Permit A " CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00213
-• `o, DEVELOPMENT SERVICES DATE ISSUED: 4/26/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL:. -01201
SITE ADDRESS: 13900 SW PACIFIC HWY
SUBDIVISION: ZONING: C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Motion detectors, located in aerobics and kids club areas
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: 2 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:
MILLER, PRUDENCE M LUMBER ELECTRIC
4220 SW GREENLEAF DRIVE 2981 BUCKMAN
PORTLAND, OR 97221 WEST LINN, OR 97068
Phone: Phone: 503 - 638 -1947
Reg #: ELE 36 -19C
LIC 80424
SUP 1922S
FEES Required Inspections
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 4/26/01 $60.15 2720010000( Wall Cover
Elect'I Final
5PCT CTR 4/26/01 $4.81 2720010000(
Total $64.96
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: Issued By:
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:
CON r • TOR INSTALLATION ONLY
/ 1 / / 4 ,bz(�
SIGNATURE OF SUPR. ELEC'N: ���� DATE:
LICENSE NO: •
Call 639 -4175 by 7:00pm for an inspection the next business day
.,.
Electrical Permit Application
Daterecrived: 4 -b! Permit no.ek,,gC0/ - )? 13
n > . City of Tigard Project/gipl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date be red: By: 1 Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case
fill: no.: Payment type:
Land use approval:
11'I'I: OI I'I:R1lfl'
CI & 2 family dwelling or accessory �Commercial/industri CI Multi - family ❑Tenant improvement
O New construction ❑ Addition/alteration/replacement ❑Other. 0 Partial
LL
Job address:
en / 4L /P /< ij Bldg. no.: Suitt no.: Tax map/tax lot/account no.:
4 Lot 'Block: 'Subdivision:
P r o j e c t name:i e 4 ' 1 1 0 1 ' C / I Description and location of work on promises: 077 2)e:7 — e2es
V ` Estimated date of completion/inspection: #d i e' At✓
CONTRACTOR AI'PL ICATION
Job no: - .. Fee Max
Business name: L N ly r R., /7eG7,0 / Description Qty. , (en.) Total no.tarp
p Newresldeatid- siagleoroo>kF unlly per
Address: e2. le, ip (.I G,E',fr„ ,80 _ dwellIngmdt. h adechedgrnage. ,
City :W , 4 eJ7L, »- Sta te: OA I ZIP: 97tl 6 Y Senvloehrcladad:
Phone: - $p .1-.1 21 S I Fax:}-7,$t E -mail: Vf 0094i10 -1000 sq. tL or less 4
CCB no.: et • ,2 .4 Elec. bus. lic. no: , 31 - ) cf
Each addition 11500 sq. ft. or portion thereof
Limited energy, residential 2
City /m. 1 • lie. no.: 0 f 6*? Limited energ y, non-residential 2
- I Each =infer cued home or modular dwelling
rr of supervising electrician required Date -lt J,,4 /0/ _ Service and/o • feeder 2
Sup. elect name (print): L E4 C.."4 1/2.4- License no:
Z Sorticea orfieders- laehallatloo,
alteration or relocation:
200 amps art ms 2
Name (print): 9 2.4 ito i' 4 L, < , / 7,V e f:f • 201 amps to 400 amps _ 2
� 9D a � f-C/ yc / a/ 1
401 amps to 00 amps 2
Mailing address: 601 amps to 1000 amps 2
City: 7- 6 0 I stale: b R.-I : may' 7.2 z S Over 1000 an.ps or volts . - 2
Phone:,24.- 7300 'Fax: E-mail: I Reconnect on .y 1
Owner installation: The installation is being made on property I on Temporary a xvlcesor feeders -
which is not intended for sale, lease, rent, or exchange according to Installation, r Iteration, orrelocation:
200 amps or 1 ass 2
ORS 447, 455, 479, 670, 701. •
201 amps ro 4 00 amps 2
Owner's signature: Date: 401 to 600 an cps . 2
Branch circt Its - new, alteration,
Name: or extension per panel:
A. Fee for br inch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fe: for br arch circuits without purchase
Phone Fax E service or feeder fee, first branch circuit: 90 4 4di�3S 2
Each addition al branch circuit ¢.d f !.S•:N)
PLAN H I V I IAN' (Please cheek all that apply) Misc. (Servl:eor feeder not included):
❑ Service over 225 amps-commercial ❑ Heslth- catefodlity Each pump o • irrigation circle 2
❑ Service over 320 amps - rating of 1&2 ❑ Hazardous location Each sign or' mtiine fighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal dwell (a) er a limited energy panel,
❑ System over 600 volts nominal more residential units in one suucuue alteration, or =tension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description
❑ Occupant load over 99 persons O Menufocttuel smarms or RV pads Es& additic ml inspection over the allowable In any of the above:
❑ Egress/lightingplan ❑ Other: _ Per inspetior I I I I .
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all j ®sdksioas swept coedit cards, please call Jurisdiction for more infermatioa. Notice: This permit appl,cation Permit fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained' Plan review (at _ %) $
Credit card camber. I / within 180 days after h i e s been State surcharge (8%) .... $ •
eip1ea accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 4444615 (t /COM)
Too 121 OIVDI.L d0 AJJIO 0961 862 £05 %Vol 6T :80 fill TO /9Z /b0
CITY OF TIGARD BUILDING INSPECTION DIVISIO
MST
24'Mour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested S, AM V \ PM BLD
Location /3 yG u fkGi f ` a /iw Suite MEC
Contact Person Ph sa'r 1 2.1 PLM
Contractor Ph SWR
BUILDING Tenant/Owner
ELC 21-0/ — vo 2/3
Retaining Wall ELR
Footing Access:
Foundation I / i FPS
Ftg Drain , I ' I A.L ► i
Crawl Drain Inspection Notes: . SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains _�► _ yIi
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PA ART FAIL
L ICAL
Service
Rough In
UG /Slab
Low Voltage
larm
F'
PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Otheoach /Sidewalk �-� I nspector a72a Ext
Date
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.