Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00527
�l�i► DEVELOPMENT SERVICES DATE ISSUED: 8/22/03
13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171 PARCEL: 2S115AB - 01900
SITE ADDRESS: 16200 SW PACIFIC HWY A
SUBDIVISION: TIGARD TOWNE SQUARE ZONING. C -G
BLOCK: LOT : JURISDICTION: TIG
Project Description: Tenant Improvement
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: 30 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:
BIT HOLDINGS LTD PARTNERSHIP A + J ELECTRIC
BY FORUM PROPERTIES INC PO BOX 330
FIVE CENTERPOINTE DR STE 290 , FOREST GROVE, OR 97116
LAKE OSWEGO, OR 97035
Phone: Phone: 359 - 5891
Reg #: LIC 959
SUP 4534S
FEES ELE 34 -1C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/22/03 $246.35
[TAX] 8% State Tax 8/22/03 $19.71 Ceiling Cover
Wall Cover
Total $266.06 Elect'I Final
This Permit is issued subjed 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: �?/yy� 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
. .
Electrical PernnitApplication OFFICE LiSF i NI
Date received:: a2 0 thrill V w'l . ' • ' / J) 405A
',J City of Tigard Pro ect/appl. no.: t Expire date:
Cfry ofTlgo,/ Address: 13125 SW I•iall Blvd, Tigard, OR 97223 Dutc issued:
Phone: (503) 639 -4171 �Y: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
11 PIE Of PERMIT
0 I & 2 family dwelling or accessory • Commercial /industrial O Multi - family 0 Tenant improvement
7 New construction ddition/alteration /repluccntent 0 Other: 0 Partial
.108 SITE 1 NF0Hf%lA1'ION
Job address; _ ' (.I) a ! _ _ : s a � 0, Acv/ _ . Bldg. no.: Suite no.: A Tax map/tax lot/account no.:
Lot: Block: Subdivision:
/ Project name: 77((0 Dig g I Description and location of work on premisesT� pa Al- I ryyrvtveY» en-it
Estimated date of completion /inspection:
cON'l'tt:ACTOIR APPLICATION ILL S €Hkd)L.LL:
Job no:
Fee Maw
Rwincss name: i 4 tTat'r .....Q ..�/1C_ . Description Qty. , (ca.) Total no.isnp
Address New scsi &Instal- single orm ttj- fsinalyper
kb Rb V 9 3C) City: a.-o f 5-1- i b I Stare: Oki Zip: l d ° hod ,
Phone: 'rg_ 1 Fax: 59R- 9R- wadi E -mail: 1000 sq. I. or less 4
CCB no.' Q Elec. bus. lie. no: 344-
Each additional 500 sq. ft_ or portion thereof
Limited eaerly, residential 2
City/ etro li . no.: _ Limited energy, son iesidcntial 2
a (--o R Each manufactured home or mOdu1sr dwelling
- Signature of supervr cc rogue Date p Service and/or feeder 2
Sop. deem name (print): Li.. no;4[g S Se r relocation: ce+eOrfecrs- on,
200 amps or less 2
Name (print) S/Il fri ile -� 31 ' t DOF t S L-LC .
201 mops to a00 amps 2
Mailing address: I ( ( 2..1 SW c _ I 6 c 401 amps to 600 amps 2
l� - 60l am to 1000 amps 2
C • 0 .& , Stater a ZIP: ' . r 5 Over 1000 amps or volts V 2
Phone: ,2 q op Fax: E-mail: Reco,tuom only -- T
—
Owner installation: The installation is being made on property l own Temporary services orreedev); -
which is not intended for sale, lease, rent, or exchange according to inttalhition..atteration, orreloeadoiu
ORS 447, 455, 479. 670, 701. 200 mops or ter` 2
201 amps to 400 amps 2
Owner's signature: Date: _ .__...._ .. 401 to 600 amps 2
F NC. I N E E R Branch circuits - new, alterrttioa,
or extension per panel:
Name; A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
—
City: State: ZIP: 13. Fee for branch circuits without purchase ��jj�
Phone of servke or feeder fee, first branch circuit: 1 {{ - ItP � 2
F ax: is -mail: Each additional branch circuit 3C) (off [CN '
PLAN 12LVIEW (Please check all that apply) Mist . (Service or feeder trot included):
3 Service over 225 am wcontnetcial O Health-care facility Each ptunp or irrigation circle , 2
Cl Service over 320 amps-rating of lid Q Hazardous location Feclt Sian or Outline lighting 2
Emily dwellings Cl Building over 10,000 square feet four or Signal circuh(s) or a lianised energy panel,
O System over 600 volts nominal more residential talus in one strociate altercation, or extension° 2
O Building over three stories 0 Feeders. 400 amps or mom *Description;
0 Occupant toad over 99 persons 0 Manufactured structures or kV park Each additional Inspection over the allowable in any of the :dome:
❑ F:gtrs4ligtrtiag plan • l r Other: Per inspection I L I
Su _ seta of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other '—
ill jurindietionr ecxept audit cards, please call jurbdlntcm ror more information. Notice: This permit application
Permit fee $ t 24(Q • °'. b
a L" MasterCard expires if a permit is not obtained P
lan n review (at _ %) $
_ c. ' c am umber: • 0 1,; 0 C 4' j 1'.3' aj f /o4 within 180 drays aRer it has horns State surchar ($ %) $ A a [ xpircn accepted as complete. TOTAL S � �
' `` ma y. j ? wo u n`t n A 46
new or 611, into: — Amount 440.4615 (6/00/COM)
Td WdZZ : ZT £00Z TZ ' T86T- 6S£ -£0S : 'ON Xdd O I X110818 fd : woad
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/, BUP
Received `- 1 � Date Requeste 7 z 2 9 AM PM BUP
Location /44.00
Suite at MEC
Contact Person Ph ( 974 q q Z a! PLM
Contractor Ph (____ ) SWR
BUILDING Tenant/Owner � iM r t 1 - _ ELC
Footing ( OD 2_7
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: � . �� .7J-4.(e/7.- 4/ SIT
Post & Beam
Shear Anchors 1-5,
Ext Sheath/Shear
Int Sheath/Shear
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 Drains
Sewer C."/"./
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
(G�
UG/Slab
Low Voltage
0110-11- El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
' I - 17 M PART FAIL
SITE El Please call for reinspection RE: Ei Unable to inspect – no access
Fire Supply Line
ADA D Ac)/ Inspector �w Ext
Approach/Sidewalk 'T
Other:
Final DO NOT REMOVE this inspection record from the job =1te.
PASS PART FAIL