Permit / Cast OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00249
I� DEVELOPMENT SERVICES DATE ISSUED: 4/11/2005
cal II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112DD -01400
SITE ADDRESS: 15686 SW SEQUOIA PKWY ZONING: I -P
SUBDIVISION: MARRIOT LOT : JURISDICTION: TIG
Project Description: 2 branch 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: 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 ASSOC. JARMER ELECTRIC INC
15350 SW SEQUOIA 5105 SW45TH AVE
TIGARD, OR 97223 PORTLAND, OR 97221
Phone: 503 - 624 -0727 Phone: 246 -5381
FEES Reg #: LIC 6924
Description Date Amount SUP 4044S
ELE 26 -14-14
4C
[ELPRMT] ELC Permit 4/11/2005 $53.50
[TAX] 8% State Surcharge 4/11/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
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- 33 -2344.
Issued By: Permittee Signature: AS � '� � _
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 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
)E1 trical Permit AppilitECIE IVED FOR OFFI( 1: l SL ONLY
City of Tigard - Davy. /1 04 a6 Permit No.i j —ppd
13125 SW Hall Blvd., Tigard, OR 97223 APR 1 1 2QO Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 ' i "" `'r-I I ' Date/BY: Other Permit:
Inspection Line: 503.639.4175 ' Date ReadyBy: 10/it See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGA • Not i fied/M e thod : 7/(1 I ® Supplemental Information
• BUILDII VISION TYPE OF * PLAN REVIEW .2.5 :
❑ New construction Addition/alteration/replacement Please check all that apply:
13 Demolition ID Other: ['Service over 225 amps, comm'I ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., •
• • ' . CATEGORY OF CONSTRUCTION , of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ''Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi - family ❑ Master builder ❑ Other ['Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
•JOB SITE INFORMATIO : •II 2 . 9 t N ` ` - ❑Egress/lighting plan RV park
'-` . . I 6 (a • b ['Other:
facility
Job no.: ( f I Job site address. .. • (, S��.l.w l 0. Pt W-13 Submit 2 sets of plans with any of the above.
City/ State/ZIP: I I C.� y _ O fe 9 z a 3 J The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: Project name: FEE* SCHEDULE
_ Dmertption I Qtr I Fee. I Total I ••
Cross street/directions to job site: New residential single or multi -family dwelling unit.
Includes attached garage.
?. t,C) y y _ pc..-2. �e , df i y yr 1,000 sq. ft. or less 145.15 4
Subdivision: f ` L ot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map/parcel no.: • Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
c°
'� ��O Ex i 4 L t G �"�' S dwelling, service and/or feeder 90.90 2
1 e T J Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
• .❑ PROPEETY_OWNER _ ._- - I - O TENANT .. 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: t � ' "" 601 amps to 1,000 amps 240.60 2
Address: C .
Over 1,000 amps or volts 454.65 2
� � Reconnect only 66.85 2
City/State/ZIP: 1 3• -_ 6 `7 _ V !73 7 Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fa x: ( ) relocation
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 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, I
each branch circuit 46.85 ..S 2
Address:
. • . Each add'l branch circuit - I 6.65 - (,(o$ 2
•
City/State/ZIP: 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: Zfl 2,,, E2 Ei-EC r Qt e l Doc_ -
Address: S/ a 6 I../ S % ?``-- s- L0 0 Each additional inspection over allowable in any of the above
//�� Per inspection 62.50
City/ State/ZIP: /0 % ■/t_, AJ 4 Q /_ 6 1722/ Investigation per hour (1 hr min) 62.50
Phone: (S33 ) 2 y Co - r3 el I Fax: (s 2 vq - e03.7 Industrial plant per hour 73.75 - - •
ELECTRICAL PERMIT FEES*
CCB Lic /p ' Li I Electrical Lic.: 2(o / 41/14 Suprv. Lic.: yogi/5 Subtotal 53 ,,s
Suprv. Electrician signature, required: q' 4..._...._-_,_ Plan review (25% of permit fee)
Print name: Yry 4 , - � I
, j r ,e "i E , a 4 --4-o S
State surcharge (8% of permit fee) L f
TOTAL PERMIT FEE S 7_ 8
Authorized signature: 3 I S --- This permit application expires If a permit is not obtained within 180
days after It has been accepted as complete
Print name: I Date: • Fee methodology set by Tri -County Building Industry Service Board • Number of inspections per permit allowed.
is \Building∎PermiMELC-Pmni:App.doc 12/03 ' 440-4615T(10/02/CDMM'EB
' , Y OF TIGARD '
BUILDING DIVISION PERMIT #: ELC2005 -00249
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2005
Phone: (503) 639 -4171 y; illh
Inspection Requests (24 Hrs.): (503) 639 -4175 s' �: _..
INSPECTION WORKSHEET FOR DATE: 9/1 /2005 TIME: 7 :14AM PAGE: 92
SITE ADDRESS: 156. SW SEQUOIA PKWY CLASS OF WORK:
SUBDIVISION: MAR' OT LOT #: TYPE OF USE:
PROJECT NAME: TOUR • D BY MARRIOTT
DESCRIPTION: 2 branch c• suits.
OWNER: PACIFIC RE . TY ASSOC., PHONE #: 503-6246300
CONTRACTOR: JARMER F_LE; RIC INC PHONE #: 246 -5381
Inspection Request Scheduled For: \° Date: 9/1 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
35 _. -- L voltage ' �� 14706 -01 503 -620 -5203 N
Corrections /Comments Instruc ion s°
1 \
1
I
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: A Iv h) q Le Date: 9 - 1 ` QS Phone #: (503) 718- 2M LI 4 ■