Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00553
ar DEVELOPMENT SERVICES DATE ISSUED: 9/29/2006
671J1. 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: (2) circuits for cellular tower. Job #11459 - 300.
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: 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:
MARA HYLTON OREGON ELECTRIC GROUP
6802 SOUTH 220TH ST 1010 SE 11TH AVE
KENT, WA 98023 PORTLAND, OR 97214
Phone: 475 - 251 -8480 Contact #: FAX 503- 535 -2763
PRI 503 - 234 -9900
FEES
Description Date Amount Reg #: ELE 26 - 95C
[ELPRMT] ELC Permit 9/29/2006 $53.50 LIC 203
[TAX] 8% State Surcharge 9/29/2006 $4.28 SUP 4460S
Total $57.78 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: �J� ) f P Permittee Signature: c R.74 e
\ c ‘ c
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.
. SEP -28= =2006 12:29PM FROM -OR ELECTRIC SVC 5035352763 T -036 P.001 /002 F -858
Electrical Permit ADpIiCatiell l I l O l: a r I.1(' 11 psi: t: O N I.\
City of Tigard 1' z : Received - w • Permit No. id t t ) 1
13125 SW Hall Blvd., Tigard, OR 97223 DMira ,
Phone: 503.639.4171 Fax: 503.598.1961r 28 8 2006 ,411, keg \ , i . i s. '` Other Permit:
Line: 503.639.4175 ' q Hate Retedylay ®See Page 2 for
Internet www.ci.tigard.or.us a Notiiled/Method aiM Supplemental Information
• 7�� TiV Tl�R. Pla►N REVIEW _
❑ New construction Addtttttn /alteration/teplacement Please check all that apply:
❑ Demolition [] Other: ['Service over 225 amps, comm ['Hazardous location
❑ Se vice over 320 amps — rating EIBuildng over 10.000 sq. ft.,
CATEGORY OF CONSTRUCTION . - . of 1- and 2 -family dwellings 4 or more new residential
❑ 1- and 2 - family dwelling 0 Commctcial/indusrrial ❑ Accessory building ❑ System ova 600 volts nominal units in one structure
ID Multi-family ❑ Master builder ❑Other ❑lading over three stories CI Feeders, 400 amps or more
['Occupant load over 99 penow ['Manufactured structures or
. JOB SITE INFORMATION AND LOCATION ❑ Ealcsailighting P h u RV park
Job no.: 11459-300 I Job site address: 12955 SW PACIFIC HWY El Health facility ❑Otter:
Submit 2 ads of plans with any of the above.
City/State/ZIP: TIGARD, OR 97223 The above arc not applicable to temporary constitution service.
Suite/bldg./apt. no.: J Project name: GENERAL DYNAMICS TOWER * S U ' I •.
omerhatw Bea 'raid
Cross street/directions to job site: Ncw residential singlet or multi -family dwelling unit.
Includes attached garage.
1,000 sq. 0. or less _ 145.15 4
Subdivision: I Lot no.: Ea. WTI 500 sq. tt or portion 33.40 1
- Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy. non- residential 75.00 2 •
DESCRIPTION OF WORK Each manufactured or modular
TWO CIRCUITS FOR CELULAR TOWER dwelling, service and/or feeder 90.90 2
_ _ _ Services or feeders installation, alteration, and/or relocation
_200 amps or less 80.30 2
El PROPERTY OWNER ❑ TENANT • 201 amps to 400 amp __ 106.85 2
401 amps to 600 rumps 160,60 2
Name: GENERAL DYNAMICS 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 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
. ❑ APPLICANT 1 ❑ CONTACT PERSON 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.
. each branch circuit 46.85 .8 2
Address: -
Each add'i branch circuit 1 6.65 b. 105 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, altaadonl or
extension. Dcsearbc Page 2 2
Business name: Oregon Electric Group -
Address: 1010 SE 11th Ave Each additional inspection over allowable Injy of the above
- Per inspection 62.50
City/State/ZIP: Portland, OR 97214 " Investigation pa hour (1 hr min) 62.50
Phone: (503) 230.9900 I Fax: (503) 535-2763 industrial plant per hour 73.75
ELECTRICAL PERMIT FEES"
CCB Lie.: 203 1 Electrical Lic.: 2. • v . . u . •, 'o.: 4460S Subtotal 53. E
Suprv. Electrician signature, required: ! Plan review (25 %ofpermit fee)
M a.t J J. tl1 i — State surcharge (8a% of permit fee) I. f a
Print name:
�' •, i� TOTAL PERMIT FEE 57,1$
Authorized signature: _ This permit application expires it o permit to not obtained within 180
y drys otter it ems been accepted as complete
Y
Print name: ' I e xY ' J _ -11 , Ukvl G I ' ' te: 09/28/1 ' • Fee methodology art by Tri- County Building Industry Service Board
il l
•• Number of inspections per permit allowed.
benikI as 'PemffiwiC- PomieApp.doc 15 44o.4615T(Iarm2FCOtwwm
CITY OF TIGARD
A „
BUILDING DIVISION PERMIT #: ELC2006 -00553
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/29/2006
Phone: (503) 639 -4171.. 11
Inspection Requests (24 Hrs.): (503) 639 -4175 -.., IL.
INSPECTION WORKSHEET FOR DATE: 5/11/2007 TIME: 7:01AM PAGE: 105
SITE ADDRESS: 12955 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT #: 037 TYPE OF USE:
PROJECT NAME: CINGULAR UMTS -PL77
DESCRIPTION: (2) circuits for cellular tower. Job #11459-300.
OWNER: HYLTON, MARA PHONE #: 475.251 -8480 •
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503 -234 -9900
Inspection Request Scheduled For: Date: 5/11/2007 Pour Time:
Code # Inspection Description - : - • Contact # Message
199 Electrical final 048081 -01 503 -B49 -3291 Y
Corrections /Comments /Instructions: -- - �__ _ ` •
•
g
, X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G-1 N •1gl5" Date: Si iiJ 0 r) Phone #: (503) 718- 1-144)
CITY OF TIGARD
BUILDING DIVISION ' PERMIT #: ELC2006- 00553
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/29/2006
Phone: (503) 639 -4171 tw
Inspection Requests (24 Hrs.): (503) 639 -4175 I I
INSPECTION WORKSHEET FOR DATE: 5/10/2007 TIME: 7:02AM PAGE: 37
SITE ADDRESS: 12955 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT #: 037 TYPE OF USE:
PROJECT NAME: CINGULAR UMTSPL77
DESCRIPTION: (2) circuits for cellular tower. Job #11459 -300.
OWNER: HYLTON, MARA PHONE #: 475 -251 -8480
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503-234 -9900
Inspection Request Scheduled For: Date: 5/10/2007 Pour Time:
Code # Inspection Description # ;� Contact # Message
199 Electrical final 048030 -01 \\ 503-849-3291 Y
Corrections /Comments /Instructions: \ ., ,
G-4o‘ v ii t-R Na`' $ A m. le Inn..
NO OM (J C% 03 Ain
•
1 - . : T 4 l g ¶ ). Am
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS
X FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' Date: 6 69 Phone #: (503) 718- Z44)