Permit C ITY O TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00165
`r° 6 DEVELOPMENT SERVICES DATE ISSUED: 4/1/2004
` -�' 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S101AD- 01000
SITE ADDRESS: 12703 SW 67TH AVE
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT : 033 • JURISDICTION: TIG
Project Description: 200amp. service. Tempory power.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 0 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
EQUITY GROUP FUND ONE, LLC BEAR ELECTRIC
P.O. BOX 389
DONALD, OR 97020
Phone: Phone: 503 - 678 - 1355
Reg #: LIC 20919
ELE 24 -107C
FEES SUP 3162 -S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 4/1/2004 $66.85
[TAX] 8% State Surcharge 4/1/2004 $5.35 Rough -
Elect'I Final
Total $72.20
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By: Permit Signature: dh ,(O�IIrL
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE: -
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: 3 ( S
Call 639 -4175 by 7:OOpm for an inspection the next business day
MAR. 3 1 . 2004 1 0 : 1 9 A M SAVIN N0. 097 P. 2„
Electrical: erm t Application l i�eiv ,, .._ .,.,._ oR: Electrical
� '7 ,5 ',v, :,
� Permit No � r,1-49'� �' � x/
!_i ;, i Date/By: � / //D `� �!/ ( Pe r milJ
Cit A!+ al Sign
y Tigard RECEIV Planning Datc/$v: Permit No.:
13125 SVviiall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: PetmitNo.; ��� --
pp� ' x y �� >p2 -� ./- .
Phone: 503 - 639 - 171 Fax: 5 t` -S9 6 �, " °y Post- Review Land Use
Internet: www.ci.tigard.or.us . OF TIGP' `LI J ��� t Case a.if- : ® —
J Sec page 21'or
24 -hour Inspection Request: B _ 75IV1 = „ . Y-.` Name/Method: iLY _ Supplemental Information.
•
r vl: v v4u• M' y ' � '("° t • wT+i. . •�n v+.�T lark
�.. •�;�{`,Si , ",'� a g :+a.a+:i:'k�T3�,F�":Qrf'a'VI?�' :Zr r�+dirs: i..� • ar ,y��.a�u;� : �. �l�aws ';'p'��i�'�'��1�+`.k�+���; leers e • c�c`-: �1: T. ��8fs,1PA�'�•`rr,�µ-= : :. - ,r �;
11K3 New construction . ■ Demolition p IJ facility
; . �N
� 0 over 225 amps- Health -care Estill
• Addition /alteration/re•1acerent • [] Other: commercial 0 B uuo l 10 on
Service over 320 amps - rating of uild 7dingng over 10,000 square feet,
a ;;;, '... ' - - , o �, Q,QI`TS)It , • o ”: si`: , --.-4 1 & 2 family dwellings four or more residential units in
• 1 & 2 -Famil dwellin • Gi Commercial/Tndustrial ❑ System over 600 volts nominal one snvenire
• A �. ❑ Building over three stories ❑ Feeders, 400 amps or more
I, r1 c sso Bu .1dlx2' 0 Occupant load over 99 persons ❑ Manufactured structures or RV park
1111 Master Builder Di Other: ❑ Bgess/lighting plan ❑ Other:
, ;, `' 0?.$Ik 331•We A'rif'131% 'T O. 1 7101 V.". M 1:"r`'c' Submit seta of plans with any of the above.
The above are not aeplic�ab1e to temper : construction service.
Job site address: ue.i a . •
Suite #: � Bla +. /A•t. #: Number of inspections per permit allowed
Pro-eat Name: C a. ors. Cref o •C Description Qty [tee (ca.) Total JI I
New residential -sin; a or multi - family per . •y
Cross street/Directions to job site: dwelling unit Includes attached garage.
Service included:
1003. ft. or less • 145.15 4
Each additional 500 sq. ft. or portion thereof _ 33.40 . 1
Subdivision: Lot #_ Limited energy. residential 75.00 2
Limited energy, non: residential 75.00 2
Tax nia./ • arcel #: Each rnanu!ecntredliorrte or modular dwelling
Ort '4 , 1• O] "' ""' f
' �'� service 90.90 2
�j1�`.'
Services or feeders - Installation,
alteration or relocation:
-r a w F a.. 200 amps or less 80.30 2
t-�•1� 201 amps to 400 steeps 106.85 2
401 amps to 600 amps 160.60 2.
MI D . .. •�,�:f '� ��' 'y^J'`�� r r � a r:r :'P ' • 11
1''`'71.1. ; .` j tV3 601 amoS to 1000 amps
. f� � •1:Y�II��.s4'��� 'ofiw,�:�....��i.�i �.,:.�r��wFl:l�Ah. � 240.60 2
Over 1000 amps or volts 454.65 2
Name: [, • _ _ - Recooneu only 66,85 2
Address: a (S ul , Temporary services or feeders - installation,
Ci /Start? /Zi.: . _ _ alteration, or relocation: p �.�•
7b 70 200 amps or lass _ ' 66.85 CL. as 1
Phone :3).3 - 70- 2 . 2 : Fax: . ., O -- 8; . - 201 snips to 400 amps 100.30 2
' '
*2 ,,k l ',. .F+k3w, `,,�. Ntili -1' -.0 '"` E �' Brand r c p -new, alteration, or 133 -75 2
Name: • extension per panel:
A. Fee for branch circuits with purchase of
,�
Address: ,�i.• • a service or feeder fee, each branch circuit 6.65 , 2
IEMETMIIIIIIIIIIIIIII B. Fee for branch circuits without purchase of
servme or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 • 2
E-m- . ; Mise.(Servica or feeder not included):
a n c • • • • , Each pump or itrigatio circle 53.40 2
felO;:f�Y?'�Wtt 47.:ujT�: : 2fh_, . S 6 41,1 r..4'w�Ok~s�,Z,� `4:1:V ,a Each or rirr ine i? cir 53.40 si Job No: S ignal circuit(s) or a limited e ne 2
�� • aa ) rgy panel,
Business Name: e gt- r _ L, Descri extension Page 2
Description:
Each additional inspection over the allowable in any of the above:
Ci /State/Zi • : . 4 o Zo Per inspection Per hour `M's. 1 hour) 62.50
Phone: S _ 713' -/ is Fax: s, S - 7: - 11 Ci : lnves ion fe e:
CCB Lie. #: • , p "/ Lic. #: a 2' J— / o 7 , other. p{p. ,.' �
�. t_.s - rp �. ry b y s,c1' � ` :4 - ;4 • 7; �'!•ifj :, �t ,,.
•
Supervising electrician �' " � v - -� J rw iy ✓ 25:,;
Si a . tore re • uired: M :- . Fee) Subtotal S - S
Plan Review (25% of Permit Fee $
Print Name: ■ • $ .t-) S IPECIVAgfigiM State Surehazge (8% of Permit Fee) $ S. $$
TOT FE)tNQT FEE S?� • 2 0
Authorized Notice! This permit application expires ifs permit is not obtained within
Signature: Date; 180 days after it has been .accepted as complete.
*pee methodology set by Tri- Counry Building Industry Service Board.
(,Please print name) •
i:\Dsts\Pcmdt Forms\ElcPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Lire: (503) 639 -4175 .
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested I � ` ' AM PM BUP
Location / x 70 3 6 7 44 / Suite MEC
Contact Person Ph ( ) 6 7 F
PLM
Contractor Ph ( ) SWR
BUILDING. Tenant/Owner ELC e l - ' c) l S
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 ' l V\ ` i 1 V u V" A 1(x ' 1-lioit
Fire Sprinkler
Fire Alarm. \
�u
Susp'd Ceiling `
Roof l
Other: 1� � cA4 t `O C;� 1 L \ibC
PASS PART FAIL `°
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole A ..
Storm Drain
Shower Pan
Other:
Final •
PASS PART FAIL
M
V
ECHANICAL _(
Post & Beam \
Rough -In
• Gas Line '÷7
e Dampers
Final - - )
SS • PART • FAIL
EL RICAL
ervic .
ough -In .!'`��
UG /Slab
Low Voltage •
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PAS' AIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADAoach /Sidewalk Date 6 _ I nspector. / Ext
PP
715"
Other:
Final DO NOT REMOVE this inspection record front the job ite. .
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Vo / Date Requested d AM PM BUP
Location /2703 5w (o l Suite MEC
Contact Person A- Ph ( f ) 40 7— 0S-27° PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC ft ve16
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
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In fr •
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
RT FAIL
CTRIC
Service
Rough -In
UG /Slab
Low Voltage
Fi larm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
FF SS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA `
3 Y Date / ` O Z^ ` Inspector --, /7 � y Ext
Other: /7
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL