Permit C ITY OF TI CARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00215
� DEVELOPMENT SERVICES DATE ISSUED: 4/28/04
I
�fl 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2S 112 DA -01400
SITE ADDRESS: 06650 SW REDWOOD LN 200
SUBDIVISION: PP1996 - 048 ZONING. I -P
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: 100amp service,4 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: 1 W /SERVICE OR FEEDER: 4 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:
PACIFIC REALTY ASSOCIATES PENDY'S ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 20836 NE LAUGHLIN RD
PORTLAND, OR 97224 YAMHILL, OR 97148
Phone: Phone: 503 - 550 - 2144
Reg #: ELE 34 -122
LIC 55601
FEES SUP 2733S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/28/04 $103.90
[TAX] 8% State Surcharge 4/28/04 $8.56 Elect'I Service
Rough -in
Total $112.46 Elect'I Final
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.
4' Issued By: , _ � � / Permit Signature: „1
•
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: v_9
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application - . ... FOR OFFICE USE ONLY : wy f G;
City of Tigard R eceived
Date/By: a% Permit �Nm z ,, v c, • 002/ S�
13 125 SW Hall Blvd., Tigard, OR 97223 Plan Reyre■
Phone: 503.639.4171 Fax: 503.598.1960 I Date/By Other Permit:
Inspection Line: 503.639.4175 n Date Ready /By Jars 0 See Page 2 tor AsdX
Internet: www.ci.tigard.or , us Notified /Method /) Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction A 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. It..
CATEGORY OF CONSTRUCTION of l- and 2- family dwellings 4 or more rev. residential
❑I- and 2- family dwelling Commercial /industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑ N./bid-family family ❑Master builder ❑ Other: ❑ Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑ Ianufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
I El Health-care facility ❑Other:
Job no.: Job site address: ‘6,..50 Jv 64./ FG S�ed J N r
Submit 2 sets of plans with any of the above.
City /State /ZIP: 0/ nee. 97 2 - Z T The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suit Idg. /apt. no.: i itt® Project name: le ,� p
� L�G'YZ ��JX Description Qty. I Fee. I Until I '
Cross street/directions to job site: '7,7 N V6 eicic !f „� � e New residential single - or multi - family dwelling unit.
[, Includes attached garage.
I ,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq ti or portion 33.40 I
Limited energy, residential 75.00 2
Tax map /parcel no.:
• Limited energy, non- residential 75 00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 00.90 2
� /d2o4^'j9 `` �s'd G
®& e i2 - f - "– rr e- ciA �o V / Services or feeders installation, alteration, and /or relocation
/,L&A./ (,l P, cSrfd76vh 200 amps or less f , 80.30 10 ,3V 2
201 amps to 400 amps / I06 85 2
❑ PROPERTY OWNER 'TENANT
401 amps to 600 amps 160 60 2
Name: e-');76t5te. c;— - /,,9,44...., 601 amps to I ,000 amps 240 60 2
Address: �! Oa10 ` Over 1,000 amps or volts 454 65
(O � 4 .0 Reconnect only 66 85 2
City /State /ZIP: �.,r e3f7 r 9 7 2- y . Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( )
200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 '
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133 75
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 /
Business name: branch circuit `Y 6 65 ( .00 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 '_
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or imgation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe. Page 2 _
Business name: v®y6 eL.�f.7 `oje.... t
Address: 8 NA 4, i _ _ .0 Each additional inspection over allowable in 5 (1 any of the above
�Z�IiL_ Per inspection 62.50 1
City /State /ZIP: )7 . fiJ'u. - en g- 97 / 41( Investigation per hour (t hr min) 62 50
6 ) 66a_L.134 J Fax: - ) J ��
Industrial plant per hour 73.75
Phone:
���" ELECTRICAL PERMIT FEES*
CCB Lic.:5 Electrical Lice, ,oZac_l Supry Llc.:a7 3 -5 Subtotal /0 , q6
Suprv. Electrician signature, required: A 4a / Plan review (25% of permit fee)
State surcharge (8% of permit fee) Q' 56 Print name: � l�/4 �` 641 --�� '!e e: I, � o
• �/ — C , TOT.Al PERMIT FEE L, a, T`0
I Authorized signature: This permit application espires if a permit is not obtained within ISU
day after it has been accepted as complete
Print name: Date: ` Fee methodology set by Fri-County Building Industry Service timid
" Number of inspections per permit allowed.
i ;Budding V Permits 1ELC- Permnipp doe I 2;03 a40- 4015T( IDrtoco,vt /welt
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
I Audio and Stereo Systems*
I I Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
I Audio and Stereo Systems
n Boiler Controls
Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
• Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems: •
*No licenses are required. Licenses are required
for all other installations
1 \ Building \Permits \ELC- PermuApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
r 1" —6 V AM PM BUP
Received 3 � Z��""�c Date Request
Location
IY& 50 MEC
Contact Person Ph ( ) 5 30' 2 /V 'VPLM
Contractor P Aio I. J d\g /0 / Ph ( ) SWR
BUILDING Tenant/Owner l\, .3 GE "<t Z ! S •
Footing ELC
Foundation Access:
Ftg Drain ELR c (31 d d 8 j
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation •
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
■ •. h-
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
UG /Slab
+•,
ASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE " Please call for einspect'•n RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA D Inspector �� / Ext
Approach /Sidewalk P
Other:
Final DO NOT REMOVE this inspection record rom the Jo • site.
PASS PART FAIL