Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00030
DEVELOPMENT SERVICES DATE ISSUED: 1/17/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 2S102CB - 03101
SITE ADDRESS: 12950 SW HWY 265 ZONING: C -G
SUBDIVISION: HUDSON PLAZA LOT : 021 JURISDICTION: TIG
Project Description: TI 12 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: 11 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 #: LIC 75059
[ELPRMT] ELC Permit 1/12/2006 $120.00 SUP 1965S
[TAX] 8% State Surcharge 1/12/2006 $9.60 ELE 34 -283C
Total $129.60 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- 332 -2344. ,,�Q
Issued By: Permittee Signature: (J) Gc ('.u..�..r/1•.-
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.
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lect r beat Perri i A- leca C E I V I s G FOB. OFFICE usEoNl v _. . .
Ida/ of TIgTigard Received �Q / gig PennilNo. :�'7 �.n6 �OVV
Date/By: / 1 7 f. ,J Aw
13125 SW Hall Blvd., Tigard, OR 97223 JAN Pla Review
Phone: 503.639.4171 Fax: 503.598.1960 : JAN 1 u �I �''?_ Date/Br. Other Permit:
e
Inspection Line: 503.639.4175 s Vii.r_ i I Date &eadyiBy: Id See Pap 2 for
Internet: www.ci.tigard.or.us CITY OF GARD Notified/4ethod: Supplemental Information
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ca• X � �,.r� �- �l .rlu1�,411�d, �._!�_.:ll: -x4u ��.,ti.� ..� ... ��,rr.t v,�4�11N�] �� rr`�G P a.
0 New construction ® Addition/alteration /replacement Please check all that apply:
Dernolihon ❑Other ❑Service over 225 amps, comm'I ❑Hazardous location
❑ roa wr T, , , T N r ,,d �y� ! � x� 4, ❑ Strvice over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
+' /r , , ,i `• , . i� - ; of t � ' `A y l 1 V �s,r't '1t l 11}hi �' ""is ;. of 1- and 2- family dwellings 4 or more :►ew residential
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❑ 1 - and 2. family dwelling 121Commercial/industriai ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
Multi -family Master builder er. Manufactured structures or
1:::] Y ❑ M b ❑ Oth DOccupant load over 99 persons ❑
, > + l h r .n r L4 �J-• z ! - �ti f F' I : +1. +�F1k ',,
ilia ° ; l•0 � +� + V' r 1i. 4i 1 ? ] r (iii i ' } i„1,t;j1_��,rxk .,Y 4! �J�411. ,�LEi �.� _. _':s �'.': ❑Egtess/lighting plan RV park
L L! 6�L.� }, I. •., L.� : 5r1.,, fc:.._ _ '. -: 1a
r C. /+ ❑Health -care facility ❑Other •
Job no.: I 'L
1 ' Job site address: � ,7 5 e r jt. v `t t Submit 2 sets of plans with any of the above. . •
City /State/ZIP: Y r The above are not applicable to temporary construction service. '
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Sutte/bld / t no.: Project name ' , . f li : 5k. i. !.� Jlr' r F 6 ?G i _S. J _ , "P r.• ••
g' / Description QI Bee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit .
Includes attached garage.
1,000 sq. R. ar less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 1
Limited energy, residential 75.00 2
Tax map/parcel no Limited energy, non - residential 75.00 • 2
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G . "' Jtp 4 + i ' _ a !' r i,il 3 `4a 1 ,-;. 1 1�1 c1It` l - .. ;� -� I , ', .,;_ii, l. l. 'L } ,..N._Thm. Eacll Mnufactured or m odular
..� aa- :r lrs�r±. k,r�:_aiL _ 1r_ . >.. ml.tL_ ,t F_ �� I� 5, � t,i, � � + :
dwelling, service and/or feeder 90.90 2
u i Services or feeders Installation, alteration, and/or relocation
200 amps or less n 80 0 . 2
3 3C
t r T"i - ^ g ific Fm rl, +L WI ti l+ n L it ��, d �'� r ` Vyy fr z ; l� 201 snips to 400 amps 106.05 2
� t
+ r t'rx+lr i u u Fir d :rti y; ` , n + ..,. t a ..... + 1 II }� ∎iltr 'i -. 3 > s n z.I` #k
+ N.I,_k - -- - 1, . ; a.� .xS.,ra1 e., ,xx �.�.a�s_, ,. t.,q 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
Fax: ( ) relocation
Phone: ( ) 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
z t r S ., ! �-� ' 41: 11 r r ,. ? r i r , " ',. ii ''�" + i' A. Fee for branch circuits with
• ' . . �`iI I I '%: , .+i;;l €. 1 t + +v .JI F &r M Zf 1 '' i... fk4 ,
_�._ .,._ _�t,.r -.. -�_ r r. a.., :r.._,r��!_F _. . :,r..�_Vi service or fe eder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 y ` *C 2
each branch circuit 1
Address: Bachadd'lbranchcircuit /i , 6.65 .3 ' . 2
City /State/Z1P: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: ( ) Sign or outline lighting 53.40 2
E - mail :. } Signal circuit(s) or limited -
Sl ^F�� I �j �n r � t i ' , ^ `'�. aP r .0 ,u., J � tt t • i' S: 1 11 hl,l'go,' y. t+i y i� �' 7 Ji n .. , k energy Panel, alteration, Or
�ti f t i %2 4:e e 1 i t, t....t?.9. afti t1 ' l Ari
�., r._,. ..,, y,. tw,.1 _ r.. s__ 3 1n .,�z r. ] s r{Mc ty r l 1 extension. Describe: Page 2 2
Business name: - . _ e .,
Address f Each additional Inspection over allowable in any of the above
L� G) Per inspection 62.50
City/State/ZIP: r i tf7. d 1 ,..... ..' ? Z., ( Investigation per hour (1 brmin) 62.50
Industrial plant per hour 73.75
Phone: (. ii ) 4 2ek ` 3fa Fax: (5703 ) �?.t{ - Z- j' ; � ;ff ti.10 :- . j i1 ::frE!srilil r : Z 7 ;3 ,: :4: t
CCB Lic.: 7-S'‘) c w Electrical Lic.: pi, 74.3 C Suprv. Lic.: taci 6s- S Subtotal I W .�
Suprv. Electrician signature, required: / Plan review (25% of permit fee)
State surcharge (8% of permit fee) 9, & 61
Print name: _ . 1► Date: / - TOTAL PERMIT FEE 1 21, (,U
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 sot by Tri County Building industry service Board
4 ' Number of inspections per permit allowed.
BBuildieePerm2100$LC- PemdtAppdoc 12.03 440.4615T(10/02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: RLC2006.00030
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1117!200;.;
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: J8/20f6 TIME: 7 :01AM PAGE: 2:8
SITE ADDRESS: 12950 SW PACIFIC HWY 265 CLASS OF WORK:
SUBDIVISION: HUDSON PLAZA LOT #: 021 TYPE OF USE:
PROJECT NAME: STATE FARM INC
DESCRIPTION: TI 12 branch circuit.
OWNER: HENDERSON, MARRY )OROTHEA, PHONE #:
CONTRACTOR: WILLAMETTE ELECTRIC C PHONE #: 503.624 -3631
Inspection Request Scheduled For: sate: 2/81200€ Pour Time:
Code # Inspection Description C• Arm # Contact # Message
199 Electrical fina 02E ' 01 503-624 -:5631 N
Corrections /Comments /Instruc • s:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C3 , v w Date: 11 61 Phone #: (503) 718 - 2/1141
CITY OF TIGARD - •
BUILDING DIVISION PERMIT #: FLC2006•C0030
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/17/2CI()f;
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/24/20 TIME: 6 :56AM PAGE: yj
SITE ADDRESS: 1295()/ PACIFIC HWY 265 CLASS OF WORK:
SUBDIVISION: HUDSON PLAZA LOT #: 021 TYPE OF USE:
PROJECT NAME: STATE FARM INC
DESCRIPTION: TI 12 branch circuit.
OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #:
CONTRACTOR: WILLAMETTE ELECTRIC INC PHONE #: 503 - 624 - 3631
Inspection Request Scheduled For: Date: 1/24/2006 Pour Time:
Code # In • - tion Description Contact # Message
125 Wall cover 025601 -01 503- 624. N
Corrections /Comments nstructions:
/ ASS ❑ PARTIAL APPROVAL ❑ CANCEL 111 NO ACCESS
❑ ` FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v A N (:)e Date: 2 V Phone #: (503) 718 - 1 —
•