Permit •
,., CITY OF TIGAR.D ' ;' ELECTRICAL PERMIT
PERMIT #: ELC2004 -00736
i DEVELOPMENT SERVICES DATE ISSUED: 11/16/2004
V' �i 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 102BD -01200
SITE ADDRESS: 12825 SW PACIFIC HWY
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING. C -
BLOCK: LOT : 008 JURISDICTION: TIG
Project Description: Network cabling & (2) circuits for registers.
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: 1
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:
CONOCO PHILLIPS COMPANY SME CORPORATION
600 N DAIRY ASHFORD 6550 N INTERSTATE AVE
HOUSTON, D( 77079 PORTLAND, OR 97217
Phone: 206- 706 -2340 Phone: 503 - 286 -3728
Reg #: LIC 40659
ELE 26 -556C
FEES SUP 4214S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/16/2004 $128.50
[TAX] 8% State Surcharge 11/16/200 $10.28 Low Voltage Inspection
Rough -in
Total $138.78 Elect'I Final
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 -23 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: - DATE: 4
LICENSE NO: .54 1-
. 5
Call 639 -4175 by 7:00pm for an inspection the next business day
/
Electrical Permit Application— G VE — -- - - FOR OFFICE USE ONLY
... -
City of Tigard
/
alt Received I ...7 _ 4
Date/By:
Permit No.: / ' /6/ op- 7 A
13125 SW Hall Blvd., Tigard, OR 97223 NOV 1 6 280 Plan Review
4 ,,,, , q ,
_.,-"
Phone: 503.639.4171 Fax. 503.598.1960 Date/B : Other Permit:
Inspection Line: .503.639.4175 L'ITY OF TIGAR --!..., Date Ready/By: NE 121 See Page 2 for
rn
Inteet: www.ci.tigard.or.us ataDiNG nitite.. Notified/Method: Supplemental Information
e-ik: ,.:!: -' ' lx,A•kdia„, ,,,;' , .1:,L.,, kv ..•.-- -. "
E] New construction Addition/alteration/replacement Please check all that apply:
D
['Service over 225 amps, comm'l E Hazardous location
Demolition E Other:
. 0 Service over 320 amps - rating EBuildng over 10,000 sq. ft.,
WV *Wrinidgifka
.a of 1- and 2-family dwellings 4 or more new residential
0 1- and 2-family dwelling aCommercialhndustrial 0 Accessory building El System over 600 volts nominal units in one structure
EBuilding over three stories ['Feeders, 400 amps or more
0 Multi-family . El Master builder D Other:
El Occupant load over 99 persons ['Manufactured structures or
'1,3,1101,0 t • i : 1 ) , M I : f : t i l a l i t 1 , 1 1 C 7 4 . 4 V 4 , 1 [I E gre s s /1 i gh tin g plan RV. park
EHealth-care facility El Other:
Job no.: 2_70 3 - 9 i, 9 Job site address: ) z4. 2.._s:- ,.. p Al
Submit 2 sets of plans with any of the above.
City/State/ZIP: 71._/6_4/2/2 42- i The above are not applicable to temporary construction service.
1.13AM„- el-gki?470CIRe§r415WI-7 i.::7!• '
Suite/bldg./apt. no.: Project name: 4 w i t , 6
Description Qty. Fee. Total **
Cross street/directions to job site: l e3t4 F 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
Limited energy, residential 75.00 2
Tax map/parcel no.: . Limited energy, non-residential 1 75.00 2
f&IM4, illifi if Each manufactured or modular
, dwelling, service and/or feeder 90.90 2
'OA._ 6-AA/ C-- 4 2- c/o , /vez,r /I/4/0 Services or feeders installation, alteration, and/or relocation
ff4- 5 AL&isf€4... ( (ri 200 amps or less 80.30 2
ATIPingfiffipilifP'''Milla,"CinilrfrfitIfW9friAVy. lid:WOW:i 201 amps to 400 amps 106.85 2
VIlift.4,:i4,.. •,.A:;,,, • 'AI,,,,,,,,IIIi. Y, -• 4,,4-r.,AliWav400-•,..14,-,,„*A•ra,.A24.-Votzel,Falift 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
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
WairtZgrAVIZAWEreAV , ,AggifiLVOMMVOMIVE - 06,40:4* A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
) (46\
each branch circuit
Address:
Each add'l branch circuit
6.65 2
City/State/ZIP: Miscellaneous (service or feeder not inclu e
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
smarmat fogniz,0001:4"tothwetega- gmisinam energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Each additional inspection over allowable in any of the above
Address: , c5 - 0 4/, ..,r,,,,/,,, ..._,,,..,z_
Per inspection 62.50
City/State/ZIP: p / ,,,,rte.... / .3 72 24 "-7 Investigation per hour (1 hr min) 62.50
Phone/ ( 800) 5 - - 5---0 — 1 s 7 5--- Fax: ( ) Industrial plant per hour 73.75
M. 4' MICARPWItigUt Wr7='''
CCB Lic.: Li 0 4 5 Electrical Lic.:-$S r_ Suprv. Lic.: Li u ti 5
Subtotal
•
Suprv. Electrician signature, required: Plan review (25% of permit fee)
-› State surcharge (8% of permit fee) jd
Print name *Lc.( R e - 0 A - V 1 S Date: 1/40/0,
TOTAL PERMIT FEE /,__. 7 )1'
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board
0 * Number of inspections.per permit allowed.
i: \ Building \ Perrnits \ ELC-PermitApp.doc 12/03 440-4615T(10/02/COWWEB
Electrical Permit Application - City of Tigard r.
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
❑ Other:
fmE
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i: \ Building \Permits \ELC•PermitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ Q� BUP
--
Received Date Requested c (e AM PM BUP
Location / D a S I U -il Suite MEC
Contact Person Ph ( gZIO ) 1E PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner '7 ELC °L�D y " bo 73
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler C
Fire Alarm L
Susp'd Ceiling
Roof
Other: lAff
Final
PASS PART FAIL
`,.PLUMBING �=
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
- MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL'» °e.
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of .$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
1 PART FAIL
SITE call for reinspection RE: Li Unable to inspect — no access
Fire Supply Line
ADA .— [i� �. O vi
Approach/Sidewalk Date ` \ Inspector A`� S� Est
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL