Permit --art O �F TIGARD ` ELECTRICAL PERMIT
PERMIT #: ELC2003 -00240
,V, l� IT DEVELOPMENT SERVICES DATE ISSUED: 4/25/03
^ � I II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
• PARCEL: 2S112DD -00700
SITE ADDRESS: 15786 SW UPPER BOONES FERRY RD
SUBDIVISION: BLDG D ZONING. IP
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of data /telecommunications and (4) 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: 1 401 - 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: 3 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 BEAR ELECTRIC
15350 SW SEQUOIA PKWY #300 -WMI P.O. BOX 389
PORTLAND, OR 97224 - DONALD, OR 97020
Phone: Phone: 503 - 678 - 1355
Reg #: LIC 20919 •
ELE 24 -107C
FEES SUP 3162 -S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/25/03 $141.80
[TAX] 8% State Tax 4/25/03 $11.35 Low Voltage Inspection
Rough -in
Total $153.15 Elect'I Final
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-
Issued By: AC Permit Signature: e v,/ x70/0 i e 4a-770A/ .
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 INSTALLATI N ONLY .
• : O"-/ /°G / e f)
SIGNATURE OF SUPR. ELEC N. � i° DATE: •
•
LICENSE NO: .
• - Call 639 -4175 by 7:00pm for an inspection the next business day '
•
APR. 25.2003 , 2:36PM SAVIN rse �} Go el, sT+ NO. 724 P. 1
Electrical Permit Application ` ' OFFICE USE ONLY
(� I� II11 Date received: 9 ZS (.33 Permit no :ELCti200
'lr - l li City of Tigard L� RECEIVED Project/appl. no.: Expire date;
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: = �; %e, Receipt no.
Phone: (503) 639 -4171 APR 2 . 2003
Fax: (503) 598 -1960 Case file no.; Payment type:
CITY OF TIGARD
Land use approval: Rl_ll) flIhl(, nIVISION
TY.t'.E OF PERMIT
0 1 & 2 family dwelling or accessory 14 Commercial /industrial ❑ Multi - family ❑ Tenant improvement
0 New construction 0 Addition/alteration /replacement Cl Other: ❑ Partial
JOB SITE INFORMATION
Job addresf f e5 V14. �'I,tl (y pr_K ii? e .. Bldg. n Suite no.: Tax map /tax lot/account no.: k.
Lot: Block: 'Subdivision: r aim .. or „ e k s — "..e. r r ear it
Project name: , Description and location of work on premises:
Estimated date of completion/iaspection: 2 i? , c. --P
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: /0'2,1 4 Lf w 7 9 Cn 5 y, O , : Cj Fee Max
Business name: 0e. f a 1,e. Gar IAA, _
Description Qty. (ea) Total no. ivap
Address: O . Eg e 3 8 Q N ellIngdrntial- single attached [- family per
dwef l lug unit Includes a ttached gara ge.
City: p ` 6¢ I State: v• r Lz1P: g'). 2-0 Servicefoduded:
Phone:6 7 9' -/355 [Fax: 4 7 $ —(/ od E -mail: 1000 sq. ft. or less , 4
CCB no.: 2 t9 r F I Elec. bus. lie. no: 2 y- h,-.) G Each additional Soo sq. ft. or portion thereof ,
Limited energy, residential 2 —
City /metro lie, no.: CJ Limited energy loss- resid ential 75 75 2
(//2_,,i-- a 3 Each manufacntred home or modular dwelling
Signature of supervising electrician (required) pate Service and/or feeder 2
Sup. elect. name (print): 'D; ? 47 .4 License no: 3` 2S Services or feeders – Installation,
alterati on or relocation:
e "'• e , 20U amps or less 2
Name (print): 201 amps to 400 aims 2
Mailing address: 401 amps to 600 amps 2
601 amps to 1000 amps 2
City: State: ZIP: Over 1000 snips or volts 2
Phone: I Fax: E -mail: Reconnect only 1
Owner instillation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelo=don:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 Snips 2
Owner's signature: Date: 401 to 600 an.s 2
ENGINEER Branch circuits. new, alteration,
Name: or extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder the, each branch circuit 2
City: State: ZIP: B. Pee for branch circuits without purchase ,( � 9 4 8 r 2
of service or Ihedar fee, first branch circuit `
Phone: Fax: E-mail: Each additional branch circuit; ,3 ‘.LS isys
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1&2 0 Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10,000 Square feet four or Signal circuits) or a limited energy panel,
0 System over 600 volts nominal mutt ,csitletitlai units in one structure alteration, or extension* 2
O Building over three stories ❑ Feeders, 400 amps or more "Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV par Each additional inspection over the allowable In any of the above:
❑ Egress/lighting plan ❑ Other:
Per inspection I 1 I I
• Submit sets of plans with any of the above. investigation fee
The above are not applicable to temporary construction service. Other
Not all jurudiotion5 accept credit cattle, pleaan toll jurisdiction fbr more Information. Notice: This permit application
Permit fee $� /y/,PO
`,9 v1Se D MasterCard �t expires if a permit is not obtained flan review (at _ %) $
G a�{ card number;ArR'3 lOr.III U4 Q / ^ 1.3 within 180 days after it has been State surcharge (8 %) 5 .J4 ------ A 35
k`tnrez Etc CMt2.c, Ai NC - Expires accepted as complete, TOTAL $ /5 f
�y
Name of cardholder as alt n o c redit card co
mel�s l,t $ Inl — a( / /
Car o f er segrtnmre Amount 440 -5615 (6l00/C0M)
C ill.
w
CITY. OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 -
INSPECTION DIVISION Business Line: (563) 6i9 -4171 MST
BUP
Received 3 Ot t /19 2 -q Date Requested ti' 30 AM PM BUP
Location / S� S& S GU uite A�4 P MEC
Contact Person Ph ( j ' ) 1 /35 PLM
Contractor frA_ Ph ( ) SWR
BUILDING Tenant/Owner 0,911 a7;44., ELC 04
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
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
C./
Roof
Other:
Final '
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service ` �( ` / r
Sanitary Sewer �s t a 0J D j_ 0 �1 V a ig a Fl �V 1.,4A'I
Rain Drains n 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
CtreFR ICAD
Service
Rough -In
UG /Slab
I .r Volta•
. Fire larm
PAR FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
❑ Please call for reinspectio r RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA D ' o' Insect S��' /� Ext
Approach /Sidewalk P , . �
Other:
Final DO NOT REMOVE this Inspection ord from the job site.
PASS PART FAIL