Permit ,5 „ ` ELECTRICAL PERMIT
ib. , '` CITY OF TIGARD
I
'' ° PERMIT #: ELC2008 -00078
COMMUNITY DEVELOPMENT
DATE ISSUED: 2/12/2008
TIGARD i 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135BD-00300
SITE ADDRESS: 09735 SW SHADY LN ZONING: C -
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: TIGARD MEDICAL
Project Description: Reconnect HVAC
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: SIGNAUPANEL:
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:
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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
HAZEL INTERNATIONAL, INC AND WILLAMETTE HVAC
HIGASHIYAMA HIGHLANDS CO, LTD 3075 SW 234TH AVE. #206
BY NORRIS + STEVENS REALTORS TIGARD, OR 97281
PORTLAND, OR 97204
Phone: Contact #: PRI 503 628 - 6841
FAX 503 - 848 -2597
FEES
Description Date Amount Reg #: ELE 34- 346CRE
[ELPRMT] ELC Permit 2/12/2008 $66.85 LIC 56951
[FAX] 12% State Surchar 2/12/2008 $8.02 SUP 4025LEB
Total $74.87 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 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 503.246199 or 1.800.332.2344.
Issued By: a , ' , Permittee Signature: f . / •
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 Applicati� E^ E I V E D
City of Tig �v R D 1 ,„_/ 4 1( Permit rF,L g,ppp7e
1 3125 S W Hall Blvd., Tigard, OR 9 Plan u
C Phone: 503.639.4171 Fax: 503.598.198 2 2008 DateBRevy e Other Pertntt.
T I G:1 R D Inspection Line: 503.639.4175 Date Ready/By: hirilor ® See Page 2 for
Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE 0 1BistiteiNG DIVISION 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 ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commerciallindustrial ❑ 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 ",
1 oOF� or more.
Job no.: Job site address: 9735 Sw Shady Lane uP�cy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard Or 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Ste 308 Project name: Tigard Medical ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: tkaeription 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 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
Reconnect HVAC unit Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: 13. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax :. Reconnect only 1 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Willamette HVAC Signal circuit(s) or limited -
energy panel, alteration, or
Address: 3075 Sw 234 ave extension. Describe: Page 2 2
City/State/ZIP: Hillsboro OR 97123 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 628.6841 Fax: (503) 848.2597 Investigation per hour (1 hr min) 62.50
CCB Lic.: 56951 Electrical Lic.: 4025LEB Sup . Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 64, $ 5'
Print name: Mike Sicard Date: 2/12/08 Plan review (25% of ptrrtit fee):
State surcharge (12% of permit fee): r, 6 O 4:. — L.
Authorized signature: - / . TOTAL PERMIT FEE: 7tt/ .,1 1
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: l "I C )9 0t)079
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/1212000
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ��& ``'
INSPECTION WORKSHEET FOR DATE W8/2003 TIME: 7 :0OAM PAGE: 10
SITE ADDRESS: Or.:1/36 SW SHADY LPG! CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD MEDICAL
DESCRIPTION: Reconnect HVAC
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: Wll LAME rTE HVAC PHONE #: 503-619-6841
Inspection Request Scheduled For: Date 8/8/7008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 073962 -06 503.422-1991 Y
Corrections /Comments /Instructions: m \ �
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VQ(1)
Rty\ c4 W `TA tLC, Loon- HOPI 8 2.
G... No•ty %.%.%
n PASS PARTIAL APPROVAL
XCANCEL ri NO ACCESS
n FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: '° Date: O' IS 1 Phone #: (503) 718- 1'
CITY OF.TIGARD
BUILDING DIVISION _ PERMIT #: ac :2008.00078
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/12/2009
Phone: (503) 639 -4171 ]r'
Inspection Requests (24 Hrs.): (503) 639 -4175 ESC • 293
INSPECTION WORKSHEET FOR DATE: 2/21/20013 TIME: 7:00AM PAGE: R.0
SITE ADDRESS: 09736 SW SHADY LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: 'TIGARD MEDICAL
DESCRIPTION: Reconnect HVAC
OWNER: HAZEL INTERNATIONAL, INC AND, PHONE #:
CONTRACTOR: WILLAMETTE HVAC PHONE #: 503 -62B -611
Inspection Request Scheduled For: Date: 2121/7008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 { J3 Elocteical final 065336-01 603.916 -9217 Y
Corrections /Comments /Instructions:
TI Cr Ak S Y .
G-2o oN p w (�,� , t..1 g o� . V
N e tt.) i) •,•)• ►o PLv1 \
vSi
`rte C2-0 N • irrFc■ R. w, i tJ w F
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PASS U PARTIAL APPROVAL E CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION L I ADDITIONAL FEES ASSESSED
Inspector: Gm N 0e) LE: Date: 2/ v U �1 1 I' f j
Phone #: (503) 718 - L- "F'FD•
Community Development
TIGARD Request for Permit Action
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor %City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
V 0 1 ® City /State /Zip:
0 A F .0 Phone No.:
PLEASE TAKE ACTI N FOR THE ITEM(S) CHECKED (1):
X CY PERMIT APPLICATION.
❑ FUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: & LG 7.-4 — W ✓ J . . + / ' . - // P' ?—
Site Address or Parcel #: f73 5 G'N, Z r,
Project Name: ! ( �,�J Vi
Subdivision Name: v" Lot #:
EXPLANATION: /Y?)I17' NI / 1 te 4 /S bt/'J
,
Signature: 1 Date: s li / Q
Print Name: D a/Ccvr S •
Refund Policy
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date B Rte to Bid. Admin: Date , /7 06' B 47
Refund Processed: Date N / 9- By •i ,it: . Invoice Processed: Date By
Permit Canceled: Date ,7j5/1+,f" By of Parcel Tag Added: Date By
Receipt # Date Method Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07