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Permit
A `, CITY TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00188 11�I_ • . DEVELOPMENT SERVICES DATE ISSUED: 5/3%2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 PARCEL: 2S 101 AD -01000 SITE ADDRESS: 12703 SW 67TH AVE • SUBDIVISION: WEST PORTLAND HEIGHTS ZONING. MUE BLOCK: LOT : 033 JURISDICTION: TIG Project Description: New office • 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: 50 PER INSPECTION: 201 - 400 amp: 1 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: BEACON HOMES NORTHWEST, INC. BEAR ELECTRIC 25115 SW PARKWAY P.O. BOX 389 BLDG. A, STE. C DONALD, OR 97020 WILSONVILLE, OR 97070 Phone: 503 - 570 -8828 Phone: 503 - 678 -1355 Reg #: LIC 20919 ELE 24 -107C FEES SUP 3162 -S Description Date Amount Required Inspections [TAX] 8% State Surcharge 4/13/2004 $35.15 [ELPLCK] ELC Pln Rev 4/13/2004 $109.84 Ceiling Cover [ELPRMT] ELC Permit 4/13/2004 $439.35 Wall Cover Underground Cover Total $584.34 Elect'I Service Rough -in • 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) 246-66•- or l -800- • 344. Issu - • By: �! !� ' C._I LL .•s� / Permit Signatu • 644-4_, 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: 4/10, ; ✓QJ� -- DATE: .r LICENSE NO: / 5 Call 639 -4175 by 7:OOpm for an inspection the next business day Electrical Permit Application FOR OFFICE USE ONL — _ d Electric • RE(,' E 1 \' t r 7 1( it PermitNq aj/ —of lan W ing A� grp Sign City of Tigard Date /By: 7 7 dV `'A Permit No.: 13125 SW Hall Blvd. A cs r <, 2 Review Other Tigard, Oregon 97223 Date /By Permit No.: Phone: 503- 639 -4171 Fax: 503 - 598 -1960 . . '- Review Land Use *� f t� F TIG • ; : l Of< I Case No.: Internet: www.ci.tigard.or.us � �1 N(;� a=1� ' ) ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 " � Name/Method: . ., . /I Su..lemental Information. TYPE OF WORK PLAN REVIEW (Please check all that apply) ' New construction ❑ Demolition )q over 225 amps- ❑ Health -care facility ommercial ❑ Hazardous location ❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet, ' CATEGORYOF CONSTRUCTION 1 & 2 family dwellings four or more residential units in ❑ 1 & 2- Family dwelling Commercial/Industrial ❑ System over 600 volts nominal one structure ❑ Building over three stories ❑ Feeders, 400 amps or more ❑ Accessory Building Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park ❑ Master Builder ❑ Other: ❑ Egress /lighting plan ❑ Other: JOB SITE INFORMATION and LOCATION - Submit sets of plans with any of the above. The above are not applicable to temporary construction service. Job site address: / A.703 Sty 4,7 71 A Vt - FEE* SCHEDULE ' - Suite #: Bldg. /Apt. #: Number of inspections per permit allowed Project Name: lC egD.c<<t Description Qty Fee (ea.) Total Cross street/Directions to job site: New residential - single or multi - family per j dwelling unit. Includes attached garage. Service included: 1000 sq. ft. or Tess • 145.15 4 Each additional 500 sq. ft. or portion thereof 33.40 I Subdivision: Lot #: Limited energy, residential 75.00 2 _ Limited energy, non residential 75.00 2 _Tax map /parcel #: Each manufactured home or modular dwelling DESCRIPTION. OF WORK service and/or feeder 90.90 2 �( ( KO Services or feeders - installation, - low t " alteration or relocation: 200 amps or less 80.30 2 201 amps to 400 amps f 106.85 fO(ca. a• 2 401 amps to 600 amps 160.60 2 OW"—, ❑ TENANT - .- '. • - . 601 amps to 1000 amps 240.60 2 J . Over 1000 amps or volts 454.65 2 Name: [c yy„c- Ai 6T��..' 1e a . Reconnect only 66.85 2 Address: ,2 SIts 3u rq-wkul OA A .Soze. C Temporary services or feeders - installation, alteration, or relocation: City /State /Zip: (A, Ge 9 7670 200 amps or less 66.85 1 Phone: $b3. 6 - *Kg Fax: 3- S7c - Ho 201 amps to 400 amps 100.30 2 . ❑ APPLICANT'' " . • . . ❑ CONTACT PERSON Branch n 600 ch amps 133.75 2 c Bran circuits - new, alteration, or Name: extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit SD 6.65 3 3 2s62 City /State /Zip: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit 46.85 2 Phone: Fax: Each additional branch circuit 6.65 2 E -mail: Misc.(Service or feeder not included): CONTRACTOR • - Each pump or irrigation circle 53.40 2 Each sign or outline lighting 53.40 2 Job No: Signal circuit(s) or a limited energy panel, Business Name: 13ecetle_ et c) -r/4. C.. Description: on, or extension Page 2 2 Description: Address: Po 6 ox 3$9 City/ State/Zip: /► Each additional inspection over the allowable in an of the above: y p ,i,u .... o 702, O Per inspection per hour (min. 1 hour) 62.50 Phone: S -- tp3 -678' -f3s-- Fax: Cos Investigation fee: Other: CCB Lic. #: p 9/ � Lic. #: ,2 H - l o 7 C. Electrical Permit Fees* _ Supervising electrician Subtotal $ N39, 3 S signature required: r/ - " Plan Review (25% of Permit Fee) $ 1 0 `?'. 8Y Print Name: 3.);:r e el SIB /A) S Lic. #: 'lC Z ( 5 State Surcharge (8% of Permit Fee) $ 3 S-, [ ,i TOTAL PERMIT FEE $ t c" . Qom/, 3 y Authorized Notice: This permit application expires if a permit is not obtained within Signature: Date: 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. (Please print name) is \Dsts \Permit Forms\ElcPermitApp.doc 01/03 Electrical Permit Application - Cite of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all systems $75.00 Check Type of Work Involved: Audio and Stereo Systems n Burglar Alarm Garage Door Opener n Heating, Ventilation and Air Conditioning System n Vacuum Systems I -- 1 Other COMMERCIAL WORK ONLY: Fee for each system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems n Data Telecommunication Installation Fire Alarm Installation IiVAC Instrumentation n Intercom and Paging Systems 0 Landscape Irrigation Control n Medical n Nurse Calls n Outdoor Landscape Lighting E Protective Signaling n Other • Number of Systems * No licenses are required. Licenses are required for all other installations i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspeek*n Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST •BUP Received 7 /d0 Date Requested 76 AM 11 0 BUP Location 7 &3 Suite MEC Contact Person Ph ( ) 353 PLM :Contractor Ph ( ) SWR • BUILDING Tenant/Owner ELC Y -10 /7J ? 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 -E-� -1 � �/ J 1 �"�— Firewall • Fire Sprinkler Fire Alarm Susp'd Ceiling • Roof . Other: Final . PASS PART FAIL • PLUMBING Post & Beam • Under Slab • • 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 RT FAIL CTRI wir - Rough -In UG /Slab Low Voltage • Fire Alarm • inal ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. S PART FAIL Please call for reinspection RE: ❑ Unable to inspect — no access . Fire Supply Line ADA l4� 4?P Ext Approach/Sidewalk Dat® _ �/ ©� Inspe ®r � Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL •