Permit -"CITY OF TIG ELECTRICAL PERMIT
PERMIT #: ELC2004 -00759
M SERVICES 1/2
DEVELOPMENT S DATE ISSUED: 12/ 00 4
cll
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S112DD -01400
SITE ADDRESS: 15686 SW SEQUOIA PKWY
SUBDIVISION: MARRIOT ZONING: I -P
BLOCK: LOT : JURISDICTION: TIG
Project Description: Replace existing light fixtures.
Job # 5967.
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: 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 JARMER ELECTRIC INC
500 108TH AVE NE 5105 SW 45TH AVE
P 0 BOX 3646 PORTLAND, OR 97221
BELLEVUE, WA 98009
Phone: Phone: 246 -5381
Reg #: LIC 6924
SUP 4044S
FEES ELE 26 -I44C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/1/2004 $46.85
[TAX] 8% State Surcharge 12/1/2004 $3.75 Rough -in
Elect'I Final
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -0699 or 1 -800- 332 -2344.
Issued By:j9 Permit Signature: 5�2 qe
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
Eitct"i�:: . Permit 1.0R 01 t
�� six ONi.V
Cl of Tigard � tiVE® Received - — ' Permit No.: )
Date/8 y
• 13125 SW Hall Blvd., Tigard, OR 97223 • ` e, Plan RReview . y : A , 503.639.4171 Fax: 503.598. L C 0 1 2004 I I\ • Date/13 D't ' Other Permit
Inspection Line: 503.639.4175 —1 'J E. Date Ready/By: ® See Page 2 for
• Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
CITY OF TIGARD , ;...1
:.•
�tAl!�1�111�'ll�fll!$�Ni • • ... .� ' • : z.. . . .. • . . � �:�' ; :.� ,.�
❑ New construction Addition /alteration/replacement Please check all that apply:
❑ Demolition El Other: ['Service over 225 amps, comm'I ['Hazardous location
['Soviet over 320 amps - rating [Mulleins over 10,000 sq. ft.,
. . . CATEGORY OF CONSTRUCTION • . +. t ti of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling J Cotnmercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder El Other ['Building over three stories ❑Fades, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE, INFORMATION- AND LO€ TIO1N , "� ■ `` DEgress/lighting plan RV park
Job no.: Job site address: /..574 ScAi �2 ❑Health facility ❑O
S� (i I t� f Submit 2 sets of plans with any of the above.
City/State/ZIP: n Ae w )' The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: I Project name: eiri4,/' /A ay Aube .0) _ _ FEE .I��p><Jl'Fri: ' :' 9 : - '
Description I Qtr. I Fez I Ti M I "
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK • • Each manufactured or modular
.. , 6t A A £ s / .- 9e co . x �� /e � dwelling, service and/or feeder _ 90.90 2
� «/ rf �L - 7� Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I . ❑ TENANT , . '.. •.: •, 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1 1
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON - : - A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
Address: each branch circuit ! 46.85 0 2
Each add'I branch circuit 6.65 2
City/ State/Z1P: Miscellaneous (service or feeder not Included)
Phone: ( ) I Fax:: ( ) Pump or irrigation 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 2
Business name: TR/Q re. Ea- Et_ECT ear d. c ItUC -
Address: ,5"--/ O S <S' 4- - , S e, 2_0 O Each additional Inspection over allowable In any of the above
Per inspection 62.50
City/State/ZIP: 4r Q i L AJ 4 d 2 ' 7 2 2 / Investigation per hour (1 hr min) 62.50
Phone: (S33) 2 q Co - 5'3 E/ I Fax: (503) 2e/ - to 3 7 industrial plant per hour 73.75
CCB Lic.: 4092 y I Electrical Lic.: 262 / 4 Suprv. Lic.: '/Dy Subtotal ! [' S _:
Suprv. Electrician signature, required: n/ C — _ Plan review (25% of permit fee) 7
Print name: ate: .- D ~ ,/ State surcharge (8% of permit fee) ? 7C
�� /2 % J , M E I G TOTAL PERMIT FEE n ei
Authorized signature: This permit application expires If a permit Is not obtained within 180
days after It km been accepted m complete
Print name: I Date: • Fee methodology by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
islBuilding \ Permits ELC.PernmApp.doe 12/03 440-4615T(10/02/0OM/WEB
CITY OF TIGARD 24 -Hour
BUILDING Insp.ctian Line: 4503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 0.-
AM PM BUP
Location / 5 Ito g42 �d U V-�� ) Suite MEC
Contact Person , Ph ( ) ? 46 - S - 3e1 PLM
Contractor �i i,� Ph ( ) SWR
BUILDING Tenant/Owner / / ELCo 00 9 &O 757
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 ` > I \J\p " A(lAe 1 V W
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service C
Sanitary Sewer q
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
1 ,--
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
Fire Alarm
0
P PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
TE 0 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line �
ADA i - g.\ —. 05 j
Approach/Sidewalk Date Inspector fI/ Ext
Other: 1/
Final DO NOT REMOVE this inspection record from th job site.
PASS PART FAIL
•