Permit A., CITY. OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00258
DEVELOPMENT SERVICES DATE ISSUED: 5/13/2004
I- ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S101 DC -03900
SITE ADDRESS: 07150 SW SANDBURG ST
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING. C -P
BLOCK: LOT : 004 JURISDICTION: TIG
Project Description: (2) branch circuits for TI
Job No: 1708
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:
PROGRESSIVE CASUALTY BACHOFNER ELECTRIC INC
INSURANCE COMPANY 55 SE MAIN
6300 WILSON MILLS RD PORTLAND, OR 97214
MAYFIELD VILLAGE, OH 44143
Phone: 1 -800- 776 -4737 Phone: 233 -2006
Reg #: LIC 44569
SUP 1769S
FEES ELE 26 -451C
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 5/13/2004 $4.28
[ELPRMT] ELC Permit 5/13/2004 $53.50 Rough -in
Elect'I Final
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 OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246-6 or 1 -800-33 - 344. •
Issu d By: 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:
Call 639 -4175 by 7:00pm for an inspection the next business day
05/12/2004 14:51 5032332%3 \D BACHOFNER ELECTRIC PAGE 01
Electrical Permit A 'e -I
- � —� -�-- tt►u Ill I lc 1, t st, t►\t.1
Cary at Tigard
Date/13
/Cf/w����1
25 SW Mall Blvd , Tigard, OR 97223 �QO !�][3� J . �� - QQ� ��
n 0 Plan Review
Ili
Phone: 503.639.4171 lax. 503.598.19.60a . A s I PlanR : Other Permit
Internet:
inspection
www ci503.639.4175 onus G��°� O¢ A �0 > -, f l " 4. I - N s See Pagel for
{ ll ii _ /�i �PP1�eoal latormatioo
�, ~ t'-`, - ;-,.- , -- -, -. Tr tg - ig.. 1 } , :Kt } �ii rl � r , ,,, � -, 1 + r �,0...(I1T1 w,:r ai.. ,!�: �t r : z� � ;Y..4:: „" . :: 7 ... ry -�fi iii .. y � j 1 r +
" „'1- , "S-.ti'l.�,a,)d1.' tr.vrv. -7w-; a'vi'!:1'G1 - - 1; .1:1'1 ?- 2 _.�. - ,1 : I .iyk x - •x.1 0 -e ,, , !r I4, g.. � i )) f .s77. r a•�ar �'r�:vr:.-:"u1." .� ;, -
.. ='Wa. - rr' � ,Ib_ rU.: • «%,: ' - . - . � {y v.(a, }11i2;3 •�„ • .r,.a,� r'� „ti, t:.c•.cti l li.t<v,f I^ , +
❑ New construction ❑ Addit ion /alteration/replacement Please check all that apply:
❑ Demolition 225 amps, comm'I ['Hazardous ..., '. N :,uavz- „ ❑Service over 320 - ❑ Buildng ove
location
„ ...,.,.. -, c �`w. ;'x -.�, 4 ° ,' 10,0
,. -. .:. >..., , ' ,r r,• , -r t'. }, - - „4��':,: -c 9; c ':; 10,000 sq. @,
,.... ::.... ": - . 21 : .,r��::.., ,�.,a, -rw • ". ; te r . ., —: , I' 'r::`.: of I- and 2 -famil • 1::- :. ' .a.:••.;;.,5:wvr,4Y ;�_rp.; rc - ?:; .;:. „�- '.„:.;::. ' .- Y dwellings 4 or more new residential
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 carps or more ❑ Multi - family ❑ Master builder ❑ Other:
:t ” Ay' r . I +.rr rw, or :.�:; w.cr, q r „ �+ • s ,,1, r . � S: r r, . . . •, r ❑Occupant load over 99 persons (]Manufactured structures or
•r , l T `:r « .nt3 / i.,r1T1;v1f11L• -.v A i + i Y t t I ,i . u r T � t( -1,,,),-.;.;. t
y k r ,. i i t �'st' n
rt�lcc:lLt+: .�c,nt r a�, ,r r'. �. ., +� ❑Egr ess /I lg h tingptan RV park
❑Healthtiare facility ❑Outer:
Job no.: 1 708 Job site address:
7150 SW SANDBURG RD Submit 2,. sets of plans with any of the above
City/State/ZIP: TIGARD OR The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: PROGRESSIVE INS - :' :15,:xiti*l s :'_ ..,._,.._ ',:.. ..... <,Rai,, "," : " " ... ;,: , 'Fi
Description 00- Fa► Total '
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: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no,: Limited energy, residential 75.00 2
s•.. -, -r , l x n I t r, v sn u ,,. n i Limited energy, non-residential
. -..• � I ) :iI3 {�'� ��� i r%r ^x.n.rr�,r+„ a h r +,y ldGAdlal 75.()0 2
. N;+._.. ,.. l 1 p tc 11 ppll Y 5 r -i� -
} r `• "••�::�•• .CU\f �.ltif �.i all "h.a o err. r . } aeSYd. *��$4'*V�rc`i1trlil- '>: -4u , .7 -� e�,l ,t,.ri YnnA .6,(e. - -" Each manufactured or modular
dwelling, service and/or feeder 90.90 2
RE— INSTALL DEVICES & RELOCATE Services or feeders installation, alteration, and/or relocation
kg a a 200 amps or leas 80.30 2
r ,, iy , t7w ,r9 ,r q r ✓r - i i. �.. ' 1 1 G , , •f n�, y r� +st" ;{ n 201 amps t e �1 p ' .e 1 z � �fi �p f�Y' tf , I u 1 +t ,; r , o � t 'r +n7 � il ,v' .; DS l0 400 amps 1 06.85 2
:...„ � ,,f .a ,a( .•,�°a+� r t 'r:4' 3A,r , X11 _ L "..° •IY'' J w...�r ! 4 ,r {, i $ p
�,t at r 3 }P 401 amps to 600 amps 160 "60 2
slier • • - EM 601 amps to 1,000 amps 240.60 2
Address: 1 r at no •
9 9 Over 1,000 amps or volts 454.65 2 _
I Reconnect only 66 2
City/ State/ZIP: I./A NY 6 L a Temporary services or feeders tostellatlon, alteratlon, aud/or
Phone: ( ) J Fax: ( ) relocation
200 amps or less 66.85 1 I
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:
e w v a - v rnr7 s n , Ury w, ,m r ,- Branch circuits new. alteration, or extension, per panel • ' ' .. , ' . -- ;.r i r'n "' � wS 12 , : : r , ' `Wt -4 i +2, ` ,;“ Y c+�i f'. r p r y Z, A Fee for branch circuits with
,_` ` a '�' J '" ' - ' - .. " ,,• ` r, •' ' ' service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 1 46 "85 46 85 2
Address: ..
Each add'l branch circuit 1 6.65 6_ 64 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) F ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E-mail: _ Signal circuit(s) or limited-
'`, , • ,,! `''' • Mi r 5 " )M - iir ^ ; ' K vo y ii • yam u r r } r W , r r T . r ; : ;,
1 : 4. +: tT`�._ :,e1.?IY •. °,r' 7.; M1 ° r } , : , t o . ,.,. ,..,._,+.,„.:',: !4 i t{ . � ° .r', i" "i 1 , r. . 1_
. • � a -,f. _ ; energy Panel, alteration, Or
l- ' extens Describe. Page 2 2
Business name: BACHOFNER ELECTRIC, INC.
Address: 55 SE MAIN Each additional Inspection over allowable In any of the above
Per inspection 62.50
City/State /ZIP; PORTLAND, OR 97214 Investigation per hour (1 hr min) 62.50
Phone: (503) 233 -2006 Fax: (503) 233 - 2963 Industrial plant per hour 73.75
31 +T. ,:i! ., v:f ;b". rn, . 4vv4 7 .. . ,$•� rii: + . ... . V -- .iir5 - +r
CCB Lic.: 44569 � p Subtotal _ 53 _ 5A
Suprv. Electrician Signature, requir• � � Plan review (25 %ofpermtt fee) i
Print name: +� / ' i ate: State surcharge (8% of permit fee)
ROBERT A. BACHOFNER 5 - 12 -04
Authorized signature: 70TH[. PERMIT FEE 5-4-?
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building industry Service Board
•• Number of urup per penmi allowed
I\auudlna1Permlrs\ELC -Pumo Apr doe 1210) 440.461 ST( t0 VCOMrwea
CITY OF TIGARD 24 -Hour
BUILDING . Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received / 0 5 P Date Reques ed S GfD - 64AM_ PM BUP
Location 7/ 50 6 /Anil r Suite MEC
Contact Person ( ) 3 3— UU6. PLM
Contractor Ph ( ) SWR
BUILDING (ewner �i/L . �v/I ELC • 2 Footing 1
U
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
Fi rewal I
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
Fina Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date i Inspector
2 . Q
Approach/Sidewalk
Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL