Permit i# CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00247
Alln DEVELOPMENT SEtRVICES DATE ISSUED: 4/11/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S134BC - 00600
SITE ADDRESS: 12390 SW SCHOLLS FERRY RD ZONING: C -
SUBDIVISION: PP1993 - 057 LOT : 002 JURISDICTION: TIG
Project Description: 200 amp panel & cell equipment.
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: SIGNAUPANEL:
MANF HMI SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 2 W /SERVICE OR FEEDER: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
THOMPSON, DENNIS C AND WESTOWER COMMUNICATIONS INC
DAVIDSON, WILLIAM G 19500 SW CIPOLE RD
12475 SW MAIN ST TUALATIN, OR 97062
TIGARD, OR 97223
Phone: Phone: 503 - 210 - 1000
FEES Reg #: ELE 34 -676C
Description Date Amount LIC 140471
SUP 4140S
[ELPRMT] ELC Permit 4/11 /2005 $173.90
[TAX] 8% State Surcharge 4/11/2005 $13.91 REQUIRED ITEMS AND REPORTS
Total $187.81
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- 800 - 332 -2344 •
Issued By: � L� Permittee Signature:
e v41° -
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.
Elct"r cal Permit Application FOR OFFICE USE ONLY
Cl of Tigard Received i Pemu No
131 Hall lvd , 1'i ard, OR 97223 Date /By y � 1� ('� e.•e,.,a) ) /�ctv 7
i= Plan Review
Phone. 503 639 4171 Fax: 503 598 1960 i> Date /By Other Permit
Line 503 639 4175 e I I Date Ready /By Juns El See Page 2 for
Internet www ci.tigard or us Notified/Method .f/ Gl Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply.
❑ Demolition ❑Other: CI Service over 225 amps, comm'l 0 Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft ,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ I - and 2 family dwelling ® Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑Building over three stories 0 Feeders, 400 amps or more
❑ Multi family 0 Master builder 0 Other:
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION El Egress/lighting plan RV park
Job no.: 63 -10346 Job site address: 12390 SW Schools Ferry Road ❑Health - care facility [Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: Tigard, OR 97281 The above are not applicable to temporary construction service.
Suite/bldgi /apt. no.: Project name: Sprint co- locate FEE* SCHEDULE
Description I Qt). I Fee. I Total I **
Cross street/directions to job site: Schools Ferry to SW North Dakota turn south one New residential single or multi - family dwelling unit.
Includes attached garage.
block turn east cell tower is behind the car wash 1,000 sq. ft. or less 145.15 4
Subdivision: Lot 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
Install new 200 amp panel and Sprint cell equipment dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 2 80 30 /6040 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
relocation
Phone: (503) I Fax: ( ) 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 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each '—'1_, 6.65 I 3,3 2
Business name: branch circuit
B Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
Address: each branch circuit
Each add'I branch circuit 6 65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53 40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53 40 2
E - mail: Signal circwt(s) or limited-
CONTRACTOR energy panel, alteration, or
extension Describe Page 2 2
Business name: Westower Communications Inc
Address: 19500 SW Cipole RD Each additional inspection over allowable in any of the above
Per inspection 62 50
City /State /ZIP: Tualatin, OR 97062 Investigation per hour (i hr min) 62 50
Phone: (503) 210 -1000 Fax: (503) 210 -1001 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 140471 Electrical Lic 34 -676C Su rv. Lic. • 4140S Subtotal f ' 71 , 9 C)
Suprv. Electrician signature, required. W r•- _ Plan review (25% of permit fee) �7
Print name: 13A Ma y ST R I f e Date: y / / O State surcharge (8% of permit fee) S f �
. TOTAL PERMIT FEE I g7, 8 (
Authorized signature: 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 Tn- Cowtty Building Industry Service Board
•• Number of inspections per permit allowed
i \Bwlding \Pemuts \ELC- PermitApp doc 12/03 440- 4615T(10/02/COM /WEB
CITY OF TIGARD . •
BUILDING DIVISION PERMIT #: ELC2005 -00247
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 - I I..
INSPECTION WORKSHEET FOR DATE: 4/14/2005 TIME: 7:10AM PAGE: 4
SITE ADDRESS:
E 12390 SW SCROLLS FERRY RD CLASS OF WORK:
SUBDIVISION: PP1993-057 LOT #: 002 TYPE OF USE:
PROJECT NAME: SPRINT
DESCRIPTION: 200 amp panel & cell equipment.
OWNER: THOMPSON, DENNIS C AND, PHONE #:
CONTRACTOR: WESTOWER COMMUNICATIONS INC PHONE #: 503. 210.1000
Inspection Request Scheduled For: Date: 4/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service/reconnect 004543 -01 503 - 969-2956 Y
Corrections /Comments /Instructions:
l/
fr/
PASS , 111 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL � ,, ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ALA-t._-- / cJ -"'`- G Date: — / 2 1 Phone #: (503) 718 -