE
Suite #: zits' I Bldg. /Apt. #: _ Number of inspections per permit allowed
Project Name: / .( _ Pa�p,� "� " e ate, De lion Qty Fee (ea.) Total T
New reside - single or multi - family per •
Cross street/Directions to job site: dwelling unit. Includes attached garage.
4 / J n (�( 1/I�[ / Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: I Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
- ( Services or feeders - installation,
t o l o ca 4e__ � �t O pA ei alteration or relocation:
200 amps or less ( 80.30 00.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
(PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: ,tk ( -{-p.ti crew Reconnect only 66.85 2
Address: '3O ( ,v. 4/. /k (d, Temporary services or feeders - installation,
/ alteration, or relocation:
City /State /Zip: PAr 9 - )2--2-9 4 200 amps or less 66.85 1
Phone: 03- (,43-S?3") Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: • extension per panel:
A. Fee for branch circuits with purchase of (,O
Address: service or feeder fee, each branch circuit 6.65 2.6 -2- 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2 -
Phone: I Fax: _Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: it 2-73 _s- Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: fre I ( E/P ,-, Description:
Address: 2_0'7 SG ,V, G/, AIocJ _ Dr. 51.44-,9 4'(/
/ Each additional inspection over the allowable in any of the above:
City /State /Zip: // f � / �( 9 7 / 2 S! Per inspection per hour (min. 1 hour) 62.50
Phone: 903 - (,I/ 1 23 Fax: S -690 — ,Vg2/3 Investigation fee:
CCB Lic. #: / 5 Lic. #: 3 eF - (o / 8'L Other: Electrical Elerical Permit Fees *
Supervising electrician i Subtotal $ / of -f °
signature required: / Plan Review (25% of Permit Fee) $
Print Name:A4 E // Lic. 44.$" - ] .� State of Permit Feel $
P TOTAL PERMIT FEE $ /./5
Authorized ��� Notice: This permit application expires if a permit is not obtained within
Signature: �r d Date: B 180 days after it has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
/404 A- E 4
(P1 se print a )
i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information - --
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Burglar Alarm
• Garage Door Opener
O Heating, Ventilation and Air Conditioning System
O Vacuum Systems
El Other
� 1 e
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Ell Audio and Stereo Systems
❑ Boiler Controls
0 Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
HVAC
Instrumentation
El Intercom and Paging Systems
▪ Landscape Irrigation Control
0 Medical
❑ Nurse Calls
• Outdoor Landscape Lighting
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElePermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ` AM PM BUP
Location /I_1�_.' _ Suite a `t'd MEC
Contact Person wl , Ph ( 7 /) 5 - 0 % 0 ' PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC '1:20 O d 'i - 604/8
Footing
Foundation ELC
Access:
Ftg Drain ``l� \( f�- ELR
Crawl Drain �V �` l
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation p�.p/� v11 a ,�
Drywall Nailing (} 1 1 �`
Firewall V L
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
Fire Alarm
ASS PART FAIL 1=1 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE El Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Dat d Ins �-1 n'1- �P�7�I� Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL