Permit CITY OF TIGARD ELECTRICAL PERMIT
rOf PERMIT #: ELC2003 -00722
l DEVELOPMENT SERVICES DATE ISSUED: 12/16/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 115 BA -00101
SITE ADDRESS: 16200 SW PACIFIC HW 0
SUBDIVISION: TIGARD TOWNE SQUA- ZONING: C -G
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Install 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: 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:
BIT HOLDINGS LTD PARTNERSHIP 2 FOX ELECTRIC INC
BY FORUM PROPERTIES INC 1010 NE 67TH AVE
FIVE CENTERPOINTE DR STE 290 PORTLAND, OR 97213
LAKE OSWEGO, OR 97035
Phone: Phone: 503 - 307 - 7661
Reg #: LIC 154826
ELE 26- 11113C
FEES SUP ._ _4532S _
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 12/16/03 $66.80
[TAX] 8% State Surcharge 12/16/03 $5.34 Rough -
Elect'I Final
Total " $72.14
r
•
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 Notificatio C- ter. Those ru - . are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to • 1 ' at (5 • :' 99 or
1- 800 - 332 -2344.
Issued By: Permit Signatur= . / , A
OWNER INSTALLATION 0 Y %/_ '
The installation is being made on property I own which is not intended for sale, lease, or re .
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: 4 5 3 c ■'
Call 639 -4175 by 7:00pm for an inspection the next business day
(Electrical Permit Application Received FOR OFFICE � US a E ONLY
Date/By:/ i Vu3 13 Permit No.: � 3 - 007 1 7-
City of Tigard Planning Ap rov Sign
13125 SW Hall Blvd.
Plan Ry: Permit No.:
Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
g ��° e i I � I Contact Case No.:
Internet: www.ci.tigard.or.us J � „
24 -hour Inspection Request: 503 -639 -4175 m ct �uis : See Page 2 for
Name/Method: I I,, � I Su Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
Addition/alteration /replacement p Other: commercial ❑ Hazardous location
CATEGORY OF ONSTRUCTION ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 a
Accessory Building g ❑ Multi- Family
0 Occupant load over 99 persons amps or more
Other: ❑ Manufactured structures or RV park
❑ Master Builder
❑ ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
in/ V ! / The above are not applicable to temporary construction service.
Job site address: /(pZOfj
FEE* SCHEDULE
Suite #: 0 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: �d t/A�t/L.P A tftert,« Description Qty Fee (ea.) Total !
Cross street/Directions to job site: New residential- single or multi - family per
dwelling unit. Includes attached garage.
I
TU Service included:
' 1000 0 sq. ft. or less 145.15 4
11/4) ) e.X r I ti tfG k S Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #:
Limited energy, non residential 75 00 - 2
Tax map /parcel #: Each manufactured home or modular dwelling
ESC OF WORK service and/or feeder 90.90 2
AAA J� Services or feeders - installation,
C t rr U t v f' CL)Li vt. Lf alteration or relocation:
0-Vj ii tavtA Q er - `S k 200 amps or less 80.30 2
1 / c 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY QWNER I XTENAN'r 601 amps to 1000 amps 240.60 2
Name: /f� ~ Over 1000 amps or volts 454.65 2
✓�d t/CP Pi i C .t Reconnect only 66.85 2
Address: /' Zoo /fiat/ 72 bil td r Ge_ � Temporary services or feeders - installation,
City/State /Zip: 'T a �� (>2 alteration, or relocation:
200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
El APPLICANT JCONTACT PERSON
401 to 600 amps 133.75 2
i Branch circuits - new, alteration, or
Name: `----Ed X / extension per panel:
Address: Cr, A. Fee for branch circuits with purchase of
� 4 / p er/ i �— service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
Phone: service or feeder fee, first branch circuit 1 46,85 4,, Tr5i
Fax: Each additional branch circuit 3 6.65 / 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: 2,.. FO j alteration, or extension Page 2 2
Description:
Address: /0/0 A) 67
City /State /Zip: ,2T�A,va Q� Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. I hour) 1 62.50
Phone: 307 76 (' / Fax: 5' 6, 3 i/6/ Investigation fee: I
CCB Lic. #: / s 6 a. Lic. #: / 3 L Other:
Supervising electrician P f Electrical Permit Fees*
signature required: / Subtotal $ 66. $b
Plan Review (25% of Permit Fee) $
Print Name: -8-04 - c. /".3/.e:7
L9 S State Surcharge (8% of Permit Fee) $ S, 3
Authorized TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained i
Signature: Date: 180 days after it has been accepted as complete.
•Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems
Burglar Alarm
❑ Garage Door Opener
El Heating, Ventilation and Air Conditioning System
Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260) •
Check Type of Work Involved:
Audio and Stereo Systems
0 Boiler Controls
Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
HVAC
•
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control
Ei Medical
El Nurse Calls
Outdoor Landscape Lighting
El Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Z L7 4 7 4 . 0 mate Reque ed t Z 3 AM PM BUP
Location / Z 07) aid Suite ' - MEC
Contact Person laao Ph ( 3) 3 U 3 - 7C:96 / PLM
Contractor � Ph ( ) SWR
BUILDING Tenant/Owner 4 3 — 00 722,
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
Roof
CS"—
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
(CTRL
Service
Rough -In
UG/Slab
Low Voltage
Fi : -, - rm
inal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• • SS) PART FAIL
Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ir-c,Igc23 Inspector _ g, i Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL