Permit r, A
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00492
,sl DEVELOPMENT SERVICES DATE ISSUED: 7/11/2005
�l �! 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2 S 102 B D -02600
SITE ADDRESS: 12955 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT : 037 JURISDICTION: TIG
Project Description: Add new service.
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: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 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: 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:
MARA HYLTON LEGACY WIRELESS SERVICES, INC
6802 SOUTH 220TH ST 4252 SE INTERNA11ONAL WAY #F
KENT, WA 98023 MILWAUKIE, OR 97222
Phone: 475 - 251 -8480 Phone: 503 - 656 -5300
FEES Reg #: LIC 150432
ELE 37 -989C
Description Date Amount SUP 3305S
[ELPRMT] ELC Permit 7/11/2005 $80.30
[TAX] 8% State Surcharge 7/11/2005 $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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:' i ..��� ; Permittee Signature: ,12 0
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.
1
07- 08 -'05 11:37 FROM- Legacy Wireless 503 - 656 -5305 T -364 P002/002 F -964
• , . .
Electrical Permit Application FOR OFFICE USE ONLY t e L IV L- Received
City of Tigard na1�s ; — — LJ ✓ ' Permit No.: 6_42655 ( �y 1 P ,Z
13125 SW Hall Blvd.. Tigard. OR 97223 . 2U�
v J Plan Review Other Permit:
Phone: 503.639.4171 Pax: 503.598.1960, ;'w 9° % R t
r 1 I"� " B ' Date
Inspection Line: 503.639.4175 ,_�_ 11. " s 11, Date Ready/By: lira
s See Page 2 for
Inter www,ci.tigard.or,us GiTV 0 F_ f (ZAri Notified/Method: Supplemental Information.
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New construction ID Addition/alteration/replacement Please check all that apply:
I: Demolition ❑Other: over 225 amps, comm'1 Hazardous location
['Service v
•,, V:: • 1 ,i,�!; ' �" fie} 9 F. ::� Qa llo T V v ._ i w. ,i :• :. -, :- ❑ of 1 - t and 2 2-family dwellings ❑ 4 or more new residential
.: , . h.. � ;, • r.. ' .. i.. .... . , . i;l� Q,l! Fn7AA.ilyR ..._ ..:� 1;p�, ,. . , f i:j; 5'; ',1'.
rating
❑ 1 - and 2- family dwelling N'Commerci& /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
1:1 Multi-family ❑ Master builder ❑ Other: P d ructures or
amps
. ,','�a;i ['Occupant over
oad over persons ❑Manut ictu
stories
t l 0 99 c
1�t� � s. /, 1
.:�...... ...... .... ...........:��� ?
> .. ' ��'•`� ;�}� ��!!:'�::!••:`,..; ❑I? css/li tin tan
.....,. i:•!:.• �'.;'''�•: +�': :;:,•:1•:: ..
�'i�l !,: r;. ..: .; t ,: .. •I...' t.. .':fit! ..�... .:i': .r F:i'r, =i ; ; '.i
...�. bR 6h g P park
rob no.: Job site address: / Q9 . P Si,J 012_, - • ❑Health -care facility Other;
Submit 2 sets of plans with any of the above.
City/ State/ZIP: I i c and 0 2 ct D'a The above are not applicable to temporary construction service.
Suite/bldg / apt no.: I Project name. /i c?eerc) Description I Oty. I Fee. I Total I- ••
V
Cross street/directions to job site: b t2. h 1 p, A v -1 na ct II f New residential single - or multi - family dwelling unit.
t' Includes attached garage.
on r i a Y1 t; ce Poe r Weil r, U ¥ St, r'e.4 •• - Q.. 9 9 1,000 sq. ft. or less 145,15 - 4
Subdivision I Lot no.: Ea. ad4'1 500 sq, ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
..._ ............_._ . ....... ....,. .. ,.I..i :.lr : +.;u
,�i:'I� ?:;,!j .,,. .,.:;..,... .., , • rp,r,, v:IG;I'li:!IF;,,,• , -. ,ki!N: ^!i:i:;iuy_a; = ;; .c_:: r- 7 5.00
„�.,, It, ; . / ,li 'i;.,,,1 ''ir.11li? ::n!::.: �:�._.. A�SGA.11��41�C:4F't WU�.�'� _ = .....;: _;.. ...::.....f .
Limited energy, non - residential 2
:::,: �tl . L: 1: ":,:: :. - . w•+ �N:! c: 4i�ail :i *::r.�:i'iiilif�iik,`;yt:;.� Each manufactured or modular
A 8 rJ � u S'e N vi e�. S service Or feeders installation, feeder 90.90 2
crvce5 rs installation, alteration, and/or relocation
200 amps or l ass 80.30 QQ 2
-; ., '. - ;i : k i .. ,. ,, u ,r., ; t,: !cur u ,. , ng -.:, 201 am PS to 400 am 106.85 2
... :.,:.:_ . :f....,. <<� .. f ij:;;•Sa.l 'f), ; r,, :t::N � ::.��. _ _ P Ps
t � 1.'.� is1RB ,��' ( �.. - _ '� . ii'ri: r.�,.t ,t.
....._.,:::....:•::::_:::::: �,:_.. : - ::::::::::::•:......_„. 401 amps to 600 amps 160.60 2
Name: C,` v1., - �y e_Le 601 amps to 1.000 amps 240.60 2
Address: c h f/ .. Over 1,000 amps or volts 454.65 2
U` ` �� Reconnect only 66.85 2
City/State /ZIP: ge II e . Jc)€ (,t.) •) c igiC/S -•' Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I 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
. , ........................................... A. Fee for branch circuits with with r •, . r:,.. :, :•.. , r �:" : ; to . kg ra.;..
:ii•,I.'oF.I:tlthlp. rill .!1,':�': ^. i• F.!:5::!:,:�: I ,m,:,!,t;;.E.;!! r.!: ;:!.._... . Y!n?::Mr .... `.�..riti� �s. , y 1;..,,. � serYiCC or fCCder fee, each
Business name: I.sa. c-to_c-s.-.1 W v( e ` esS S c st_s,1riG branch circuit 6.65 2
B. Fee for branoh circuits
Contact name: `. o - ...% v-. G. wtlhorrt service or feeder fee, 46.85 2
Address: t , & S S \ et,,� v-n ck 1 L U C L each branch branch 6.65 2
circuit
'1 � 1,. ' ► Q_. M l laa Each add'1 branch circuit
City / State/ZIP: N\ �� W (Xtj v � `'' Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (St (05(0 ..&&.. I Fax: : (,Std) -S Sign or outline lighting 53.40 2
E -mail: kCO,r1S \o..Car,. I egack - (d 'y //p S5 , Cmr' ) " Signal rcuit(s)
cI
sF :•I':r :
:!,:. . x�:: l::�i n..::•w � W anal. alteration. or :,,r.,,..s u niH..i . t ..• :.;:: ! ,:.:�'..f ..:.;pia :. . . . ... .• :...:...._ d - .- ., .. -, .,.ri +::� Describe: 2 2
.........
extension. escri : Page
Business name: L M, Cl�y e )e.c. '-y - ct,
Address: y as a S 1 () 4 r r\o icY»u I >� � c( S r _ Each Pcrin inspection octal inspection over allowable in any of the above
�" � n � on 62.50
•.o City /State/ZIP: (\‘\t.t.) etv.�c.�l e� 042. . pl�` - Investigation per hour (1 hr min) 62.50
I c Industrial plant per hour 73.75
Phone: 6�„ �� (,,„, "S e7 Fax: ( ) �pv� ^�j' c' ::iE:. :�;:;;;�' i ... i:: ;..'_.. .
CCB Lie.: �5 t '-/ ;3 Electrical Lic. :3'V 8'9 � Suprv. Lie. >S Subtotal 350.30
,s, Suprv. Electrician signature, required: ( 4) � `r��� 7 y Plan review (25% of permit fee)
Print name: n Date: State surcharge (8% of permit fee) C • Li
' n �C le 1Y7 - TOTAL PERMIT FEE llp;)' -'
I
Authorized signature: This permit application expires if x permit is not obtained within ta0
days after it has been accepted as complete
Print name: I Date: • Fee methodology set by Tri.County Building Industry Service Board
- • • Number of inspections per permit allowed.
' is lBuildinePermi t.- l6LC-Permi!App.doc 11/03 44046I5T(1e/02/COM/WE9 ,
i
CITY OF TIGARD .
BUILDING DIVISION N PERMIT #:
ELC2005 -00452
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/11/2005
Phone: (503) 639 -4171 Avt0411lit
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/15/2005 TIME: 7 :03AM PAGE: 71
SITE ADDRESS: 12955 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT #: 037 TYPE OF USE:
PROJECT NAME: CINGULAR
DESCRIPTION: Add new service. 7126105: Added (1) 200 amp service & (1) 400 amp.
OWNER: HYLTON, MARA a .,1 le s5 PHONE #: 475- 251 -8480
CONTRACTOR: LEGACY WIRELESS SERVICES, INC C:kb c6; ) t7 PHONE #: 503- 656 -5300
Inspection Request Scheduled For: Date: 9/15/2005 Pour Time: d0
Code # Inspection Description Confirm # Contact # Message CU V "
_ I_ I
199 Electrical final 015768.01 360-608-0665 v
Corrections /Comments /Instructions:
h t c '
1 1 �l,► 1� ? , PN B\_�� 7- \) c a; �, L ( i i . I �
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ket./
7
C )-- " --- 7 Date: 7 1:��Phone #: (503) 718 -