Permit A, CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00016
iI ., DEVELOPMENT SERVICES DATE ISSUED: 1/16/03
AA. � I° 13125 SW Hall Blvd., Tislard, OR 97223 (503) 639 -4171
PARCEL: 2S115BD-02800
SITE ADDRESS: 16485 SW PACIFIC HWY
SUBDIVISION: ZONING.
BLOCK: LOT : • . JURISDICTION: KIN
Project Description: Install 15 branch circuits for wall heater that are replacing baseboard heaters.
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: 14 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:
HEALTH RESOURCES, INC OREGON ELECTRIC CONST /GROUP
PO BOX 987 1010 SE 11TH AVE
TUALATIN, OR 97062 PORTLAND, OR 97214
Phone: Phone:
Reg #: LIC 203
SUP 4460S
FEES ELE 26 -95C
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 1/16/03 $139.95
[TAX] 8% State Tax 1/16/03 $11.20 Rough -in
Elect'l Final
Total $151.15
•
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: �� /� / //� •� Permit Signature: Xk. 0_14)0
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: `MOO C
Call 639 -4175 by 7:00pm for an inspection the next business day
- ,
Electrical Permit Application OFFICE USE ONLY
D tc received: / — /10 -o d� Permit no.iG(►(� - t'/W F/
,� , r .•! ' >> City of Tigard EC E I V E D Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blv Tigard, OR 97223
Date issued: By: TI5 Receipt no.:
Phone: (503) 639.4171
Fax: (503) 598 -1960 JAN 15 2003 Case file no.: Payment type:
Land use approval: CITY OF TIGARD
. . , r
'rV Pr OF PERMIT
•
U ❑ 1 & 2 family dwelling or accessory CkCommcrciai /industrial 0 Multifamily ❑ Tenant improvement
-•N. 0 New construction 3 l Addition /alteratiotl/rcplaccment 0 Other _ ❑ Partial
- JOB SITE 1NFORR'IATION
Job address: 1 6 • - Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot Block: • Subdivision:
t Project name: . • , • ; - _ Description and location of work on premises: • - - • A_
Estimated date of completion /inspection: • • , - - •
CONTRACTOR APPLICATION FEE
.106 no: 73869 Fee Max
Description Business name: Oregon F 1 Pr -t i r (,rn» mt' Qty. (ea.) Total no.iasp
Address: Newrcsidential- le ormaki•Gm7y
1010 SE 11 th A e dwelUrtgunit.Inc(udesattathcd�e.
City: Portland [State: OR [zip: 97714 Servieein<taded:
Phonc: -9900 I Fax: 234- 10ktmail:
• CCs no.: 203 l000sq.R.orlesa
Elec. bus. lie. no: 26 -95C Each additional 500 sq. ft. or portion thereof
Limited energy, residential o- 4
2
Gity /m o lie. no : Limited energy, non-residential 2
1/15t01 Each manufactured home or modular dwelling
5i_ '�• c y -.‘i — Date Service and/or feeder 2
. rin t r car .. e
■ s - License no: 44 1 Servueesorfeedcra- installatlon,
PROP rig i l' OWNER alteration or relocation_
200 ampsarlcsa 2
Name (print): AVame:l<f: A 201 amps to 400 amps 2
Mailing •
address:
401 amps to 600 amps 2
- 601 amps to 1000 amps 2
---4 City: State: ZIP: Over 1000 amps or volts 2
Y Phone: (-)3_34.1 _ E -mail: Reconnect only 1 __
�� Owner installation: The installation is being made on property 1 own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to instillation, akcratiotyorrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 am s to 400 am. S 2
• t Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits. new, alteration,
Orexecnsista per panel:
Name: A. Fee for branch circuits with purchase of
� Address: service or feeder fee. each brunch circuit 2
-4 - City: State: ZIP: B. Fcc for branch circuits without purchase
of service or feeder fee, first branch circuit: 1 4 6 . 85 2 _
Phone: Fax: E - mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc • (Service orfeedernotincludad): 1 —r '-9 T
�'
0 Service over 225 amps-conunocial O Health -cam facility Each pump or irrigation circle 2
O Service over 320 amps-rating of IS r2 ❑ Hazardous location Each sign or Outline lighting 2
family dwellings O Building over 10.000 square feet four or Signal circuit(s) or a limited energy panel.
O System over 600 volts nominal more residential units in one structure altcralian. or extension' 2
D 8uikung over three stories O Feeders, 400 amps or more
*Description:
Occupant load over 09 persons ❑ Manufactured structures or RV p Fach additional inspection over the allowable Inanyoldie above:
c O Egress/lighting plan ❑ Other: Per inspection I I
`�. Submit _ sets of plans with any of the above. I nvectigation fee -- -
The above are not applicable to temporary construction service. Other
‘4 ' all juriaaltctiuns accept cred rm
it cards. please cull jurisdiction for more information Notice; This permit application Permit fcc $139.95
Q O Visa O MasterCard expires if' a permit is not obtained Plan review (at _ %) $
~ Credit card number. / / within 180 days after it has been State surcharge (8 %) $ 1 1 . 20
Expires TOTAL $
accepted as complete. 15.1.---1-5--.
Name or cardholder as shown an credit card
S
Cardholder rigttjNrr Amount , 44Q451$ (hrtte/COM)
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