Permit CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT #: ELC2001 -00076
A 'ittiO I DEVELOPMENT SERVICES DATE ISSUED: 02/05/2001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S1 12 DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 125
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Installation of 2 branch circuits. Af ,
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: 1 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 BACHOFNER ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 55 SE MAIN
PORTLAND, OR 97224 PORTLAND, OR 97214
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Phone: Phone: 233 -2006
Reg #: LIC 44569
SUP 2808S
ELE 26 -451C
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 02/05/2001 $53.50 2720010000( Elect'I Final
5PCT CTR 02/05/2001 $4.28 2720010000(
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of OR. Spedalty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE �,� e �� ��9 ISSUED BY:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
: -- .
City Alk Electrical PermitAgp - li cat n*
�
, c .-c' ,t (Date received: ,2/$/0 Permit tam CLG244/- 1100
r �,,� • `,1 I . of Ti C - ' O �V��' Q Project/appL no.: Expire date: •
city 8 Address: 13125 SW Hall Blvd, Tigard, ORS Date issued: By: 2 eipt no.:
Phone: (503) 639 -4171 011*
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
T\.F ()I: Pill NW
O 1 & 2 family dwelling or accessory 0 Commercialrindustrial 0 Multi - family O Tenant improvement
• U New construction al Addition/alteration/replacement 0 Other. - 0 Partial
Job address: 15350 SW Sequoia Pkwy Bldg. no.: 241 Suite no.: 125 Tax map/tax lot/account no.:
Lot I Block: • I Subdivision:
Project name: Contractors Register I Description and location of work on premises: 1st floor
Estimated date of completidnrinspection: 2 / •
( ON 1H \( FOR , \1'1'1.1(' 110\ 11:1: St. IIEI)1:1 1
Job no: 9110 Fee Max
Business name: Bachofner Electric, Inc. • won Qty (on.) Total no. hem
New residential- single or mald-terror per
Address: 55 SE Main St. dwellbhgdtl>xladesatbarhedga
City: Portland I State: OR I ZIP: 97214 Sa feared dark
Phone: 503- 233 -2006 I Fax: 233 -2963 I E-mail: 1000 sq. ft. or less 4
Each additional S00 sq. R or portion thereof
CCB no.: 44569 I Elec. bus. lie. no: 26 -451C . Limited ,.residential 2
City/metro lic. no.: 2536 limited energy, non- raddenanl 2
• Each manufactured home or modular dwelling
Signature of supervising electrician (required) pate _ Service and/or feeder 2
Sup. elect. name (print): W. Bachofner license no: 2808S Services or feeders— installation,
alteration or relocation:
200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: over 1000 amps or volts 2
Phone: I Fax: I E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services err feeders - . -
oir
which is not intended for sale, lease, rent, or exchange according to Imiallation,alleration,orreloadl
200 amps or less 2
ORS 447, 455, 479, 670, 701. • 201 amps to 400 amps 2
Owners signature: Date: 401 to 600 2
Branch ciradts - new, alteration,
or extension per paoeh •
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I S I ZIP B. Fee for branch circuits without purchase '
Phone: Fax: E -mail' E of service or feeder fee. fast branch circuit: I 2
Each additional branch circuit 1 / •(O t
I'1": \\ 12L\ II \ (Please check all that aphlq) Misc. (Service or feeder not baebded):
O Savice ova 22S amps ao®mercial - O Health-care facility Each pump or irrigation circle 2
O Service ova 320 amps-rating of 182 Cl Hazardous location Each sign or outline lighting 2
family dwellings O Buildiing 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 Mach= alteration, or extension' 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each addttlooal over the allowable In any of the above:
0 EitTessniithda8Plan 0 Other. - Per inspection , I I I
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other �
Not as *Wisdom accept credit cads, please can )mt+tction for more information Notice: This permit application Permit fee $ -
0 Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
credit cad number / / within 180 days after it has been State surcharge (8%) $
Ott° accepted as complete. TOTAL $ S7 7 g
Name of cardholder as drown on credit card
Cardholder signature Amoont - 440.4615 (6/00#C)M)
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