Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00055
DEVELOPMENT SERVICES DATE ISSUED: 2/4/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171
PARCEL: 2 S 112 D C -00100
SITE ADDRESS: 15675 SW 72ND AVE
SUBDIVISION: OREGON BUS. PARK III ZONING: I -L
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Add (2) branch circuits. (add two switches and relocate (2) outlets in office walls.)
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: 1 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 REALTY ASSOCIATES CAPITOL ELECTRIC CO INC
15350 SW SEQUOIA PKWY #300 -WMI 11401 NE MARX ST
PORTLAND, OR 97224 PORTLAND, OR 97220 -1041
Phone: Phone: 255 -9488
Reg #: LIC 048748
SUP 3132S
FEES ELE 26 -496C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 2/4/04 $53.50
[TAX] 8% State Surcharge 2/4/04 $4 Rough -
Elect'I Final
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246.6699 or 1.800- 44.
I � Q/G� � Permit Signature: /
ssued By:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO: _ 3 ( j a S
Call 639 -4175 by 7:OOpm for an inspection the next business day
F . Electr�eaY Permit A Date receiver _ MI Permit no.' Z. rj G>��'r,
Project/appl. no.: kxpire date:
.447:11V City of Tigard i:AE 4 Date issued: By$� Receipt no.:
• CITY Of TIGARD Address: 13125 SW HALL BLVD T Case file no.: Payment type:
Phone: (503) 639 -4171 Fax (503)9- 960 , 1 r".LBO ,J
Lund use approval: G1'(� ,v1Sk�N </ d1
Ivit
❑ 1 & 2 family dewlling or accessory Commerci /industrial ❑ Multi- fancily ❑ Tenant improvement
O New construction ❑ Additien/alteration/replaccment ❑ Other. ❑ Partial
Job address: 15675 SW 72ND AVE City; TIGARD Bldg. No.: Suite no: Tax map/tax lot/account no.:
Lot: [Block: N/A (Subdivision: ,
Project name NIKE GOLF ]Description and locution of work on premises: ADD TWO SWITCHES AND RELOCATE
Estimated date of completion/inspection: 2 OUTLETS IN OFFICE WALLS
Job no: 24-35 Fee Max.
Business Name: Capitol Electric Co., Inc. Description Qty. (en.) Total no. inep
Address: 11401 NE Marx New residential •,Ingle or multi- fuutily per
City: Portland State: OR ZIP: 97220 -1041 dwelling unit Includes attached garage.
Phone: 503. 255.9488 Pas: 257 -7121 !E-mail: darrollecuothr.com Service included:
CCB no.: 48748 !Elec. bus. lic.no: 26 1000 sq, ft, or loss 5 145.15 4
Ci , metro lic.no.: NIA / Fach additional 500 sq. ft. or portion thereof 5 33.40
!Z 1r /r//r 2/3/04 Limited energy residential f 75.00 2
Signature ot'supervising electrician (toquir • Dare Limited energy. non - residential S 45.00 2
Sup. elect. name (print): Darrell MGNee& License no.: 3132 -5 Each atanuluctured home or modular dwelling
Piu i'GRIN tityNt Service and/or feeder S 90.90 2
Name (print): Services or feeders - installation,
Mailing address: alteration or relocation:
City: f State: (ZIP: 200 snips or less s 80.30 2
Phone: Pax: 1E-mail: 201 amps to 400 amps 5 106.85 2
Owner installation : The installation is being made on property 1 own 401 amps to 600 amps S 160.60 2
which is not intended for sale, lease, rent, or exchange according to 601 amps to 1000 amps s 240.60 2
ORS 447, 455, 479, 670, 701. Over 1000 amps or volts S 454.65 2
Owner's .signature; Date: Reconnect only ^ - s 60.8i 1
111111 111 Temporary services or feeders -
Name: installation, alterations, or relocation:
Address: 200 amps or less 5 66.85 2
City: _ State: ZIP: 201 amps to 400 amps S 100.30 2
Phone: Fax: E •mail: 401 amps to 600 amps 5 133.75 2
PI AN REVIEW (Masi. . check :((( that app( ') Branch circuits - new, alteration,
❑ Service over 225 amps•cootmekcial ❑ Health -rue facility or extension per panel:
l3 Service over 320 limps-rating of lila D Hazardous lotatiou A. Pee for branch circuits with purchase of
faintly dwellings ❑ Building over 10,000 saute ft. four � service or feeder fee, each branch circuit 5 o.65 2
Q SyalcuL 600 volts tuunhul note residential 511115 in one atructutc B. fee for branch circuits without purchase
❑ Building over three stories ❑ Feeders, 400 amps or more of service or t'crder fee, first branch circuit: 1 S 46.85 46.65 2
D Occupant kind over 99 person: a maauEaenres struutaar or RV Park Each additional branch circuit: 1 S 6.65 6.65
❑ Ebreus/liihriug plan 0 Other: Misc. (Service or feeder not included):
Submit sets of plans with any of the above. Each pump or irrigation circle S 53.40 2
The above are not applicable to temporary construction service. Each sign or outline lighting S 63.40 2
Sigasi circuit(s) or a limited energy panel,
alteration, or extension* S 75.00 2
*Description: _
Each additional inspectionovar th allowable in any of the above:
Per inspection [ I S 62.50 1 I
investigation fee
Other
p Visa p MasterCard Permit fee $ 53.50
credit card number: / / _ Noble: this permit application Plan review ( ) $
Expires expires If a permit is not obtained State Surcharge 8% ) $ 4.28
Name ormrdeoldnr m shovrn an credit cord within 180 days after It has been
S TOTAL $ 57.78
Ammo( accepted as complete.
cuovkdcr altlna arc
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
r
Received 0 � � z Z Date Requested c /D / d AM PM BUP
Location /5 7 5 92' Suite MEC
Contact Person � .. 6 :2-/A If "h( ) 9971 3-7) _ R.-3' *LM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner &70 $ 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 C r
Drywall Nailing `- F> v 9
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 PART FAIL
ELECTRICAL
Service
Rough -In
Low Vo lt i / o 2 n
Low Voltage F p I V �
F' rm
in- • Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
S E ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date a — /(7 --- Inspector ' ( Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received 2 i Date Requested e f /t9/ AM PM BUP
Location ?,5 7 2 `t Suite ME .) = 0 O 6 4/3
Contact Person �e�-! Ph ( VD/ /7' ' / PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner � ELC
Footing
Foundation ELC
Ftg Drain Access: 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
Oth •
i PART FAIL
461
' BING
Post & Beam
Under Slab -
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PA - FAIL
.
Rough-In
Gas Line
Smoke Dampers
Fina
SS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA 2/, / /v (,�
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL