Permit „ CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00046
JhL �l� ( DEVELOPMENT SERVICES DATE ISSUED: 2/3/04
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13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102BD -00600
SITE ADDRESS: 12725 SW PACIFIC HWY
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING. C -G
BLOCK: LOT : 050 JURISDICTION: TIG
Project Description: (2) branch circuits. Job No. 10299
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:. SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
FLOYD BERGMAN COHO ELECTRIC INC
12725 SW PACIFIC HWY PO BOX 40
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: 503 - 997 -8299 Phone: 503 - 582 -9774
Reg #: LIC 157169
ELE 3 -575C
FEES SUP 3483S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/3/04 $53.50
[TAX] 8% State Surcharge 2/3/04 $4.28 Rough -
Elect'I Final
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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- 800-33 ••• .
ta #4
Issue Y B I Permit Signature: } 4 p
/i
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
•
Jan 30 04 09:02a p.1
El Permit Application FOR OFFICE USE ONLY
C R ece i ve d .,/ Electrical
Date/By: /7 /t • f ,, Permit No.: - - -,41.e.1„6 R EC E I V D Planning Approval L i���5r/ S ign
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd: Plan Review Other
Tigard, Oregon 97223 JAN 3 U 104 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 ` /,_,, Post- Review Land Usc
CI TY OF � tr Date/By: Case No.:
Internet: www.ci.tigard.or.us a ► e _I �� Contact kris.: El See Page 2 for
24 -hour Inspection Request: 503- 63B10IN a � - - Name /Method: Supplemental Information.
- • . • ' TYPE OF WORK. PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
f Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
_ ❑ 1 & 2- Family dwelling 'Commercial/Industrial ❑ System over 600 volts nominal one structure
CI 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 [I Other: ❑ Egress/lighting plan ❑ Other:
• JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: \ 1 , - f '�\N; p�. �{ 4, r . t1v FEE *'SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: C: i . 1- c,!-- y ..- 4s Description Qty I Fee (ea.) Total 1
Cross street/Directions to job site: New residenttal- single or multi- family per
dwelling unit. Includes attached garage.
Service Included:
1000 sq. ft. or less 145.15 _ 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Limited energy, residential 75.00 2
Subdivision: I Lot #: Limited energy, non residential 75.00 - e
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK.'. - service and/or feeder 90.90 <
' Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30
201 amps to 400 amps 106.85
401 amps to 600 amps 160.60
:PROPERTY ' OWNER.. ' :-': I. TENANT 601 amps to 1000 amps 240.60 ,
Over 1000 amps or volts 454.65
Name: \ r . .t'��. -�C: ` ` Reconnect only 66.85
• Address: 1 a-l� �W � � � �, (A L tL�. Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: T ` j — C 200 amps or less • 66.85 1
Phone: `=f - 11- Z.,:)� Fax: 201 amps to 400 amps 100.30 ,
401 to 600 amps 133.75
❑ APPLICANT.: ` • :. ..; CONTACT. PERSON • Branch circuits - new, alteration, or •
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 .
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 UL .<
Phone: I Fax: Each additional branch circuit 1 6.65 6, b , I
E -mail: Misc.(Service or feeder not included):
CONTRACTOR..
Each pump or irrigation circle 53 40
53
Each sign or outline lighting •
Job No: \ `--1 Signal circuit(s) or a limited energy panel,
�l� - I • - alteration, or extension -. Page 2 .
Business Name:
X - 1 A ,c_r( . , :�7f1t_. Description: .
Address: -. C., {?, k4 6
• Each additional inspection over the allowable in an of the above:
Ci ty /State /Zip: ...,.....-.\..-\\;.\\c C` c \1 Per inspection per hour (min.1how) • 62.50
Phone: 75 . - c 'Fax: l �j ` r', c -). - `W;` -l(1 Investigation fee:
Other.
CCB Lic. #: \S ( ( \ Lic. #: ?)— ;=7-1 ._ `:' Electrica `liPeratit;Fee's•.:: . `°'� , " `..` ..' .
Supervising electrician S „5 `i •t3 .
signature required: .. Plan Review (25% of Permit Fee) $
Print Name: k Cx - .\i ?
I Lic : ,�}4=) =3 . State Surcharge (8% of Permit Fee) $ 9 , tom. F 's
TOTAL PERMIT FEE $ • = 7 . 1 -1 a e> .
Authorized 2 i Notice: This permit application expires If a permit is not obtained within
Signature: i 5. Date: N-30 r 180 days a it has been accepted as complete.
\\ ` , •1 • • 1 d_ *Fee methodology set by Tri- County Building Industry Service Board.
// P leasee (, prriint name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Ljue: (503) 639 -4175 MST
INSPECTION DIVISION Business Lines (503) 639 -4171
BUP
Received V 7: Date ReA uested - AM PM BUP
Location /Z 7Z5 f Suite
Contact Person // f �� P J12 7 7f )C'® PLM
Contractor (-.D'`f.U" c(Zl.0 Ph ( ) SWR
BUILDING Tenant/Owner �.� r c_Cr.cX2QA is_— 4� ` 7 4- 00&)4,
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain •
Slab Inspection Notes: cc G•�� SIT
Post & Beam f Ce-4, t 2,Q
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler C
Fire Alarm
Susp'd Ceiling
Roof j ?
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
ART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
. SITE ❑ Please call for reinspection RE: II Unable to inspect – no access
Fire Supply Line L
ADA D �° / Inspector AWi _..�Li -i � Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this inspection record from the ' site.
PASS PART FAIL