Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00025
wV DEVELOPMENT SERVICES DATE ISSUED: 1/14/2005
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2 S 115 BA - 0050 0
SITE ADDRESS: 16035 SW PACIFIC HWY
ZONING:
SUBDIVISION:
BLOCK: LOT : JURISDICTION: KIN
Project Description: One hour of inspection time to review code issues for conversion.
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: PER HOUR: 1
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:
TOIVA SEPP ROSS ELECTRIC INC
16035 SW PACIFIC HWY 2870 SW 221ST AVE #203
KING CITY, OR 97224 HILLSBORO, OR 97123
Phone: 503- 620 -2185 Phone: 503 - 642 -2800
Reg #: LIC 157891
ELE 34 -436C
FEES SUP 4232S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/14/2005 $62.50
[TAX] 8% State Surcharge 1/14/2005 $5.00 Elect'I Final
Total $67.50
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
Ali 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 -800- -23
Issue By: / / ; r Permit Signature: l_
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: r -Gr2' mi l a _t'c, - 4 '1 DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
c &-c:! ;00a-cot( P.9
Electrical Permit Application FOR OFFICE USE ONLY
City Of 'Tigard
R e eived I /5/ O S P No.: f ( �r �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / �Iy `` e& DateB : Other Pe • .
Inspection Line: 503.639.4175 1 I� Date Ready /By: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
. ,.. t ~ t , �.°r" 7 - '' 0 dt 7 t :'.y c y J. ,;, It y xZ a l ',. - _
. • 4 „ a � " , c x .Tr' OF SVOTi : xf= r , „ ,P .; t ff t . 1 .
a _t: ..' L a.,, � . s w. , ,.. f. • , x,..=,. , 1 • .a,. .z . . s.,... s ,, .. _ ....� _ _ .... . , . ...
PLAN. R�:XIEW ;, .r
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
['Demolition ❑ Other:
El Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
rr � * , C .,/ CATEGORY OF C OTSTRUCTIO N , r 4 '' ` ' ,- '," of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories []Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other:
['Occupant load over 99 persons CI structures or
a ° .§ '
,� .,.�. �` ._ f " tJOB; SITE INF T ' ION A IWA LOCATION . [ „ - „ }. .rX i r.. _:. RV. park
12Mr1, ['Egress/lighting
Job site address: �/ ' ❑Health -care facility ['Other:
no.:
/6 0 $ j R� r ' ' /' - J °� Submit 2 sets of plans with any of the above.
City/State /ZIP: 7,, '' / � 'l , l c� The above are not applicable to temporary construction service.
7 ' ` X Y ''qx ,W ,: `FEE* SCHE�D:TJL >
Suite/bldg. /apt. no.: Project name: S � ; A
��P' /X t Description Qty. I Fee. I Total I *
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 • I
Limited energy, residential 75.00 2
Tax map /parcel no.:
u „ Limited energy, non - residential 75.00 2
d, r t 3 e DESCRIPTION O.k ? .X At ...-,':-f7';',, , _ . ,s ” ,,;.,, � , .. Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
.
' _ a r '' � . .... .
TEI'" "t ' „k %''
t.. _, .. .,.. _ ,_. . 401 amps to 600 amps 160.60 2
Name: 7 v 0 z S b 601 amps to 1,000 amps 240.60 2
Address: /if 4 6 _, L cil j Over 1,000 amps or volts 454.6 2
Reconnect only 66.85 2
City/State/ZIP.. p w _ 4 e- p Temporary services or feeders installation, alteration, and /or
relocation
Phone: (sty ) ; _0 0 T G Fax ( ) 200 amps or less 66.85 1
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
/{ . ;1z A. Fee for branch circuits with
'...
® "APPLCANT `.' t` ; rr , .. CON`T C'L PEILSQL�tr ,
service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address:
Each add'1 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 circuit(s) or limited-
,1�..'_ .; 4 r -¢ -. i . x t ' t 'ON F.RACTOR. . . , x.. x . Y r , .�r _ 7 x . r qt energy panel, alteration, or
�r � i � L 1
extension. Describe: Page 2 2
Business name: ,evf1 Z7 a4
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50 69,4 SO
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
, Z ELECTRIC„AL''PERMITx "FEES 17 Z " ....
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal (0 a ,5
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5.00
Print name: Date:
TOTAL PERMIT FEE (0'7 , 50
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 Tri- County Building Industry Service Board
**Number of inspections per permit allowed.
i:\Building\Permits\ELC- PermitApp.doc 12/03 440.4t15T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
itaigatiWOMWVENWAMEEMfil
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
refiwavtaf,NrOaTOWENTIETATIOM
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
•
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑• Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\ Building \Permits\ELC- PemdtApp. doc 04/03
1
Fax Transmittal Cover Sheet C2G0�cc) 2S
40k,
; III;, Building Division
City of Tigard
Date January 14, 2005
Number of pages including cover sheet 2
To: Steve Ross From: Debbie Adamski
Co: Ross Electric Co: City of Tigard, Building Division
Fax #: 503 - 642 -5815 Fax #: 503- 598 -1960
Ph #: 503 - 642 -2800 Ph #: 503 - 718 -2450
SUBJECT: ELC2005- 00025, Dr. Sepp Electrical Permit
MESSAGE: Please sign the attached Electrical Signature Form and fax it to the
number above. We will need to receive this signed form before any inspections can
take place.
Thanks!
is \dsts \forms \FaxTransmittal.doc 01/14/05
CITY OF TIGARD /
13125 S.W. HALL BLVD. / -
TIGARD, OR 97223 , � / � ,
p IMPORTANT PERMIT NOTICE PIC 0 /441
.3)1\cl p
ROSS ELECTRIC INC
2870 SW 221ST AVE #203
HILLSBORO, OR 97123
Electrical Signature Form 't<$11) I.
Permit #: ELC2005 -00025
Date Issued: 1/14/2005 a y
Parcel: 2S115BA -00500 z It • -,
Site Address: 16035 SW PACIFIC HWY
Subdivision:
Block: Lot:
Jurisdiction: KIN
Zoning:
Remarks: One hour of inspection time to review code issues for conversion.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
TOIVA SEPP ROSS ELECTRIC INC
16035 SW PACIFIC HWY 2870 SW 221ST AVE #203
KING CITY, OR 97224 HILLSBORO, OR 97123
Phone #: 503 - 620 -2185 Phone #: 503 - 642 -2800
Reg #: LIC 157891
ELE 34 -436C
SUP 4232S
,�� fE 4 AN INK SIGNATURE IS REQUIRED ON THIS FORM
f
VO tO X
1 c`
Signature of Supervising Electrician
/ i7/D5
If you have any questions, please call 503.718.2433.
CITY OF TIGARD 24-Hour • SLC= C:U - 0.K.;
BUILDING 41) Inspection Line: (503)639-4175 10
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP
Received 1 Date Requested 1 AM PM BUP
Location ( (p 0 3 5- Peic_t t C. 14.4-4)1
.4-4) Suite MEC CiS— 00/
C�
Contact Person Ph ( � ) PL ki-ty C ‘ II
Contractor Ph( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing1
Insulation CS I tt -{—e� - , 051 //
5 W� , ,-1
Drywall Nailing
Firewall
Fire Sprinkler -j- 412I Q
Fire Alarm to C1 �IS•- r t U
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING O v' . l 4 f)vvt 4 C
Post&Beam I) t� „ / 4
Under Slab / "�
Rough-In /
Water Service
Sanitary Sewer C d i L e �me tvteck6K, C ( [2.0u k ' vk
Rain Drains
Catch Basin/Manhole k) C W
Storm Drain
Shower Pan
Other:
Final
RASSB—SART IL
MECHANICAL
P. : -am
'.u..- m
Smo e Dampers
Final
PASS PART AIL
ELECTRICAL
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: Unable to inspect—no access
Fire Supply Line
ADA
Approach/Sidewalk Date /--21— O Inspector �C� Zaltrirea/4 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL