Permit A.,.tITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -26003
.`��ya DEVELOPMENT SERVICES DATE ISSUED: 9/30/02
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 1 S134BC -00900
SITE ADDRESS: 12394 SW SCHOLLS FERRY RD
SUBDIVISION: PP1993 -058 ZONING: C -G
BLOCK: LOT : 003 JURISDICTION: TIG
Project Description: Installation of service and (5) branch circuits for cell site.
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: 5 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 0 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:
THOMPSON, DENNIS C AND WEST SIDE ELECTRIC CO INC
DAVIDSON, WILLIAM G 1834 SE 8TH AVE
12475 SW MAIN ST PORTLAND, OR 97214
TIGARD, OR 97223
Phone: Phone: 231 -1548
Reg #: ELE 26 -135c
FEES Required Inspections
Description Date Amount Elect'l Service
[ELPRMT] ELC Permit 9/27/02 $113.55 Rough -in
[ Elect'l Final
[ELPRMT] ELC Permit 9/30/02 $0.00
[TAX] 8% State Tax 9/27/02 $9.08
(additional fees not listed here)
Total $122.63
This Permit is issued subjed to the regulations contained in the Tigard Muniapal 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: t ��? I - Permit Signature: c4// -:G/ C'r,z-/ /D/V
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:
Call 639 -4175 by 7:00pm for an inspection the next business day
M._7:a6 _ p06 d0y
/7/%1S '2oo 2- —P00/(,
c,c/'..2.00 o 2 — g ' ?
Electrical Permit Application pFFICE USE ONLY
r y , y Date received: y /Z.5 /oY Permit no.:E�2o02-A606
„ � City of Tigard VLr V tI' Pro)ecdappl. no.: r:xpirc date:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
city rf Tigard Z , etc issued: 1Ty: j)f f f 'Roc tips no.:
Phone: (503) 639 Fax: (503) 598 -1960 SEP . 2002 J /i t , E ase tile no.: Payment type:
I .and use approval: (Al i ti.di' ::.',. 3.!3 :4' • ./
✓ TYPE OF PERMIT
U 1 & 2 family dwelling or accessory 19�Commercial /industrial U Multi - family 0 Tenant improvement
U New construction 0 Addition/alteration/replacement U Other: __..❑ Partial
JOB SITE INFORMATION
Job address: L. ),3 c i L4 e ; ,....j C , %I c p Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: IBlock: (Subdivision: _ _ . --
l'rojcct h �� p � e \\ S C } .e- 'Description and location ot' work on premise,: I .„r ,, •, , ,, a , , �� ) f • S r' +
Estimated date of completitn/inspecction:
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: Fee Max
Business name: WAS C ct sit. 4'1.42% dt% [ Deseripdoa Oh. (.) '•clan nn. imp . New rewldentml. singleor molti.family per
Address: • It, 4 - _ - 4_ dwellamonit. IncludesaHBchedgarage.
City: 7 r`-{ c State: ,J ZIP: q 7 Z.14 Scrviccin lodcd:
Phone (- i 1; t. - Fax:7 6--04-7-7 E -mail: 10110 9. It or le e1 _ 4
(CI; no 1 7,3,0 , cm Elec. bus. lic. no . Z . 6-- t 35 t—._ Rauh additional 500 nq. IL orNwAion tlx:n:of
Limited energy. resuleulr:rl 2 • City /trio O lic, n0.: -,.,. .- / 1 Limited energy, non- ,csidential 2
(/ e / 0 0) ? Each manufactured home or modular dwelling
Signature (Ifs • isin)r electrician (regatired) Dale /p / / a� SC and/or feeder 2
'fir Servi or feeders - installation,
t 1 Sup. elect. name (Print): J . t G• �� I. ; rxmsc no; �o )
PROPERTY OWNER altera.ionorrctounion_
200 amps or less I (30.. it) (.o.3 2
Name (print): 201 amps to 400 amps - _ 2
— — - _
Mailing :address' X111 imps to 6(10 amps 2
601 amps to 10011 4mlm 7.
City: rStatc 12J _ _
1': Over 1000 yaps Or volt. _ 2
Phone: !Fax: IE -mail: Reconnect only I
Owner installation: The installation is being made on property I own 'Few pantry services or feeders -
which is not intended for salt, lease, rent, or exchange according to "' teary ° ti°", "iletali°",°rtct°cat' °tc
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps In 400 amps 2
Owner's signature: _ Date: _ 401 to 600 am s 2
Orasch circuits - new, alteration,
Mime: or extension per panel:
A. fur branch circuits with purchase of
Address: - _ _.__ I service or feeder fee, each brunch circuit r L.1o5 51 2 . --
City: _ _•— [State: 1 ZIP: -' ^•
1 •_ Il. Poe for branch circuits without pun:hssu
Phone: Fax: E of service or feeder fec, fist branch circuit; i 2
Each additional branch cttcuit:
PLAN REVIEW (Please check all that apply) Mt. c.(Scrviccor feeder not included):
U Servirx ovtr 225 :ampyommercial U Ilcalthcam facility ratan, pump or irrigation circle - _•. 2 ..,.
U Scrvieu r iver 37.0 amps -rating of I &2 U Harrtthw.t bath m Bach sign or outlittu lighting 2
family dwellings 0 'wilding over 10,000 square foot four or Signal circuit(,) or a limited energy panel, a
❑ Sysiem over 600 volts nominal more residential units in one structure alturatinn, or extension' 2
O Building over three stories ❑ l teats, 400 amps or more *Description: _ _
U Occupant load over 99 persons ❑ Mnnufachtrext structures or RV park Each additional Inspection over the altuwabMin any of the above:
U Egress/lighting plan U Other
-- • • - Par inspection
Submit _ -- sets or plam with any of the above. Invcsti fee
The above are not applicable to temporary construction service. Other
Permit fee $ 11 "
' 14nr all juriµt:eaiona accept credit cards, plea; call jurisdiction for more information, Notice: This permit application
XViIS, ❑ M expires if a permit is not obtained Plan review (at _ %) $ .., .
Credit card nu within 180 days after it has harm State surcharge (8%) $ —. G (1 (• . ._
r , pare' TOTAL $ 1 7 3
act opted as complete. '__-
N f eardhldcra4S.rho cued' I '
L sI2
Cardholder s to .-- ......... 6n1Nrni 4411 - 4619 (Notp(.()M) ■
T ' d LL90 - 9cL (COS) 'o3 o L Oai3 aptS %sem eLiP t90 20 SZ daS
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTIONDIVISION Business 'ne: (503) 639 -4171
BUP
Received Date Request- / I c' AM PM BUP
Location 1 4)-3 4 _ Sri Suite MEC
Contact Person Ph ( ) - PLM
Contractor 60gg/ -- � . ,c,/e y*°* _ Ph ( ) a3 I- /SY SWR
BUILDING Tenant/Owner ELC o` — 2e) o 3
Footing
Foundation ELC
Ftg Drain Access:
ELR
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
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
Fir= Iarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S Ei Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA Date gv. 6 / Inspector � ector �� c1 Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspect12n Line: (503) 639 -4175 MST
INSPECTIOU DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 1d AM PM BUP
Location - uite MEC
Contact Person Ph ( ) • PLM
Contractor Ph ( ) a 3 i' - SWR //
BUILDING Tenant/Owner ELC ca 8 d)
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall • _' h/ 1�
Fire Sprinkler
Fire Alarm —
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL �.
PLUMBING
Post & Beam t
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
EL CTRICAL
- erg*" ic
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
/P ASS PART FAIL
0 Please call for reinspection RE: El Unable to inspect – no access
Fire Supply Line
ADA �C'� / 4 (1) Inspector `_ .CD • Ext �. •-∎
Approach/Sidewalk Date tir
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL