Permit r `1i CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00564
V DEVELOPMENT SERVICES DATE ISSUED: 9/10/03
�` --' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S 126BC -01506
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 350 ZONING: C G
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of (3) branch circuits and limited energy panel.
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: 1
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: 2 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:
PORTLAND OFFICE ASSOCIATES HILLSBORO ELECTRIC
BY TC PORTLAND, INC 21185 NW EVERGREEN PARKWAY
8930 SW GEMINI DR HILLSBORO, OR 97124
BEAVERTON, OR 97008
Phone: Phone: 503 - 439 -9666
Reg #: ELE 34 -433C
L1C 134481
FEES SUP 4941S
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 9/10/03 $135.15
[TAX] 8% State Tax 9/10/03 $10.82 Low Voltage Inspection
Rough -in
Total $145.97 Elect'l Final
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: ,- y , . - Permit Signature: d'^/ /97°,e---/C4-77o/Ni
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: a/\./ ''G 1 e' PI DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
t g From:H?LLSBOR0 ELECTRIC LLC. 5036013680 09/08/2003 10:51 #274 P.001
Electrical Permit Application FOR OFFICE USE ONLY
Received / Electrical
� 0,3 � gt Permit No.F 3 'JO 56 if
City of Tigard RECEIVED Dat
Planning Approval sign
Pla Rev Permit No.:
13125 SW Hall BIvd.
Plan Review Other -
Tigard, Oregon 97223 cc p 0 8 2003 Date/By: Permit No. :Jr /x2003 603 7
Phone: 503- 639 -4171 Fax: 50 8- 960 Post - Review Land Use
, r a , f I ` ` Date./By: terse N
Contact Internet: www,ci.tiga:rd.or.us o.:
24 -hour Inspection Request: 503$Ii� p ' r �' i f N J Supplemental Page 2 for
BUI U�INN s� mantal Information.
• • • ' .., :. TYPE QF•W.ORK '' ' ... PLAN REVIEW lease check all that a ' 1 `
New construction ❑ Demolition Service over 225 amps- Health -care facility
U Addition/alteration/replacement ❑ Other: commercial ID Hazardous location
El _ Service over 320 amps- rating of 0 Building over 10,000 square fat,
CATEGORY OF CONSTRUCTION.'0,..:. ...: 1 & 2 family dwellings four or more residential units in
[] I & 2 -Famil dwellin: NI Commercial/Industrial ❑ System over 600 volts nominal one structure
Accessory Building • Multi- Family ❑ Building over three stories CI Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
Master Builder ■ Other; fl Egress/lighting plan ❑ Oar:
.;; • 4;:~:: ' JOB, SITE: FOXWATION'and i;OCAITION Submit seta of plans with any of the above.
Job site address; / - OS"' ' �i The above are not applicable to temporary constructi service.
✓' ei, ,i .,
Suite #: tv,./ Bldg. /Ap I a >9" s HEri .. 'E.:';',',;,-.:,'.;:?, 1 -7:-, ; : , '::'t!;;A , ;
p Number of inspectio ( r permit allowet
Project Name; 69 �r I Description F ee Qty (at.) Total
Cross street/Directions to Ob site: New resldeatlal-single or multi-family per
ONE. E.- Oilier- dwellin unit. Includes attached garage.
Service included:
1000 sq. ft or less 145.15 •
Each additional 500 sq. tL or portion thereof 33.40
Subdivision: I Lot #: c mited ens', residential - 75.00
Tax map/parcel #: Limited energy, non residential • 75.00
Each manufactured home or modular dwelling
,'t.h > •; ,;� ; ;,k. ?L r; :'` {:!.D ESCRIPTIOI ., ,: ;y" ; ,. :' >:, *•. service and/or feeder 90.90
3crvices or feeders - in
r retrt v' - Try f rove rNeA alteration or relocation:
200 amps or less 80.30 ;
201 amps to 400 amps 106.85 ;
401 amps to 600 amps 160.60 2
:; P11.0k ` '1 a ONE/ !'fi,; � ,-., •'« >TENA'N'F '':F; -- p ii' : ; .. 601 amps to 1000 amps 240.60 7
Over 1000 amps or volts 454.65 2
Nam 'H/
Address: 5NV • Reconnect only 66.83 2
Q■J i v Temporary services or feeders - installation, ,
l alteration, or relocation:
C ty /StA Zip: �, -4 Q� 200 amps or leas L 66.85 1
Phone . -_., -� Fax: 201 amps to 400 tuns 100.30 2
�' ' i • "., Y, • w . - . 401 to 600 amps 133.75 2
;t' •, , y
� .... g COSTAvrAERsONi ri ".i:i, Branch circuits - new, alteration, or
> Name: extension per panel:
Address: A. Fee for branch circuits with purchase of
service or finder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee first branch circuit
Phone: I Fax: Each additional branch circuit _ 6.65 , / . ~ 2
E -mail: W btisc.(Service or feeder not included):
» Ali' •: ; <.tl 5, . f("iIZAG�O a' :'. '�s :� pr;: �' ;�,•rw ;:,•. Each pra or irril<atie circle 53.40 2
r �r I.. Each s n i t or Outline li n tang 53.40 2
Job No: ,� f) ! 1 - Signal circuit(s) or a limited energy panel
Business Name: HiEliborn E 1 t tit i (. ALL- . Description!
or extension I Page z 750 2
DeaCflptl0n:
Address: .21 Ig5 14 ' er Pk, r MI • 110
City/State/Zip: �.� I mp 1 cj Each additional inspection over the allowable In an of the above:
7 tp4 Per inspection per hour `min. 1 hour) 62-50
Phon - . 503 it - L ,.. , Fax i - , , "• - • 0 Investigation fee:
CC13 Llc. :13 -IN $ I Lic. - et�1G Other:
Supervising electrician :r> :. ''� ; Eteict[1�P tg �rf, < ,!;. .• .� _ `, ;
a � "' i ' e!'wl Res. +'�,•1 __. ,.�;,., . , :.
( v Subtotal 5 13.5,14 signature required: 1 " i er _ Plan Review (25% of Permit Fee) $
Print Name: 3bei V • 0 I Lie. #: y 15 1;171 y , State Surcharge (8% of Permit Fee) $ j2,
TOTAL PERMIT FEE $ f�.59 7 _
Authorized Q c _ 4 Notice: This permit application expires If a permit Is not obtained within
Signature: _ Date: 1 180 days after it, has been accepted as complete.
. o , ��C *Fee methodology set by Trl- County Building Industry Service Board.
(Pldase print name)
i :\Dsts \Permit Forms\filcPerrnitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
q BUP
Received Date Requested / — a/ AM ' PM BUP
Location 9062-0 141q-k �/ • Suite : 3 S'O MEC
Contact Person �- ✓�►'�� Ph ( )9 2 2 i 2 -( 0 PLM
Contractor /J- / /84s.e Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing C 3 005-6•14
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/
Framing
Insulation
Drywall Nailing
Firewall
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 - -
L= Volta.
Fire Alarm
'OM Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
❑ Please call for reinspectio - E: Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date _ Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
•