Permit A--, CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00094
Ail. DEVELOPMENT SERVICES DATE ISSUED: 2/27/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110DC -02200
SITE ADDRESS: 15570 SW PACIFIC HWY
SUBDIVISION: WILLOW BROOK FARM ZONING. C -G
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: Add (3) branch circuits. Job No. 21 -839
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:
TIGARD, CENTER LP 3D ELECTRICAL SERVICES INC
9777 WILSHIRE BLVD #609 PO BOX 173
BEVERLY HILL, CA 90212 OREGON CITY, OR 97045
Phone: Phone: 503 - 657 - 9173
Reg #: ELE 3 -460C
LIC 135234
FEES SUP 4478S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/27/04 $60.15
[TAX] 8% State Surcharge 2/27/04 $4.82 Rough -
Elect'I Final
Total $64.97
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 OA : • - I: ■ 110 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1-800-3 2344. , •
^
Issu = • By: ; , I '+ — � 04, 4 , Permit Signature: 4,, / y z
�- �,- Qeir/0 -vim
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 IN TALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 7 i0 --c---- DATE:
LICENSE NO: 37 03
Call 639 -4175 by 7:00pm for an inspection the next business day
FEB - 26 - 2004 THU 03:06 PM P.001 /001
Electrical Permit Application
. Datereceived: Oa Permitno.: _.,, ,_,,, .. 44
.. ":I I!' City of Tigard Project/appl, no,: Ex . ire date:
City Address: 13125 SW Hall BIVd, Tigard, OR 97223 Date hawed: Re no.:
te/,
Phone: (503) 639 - 4171 A
Fax: (503) 598 -1960 Case file no.: • • Payment type: ' ' ;
Land use approval:. • _, . . . ,...., .
'fi ()1 1.1:itMIT
01 & 2 family dwelling or accessory , 0. Commercial/Industrial , 0 Multi - family • • 0 Tenant improvement
0 New construction O. Addition /aitez tion/replacenient 0 Other:. • 0 Partial
Job address: I S Sty t;. -' ∎ e t3wu) Bldg. no,; Suite no.: Tax map /tax lot/account no.;
Lot 1 Block: 1 Subdivision:
Project name: (Description and location of work on premises: I ,IS FJ - ' b 1i� OsCld c.3.1.,T j
Estimated date of com letlon/inspection: -
Job no: 21— 19' . riga Miti
Business name: 3D -. A. Svcs r 1a►C Defaiptton Qty. (ea.) Total no. Imp ,
New resideatlal - drtgieornntlti- fandly par .
Address: PO cgs ,t- l n 3 dwel tinguntt.Inelwleoettacbedgproge. •
City: E „ p r h l u ri 1 State: O -1 ZIP; 9 rnalig Serritotndueed:
Phone: for ? -Q 173 1 Fax:eST= -711:51B -mail: 1000 sq. ft. orless 4
CCB no.:.13SZ &L) } I Elec. bus. lie. no: 3 - *O C.. • -
' Each additional 500 eq. ft, or portion thereof
_ _ Limited enemy, toaidentisl 2
City /metro 11c. no.: S 94 Ei Limited energy, non- reeldentlel 2
s %...›,r 6 ,,, 272_ P 0 W Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/orfeeder 2
Services orfeeders— lnstallatlon, .
Sup. elect name (print): to.... amine no3� alteration or relocation:
200 am or leas • 2 •
Name (print): 7 4,427 e 1-P 201 amps to 400 amps 2
Mailing address; 401 amps to
WO amps 2
.
601 amps to 1000 amps 2
City: 1 State: 1 ZIP: Over 1000 amps or volts 2
Phone: 1 Fax: 1E-mail: _ Reconnect only 1
Owner installation: The installation is being made on property I own 'lbmpossrystuw1cesor feeders - . • .
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, °rrelo`vti°n'
ORS 447, 455, 479.6.70, 701. 20 amps or leis 2
lot nml+nrn Off arolu 2
Ow11er's signature: Date: 401 to 600 am 2
Branch clrculta - new, alreradotl,
Name: or extension per pool:
A. Pee for branch circuits with purebue of
Address; service or feeder fee, each branch circuit . 2
City: • 1 State: • 1 ZIP: B. Fee for branch cirouita without purchase 1 / t r s
Phone: Fax: E-mail: - of aervia t or feeder fee, first branch circuit; yd 2
Each additional branch circuit:
Micro. (Service or feeder not Included)t
O service over 225 ampa- aanunemial ' .a Health -care facility Hach pump or irrigation circle 2
Q Service over 320ampe-radngo(l191 0 Hazerdouslocatian Each signer outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(e) or a limited energy panel,
O System over 600 volts nominal mom residential units is one stmclum alteration, or extension* 2
O Building over three stories 0 Medan, 400empsormore • •Deacdption:
O Occupant load over 99 persons 0 Manufactured structures or RV park Bach additional inapeetloo over the allowable in any of the above:
0 Bgresa1118htingplan 0 Other: Peritupoodon I I, I I '
Submit _ set of plans with any of the above investigation fee
' The above are not applicable to temporary construction service. Other its
Not all tdktt
t lerl0na accept credit cards, picric colt Jurlid'ictio m
o for more info: ate%, Notice: This permit application Permit fee $
Vies O M .. -- ! - expires if a permit is not obtained • Plan review (at -_._ %) $ ,s 9,
aviators
( _ Al within 180 d surcharge (8%) .... $
• t - 1e° accepted to t $ • 0
. 9 7
meust � �etS (tuoolCOM)
r�ed6o tier swum FEB 2 6 2004
4so
(lit �`— — .•a
. � 9 ` 404 - v G'i °ti CITY OF TIGARD • love -a. BUILDING
DIVISION
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested 3 _a V AM PM BUP
Location / S.S 7 d ! Suite MEC
Contact Person Ph (L) gS�O PLM
Contractor Ph ( ) SWR ( /
•
BUILDING Tenant/Owner ,-.■■ if --- ELC DO 97
Footing ■Q/+e)
ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: 7 am ,,,/f SIT
Post & Beam D � d����X?�
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
°''°"\j'
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
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
4111
PA PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date y Cil/ Inspector Ext
Other: T
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL