Permit -'' CITY -AOf TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00504
1 DEVELOPMENT SERVICES DATE ISSUED: 8/11/2004
111 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25101 DD -00401
SITE ADDRESS: 06955 SW SANDBURG ST
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING. I -P
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: (4) branch circuits for copier outlets.
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: 3 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:
SOURCE PARTNERS, LLC EMPIRE ELECTRIC COMPANY
6955 SW SANDBURG ST 2014 SE 9TH AVE •
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 256 -5554 Phone: 503 - 777 -3108
Reg #: LIC 147727
ELE 3
FEES SUP 3192S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/11/2004 $66.80
[TAX] 8% State Surcharge 8/11/2004 $5.34 Rough -
Elect'l Final
Total $72.14
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 a re 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: V A �!` // . Permit Signature:
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: 3! 4
Call 639 -4175 by 7:00pm for an inspection the next business day
FROM , - -mp T RF ELECTRIC CO FAX NO. : 5037774152 Aug. 11 2004 08 : 44AM P2
. , . . , •, • . . •• ..... . .
.. . .. .
FOR orri(r: i•tiL, ONLY
. . . , . .
City of tlgard Re , it 0 ; a mirrrap d,
i 3 t 25 SW MD NA. Tigard. OR 4,14 1 1 2004 A
. iew Other Parra
phone: 503.639A17l Pax: 503398-1960 — 'z''
., li( Dotal
inIPCCtfgn "IC; 503 CITY OF TIGARD . ,-,...-41- -II.. mot • xr hoc 81 Ea Page Mr •
1ntenten www.of.rigard.or.ua nattnenteadtod: • . , - , 1 enrwasanoo
1 I. I !VISION
I
,..r e ; ,..... 19. - v &Tyliii 4i =.:,; :. :... __ ... ...... . • .t:
. 17:1•., - . — r
U New construction :5 . • itionlaitmation/replacemcnt please check all that spray:
OSer,fice over 225 lunpa. COMM') rilnlotis location
0 DemolltIon Ci Other . cis over 320 omps rating Ofhliking O'er 10.000 $(1. ft..
v....f.r . ! ... :?, ! ' ; 7: lijatigrO ': . ,:..'. :'',.1.. ... : •:.. i3 1141'1 oft and 2-Camity dwellings 4 or mom new residential
0 1 - =I 2 dwelling , O. .1.- ' allindusnial 0 Accessary building C1Systran over 600 volts nominal units in one Cincture
131suildios ova date stories OFealas, 400 amps or mon
0 Multi-franil • 0 Master builder 0 'Ma: 1:10/x.pant load over 99 persons 0M4nufactured s Or
' oge --,. - .-,..- : ....v iikwyjausii§y "i : J , -...i -..' ., .- ri AV park
, f alSba. .. 4: .. • . I I .-.2:.-' ,:' ::', • • • . • .' 1_,F.Vcsitlieltht13 Plan
' OtIcatth•Com facility 1:10111er
Job no.; Job stle address: t p 5 (A) 0," I .
111011 •
. 7,07 . 7 ... „.. . . , . . . , i7::„.„... , ,,. .. . . .., . . . ,
Submit 2 tea distant with any of the above. •
Cily/Stattall j (a. of f 0 • The a ire a m ippliCebli to temporary oanuroction zawice.
. Sulte/bklg./apt, no.: I itoject name: D 0 CV S Oti se 4-I-
Cross sect/directions to Job site: New residential dngle or multi-tandly dwelling unit. .
. . .
. todudes attached is e. • •
• 1,000 sq. O. or lea .111 145.15 4
- ....
1 ' SubdiviS1011: 1 Lot o.: Ss. sal 500 sti. e - or Pardon IIIIII 33.0 I
Unified energy, residential MI 7s.00 2
Tax maptpareel no.: Limited -. :4 0ton-residential MI 75.00 III= 2
' - -, .... .
? : : :.!:iiiaMillrr! 2711?Sitgirl'.0 • ...::- :-:: :.,g Each rcadafactscd a r ITIodulse IIII
V, <70.. / r
P -- t k..". 0 (frier-5 Aydin : servicx andke feeder l■ 90.90
Services or feeders loslidlation, alterallon. autlior relocation 2
200 amps Or ICU 80.30 2
*l ti ...';. 2°1 unPs ft dQ° an" 106413 2
• ' - , 401 amps to 600 • • • 160.60 2
Nun: 601 arms to 1,000 amps 24.60 . 2
Address Over 1,000 amps or volts 454.65 2
; , . .
Reccancce only 66.85 2
CityfStaterZIP: Tozpormy lerikes or retrial, inetaUstion, alterst44, ad/or
. •
relocation
Phone: ( ) Fax: ( ) 200 amps or less ' 66.85 1
Owner ineuelladon: This installation is being made an property that I own which iS not 201 amps to 4 00 amps 112030 . ' . • 2
intended for sale., lease, rent, or exchange. according to ORS 447, 449, 670, and 701. I_
401 amps tip 600 amps ,
/33.7S 2
Owner signature; , Date: Wench eiresits - wow. alteration, or entenslon,per panel —
::! -6; . P '. r: i 6 1,1:e *it. ie.l.'!!. ;; •:::!. El( .; ii";;;;,..''..1.;•..,;..;i:torpgiliz A. F*4 for h circuits wish
6.05 2
• Business =me: • branch deceit
B. Fee for branch circuits .
Cootnet nan1e keinue service a fccdcl fee
tacit 46.85 4 14 4 g5 - 2 • h branch circuit
Addxr,sc: .. • Each addibTVICII CigWit % dAS I Cl fi 5 2
—
city/state/EP; • Miscellonsons (senTice or feeder not Included)
Pump or in/it:Woo eiveia 53.40 2
Phone: ( ) I Fax: : ( )
— - Sip or gram Ithrinc 53.40 2 ,
E-mail: ' Signal decants) or 'foaled-
tigtH .1 •.'..VPigitti t .. ' i . I °walk°, or
extension. Daertbe: . Page 2 2
Bodiless name: Empire Elect Die Co. _
Each additional Inspection aver allowable lo soy of the above
,.....A 9 t h a v g. ,_
Per inspection 62.50
City/State/ZIP: Portland, OR 97214 Investigation per hi:Rff a br min) ,
62.50
•
Phme: 603 ) 777-3108 FAX` (503 ) 777-4152 Industrial plant per how 73.75
:?'' .i.4XLECTRICMYPE111 ' • • ' :•
CCI3
Lic - 147 Electrical Lic.: - Supra. Lie.: • iril—
,....
Suprv. Electrician sigosno% required: "IT" 77/ KI/7".4.- --- Plan revicw (25% of mantic fee)
Priettnamc David Manwiller Dme: 6/10/04 • state em ---- . UssiofP:rmitrev) _____
.....AL ERMITFEE
Authorized signatur= Ttig permit application expiry, a $ ma* i ma onward .45/aia ISO
. On. saw ft 6.ss bees lineasscd as eolopielf
Print name: I Dare? • Fee nalbodoloay by by Tri-Comey suPdhsg wispy Verner Boons
--- •• entaterof hepaticas papa allowed.
1:04/14.60(nr4ittet-C-PermitApp do€ 1341 416.4613111OV2JCOMMED
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business line: (503) 639 -4171 MST
BUP
Received Date Requeste f S. - PM BUP
Location -AA uite MEC
Contact Person / ' ' Ph ( ) , a— `� Z � PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC acO( ( 6 3 - 3'
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes:(4 SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear ( (/ 011.
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
P
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
T FAIL
ECTRI L
Service
Rough -In
UG/Slab
Low Voltage n'I•U e
Fire Alarm
�' � ;I`� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
- AS PAR •
SITE L Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date /5 � � Inspector �� Ext
Other:
Final DO NOT REMOVE this Inspection record Won' the job site.
PASS PART FAIL