Permit CITY OF TIGARD ELECTRICAL PERMIT
filk PERMIT #: ELC2007 -00343
COMMUNITY DEVELOPMENT DATE ISSUED: 5/18/2007
e G < p � . 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 DA -00100
SITE ADDRESS: 13010 SW 68TH PKWY ZONING: C -P
SUBDIVISION: TRIANGLE CORPORATE PARK LOT : 007 JURISDICTION: TIG
PROJECT: US BANK
Project Description: (10) branch circuits for new office and break room.
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: 9 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 NORTHWEST PROPERTIES ALLIED ELECTRIC
9665 SW ALLEN BLVD PO BOX 1640
BEAVERTON, OR 97005 NORTH PLAINS, OR 97133
Phone: 503 - 626 - 3500 Contact #: PRI 503 - 614 - 8000
FAX 503 - 614 -1186
FEES
Description Date Amount Reg #: ELE 34 -I 12C
[ELPRMT] ELC Permit 5/18/2007 $106.70 LIC 38538
[TAX] 8% State Surcharge 5/18/2007 $8.53 SUP 31955
Total $115.23 REQUIRED ITEMS AND REPORTS
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. 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 • d - . 699 or 1.800.332.2344.
Issued By: . iii i ` _ i / Permittee Signature: I
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 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
-Electrical Permit Application f , .�: -, t FOROFFI F u ONL�.� ° �y t
F ,
:r`�
' " Recei
' Ci of Ti and Permit No.:
S , a h' g Date/By: �1 i� 0 � ELL2�0� - Oo ll
1 3125 SW Hall Blvd., Tigard, OR 97223 Other Permit: g ! e •) _ - _ M�jKi
r,. ° g Plan Review l/ till �r J ` " t
° 4 Phone: 503.639.4171 Fax: 503.598.1960 Date/By: ,4, Inspection Line: 503.639.4175 Date Ready /By: Juris: RI See Page 2 for
,TT IGAltD' �
t.,- -•m .1 :'v; Internet: www.tigard - or.gov Notified/Method: 14 Supplemental Information
- TYPE OF WORK - PLAN REVIEW
❑ New construction • ,Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION: exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to pound, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump.. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: ,l , \ 9—RA 1o0HP or more. occupancy.
l �,,
' 30 � D r i._ _) o v 1 K �' ' p - \ \ ❑ Six or more residential units. ❑ Recreational vehicle parks:
City/State /ZIP: • 1 l�41,, ❑ Health -care facilities. ❑ Supply voltage for more than
{{ ❑ Hazardous locations. 600 v olts nominal.
Suite/bldg. /apt. no.: Project name: U , S , 4-3A (JI_ u 6S, t 9 � ❑ Service or feeder 600 amps or more.
FEE (SCHEDULE
Cross street/directions to job site: . Description I qty. I Fee. 1 Total . 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lotno.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no:: Limited energy, residential
DESCRIPTION -OF WORK ' • (with above sq. ft.) 75.00 2
/ Limited energy, multi - family 75.00 2
c `j/f ,,.G 6. ._- ti of ix-e, br �(< ttctr-, residential (with above sq. ft.)
Services or `eedders installation, alteratien,?araleT r4Ir.caticn
_ , 200 amps or.it :ss 80.30 2
_PROPERTY OWNER ' • , _ • - ❑ TENANT - 201 amps to 400 amps 106.85 2 •
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over.1,000 amps or volts 454:65 2
City/State /ZIP: Temporary services or feeders installation, alteration; and/or
relocation
Phone: ( ) 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension,.per panel
Owner signature: Date:
A. Fee for branch circuits with
❑'. APPLICANT I ❑ CONTACT - PERSON' above service or feeder fee, 6.65 2
- each branch circuit
Business name: B. Fee for branch circuits. -
without service or feeder fee, I • q6 85 �(p 2
Contact name: first branch circuit `
Address: Each al branch circuit q 6.65 5R . 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90:90. 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
(J� Signal circuit(s) or limited -
Business name:
energy panel, alteration, or
Address: '7t/n ! d ( extension. Describe: Page 2 2
City/State /ZIP: A 9 7 / 3 3 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) 6/ y '�/ ^ hr ) Fax: ( ) 6/4 / / P 6 Investigation per hour (1 hr min) 62.50
CCB Lic.: , 38538 Electric 'c.: //aC__ Suprv. Lic.: 3 /95-5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
`1 J1gh1Suprv. Electrician signature, requir d: �� Subtotal: l) t % • 776)
Print name: [� Date: Plan review (25% of permit fee):
< < j f) c State surcharge (8% of permit fee): g . 3
Authorized signature: TOTAL PERMIT FEE: // ,} a3
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
" Number of inspections allowed per pennit.
I: \Building\Permits\ELC- PermitApp.doc 05/23 /06 440- 4615T(1 I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL' WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
j. " COMMERCIAL:WORK O NLY:
Fee for each commercial $75.00
system
(SEE DAR 9 : :
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑. Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007- 00343
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/113/2007
Phone: (503) 639 -4171 ICI
Inspection Requests (24 Hrs.): (503) 639 -4175
•
INSPECTION WORKSHEET FOR DATE: 5/21/2007 TIME: 7:02AM PAGE: 34
SITE ADDRESS: 13010 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 007 TYPE OF USE:
PROJECT NAME: US BANK
DESCRIPTION: (10) branch circuits for new office and break room.
OWNER: PACIFIC NORTHWEST PROPERTIES, • PHONE #: 503 -626 -3500
CONTRACTOR: ALLIED ELECTRIC PHONE #: 503. 61480001
Inspection Request Scheduled For: Date: 5/21/2007 Pour Time:
Code # Inspection Description ��- Confirm_# Contact # Message
125 Wall cover \\ 048705 -01 503 -816 -4500 N
Corrections /Comments/ Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: b® Date: 4241 69 Phone #: (503) 718 - 2.!$