Permit C ITY OF TIGARD ELECTRICAL PERMIT
4 PERMIT #: ELC2005 -00104
` e seI re DEVELOPMENT SERVICES DATE ISSUED: 2/23/2005
A � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S102CC -00500 •
SITE ADDRESS: 13500 SW PACIFIC HWY 15
SUBDIVISION: SHERWIN - WILLIAMS ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Temporary Service.
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:
13500 PACIFIC CORP BY CAP ADVISORS RICHART ELECTRIC
38345 TEN MILE RD STE 170 14600 NE 20TH AVE.
FARMINGTON HILLS, MI 48335 VANCOUVER, WA 98686
Phone: Phone: 360 - 514 - 5859
FEES Reg #: ELE 37 -IO23C
LIC 50439
Description Date Amount SUP 5015S
[ELPRMT] ELC Permit 2/23/2005 $66.85
[TAX] 8% State Surcharge 2/23/2005 $5.34 REQUIRED ITEMS AND REPORTS
Total $72.19
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)
::::: -0 ma
5 .0
y obt c .L � r Permit Signature: `I
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 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit _at�.of��9 FOR OFFICE USE ONLY
•
City f Tigard : pet No 1312 SW Hall BlvdTi ard, OR 972B 2 3 200 , Date J � - 001 O'1
g / � \ Plan eview
Phone: 503.639.4171 Fax: 503.598.1 m� � � Date/By: Other Permit:
Inspection Line: 503.639.4175 tl yy e'' Date Ready/By: lam I See Page 2 for
Internet: www.ci.tigard.or.us CIT OF Il,IGA Notified/Method: Supplemental Information
,'"5 - L , , :, , ^; n :!�( *}
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'��' 'i 1 ,. %r: i. , z _, - • _ �• , �.i- a .t. • r.. •.•.Z. �„ ��r ._�1• i4" �,G'1rE^�" •'6•17• - �W. C+? r. �': .IiF ^,',. -,. r. Tf.•. r "Hr ,•'"! .. a ...
❑ N ew construction ❑ Addition/alteration/replacement Please check all that apply: '-''''.•-:
OService over 225 amps, comm'l DHazardous location
❑ Demolition ❑ Other:
.. i .� _ _ ❑Service over 320 amps - rating DBuildng over 10,000 sq. ft.,
- '' F ''' =PCA1 G'OT2 -i' ,€ONStRTIGTIOil,F: • _ ? a . ;'i ^f": . ' . ' '', ; of 1- and 2- family dwellings 4 or more new residential
`,rr^ ':.,;'--='- t, ' ` ` ,.,ii, :-i ,l , .: -.,. - , _, •� : ,., . ? 4
❑ 1- and 2- family dwelling [ '''Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder
DBuilding over three stories :Weeders, 400 amps or more
❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or
,,: OB` SISrE - INFO oN: ` oc .2 or .' , t t:. RV ` r''- - -.., � �s� sr� -, . ��� -. .�� i . � r � ;` "' .. _- - >��. �. _ ,_ . ❑ Egress lighting plan R ark
P
:!:' n , :� ' I , ., - ❑Health -raze facility ❑Other:
Job no. : �Q j S U Job site address: 13.5 SW r � w Y Submit 2 sets of plans with any of the above.
City/State /ZIP: �' Gtf J GtreuQ 14 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name:
he fW n �; ;. �' �=. 0 . ; ;,, F >i _r ;,:,;` >: _ • .
S �'�on - ►s Description I Qty, I Fee, I Total
Cross street/directions to job site: 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
Tax map /parcel no.: Limited energy, residential 75.00 2
s v • , s3 , - Limited energy, non - residential 75.00 2
'j,'-± '. - - , '', DES RI -WORK,::' - i ? x ; r , , ,. ,: +-r1 t_.. S ' [_ 6:. Each manufactured or modular
dwelling, service and /or feeder 90.90 2
I V (1e 14 t 1, �� �' Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
-tt ;� -- ,-' , •.: ;: 106,85 2
4 � ' ❑ �)J',g - OW1V�R � ° ' -? Y;,'�,. � � �: , T)�N T ^:'. _• �',.;: 201 amps mps to 400 amps
' „ ' *: :' {. `
. 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 (oG /4 I
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
:* w ' !n '= •r . ,,,` r; , c , ' - t ''',�,'. : • A. Fee for branch circuits with
_ r> ❑ APL�CAIVT'; � �i� ; +5 >' i '- I i ' .,, ` � ,- ,�; I�r = , UiaF AC'T+ PE� t . . .
service or feeder fee, each 6,65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
each branch circuit
Address:
Each add branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
", ms's ;�. , a .i -,;: a •,e' : _ TM energy panel, alteration, or
. -
� '•�. Y .:. .. 4'.. - i.:� .'�,' ' `: - ,C'011l RACT01; � .`. - -, �':� ..,. r: `t' ' 4 _' -, _:�:.._. '
,,.-, . 11 . , . ;` ° � r c. °' i• 4 E. i , 4 46,--74- ,Z e c i s extension. Describe: Page 2 2
O Business name: t r C _
Address: /e/L0(5 ,,(/L ?_Cr Each additional inspection over allowable in any of the above
Per inspection 62.50
- .Ts: , City/State /ZIP: V,n G0uveif" (A S 11 . Investigation per hour (1 lir min) 62.50
' ('k)
Phone: ) 5't/ 5'�l 1 - Fax: (ZmO) rr' - fie,/ Industrial plant per hour 73.75
_ ' H
L; _.FL.E T AL/';PE 'IIT'0 .. ; :i:r; .: ` W
CCB Lic.: SQL/ 3 c Electrical Lic. .-/(.0,7,C, Suprv. Lic.: - S • Subtotal s
Suprv. Electrician signature, required: —) - 1 — 0 (, ,G► - 1 _ G ,'7 Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 5, 34
TOTAL PERMIT FEE `� )
Authorized signature: 2(-e. This permit application expires if a permit is not obtained withi 180
/� _ days after it has been accepted as complete
Print name: /I/j,�e t72.4 /C Date: 2_ 2 3 _06 • Fee methodology set by Tri- County Building Industry Service Board
**Number of inspections per permit allowed
i:Building\Per nits\ELC- PermitApp.doc 12/03 440.4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information '
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ G arage Door Opener*
❑ H eating, Ventilation and Air Conditioning
System*
❑ V acuum Systems*
❑ Other:
TO. C' W v
•
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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ O utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
BBuilding \Pamiu\ELC•PemritApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection L1r e: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested Z` sB AM PM BUP
Location 00 P Ft C— Suite MEC
Contact Person M 1(_ Rd 6 4 4 -? Ph ( 3(0D ) 109 - bZ h S" PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ____75 w kk/ QV 1- i s 014/7 ELC
Footing ELC Za9 S /
Foundation 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 0 11 , 1 •
Fire Sprinkler '� �, 11161! /elf - —
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab C
Rough -In Ci>
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
CAL
`rLM-'r
UG/Slab
Low Voltage
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
❑ Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line 19
ADA L Approach/Sidewalk Date G v O Inspector Nt7pLGb4 Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL