Permit CITY OF TIGARD. � � ELECTRICAL PERMIT
PERMIT #: ELC2006 -00254
• �� DEVELOPMENT SERVICES DATE ISSUED: 5/10/2006
` � I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 102 B D -01900
SITE ADDRESS: 12900 SW PACIFIC HWY ZONING: C -
SUBDIVISION: HUDSON PLAZA LOT : OOD JURISDICTION: TIG
Project Description: Temporary power.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: • 0 - 200 amp: 1 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: 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:
HENDERSON, MARILYN DOROTHEA WILLAMETTE ELECTRIC INC
JENSEN HUDSON TRUSTEE PO BOX 230547
11795 SW KATHERINE ST • TIGARD, OR 97281
TIGARD, OR 97224
Phone: Contact #: PRI 503- 624 -3631
FAX 503- 624 -2938
FEES
Description Date Amount Reg #: ELE 34 - 283C
[TAX] 8% State Surcharge 5/10/2006 $5.35 LIC 75059
[ELPRMT] ELC Permit 5/10/2006 $66.85 SUP 1965S
Total $72.20 REQUIRED ITEMS AND REPORTS
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: Permittee Signature: ?"- : c_ga t vim.
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
. MAY .09 2006 11:12AM WILLAMETTE ELECTRIC 5036242938 p.2 • . - rt 1r T' t- 1 z .i... 0 �r 1 v ' i:_ ,�, , n:, r a 5 ' l t, •ht • -
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13125 SW F-1211 141w1., Tigard, OR P lan Rev •
r. =1;. ,+ ; Other Permit:
Phone: 503.639.4171 Fax: 50" 9 .! 960 `L t ,1 i�q U ate/B y _ _
Inspection Line: 503.639.4175 , r 0 2006 `.' S" E ro Date Ready /By 1u E I Sec Page i for -
Internet: www.ci.tigard.or.us- Notified/Meulod: L • SupplementalIntormation _ ;
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•
❑ New construction ;91 ` • ditj( t 1i • n/replacetnent Please check all that apply: • ,
['Service over 225 amps, comm'I ❑Hazardous location
❑ Demolition ❑ Other:
5� :a �>t `� t „ ,I� a, . m , ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
;� ' ����� 1 , " p❑� r „ f r�= t1 '' ;t 1 +1 3 , E ./ F l ` =4t F+ l ` k' i .. . ' : i of 1- and 2-family dwellin 4 or more new residential
I'i'i •< �''' .a .1,."r t tL1 r� , •...,M. y .�t� ., i.T:[. iir`,�! {.., r na - . • .`r . ,:C..._r y Sii -b ,�n.• : : : , y 8S
❑ 1- and 2- family dwelling MI Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi-family ❑ Master builder ❑ Other:
. _ ❑Occupant load over 99 persons ['Manufactured structures or
i 'r rh t ,.+ Ny a "e1 L" I �. -.. .�.T,,/c '7 y l a, (S •r.v;
=,�2 ),, " I �l .^.; .,. : y -:+' -ill , f .3'1,Iraz 1 'f4 �t I. triCd- a21r.I?k 1 tiiiii :- au,t2�tyl.lr_iliv'. ❑Egressllightingp lan RV park
•• �_�.N�vBs �� Li, 2c' S. L'±__.. 1.. ::. 1�_ ti:. �4 il L1. �... L,..+., . : "�1'1F,'t4F, �':.�'b;M1�.,3.i ;.4,Et��._16'k_ t'i.1151"}y' .1.?
o site ❑Health -care facility
Job no.: J
['Other:
`{ b it address: Z4� �ctt e C Submit 2 sets of plans with any of the above.
City/ State/ZIP: e- ,/� The above are not applicable to temporary construction service.
t t, l l ,�/�• �{�TC''T{'•�'T.�E -r :iT: M � I °Il''•>.�9�' I
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Suite/bldg./apt. no.: Project name: °''` 1 .
I' -v eel,- Z� _ Description Qty. Fee, Total .
Cross street/directions to job site: New residential single- or multi- fandly dwelling unit.
v al s e.... - Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: • I Lot no.:. Ea. add'L 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
�..r { i � s((.. t' .d, 4 uLt�., w.'A r '.' G r 0 # 4 "k, r T1,W c1; Limited energy, non - residential 75.00 2
9�� ��1`7 N111 111 M OfM 9� f R �{,�� i^ . ",2 l;RC.,. {.
, 1 ' 1 f' . a l t . %:„ a �� -1� •'i, P -5 y 1,1V4 ° a; 'i:,,fiF,t tit r + Fach manufactured or modular
dwelling, service and /or feeder 90.90 2
t e Services or feeders installation, alteration, and /or relocatio
200 amps or Less 80.30 2
W 44"t; e x 's ` .7 a , v ' Q s 't } 4 r '1 V` ? S I d a ^ I, I� ''7 �n n r ? Y a j N Tai 2 atr to 400 amps 106.85 2
::- or.:f s3 *1 . �An: - 'i.,.._.,v :,�J}.,: ...a L ll [ ., �.a iEita 1. dr � lnlrt
4 01, 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
Phone: ( ) I Fax: ( ) relocation {
200 amps or less . 66.85 `( � l .
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.3C 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
't17''''' ' . r h0; € { rzi '
r li ? t t � T - j 1i F a si -Si a, +i r I C I rf �'T I v' ng, A. Fee for branch circuits with
Jt-f_ .,∎Iii -� ± �tl , , 4 �r t i. ,. . i..?. Z „16:.:.,. _ #!1 ?!, :._3. 't�:sd.:l" a '. i.. , .�X _.n . ;_IA.
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53,40 I 2
Phone: ( ) I Fax:: ( )
Sign or outline lighting 53,40 2
E -mail: Signal circuit(s) or limited-
1vt . f 4 tC , - "• 3 �` m ii' @ F ii ly;v Ma, `8• .0. [7 iii +� 1 r ^ - d . : -{ , , .1 panel, alteration, or
: +c' 1 i ! '' 1 i a � t�+ y ''q . y-rc ti a, Al k.., c c�' energy pa
. 3' '- + Q .a.se ''_ 9 " extension. Describe: Page 2 2
� i (1 oY "t �4-e °' , .''''! ,t tg ( ° i- -
Business name:
Each additional inspection over allowable in any of the above
Address: p ; 0 ay „ , 2 s 4-
Per inspection 62.50
Ci / State/ZIP' CJ ? -is' I investigation per hour (I hr min) - 62.50
Industrial plant per hour 73.75 III
Phone: ( ,i; ) Z, -: t� a 6..i ( Fax (yam) 6,��,� - Z. j ?' sa
1 . v ':
J vi °+I t�5., iat.1 yl
CCB Lic.: 7 .i• c) Electrical Lic.: $4(- 74.3 C_ Suprv. Lic.: f tj' 6 5 • •C Subtotal 6 6, 'r
•
Suprv. Electrician signature, required: 7:7_ Plan review (25% of permit fee)
Print name: i� ti r J /
Date: p _ State surcharge (8% of permit fee) S, 7
("G _ p TOTAL PERMIT FEE ?Z. • ZG
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
"• Number of inspections per permit allowed
is }B.,ildingWerrras\ELC- Pcrnti[App due 17103 440.4615T00I91/COM/WEB
CITY OF TIGARD _
#: BUILDING DIVISION PERMIT #. ELC2006 -00254
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 51100.00C,
Phone: (503) 639- 4171 hwy, I I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/2012006 TIME: 7 :01AM PAGE: 66
SITE ADDRESS: 12900 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: HUDSON PLAZA LOT #: 001) TYPE OF USE:
PROJECT NAME: HUDSON PLAZA
DESCRIPTION: Temporary power. s , 1 ,0 , CoR►J' (�
OWNER: HENDERSON, MARILYN DOROTHEA, - --s— PHONE #:
CONTRACTOR: WILLAMETTE ELECTRIC INC PHONE #: 503 - 624 -3631
Inspection Request Scheduled For: Date: 6/20/2006 • Pour Time:
Code # Inspection Description Confirm # Contact # Message
110 Temporary electrical service 031951 -01 503-6243631 N
Corrections /Comments/ Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑..ADDITIONAL FEES ASSESSED
rJ // �J J
Inspector: Date: 6 f2O �
Phone #: (503) 718 - �jfYO