Permit it • ,i CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00399
. DEVELOPMENT SERVICES DATE ISSUED: 7/1/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 103 D D -00800
SITE ADDRESS: 13815 SW PACIFIC HWY 60
SUBDIVISION: ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: 10 branch circuits.
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: 9 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:
D.W. SIVERS COMPANY ATLAS ELECTRICAL CONTRACTORS
4730 SW MACADAM AVE 4403 SE ROETHE RD
#101 MILWAUKIE, OR 97267
PORTLAND„ OR 97201
Phone: 503 - 223 -2680 Phone: F- 659 -4944
Reg #: 9:39 -2212 2581S
LIC 1532
FEES ELE 3 -2C
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 7/1/2004 $106.70
[TAX] 8% State Surcharge 7/1/2004 $8.54 Rough -
Elect'I Final
Total $115.24
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- .44. ,
.
Issued By: I / - 42t,e) Permit Signature: l/
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
* E Bari al Permit Applingon FOR OFFICE USE ONLY
t Ciy of Tigard E I VE Received / �j
� /
Date/By: 74e/eV /eV i/�7Q Permit No.: Ile jti ...OD 3
13125 SW Hall Blvt.�l, Tigard,OR 97223 !Hai Plan Revie
Phone: 503'.639.4171 Fax: 503.598.1960 JU 2 8 201 ' l Date/By: Other Permit:
Inspection Line: 503.639.4175 X 1. 1 e• Date Ready/By: lulls: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /C Supplemental Information
CITY OF TIGARD
retgMatfliti /ISION PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Buildin over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: 11549 Job site address: 13815 SW PACIFIC HWY ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: TIGARD, OR 97239 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 60 Project name: NATIONWIDE INSURANCE FEE* SCHEDULE
Description I Qty. I Fee. I Total I ••
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'I 500 sq. ft. 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
WIRE FOR NEW OFFICE dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 1) w SL. 601 a 601 amps to 1,000 amps 240.60 2
Address: T 760 5u/ 4/.6 307 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: r R 7 v..37 Temporary services or feeders installation, alteration, and /or
"� relocation
Phone: (SV9) a:1_3— a..$'0 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
❑ APPLICANT ❑ 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, I 46.85 ryr . 37 2
Address: each branch circuit
Each add'l branch circuit 6.65 6 gis 2
City/State /ZIP: Miscellaneous (service or feeder no included)
Phone: Pump or irrigation circle 53.40 2
( ) Fax: )
Sign or outline lighting ( 53.40 2
E -mail: Signal circuit(s) or limited- 1
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: ATLAS ELECTRICAL CONTRACTORS, INC.
-
Address: 4403 SE ROETHE ROAD Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: MILWAUKIE, OR 97267 Investigation per hour (1 hr min) 62.50
Phone: (503) 659 -2212 Fax: (503) 659 -4944 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: 1532 Electrical Lie.: 3 -2C Suprv. Lie.: 5009S Subtotal lob. 7 0
Suprv. Electrician signature, required: r r Plan review (25% of permit fee) • 0 0
Print name: , Date: 06/25/04 State surcharge (8% ofpetmit fee) $ . S
TOTAL PERMIT FEE I / 5 . 2.
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.
i:IBuilding\Permits'ELC- PermitApp.doc 12/03 440 - 4615T(10102 /COM /WEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line, (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 7 queste 7/A?, AM BUP
Location fag` jate
�v Suite MEC
Contact Perso Ph ( ) 7P PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC c: 3f
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: �� SIT
Post & Beam eee '' '
Shear Anchors
Ext Sheath/Shear •
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fire Sprinkler
Fire Sprinkler , v
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
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
'FC�CTRICA
SeRn
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ZED PART FAIL
SIT ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA ✓ 22 � 0 /0! / � � Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL