Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00748
DEVELOPMENT SERVICES DATE ISSUED: 12/31/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 2S101AA 06400
SITE ADDRESS: 12323 SW 66TH AVE
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: C -G
BLOCK: LOT : 024 JURISDICTION: TIG
Project Description: Tenant Improvement
work located in the middle of the office space
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:
DICK SOUTHARD VIKING ELECTRIC INC
20400 NE 122ND ST 4326 SE WOODSTOCK
BRUSH PRAIRIE, WA 98606 STE 518
PORTLAND, OR 97206
Phone: 360- 256 -5764 Phone: 775 -3479
Reg #: LIC 00056527
SUP 3088S
FEES ELE 26 -569C
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 12/31/03 $66.80
[TAX] 8% State Surcharge 12/31/03 $5.34 Ceiling Cover
Wall Cover
Total $72.14 Elect'I Final
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) 246-6699 or
1- 800 - 332 -2344.
Issued By: , Permit Signature: !
OWNER INSTALLATION ONLY
The installation is being made on prop rty I own which is not intended for sale, Teas , or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:OOpm for an inspection the next business day
4
Electrical Permit Application FOR OFFICE USE ONLY
-��
City of Tigard Date /B : ,2..) b3 awe Permit No.�%4 4 3 _� • 7 A 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � /� �" "�� 1P ``- Date/B : Other Permit:
Inspection Line: 503.639.4175 - i �!�. Date Ready /By: turn. BI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location
Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling V Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories OFeeders, 400 amps or more
❑ Multi - family 0 Master builder 0 Other:
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address:l3 2 3 S ( , U 6 6 r 4
DHealth-care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: 77 6 Rt ,p 0 R 9.7 z L 3 The above are not applicable to temporary construction service.
• Suite/bldg. /apt. no.: Project name:
FEE* SCHEDULE
/ / 7 Description I Qty. Fee. I Total I **
Cross street/directions to job site: b b r r FAA Al KLI A New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less ' 145.15 4
E a. add'l 500 sq. ft. or portion 33.40 1
Subdivision: Lot no.: 02 (� q o
P
/ Limited energy, residential 75.00 2
Tax map /parcel no.: 2- s / o) AA —06 Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK ) Each manufactured or modular
j / dwelling, service and /or feeder 90.90 2
i(/VI �1/ /Ulm /f1/) Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ENANT
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: F C J 1 n . zil 0�.etf-vvi . «.-7„ Q 7,1> 601 amps to 1,000 amps 240.60 2
Address: V Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
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
❑ APPLICANT J ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee,
Address: each branch circuit 46.85 6,S5 2
Each add'! branch circuit Y 6.65 j y, Is— 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 -
CONTRACTOR energy panel, alteration, or
Business name: VI K) a G C c re Tx.1 C extension. Describe: Page 2 2
(_
Address: 3� 6 SC (.�ODn .SThc' en'1B 6 ' Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: re a T ( isi w 32 a (L C l 2 0 6 Investigation per hour (1 hr min) 62.50
Phone: c3 ) 76- .— 3 tf y Fax: WOO) � 2q- 56-7 7 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 565727 Electrical Lic.: 2„, 6- s 3(t Suprv. Lic.: 3o$oS Subtotal 6 6 F $b
Suprv. Electrician signature, required: [L l 1 Plan review (25 %ofpermit fee)
[[[[�����f�2f�2LL State surcharge (8% of permit fee) ce ' 3 it
Print name: .Dd0 CA kin L Date: J 2 /3, 03 7�
TOTAL PERMIT FEE
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 \Petmits\ELC- PemtitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
• Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
` RESIDENTIAL,WORKONLYi.,,.
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:
COIVIl�RCIAL *::07 ONLY '
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ 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 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:
INSPECTION DIVISION MST
�'�usiness Line: (50
BUP
Received Date Requested AM PM BUP
Location /2.3 `( Suite MEC
Contact Person Ph ( ) 3 / — 7 7 9 ! PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC 3 -ere 7#
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 D `.,. A
Drywall Nailing I/ G
Firewall 7- 4 7 / PAX- 7 — L
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING — -
Post Beam ) Undder r Sllab
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 •
ELECTRICAL
Service -
UG/Slab
UG /Slab
Low Voltage g U �' ' c 3 F
��
're Alarm
e Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
• s PART FAIL
SITE Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line /
ADA D / 42 — Q g Ins ecto ..!!/ #4, i/ W Ext
Approach/Sidewalk P
Other:
Final DO NOT REMOVE this Inspection record-from the job s te.
PASS PART FAIL